A question 🍗🐟🧀🧈🥛🥕🍆🍅🥬🍒

[Beginner2]

Have I got this right?

Every day your diet consists of meat, fish, cheese, butter, milk, vegetables and fruit.

You don't have Helicobacter pylori.

You have very low B12.

You have many of the symptoms of B12 deficiency.

What could it be but PA.

[deniseinmilden]

Good morning!

Not many things but potentially:

SIBO (small intestinal bacterial overgrowth), whereby the growth of the bacteria that should be further down in your intestines gets out of control and affects your upper GI (gastrointestinal) tract. They feed on your food instead of you and although the nutrients are technically still inside your body they tend to pass on to where the B12 can't be absorbed or they are excreted.

EPI (exocrine pancreatic insufficiency), usually due to chronic pancreatitis, whereby the pancreas isn't functioning well enough to produce the enzymes needed for the digestion of foodstuffs so they just aren't available for absorption.

Congenital IF deficiency or abnormality: genetic disorders that affect the production of intrinsic factor and so cause the malabsorption of B12 that way - as opposed to PA which is an acquired (not genetic) autoimmune IF deficiency.

Gastric causes besides H. pylori and the above: eg gastrectomy, gastric resection and atrophic gastritis,

Hypochloridia (low stomach acid) and achloridia (no stomach acid) which affects the digestion of food and therefore the absorption of many nutrients, especially B12 because gastric acid is needed to release the B12 bound to proteins in food. I believe this is the main cause of nutrient deficiencies, particularly B12d, as we get older and our mechanisms for producing the HCl (hydrochloric acid) decline. Unfortunately the older we get the greater the problem and the number of people affected.

Intestinal causes - eg, malabsorption, ileal resection, Crohn's disease affecting the ileum, chronic tropical sprue, HIV and any radiotherapy causing irradiation of the ileum.

Drugs - eg, colchicine, neomycin, metformin, anticonvulsants.

Long-term use of drugs that affect gastric acid production (eg, H2-receptor antagonists, proton pump inhibitors) can worsen a deficiency.

This is why, although I appreciate that PA is a major reason for B12 deficiency and very important, I wish the emphasis of all awareness campaigning was for en-block B12 deficiency and less was made of PA specifically, because it results in lots of very ill people, including a huge number of older people, being denied treatment by ill-informed medics who think that the only reason for needing injections to treat a vitamin B12 deficiency is pernicious anemia. The more the knowledge of PA as a cause of B12 deficiency is promoted, unfortunately the worse the problem becomes, with many Drs then thinking that if you don't have PA then you don't need injections. In effect this inadvertently actively discriminates against the aging population.

I lost count long ago of the number of people, of all ages, who post on here because they can't get injections because they have tested negative for IF antibodies and so they miss getting a PA dx and, as a consequence, the correct treatment.

[newlandvale in reply to deniseinmilden]

Hi denise and beginner2

There appears to be a lot more genetic disorders - the IF genetic being just one

Includes genetic defect (C) adult onset.

All treated with weekly or more shots of hydroxocobalamin

Take a look at this info from American National Institutes of Health

ncbi.nlm.nih.gov/pmc/articl...

Sorry - don't know how to make it a link

Perhaps the more tech savvy on here could do this

[newlandvale in reply to newlandvale]

Looks like it's become a link after I pressed Reply!

[deniseinmilden in reply to newlandvale]

Thank you!

[bookish in reply to newlandvale]

Thank you very much for that. I have MTR (plus COMT and MTHFR so potentially reduced methylation) and methylfolate plus methylcobalamin has made a vast difference, even compared to methylcobalamin alone.

[mickeymouse42 in reply to deniseinmilden]

>Hypochloridia (low stomach acid) and achloridia (no stomach acid) which affects the >digestion of food and therefore the absorption of many nutrients, especially B12 because >gastric acid is needed to release the B12 bound to proteins in food.

I've suggested this to an NHS gastroenterlogist and dietitian and neither agreed with this. Can you point to any references that explain this in detail?

[deniseinmilden in reply to mickeymouse42]

There's a reference in my main post on this and I'll try to remember to find something later/tomorrow.Please remind me if I forget - lots on at the moment.

[Beginner2 in reply to deniseinmilden]

Thanks deniseinmilden I had forgotten most of your information.

I was one [as many in Gloucestershire] of those who was refused injections because -

"I lost count long ago of the number of people, of all ages, who post on here because they can't get injections because they have tested negative for IF antibodies"

[deniseinmilden in reply to Beginner2]

I'm surprised how much I could remember, once I started... Hence m opening statement of "not many times but..."

Just goes to show how much better my memory is with years of B12 jabs. They don't seem to be as deadly as many medics would have you believe!

[bookish in reply to deniseinmilden]

Thank you for that useful post x

[Narwhal10 in reply to deniseinmilden]

Hi Deniseinmilden,

I agree with you regarding the focus being on the rubber stamp of PA. Vitamin B12 deficiency is still that and has massive implications. People can be seriously ill and misdiagnosed, mistreated from functional B12 deficiency., in my humble opinion.