Autoimmune pernicious anaemia (PA) is just one of many causes but it seems many doctors consider it to be the only serious cause of B12 deficiency and therefore the only one worth treating with B12 injections. In fact ALL causes of this debilitating condition require correct and adequate treatment and it is ALWAYS SERIOUS. Remember this condition attacks the nerves and affects all body systems.
Some doctors become so fixated with PA that they neglect and under treat seriously B12 deficient patients. Those of us, up to 60% who fail to achieve a the correct diagnosis of PA due to the inaccurate diagnostic tests (gastric intrinsic factor antibodies & parietal cell antibodies), may be given an extremely poor deal along with those who do not have PA but are B12 deficient due to other causes.
The widespread use of Metformin and Omeprazole to name just two drugs, which stop us from absorbing B12 from food, cause untold damage. In the case of the diabetic drug Metformin, a doctor may confuse the tingling and numbness in fingers and toes caused by B12 deficiency with diabetic neuropathy, thereby potentially condemning the patient to serious and permanent nerve damage.
Neither of these drugs (and many others) warn the user, or the prescriber, on the ‘Patient information leaflet’ (PIL) of prolonged usage causing B12 deficiency.
Most patients with B12 deficiency will require B12 injections FOR LIFE, whether they have; coeliac disease, have had a gastric bypass, atrophic gastritis, Crohn’s disease, advanced liver disease they all need injections and NOT the low dose cyanocobalamin oral tablets which ignorant doctors prescribe. Please note there are many more causes of this condition, visit http://www.b12deficiency.info/what-are-the-causes/
There are however some causes of B12 deficiency which CAN be temporary;
• Helicobacter Pylori – Provided this bacterial infection has been short-term and that
H-pylori lesions have not damaged the wall of the stomach or duodenum the patient can recover from this deficiency. If damage has occurred then B12 injections will be required for life.
• Parasites, such as fish tapeworms, or Giardia lamblia – ONLY IF these infestations are correctly diagnosed and effectively eradicated B12 deficiency can be corrected with appropriate treatment. Unfortunately parasitic infestations are hard to confirm as the diagnostic tests for these are also prone to flaws and frequently miss ‘host’ patients who would otherwise be able to absorb B12 from their diet.
Patients using stomach acid lowering drugs (H2 Blockers, PPI’s and antacids) have a secondary problem alongside a resulting B12 deficiency; a greater vulnerability to parasites which can unfortunately lurk undetected for years. These patients may have a very poor chance of naturally ridding themselves of these invaders who interfere with normal B12 absorption and compete for any B12 present in the diet. A healthy level of stomach acid is required to kill off these parasites.
Many B12 deficient patients, whatever the cause, are discriminated against and treated as second class citizens every day, in treatment terms, but an ignorant doctor who does not understand the myriad of causes of this condition is doing harm by assuming oral tablets will be absorbed and correct a deficiency.
If autoimmune Type 1 and Type 2 diabetes patients were treated with the same level of discrimination, there would be uproar. Imagine GP’s only allowing type 1 patients insulin and sending all type 2 patients off to simply look at a pig?
If you are a doctor fixated on PA and your patient does not test positive for IFA or PCA then you must still treat this patient properly, explore other causes, and remember they may have a parasite that tests can’t detect.
• If you can’t find the cause please remember this is not the fault of the patient
• Treat their symptoms, and don’t assume it is ‘all in their mind’
• Give them loading doses (6 injections over two weeks)
• And if they have NEUROLOGICAL symptoms REMEMBER to continue their loading doses until their symptoms STOP IMPROVING, as per NICE and BNF Guidelines.
http://cks.nice.org.uk/anaemia-b12-and-folate-deficiency#!scenariorecommendation:4
Information on PA Tests – http://www.b12deficiency.info/assets/pat-kornic-testing-f.pdf
http://www.b12deficiency.info/what-are-the-causes/
http://www.b12deficiency.info/what-to-do-next/
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