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Vitamin B12 Deficiency: Pernicious Anemia

Pernicious anemia is due to lack of vitamin B12 and is characterized by progressive nerve damage that causes forgetfulness, loss of ability to concentrate and abnormal sensations such as burning, itching and loss of feeling. However, many people with pernicious anemia do not have abnormally low blood levels of vitamin B12.

A study in the Journal of the American Geriatrics Society shows that older people have lower blood levels of a chemical called homotranscobalamin II that carries vitamin B12 into the cells (1), so they need higher blood levels to have normal tissue levels. Since low-normal blood level of vitamin B12 do not rule out B12 deficiency, the diagnosis of pernicious anemia is often made late in the course of the disease after people have suffered permanent nerve damage. According to a report in the Archives of Internal Medicine, two percent of Americans over 60 have low blood levels of vitamin B12 (2), but the incidence of vitamin B12 deficiency causing nerve damage in older people is much higher than that, sometimes as high a 50 percent (3,4). This means that many older people who are diagnosed with senility actually suffer from lack of vitamin B12 which can be cured by taking vitamin B supplements. Many cannot correct their B12 deficiency with diet changes, because the problem is caused by failure to absorb B12 in the intestines (5). Lack of vitamin B12 can cause heart attacks (6,7), so all people over 60 should be screened with blood tests for vitamin B12 and those with normal levels of B12 and symptoms of nerve damage or arteriosclerosis should also get a blood test called homocysteine. Almost always, those with a deficiency can a cured by taking a 1000 microgram pill of vitamin B12 once a day. They usually do not need to take injections. Low levels of B12 are also associated with stomach diseases and infections such as Helicobacter pylori (see report #G123.

By Gabe Mirkin, M.D., for CBS Radio News
Checked 9/12/17

1) J Metz, AH Bell, L Flicker, T Bottiglieri, J Ibrahim, E Seal, D Schultz, H Savoia, KM Mcgrath. The significance of subnormal serum vitamin B-12 concentration in older people: A case control study. Journal of the American Geriatrics Society 44: 11 (NOV 1996): 1355-1361.

2) Carmel R. Prevalence of undiagnosed pernicious anemia in the elderly. Archives of Internal Medicine. 1996 (May 27); 156: 1097-1100.

3) E Joosten, A Vandenberg, R Riezler, HJ Naurath, J Lindenbaum, SP Stabler, RH Allen. Am J of Clin Nutr 1993 (Oct); 58(4): 468-476. homocysteine, cystathionine, methylmalonic acid, and 2-methylcitric acid.

4) J Lindenbaum, IH Rosenberg, PWF Wilson, SP Stabler, RH Allen. American Journal of Clinical Nutrition 1994 (July); 60(1): 12-14.

4A) LH Allen, J Casterline. American Journal of Clinical Nutrition 1994 (July); 60(1): 2-11.

5) 6-week period of vitamin supplementation (1.0 mg folic acid, 10 mg pyridoxine, 0.05 mg cyanocobalamin. JB Ubbink, A Vandermerwe, WJH Vermaak, R Delport. Clinical Investigator 1993 (Dec); 71(12): 993-998.

6) JAMA December 8, 1993; 270 (22): 2693-98 and 2726-7.

7) homocysteine levels are associated with carotid artery stenosis. NEJM 1995 (Feb2); 332(5): 286-291.

June 1st, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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