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C-bri (Cazenovia, New York) on 01/05/2014
5 out of 5 stars

After nuclear testing at the hospital because of pernicious anemia (probably 15 years ago), it was determined that I can't absorb B-12 in my intestine (auto-immune problem). Since that time I have been taking nascobal a prescription nasal spray one a week. Recently, I found it easier to go to my doctors office once a month for a shot of B-12. You do not want to fool around with pernicious anemia.
REPLY   8      

Replied By Jholl (Louisville, Ky) on 05/21/2015

I had an aunt I never knew who died at age 4 of pernicious anemia. Her family discovered their are a myriad of levels of B-12 that are found. You can have a tendency to low levels of B-12 even if you do not have pernicious anemia. Most people know that their levels drop off as they age as well.
REPLY   8      

Replied By Bobbie (USA) on 08/18/2021

I heard that if you have PA (pernicious anemia), you can still show normal blood levels but will show deficient on micronutrient testing because it can be circulating but not absorbing.
REPLY   10      

Replied By Maureen (MD) on 11/05/2021

I have pernicious anemia and will have to have B12 shots for the rest of my life. B12 is the only vitamin that requires a cofactor in order for your body to absorb it. The cofactor is called intrinsic factor. Intrinsic factor is a protein secreted by the stomach that joins vitamin B-12 in the stomach and moves it through the small intestine to be absorbed by your bloodstream. Without intrinsic factor, vitamin B-12 can't be absorbed and leaves your body as waste. An inability to make intrinsic factor can be caused by - endocrine-related autoimmune disorders, such as diabetes or thyroid disease, surgery to your stomach or small intestine, abnormal bacterial growth in your small intestine, Crohn's disease or celiac disease, use of PPIs, old age.

I have tried all kinds of oral supplementation with limited success. I find I need an IM shot every three weeks to feel good.

REPLY   13      

Replied By Stephnnie (KS) on 11/26/2025

Have you tried increasing your stomach acid with ACV or HCL tablets? For HCL tablets you increase the number of tablets taken one by one at each meal until you notice your stomach burning and then back off one tablet and keep taking that number per meal until that number produces a burn in the stomach, next meal you back off one tablet. Continue this until you're at a stable dosage or even no longer need supplementation. So many people take PPI medications to decrease stomach acid in a misguided understanding that "too much" stomach acid causes acid reflux, when it is actually too little. Stomach acid causes the lower esophageal sphincter to close tighter, so when acid is low is when the reflux symptoms occur. If you're already on a PPI, getting off that and improving your stomach acid is a very difficult process, so seek a naturopathic/holistic provider experienced in that to help you. Without stomach acid, not only are you not absorbing B12, there are a whole lot of nutrients your body is unable to absorb through food. Best of luck to those in this situation.