Cross-sectional studycited by the Tayebat archiveabstract only checked A-PPI-10 standard review
PPIs and low magnesium (Rotterdam)
Proton pump inhibitors and hypomagnesemia in the general population: a population-based cohort study.
Overview
Kieboom BC et al.. Am J Kidney Dis 2015 · PMID 26123862 · DOI 10.1053/j.ajkd.2015.05.012
PPI users had twice the odds of low magnesium, especially with long use and loop diuretics.
Does the study support the specific claim? Yes · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Mg and PPIs.
- How was the study done?
Population cohort.
- How many people, animals or samples were studied?
9,818.
- What was actually found?
Higher odds of low Mg.
- How large was the observed effect?
OR 2.00.
- What do the results mean in everyday life?
Check Mg with diuretics.
- What are the study's limitations?
Single measurement.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
Dutch data.
- What can explicitly not be concluded from this study?
Causation.
Scientific in-depth review
1. Full reference
- Authors
- Kieboom BC, Kiefte-de Jong JC, Eijgelsheim M, Franco OH, Kuipers EJ, Hofman A, Zietse R, Stricker BH, Hoorn EJ
- Journal
- Am J Kidney Dis
- Year
- 2015
- Identifier
- PMID 26123862 DOI 10.1053/j.ajkd.2015.05.012
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
Is PPI use associated with hypomagnesaemia in the general population?
3. Study design and population
- Study design
- Cross-sectional study – Population-based cohort (Rotterdam Study), cross-sectional analysis of serum magnesium
- Population
General population ≥45
- Country
Netherlands
- Period
Rotterdam Study
- Sample size
9,818
- Inclusion and exclusion criteria
see abstract
4. Methods and endpoints
- Exposure / intervention
PPI use; H2RA use
- Comparator
No use
- Endpoints
Serum Mg; hypomagnesaemia ≤1.44 mEq/L
- Statistical methods
Adjusted regression
5. Actual results
- Results
Serum Mg −0.022 mEq/L in PPI users; hypomagnesaemia OR 2.00 (1.36–2.93); with loop diuretics OR 7.22 (1.69–30.83); prolonged use OR 2.99 (1.73–5.15); H2RA OR 2.00 (1.08–3.72).
- Absolute risks
not reported in abstract
- Authors' conclusion
PPI use is associated with hypomagnesaemia in the general population, stronger with prolonged use and loop diuretics.
6. Strengths
- Population-based
- Adjusted for kidney function and diuretics
7. Weaknesses
- Single Mg measurement
- Cross-sectional
- Few cases (n=36)
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Small case numbers; cross-sectional.
9. Assessment of the statistical interpretation
Modest relative risks from observational data; see bias notes.
10. Relevance to the specific claim
11. Independent contrary findings
Absolute Mg difference small.
12. Transferability to Germany and Europe
High: European (Swedish, UK, Dutch, German) data show similar associations; PPIs are widely used in Germany.
13. Overall methodological judgement
Credible association; absolute effect small.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | low |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | essentially correct but incomplete |
14. Open questions
15. Linked fact checks
- Long-term acid suppression is linked to vitamin B12 deficiency and low magnesium. – Studies supporting the claim
- Acid blockers stop the absorption of all minerals, iron and vitamin B12, so nothing that is eaten benefits the body, the immune system stops working, and hair falls out. – Studies supporting the claim
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
Listed in the archive bibliography of the acid-blockers rule without its own interpretation; used implicitly to support the rule summary ('long-term suppression turns against the body: CKD, bacterial overgrowth, C. difficile, pneumonia, B12 and magnesium deficiency, hip fractures, microbiome change, excess mortality').
- A. What was actually studied?
Is PPI use associated with hypomagnesaemia in the general population?
- B. What did the authors find?
Serum Mg −0.022 mEq/L in PPI users; hypomagnesaemia OR 2.00 (1.36–2.93); with loop diuretics OR 7.22 (1.69–30.83); prolonged use OR 2.99 (1.73–5.15); H2RA OR 2.00 (1.08–3.72).
- C. What conclusions do the authors themselves draw?
PPI use is associated with hypomagnesaemia in the general population, stronger with prolonged use and loop diuretics.
- D. What does the archive derive from it?
Supports magnesium part.
- E. Is this derivation scientifically justified?
Yes as association.
- Adequacy of the interpretation (by the archive)
- essentially correct but incomplete