Why would vitamin B-12 sometimes not get absorbed?

I have a friend who has a problem absorbing vitamin B-12. What can be the reasons for this?

Your friend probably has pernicious anemia, but there are other causes of failure to absorb this vitamin, including alcoholism, severe gastritis, and some intestinal problems, such as Crohn’s disease.

Pernicious anemia is the most common cause. The name dates back many years to the time when there was no treatment for this type of anemia. Persons with it would become increasingly ill and die, often with severe neurological complications. It is now easily treated with injections of vitamin B-12, which are inexpensive and have no harmful side effects.

Doc’s Advice: Why would vitamin B-12 sometimes not get absorbed?

Pernicious anemia is now thought to be an autoimmune disease — one in which the body for some reason produces antibodies against its own tissues. In pernicious anemia, there are usually antibodies against parietal cells — the cells in the stomach that produce something called “intrinsic factor,” which is needed for vitamin B-12 absorption. Antibodies against the intrinsic factor itself may also be present. People who can’t make enough intrinsic factor can’t absorb vitamin B-12 from the gastrointestinal tract.

The condition is more common in the elderly, although young people can get it. It is important to make the diagnosis accurately, since this form of anemia can lead to severe damage to the nervous system if left untreated and can even cause a demented state that can be confused with Alzheimer’s disease. Once someone is correctly diagnosed, injections of vitamin B-12 will completely prevent these neurological problems and will completely cure the anemia. The diagnosis may be more difficult now, since fortification of foods with folic acid is being done. Folic acid cures the anemia of pernicious anemia, but does not prevent the neurological complications. Therefore, we may see more, older people who are not anemic, but are developing neurological problems. Certainly, anyone developing memory problems should have their vitamin B-12 level checked before a diagnosis of Alzheimer’s disease is accepted.

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