door bhrw | mei 30, 2025 | B12 |
Understanding the 2024 NICE Guidelines on Vitamin B12 Deficiency and Pernicious Anaemia
In 2024, the UK’s National Institute for Health and Care Excellence (NICE) published its final set of guidelines regarding vitamin B12 deficiency. They are a significant step forward, as they have clearly outlined some crucial steps in diagnosis and treatment. However, they also raise concerns, especially around the diagnosis and treatment of a condition called pernicious anaemia (PA). PA is the most common non-dietary cause of B12 deficiency and is often poorly understood and wildly underdiagnosed. PA is a serious, lifelong condition requiring regular vitamin B12 injections. However, many patients report that current treatment guidelines (one injection every 2–3 months) are by far not enough to manage their symptoms effectively.
Controversial Renaming
The 2024 NICE guidelines suggest replacing the term “pernicious anaemia” with “autoimmune gastritis” (AIG). The authors of this article argue that this change is problematic. While AIG and PA are related—AIG can lead to PA over time—they are absolutely distinct entities. PA is a later, more specific stage of the disease, defined by a true inability to absorb B12 due to intrinsic factor deficiency. Renaming PA will create confusion, not only for patients but also for healthcare providers. It might also overlook the fact that PA can occur independently of full-blown AIG. Therefore, the authors advocate for keeping the name or at least adopting a clearer, more accurate term that reflects the autoimmune nature and B12-related consequences of the disease.
Challenges in Diagnosis
PA can be difficult to diagnose because its symptoms are vague and vary from person to person. Some people may not show typical digestive symptoms, which can mislead doctors. Current testing methods have also serious limitations. The testing of serum B12 may yield different results, depending on the specific assay used. Derived biomarkers, such as methylmalonic acid and homocysteine, are not very reliable markers. As an example, 30-50% of people with biochemically detected B12 deficiency were found to have normal serum MMA. Furthermore, the most commonly used test checks for antibodies against intrinsic factor, but this only detects PA in less than half of cases. Other tests, like stomach biopsies or checking gastrin levels are underused, despite being helpful. Undergoing a upper gastrointestinal endoscopy is a burdensome procedure for many. Surveys show that most PA patients in the UK are not given such a gastroscopy (an internal examination of the stomach), which -in contrast- is a standard diagnostic tool in other countries.
Positive Developments in the Guidelines
Despite the concerns, the new guidelines do include promising changes. They recognize the importance of tailoring treatment to the individual—a shift from the one-size-fits-all model. Many patients feel better with more frequent injections, and many are able to self-administer B12 at home, allowing optimal treatment while reducing the burden on healthcare providers. The guidelines also highlight the need for more research, including how to better support patients in managing their own care. This includes reviewing whether regular monitoring, such as for cancer risk, should be introduced for PA and AIG patients—something currently missing in UK practice but found in some European healthcare systems.
In short, the 2024 NICE guidelines represent progress but don’t fully address the complex reality of pernicious anaemia. Replacing its name may oversimplify a multifaceted condition and hinder proper diagnosis and care. The authors stress the importance of clearer diagnostic pathways, more personalized treatment, and ongoing medical education. They call for a more patient-centered approach that reflects both the science and the lived experiences of those with PA.
Find the full paper at: https://www.nature.com/articles/s41430-025-01583-4
door bhrw | apr 2, 2025 | B12, gezondheidszorg |
Parkinson’s disease (PD) is a complex neurodegenerative disorder that affects movement and a wide range of motor and non-motor functions. Among the various factors studied in relation to PD, vitamins—particularly vitamin B12—have garnered significant attention. Recent research suggests that vitamin B12 deficiency not only exacerbates the symptoms of PD but may also play a role in its progression. This article explores the intricate relationship between vitamin B12 and Parkinson’s disease, including its potential mechanisms, clinical manifestations, and therapeutic implications.
Given the strong association between B12 deficiency and PD symptoms, supplementation has been proposed as a potential therapeutic strategy. Studies suggest that vitamin B12 supplementation may:
1. Improve gait and balance in PD patients with neuropathy.
2. Reduce homocysteine levels, potentially slowing cognitive decline.
3. Support nerve regeneration and reduce the risk of neuropathy.
4. Enhance overall well-being and quality of life in PD patients.
However, it is important to note that while B12 supplementation can address deficiency-related symptoms, it is not yet proven to modify the course of PD itself. More research is needed to determine whether B12 therapy can alter disease progression in a meaningful way.
For PD patients, regular monitoring of vitamin B12 levels is recommended, especially for those undergoing long-term Levodopa therapy. If a deficiency is detected, supplementation should be considered to prevent further complications. Physicians may also recommend dietary adjustments to include more B12-rich foods or prescribe injectable forms of the vitamin for better absorption.
Link: https://link.springer.com/article/10.1007/s00702-024-02769-z
door bhrw | nov 15, 2024 | B12, gezondheidszorg
Er zijn de afgelopen jaren een aantal wetenschappelijke artikelen gepubliceerd die suggereren dat hooggedoseerde (parenterale) vitamine B12 behandeling een gunstige rol kan spelen bij aandoeningen, die niet gekarakteriseerd worden door een B12 tekort. Dit zijn aandoeningen als neuropathie, multiple sclerose, amyotrofe lateraal sclerose, sepsis, en de ziekte van Parkinson. De rationale hiervoor is dat vitB12 een aantal belangrijke functies en effecten heeft op de zenuwfunctie en in het brein. Hieronder vindt u de belangrijkste recente bevindingen op dit gebied.
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door bhrw | nov 13, 2024 | B12
The article by Pluvinage et al (published in Sci. Transl. Med. 2024; 16:eadl3758) explores a novel autoimmune cause of vitamin B12 deficiency in the central nervous system (CNS), termed “Autoimmune B12 Central Deficiency” (ABCD). Researchers from San Francisco discovered autoantibodies targeting the transcobalamin receptor (CD320), a key protein in vitamin B12 transport, impairing B12 uptake into the brain despite normal serum B12 levels.
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door bhrw | nov 2, 2024 | B12, gezondheidszorg
Het is zover. Op 1 november zijn in 3 academische ziekenhuizen de eerste longcovid poliklinieken geopend. Zij laten mondjesmaat mensen met longcovid toe, op verwijzing van de huisarts. Op diverse sociale media is hier heel veel berichtenverkeer over. Een van de belangrijkste doelstellingen is ervaring op doen met diagnostiek en behandeling van mensen met longcovid. Drie poliklinieken, oftewel: een druppel op een gloeiende plaat, gezien de schattingen van aantallen mensen die met longcovid ziek thuis zitten.
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door bhrw | okt 31, 2024 | B12, gezondheidszorg
Zo nu en dan zie ik nog oude blogs van mijn hand op LinkedIn verschijnen, zoals recent gebeurde met een stukje dat ik in 2016, dus alweer ruim 8 jaar geleden, schreef over de combinatie van vitamine B12 tekort en de schildklierziekte van Hashimoto.
In dat stukje beschrijf ik twee mensen met vitamine B12 tekort. De eerste is een man met klassieke pernicieuze anemie, bij wie het even duurde voordat de ernstige hypothyreoïdie die hem ook parten speelde werd vastgesteld. Een klassieke situatie, waarin twee auto-immuun aandoeningen hand in hand gaan.
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