لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.سایت جـوم آریـا یکی از بهترین ارائه دهنده ی قالب های فارسی جوملا و وردپرس است .

فلفل های رنگی، کاکائو، هندوانه، گوجه فرنگی، چای سبز، زردچوبه و انواع توت های رنگی در برابر اشعه مضر خورشید اثر محافظتی برای پوست دارند و استفاده از آنان در تابستان توصیه شده است. برخی از گیاهان به طور طبیعی در بافت خود آنتی اکسیدان تولید می کنند؛

لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.سایت جـوم آریـا یکی از بهترین ارائه دهنده ی قالب های فارسی جوملا و وردپرس است .

نتیجه یک مطالعه گسترده نشان می دهد که تغذیه سالم زنان، احتمال ضعف حرکتی را در سالخوردگی آنها کاهش می دهد. نتایج این تحقیق که 54 هزار و 762 زن در آن شرکت داشتند، در شماره ژوییه نشریه Nutrition منتشر می شود.

Taking carnitine with omega-3 fish oil is one of the simplest things you can do to lose weight and raise your energy levels. The cool thing about carnitine is that by elevating the amount of carnitine stored in your muscles, you will see improvements in your quality of life. Fat loss and more energy are two of these benefits, but taking carnitine is known to improve all of the following:

•    High-intensity work capacity
•    Increase athletic performance
•    Speed your recovery from intense exercise
•    Make your brain work better
•    Prevent oxidative stress that leads to longer term health problems such as cardiovascular disease, diabetes, and chronic inflammation

A recent study in The Journal of Physiology provides groundbreaking evidence that carnitine supplementation can improve athletic performance, something that researchers have had trouble proving for years. Emerging research on the benefits of carnitine for health in conjunction with evidence that clarifies the best ways to take carnitine (insulin must be present in the body for carnitine to be delivered into the muscle), make it time to revisit this amino acid. Let’s look at the top ten health benefits of elevating your carnitine levels with a focus on achieving optimal body composition.

1)    Take Carnitine to Burn Fat: The Basics
Carnitine is an amino acid composite that is made from lysine and methionine. There are a couple of different forms of carnitine, such as acetyl-L-carnitine and L-carnitine tartrate, and we’ll look at which forms you should be taking and when. In this article, unless otherwise stated,  “carnitine” will be used to refer to L-carnitine tartrate.
 
Carnitine is a potent fat burner because it is responsible for the transport of fats into the cells to be used for energy in the body. By raising the level of muscle carnitine, you support the fat burning process, and because your body becomes more efficient at processing fuel, it will increase your energy levels. Elevating carnitine will also improve physical performance by burning more fat, sparing glycogen, clearing muscle lactate, and increasing anabolic hormone response.
 
2)    Pair Carnitine and Omega-3 Fish Oils For Fat Loss
For carnitine to be effective, you need to ensure you have adequate levels of omega-3 fish oils in the body. In order for your body to actually “load” carnitine that you take in supplement form into the muscles where you want it, it has to be accompanied by insulin.
 
Omega-3 fatty acids come into the equation because they will improve the health of every cell in your body if you get enough of them. The cells are made up of two layers of lipids or fats, which will be composed of good fats or bad fats depending on the type you eat. If the cell lipid layers are made up of omega-3s, the cell will be generally healthier, and it will also make them more sensitive to insulin. Having your cells be more sensitive to insulin allows your body to get the most energy production out of supplemental carnitine.
 
I mention this relationship between omega-3s and carnitine because you won’t optimally benefit from taking carnitine unless you have already attended to your omega-3s. In working with obese clients, I’ve found that using high doses of fish oil with carnitine tartrate will allow the fat to start to come off.
 
Omega-3s increase metabolic rate by increasing cell activity and fat burning. Carnitine is the delivery system for long chain fatty acids such that the less carnitine you have in the body, the fewer fatty acids that get into the cell, meaning you don’t burn them for energy. Instead, the fatty acids go into a depository and are stored as fat. By elevating carnitine, fat burning increases and you give the cell the right genetic machinery to raise metabolism. You’ll have more energy, feel more motivated, and any excess fat begins to come off.
 
3)    No Need For Carbs: Carnitine with Omega-3s for Fat Loss
The new study in The Journal of Physiology, which we will highlight below starting with #5, showed that taking carnitine with carbs is effective for elevating muscle carnitine levels and improving athletic performance. But carbs aren’t necessary as long as you get adequate omega-3s. A study in the Annals of Nutrition and Metabolism showed that combining carnitine, omega-3s, and polyphenols resulted in lower blood lipid levels and better cellular energy production, which has the implication of fat loss if the study had been of longer duration—it was only 12 weeks.
 
Researchers found that triglycerides were lowered by 24 percent and free fatty acids decreased by 29 percent compared to a placebo group that had no changes. These changes indicate healthier markers of cholesterol, better energy use, and fat burning that will lead to fat loss. Additionally, genes that increase fat burning in the body were “activated” indicating a better metabolic profile. Take note that the polyphenols were included to raise antioxidant levels and fight oxidative stress that leads to chronic inflammation and poor cardiovascular health, among other things. They are not necessary for the carnitine to work its magic.
 
4)    Carnitine Fights Visceral Belly Fat
Visceral belly fat is one of the toughest fats to lose once you’ve got it, and it causes numerous health problems. Once you begin to gain visceral fat around the belly, it will lead to fat gain within the organs such as the liver, the heart, or even in muscle. Fat gain in the liver leads to non-alcoholic fatty liver disease, while epicardial fat is a type of visceral fat that is deposited around the heart and is considered a metabolically active organ, altering heart function.
 
Raising your carnitine levels will fight this visceral fat gain because it increases fat burning, which has the effect of taking triglycerides and low-density lipoproteins out of the system so that they don’t build up causing high cholesterol and atherosclerosis. A new research study in the journal Food and Chemical Toxicology illustrates this. Researchers gave a carnitine supplement to mice who were fed a high-fat diet in order to make them gain weight. In comparison to a group of mice fed a placebo, the carnitine group gained substantially less visceral and subcutaneous fat (fat that is right below the surface of the skin that you can pinch with your fingers). The placebo group exhibited the beginning stages of non-alcoholic fatty liver disease and atherosclerosis, neither of which were evident in the carnitine group.
 
5)    Take Carnitine To Improve Performance
The study in The Journal of Physiology is the first to show that muscle carnitine content can be increased in humans through diet . Once carnitine is elevated, metabolism in the body is dependent on the intensity of exercise, allowing for better energy use and performance.
 
Researchers gave a placebo or a supplement of carnitine tartrate and carbs (2 g carnitine with 80 g of carbs twice a day) to experienced athletes who were training for a triathlon three to five times a week. At various points throughout the study subjects performed the following exercise tests: two thirty-minute repeated bouts of exercise (the first at 50 percent of maximal oxygen uptake and the second at 80 percent), followed by an all-out 30-minute performance trial.
 
After 24 weeks of supplementation, the carnitine group increased performance from baseline by 11 percent in the exercise trials compared to no improvement in the placebo group. Participants who took carnitine also rated the trial and the exercise bout they performed at 80 percent of max to be easier than at baseline, while the placebo had no difference in rating of perceived exertion (RPE).
 
Two key points from this study are essential for making carnitine supplementation effective at elevating performance. First, it takes a long supplementation period to raise muscle carnitine levels and reap the benefits of improved energy production. In this study after three months there were no changes in performance or RPE from baseline, but after 6 months those improvements were pronounced and statistically significant. Somewhere between 3 and 6 months is the magic number, meaning taking carnitine is a lifestyle supplement just like omega-3s are.
 
Second, carnitine doesn’t accumulate or “load” in muscle unless accompanied by high insulin concentrations. This explains why many previous studies have NOT shown increases in muscle carnitine after taking it in multi-gram doses. In this study the carnitine was taken with carbs because the carbs triggered insulin release, which allowed the carnitine to load into the muscle. Take note that there is a big focus in the health world on minimizing insulin secretion from carbs for optimal body composition. This is critical, but be aware that insulin is actually a potent anabolic hormone if the cells are sensitive to it and if appropriate levels are present.
 
Pairing carnitine with carbs is one option, but as shown in #3, carnitine can also be paired with omega-3s, which may be more appropriate for individuals whose primary goal is to lose fat. In my experience, best fat loss results come from a 5 to 1 ratio of omega-3s to carnitine. If you’re taking 20 grams of omega-3s, you’d pair it with 4 grams of carnitine. But, if you’re more conservative with your omega-3 supplementation, you can start with 1 to 2 grams of carnitine and work up to 4 grams, which was the dose used in this study.
 
6)    Increase Work Capacity With Carnitine
Another benefit of raising carnitine levels is that you’ll have a greater work capacity, but it will not feel as physically difficult.  You’ll be able to lift more weight, complete more reps, or run faster and longer, but with more ease. This is because higher muscle carnitine levels help decreases pain, muscle damage, and markers of metabolic stress from high-intensity exercise by decreasing lactic acid production.
 
A higher level of carnitine increases energy production, but it also has the effect of accelerating muscle buffering by maintaining the pH of the muscle and minimizing the accumulation of hydrogen ions.  Basically, carnitine helps eliminate the byproducts of intense exercise that cause pain and muscle damage (the burning you may feel when training hard), allowing you to work harder.
 
In the Journal of Physiology study, results show how higher muscle carnitine levels increase work capacity by reducing lactate accumulation in the muscles. Following the exercise bout at 80 percent of maximal, muscle lactate buildup was 44 percent lower in participants that supplemented with carnitine compared to the control group. Following the exercise bout at 50 percent of maximal, the carnitine group used 55 percent less muscle glycogen than the control group indicating that they burned more fat for fuel and had improved energy production. ??
 
The combination of less lactate buildup and greater fat burning in the two exercise bouts allowed the carnitine group to increase work output by 35 percent, while having a lower RPE.  In simple terms, taking carnitine is a no-brainer if you want to improve body composition by burning more fat and be able to train at a higher level!
 
7)    Enhance Recovery with Carnitine
Take carnitine to speed both short- and long-term recovery from intense training and you’ll have less pain, soreness, and feel more energized. Muscle lactate buildup is a limiting factor that inhibits performance and causes muscle pain, meaning that if you produce less of it and are able to clear it faster, you will have a faster recovery.
 
Taking carnitine will also support an anabolic response to exercise by up-regulating the androgen receptors, which will “help to mediate quicker recovery,” according to one research group. Two studies led by William J. Kraemer tested the hormonal response to taking carnitine tartrate. In one of these studies, supplementing with carnitine for 21 days produced an increase in the resting content of the androgen receptors that bind with testosterone, indicating a better anabolic environment. Following resistance exercise, participants also had increased androgen receptor content that indicated greater cellular uptake of testosterone and increased protein synthesis. Enhanced protein synthesis allows tissue that was damaged during training to regenerate faster and speed recovery.
 
The second study also had participants take carnitine or a placebo for 21 days and found that after intense resistance training, the carnitine group had reduced muscle tissue damage (assessed by MRI) and increased IGFBP-3 levels (a binding protein that promotes tissue synthesis). Researchers suggest carnitine supplementation helps promote recovery  by producing “more undamaged tissue, (and a) greater number of intact receptors that would be available for hormonal interactions.”
 
8)    Improve Cognitive Performance with Acetyl-L-Carnitine and Increase Motivation
A form of carnitine called acetyl-l-carnitine will give you superior brain function and increase motivation, meaning it’s a great supplement for people who want to lose weight but feel unmotivated to exercise. Acetyl-l-carnitine helps DHA omega-3 fish oils work their magic on the brain—just like carnitine tartrate, this form needs to be taken with omega-3s in order to facilitate fat burning for energy in the brain.

Acetyl-l-carnitine is a powerful antioxidant and can detoxify the brain of heavy metals we suggest pairing it with Alpha Lipoic Acid along with DHA because all together they support dopamine levels, while increasing attention span and motivation. For depressed people or those who need to lose weight, it works wonders on motivation and self-initiative, both with training and work-related tasks. And by taking acetyl-l-carnitine, you’ll still benefit from improved energy, physical performance, work capacity, and a speedy recovery, all benefits to help you achieve a lean physique.
 
A number of research studies support the use of acetyl-l-carnitine for a better brain. For example, a new study in the Scandinavian Journal of Gastroenterology found that giving patients with liver dysfunction acetyl-l-carnitine significantly improved their physical function, general health, overall mood, and well-being. They also reported less depression and anxiety.
 
9)    Prevent Type 2 Diabetes and Improve Insulin Health With Carnitine
Carnitine is emerging as a supplement that can prevent type 2 diabetes because of how it improves fat metabolism. It can counter the diseases of metabolic syndrome by preventing  atherosclerosis, and supporting cardiovascular health, while inducing fat loss.
 
Plus, raising carnitine levels will fight related type 2 diabetes factors because it has antioxidant properties, meaning it abolishes free radicals and reduces oxidative stress.  The key to improving your insulin health and losing fat with carnitine is to understand that the following interrelated factors must be present for this method to be effective:
A)    Take carnitine with omega-3 fish oils. Remember, a 1 to 5 ratio is suggested.
B)    Adopt this supplementation protocol as a lifestyle habit, not a one time thing. Research shows androgen receptors are up-regulated after three weeks, triglycerides are improved after three months, but muscle carnitine level isn’t elevated for close to six months.
C)    A high-protein diet and exercise will make it much more effective
 
10)    Carnitine Supplementation Counters Cachexia or Wasting Disease
Raising carnitine levels can counter cachexia or wasting syndrome that is associated with diseases including cancer, AIDS, heart disease, and lung disease. Although this is not a common problem among the Poliquin readership, it should be mentioned here because carnitine supplementation is able to restore metabolic parameters in individuals with cachexia and thereby help fight the progression of life-threatening diseases.
 
Cachexia is characterized by progressive weight loss, muscle loss, cognitive decline, poor insulin health, inflammation, and poor organ function, among other things. Emerging evidence shows that in patients with cancer cachexia, carnitine is depleted and metabolism is impaired. A new study in Nutrition Journal  found that giving carnitine to men with pancreatic cancer who were suffering from cachexia improved their lean mass, increased energy metabolism, and improved their quality of life. Using carnitine produced a trend to increased survival over the course of the study and towards reduced hospital stays.

11)      Take Carnitine to Improve Male Fertility
Having adequate carnitine levels has been shown to be necessary for male fertility. One study found that fertile males had higher levels of carnitine and this was associated with healthier sperm. The men who were classified as infertile had lower carnitine and compromised sperm health. This study suggests that ensuring you have get adequate carnitine in conjunction with healthy lifestyle practices can support fertility.

12)      Use Carnitine for Better Skin
A topical carnitine cream can improve the health of your skin by decreasing the amount of oil released by the pores. A new study in the Journal of Cosmetic Dermatology found that a carnitine cream increased the amount of fat that entered the cell, which decreased the oil secreted by the skin. This led to less oily skin and a smoother overall appearance. It also indicates the value of using carnitine to improve the transport of carnitine across the cellular wall to be burned for fat because Beta fat oxidation, or burning, was enhanced.
 

Calcium and vitamin D are essential to keeping bones strong, dense and healthy as we age, as well as preventing bone loss, osteporosis, and skeletal fractures. Calcium builds and maintains healthy bones and vitamin D assists with absorption and increased uptake.

Alarmingly, 90 percent of women in the U.S. are deficient in calcium and 50 to 90 percent are deficient in vitamin D. These numbers are even higher among minorities, including Hispanics and African-Americans. Even among children, 30 to 40 percent are already deficient in calcium and vitamin D. Furthermore, about 50 percent of women and 20 percent of men aged 50 and older will have a fracture as a result of osteoporosis.

Clinicians and patients have become concerned about the possible, but unproven links between calcium supplements and heart attacks. In an editorial published in the current issue of the Journal of Cardiovascular Pharmacology and Therapeutics, E. Joan Barice, M.D., M.P.H., affiliate associate professor, and Charles H. Hennekens, M.D., Dr.P.H., first Sir Richard Doll professor and senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University, provide reassurances to clinicians and their patients about calcium and vitamin D supplements and cardiovascular disease.

The authors emphasize that the benefits of calcium and vitamin D supplements on bone health are conclusive, and that the totality of evidence is reassuring on cardiovascular disease. The totality of evidence includes all sources of information whether basic or clinical research, especially studies designed to test the question. Previous concerns were based largely on over-interpretation of results from studies not designed to test the question as well as overreliance on a few sub-groups of individual studies rather than looking at the totality of evidence.

To decrease disability and death from osteoporosis, many guidelines recommend daily intakes of 1,200 mg of calcium and 600 IU (international units) of vitamin D.

Hennekens and Barice conclude that it would be unfortunate if clinicians failed to prescribe the combination of calcium and vitamin D supplements as adjuncts to therapeutic lifestyles changes of proven benefit, especially regular physical activity, to the very large number of patients in whom the benefit-to-risk ratio in clearly favorable.

"While drugs to prevent and treat osteoporosis serve as bricks in strengthening bones and preventing bone loss, calcium and vitamin D serve as mortar," said Hennekens. "Without adequate intake of this combination, as recommended by most guidelines, we can neither achieve nor maintain healthy bone structure."

Barice has been a national leader in women's health as well as addiction medicine. She established the Florida Society of Addiction Medicine and achieved designation of the specialty by the Florida Medical Association and subsequent recognition by the American Medical Association. Her numerous other accomplishments benefiting public health include chronic pain management and the appropriate use of alternative and complementary medicines.

Hennekens has received numerous recent honors including the 2013 Fries Prize for Improving Health for his seminal contributions to the treatment and prevention of cardiovascular disease, the 2013 Presidential Award from his alma mater, Queens College, for his distinguished contributions to society, the 2013 honoree as part of FAU's Charles E. Schmidt College of Medicine from the American Heart Association for reducing deaths from heart attacks and strokes, and the 2014 Ochsner Award on cigarette smoking and disease. From 1995 to 2005, Science Watch ranked Hennekens as the third most widely cited medical researcher in the world and five of the top 20 were his former trainees and/or fellows. In 2012, Science Heroes ranked Hennekens No. 81 in the history of the world for having saved more than 1.1 million lives.

سایت جـوم آریـا یکی از بهترین ارائه دهنده ی قالب های فارسی جوملا و وردپرس است . شما عزیزان می توانید با مراجعه به سایت ما قالب مورد نظر خود را پیدا کنید و با هزینه کمی صاحب یک قالب زیبا و پراز امکانات شوید .لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.

سایت جـوم آریـا یکی از بهترین ارائه دهنده ی قالب های فارسی جوملا و وردپرس است . شما عزیزان می توانید با مراجعه به سایت ما قالب مورد نظر خود را پیدا کنید و با هزینه کمی صاحب یک قالب زیبا و پراز امکانات شوید .لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.

سایت جـوم آریـا یکی از بهترین ارائه دهنده ی قالب های فارسی جوملا و وردپرس است . شما عزیزان می توانید با مراجعه به سایت ما قالب مورد نظر خود را پیدا کنید و با هزینه کمی صاحب یک قالب زیبا و پراز امکانات شوید .لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.

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سایت جـوم آریـا یکی از بهترین ارائه دهنده ی قالب های فارسی جوملا و وردپرس است . شما عزیزان می توانید با مراجعه به سایت ما قالب مورد نظر خود را پیدا کنید و با هزینه کمی صاحب یک قالب زیبا و پراز امکانات شوید .لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.

سایت جـوم آریـا یکی از بهترین ارائه دهنده ی قالب های فارسی جوملا و وردپرس است . شما عزیزان می توانید با مراجعه به سایت ما قالب مورد نظر خود را پیدا کنید و با هزینه کمی صاحب یک قالب زیبا و پراز امکانات شوید .لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.

لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.

لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.

لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.

لورم ایپسوم متنی است که ساختگی برای طراحی و چاپ آن مورد است. صنعت چاپ زمانی لازم بود شرایطی شما باید فکر ثبت نام و طراحی، لازمه خروج می باشد.

In humans, vitamin C is essential to a healthy diet as well as being a highly effective antioxidant, acting to lessen oxidative stress; a substrate for ascorbate peroxidase;

Collagen, carnitine, and tyrosine synthesis, and microsomal metabolism
Ascorbic acid performs numerous physiological functions in human body. These functions include the synthesis of collagen, carnitine and neurotransmitters, the synthesis and catabolism of tyrosine and the metabolism of microsome. Ascorbate acts as a reducing agent (i.e. electron donor, anti-oxidant) in the above-described syntheses, maintaining iron and copper atoms in their reduced states.

Vitamin C acts as an electron donor for eight different enzymes: These reactions add hydroxyl groups to the amino acids proline or lysine in the collagen molecule via prolyl hydroxylase and lysyl hydroxylase, both requiring vitamin C as a cofactor. Hydroxylation allows the collagen molecule to assume its triple helix structure and making vitamin C essential to the development and maintenance of scar tissue, blood vessels, and cartilage.


2 are necessary for synthesis of carnitine. Carnitine is essential for the transport of fatty acids into mitochondria for ATP generation.
The remaining three have the following functions in common but do not always do this:
dopamine beta hydroxylase participates in the biosynthesis of norepinephrine from dopamine.
another enzyme adds amide groups to peptide hormones, greatly increasing their stability.
one modulates tyrosine metabolism.
Antioxidant
Ascorbic acid is well known for its antioxidant activity. Ascorbate acts as a reducing agent to reverse oxidation in aqueous solution. When there are more free radicals (Reactive oxygen species) in the body versus antioxidant, a human is under the condition called Oxidative stress. Oxidative stress induced diseases encompass cardiovascular diseases, hypertension, chronic inflammatory diseases and diabetes The plasma ascorbate concentration in oxidative stress patient (less than 45 µmol/L) measured is lower than healthy individual (61.4-80 µmol/L) According to McGregor and Biesalski (2006). This reaction can generate superoxide and other ROS. However, in the body, free transition elements are unlikely to be present while iron and copper is bound to diverse proteins. thus, ascorbate as a pro-oxidant is unlikely to convert metals to create ROS in vivo.

Immune system
Some advertisements claim that Vitamin C "supports" or is "important" for immune system function. These claims are partially supported by the scientific evidence (see Chandra RK, 1997, "Nutrition and the immune system: an introduction". The American Journal of Clinical Nutrition 66 (2): 460S–463S. PMID 9250133.)

Use for 2 or more years of proton pump inhibitors and histamine 2 receptor antagonists (two types of acid-inhibiting medications) was associated with a subsequent new diagnosis of vitamin B12 deficiency, according to a study appearing in the December 11 issue of JAMA.

"Vitamin B12 deficiency is relatively common, especially among older adults; it has potentially serious medical complications if undiagnosed. Left untreated, vitamin B12 deficiency can lead to dementia, neurologic damage, anemia, and other complications, which may be irreversible," according to background information in the article. Proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) suppress the production of gastric acid, which may lead to malabsorption of vitamin B12, and they are among the most commonly used pharmaceuticals in the United States. However, few data exist about any association between long-term exposure to these medications and vitamin B12 deficiency in large population-based studies.

Jameson R. Lam, M.P.H., of Kaiser Permanente, Oakland, Calif., and colleagues evaluated the relationship between the use of acid-suppressing prescription medications and vitamin B12 deficiency within the Kaiser Permanente Northern California population. The researchers identified 25,956 patients having new diagnoses of vitamin B12 deficiency between January 1997 and June 2011 and 184,199 patients without B12 deficiency, and compared their exposure to acid inhibitors as observed via electronic pharmacy, laboratory, and diagnostic databases.

Among patients with a new diagnosis of vitamin B12 deficiency, 3,120 (12.0 percent) were dispensed a 2 or more years' supply of PPIs, 1,087 (4.2 percent) were dispensed a 2 or more years' supply of H2RAs (without any PPI use), and 21,749 (83.8 percent) had not received prescriptions for either PPIs or H2RAs. Among control patients, 13,210 (7.2 percent) were dispensed a 2 or more years' supply of PPIs, 5,897 (3.2 percent) were dispensed a 2 or more years' supply of H2RAs (without any PPI use), and 165,092 (89.6 percent) had not received prescriptions for either PPIs or H2RAs.



The researchers found that the magnitude of the association was stronger in women and younger age groups with more potent acid suppression (PPIs vs. H2RAs), and that the association decreased after discontinuation of use. There was no significant trend with increasing duration of use.

"We cannot completely exclude residual confounding [factors besides the drugs] as an explanation for these findings, but, at minimum, the use of these medications identifies a population at higher risk of B12 deficiency, independent of additional risk factors. These findings do not recommend against acid suppression for persons with clear indications for treatment, but clinicians should exercise appropriate vigilance when prescribing these medications and use the lowest possible effective dose. These findings should inform discussions contrasting the known benefits with the possible risks of using these medications," the authors conclude.