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Question for Dream69
9 Replies
JJ1 - March 27

Earlier, when I was going through my bouts of anemia, you suggested several types of anemia could be my problem and one was pernicious anemia. This can be caused by a lack of vitamin B12 or inability to absorb B12. ............Today I had follow up blood work done by my hematologist and I was reviewing the results and noticed one of the only things off now that I have had my iron injection is the red blood cell distribution width (RDW). The normal range is 11.7 to 14.6 percent and my reading is 31.1%. This parameter was high previously when a bunch of other readings were out of whack. I started reading about B12 absorption problems because I am sure I have a pretty good diet in terms of B12 and I noticed that absorption can be affected by a lack of a protein called intrinsic factor in the stomach. This got me curious so I did another google search on intrinsic factor and proton pump inhibitor medications for acid reflux (I take Nexium) and found several references to these drugs causing problems with intrinsic factor, but these references were in discussion boards and not sure how reliable. So now I am wondering if this could be pernicious anemia. Many of the symptoms are actually similar to fibromyalgia, including memory problems, confusion, muscle and joint aches, irritable bowel syndrome, etc. along with anemia. I have a call in to the hematologist to inquire whether I have had any tests run that would rule out pernicious anemia and am waiting to hear back. Wondering if you have run across anything in the literature, Dream, that would support the link between proton-pump inhibitor drugs and lack of intrinsic factor in the stomach? I am somewhat hopeful since pernicious anemia is pretty easily treated by B-12 injections or pills.


JJ1 - March 27

Found this in under vitamin b-12 (I have been on proton pump inhibititors --first Prevacid and now Nexium -- for about 10 years) ........"Proton pump inhibitors (PPIs): The PPIs include omeprazole (Prilosec®, Losec®), lansoprazole (Prevacid®), rabeprazole (Aciphex®), pantoprazole (Protonix®, Pantoloc®), and esomeprazole (Nexium®). The reduced secretion of gastric acid and pepsin produced by PPIs can reduce absorption of protein-bound (dietary) vitamin B12, but not supplemental vitamin B12. Gastric acid is needed to release vitamin B12 from protein for absorption. Reduced vitamin B12 levels may be more common with PPIs than with H2-blockers, because they are more likely to produce achlorhydria (complete absence of gastric acid secretion). However, clinically significant vitamin B12 deficiency is unlikely, unless PPI therapy is prolonged (2 years or more) or dietary vitamin intake is low. Vitamin B12 levels should be monitored in people taking high doses of PPIs for prolonged periods. "


larry - March 27

Hi JJ1, At the risk of sounding like a broken record I am sharing this info with you again as it pains me terribly to see that this anemia thing is still a mystery for you and your doctor. I do hope that you take my suggestions seriously and buy Mary's books or visit these sites. There is no reason for you to have to go thru this as it really isn't a mystery for doctors that are well versed in healing fibro. .............1.).
another site is 2.)
is a disorder characterized by a decrease in the number of red blood cells that carry oxygen to various body tissues. If you have hypothyroidism, you may also have an associated mild anemia as one manifestation of the general slowing of your body functions that occurs in your condition. The anemia usually causes no symptoms and corrects itself when your hypothyroidism is treated. It is not a separate disease, but is due instead to the low thyroid hormone level. (NEARLY 100% of fibro patients are HYPOTHYROID.)

A more serious type of anemia, known as pernicious anemia, is a separate disease that tends to occur in older patients who have or have had Graves' disease or Hashimoto's thyroiditis, and their relatives. This kind of anemia is caused by a deficiency of Vitamin B12.

Under normal circumstances, cells lining your stomach make a substance known as intrinsic factor that enables your body to absorb Vitamin B12 from food. Some individuals lose the ability to absorb Vitamin B12 due to failure of the cells that make intrinsic factor. The damage seems to be caused by a self-destructive process involving the body's immune system, similar to what occurs in Addison's and Hashimoto's diseases." -------From the website, 3.)
anemia is one of the autoimmune conditions discussed in the book "Living Well With Autoimmune Disease." by Mary Shomon. The book discusses how pernicious anemia is connected with autoimmune endocrine conditions, including Hashimoto's thyroitis, thyrotoxicosis, diabetes, Addison's disease and primary ovarian failure. People with these autoimmune conditions are at higher risk of pernicious anemia, and vice versa. " The book can also help you understand why your thyroid tests appear "normal" when you may be very sick. 4.) From the same site- “
• Eat more foods that are good sources of iron. Concentrate on green, leafy vegetables, lean, red meat, beef liver, poultry, fish, wheat germ, oysters, dried fruit and iron-fortified cereals.
• Help your body absorb iron better by eating foods high in vitamin C.
• Red meat can supply iron, but also helps your body absorb iron from other foods.
• Limit your use of tea, except herbal teas. The tannins in tea can inhibit iron absorption.
• Avoid antacids, phosphates (found in soda, beer, ice cream, candy bars, etc.) and the food additive EDTA. These block iron absorption.
• Increase dietary fiber to prevent constipation. “”
----Additionally, the book and these sites can help you find a doctor that is part of the medical community that has successfully treated fibro. Since fibro is not taught in med school, most doctors are still guessing on how to treat it. It is very treatable and you CAN recover and be completely symptom free, if you find one of these doctors that have had this highly specialized training. I wish you Good health.


JJ1 - March 27

Thanks, Larry. I really should look into the thyroid more. The only thing is, what you quoted states: "an associated mild anemia" and I really don't think my anemia can be characterized as mild. It was quite severe. My hemacrit was down to a 6 and my ferritin level was 1. I am very suspicious of the proton-pump inhibitor link since I can associate the onset of my fibromyalgia symptoms with around the same time I started taking Prevacid. A few years back I was switched to Nexium. Anyway, I am not ignoring you, just not there yet.


JJ1 - March 27

"Under normal circumstances, cells lining your stomach make a substance known as intrinsic factor that enables your body to absorb Vitamin B12 from food." ---------------- This is what leads my back to my heartburn meds being a possible cause. I have found mention that proton pump inhibitors can cause problems with the intrinsic factor. Also the lack of stomach acid can cause difficulty in getting B12 from meat sources, but my diet also includes fortified cereals so I don't think that is the problem. ....................... I did hear back from my doctor's office and they said that an elevated RDW was normal after getting IV iron and they ignored the fact or failed to look and see that my RDW was high BEFORE I had the iron.


dream69 - March 27

Reduced serum vitamin B12 (cobalamin) levels have been documented occasionally during long-term treatment with a proton pump inhibitor (PPI) in selected groups of patients. This has largely been confined to patients being treated for Zollinger-Ellison syndrome who have sustained drug-induced achlorhydria, which does not ordinarily occur during treatment with a PPI. An appreciation of normal cobalamin metabolism and the pharmacological action of the PPIs adequately explain the mechanism for this reduction. PPIs do not promote the development of pernicious anemia.
J Clin Gastroenterol. 2000 Jan;30(1):4-6.


dream69 - March 27

This article responds to controversial issues about the long-term use of acid suppression raised in a recent article in this journal by Waldum & Brenna. Although rebound acid secretion occurs following proton pump inhibitor therapy, the clinical significance of this is unclear, but the proposal that this is a major driver of acid-related diseases is considered implausible. The polypoid deformity of the gastric corpus that can occur with long-term proton pump inhibitor therapy is not neoplastic, and therefore has no bearing on other issues raised about proton pump inhibitor therapy and gastric malignancy. Current data in humans suggest that the magnitude of serum gastrin elevation from proton pump inhibitor treatment of up to 10 years, and any theoretical risks from this, have been overstated by Waldum & Brenna. Pernicious anaemia is a model of very doubtful validity for the risks of proton pump inhibitor therapy on several grounds. The proposal that diffuse gastric carcinoma arises from acid suppression-induced stimulation of enterochromaffin-like cells is challenged vigorously, because this is based on an implausible and substantially criticized interpretation of histopathology. It is agreed that it is appropriate to be cautious about the safety of long-term acid suppression, because no data are available for lifelong treatment in humans. Such caution should be tempered by a critical assessment of the benefits of this treatment in relation to any possible risks. The substantial data that now exist from long-term treatment of humans with proton pump inhibitors has not thus far revealed any definite risks. The risk of death from anti-reflux surgery, although small, would seem to far exceed any possible risks associated with long-term proton pump inhibitor use. Available data suggest that denial of the benefits of effective acid suppressant therapy to patients with clear-cut troublesome acid related disorders is an overreaction to concerns about the biological effects of inhibiting acid secretion with proton pump inhibitors.Department of Medicine, Western Hospital, Melbourne, Australia.


larry - March 27

Hi again, If you read the next paragraph after the "Mild" comment you will see the info that pertains to you. I don't mean to imply that the problem is ONLY the thyroid. The Thyroid is just one gland of the entire endocrine system, when that is stressed it affects the other glands, adrenals, hypothyalmus, pitutary, etc.. BTW, ADD is also associated with this syndrome. There is a book about reversing ADD in 18 days by Dr. Bob. It makes sense as it addresses the nutritional deficiencies......http://www.drbob4he
....... This method came highly recommended by a psychariast that specializes in ADD. My twin sister also has fibro and her son has ADHD. The fibro and fatigue centers also talk about the association.
Let me know if you have any questions, I am glad to help.


JJ1 - March 28

Larry, I took the time read your entire post. Sorry I didn't the first time. Thanks again.


Jeanmac - October 18

Nexium was definitely the cause of all my fibromyalgia symptoms. I was prescribe these 12 years ago for acid reflux. I was diagnosed fm several years later and gradually got worse over the years to where I truly felt life wasn't worth living. I determined to get to the bottom of my health problems and for the past 8 months began a journey which led me to coming off my Nexium. Hey presto. No more fybro!!!!! 2 months of feeling normal. I have energy, virtually no pain, no ibs, no fatigue, no no brain fog, better mood, no longer feel suicidal. My body doesn't feel like the life is being sucked out of me. I have now introduced multivitamin, extra vit b12 and magnesium to build up what I believe my body was starved of for years. If you have been on proton inhibitors and have fm, I would seriously consider coming off them. I started taking Apple Cider Vinegar and changed to Zantac then came off Zantac while continuing ACV. After a few more weeks I reduced ACV and now only take it if I have a bit of an upset tum. Read up. I eat a better diet in order to help my tum too.



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