Last week I discussed the often overlooked condition of low stomach acids and its implication. Low stomach acid may be a symptom of a larger issue – this is where we really need to be a nutritional detective to try to put all the pieces together.

The parietal cells in your stomach produce both gastric acid and a protein secretion called intrinsic factor. Pernicious anemia is an autoimmune condition that attacks the parietal cells in the stomach. It attacks the cells that produce gastric acid and make intrinsic factor. This condition leads to low stomach acid production and there is a further complication seen…

When we eat foods rich in vitamin B12, adequate stomach acids are necessary to cleave vitamin B12 from the protein it is bound to. Then it binds with intrinsic factor and moves further down the digestive track where it is absorbed. It will not be absorbed if it is not bound to intrinsic factor. So this autoimmune condition really puts a damper on our body’s ability to absorb vitamin B12.

One thing to note there, one study found that 20-25% of patients who have Thyroid autoimmunity, Hashimoto’s, also have pernicious anemia and probably don’t know it. Once you have an autoimmune condition – you are at higher risk for acquiring another autoimmune condition. It is important to get this checked out.

If you aren’t producing enough stomach acid, just by itself, you are going to have a tough time absorbing vitamin B12 (from all these delicious protein rich foods). This is such an important vitamin in the body. It is a cofactor in the pathway that produces the active form of folate in the body and it is the cofactor converting homocysteine into methionine. High homocysteine levels are linked with inflammation and cardiovascular disease and heart attack risk.

The labs that will identify an issue with B12 is a serum B12 lab. You can also test for homocysteine and Methylmalonic Acid or MMA – both of these will increase with a B12 deficiency because without B12, neither of these enzyme reactions will go forward in the body. Testing both of these markers is ideal, because this will also help you differentiate between a B12 and folate deficiency. MMA will not be high with a folate deficiency, but homocysteine will. Though this does not tell you why your B12 is low – remember that low B12 is just a symptom. If your labs come back showing that you are B12 deficient, and your doctor wants to address this with supplements, great – and WHY is your vitamin B12 low? I want to know why it is low so we can address the root cause as well.