What your doctor doesn't tell you about pantoprazole – and Dr Petra Bracht does

Every morning millions of people in Germany swallow their tablets — acid blockers, cholesterol-lowering drugs, diabetes medication, painkillers. Routinely, dutifully, as prescribed.

What is readily overlooked: many of these medicines are silent nutrient depleters. They solve one problem while creating a new one — one that often stays invisible in the next blood count.

Dr Petra Bracht, a specialist in general medicine, nutritional physician and Spiegel bestselling author, speaks plainly in her YouTube video “Diese Medikamente meide ich als Ärztin!” about what is said too rarely in practices.

Uwe Gröber, pharmacist, head of the Academy for Micronutrient Medicine and author of the standard work “Arzneimittel und Mikronährstoffe”, adds the clinical dimension with a focus on metformin and acid blockers — and explains which nutrients disappear particularly reliably under these long-term medications.

Medicines intervene in metabolism — that is their purpose. But many do so with collateral damage.

Proton pump inhibitors such as pantoprazole or omeprazole lower stomach acid so effectively that at the same time the absorption of vitamin B12, magnesium, calcium, zinc and iron from food is massively restricted.

Stomach acid is not an enemy — it is a digestive tool.

Statins, the world’s most prescribed cholesterol-lowering drugs, block the very biochemical pathway responsible for the body’s own production of coenzyme Q10.

CoQ10 is the fuel of the mitochondria — without it no engine runs. And painkillers such as ibuprofen damage the intestinal lining when used long term, which in turn worsens nutrient absorption overall.

Dr Petra Bracht puts it directly: “We treat one building site and open up another.”

Metformin is the world’s most prescribed medication for type 2 diabetes — and at the same time one of the most underestimated micronutrient depleters.

Uwe Gröber explains the mechanism in his video: in the gut, metformin blocks the calcium-dependent transporter through which vitamin B12 is normally absorbed.

The consequence is a creeping fall in B12 — silent, over months and years, until nerve damage, memory problems or depressive moods set in, which are then wrongly dismissed as a diabetes complication or a symptom of ageing.

And that is not all: metformin additionally depletes vitamin B1 (thiamine), folic acid, magnesium and vitamin D. Gröber puts it unambiguously: “Anyone who prescribes metformin and does not monitor B12 risks neurological damage that would have been avoidable.”

Vitamin B12 deficiency from long-term PPI use often shows itself gradually: exhaustion, tingling in hands and feet, memory lapses, depressive moods. Because these symptoms are diffuse, they are rarely connected with the stomach medication that has been taken daily for years.

Magnesium deficiency — likewise a side effect of PPIs — appears as muscle cramps, heart rhythm disturbances and poor sleep. A CoQ10 deficiency caused by statins leads to muscle pain and muscle weakness, which many of those affected wrongly attribute to age, as well as to reduced performance and strain on the heart — with a medication that is meant to protect the heart, of all things.

With metformin-induced B12 deficiency the neurological dimension is particularly alarming: a review published in PMC in 2025 (PMC: 12278092) shows that metformin-related B12 deficiency is one of the most common but most overlooked causes of diabetic neuropathy — with numbness, burning and gait disturbance that would be entirely avoidable through timely B12 monitoring and supplementation.

…a meta-analysis published in 2025 (PubMed ID: 40995253, PMC12456669) with 693 patients shows that long-term PPI use lowers the vitamin B12 level by 12 to 18 per cent within twelve months — while at the same time raising bone markers of breakdown?

And a recent systematic review of statins (PubMed ID: 41158831) shows that CoQ10 supplementation for statin-related muscle pain led to a significant improvement in all the randomised studies examined — without notable side effects.

Mark Hyman, American physician and author of “The Blood Sugar Solution”, sums the problem up precisely: “We treat laboratory numbers with medication instead of understanding the causes behind the figures — and in doing so we deplete the resources the body needs to heal.”

Anyone taking medication — or deliberately avoiding it and wanting to know the status quo — should check regularly what the body is missing.

Vitamin B12 in serum, ideally combined with holotranscobalamin as an early deficiency marker, is essential for everyone taking PPIs or metformin.

For long-term metformin users, Uwe Gröber recommends an annual B12 check as well as parallel measurement of methylmalonic acid as a functional B12 marker, which makes deficiencies visible earlier than the serum value alone.

Magnesium should be measured not only in serum but intracellularly, since the serum value often stays within the normal range for a long time despite a deficiency.

Coenzyme Q10 in the blood is the decisive marker for everyone taking statins. Folic acid, vitamin B1, zinc and vitamin D round off the profile — with different priority depending on the medication.

Anyone looking for all of that in a standard blood count is looking in vain.

The connection between taking medication and nutrient deficiency is well documented scientifically — and is structurally ignored in routine medicine.

ORY Analysis offers a complete micronutrient profile that closes exactly this gap: B12, intracellular magnesium, CoQ10, zinc, ferritin and further markers are recorded systematically, interpreted and accompanied by recommendations for action. Prevention does not mean taking no medication.

It means knowing what it does in the body — and counteracting in good time.

Sources

1. PMC (2025): „A Systematic Review of Long-Term Use of Proton Pump Inhibitors (PPIs) in Older Adults on Polypharmacy: Do PPIs Deplete Nutrients?" PubMed ID: 40995253. https://pubmed.ncbi.nlm.nih.gov/40995253/
2. PubMed (2025): „Effects of coenzyme Q10 supplementation on myopathy in statin-treated patients: a systematic review and meta-analysis." PubMed ID: 41158831. https://pubmed.ncbi.nlm.nih.gov/41158831/
3. PubMed (2023): „Vitamin B12 deficiency and use of proton pump inhibitors: a systematic review and meta-analysis." PubMed ID: 37060552. https://pubmed.ncbi.nlm.nih.gov/37060552/
4. PMC (2025): „Metformin-induced vitamin B12 deficiency: An underdiagnosed cause of diabetic neuropathy." PMC ID: 12278092. https://pmc.ncbi.nlm.nih.gov/articles/PMC12278092/
5. PubMed (2024): „Metformin Use and Vitamin B12 Deficiency in People with Type 2 Diabetes. What Are the Risk Factors? A Mini-systematic Review." PubMed ID: 39526048. https://pubmed.ncbi.nlm.nih.gov/39526048/
6. Dr. Petra Bracht (2025): „Diese Medikamente meide ich als Ärztin! (Vorsicht!)" YouTube. https://www.youtube.com/watch?v=cx6X82GAxjw
7. Uwe Gröber (2022): „Wichtig bei Metformin und Säureblocker: Vitamin B12, B1, Folsäure, Magnesium, Vitamin D." YouTube. https://www.youtube.com/watch?v=eI3dshG8MlY
8. Gröber, Uwe (2018): Arzneimittel und Mikronährstoffe – Medikationsorientierte Supplementierung. 4th edition. Stuttgart: Deutscher Apotheker Verlag.
9. Bracht, Petra (2021): Klartext Ernährung. München: Gräfe und Unzer Verlag.
10. Hyman, Mark (2012): The Blood Sugar Solution. New York: Little, Brown and Company.
11. Thieme Connect: „Protonenpumpenhemmer (PPI): Mikronährstoff-Räuber mit weitreichenden Konsequenzen." https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-1743-6980