I came across an article that seems quite informative on the general topic of B12 deficiency, and especially on the topic of its neuropsychiatric symptoms. The article title is "The Neuropsychiatry of Vitamin B12 Deficiency in Elderly Patients".
Here is the link:
I'm becoming convinced that a lot of elderly problems aren't down to age but B12D. Many elderly people I know seem to have an overwhelming fear of falling which is destroying their quality of life. For example my elderly uncle wouldn't go to his sons for christmas dinner for that reason. He is very unsteady on his feet but it is totally irrational to refuse to go to christmas dinner when his son will be picking him up and supporting him all the way. I think B12D anxiety is the reason why he is so irrational - and probably the reason why he is unsteady on his feet.
Hi Wise GuyWhat an excellent article, well worth the long read. It focuses on b12 deficiency in elderly but seems equally relevant to those with PA.
I have found MMA testing not easily obtainable under NHS testing although Guys/St Thomas's will do you a private test IF your gp OKs it. (or they did some yrs ago).
Thank you for sharing.
Really good study. Thanks for sharing.
Thank you for posting that.
A few other links for anyone reading this thread who's interested in B12 deficiency and mental health.
b12deficiency.info/mental-h...
Thank you WiscGuy, very informative. I would point out, and we all probably already know this, that the report mentions correctly that the liver stores about 3-5 years worth of B12. However, for those with advanced stages of PA this is completely useless as the liver releases that B12 through the bile duct into the duodenum where it must bind with IF in order for it to uptake in the Ileum. No IF, no uptake. So most of us who injecting B12 most likely have a topped off B12 tank but as it's released it just passes on through. I offer this only because early on in my treatment, before I understood this, I had many US doctors tell me that once my stores were replenished then I could go for some time without an injection.
Thanks again for posting that.
I had somehow missed this important piece of the puzzle. Thanks for sharing.
Yes if the procesding system is broken you can't utilise the b12 released from your liver. Or can you absorb enough from food.
Medics use the term .
B12 replete on blood forms .
Maybe replete in your blood but if not getting to your cells useless .
The part I don't understand is if wd pee out what's not used why is so much left in our bloodstream. ??
Does that mean having iron infusions are pointless? I ask because this time last year when I was diagnosed with PA I was given an iron infusion as well as being taught how to self inject by the Nuffield Iron Clinic.
Still very confused re iron, folate, ferritin business….
Yervaud, great question. The answer is certainly no if you had low ferritin. Iron is just as essential to most every system as B12 is. One difference is that to much iron can be toxic and to much B12 is not so dosages for iron really need to be watched.
But Yes, it is known that those with PA are at high risk for iron deficiency.
However, the process and the location of Vitamin B12 absorption and iron absorption are entirely different. B12 requires Intrinsic Factor (IF) to bind before it can be absorbed in the terminal ilium (the last part of the small intestine). Iron does not require IF binding and it is primarily absorbed in the duodenum and proximal jejunum (the first part of the small intestine. I was only addressing the recycling of B12 from the liver stores not being able to be absorbed do to lack of IF.
The cause of iron malabsorption for those with PA could be a complication of achlorhydria. It is known that those with PA can have Hypochlorhydria (low stomach acid) or in advance stages, like myself, Achlorhydria (no stomach acid) cause a whole cascade of digestive issues including malabsorption of iron. A couple of those are the microbiome in the small intestines. Many people with PA will have a damaged microbiome where “bad” bacteria overtake the “good” bacteria that your body needs to properly digest and absorb nutrients. This can lead to conditions like Small Intestinal Bacteria Overgrowth (SIBO) and irritable bowel syndrome (IBS). In addition proper stomach acid regulates the contraction of the Gall Bladder thus releasing bile and pancreatic enzymes to the small intestine. With these conditions the body has a reduced ability to absorb iron amongst other nutrients. So those with PA should have there iron/ferritin serum levels checked periodically.
Hope this helps some...
Best wishes
Thanks for great article and comments. I also note the paragraph re safety of B12 but need to watch for hypokalemia.
How do others on this website keep on top of electrolyte balance? Given our malabsorption of food issues.
Hypokalemia is only a significant risk with severe anemia in early stages of B12 treatment. If you're a month clear of your loading doses, I believe hypokalemia as a result of treatment is very unlikely. Nevertheless its good to eat plenty of healthy high potassium foods (unless you have kidney issues). But beyond the initial surge of red blood cell production (correcting anemia) after deficiency, electrolyte stability is not going to be adversely affected and is highly/closely regulated.
Thanks Technoid. Before I was diagnosed with PA, I had two Long Covid hospital scares in 2021 both of them post vaccines. The first admission only detected slightly low potassium. The second admission required 5 bags of intravenous sodium. So I am a bit electrolyte paranoid these days. Though they seem ok in recent bloods.
OK! Worth keeping an eye on for you then! Did they explain how come you lost so much sodium?
Symptoms of b12 deficiency 
B12 deficiency symptoms 
B12 and iron deficiency link?
