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From: B. Harris)
Subject: Re: Prilosec vs. Zantac
Date: 22 Feb 1998 23:44:39 GMT

In <> (Polar)

>	I take both, alternately, on advice of my GI specialist, for
>hiatal hernia w/reflux.
>1.	Since one is a proton pump something? and the other is an HCL
>blocker (I hope these terms are correct), doesn't one's system get a
>little confused with these alternating inputs?  I think I asked this
>before, but cannot find the answer.

  Prilosec blocks the proton pump in gastric cells, which makes acid.
Zantac is an H2 blocker, not HCl blocker.  The H2 receptor (Histamine
number #2) is told by histamine to tell the cells to make acid (HCl).
Combinations of these two drugs really shut down all acid production.

>2.          My acupuncturist thinks I may have a vitamin B deficiency
>because (paraphrasing his explanation):  HCL acts as a "knife" to cut
>protein for digestion in the stomach.  Since HCL is being inhibited to
>a significant degree, is protein passing through without being
>properly digested/absorbed?

   No.  Most protein digestion occurs in the duodenum and small bowel,
under the action of pancreatic enzymes which don't need acid.  Stomach
protein digestion is minor, and not something you need.  The function
of the stomach is mainly to store food and sterilize it with acid.
Most digestive functions are taken care of later.  And what any of this
has to do with B vitamins (except B12) is beyond me.  Acupuncturists
should stick to acupuncture.

>		  I don't know what to make of this, as I
>feel pretty  healthy. But he says there can be "subclinical"
>deficiencies going on, and that I should consider a B 12 supplement.

    That's probably good advice, but the B12 you get in any
multivitamin should be more than enough.

>3. 	With regard to the B vitamin, he used the term "intrinsic",
>which my pharmacist says is an old term.  Is it out of use? What
>does/did it mean?

    The intrinsic factor is made by stomach cells to bind B12.  You
make quite enough of it to work, whether you take acid-blocking drugs
or not.  The B12 problem that results from low acid, results from not
being able to remove B12 from binding sites in food, a process that
DOES require acid.  However, the B12 in vitamins (any vitamin) is free,
and doesn't require acid to be released.  It does require intrinsic
factor to be absorbed, but (as noted) your intrinsic factor is probably
just fine.  The B12 problems that occur with low acid and aging are all
easily solved with low doses of B12 as found in vitamins.  It is (with
rare exceptions) only complete gastric parietal destruction of the kind
that produces pernicious anemia (no intrinsic factor), requires
something more.  That would be large oral doses of B12 on the order of
1000 ug, which takes a separate pill; or else B12 shots. People who
have low acid levels do NOT need anything this drastic.

   If you're really curious, you can always have your blood levels of
B12 tested yearly.  If they're in mid to high range (greater than 500),
don't worry about it.  If lower, you can consider a better supplement
than a simple multivitamin.

                                    Steve Harris, M.D.

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