Nutritional Deficiency Associated GERD

Gastro-esophageal-reflux disease is one of the most common geriatric disorders (diseases of older age). But nowadays, the younger generation is also suffering from acid reflux due to abnormal eating habits and excessive ingestion of processed foods.  Tinned or canned food uses a high amount of preservative or salt, which aggravates the stomach and the food tube, resulting in acid reflux. Someone may have a defective esophageal sphincter (constrictor) by birth. But the percentage is significantly less. Commonly the patient will feel heartburn after eating or being on an empty stomach for a long time. Nocturnal non-productive cough, nausea, vomiting is also present in some cases. 

Such widespread distribution of GERD helped with extensive research. Thanks to doctors and researchers, we now have a wide range of effective therapy for this disease. According to the leading medical board and peer-reviewed journal, medical, surgical intervention, lifestyle modification, and cognitive behavioral therapy are everyday use. 

But, as the darker side of a coin, there are some side effects of this therapy. The most common aftereffect of GERD therapy is nutritional deficiency. 

Aftereffects Of GERD Therapy

PPI (Proton Pump Inhibitor) is the most commonly used drug to treat the symptoms of GERD. Omeprazole, Rabeprazole is so known and safe that these drugs are now OTC. You can buy these drugs without any prescriptions. The drugs act by inhibiting the absorption of the proton (H+) in the gut. Thus the acidity reduces. Less acid means less chance of regurgitation and a lower case of reflux (กรดไหลย้อน).

But in the natural digestion process, we need lower ph (acidic condition) to activate the enzymes. Like Pepsinogen, to break down the protein into amino acid (simple, absorbable form). In prolonged use of PPI, the protein breakdown process hinders. We know protein is the building block of our body. Thus GERD therapy may induce weakness and muscle wasting.

Vitamin B12 binds with protein, usually cleaves from it after the effect of Pepsinogen. Then it couples with cyanocobalamin and enters the systemic circulation. As the PPIs don’t let the protein to cleave ultimately, there will be fewer vitamin B12 in the body. This vitamin is essential to maintain better nerve conduction and prevent anemia. GERD therapy may induce the disease, as mentioned earlier.

Vitamin C is an acidic nutrient (ascorbic acid). Doctors advise to avoid or reduce the intake if you have GERD. But this vitamin is essential for a healthy collagen level, preventing and healing infections fast, reducing gum bleeding, and more. Plus, the prolonged intake of PPI will reduce the absorption rate. This double effect may be a concern in the future. However, vitamin C supplement intake is not an option now. 

Our dietary form of iron is Ferric oxide (Fe3+). This form is insoluble in gut media. So the ascorbic acid reduces the iron into ferrous form (Fe2+) by forming a chilling agent. This ferrous form is water-soluble and absorbable from the gut. But in the long-term usage of PPI or H2 blocker (Histamine Receptor Blocker), there will be vitamin C deficiency and, as a result, iron deficiency. Iron is very vital to maintain the RBC (Red Blood Cell) in the human body. As a result, anemia, pulse, and weakness will happen. 

The vitamins and other nutrients like magnesium, potassium, and such can’t act reasonably in the presence of GERD reducing agents. But these substances are crucial to maintaining action potential, nerve conduction, normal blood count, and such.


In older patients with GERD, vitamin D deficiency is an associated symptom. So their bones are brittle, and fractures become a common phenomenon. 

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Christophe Rude

Christophe Rude

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