Iron from food is absorbed into your bloodstream in your small intestine. An intestinal disorder, such as celiac disease, which affects your intestine's ability to absorb nutrients from digested food, can lead to iron deficiency anemia. If part of your small intestine has been bypassed or removed surgically, that may affect your ability to absorb iron and other nutrients.
The reduced stomach acidity that results from PPI use may interfere with absorption of multiple nutrients and result in deficiencies that can show up in the form of anemia. Anemia is a condition in which the body's red blood cells are diminished in number. There are two types of anemia: one caused by iron deficiency, the other by vitamin B12 deficiency. While admittedly uncommon as a side effect of PPI use, these deficiencies can occur.
The reason PPIs can induce anemia relates to how some nutrients are metabolized and absorbed. Vitamin B12 from natural sources, which includes all animal-derived foods, is bound to protein. To be absorbed, it needs to be split apart from this protein, a process that generally happens in the highly-acidic environment of the stomach. A less acidic stomach, however, prevents dietary vitamin B12 from being liberated and therefore absorbed. Fortunately, other forms of B12 are not protein-bound and can be easily absorbed, even in the context of chronic PPI use. Foods that are fortified with Vitamin B12—including some breakfast cereals, nutritional yeast, and certain vitamin-enhanced beverages—can provide more readily-absorbed vitamin B12, as can supplements. For people taking PPIs on a long-term basis, regularly including one or more of these foods in their diets is an easy preventive measure to consider.
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