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Pernicious Anaemia Society
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Acne, low stomach acid and B12

For the longest of times I've had issues with my skin, from the age of at least 16 I broke out with very bad cystic acne then it continued like that for many years and even until this day I am not happy with my skin which I will explain.

I got very sick when I was about 18-19 and nobody knew why, I stopped eating had no energy to do absolutely anything and there were times I would faint, it got so bad my own Mother thought I had cancer or something seriously wrong. Doctor after doctor we saw and they had no idea what was wrong with me, still my skin issues plagued me but at that time it was the least of my worries (kind of)

When I was finally diagnosed wit pernicious anemia it was an answer to our prays like finally we knew what was wrong and could put a label on it (I was 20 by now). The booster injections started then monthly and finally once every three years. During this time my skin never got any better until I decided to change up my diet stopping diary cutting back on sugar the usual things people do I guess. Even though my skin got a lot better probably lets say 80% after a good solid year of eating clean and doing everything right I was happy that my hard work paid off.

Right now as I sit here (I am 25) so five years after having the injections I can honestly say I am a health freak, I eat *super* clean, work out and have even gone to the extreme in cutting out certain chemicals I come into contact with (shampoo/soap/etc) .. even after doing this and I can even dub my diet/lifestyle super healthy It still remains. I have bad skin and although not cystic anymore it still plagues me and I get this weird dry flaky skin which kind of looks like seborrheic dermatitis. I've tried everything imaginable to cure my bad skin as it ruins my confidence, pretty want to look as healthy as I feel.

Lately someone responded to me on these forums (sorry I forget the name) but they mentioned that PA can cause you to not produce enough stomach acid to break down food which in turn causing you to not break down or absorb your food properly. I know that acne or any skin condition usually stems from what is going on inside of your body live/kidneys/stomach etc so I wonder is my acne/seborrheic dermatitis being caused by low stomach acid due to damage to my stomach? ..

I've already touched up with my doctor my thoughts and feelings about how I can eat a pretty well sized meal and an hour or two later be starving hungry and his response was pretty much nothing, he kind of looked at me like I was really naive and dumb.

My question I put to all of you guys on this forum is this, does having pernicious anemia cause you to have low stomach acid which would possibly cause skin issues in the long run due to not absorbing key nutrients and if so what could be done about this problem?

PS: I would like to know if I am on to something here and maybe others could possibly share their skin conditions if any, if none of you have skin conditions then its back to the drawing board for me and mine.

(sorry for long post)

18 Replies

It's a good post. Your journey and intensity sound just like me! Although I went undiagnosed for almost 20 years and have quite a bit of nerve damage as a result. My skin is horrendous and I've been down your route of super clean food and daily exercise which really helps.

We're onto something. There are tests you can have which determine what is being absorbed and what isn't which I'm about to investigate. My guess is that tablet supplements are a waste of time so it's a question of how to get whats missing into my body effectively.

Keep going!



First off:

When it comes to stomach acid and B12 lets not look at cause and effect (or everyone starts discussing autoimmune)

And you can also forget about the PA and stomach acid. (or everyone starts discussing autoimmune)

What there is, is a link between stomach acid and B12 deficiency.

Yes, the absorption of B12 and other nutrients is inhibited by the lack of stomach acid.

Yes, it can, and does, affect your skin.

The skin thing is quite complicated even without the stomach acid thing.

Erm, I actually don't know where to start here...

Yes, there might be some answers - I certainly hope so because the skin on my face looks as if it belongs on somebody about 75 at the minute - and there is someone I need to discuss things with and some stuff I need to get and try out.

And there is some stuff I need to study.

...however I would also like a home to do it in - and I've got to sort that first.

But, yes, there is a link and your doctor will look at you as if you are demented because they don't even understand B12.

Can you get your stomach acid levels checked? First things first. If you don't have stomach acid or you have low stomach acid, then things aren't going to get better.


By the way, in your original post you mention only have a jab once every 3 years - I think you mean months but I just thought I'd better check.

Also do you use lanolin based products on your skin? It's only a little thing but if you do, then stop.


Hi Krealan ,

Its more the other way round, low stomach acid can cause PA/B12 def. I believe.

There are a lot of papers that imply a connection of achlorhydria and acne see:



Kind regards,


PS on the old PAS forum is a topic called acne and rosacea, see:


Go to the section called other conditions and 18th topic down, You will find the topic started by Skeeter, he has great success with omega 3 oils..

"I say HAD because I found a supplement that changed that drastically! I no longer have to use antibiotics and my Rosacea symptoms are much less.

I take a supplement called:

21ST Century

Triple Omega Complex 3-6-9

Reflux Free


I just mentioned the brand that I use...but there is a lot of other brands out there just as good. If anyone decides to try this...there is a few things that you need to be aware of:

1) Be sure that you get a supplement that is REFLUX FREE...the reason being...a lot of people get what is known as the Burp Effect;...that is...they get a fishy taste in their mouth from taking omega fatty acids...but if you get one that is REFLUX FREE... it won't do that...you get no bad taste in your mouth.

2) It doesn't work real fast...you need to be patient with it. It took me almost a month before I started to see good results from it...then by the end of the second month...I was able to go off the antibiotics slowly.

3) I also have Ocular Rosacea...which a lot of people who has Rosacea also has. For me, it is itchy, dry eyes (some people have the wet/weepy type) that feels like you have sand or something in them. At times it can be quite painful. But, after taking the supplement for a few months...that no longer is a problem!

4) This one I'm not sure how this comes into play. I use to have a problem with eating dairy products. My stomach would get sore and my Rosacea would flare up...my face would breakout. Doctors told me that I was lactose intolerant...so I tried the lactose products that was suppose to solve that problem...but they didn't work. After several months of taking the supplement...I found that I can eat dairy products and have no problems!

5) Like all drugs, supplements, you need to do your home-work. You are the only one that knows your own medical situation. So, before you take any new drug, supplement, etc...be sure of the risks and check to be sure that your situation will allow you to take them safely...If you are not 100% sure...check with your doctor first before using. I say this because...for example...people who are taking blood thinning medications should check with their doctor first...before using this supplement...because Omega supplements have blood thinning properties to them.

6) I take 1 softgel-3 times a day

7) I don't know if this supplement will work for acne or acne like conditions that happens to some people with PA...after they have their B12 injections...but if I had to guess...I think that it would be worth a try.



Last edited by skeeter on Fri Jun 08, 2012 8:08 pm, edited 2 times in total. "

Also if your stomach acid is not acidic enough you can help your self by drinking fresh orange juice with your meals, or drink water with lemon slice, and or squeeze lemon over salad/ fish etc / over your food.

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I will certainly check this out thank you Marre .. I think I will try and drink half a lemon with warm water before every meal see if that helps.

So this low stomach acid problem can be reverse it has nothing to with PA particularity? I was feeling very down thinking I feel the way I do because of this condition and now I am forced to look this certain way because of it also.

Good to know that I can heal my stomach acid problem even though I have PA, I thought there was nothing that could be done because of the PA.

I just found this page completeherbalguide.com/201...

and when I read this *People with hypochlorhydria often say that they feel hungry all the time. The food in their body is not being properly digested, and absorption of nutrients is impaired, triggering hunger.*

This is exactly how I feel .. I explained this to the doctor saying I think I don't absorb food.


Hi ,

Re:"low stomach acid problem can be reverse it has nothing to with PA particularity?", It can not be reversed. I can be helped by adding acid to meals. It can be caused by autoimmune PA, but also by several medical conditions (H Pylori), bacterial overgrowth, and specific gastric surgery, medication or just getting older etc, once you have it and many people will get it in older age in will not heal it self.



"parietal cell dysfunction can be induced by antiparietal cell antibodies. In addition, abnormal hormone secretion can alter parietal cell function. Chronic inflammatory changes related to gastric Helicobacter pylori infection can also induce parietal cell changes.

Among the origins of achlorhydria that are related to medical care, medications like proton pump inhibitors that block H+/K+ -ATPase activity can induce achlorhydria.

Two major gastric surgeries also lead to achlorhydria. First, the Roux-en-Y gastric bypass surgery involves formation of a 15- to 30-mL fundal pouch. Second, antrectomy with vagotomy is an older surgical procedure that is designed to block acid secretion regulated by gastrin release from the antrum and acetylcholine release from the vagus nerve.

Patients with mucolipidosis type IV, an autosomal recessive lysosomal storage disease, may be constitutively achlorhydric. In this condition, a defective TRPML1 (Ca2+ -permeable TRP channel) causes reduced levels and mislocalization of the gastric proton pump and alters the secretory canaliculi, causing hypochlorhydria and hypergastrinemia.[6] "


"Achlorhydria may develop as a result of the following conditions:

• Antiparietal cell antibodies ◦Antibodies directed against gastric intrinsic factor results in cobalamin deficiency; this is called pernicious anemia.

◦The 2 types of anti-intrinsic factor antibodies are as follows: (1) antibodies that block attachment of cobalamin to intrinsic factor, and (2) antibodies that block attachment of the intrinsic factor-cobalamin complex to ileal receptors.

◦Clinically, highly specific anti-intrinsic factor antibodies are found in about 70% of patients with pernicious anemia. A second component of pernicious anemia is chronic atrophic gastritis that leads to a decline in intrinsic factor production. The chronic atrophic gastritis in pernicious anemia is also associated with an increased risk of intestinal gastric cancer and gastric carcinoid tumors. Clinical factors associated with autoimmune gastritis in addition to vitamin B-12 deficiency include celiac disease, neurological symptoms, and a positive family history.[10]

◦Pernicious anemia occurs in association with other autoimmune disorders.[11] In one study, autoimmune thyroid disorders were observed in 24% of 162 patients with pernicious anemia. In this condition, fundic histology is characterized by severe gland atrophy. Ninety percent of patients have antibodies directed against the H+/K+ -ATPase pump. In these patients, achlorhydria leads to pronounced hypergastrinemia (>1000 pg/mL) with subsequent hyperplasia of gastric ECL cells. Gastric carcinoid tumors develop in 3-5% of patients.

◦Parietal cell antibodies are found in 20% of patients with type 1 diabetes, denoting autoimmune gastritis, achlorhydria, and pernicious anemia. This condition may predispose to ECL cell proliferation and gastric carcinoid tumors.

• Chronic gastric H pylori infection ◦ECL cells in the gastric mucosa control acid secretion by releasing histamine from gastrin stimulation. During chronic H pylori infection, proinflammatory cytokines, such as interferon (IFN)-alpha and tumor necrosis factor (TNF)-alpha, are released. This cytokine release can affect ECL cells by impairing their secretory function and lead to achlorhydria and subsequently gastric cancer via ECL hyperplasia by increased gastrin stimulation.[12, 13]

◦Chronic gastric H pylori infection produces gastritis, most prominently in the body of the stomach, and leads to profound suppression of gastric acid secretion.

◦Recent studies have demonstrated an association between childhood infection with H pylori and low serum iron and hypochlorhydria.[14]

• Proton pump inhibitor therapy ◦The use of PPIs alters the role of gastrin in maintaining gastric homeostasis and the control of acid secretion. Profound suppression of gastric acid has been associated with bacterial overgrowth, enteric infections, and hypergastrinemia.

◦Gastric knockout mouse models with inactivated parietal cells subsequently have achlorhydria. Achlorhydria stimulates antral G cells to release gastrin. Gastrin, in turn, stimulates the oxyntic mucosa, which may ultimately lead to hyperplasia of ECL cells. In these models, bacterial overgrowth and intestinal metaplasia leading to gastric tumors have been observed. Further, perturbation of gastrin (and gastrin precursor) homeostasis leading to colorectal carcinogenesis has been examined in these models.

◦PPIs should be used in disorders that clearly benefit from this therapy and in patients in whom the benefits outweigh the risks associated with PPI therapy. "

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Can I heal my low stomach problem by eating a healthy diet? I've heard of people healing their low stomach acid or is it different if you have pernicious anemia (incurable?)

What course of action would you recommend me doing, I've been thinking about taking apple cider vinegar before meals not sure what else to do.


Yes you can help your self by eating a healthy diet.

It is unlikely you can alter what may have changed in your body. You can try apple cider vinegar before meals; see if that helps.


I've read that many people with low stomach acid went on to reverse it by taking Betaine HCl (with pepsin), Apple cider vinegar among other things eating healthy e.g sauerkraut.

I just don't know whether doing this applies to me if my low acid stems from pernicious anemia or even if my pernicious anemia stems from low acid (vicious cycle) ... It seems that what works for others doesn't work for us in many cases so I am a little confused if I could help my low stomach produce more, one person said that when you take these nutritional supplements it gives your stomach a break and in return tricks it into jump starting and producing more acid.

Only time will tell.


You can but try, who knows...Marre.


Hi Krealan, as others have already told you on here, your low stomach acid, if you have it, could produce malabsorption issues which will, in turn, produce nutrient deficiencies. If these 'hungry after two hour' feelings you have go hand-in-hand with weight loss then yes, you definitely might have a nutrient deficiency problem. Otherwise, not so much. It's more likely something more basic, like you are eating too many carbs, or too small meals! If you are having malabsorption issues you should also see some other signs which would be red flags, such as oily, grey floating poop (no fat absorption) or other weird poop issues. You may also develop allergies and skin irritations. Which leads me to your skin problems.

First, I have to point out that dry flaky skin is a primary symptom of low thyroid problems. Likewise, thyroid problems go hand-in-hand with B12 deficiency and PA, so if you have one you have a greater likelihood of having the other. I really do not know if there is a thyroid/acne connection but someone on the thyroid forum could put you straight on that.

One other issue I'd suggest you should give serious thought to is coeliac disease. Is it possible your skin condition might actually be Dermatitis herpetiformis? Below is the definition from the coeliac website:

"(DH) is the skin manifestation of coeliac disease which occurs as a rash that commonly occurs on the elbows, knees, shoulders, buttocks and face, with red, raised patches often with blisters. It affects around one in 3,300 people."

If this fits, then you are diagnosed purely on the strength of it and you don't have to be tested for coeliac. One dubious 'advantage' of having it! The best way of checking is to actually Google search it under "images" and you will see loads of pictures of it. That will let you see immediately if your skin condition matches it. It's quite distinctive so you shouldn't mistake it and if it's not right then it's one more thing you can strike off the list!

Certainly if you had coeliac it would account for improvements to diet helping, but would also explain why you were still exhibiting 'allergic' skin reactions - if, of course, that's what they are - since until you remove all gluten you will still be sick.

Anyway, hope something in there strikes a chord.


Sometimes its like I am eating empty food .. I checked for Dermatitis herpetiformis and that is certainly not what I have, now that Marre said that low stomach acid can't be cured or eating healthy can't force your body into making more am a little dejected if that is indeed what I have.

Here is a typical example I was eating 4000-4500 clean calories per day for a month while working out a lot, I gained zero weight ... what kind of person doesn't gain weight and in fact there were some days my calories fell below 3000 and lost weight .. :S how is that possible

I will be taking apple cider vinegar and lemon before meals going to see if it helps.


Krealan, you could just have a fast metabolism. People do, and it's a great thing to have! And exercise can easily burn up 6000 calories and more, depending on what it is. But if you feel tired and have other symptoms then no, not great. I can't imagine a doc would care much about the acne, but they SHOULD care about weight loss if you are (over)eating. Do you have ANY other symptoms, other than bad skin?

An overactive thyroid is a possibility. Do you ever get heart palpitations or feel hyper-excitable? Excessive sweating? After that, I'm running out of ideas. What I would say is that if you are still having regular B12 injections and everything else is ok then the eating thing could be a problem, but ONLY if you are losing weight. If your weight stays fairly constant, and you are having your B12 injections, then I'd guess you are healthy. And lucky! Most people would give their eye teeth to have a fast metabolism.

Have you had your B12 levels checked recently? Are they okay? I would think it's the first thing to check, since you know you have PA. I wouldn't assume anything about it based on your past history. Things change. If you haven't had a blood test recently at least ask for one of those on the grounds that your appetite is out of control and you are losing weight or having trouble maintaining it. That's perfectly reasonable as a request.

If you are eating a good clean diet and exercising, your acne is nothing to do with your diet. It seldom is anyway - that's an old wives' tale. You don't say how old you are. If you are still young there's a good chance your skin hasn't settled down yet. It has improved and it may get better still. If you genuinely had malabsorption so badly you were losing weight or were able to consume huge amounts of calories, your body would be showing symptoms everywhere from nutrient deficiencies. I suffered from malabsorption issues due to gallbladder problems and I ended up with a B12 deficiency that caused severe nerve damage, and I estimate that took about two years to show up, so that gives you an idea of timescale. I didn't lose weight - quite the opposite - and the only food I wasn't absorbing, per se, was fat. So you can see that if you really ARE processing all your food without taking nutriment from it you would be in a bad way and know all about it. You would also almost certainly have diarrhoea.

If you are otherwise healthy, other than your bad skin and your PA, which is being treated successfully, then you are in good health. But I would get your B12 tested if it hasn't been done in a long time, just in case there is something lurking there that you don't know about. You may simply need more frequent injections.


I am 25 years old, I sometimes get weird heart races when I lay in bed or spasms as I would describe them. I get weird dry skin that almost looks yellow I thought it might be seborrheic dermatitis but my skin does not get as red as the pictures I see online of other people, I do however have it very dry and red along my nose crease. Whenever I seem to go outside or at long distance my eyes start to fail me even though I *know* I have good eye sight something is just off about the way my eyes react.

Whenever Ive had my b12 tested it was right after an injection so my numbers were high .. I don't want to stop the injections just to prove that its my PA, the risk is too great for me. I have ordered b12 injections from Goldpharma so soon I will be self injecting sub-cut.

I just feel tired all the time and whenever I eat can't seem to get any energy from it, example when I used to drink caffeine (I don't anymore) I could drink x5 cups of coffee or many redbulls at a time and not feel the effect of any energy increase, where as a normal person would be claiming the walls as they say ..

All this has made me put two and two together thinking ive got some kind of Hypochlorhydria/Achlorhydria condition.

Not really sure how to proceed in getting a confirmation on that or if I can treat it naturally with apple cider vinegar/lemon before meals .. some people said to drink sea salt water before a meal. I am all about the holistic approach and if I need to change up my diet by eating fermented veggies that's what I'll have to do eat, even god forbid give up meat :(

PS: My stomach bloats out quite a lot its kind of embarrassing considering the rest of me is slim/skinny 160lbs 6 ft 1.. I've heard this can be due to low stomach acid also.


Well, that's not TOO old for your skin still to be in transition, but your racing heart and the eyesight problems are both classic signs of an overactive thyroid, so that is definitely one to have tested. The yellow skin is also thyroid related, but only if it is your overall complexion. The rash you get at your nose; it's not a butterfly shaped rash going across it, is it? That's a sign of another autoimmune disease, lupus. Again, it's very distinctive. If you put lupus butterfly rash into Google images you will see it. Can't mistake it for anything else.

You should definitely NOT stop your injections, nor should you have to pay for more yourself, if that's your problem. You should have it retested BEFORE an injection, not after. Has your doctor refused to test it or something? Has s/he told you it is fine?

You could definitely have low stomach acid, although you're a) very young for it and b) it's much more commonly associated with thyroid than B12 deficiency, but as you have PA, I suppose it's a possibility. But again, you would be showing other problems, like poor gut motility. Are you badly constipated? Do you burp every time you eat? Do you have gastric reflux? You are highly unlikely to have low stomach acid all by itself. It doesn't work that way. It would have extensive knock-on effects, not least of which would be a heavy, bloated gut that would loathe 6000 calorie days and big meals and let you know all about it. Running and exercise would be a nightmare because you would feel leaden every time you ate. I can't see an exercise regime sitting too well, and six cups of coffee would probably have you clutching your chest like you were having a heart attack!

I have to confess with the symptoms you've given, my money would be on overactive thyroid, but I am not seeing you here in front of me so everything is a wild guess on sketchy information, and I'm not a doctor! I definitely can't see your skin being part of low stomach acid though. Thyroid maybe, stomach acid - no.


Are you in UK? I was horrified when you wrote 'diagnosed with PA.... now get jabs every 3 YEARS!!!!!!!!!. That should read a minimum of every 3 MONTHS!!!! If it is 3 years then get rid of GP, he/she is awful.

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I think you have a stomach ulcer at the very least (without internet diagnosing you). You sound exactly like me. Bloating. Hungry all the time. Skin problems in forever even when eating healthy (but less acne when eating good). I am having an endoscopy in 8 days time. I think I have a mild bleeding ulcer at the very least and I think it has been going on for years due to the symptons and whatnot. Plus ulcers cause anemia (bleeding). They can be very mild. If you have a bleeding ulcer your heart will be working extra hard to account for the blood loss and oxygenated blood will struggle to reach all parts of your body, like the skin. You will feel fatigued easily which I assume you do because you have been diagnosed with anemia etc etc. Get an endoscopy done! If you have been diagnosed with amenia (if it is an ulcer), then you could end up with a perforated ulcer. Which is when the ulcer goes through the stomach wall or a blood vessel completely.

Hope all is well anyway and it is something or nothing mate!


I see this is old post but I have issues with acne too and feeling like I have morning sickness every morning if I get up before 10! It's so bad. I can tell I don't absorb my food well. Right after eating ive always had to use the restroom sometimes run to it and go :( I also can eat a huge meal and not feel full or I'll be full and starving an hr later.

I am not sure how to fix this other than digestive enzymes (I use papaya ones) and lots and lots of probiotic pills.. :(

I've said since I was younger when someone asked what's wrong I'd joke around but be serious "...I feel.. malnourished" and it's because I was and am! You've got to listen to your body. I knew something was wrong over 10 years of being sick drs told me I just needed antidepressants but screw that. I have a new dr a naturopath and he tested my blood first appt and personally called me 3 days later saying I have a high positive test for antipariatel cell antibodies! He said autoimmune disease of the stomach and I don't have enough avid that's why drs thought I had reflux because I had all the symptoms but it was LOW stomach acid! He said salads and stuff aren't good for you because they're hard to absorb. I'm vegan too and try to eat well but raw foods make me sooo sick. They have to be cooked :(

I do self b12 injections twice a week and am on a very high iron supplement as my ferritin is at a 6 but my hemoglobin is fine..


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