Pernicious Anemia

[annacsmom]

Can anyone explain what pernicious anemia is. My daughter is highly anemic - ferritin level of 5, but her b12 is about 590. She also has hashimoto's, celiac, and has had vitiligo has a child. I don't know if this is something else we should look out for. Thanks

[trents]

Can anyone explain what pernicious anemia is. My daughter is highly anemic - ferritin level of 5, but her b12 is about 590. She also has hashimoto's, celiac, and has had vitiligo has a child. I don't know if this is something else we should look out for. Thanks

Did you mean to say that your daughter has had vitiligo as a child or that her child has it? What are her hemoglobin and hematicrit levels?

Anyway, pernicious anemia results from the body being unable to adequately absorb vitamin B12 from dietary sources. B12 is necessary for the proper manufacture of hemoglobin, the oxygen-binding protein in red blood cells. People with pernicious cannot produce or produce enough of something called the "intrinsic factor" (which is an enzyme, I believe) necessary for the uptake of B12 from food sources passing through the gut.

Historically, people with pernicious anemia have had to get B12 from injections or from sublingual (under the tongue) supplements. However, some experts are saying that mega does of oral B12 (like 4 mg) can be effective since there is evidence that at least a small percentage of the oral form is passively absorbed through the intestinal mucosa, even when the intrinsic factor is lacking or missing.

Steve

[tiffjake]

Did you mean to say that your daughter has had vitiligo as a child or that her child has it? What are her hemoglobin and hematicrit levels?

Anyway, pernicious anemia results from the body being unable to adequately absorb vitamin B12 from dietary sources. B12 is necessary for the proper manufacture of hemoglobin, the oxygen-binding protein in red blood cells. People with pernicious cannot produce or produce enough of something called the "intrinsic factor" (which is an enzyme, I believe) necessary for the uptake of B12 from food sources passing through the gut.

Historically, people with pernicious anemia have had to get B12 from injections or from sublingual (under the tongue) supplements. However, some experts are saying that mega does of oral B12 (like 4 mg) can be effective since there is evidence that at least a small percentage of the oral form is passively absorbed through the intestinal mucosa, even when the intrinsic factor is lacking or missing.

Steve

Yup! I have pernicious anemia. I was absorbing a good amount of B12 after going gluten-free, but then it teetered off, and I am back to the sublingual tablets. I used the shots for years, and got tired of them. You daughter might enjoy the sublingual tablets more than the injections.

Pernicious Anemia is believed to be genetic, and is "life long" though the body may absorb more B12 from time to time. My body seemed to "cure" itself for about 6 mos, but the went back to anemic.

GNC has Sublingual B12 that is gluten-free.

[georgie]

Steve, I have low B12 and Dr is still testing for Pernicious Anaemia. I probably have it. My B12 was very low when dx. I notice your daughter's Ferritin is very low. Is she being treated for that? Should be 70 - 80.

[trents]

Steve, I have low B12 and Dr is still testing for Pernicious Anaemia. I probably have it. My B12 was very low when dx. I notice your daughter's Ferritin is very low. Is she being treated for that? Should be 70 - 80.

georgie,

I don't think you meant to reply to my reply to the oringinal post by tiffjake, did you?

Steve

[NicoleAJ]

Actually 590 is a pretty solid number for B12. It should be between 200 and 1100. People can start having neurological symptoms when they get too low on that scale, but 590 is perfectly normal. They should keep an eye on it, and she should take supplements in case she's not getting enough in her diet, particularly if she's a vegetarian or vegan, but unless the B12 dropped significantly lower, I would say that the intrinsic factor is probably working (at least for now).

[annacsmom]

Thanks for all your replies.

Georgie: She is taking an iron supplement -- is that good enough for her very low ferritin level?

NicoleAJ: Thanks for the info about b12. I thought her level was ok. She is taking a b complex vitamin for energy, immune system, etc. But if she starts going downhill, as she has been known to do, I think I'll try the sublingual b12 you mentioned. Thanks

[RiceGuy]

Though the B12 level seems good right now, I believe I read that the body will rob B12 from various organs, stored reserves, and anyplace else to keep the blood levels up, so the number may be misleading. You should check on that, as I'm not totally certain at the moment. If and when you find a supplement is desirable, from all the recent reading I've been doing on it, the methylcobalamin form is best, as it doesn't require the liver for conversion. The cyanocobalamin form is much more common in the supplements, but does require conversion. It also includes cyanide so I don't feel too comfortable taking that. The amount of cyanide is supposedly dealt with and disposed of, but that's if the gut is operating well enough to handle the task. Articles indicate that persons with certain sensitivities, digestive problems, and various other health concerns may want to avoid it. Do watch for the addition of other vitamins, as they generally have known toxicity levels, whereas B12 itself does not. For instance, too much niacin can cause skin problems among other things.

Source Naturals makes some in the methylcobalamin form, and they specifically state gluten-free. In all forms, lower dosages are absorbed more effectively than larger ones.

[annacsmom]

Source Naturals makes some in the methylcobalamin form, and they specifically state gluten-free. In all forms, lower dosages are absorbed more effectively than larger ones.

[georgie]

Annacsmum, Have found this on the Forum -

The ideal level of ferritin

70-90

The dosing level

150-200 mg daily

What type of iron is best absorbed and / or best tolerated by stomach

ferrous fumarate

ferrous gluconate

ferrous bisglycinate

[RiceGuy]

Where can I get this brand of b12? Also, should she still take another supplement with multiple b's, or is b12 good enough? Thanks Riceguy

There are a number of online stores that have the B12 if your local health store doesn't have it. For example there's Open Original Shared Link, and Open Original Shared Link, , just to name two. Prices seem to vary widely, but a Google or Amazon search should turn up some good deals.

As for other supplements, that's not as easy to suggest with specifics, because not all vitamins are tolerated in high doses. It depends on what she is absorbing well, and what she is not. For instance, I am likely better off not taking a supplement with folic acid, since I eat bunches of dark leafy vegetables daily. However, if I wasn't absorbing it, that would be a different story. In the case of Pernicious Anemia, the B12 from food isn't absorbed properly, if at all. So in that case a supplement is required. Again, since there is no known toxicity level for B12, the chance of getting too much seems nill. Plus the body stores it for later use, so the extra will be handy whenever it's needed. Apparently B12 assists in the digestion of proteins, fats, and carbohydrates, so if she eats protein-rich foods like peanut butter, foods with a lot of soy such as soy milk or cheese, etc, then more B12 would be used up. So her particular diet really comes into play here, and as the healing continues, and foods are added or removed from the diet, balancing the supplements would seem to require periodic modification. I don't mean to make it sound like you have to be a biochemist or something, nor to suggest regular blood work to check every detail. It's just not my place to make any sort of "ultimate recommendations".

I would suspect at least some additional deficiencies, as the intestinal damage would cause malabsorption. Everyone is different however, and often what works for one person simply doesn't for another. Generally a healthy person can simply maintain a reasonably diverse diet, and get all the nutrients they need. If with such a diet she has certain symptoms, or tests reveal deficiencies, then those are the ones to address most. Adding more of one type of food or less of another may be all that is needed, or a supplement might be better if the imbalance is great enough.

For one last example, suppose a person finds they don't tolerate fats very well. This may be caused by a problem with the liver, or believe it or not, a deficiency of cholesterol. The liver uses cholesterol to produce bile acids, which are then used to help digest fats. So the individual may be wrongly limiting fats, thus various other issues would eventually arise as organs run low on certain nutrients like omega-3's. However, the problem might simply be that they aren't getting enough fiber, which combines with the bile and helps eliminate it, signaling the liver to produce more. If such a trend continued, an elevated cholesterol count or weight gain may result, and they'd wonder why when they already limit the fats and/or cholesterol!