Intrinsic factor is needed to absorb vitamin B-12

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: I had a vagotomy and antrectomy in 1980. I’m 76 now and for the past several years have been anemic. My doctor gave me five B-12 shots, and I have been taking B-12 pills for the past 1 1/2 years. I also needed iron infusions. The surgeon reported that because I’ve had an antrectomy and vagotomy, my body can’t absorb vitamin B-12 pills. My family doctor says that’s not true. The surgeon, in whom I have total faith, suggests I go for B-12 shots every three months. Whom do I believe, and what should I do? — S.D. ANSWER: The anterior part of the stomach makes gastrin, a hormone that helps the body absorb iron. This explains why you needed the iron infusions. However, vagotomy and antrectomy together may reduce the stomach’s ability to make a protein called intrinsic factor, which helps absorb vitamin B-12. Your surgeon is right; it’s much harder to absorb vitamin B-12 without intrinsic factor, and many people in your situation are treated with B-12 injections. However, your family doctor is right, too. With enough vitamin B-12, 1,000 times more than you would need if everything worked perfectly, your body can absorb all the vitamin B-12 you need. In a study that compared injection with high-dose oral B-12 in people with deficiency and difficulty absorbing, both worked very well at reversing the anemia. I recommend oral vitamin B-12 for everybody in your situation. However, some people are very happy getting their injections (usually monthly) and don’t want to switch. *** DEAR DR. ROACH: Are Paget’s disease and multiple myeloma the same disease? — D.I. ANSWER: They are not the same disease. I can see why someone might think that, because Paget’s disease of the bone causes “holes” in the bone that can predispose a person to pain, deformities or fractures. Nobody really knows why the cells that break down bone are activated in Paget’s disease — a virus has long been suspected but never proven. Multiple myeloma, by contrast, is a cancer of plasma cells, which normally live in the bone marrow and make antibodies. These also cause “holes” in the bones that can lead to fracture. Paget’s disease, if caught early, can be treated very effectively in most people with medication, usually the same medication used for osteoporosis. Multiple myeloma, unfortunately, is much more difficult to treat, but cancer experts are devising ever more effective treatments for multiple myeloma. *** DEAR DR. ROACH: It has been half a century since I was an intern and had the opportunity to give a local nerve block for a fractured rib. Even the intern could put the needle above the rib, make sure it wasn’t in a vessel and inject Novocaine (that’s what we had back then). It puzzled me that doctors are no longer using that simple technique to relieve pain. My suspicion is that this is not the only effective therapy that has withered over time. I wonder why. — Dr. J.M. ANSWER: Thank you for your note. It’s an interesting question. My first thought is the duration of action. Novocaine lasts only minutes to hours, and the pain of a fractured rib persists up to six weeks. However, there are newer agents, such as bupivacaine, that can last for days. Still, that would be a lot of injections, each with a small chance of a side effect. I think you are probably right that there are some effective treatments that we no longer use. Colleagues who have trained in other countries have shared much knowledge not taught — at any rate not to me — in medical school.