During Covid, my sister’s vitamin B12 injections for pernicious anemia were changed to tablets, which her body was unable to absorb. A blood test showed that she also now has severe iron deficiency anemia. Did her lack of B12 contribute to this new diagnosis?
Linda Pearsall, Burton on Trent.
Pernicious anemia means that you cannot absorb vitamin B12 properly. As well as being key to making red blood cells, B12 is important for healthy nerve cells, and a deficiency can lead to symptoms such as pale skin, muscle weakness or bleeding gums.
As many as 20 percent of people over 60 and 6 percent of people over 60 have pernicious anaemia.
It’s actually an autoimmune disease, where our antibodies attack cells lining the stomach that make a protein called intrinsic factor.
The only treatment is a regular injection of B12: this brings the vitamin directly into the bloodstream (file image)
Taking it orally doesn’t make sense as it can’t be absorbed due to the lack of intrinsic factor, says Dr Martin Scurr
This substance combines with vitamin B12 to aid absorption in the small intestine, so the damage to the cells leads to a deficiency of the vitamin.
(It’s not clear why this condition becomes more common with age, but it may be that after a lifetime of exposure to infections, the body is more likely to produce antibodies similar to those that damage cells.)
The only treatment is a regular injection of B12: this brings the vitamin directly into the bloodstream. Taking it orally is of no use, as it cannot be absorbed due to the lack of intrinsic factor.
Normally, a patient with pernicious anemia should receive a B12 shot every three months. It can also be given monthly.
But during the pandemic, many patients had their injections stopped and instead given ineffective pills – a bad decision, made without a clear understanding of the condition. Your sister shouldn’t have had her injections stopped. This amounts to stopping the insulin injections that someone with type 1 diabetes needs and is reprehensible.
It may be that the iron deficiency anemia she has since developed is related to her pernicious anemia, as you suggest.
Iron deficiency anemia can be caused by chronic blood loss in the gut.
Patients with pernicious anemia sometimes develop gastric polyps — abnormal growths on the lining of the stomach — which can lead to microscopic but persistent blood loss. These growths are a result of the inflammation caused by our antibodies attacking the stomach lining.
It is essential to get a referral to a gastroenterologist for an endoscopy and a biopsy of the stomach lining.
My 59 year old daughter is an anxious person who makes everything catastrophic. She’s done her best to control her panic, but it would be a big help if she knew it wasn’t harmful, and a time frame to call for medical attention.
Name and address provided.
I’m so sorry to hear about your daughter’s anxiety. Catastrophizing is the tendency to see the worst-case scenario in every frightening situation, which produces an overwhelming sense of dread, along with racing thoughts and deep pessimism.
You say in your longer letter that when your daughter got a migraine, for example, she decided it meant she had a brain tumor. This is a classic type of response.
Catastrophizing is a symptom of anxiety disorders. Fear has its uses – it evolved in humanity as a way to improve our survival. But when amplified and out of control, it causes ill health, and it’s not uncommon for it to lead to headaches or palpitations, for example (largely due to an excess of stress hormones).
The answer is not medication, but rather psychological help – specifically cognitive behavioral therapy, a talking therapy that can change a person’s understanding of everyday events and their response to them.
I would urge your daughter to see a GP for a referral – I’m afraid there is a waiting period for this treatment on the NHS, but another option is to pay for it privately.
I sincerely hope your daughter gets the help she needs.
- Write to dr. Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk. Dr. Scurr cannot respond to personal correspondence. Answers should be taken in a general context. In case of health problems, consult your own doctor.
In my opinion: we need honesty about food products
Do you know what a processed or ultra-processed food (UPF) is? There’s been a lot of talk about UPFs lately, but I suspect quite a few people are confused about what makes it different from the former.
Processed food is something that has been altered in some way (which could be something as simple as putting it in a can or a jar).
Evidence that UPFs are a major factor in the escalating obesity crisis is mounting, yet options to change this are limited (file image)
By contrast, by definition (and I’m referring to the work of the Brazilian researchers who first identified them) UPFs are mostly or entirely made with ingredients that sound like they belong in a chemistry lab rather than on our plates. A large number of processes are used to make these sustainable, highly profitable and highly palatable products.
Evidence that UPFs are a major factor in the escalating obesity crisis is mounting, yet options to change this are limited. Plus, we have little idea about what it is in UPFs — chemicals and additives, or anything else — that actually causes the damage.
The time has come for food manufacturers and governments to spend more time and energy exploring the potential pitfalls of UPFs. I recognize that food production is a business and people want to eat well for less, but we must prioritize the health of the nation.