PPIs, cardiovascular disease risk, nitric oxide, PON1 (brief notes)
Stomach acid suppression can result in deficiencies of B12, calcium and other important nutrients. B12 is needed for tetrahydrobiopterin production which is in turn a cofactor for nitric oxide [NO] synthesis by nitric oxide synthase [NOS]. Also, nitrite is converted in the presence of stomach acid to nitrous acid, which then forms NO. So it seems plausible that the association of cardiovascular disease with long-term proton pump inhibitor [PPI] use could be due to lowered production of NO as the result of acid reduction. However, other mechanisms may be at work, and may be more significant - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864131/ "The evidence obtained in the aforementioned studies suggest that the underlying mechanism for cardiovascular effects of PPIs are not directly related to acid suppression, since H2-receptor antagonists are not associated with the cardiovascular risk [45, 46]. " Another explanation for the association is that PPIs inhibit PON1 ( in...