Proton pump inhibitors reduce the bioavailability of dietary vitamin C

Background: The gastric juice concentration of vitamin C is reduced in subjects with elevated intragastric pH. This is probably because of the fact that the vitamin is unstable at non-acidic pH and undergoes irreversible denaturation. Aim: To determine whether elevation of intragastric pH reduces the bioavailability of dietary vitamin C. Methods: Plasma vitamin C was measured before and after a course of omeprazole 40 mg/day for 4 weeks in 14 Helicobacter pylori positive and 15 H. pylori negative subjects. Dietary intake of vitamin C was measured and intragastric pH monitored. Results: Compared with the H. pylori negative subjects, H. pylori positive subjects had a lower mean daily vitamin C intake (141.7 mg vs. 41.5 mg, P < 0.01) and also lower plasma vitamin C concentration (25.1 mu g/mL vs. 17.4 mu g/mL, P < 0.0001). After 28 days of 40 mg/day of omeprazole the mean plasma vitamin C level had fallen by 12.3% (P=0.04). This fall affected both the H. pylori positive and negative subjects. Conclusions: We have shown that a short course of omeprazole will cause a reduction in the plasma vitamin C level of healthy volunteers. This decrease in plasma vitamin C is independent of dietary intake of the vitamin and indicates reduced bioavailability. The clinical significance of this is unclear but any adverse effects will be most apparent in H. pylori infected subjects who have a low pre-treatment vitamin C status.