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Cynocobalamine deficiency.,
Most individuals with pernicious anemia need parenteral (deep subcutaneous) injections (shots) of vitamin B12 as initial therapy to replenish depleted body B12 stores. Body stores of vitamin B12 can then be managed by a daily oral supplement of B12. A physician will manage the treatment required to maintain the vitamin B12 status of individuals with pernicious anemia.
Individuals with gastrointestinal disorders
Individuals with stomach and small intestinal disorders may be unable to absorb enough vitamin B12 from food to maintain healthy body stores. Intestinal disorders that may result in malabsorption of vitamin B12 include:
- Sprue, often referred to as Coeliac Disease (CD), is a genetic disorder. People with CD are intolerant to a protein called gluten. In CD, gluten can trigger damage to the small intestines, where most nutrient absorption occurs. People with CD often experience nutrient malabsorption. They need to follow a gluten free diet to avoid malabsorption and other symptoms of CD.
- Crohn's Disease is an inflammatory bowel disease that affects the small intestines. People with Crohn's disease often experience diarrhoea and nutrient malabsorption.
- Surgical procedures in the gastrointestinal tract, such as surgery to remove all or part of the stomach, often result in a loss of cells that secrete stomach acid and intrinsic factor. Surgical removal of the distal ileum, a section of the intestines, also can result in the inability to absorb vitamin B12. Anyone who has had either of these surgeries usually requires lifelong supplemental B12 to prevent a deficiency. These individuals would be under the routine care of a physician, who would periodically evaluate vitamin B12 status and recommend appropriate treatment.
Older adults Gastric acid helps release vitamin B12 from the protein in food. This must occur before B12 binds with intrinsic factor and is absorbed in your intestines. Atrophic gastritis, which is an inflammation of the stomach, decreases gastric secretion. Less gastric acid decreases the amount of B12 separated from proteins in foods and can result in poor absorption of vitamin B12. Decreased gastric secretion also results in overgrowth of normal bacterial flora in the small intestines. The bacteria may take up vitamin B12 for their own use, further contributing to a vitamin B12 deficiency.
Up to 30 percent of adults 50 years and older may have atrophic gastritis, an overgrowth of intestinal flora, and be unable to normally absorb vitamin B12 in food. They are, however, able to absorb the synthetic B12 added to fortified foods and dietary supplements. Vitamin supplements and fortified foods may be the best sources of vitamin B12 for adults over the age of 50.
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