Pernicious Anaemia Society
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why am I B12 deficient?

after being diagnosed B12 deficient a year ago I have completed a course of loading doses and then prescribed 3-monthly b12 injections indefinitely, i wanted to know why I need this? After having an iron deficiency a few years ago I took supplements for both iron and b vitamins (inc B12) and as a vegetarian a lot of foods in my diet are fortified with B12. I have stomach /digestion issues which my GP says are unrelated to the B12 deficiency and has diagnosed IBS… I still get B12 deficiency symptoms like tiredness and dizziness but my iron levels are apparently normal? Celiac and PA blood tests came back negative. Was can i do to improve B12 absorption? any ideas? or do I ned the injections for life? thanks for any imput!

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Hi Kaffiolio

Anyone at any age, can become B12 deficient. However, certain people are at an elevated risk. They include the following:

Vegetarians, vegans and people eating macrobiotic diets.

People aged sixty and over

People who’ve undergone any gastric and/or intestinal surgery, including bariatric surgery for weight loss purposes (Gastric bypass).

People who regularly use proton-pump- inhibitors. H2 blockers, antacids, Metformin, and related diabetes drugs, or other medications, or infections such as h-pylori that can interfere with B12 absorption.

People who undergo surgeries or dental procedures involving nitrous oxide, or who use the drug recreationally.

People with a history of eating disorders (anorexia or bulimia).

People with a history of alcoholism.

People with a family history of pernicious anaemia.

People diagnosed with anaemia (including iron deficiency anaemia, sickle cell anaemia and thalassaemia).

People with Crohn’s disease, irritable bowel syndrome, gluten enteropathy (celiac disease), or any other disease that cause malabsorption of nutrients.

People with autoimmune disorders (especially thyroid disorders such as Hashimoto’s thyroiditis and Grave’s disease) Type 1 diabetes, vitiligo, lupus, Addison’s disease, ulcerative colitis, infertility, acquired agammaglobulinemia, or a family history of these disorders.

Women with a history of infertility or multiple miscarriages.

Can you see yourself among any of the above people - apart from the IBS?

The IFA test is unreliable in that it gives false negatives in people with PA half the time. So a negative result doesn't mean that you don't have PA. However, a positive result is a sure-fire, 95% certain indicator of PA.

I am not a medically trained person but I've had Pernicious Anaemia (a form of B12 deficiency) for more than 46 years.

I wish you well.

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Thank you for your reply, My GP claimed the IBS was unrelated to the B12 deficiency and although I am vegetarian I eat animal produce and soy products are fortified with B12 as well as taking iron and b12 vitamin supplements. I could 'fix' my iron deficiency (this was normal level according to my GP at my last blood test) with supplements so i wondered why the same couldn't be done with B12 - but if PA and coeliac blood tests aren't reliable then I am still guessing as to what is the cause - not sure where to go from here? I'm still asking as i still get the symptoms (tiredness and dizziness) even when i am getting the injections regularly. Thanks for your help!

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It may be you need them more regularly

If you are still having neurological symptoms the N.I.C.E guidelines allow injections to be every 8 weeks. You might point that out to your doctor.

Click on the link, then on "Scenario: Management" and scroll down to "Treatment for B12 deficiency"

google.co.uk/url?sa=t&rct=j...

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thank you I will have a look at that. Hopefully i can get some info to go back to my GP with.

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You may well have PA although you tested negative , because that test for I.F.A.(Intrinsic Factor Antibodies ) is notoriously unreliable if it gives a negative result . P.A.patients often have low/no stomach acid —Hypochondria/Achlorhydria which results in gut problems because the stomach flora is upset , causing bad bacteria to take over . I had this problem with PA . I found help in a probiotic called Symprove . It is unfortunately expensive . When I had recovered from the gut problem I made my own probiotic in the form of organic sauerkraut ., to be eaten raw , not heated or cooked . There are other probiotics on the market which might do the trick . Whatever it is worth a try . If can donyou no harm . Best wishes .

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Thank you for your reply, I do have symptoms of low stomach acid so I will give this a try - I have been looking into 'clever guts' diet to improve gut flora. I hope it helps, like you say its worth a try!

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Personally I add a few drops of lime juice to a glass of water with a meal,

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to add acidity?

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Yes it is . You can also google “diet for Achlorhydria “ . Useful tips there . 🍀

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thanks I will have a look at that - I was unaware of Achlorhydria

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