What is the cause of B12 deficiency?

Addison-Biermer Disease, also known as Pernicious Anemia, is a condition described in the 19th century by two independent scientists, Addison and Biermer. It has long remained a mistery what caused this disease, because of the serious consequences it brought to those who suffered from it. The name "Pernicious Anemia" says it all: it is a devastating form of anemia. In this blog, we will delve deeper into this condition and try to make its complexities understandable.

What is Pernicious Anemia?

Pernicious Anemia is actually a problem with vitamin B12, also known as Cobalamin. Normally, our bodies absorb this vitamin from food, especially animal products such as meat, fish, milk, and eggs. But in people with Pernicious Anemia, this absorption process does not work properly. This leads to vitamin B12 deficiency, which can cause severe symptoms.

Why is vitamin B12 important?

Vitamin B12 is critical for several bodily functions. It plays a role in blood formation, aids in metabolism and maintains our nervous system, especially the myelin sheaths that insulate our nerves. Vitamin B12 deficiency can lead to delayed nerve signals and serious neurological problems.

How is vitamin B12 absorbed?

The process of vitamin B12 absorption is complex and can go wrong at several points. It begins in the stomach, where stomach acid and enzymes split proteins, allowing B12 to bind to a protein called the Intrinsic Factor. The Intrinsic Factor is produced by cells in the stomach wall. Together, these substances allow B12 to be absorbed into the last part of the small intestine and then transported into the blood. Here are some conditions for good B12 status:

• The food should contain enough vitamin B12.
• There must be sufficient stomach acid.
• The R-factor must be produced sufficiently.
• The pancreas must produce enough enzymes.
• Intrinsic Factor production must be adequate.
• IF antibodies must be absent.
• Parietal cell antibodies must be absent.
• The small intestine (ileum) should be healthy.
• The Enterohepatic B12 circuit must be healthy.
• There must be sufficient transport protein in the blood.
• Normal B12 metabolism is required.

Why can vitamin B12 deficiency occur?

Vitamin B12 is found only in animal foods, so people on a vegan diet are at risk of deficiency if they do not take B12 supplements. However, deficiencies can also occur from other causes, such as lack of stomach acid, long-term use of antacids, problems with the pancreas, the presence of Intrinsic Factor antibodies and parietal cell antibodies, intestinal disorders such as Crohn's disease and Celiac disease, and even certain medications such as Metformin.

What are the symptoms of Pernicious Anemia?

The symptoms of Pernicious Anemia can vary, but they often include fatigue, weakness, memory problems, tingling in the hands and feet, and even serious neurological disorders if the deficiency is not treated in time.

How is Pernicious Anemia treated?

The most effective treatment for Pernicious Anemia is the administration of B12 via injections

What does the MTHFR gene have to do with B12 deficiency?

The MTHFR gene, which stands for Methylenetetrahydrofolate Reductase gene, is a gene involved in methylation processes in the body and plays a role in the conversion of folic acid (vitamin b11 ) to its active form, methylfolate. It has some relevance to the discussion of vitamin B12 deficiency (Pernicious Anemia) because folic acid and vitamin B12 are closely linked in the process of methylation in the body.

Here's how it relates:

Methylation is an essential biochemical process in the body involved in many important functions, including DNA synthesis, neurotransmitter production and detoxification. Vitamin B12 (cobalamin) and folic acid (vitamin B11) play crucial roles in these processes. They are involved in converting homocysteine to methionine, an important amino acid needed for methylation.

Cooperation between folic acid and vitamin B12: Vitamin B12 and folic acid work together in the methylation process. A deficiency of either of these vitamins can interfere with the methylation process. A deficiency of vitamin B12 can lead to an accumulation of homocysteine in the blood, which can lead to neurological problems. Folic acid plays a role in regenerating tetrahydrofolate (THF), a crucial molecule in this process.

MTHFR gene mutations: Some people carry mutations in the MTHFR gene, which can affect their ability to convert folic acid into its active form, methylfolate. This can lead to decreased availability of methylfolate in the body, which in turn can lead to an accumulation of homocysteine. This accumulation of homocysteine can increase the risk of cardiovascular disease and neurological symptoms.

Thus, although the MTHFR gene is not directly related to Addison-Biermer disease (Pernicious Anemia), it may play an indirect role by affecting methylation processes in the body and thereby interfering with vitamin B12 and folic acid metabolism. People with MTHFR gene mutations may have an increased risk of problems related to vitamin B12 deficiency and may need to pay more attention to their vitamin B12 intake and status, especially if they also have other risk factors.

Is B12 deficiency more common today than in the past ?

Vitamin B12 deficiency is more common in some populations than before, but the exact reasons for this are complex and may vary depending on the region and population group. Here are some possible explanations for the increased prevalence of vitamin B12 deficiency:

Changed eating habits: In some parts of the world, altered dietary habits are an important factor. People who follow a strict vegetarian or vegan diet have a higher risk of vitamin B12 deficiency because B12 is mainly found in animal products such as meat, fish, dairy products and eggs. If people do not consume these foods or do not have enough variety in their diet, they may develop a deficiency.

Gastrointestinal disorders: Vitamin B12 is absorbed in the small intestine, and problems in the stomach or intestines can interfere with its absorption. Some conditions, such as celiac disease, Crohn's disease, irritable bowel syndrome and gastritis, can interfere with vitamin B12 absorption. These conditions may be more common than in the past and may contribute to a higher prevalence of B12 deficiency.

Medication use: Some medications, such as proton pump inhibitors (e.g., omeprazole) and metformin (a medication for diabetes), can reduce vitamin B12 absorption by reducing stomach acid production or affecting bowel function. Long-term use of these medications may increase the risk of B12 deficiency.

Increased awareness and diagnosis: Improvements in medical diagnostics and greater awareness of vitamin B12 deficiency may lead to increased detection of cases that might otherwise go undetected. Physicians may be more inclined to consider vitamin B12 deficiency in patients with vague symptoms, such as fatigue, digestive problems and neurological complaints.

Aging population: Vitamin B12 deficiency is more common in older adults because of changes in gastrointestinal function that occur with age, as well as the fact that some older people may not consume adequate food sources of B12.

A lack of cobalt in the soil may indirectly contribute to vitamin B12 deficiency in food, especially in areas where the soil has poor levels of cobalt. Cobalt is an essential element in the diet of ruminants such as cows, sheep and goats because it is an important component of cobalamin, which contains vitamin B12. Ruminants have bacteria in their stomachs that can convert cobalt into a form that is then absorbed and used to synthesize B12.

If ruminants are not getting enough cobalt through their diet because of a lack of cobalt in the soil, this can result in lower levels of vitamin B12 in their tissues and ultimately in their meat and dairy products. This can result in a lower intake of vitamin B12 for people who rely on animal products as a food source.

However, this problem is more relevant to areas where agriculture relies heavily on grazing livestock and where the soil is indeed cobalt deficient. In many developed countries, livestock feed is often fortified with cobalt to avoid this problem, and people usually have access to foods that contain sufficient vitamin B12.