Vitamin B12 deficiency common after stomach surgery

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PHILADELPHIA, PENNSYLVANIA. It is becoming increasingly clear that a vitamin B12 deficiency can have serious consequences, particularly in elderly people. A vitamin B12 deficiency can be misdiagnosed as Alzheimer’s disease, amyotrophic lateral sclerosis (Lou Gehrig’s disease), spinal cord compression, or alcoholic or diabetic peripheral neuropathy. A vitamin B12 deficiency is also associated with elevated homocysteine levels that in turn have been linked to a significantly increased risk for atherosclerosis and heart disease. The elderly are at special risk for being deficient in vitamin B12 and, as researchers at the Philadelphia Veterans Affairs Medical Centre report, so are people who have had stomach surgery for peptic ulcers and similar conditions. The study involved 61 patients with a mean age of 63 years who had undergone gastric surgery as far back as 30 years ago and 107 controls. The researchers found that 31 per cent of the surgery group had a vitamin B12 deficiency as compared to 2 per cent among the controls. The presence of a deficiency was established through measurements of the levels of vitamin B12, total homocysteine, and methylmalonic acid in the blood. The deficiencies were corrected by daily injections of 1000 micrograms of vitamin B12 for five days followed by monthly injections. Folic acid supplementation (1 mg/day) was also used. The researchers recommend that physicians ensure that those of their patients who had gastric surgery, no matter how long ago, be checked periodically for a vitamin B12 deficiency. If one is found, the patients should be given lifelong vitamin B12 therapy (periodic intramuscular injections).

Sumner, Anne E., et al. Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. Annals of Internal Medicine, Vol. 124, No. 5, March 1, 1996, pp. 469-76