Hello
My PA was first diagnosed after a first episode psychosis. I became increasingly paranoid over the weekend but in a moment of calm I began to question if there is a connection between psychosis and prolonged diarrhoea (3 months plus) in PA. I also have hypothyroidism, irritable bowel syndrome and iron deficiency anaemia. Can anyone offer any advice please?
Hi Hidden
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), Pancreatic insufficiency, 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.
Symptoms of B12 deficiency tend to develop slowly and may not be recognised immediately. As the condition worsens, common symptoms include:
Weakness and fatigue
Light-headedness and dizziness
Palpitations and rapid heartbeat
Shortness of breath
A sore tongue that has a red, beefy appearance
Nausea or poor appetite
Weight loss
Diarrhoea
Yellowish tinge to the skin and eyes
If low levels of B12 remain for a long time, the condition also can lead to irreversible damage to nerve cells, which can cause the following symptoms:
Numbness and tingling in the hands and feet
Difficulty walking
Muscle weakness
Irritability
Memory loss
Dementia
Depression
Psychosis
Do you see your self among any other people or additional symptoms to those highlighted above?
What treatment/medication are you having for the P.A and how long since you were diagnosed?
I am not a medically trained person but I've had Pernicious Anaemia (one of many causes of B12 deficiency) for more than 46 years.
I wish you well.
Hi Clivealive
Thank you for this information. However, I was already aware of this so I guess my question is should I be concerned about the prolonged diarrhoea? I am prescribed b12 injections every 2 months (I was formally diagnosed in May 2018 but had first episode psychosis in April 2017 - staff accused me of faking my symptoms then failed to share blood results with me or my GP) but take additional b12 when neurological symptoms worsen. I have tried to modify my diet but with limited success.
PA is an auto-immune condition that affects the gut and destroys the mechanism that you use to absorb nearly all of your B12 from food. One other consequence can be lower acidity so it can affect absorption of other vitamins and minerals - particularly iron and folate. Folate is also mostly absorbed in the ileum so because PA particularly attacks the ileum it can be particularly affected though the effect on folate isn't nearly as dramatic as the effect on B12
Being hypothyroid can result in absorption problems. It can affect gut speed so could also be involved in the IBS, diarrhoea and iron deficient anaemia.
Thyroid function can also have an impact on your psychological health. If my thyroid levels are too low my mood can vary between miserable and positively suicidal depending on how low they are.
The symptoms of low stomach acidity are very similar to the symptoms of high stomach acidity - including heart burn. Most of us with low stomach acidity find that taking something slightly acidic - like lime juice in water - can help us with digestion.
There is a high cross over between PA and auto-immune thyroid conditions.
Thanks Gambit62.
It has just dawned on me that I have been taking levothyroxine at the same time that I take folate and, of course, folate is a food supplement. I wonder if this has led to my diarrhoea? I will take folate later from tomorrow and see if I notice any difference.
its generally recommended to take levo on an empty stomach. If you have PA you may benefit from taking it with something acidic - eg orange juice. This is intended to optimise absorption - as is the recommendation to take it first thing in the morning - which is when stomach movements tend to be at their quickest.
The important thing is really to take it under constant conditions to keep the amount that you are absorbing constant.
can't comment on whether taking folate at the same time as levo would cause diarrhoea - pharmacist may have an answer ...
Hi. I recently had low iron, and will always have low thyroid and IBS. These conditions tend to go-occur together. Its not uncommon for people like us to get grouped in the diabetic/fibromyalgia/RA/ and Celiac disease or non Celiac disease category as well. I have diabetes, fibro and non Celiac gluten sensitivity and mental illness. They said the root of my Diahrhea was from IBS. Diahrhea that got noticing worse when I drank, which I didn't know at the time. You lose a lot of nutrients that way and can become deficient in essential vitamins and nutrients and stuff. They said that was the root cause of my vitamin deficiency issues. You lose a lot of stuff when you have diahrhea. This in turn effects brain function. I have had iron deficient anemia a few years ago, and last March low B 12. Then my damn iron was low. But I was tired, confused and foggy headed despite my iron only being a little bit low. Who cares. I couldn't function and was physically weak! Your probably deficient in iron, zinc, folic, possibly magnesium or vitamin C, it could be anything. But low B 12 is notorious for causing neurological issues and confusion. Have your doctor test you for a vitamin panel. If you test for B 12 and your around the 200 range grey/ borderline area, have him test your MMA and homocysteine levels. Folic is very important to. It makes B 12 work better if your deficient. So end point: Your not "crazy", just deficient in essential vitamins probably and look into possible gluten issues to. These things tend to be all linked. See what's causing your Diahrhea. It could be dairy or something...
Hi Diane. Many thanks for your very reassuring comments. Can I just confirm when you said that you diarrhoea was made worse by drinking did you mean alcohol? I haven't drank alcohol for many months but did notice a change in my immune system after just a few sips of red wine prior to my diagnosis. I have made an appointment to see my GP although I've made further changes to my diet which seems to be making a difference, especially having switched to sunflower seed bread.
Thanks again.
No milk.
My symptoms have improved with eating less gluten but milk kills me. All forms. I have CKD and sunflower seeds are bad for my kidneys. Their high in either potassium or phosphorus, I forget which. I have to guard against that because kidneys have a hard time removing those two substances. Btw I know who this is. I care about you. Thanks for responding. Red wine may be healthy in some ways but it escaberates my mental illness. I've been sober for six years. I can't go back to drinking. I cannot use in moderation. I have addictive tendencies. Drinking is the last thing I should be doing even though it may offer health benefits. I need to stay away from that and drink healthy non alcoholic things
Wow I just wrote a really really long reply to you because I have suffered something very similar myself but I wasn't logged in so it wouldn't let me post and it lost it! I have the screenshots but can't see how to attach photos.
Long story short- it turned out to be coeliac disease which triggered other autoimmune diseases in myself and my Mum (her ailments-PA, thyroid, fibromyalgia, osteoporosis, ulcerative colitis) she had the diarrhoea type along with anxiety and depression whilst I had the bloating and intermittent diarrhoea/constipation and suffered a brief psychotic episode. Caused by the combined vitamin D deficiency (no surprises that my episode was in April, when vitamin D levels at lowest because we haven't been getting from the sun since October- in my case I had been in New Zealand so had two winters on the trot) and b12 deficiency from PA. Malabsorption due to coeliac disease exacerbated the depletion of both of these vitamin levels. Mum tested negative on bloods for coeliac- likely as she wasn't eating enough of it as all food was going through her, but once she did a food diary and cut gluten out the diarrhoea stopped and her liver enzymes also returned to normal for the first time in 20 years.
Head and tail of it is- gluten can trigger all types of autoimmune disorders in genetically predisposed individuals and there is lots of exciting research taking place in this area at the moment.
Thanks Nico89. Yes, I had questioned coeliac disease which could fit with some of my symptoms. I will see what my GP advises but the sunflower seed bread and the porridge seem to be helping.
Many thanks for your advice.
I never hear that sunflower seed bread helps low B 12. Why on earth would that help? I have never in my life come across an article that has stated this. Maybe it dows help but why would it replenish b 12?
It doesn't help with B12 deficiency. It helps to stop diarrhoea with IBS.
That's good advice then. I thought you were implying it helped b 12 levels so I'm sorry. I have to buy gluten free through bread and wheat or even just a little bit of that in any product gives me bad brain fog and joint pain. I couldn't axe the gluten Challange for 1 week even. I had to quit. Sever joint pain and lack of concentration all becUse of one fricking cracker a day. So she ordered genetic testing for celiac disease. It was negative. So I consider my self non Celiac gluten senstive at this point
If the bread is all sunflower meal or something, it will be ok. But almost all bread non gluten has wheat or something in it
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