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long term omeprazole usage = magnesium deficiency?

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  • long term omeprazole usage = magnesium deficiency?

    Yay? Nay?

    Horse is out of work currently and on a small maintenance dose of compounded omeprazole. Is a magnesium deficiency something that I need to worry about?

  • #2
    Most feeds contain plenty of magnesium, and there are 1,000 different supplements with Mg. Check your feed tag and see if the amount is adequate, maybe add a bit if you're worried.

    I don't keep horses on the stuff for the long haul so I don't sweat it. I suppose it is at least theoretically possible but most horses get more than they need in grain.
    Click here before you buy.


    • Original Poster

      Thank you! He's eating 2 lbs of Ultium and 2 lbs of alfalfa pellets a day currently.


      • #4
        I would not worry. Omeprazole works only on the stomach while magnesium, like most everything else, is absorbed in the small intestine.
        Pacific Coast Eventing
        Standing Yeager GF


        • #5
          Originally posted by SuZQuzie View Post
          I would not worry. Omeprazole works only on the stomach while magnesium, like most everything else, is absorbed in the small intestine.
          Omeprazole's MAIN action is in the stomach, of course, but interference with intestinal absorption of magnesium is well described with long-term use of this drug.


          Whether this is a non-issue, small issue, occasional issue, large issue, etc. is unknown in horses AFAIK. But theoretically, at least, it is worth thinking about when committing an animal to LONG TERM use of these drugs. Which I personally would really hesitate to do anyway, without a compelling reason such as documented, severe, recurrent ulcers that could not be managed in any other way.

          One of the problems with "over the counter" medications is that we tend to get a false sense of security that they're "completely safe" and we also tend to use them for much longer than we need to because they're not "really" drugs. They are. With potential down sides to go along with the up sides. Which if we're managing them on our own puts the burden of risk vs. benefit squarely in our own laps.

          For a horse needing long-term acid suppression I would much rather use an H2 blocker (like ranitidine).
          Click here before you buy.


          • #6
            Do you think it makes a difference that the magnesium used in most feeds (even the pricey ones) is magnesium oxide? I've read that the oxide form is very poorly absorbed.


            • #7
              I don't know about mag issues (sorry if this post is jumbled, long day today) but I had one horse on ulcer tx (pop rocks) for many months. This was vet approved/ induced (long story short- after 28 days + month of weaning symptoms came back. Vet said to treat for 3 months then wean. She said she has scoped some horses that even after 6 mo of GG still had ulcers)

              Anyways.... after about 2 months on treatment dose, started to see hind gut issues. There is some "research" about omeprazole causing hind gut issues. Don't know how accurate the research is (done by supplement companies) but it seemed to comport with my observations. (super gassy, acidy smelling manure, heave line, irritability) Started Succeed, hind gut symptoms went away in a week.

              Sorry, I know this has NOTHING to do with what you asked about lol, but your question reminded me about this
              Unrepentant carb eater


              • #8
                MgOx is one of the lower-bioavailable forms of magnesium, but I wouldn't say it is "very poorly absorbed". It's all relative, and very variable from individual to individual (and I'd probably guess species to species!) but in the presence of deficiency the body is able to ramp up its avidity for minerals significantly and become more efficient at absorbing what is needed.
                Click here before you buy.


                • Original Poster

                  I try to keep him on as low a dose a possible. He had severe ulcers for years. He is now managed very well on SHHN, small amount of omeprazole, and a probiotic. It turns out he is very stoic and his ulcers may stem from not only being an OTTB but a pretty severe hoof injury that he had been showing on "soundly" for 7 years. Working on the hoof now...


                  • #10
                    Thank you deltawave! I have been wondering about the mag ox for a long time. Thank you for the info.


                    • #11
                      "Things the supplement industry does not want you to know."
                      Click here before you buy.


                      • #12
                        For the OP: My guy has been on "pop rocks" for about a year now. Vet says to supplement w/magnesium even though he gets Ultium and top quality forage. Having the discussion with the vet now about maintaining the hindgut, bc omeprazole treats stomach only. Good luck! Finding the best ulcer-management routine has been a long road and lot of research on my part.


                        • #13
                          YAY! I'm so glad to read of this discussion. Thank you OP, your question was about Mg deficiency with long term use of omeprazole (which led to other ulcer drugs-Ranitidine). My horse has been on GG, Ranitidine, GG, and now a year of ranitidine. Yes, I now give Mg.
                          My horse has delayed gastric emptying, with documented, severe, and recurring ulcers. He also showed signs of hind-gut issues in December. The gastric stuff we've had a handle on for several years, but hind-gut puts a fly in the ointment. I started Succceed in January. I'm pleased.

                          My oh-so-special horse has a squadron of Vets, but I come here and get, dare I say, more information that really helps, or helps me ask questions that better pin-point the problem.

                          "What happens upstream, happens downstream" That's my vet discussing
                          gastric vs. hind-gut ulcers.

                          This ulcer- management routine is indeed a "long road" with lots of research on the owners part. Well said, NeverEnd.

                          Deltawave, et. al. keep it coming please.


                          • #14
                            Similar story to Judysmom. Had my guy on the maintenance dose of omeprazole (pop rocks at home and Gastroguard at shows) from April until August. Ended up with 2 serious gas colics (5 days hospitalization each time for right dorsal displacement and suspected hind gut ulcers) at the end of the summer and early fall and the best guess to why a horse who had never had GI issues in the 8 years I've had him was that it was due to the amount of time he was on omeprazole.

                            I will still put him on GG for shows since it made such a difference for his ulcer-prone show comfort, but I'm very wary about having any horses on it long term now. Could be that my guy was an exception, but I'm not interested in playing that -$10K lottery again!

                            Can't answer the magnesium question. I didn't notice any ill effects from the pop rocks up until the colics. But all of my horses get a custom blend of Glanzen that includes supplemental magnesium (and have for some time now).
                            Flying F Sport Horses
                            Horses in the NW


                            • #15
                              I risk sounding like a broken record on each long term omeprazole thread, take away from it what you like or disagree with regards to omeprazole and increased hindgut ulcer risk.

                              See 2nd half of below link explaining the why :

                              My laymen's term explanation of it is as follows.
                              Protein starts its digestion in the stomach, proteins, starches and sugars are digested in the small intestine with enzymes secreted from the pancreas. The horse has a limited amount of certain enzymes, especially amylases that digest starches.
                              Fiber in a horse's diet is not digested in the small intestine, it travels to the hindgut to ferment, which is what you want.
                              When proteins, starches and sugars are not fully digested in the small intestine, they travel to the hindgut, which you'd rather not have. There those proteins, starches sit to ferment, those cause a rapid release of volatile fatty acids, it lowers the PH of the hindgut, allows lactic acid bacteria to thrive and kills off your good microbial population, all of which continues to drop the PH, this sets the horse up for all kind of problems, hind gut acidosis to endotoxemia.
                              The PH in the stomach is about 1,5 to 2, in the SI 2,5 to 3, by raising the PH of the stomach you likely effect the digestive part in the SI as well as the PH, thereby likely lessening the digestion of your proteins & starches, which then have no choice but to travel to the hindgut to ferment, with risks described above. The PH of the hindgut is supposed to be around 6 to 7.
                              So this might be the reason why in some horses on longterm omeprazole you increase the risk of hindgut acidosis.


                              • #16
                                The problem with the above, Lieslot, is that starch/sugar digestion doesn't take place in the stomach in the first place. Protein digestion, yes, that begins in the stomach and does depend to some degree on a low pH to "kick start" the process. But sugars and starches need to be exposed to the enzymes in the small intestine to be digested (amylase, etc.) and these enzymes work BETTER in a neutral pH.

                                Even the amylase that's present in saliva becomes inactivated by stomach acid. So the beginnings of carbohydrate digestion that take place when forage is chewed stops in the acid environment of the stomach as salivary amylase is turned off, and is started up again with the introduction of new amylase (and all the other enzymes) provided by the pancreas in the duodenum.

                                So one could theorize that a neutral/high stomach pH could actually IMPROVE or hasten the digestion of starches. No, it's not an ideal situation, but AFAIK in humans there is virtually no impact of long-term PPI use on digestion of macronutrients in a meaningful sense. FWIW.

                                There are a lot of factual errors in that reference you are posting, I'm afraid.
                                Click here before you buy.


                                • #17
                                  I too am reading these posts about long term omeprazole with keen interest.
                                  My mare has delayed gastric emptying and has been on 1 tube of ulcergard for over a year.
                                  When she was diagnosed, she had such severe ulcers, the vets felt there was a good chance they would perforate and her stomach would rupture.
                                  Her ulcers healed after a few months of full ulcergard treatment(2 tubes), she weighs in at 2,000 pounds. It was determined that due to her delayed gastric emptying, the ulcers would return without omeprazole.
                                  I have been reading on coth about mg deficiency and hind gut issues with prolonged omeprazole use.

                                  What types of hind gut issues, would I see?
                                  I am going to ask the local vet about doing a mg blood work(and hope they can test for the levels). Anything else.?

                                  Because of her DGE, her diet is a vit/min supp, alf pellets and hay stretcher pellets soaked so of course I have concerns about the absence of long stem but it is what it is.
                                  Thanks for any links, etc and thank you DW for clarifying some of the medical jargon. I will do anything for my mare but really do not understand a lot about the chemical/medical lingo.
                                  save lives...spay/neuter/geld


                                  • #18
                                    Correct, there is zero digestion in the stomach, but some protein breakdown by pepsin. Starches & sugars are neutralized and digested in the SI and from there digested by amylases, some even say there's no indication there is any amylase present in the saliva, so indeed only the amylases in the SI are of interest.
                                    Define neutral PH for the SI, it is thought to be best at the level of 2,5 to 3 for enzymes to work at their best. So yes the question is, a horse on omeprazole with raised stomach PH above 2, what is their SI PH as a result? I don't know, not sure if any studies out there specify what it is, but it is quite likely to be above the ideal 2,5 to 3. And this is likely to affect your digestibility.

                                    Sure the article or vet may not be to the T on her theory, but it's interesting to see a number of horses on longterm omeprazole showing hindgut trouble, no smoke without fire or purely coincidental? Only future research will tell.

                                    My point about posting this is, that as owners we at least want to be aware of this. Perhaps some COTH nutritionists will give us their take on it, I'd love to hear their view on it.


                                    • #19
                                      I'm pretty sure the pH of the small intestine, after the pancreatic/bile ducts, is a lot higher than 2.5-3. I'd have to go digging, but if my memory hasn't failed me utterly it's MUCH higher than that, maybe even close to neutral. Because amylases, etc. cannot function in an acid milieu, it would be important for the lumen of the small intestine to NOT be acidic.

                                      it's interesting to see a number of horses on longterm omeprazole showing hindgut trouble
                                      I'm not entirely sure if this isn't correlation, as opposed to causation. Horses who are "ulcer prone" tend to be animals getting an excess of cereal grains and inadequate forage among other things, if one can pardon a gross over-generalization. No, of course not ALL ulcer horses are getting less-than-ideal management, but I'd be willing to at least speculate that hindgut problems in horses also receiving treatment for ulcers might be due to the diet and not the ulcer meds.
                                      Click here before you buy.


                                      • #20
                                        I may not be have been correct in what is what in which part and apologies to confusing anyone, the foodstuffs coming from the stomach into the duodenum are at 2,5 to 3,5 but as they work their way thru the SI onto the LI are buffered by bicarbonate & bile to about 7.
                                        Most aborption of foodstuffs happen in the middle part (jejenum), the ileum mainly takes care of the mineral absorbtion. Each of those sections have a PH most suitable for the enzymes to digest & absorb whatever gets absorbed at that part of the SI.
                                        And the question remains if you start with a higher stomach PH, less breakdown & altered PH of foodstuff entering the duodenum, is it possible it affects the digestability, hence causing more fermentation.
                                        In the article she even mentions fermentation of starches suddenly ongoing in the SI due the altering the PH, I didn't even know that was possible, since you do not want fermentation in the SI, whether she is correct that this happens for the reason she describes I do not know.

                                        No, of course not ALL ulcer horses are getting less-than-ideal management, but I'd be willing to at least speculate that hindgut problems in horses also receiving treatment for ulcers might be due to the diet and not the ulcer meds.
                                        Agreed on the causation effect, but we do not know for sure yet, and some vets seem to be of the opinion there is a likely correlation. I by far don't know either, just wish to reiterate, it may be warranted to at least be aware of it, rather than assume hurray horse is on Omeprazole and all is well now, monitor your horse, discuss with your vet etc if you take the route of longterm omeprazole administration.