In our earlier article, we have written about the role of stomach acid in iron absorption and iron deficiency anemia. You must know that what you put in your mouth should be properly processed to be absorbed in your body. Otherwise how much you ingest will simply pass out through the gastrointestinal tract. Vitamin B12 and folic acid are two important nutrients for the proper functioning of your body. Deficiency of which can lead to anemia apart from other health disorders. Megaloblastic anemia results from a deficiency of either B12 or folate. Although those nutrients are absorbed in the stomach, the stomach plays an important role in processing them. Here you will know how stomach problems can cause anemia.
How stomach problems can cause anemia
Effects in vitamin B12 absorption
Vitamin B12 plays an important role in the production of red blood cells. Lack of vitamin B12 impairs this process leading to form pernicious anemia along with some other health disorders.
Your body needs two important components to absorb vitamin B12, gastric juice, and intrinsic factor. Major food source of vitamin B12 includes animal sources of food where it binds with protein. Your stomach acid or gastric juice should have a normal ph level to separate it from the protein binding of food. Antacid, proton pump inhibitor or other acid-suppressing drug impair this process. (1,2,3)
|Less than 3||Normal|
|3 to 5||Hypochlorhydria|
|Greater than 5||Achlorhydria|
And on the other hand, parietal cells (the cells which secrete HCL in the stomach) of the stomach secretes glycoprotein also called an intrinsic factor or gastric intrinsic factor. It prevents the degradation of vitamin B12 and combines with it and travels through the small intestine. There it helps vitamin B12 absorption in the small intestine. If your body is unable to form an intrinsic factor or if intrinsic factors unable to combine with Vitamin B12, your body can’t absorb vitamin B12. Intrinsic factors also present in gastric juice.
Conditions that impair B12 absorption
Atrophic gastritis or inflammation in the stomach lining mostly from bacterial infection mostly helicobacter pylori impairs secretion of normal gastric juice and intrinsic factor. (4)
H. pylori infection causes loss of parietal cells which further impairs the secretion of gastric juice and intrinsic factor. We have mentioned these in our previous article H. Pylori infection, and ulcers in the stomach. In a study, helicobacter pylori were detected in 77 (56%) of 138 patients with vitamin B12 deficiency, and eradication of H pylori infection successfully improved anemia and serum vitamin B12 levels in 31 (40 %) of 77 infected patients. They concluded that H. Pylori infection is a causative agent in the development of adult vitamin B12 deficiency. Eradication of H pylori infection alone may correct vitamin B12 levels and improve anemia in this subgroup of patients. (5)
The surgical procedure of removing a part of the stomach also increases the risk of vitamin B12 deficiency. (6)
So, for absorption vitamin B12 normal function of the stomach is necessary. Stomach infection or ulcer, weak gastric juice, or inadequate secretion of intrinsic factor impairs the absorption process resulting to miss of the nutrient.
Folate or folic acid(B9) absorption
Folic acid also has to be freed from its food binder to be absorbed in the small intestine. And an environment of weak stomach acid and/or decreased ascorbic acid reduces folate absorption. (7, 8)
Researchers found atrophic gastritis results in malabsorption of folic acid but not in folate deficiency. But how can this be possible? (9)
In our earlier article, we discussed roles of stomach acid or gastric juice in relation to health complications including bacterial overgrowth. Weak stomach acid can make bacterial colonization in the lower part of the stomach and also in the small intestine. And small intestine is not designed for too much bacterial growth, so as the stomach. Some of the bacteria in small intestines produce folic acid but some compete for intrinsic factors resulting in Vitamin B12 deficiency. (10)Which is not a normal condition and responsible for developing anemia and some other health disorders.
So, the processing of a nutrient in the proper way in the body is very much important if you wish to get benefits from it. And in the same way, although you ingest through mouth food with vitamin B12 and folic acid you are likely to miss those nutrients if your stomach is not functioning properly. Earlier we have mentioned about roles of stomach acid or gastric juice indigestion, defense against pathogens, bacterial overgrowth and restoration which declines with age. However individual may have infection or ulcers in the stomach. In most cases, H. pylori play a common role of stomach infection or ulcers. We also mentioned the roles of helicobacter pylori in infection in stomach and ulcers as well as natural ways of eradication of helicobacter pylori.
In such cases, individuals having stomach infection or ulcers should go for restoration of gastric juice if tested low only after testing and remove the cause and healing from stomach infection or ulcers.
How weak stomach acid can lead to impair secretion of pancreatic enzyme. And further, it leads to malabsorption of nutrients including carbohydrate and protein fermentation as well as bacterial overgrowth.
We hope this article will give an insight into how stomach problems can cause anemia.
Disclaimer: The above article is a generalized health information purpose only not for individual with specific health condition. Individual may have varying experience to the same food based upon heath condition, allergic reaction to foods.Any application of above methods should be under guidance of proper knowledgeable healthcare professional only.
Sources & references: 1.Harvard T.H.Chan, The Nutrition Source,Vitamin B12 Deficiency: Causes and Symptoms 2.Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12),Marcuard SP1, Albernaz L, Khazanie PG.,Ann Intern Med. 1994 Feb 1;120(3):211-5 3.Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with Zollinger-Ellison syndrome,Termanini B1, Gibril F, Sutliff VE, Yu F, Venzon DJ, Jensen RT., Am J Med. 1998 May;104(5):422-30 4.Autoimmune atrophic gastritis—pathogenesis, pathology and management, William L. Neumann,Elizabeth Coss,Massimo Rugge, Robert M. Genta,Nature Reviews Gastroenterology & Hepatology volume 10, pages 529–541 (2013) 5.Helicobacter pylori—Is It a Novel Causative Agent in Vitamin B12 Deficiency?, 6.https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency- anaemia/causes/ 7.Absorption of Vitamin B12 and Folic Acid,Victor Herbert, M.D.,Department of Hematology, Mount Sinai Hospital and School of Medicine, New York, New York,Gastroenterology,January 1968Volume 54, Issue 1, Pages 110–115 8.Association of Helicobacter Pylori Infection and Serum Folate Levels in Sudan,Nazik Salah-eldin Ahmed1,MahdiH. A. Abdalla,IOSR Journal of Dental and Medical Sciences (IOSR-JDMS),e-ISSN: 2279-0853, p-ISSN: 2279- 0861.Volume 16, Issue 5 Ver. X (May. 2017), PP74-76 9.Folic acid malabsorption in atrophic gastritis. Possible compensation by bacterial folate synthesis.,Russell RM, Krasinski SD, Samloff IM, Jacob RA, Hartz SC, Brovender SR.,Gastroenterology. 1986 Dec;91(6):1476-82 10.Bacterial Overgrowth,Travis J. Rutland MD, Jack A. DiPalma MD, in GI/Liver Secrets (Fourth Edition), 2010