A Hidden Reason for Fatigue: Pernicious Anemia

Anemia is a condition that reduces the ability of blood to carry oxygen, leading to fatigue and a whole host of other symptoms. This may be due to a reduction in hemoglobin, or a reduction of the production of red blood cells. Some common deficiencies that cause reduced red blood cells are B12 (cobalamin), folate, and iron. 

Unfortunately, it is common for someone to have low iron and low hemoglobin and get a diagnosis of iron deficiency. They are then told to supplement with iron. The problem with that is too much iron can be very detrimental, and even fatal in some cases. Although iron deficiency anemia is much more common, iron overload is also common and there is less awareness of it. So having an accurate diagnosis is very important. 

Pernicious anemia is the most common cause of anemia due to B12 deficiency. It can lead to irreversible blood and neurologic disorders. In fact, the word ‘pernicious’ means deadly. But don’t worry, it was named that way before we had answers. You can live a healthy life with pernicious anemia as long as you know what to do about it. However, that means you need to supplement it for life. 

Common symptoms of Pernicious Anemia: 

Feeling tired or weak

Shortness of breath

Feeling faint

Smooth red tongue

Pale skin

Chest pain

Nausea

Vomiting 

Loss of appetite

Heartburn

Numbness in the hands or feet

Memory loss

Blurred vision

Depression

These are just some of the symptoms of pernicious anemia. What exactly is pernicious anemia? It is an autoimmune condition that attacks the parietal cells of the stomach. The inner lining of the stomach has parietal cells and they have two functions; to secrete hydrochloric acid for digestion, and to secrete intrinsic factor. Intrinsic factor is a glycoprotein that binds to B12, where it then enters the small intestine where it is absorbed. 

There are other conditions that will inhibit the absorption of B12 such as SIBO (small intestinal bacterial overgrowth), low stomach acid, atrophic gastritis, H. pylori infection, celiac disease, and alcoholism. Use of metformin, a diabetes drug, also depletes B12 stores. B12 deficiency can also just be due to inadequate dietary intake. Plants do not need B12, so they do not store it. So you cannot get B12 from a plant-based diet despite what you may have heard. Some vegetables contain cobamides, a B12 analogue and actually inhibit the absorption of B12. B12 comes from animal products. 

B12 is an extremely important nutrient involved in the methylation cycle, genetic repair, and keeps your body’s blood and nerve cells healthy. Because of its role in blood cell production, when deficient, it can cause megaloblastic anemia. The important roles that B12 has explains the wide variety of symptoms. 

How do we detect pernicious anemia? Bloodwork is a good starting point. From there you can determine your B12 status and see your red blood cell levels. There is a test called a Schilling’s test that can help tease it out. You can also test antibodies for intrinsic factor. Seeing a functional medicine practitioner is likely your best bet. 

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