March 21, 2018 at 1:53 pm #832Archived PostsModerator
A lady of 57 with Reflux, Tiredness & Pernicious Anaemia
I started seeing this lady in September 2018 and she presented with reflux, bloating, flatulence, nausea and diarrhoea. She was diagnosed with pernicious aenemia 12 years ago and has had B12 injections for the past 12 years every 12 weeks. In 1972 she had an appendectomy, in 1973 she had glandular fever, and around that time bouts of tonsill
itis and a tonsillectomy 1975, in 1992 a hysterectomy including ovaries after Endometriosis diagnosed, in 1995 kidney stones and a stent fitted for 3 months followed by a lithotripsy.
She has taken HRT for much of the time since the hysterectomy and is now on Ellesto solo because when she stopped taking the HRT she had sleep problems and hot flashes again.
She has taken Loratadine at 10mg for many years for her eczema and dermatitis symptoms and she was a regular migraine sufferer taking Sumatriptan occasionally for this. She was a regular sufferer of thrush for many years.
She has had the digestive problems for more than 10 years and taken Lansoprazole and now Omeprazole which at the time she came to see me she was taking at 20mg and 40mg during the day. She is quite an anxious person and her husband has to have a heart bypass last year which was pending when she first came to see me. She has 4 children the youngest is 27. Her mother had Ovarian cancer, was an anxious person and had IBS.
We focused on the Gut health and worked on a FODMAP approach and increased the soluble fibre in the diet. I added in Full spectrum digest enzymes and ADP with a probiotic (initially Bio-bifido BacT). I also gave her vitamin D complete and Nutri Mega Mag calmeze and all of these have worked well. She was able to reduce her PPIs to 20mg daily progressively and we added in Sanogastril. Digestive competence is a challenge and fat digestion particularly a problem. She did note that Full Spectrum digest reduce her bowel movements to small pellet like stools and when she lessened them it improved!!
After Christmas we added in IPS.
She would dearly like to come off the PPIs, however when she reduced to 10mg her nausea, loose stools, migraine, low energy and reflux returned and she is back on the 20mg Omeprazole per day again and she is feeling better!
I have had various thoughts relating to the digestion of fats and the liver health because I think this is where we should focus, however I would really like some guidance and a second opinion. On the diet we took out wheat and dairy at the start and as I said followed the FODMAPs and then reintroduced some foods however onions are alliums are a challenge for her. She regularly has stewed apple and this works well for her. She was very pleased with her progress until we went down to the 10mg Omeprazole and this was when she took a backwards step.
With very many thanks
Posted By Jane-Rose Land 21/3/2018
March 5, 2019 at 1:55 pm #833Christine BaileyModerator
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
- You must be logged in to reply to this topic.
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
- No Replies