Many thanks for your question regarding your client who is suffering with fatigue, reflux and pernicious anaemia. I understand she is on proton pump inhibitors which will further affect her absorption of key nutrients. Has she been given a reason for the reflux? I presume Helicobacter has been ruled out? Does she have an ulceration or hernias present? I would recommend you run a comprehensive stool test with parasitology including Helicobacter pylori to look at underlying imbalances.
You also mentioned you suspect fat digestion is a problem for this client – do you suspect any issues with her gallbladder – support for bile flow may be helpful for this client. So, I think the first stage is to examine underlying triggers for her symptoms and by addressing these she may be in a better position to start reducing the medication. In addition, you could include some healing nutrients for the oesophagus and stomach as it is likely there is a degree of inflammation present. Some clients find collagen powder, mucilage herbs like marshmallow root, slippery elm helpful as well as cutting out noticeable triggers such as chili, chocolate, caffeine, gluten and alcohol.
Pernicious anaemia considered to be an autoimmune condition. In some cases, it may be linked to other autoimmune conditions as well such as coeliac disease. Therefore, removing gluten 100% is important for this client. It is encouraging she is given B12 injections regularly but you may wish to run a full vitamin and mineral screen due to the PPIs to see if she is absorption nutrients effectively. In clinical practice, it has also been found that a sub-lingual form of B12 can support blood levels more effectively than with injections alone. This can be obtained via Biolab. You may also wish to add in a high strength multi with lipids to support energy production in view of her low energy levels.
Ng, J-P et al. Coeliac disease and pernicious anaemia. Postgraduate Medical Journal (1988) 64, 889-890 https://tinyurl.com/ydfwjdsv
Vitamin B12 and folate work together in several ways. Both are involved in the formation of red blood cells.
When either nutrient is lacking, red blood cells that are larger than normal (macrocytosis) can form and crowd out healthy, red blood cells. This can lead to anaemia.
The consequences of pernicious anaemia (from a lack of vitamin B12) are more serious than those resulting from folate-deficiency anaemia, due to the importance of B12 to the nerves.
Pernicious (“deadly”) anaemia can damage the brain and spinal cord, possibly resulting in irreversible neuropathies or cognitive dysfunction. Without treatment, the disease can even be deadly. Low levels of B12 can also lead to raised homocysteine. Besides a lack of intrinsic factor, pernicious anaemia can be caused by Crohn’s disease, stomach surgery, or a strict vegetarian diet. Breast-fed infants of vegan mothers are particularly at risk of vitamin B12 deficiency. Insufficient levels can also interfere with sleep patterns and of course overall energy.
Berlin R, et al. 1978. Vitamin B12 body stores during oral and parenteral treatment of pernicious anaemia. Acta Med Scand 204(1-2):81-4. https://tinyurl.com/ybm4ack8
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. It is not intended for them all to be taken, but rather just those that you select. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
Sub-Lingual Vitamin B12
B12 2000 Lozenge (BRC) – suck 1 lozenge in the morning – http://tinyurl.com/m5d2tdb
Gastrazyme (BRC) – take 2 with each meal – https://tinyurl.com/zupy566
Sano Gastril (ARG) – suck 1 around each meal or when there is soreness – https://tinyurl.com/h3mttmd
Phospholipid Colostrum (ARG) – take 1tbsp three times a day – https://tinyurl.com/zwty66b
Arthred Collagen powder (ARG) – take 1tbsp three times a day – https://tinyurl.com/j2arfe4
Multi nutrient to support energy levels
Propax Gold NT Factor (NT) – take 1 sachet daily – http://tinyurl.com/y92qbkut
Beta-TCP (BRC) – take 1-2 with each meal – https://tinyurl.com/hskrbum
Full Spectrum Digest (ARG) – take 1-2 with each meal
I hope this helps with your client
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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