Pernicious Anaemia

Digestion, Vitamins, fatigue | April 19, 2017 | Author: Naturopath

Digestion

Pernicious Anaemia

Pernicious anaemia occurs when your body can’t absorb enough vitamin B12—an essential nutrient for the production of healthy red blood cells. It is a relatively rare autoimmune condition, with a prevalence of .1 percent in the general population and 1.9 percent in people older than 60 years. First identified in the mid-19th century, this type of anaemia was once considered a deadly disease. Today, though, pernicious anaemia is relatively easy to treat with supplements or B12 injections. However, if left untreated possible complications include heart problems, chronic anaemia, stomach cancer, brain and nerve damage.

What causes it?

To understand what causes pernicious anaemia we need to firstly understand some basic biochemistry.

Introducing… intrinsic factor. This is produced by the parietal cells in the stomach in a healthy person.

Parietal cells are found in the lining of the stomach. They also produce hydrochloric acid. Intrinsic factor is essential for the absorption of B12 whilst hydrochloric acid allows B12 to be released from food. Parietal cells may fail due to infection (from Helicobacter pylori for example) or from antibodies that attack these cells. So here’s where the autoimmune component kicks in, and the reason why people with pernicious anaemia can’t absorb B12—because their immune system attacks itself and damages the parietal cells which stops the secretion of intrinsic factor, essential in the absorption of vitamin B12.

Parietal cell antibodies are routinely tested if pernicious anaemia is suspected as they are found in 80% of people with this condition. However, the detection of antibodies cannot be used to diagnose pernicious anaemia because around 10% of the general population will also have these antibodies.

How it affects the blood

Red blood cells, produced in bone marrow, transport oxygen throughout the body via our arteries.

Adequate oxygen supply everywhere in the body is essential to our survival.

Haemoglobin, the major component of red blood cells, transports this oxygen. Without adequate supplies of B12, a person would be unable to make healthy red blood cells—which are circular and have a concave centre. Without B12 the cells make a strange shape and in around 65% of cases will become enlarged.

When the red blood cells are enlarged, they are referred to as megaloblasts and the patient will be diagnosed as having macrocytosis. Because of this strange shape (not because of enlargement), these red blood cells will not be able to carry the molecule that transports oxygen—haemoglobin.

So in short, without adequate supplies of B12 a person will not be able to build healthy red blood cells. Unhealthy red blood cells means the patient will have low haemoglobin and a lack of haemoglobin is what is meant by anaemia. The result—inevitable fatigue and weakness.

What are the symptoms?

The symptoms of pernicious anaemia can come on slowly. Some of the most common symptoms include:

  • Weakness
  • Headaches
  • Chest pain
  • Weight loss

In rare cases it can lead to neurological symptoms. These can include:

  • An unsteady gait
  • Stiffness and tightness in the muscles
  • Numbness in the arms and legs (peripheral neuropathy)
  • Progressive lesions of the spinal cord
  • Memory loss

Other symptoms of a B12 deficiency, which can overlap with pernicious anaemia include:

  • Nausea and vomiting
  • Confusion
  • Depression
  • Constipation
  • Loss of appetite
  • Heartburn

Treatment options

B12 injections

These injections can be given daily or weekly until B12 levels return to normal. This is usually the fastest way to get levels up quickly. After these levels have increased your doctor will monitor your iron and B12 levels so that hopefully the injections can be given less frequently.

B12 supplements

Once B12 levels have normalised. Some people are able to maintain healthy concentrations by taking a supplement. Don’t think however you can just buy any B12 off the shelf. Look for a form that has a higher concentration of 1 mg or 1000 mcg and ideally a spray or tablet that is sublingual (goes under the tongue). Sublingual forms bypass the digestion system and reach the blood stream via absorption under the tongue. The benefit of supplements is that they help to maintain healthy levels without a decline in levels which can be experienced about a month after an injection. The active form of B12, methylcobalamin, can be found in a good quality supplements for increased bioavailability.

Diet for pernicious anaemia

Even though the dietary absorption of B12 is low for people with pernicious anaemia it is still important to eat a diet rich in this nutrient. Foods rich in B12 include meat, liver, fish, eggs, milk and other dairy products. B12 is only found in animal products, not in fruits and vegetables. This is why B12 is a common deficiency in vegetarians and vegans.

Eat a minimally processed diet rich in antioxidants like beta-carotene, vitamin C, folic acid and bioflavonoids. This can be obtained by eating a variety of fresh, brightly coloured fruits and vegetables. Eat foods rich is essential fatty acids such as oily fish, nuts and seeds to reduce levels of inflammation in the body and to protect it against damage. Avoiding iron deficiency is also important and can be done by eating meat products (especially red meat), leafy greens, beans, nuts and seeds.

In natural therapies we can take it a step further by offering other suggestions to help additional components of pernicious anaemia.

Improve gastric acid secretion and digestion

Natural therapies that help to increase gastric acid and intrinsic factor production and aid in the absorption of B12 include betaine hydrochloride, apple cider vinegar and bitter herbs.

If there is reflux, inflammation of the stomach lining or helicobacter pylori infection, turmeric, aloe vera, ginger, german chamomile, meadowsweet or liquorice could be used to aid healing and reduce inflammation.

Normalising digestive function can help in the absorption of nutrients such as B12 and it also reduces further complications.

Autoimmunity

There are specific probiotics which can be utilised to help with the autoimmune component of pernicious anaemia. These include Lactobacillus paracasei LP-33 and Lactobacillus rhamnosus GG. They may help to moderate an overactive immune response and reduce levels of inflammation. Vitamin D levels may be low also and should be assessed, as a deficiency can cause dysregulation of the immune system.
 

Talk to your doctor if you think you may have symptoms of pernicious anaemia. Early diagnosis, treatment and regular monitoring are important in preventing any future complications.

References

Andres E, Serrai K. Optimal management of pernicious anaemia. J Blood Med. 2012;3:97-103

https://www.ncbi.nlm.nih.gov/pubmed/23028239

https://pernicious-anaemia-society.org/symptoms/

http://www.healthline.com/health/pernicious-anemia#overview1

Chan CQ, et al. Oral vitamin B12 replacement for the treatment of pernicious anaemia. Front Med (Lausanne). 2016 Aug 23;3:38

https://www.ncbi.nlm.nih.gov/pubmed/27602354

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