Q: Are there any connections that you know of to pernicious anemia? My grandmother died of this condition and I’ve read about it, much from your site. I started taking sublingual vitamin V12 tablets 2500 mcg about three months ago. I began with one and am now taking two per day, both at the same time. I also take magnesium daily. My restless legs have plagued me for over 20 years rarely disturb my rest now. I do NOT know if the vitamins are the reason, I only cite the circumstances and ask for your advice.
I did try iron supplements but that left me with tarry stools and frequent diarrhea, so that’s out. I did put a soap cake in my bed and most of the time remember to keep it near my legs. Not sure that’s making the difference, if it is just a placebo effect, or if it is the vitamins.
A: To begin with, one common explanation for vitamin deficiency anemia to occur could result from an individual failing to consistently consume sufficient amounts of those vitamins required to produce healthy red blood cells. Red blood cells are those that carry oxygen from the lungs throughout the body. The second cause of vitamin deficiency anemia may occur when the body simply cannot absorb those nutrients from the foods a person eats. There are several B vitamins that come into play here. For example, two vitamins when deficient, cause red blood cells to enlarge – folate and vitamin B12. Folate (folic acid) – also referred to as B9 – is essential for metabolism and maintenance of homocysteine. It helps prevent birth defects. Food sources of folate include dark green leafy vegetables, fruits, whole grain products and more. Vitamin C (ascorbic acid) is an antioxidant required for the growth and repair of tissues. It helps with wound healing and is vital for the formation of collagen used to maintain and repair scar tissue, blood vessels, ligaments and tendons. While a C deficiency is rare, it can occur, with severe cases leading to joint pain, swelling, bruising, loss of teeth, and more. Food sources include citrus fruits, sweet and white potatoes, tomatoes, strawberries and more. Balance is key, since excesses may cause kidney stones, an upset stomach and an increase in iron absorption.
On to a B12 deficiency. This vitamin is found in red and white meats, shellfish, eggs, cheese, yogurt, breakfast cereals, and milk. A diet consistently lacking in this vitamin can occur, or may also be the result of the inability of the small intestine to absorb it from those foods consumed. Pernicious anemia is vitamin B12 deficiency due to lack of absorption of the vitamin; however, there can be other causes of a B12 deficiency such as surgery, infections, medications, or diet. Gastric bypass surgery is being performed more and more frequently and could be a cause of pernicious anemia, as can having Crohn’s disease, celiac disease, a tapeworm, or from a lack of intrinsic factor. Intrinsic factor is a protein secreted by the stomach. It teams up with B12 in the stomach and takes it through the small intestine for absorption by the bloodstream. Without intrinsic factor, B12 cannot be absorbed so it passes through the body as a waste product. A lack of intrinsic factor may be the result of an autoimmune disorder or may also be the result of gastric bypass.
Symptoms of any vitamin deficiency anemia may include fatigue, muscle weakness, heart palpitations, shortness of breath, weight loss, paresthesias (numbness and tingling) of the extremities and more. Risk factors that enter the picture for pernicious anemia other than those mentioned include having an abnormal bacterial growth in the stomach, taking specific medications such as antacids, protein pump inhibitors including Nexium, Prilosec, Prevacid and Protonix, and those medications used to treat type 2 diabetes.
Treatment is available through diet modification, adding B12 supplements in either pill form or through a nasal spray, or even via injection if the deficiency is severe enough. The injections, if given, may be received every other day but will eventually decrease to once a month. B12 injections would also be used in cases where the intrinsic factor is deficient.
Unless your doctor checked your iron level and found you to be deficient, your restless legs symptoms may be better helped by eliminating the iron supplement, massaging them while soaking in a warm tub, using an over-the-counter pain reliever such as ibuprofen, and reducing or eliminating caffeine, alcohol and tobacco products if appropriate. Ask your physician if such prescription products such as Requip, Mirapex, Neupro, Sinemet or others might be appropriate for you. Good luck.