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Pernicious Anaemia
Hi B. & Daniel,
I had a follow up appointment with my gastroenterologist. He mentioned that I had pernicious anaemia as my gastric parietal cells antibody was positive. See attached along with intrinsic factor antibodies. It was mentioned in the past. I am now worried what this is.
Is there a functional or separate blood test to confirm I have pernicious anaemia and what can I do to prevent this worsening. It seems to be centred around B12 and iron. Is folate included in this mix? I came across something called Folinic acid. What is this?
Intrinsic Factor antibodies.pdfScan – GASTRIC PARIETAL CELL AB – 14 Nov 2023.PDF
I’ve also attached my GP blood test results from 4.10.23 blood withdrawal as well.
Naveed Aslam 4.10.23 Blood Test Arranged By Dr. Kooner (GP).rtf
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9 Replies
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Hey ,
You need a healthy stomach to produce intrinsic factor. I’m a little confused about the results you have shared though. Your antibodies seem to be within the healthy reference range indicating that everything looks fine. The reason to do this test is that there is evidence of some autoimmune activation in the gastric parietal cells. This fact on its own can be part of why the diagnosis of ‘pernicious anemia’ has been made.
The iron deficiency definitely has caused anemia. From what I remember your labs for folate have always been at the lower end of the reference range (beginning this year they were 7.64 ug/L – reference range 2-20 ug/L which was high compared to other labs you’ve shown earlier). Although the focus was mostly on iron, we advised in the past a B vitamin complex because folate can contribute to a different type of anemia which could also been at play in your case.
Your serum B12 hasn’t been indicating problems with intrinsic factor as far as I have seen on your past labs. Oral supplements often aren’t enough to raise serum B12 when intrinsic factor isn’t made in the stomach.
Based on what I have seen from what you have shared over time I would say that the anemia you have experienced was mostly centered around iron and folate (in terms of vitamins & minerals – but not in terms of root causes).
If folate values are still at the lower end of the reference range, I would recommend higher dosages of methyl folate. I have no experience with folinic acid, so I can’t recommend or advise against it. You can try for sure and see how you respond to it – or just try a higher dose of methyl folate.
There is an upper tolerable limit (the maximum daily dose unlikely to cause adverse side effects in the general population) for folate of 1000 mcg per day. A lot of B complexes usually have values of folate around 400 mcg per day. If you’re still taking a B complex and your serum values are still on the lower end, you can always increase the folate dosage from the form you are currently using.
If you’re worried: I wouldn’t be worried about some ‘new’ diagnosis. These labs have brought nothing new to the table. They only ruled out problems with intrinsic factor production. It’s actually good news!
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Hi Daniel,
A quick note to say thank you for your detailed response as always. I will come back to you.
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Hi Daniel,
I am putting together a sheet of my B12 readings, both standard and active as well as folate from the past. I notice my folate has dropped even further. The liquid b12 supplement by metabiolics isn’t helping at all. Shall I send you a screenshit of the amount on the bottle
I am confused why numbers not increasing. Is there a link between B12 and folate?
I just want to make sure that if I take folate, I don’t over dose compared to B12. I want to keep them in line to each other. I am not familiar with other reputable brands.
My GP will not inject me as he says my vitamin B12 is within range.
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Hey ,
Although your folate levels struggle to get up, I wouldn’t conclude that the supplement isn’t working. There can be more reasons for why folate isn’t going up:
• Impaired absorption: gut issues can decrease folate uptake. For example, people with celiac disease or yeast overgrowth can struggle to absorb different nutrients.
• Increased need by the body: The body simply requires more folate than is absorbed. Folate is for example a cofactor for the enzyme HMNT that helps break down histamine. If you’re dealing with histamine intolerance, the body needs more folate.Folate is needed to create red blood cells as well.
• Alcohol: drinking alcohol can decrease folate absorption. Alcohol can also be internally produced by yeast when a yeast overgrowth is present. In fact, this is why we use yeast to brew beer for example.In short, I think it might not be the supplement that is the problem. it is the folate balance that needs to be addressed. Serum folate is simply the sum of the folate being absorbed and used at that moment in time.
I know I’ve written in earlier posts you could increase the amount of methyl folate if serum folate wouldn’t come up. The amount of folate in the B complex you’re taking is the amount of folate recommended daily and might not be enough to bring serum folate up.
Have you tried that?
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Hi Daniel,
Histamine has improved considerably, but DAO marker has worsened. I assume Histamine has improved due to taking Quercetin and stopping histamine foods.
Yes, I noticed Folate is only 400mcg whether I use multivitamin and mineral patches or metabolics B Complex liquid. Thorne Basic B Complex is also 400mcg. Would you mind directing me to a reputable product which is high in Folate and is in liquid form and the same for B12.
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Hey
Designs for Health has a liquid supplement that would fit. The form of folate would be slightly different – and perhaps you might react better to this one.
You’ve encountered this form before I believe when you were exploring supplements for seeking health: folinic acid (or calcium folinate as it’s called as well). This form of folate is also suitable for people who have a common mutation of the MTHFR gene. If you aren’t familiar with this, don’t worry. Forget I wrote it!
The amount of B12 in the supplement is low. Still, it could impact your serum B12 significantly. B12 absorption goes either via diffusion (which is very very very inefficient) or B12 binds to intrinsic factor produced in the stomach.
If you’re taking this supplement with a different meal as you would take your liquid B complex from Metabolix, the B12 can bind to the available unused intrinsic factor produced in the stomach, pushing your B12 up significantly.
If you don’t like to raise your B12 that much, you can take this supplement together with the liquid B complex. That probably won’t change your B12 status much since the extra B12 needs to enter the body via diffusion.
This is how you can play a bit with your vitamin B12 status. Just remember while doing this: your B12 status was always slightly below the ideal range. That means, to get it up in the ideal range, it probably needs a very gentle push.
That’s why I would choose this one
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Hi Daniel,
Is is this:
https://www.amritanutrition.co.uk/products/liposomal-b-supreme-50ml
MTHFR gene – I’ve come across this. Will you know if I have this mutation gene based on raw DNA raw data which I have?
Sorry, you lost me on paragraph 3, 4 and 5. Could I take both designs for health and metabolics B Complex together with food?
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Hey ,
While editing my response I must have by accident deleted the hyperlink to the supplement, I’m sorry! I was referring to this product from Designs for Health: Super Liquid Folate. It contains folate (but in a different form) and a tiny bit of vitamin B12.
I’m saying tiny. But compared to the amount of B12 in food it’s still a lot.
You can use it together with your current B complex. Make sure you combine both supplements with food.
You can use it in 2 ways:
1️⃣ Take it together with the other B complex. If you do it like this it will increase your serum B12, but not a lot.
2️⃣ Take it away from the other B complex. If you do it like this, it will increase your serum B12 more.
The reason has to do with the 2 different ways in which vitamin B12 gets absorbed. One is very efficient. One is super inefficient.The efficient way depends on intrinsic factor (a taxi for B12) produced by the stomach.
In the first scenario (1️⃣), you’re taking both supplements together. You might get more B12, but since all intrinsic factor is already being taken up, the extra B12 from Super Liquid Folate depends on the super inefficient way to enter the body.
In the second scenario (2️⃣), you’re taking super liquid folate away from the b complex. Now the B12 from super liquid folate doesn’t compete with the other B12 from the B complex for intrinsic factor. Taking the supplements in this way can push your serum B12 harder.
I hope it now makes sense now
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Wow! Thank you so much. It certainly does Daniel.
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