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The use of H(2)-receptor antagonists and/or PPIs may impair the absorption of protein-bound dietary vitamin B12 and could contribute to the development of vitamin B12 deficiency with prolonged use.[189] The studies reviewed in this article clearly show that omeprazole therapy will decrease the absorption of vitamin B12 by preventing its cleavage from dietary proteins.[190] A number of studies have shown an association of decreased B12 absorption with prolonged PPI use.[189,190] However, PPIs have been shown to affect B12 absorption in very short periods of time as well.[191,192] One study showed a 72% decrease in B12 absorption on 20 mg of omeprazole (Prilosec) and an 88% decrease in B12 absorption on 40 mg of omeprazole after only 2 weeks of treatment

Mitochondria have an efficient ROS buffering system including GSH, thioredoxin or Coenzyme Q10 (CoQ10) (189191), and as long as ROS are eliminated by endogenous antioxidants, there is no oxidative stress