could it be b12?





JUNE 2019



B12 is a huge molecule and absorption depends on many cofactors, so that it is quite possible to take adequate amounts of B12 in the diet, and still have a B12 deficiency. Absorption of B12 requires gastric acid, so anything, which reduces gastric acid production such as gastric surgery, atrophic gastritis, or antacid drugs, could produce B12 deficiency.





Colchine - Inhibits and impairs the receptors local to the terminal ileum of the small intestine for which B12/Intrinsic factor would bind to for absorption Chloramphenicol - most likely due to an inhibition within the bone marrow due to chloramphenicol causing bone marrow suppression and depriving red blood cells from utilising the available B12 Ethanol- Impairs absorption from the intestine due to the effects on the pancreas. May affect the pancreas’ ability to secrete proteases required to release B12 from R-binders within the duodenum Histamine 2 Receptors Antagonists (H2RA) increasing gastric PH (i.e. making the gastric pH more alkaline) can impair the activation of pepsin required for freeing B12 bound to protein within the ingested food so that it can then bind to an R Binder. When the pH is high pepsinogen does not convert to pepsin as effectively for this process to occur. Metformin- The mechanisms are multifactorial and include: an effect on intestinal motility, bacterial overgrowth, and or alterations in calcium dependent uptake of B12/intrinsic factor within the terminal ileum of the small intestine. Protein Pump Inhibitors (PPI) Increasing gastric PH (i.e. making the gastric pH more alkaline) can impair the activation of pepsin required for freeing B12 bound to protein within the ingested food so that it can then bind to an R Binder. When the pH is high pepsinogen does not convert to pepsin as effectively for this process to occur. The chronic use of these medications has the potential to cause complications related to B12 deficiency, which includes impaired DNA synthesis, impaired cell division, haematopoiesis, hyperhomocysteinaemia, and metabolism of odd chain fatty acids that is required in preventing demyelination of nerves.


For further reading: (1) http://www.amazon.com/Could-Be-B12-Epidemic-Misdiagnoses/dp/1884956467


Could It Be B12?:

An Epidemic of Misdiagnoses, Sally M. Pacholok, Jeffrey J. Stuart