A Surprising Cause of That “Weak, Run-Down Feeling”

Dr. Frank Shallenberger, MD

October 3, 2022


Ben is an 82-year-old man who has always been athletic and in great shape. But over the past nine months, his condition had deteriorated to the point he could no longer do the hikes he used to enjoy.

Instead, he sits in his chair and recollects the good old days. What happened to Ben could easily happen to any one of us.

When Ben came to see me, he was complaining of feeling weak and run down. An initial blood study showed that he was severely anemic. That means that he had very few red blood cells. The red blood cells are the ones that carry the oxygen to our cells. So, in effect, Ben’s body was in a state of oxygen deficiency. No wonder he felt horrible. But how did he get that way? That’s what we had to figure out.

The next test we did was an iron test. Red blood cells need iron in order to carry oxygen. Maybe he was short on iron. And indeed he was. The amount of iron in our body is reflected by a test called an iron saturation test. Normally, the level is at least 30%. In Ben’s case, it was down to 3%. Almost zero! So he had no iron. But how did he get that way? You might be surprised by the answer.

Ben’s diet was normal. He wasn’t having any blood loss, a common cause for low iron levels. Perhaps it was his digestion. After all, the older we are the more compromised our digestion often gets. And then a quick look at his medications gave the answer. Ben had been taking omeprazole for the past two years.

Omeprazole, also known as Prilosec, is a drug that you can buy over the counter. Doctors often recommend it as a treatment for heartburn or ulcers. In Ben’s case, the doctor was giving it to him because one of the other drugs he was giving him can cause ulcers, and the doctor was hoping to avoid them by prescribing the omeprazole.

The way omeprazole works is by shutting down the body’s natural production of stomach acid. And that is why Ben was so low on iron. Stomach acid is an important part of the digestive system. And iron cannot be absorbed when there isn’t enough stomach acid.

Back in 2004, doctors were warned about this problem. The article pointed out that while many people do not develop an iron deficiency from stomach acid-reducing drugs, many do. Especially those who already have low levels of stomach acid.

The authors stated, “Our observations support the probability that the profound hypochlorhydria [low stomach acid] induced by omeprazole may indeed impair the optimal absorption of orally administered iron.” But that is not the only study warning about the connection between omeprazole and iron deficiency.

Another experimental study looked at the effect of omeprazole on rats. Researchers gave half of the rats omeprazole. When the study was over, the researchers were able to show that even after only four weeks of treatment, the rats on the omeprazole had decreased iron levels. If this study had gone on for two or three years like it had with Ben, I am sure these rats would have been just as seriously deficient. There are several important points I need to make.

The first is the most obvious. God put stomach acid in our stomachs for a reason. It’s not an accident. Get rid of it and problems are going to happen. The drugs that reduce stomach acid not only cause iron deficiency, they are also on record for vitamin B12 deficiency, osteoporosis, pneumonia, and colitis. If you absolutely need them, then fine. But most of the time they are not needed. Why?

It’s because stomach acid-reducing drugs usually don’t treat the problem. Because in most cases the cause of reflux and heartburn is not too much stomach acid. It’s too much coffee. Other common causes are sodas (especially colas), alcohol, and NSAID medications such as ibuprofen and aspirin. Stop these and, in most cases, the reflux will just magically go away. But what if it doesn’t?

Surprisingly, one of the most common causes of heartburn and reflux is the deficiency of stomach acid called hypo-chlorhydria. So how is it possible that you can get heartburn from too little stomach acid? It’s because stomach acid protects against the overgrowth of bacteria and fungi in the stomach.

When too little stomach acid is present, it can result in an overgrowth of these organisms right in the stomach. And when that happens, the acid metabolic products of the organisms can create the symptoms of heartburn.

So if you are regularly taking drugs like omeprazole for heartburn, do the smart thing. Stop all coffee, sodas, NSAIDs, and alcohol for three weeks. At the same time, take a supplement with the herb d-limonene in it. This herb can be instrumental in detoxifying and increasing the efficiency of the stomach.

After three weeks, stop the medication and see what happens. There is a good chance that you will find that you no longer need it. And after six weeks of therapy, there is also a good likelihood that you will be able to have coffee and alcohol again – as long as you keep a lid on it. But one last precaution.

If you are taking the medications at a doctor’s order because you have either Barrett’s or erosive esophagitis, stop the medications only under your doctor’s supervision. There are indeed many people who do need these drugs. It’s just that most of them don’t.


da Conceic, E.C., T. Shuhama, C. Izumi, et al. “Iron supplementation prevents the development of iron deficiency in rats with omeprazole-induced hypochlorhydria.” Nutrition Research 21, April 2001. 1201–1208.

Sharma, V.R., M.A. Brannon, and E.A. Carloss. “Effect of omeprazole on oral iron replacement in patients with iron deficiency anemia.” South Med J. 2004 September;97(9):887-9.

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