Pernicious Anemia and B-12|
by Dr. Virginia Vetrano
Vol. XXVIII January, 1967 No. 5
Pernicious Anemia and B-12
Dr. Virginia Vetrano
"You can't get well of pernicious anemia," so imply all the authorities, "your stomach doesn't produce the intrinsic factor necessary for the absorption of B-12, but as long as you take vitamin B-12 shots, you don't have to worry." In so many words they are saying: don't correct your stomach condition; rely on this crutch, because there are billions of willing microorganisms busily engaged in excreting vitamin B-12 just for you. Recently, we admitted a woman to the Health School who had pernicious anemia. She had had it well over six years and had taken vitamin B-12 for approximately five of those years. She completely lacked hydrochloric acid, and took this in the form of a drug for a while; but then she began using enzymes. She had pain and swelling in her feet and ankles. Six years previously she developed blood clots in her lungs, while receiving shots.
Before entering the Health School, she was taking both vitamin B-12 and iron shots, once a month. Despite medical therapy, she complained of excessive fatigue plus other discomforts before coming to the Health School and she left feeling very well. Accompanying the anemia were mucus colitis and abnormal sounds in the ears (tinnitus). She had also recently suffered with an inflammatory condition of her middle ear, which became so severe that the tympanic membrane burst. She also showed signs of diverticulosis.
Although she was 74 years old and was in a very bad condition when she came, she was feeling very well when she left, after a period of only eight and a half weeks. She was old enough to be set in her ways and much of the difficulty with her was in trying to change her wrong habits of living. She was very anxious to get back to her potato diet. Although she left the Health School prematurely, as many do, she has written back saying that she is doing fine and was amazed at the way she regained her strength and feeling of wellbeing.
She suffered with one condition after another prior to coming to the Health School. Care at the Health School not only started her well on the road to recovery from anemia, but also relieved her of many of her other troubles. This is not unusual with Hygienic attention. It is a well known fact in Hygienic circles that many cases of pernicious anemia double their blood cell count in only one week of fasting, without taking vitamin B-12 shots.
Dr. William Howard Hay recorded 101 cases of pernicious anemia and only eight of them failed to recover, and these were dying when they arrived for his care. It is not news to Hygienists that these cases get well; most abnormalities of the blood are corrected through fasting.
Pernicious anemia is a grave form of anemia, characterized by an extreme reduction in the number of red blood cells with a reduction of the total number of the leukocytes, variation in the size and form of the red blood cells, a lack of hydrochloric acid secretion, often combined with neurologic symptoms and gastrointestinal symptoms in some.
Symptoms: The main symptoms are sore, shiny tongue, a lack of hydrochloric acid and sometimes an absence of the digestive enzymes of the stomach, increased tiredness, weakness, faintness, a waxy pallor or lemon yellow tint, shortness of breath and palpitation, edema, recurrent fever, digestive disturbances, pain in the epigastric region, occasional hemorrhages, often concomitant with flabby fatness.
Nervous symptoms may develop before the symptoms of anemia or later in the course of the disease and develop in about 80 per cent of cases. These take the form of symetrical paresthesias (abnormal sensations) of the toes or fingers, such as formication, burning, tingling or itching. In severe cases numbness develops. In 50 per cent of the cases spinal cord symptoms are severe and cause ataxia and muscular spasticity. Some are unable to hold things and are continuously dropping them. Performing delicate tasks with the hands becomes extremely difficult, if not impossible. The patient may eventually become a cripple due to progressive weakness, spasticity, incoordination and stiffness of the lower extremities. Nothing tastes good to these people as their sense of taste and smell is lost. They become dull, apathetic and irritable, and unable to concentrate. In some oases frank psychoses becomes a problem. Constipation and diarrhea frequently accompany the anemia. Besides a sore !
tongue, some patients complain of the whole mouth being sore.
Clinical Manifestations: The pulse is soft and quickly drops (bounding). In severe cases of anemia, recurrent bouts of fever plague the patient. The tongue is usually shiny and smooth and, in some, very red and raw like beef. The tongue may ulcerate or vesicles may form. The smooth tongue is due to atrophy of the papilla of the tongue. The heart beats very fast and a soft hemic murmur is audible. The liver may be slightly enlarged and the spleen, though seldom palpable, is thought to be enlarged in all cases. When a tuning fork is placed on the shin bone, the patient cannot sense the vibrations, nor does he have a sense of position of the various members of his limbs. He may not be able to sense when touched, but he still senses pain and temperature. If he stands with feet together and eyes closed, he will sway. Reflexes vary from diminished to heightened. Visual defects and optic atrophy develop in occasional cases. Retinal hemorrhages occur in some.
Pathology: In discussing the pathology it is important to realize that most tissue changes discussed in textbooks are changes seen after death. These are not necessarily the condition of the body in the early and even in some late stages of pernicious anemia. For instance, at death the fundus and body of the stomach show extreme atrophy. The coats of the fundus and body of the stomach are very thin and the glands of this area are almost completely destroyed; but during the course of the disease, biopsy findings show that only about 40 per cent of cases have the extreme gastric atrophy seen at autopsy. The biopsy shows varying degrees of atrophic gastritis, with cellular infiltrations into the secreting layers of the stomach and atrophy of the glands. Changes seen at autopsy are end points of pathology and do not portray the condition of the patient when he first presents himself to the physician or the orthobionomist (professional Hygienist).
The blood picture varies with the exacerbations and remissions of the disease. The red cell count may be as low as 500,000 during an exacerbation of the anemia and as high as 4,000,000 during a remission. All the elements of the blood in general are low _ the red cells, the leukocytes, and the platelets (particles necessary for clotting of blood). The hemoglobin per cent is also diminished, but not in proportion to the red cells, so that the color index may be relatively high. Many of the red cells are well colored, giving us the term hyperchromic anemia.
As mentioned before, gastric atrophy is supposedly the basic lesion of pernicious anemia. Atrophy of the gastric glands, it is thought, is responsible for the lack of so-called intrinsic factor which supposedly facilitates the absorption of vitamin B-12 from foods. Boyd states that sometimes the gastric mucosa is as thin as parchment, but again he is viewing the stomach at death. Naturally, digestion would be impaired, due to a lack of gastric secretion, at this stage. The pyloric region or antrum (lower part of the stomach) which secretes only mucus does not atrophy but is completely normal, so he states. In fact, Boyd states that an abrupt change can be seen from the atrophy of the body to the normalcy of the antral region.
Etiology: Pernicious anemia is supposed to be due to a lack of an unknown entity, which has not yet been isolated, called the intrinsic factor or hemopoietin, without which vitamin B-12 cannot be absorbed. Cecil and Loeb state that: "Although the essential lesion of pernicious anemia, failure of intrinsic factor secretion, may arise from many processes interfering with normal gastric secretory function, in most patients the gastric lesion is idiopathic." In other words, the cause of the gastric lesion is unknown.
Guyten states that the intrinsic factor is secreted in the mucous glands of the pyloric area of the stomach and to a lesser degree in the gastric glands. Best and Taylor state the opposite _ that it is the fundus and body of the stomach which secretes the intrinsic factor, and that the pathology which is characteristic of pernicious anemia proves this because the pyloric region is normal whereas the fundus and body of the stomach are atrophied.
The intrinsic factor is not secreted by the small intestines, although some think it is secreted at the beginning of the duodenum. It is thought to be a mucoprotein or many mucoproteins, and the manner by which it facilitates absorption of B-12 is unknown. It is thought to be an enzyme which acts at a pH of seven. That of the hog stomach tissue can be digested with trypsin and pepsin and is destroyed by heating to 45 degrees centigrade.
Since the intrinsic factor acts only in a pH of seven, it would seem that it would of necessity be useful only in an area of the digestive tract that is neutral or be altogether non-useful to man. Inasmuch as the secretions of the gastrointestinal tract of man are either acid or alkaline, where would the intrinsic factor be useful? Is this a real substance or the result of poor digestion and absorption? When most of the stomach is removed because of gasrtic ulcer or cancer, pernicious anemia will develop in two to seven years. Is this really due to a lack of intrinsic factor or poor digestion due to a lack of secretions in general?
We know that patients who have been on vitamin B-12 injections for years without much benefit can take a fast and get well. This would seem to indicate that they still had the power to secrete the so-called intrinsic factor. It would also indicate that, perhaps, they were suffering with a simple gastritis, and that after fasting the inflammatory condition healed, leaving them better able to secrete the necessary enzymes for good digestion. We do know the anemic get well while fasting and stay well if they continue to live properly. Why they get well could be due to a number of factors. The blood picture improves while fasting, though no extraneous vitamin B-12 is available.
Highly important, I believe, is die elimination of the toxic factor while fasting. This removes a great inhibiting influence from the blood-forming tissues. After the fast, these subjects are fed properly combined foods of vegetable origin. Properly combining their foods enables them to digest and absorb all elements in the diet. If their gastric mucosa is damaged or atrophied, as in long standing cases, feeding foods in compatible combinations will not place a burden on the impaired organ and better nutrition is maintained despite the handicap.
Hygienically, it is thought that toxemia plays an important role in the production of pernicious anemia. Toxemia itself causes lowered functioning power, not only of the secreting glands of the stomach, but of every organ in the body, including the blood-forming organs. Lowered functioning power of the gastrointestinal system hinders digestion, causing much fermentation and putrefaction. This in turn interferes with absorption of nutriments necessary for the production of blood and also causes the absorption of toxic products of indigestion, producing more toxemia which in turn causes more lowered functioning power and consequently less digesting and blood forming power.
Much ado is made of the vegans in England who supposedly after a few years develop pernicious anemia because of a lack of animal proteins in their diet. It is said that they do not develop the blood condition but that they develop the more serious troubles, such as degeneration of the spinal cord and brain. These symptoms, they say, may be developing so insidiously that the vegan may have a serious case of pernicious anemia before he realizes it. Better Nutrition (Nov. 1966, p. 11) advocates that the vegan take vitamin B-12, in extremely small amounts daily, so that this can be prevented. Thus, the big scare is going around that leads the uninformed to believe that man must be a carnivore or he must take vitamins.
Some of the vegans in England, we are informed, are of the tea and white flour biscuit type. Vegans not only abstain from flesh foods, but also from wearing anything of animal origin. This is to emphasize that they are vegetarians for ethical reasons only. I am not stating this with any maliciousness, but only to show that they have not given too much thought to their health, only to the welfare of animals. Therefore, they eat anything they like in any kind of combination that pleases the taste buds. No dietary precautions are taken _ such as getting whole grain foods or raw fruits and vegetables, or a good source of proteins. Their diet is lacking in more than one essential element. Vegans in America who also practice Hygienic living have splendid health. Man does not have to eat animals to get his vitamin B-12.
Vitamin B-12 is necessary in minuscule amounts. This, regardless of what the "authorities" say, we can get in our vegetable foods. We can store enough B-12 in the liver to last approximately two years or more. Some people who have had a total gastrectomy for one reason or another, do not develop pernicious anemia until seven or eight years after the operation. We can store a tremendous amount of vitamin B-12, or we need it in even smaller amounts than thought necessary at present. Guyten states that our minimum daily requirements is less than one microgram a day. People with good digestion and on a wholesome diet probably need less than that.
The question is: can we get it from vegetables? I say yes. We need it in infinitesimal amounts and if one is eating a diet predominating in fresh fruits, vegetables and nuts in the uncooked state, he will get sufficient vitamin B-12 to maintain him in good health for a lifetime.
Most sources state that vegetable products show no "measurable activity" when speaking of this vitamin, called cobalamin for short. "No measurable activity," does not mean that there is none at all in the vegetable. Best and Taylor state that: "The extrinsic factor (vitamin B-12) is present in liver, beef, rice polishings, yeast and other substances rich in the vitamin B complex." They continue that: "It is also found in the intestinal contents of normal persons, as well as in the feces of patients with pernicious anemia. There is, therefore, no reason to believe that a dietary deficiency of this factor is the cause of the disease."
Other authorities also condemn vegetable foods as lacking in vitamin B-12, but they never state that there is no vitamin B-12 in vegetable foods. Indeed, I think they are hiding the truth. The meat packing industry, who furnishes the money for these latest experiments, has the researchers minimizing the amount of vitamin B-12 found in vegetables and nuts. I hold that if it is not in fresh fruits, vegetables and nuts and bacteria do not manufacture it where man can absorb it, then man does not need it. The diet to which man is constitutionally adapted should furnish all the requisites of good nutrition. If it isn't present in the diet and bacteria do not produce it where it is absorbable by man, then what can we think except that nature must have made a big mistake.
The Cyclopedia of Medicine makes the following statement about cobalamin: "The vitamin B-12 requirements of man are obtained from foods, mainly those of animal protein origin: kidney, liver, heart and muscle meats being the richest sources; but lesser amounts occur in other foods, including eggs, cheese and milk. Vegetables contain practically no vitamin B-12, in contrast to their high content of folic acid." Here again we note some hedging. In contrast to the folic acid content, vegetables have practically no vitamin B-12 content. They do not state that there is no vitamin B-12 what-so-ever in vegetables.
Which vegetables do they use and are they cooked when the assay is made? Under what conditions were the tests made? A change in conditions will many times change results and produce errors in thinking. Are they sincerely trying to find it in vegetable products or are the researchers trying to satisfy their backers by finding the demanded results. Furthermore, no one gives us any information about nuts. They only contrast animal products to vegetables. What about fruits and nuts? Not until we are furnished with a reliable source of information, and not until they have tested all fruits, vegetables and nuts can we say that vegans are unable to get vitamin B-12 in their diet.
Although we only need one microgram a day, Adele Davis in Let's Get Well asserts that the strict vegetarian should take 50 grams of cobalamin (vitamin B-12) a week, "while their stomach secretions are still normal," thus implying that in time on the vegetarian diet, they I will soon develop abnormal stomachs. She states that of the vegetable foods, only "yeast, wheat germ and soybeans contain appreciable traces of vitamin B-12." Evidently she is misinformed, for it is stated in Boyd's pathology that vitamin B-12 is found in ground nuts (peanuts). However, he also has the idea that it is found in only one or two vegetable foods.
Experiments made not so many years ago * by Berg, who was not subsidized by special interests, showed that growth will be normal in animals who have a supply of fresh fruits and vegetables. White, Handler, Smith and Stetten in their Principles of Biochemistry state that: "The requirement of cobalamin is so minute that its wide distribution in foodstuffs and retention by the animal organism would seem to preclude the possibility of nutritional deficiency in normal individuals."
Berg states that vitamin B complex is present in a large number of foodstuffs and Best and Taylor state that vitamin B-12 is found in every food which has vitamin B complex in it; so, vegetables have vitamin B-12 in them even if in small amounts. I have already shown that we only need small amounts of cobalamin and that normal people have the ability to concentrate it and absorb it readily.
Berg states that: "The following whole grains and other seeds contain considerable amounts (of B complex): oats, maize, wheat, barley, malted grain, beans, soy beans, earthnuts, pulses generally, cotton seeds. Cajori reports that to maintain growth in rats, 0.5 gramme of chestnuts, walnuts or hickory nuts, 2 gramme of pine kernels, hazel nuts or Para nuts, and nearly 3 grammes of almonds were requisite. According to McCollum and Simmonds, seeds in general contain large quantities of B, the _ husks and the brans being especially rich in this substance, which can easily be extracted therefrom." . . . "Aron insists that fresh fruits contain plenty of B. Plums, pears and apples are not conspicuous in this respect; but cocoanut cake, oranges and lemons contain large quantities; and according to Osborne and Mendel, orange juice is as effective in this respect as fresh milk.
"All observers are agreed in describing cabbage as peculiarly rich in B; so are green vegetables in general. According to Osborne and Mendel, one gramme of the dried substance of lucerne or spinach contains as much B as do 2 grammes of wheat, soy beans, eggs or milk; white cabbage, clover and timothy grass are about equal to spinach. According to Steenbock, Gross and Sell, and according to Osborne and Mendel, among the last named, clover is the richest in B. Lucerne contains nearly as much, but the amount in spinach, tomatoes, cabbage, kohlrabi, carrots, and potatoes, is only half as great, and that in beetroots is less _ all measured in the dried state. The dried substance of 16 cc of milk has the same efficacy as 1 gramme of dried spinach. According to Osborne and Mendel, confirmed by Whipple, onions are fairly rich in B. So are turnips, mangel-wurzels, the leaves of the same, and tomatoes, very rich in B; and according to Steenbock, Gross and Sell, in an artificial diet, !
15 per cent of carrots, swedes, or the rhizomes of Arum maculatum (lords and ladies), will suffice to maintain normal growth, when sweet potatoes were used instead of the carrots, etc., 20 per cent was requisite; of sugar beet or of mangel-wurzel, even more was needed." While it is true that Berg was speaking of vitamin B complex, it is nonetheless true that where vitamin B complex is found, there also is found B-12, even if in small amounts.
B complex is fairly insensitive to heat, but is water soluble and will be found in the juices of vegetables which are thrown away in many households. During the cooking process of meat, 20 to 50 per cent of vitamin B-12 is lost, according to authorities. Can we not assume that much of this vitamin in vegetables is also lost in the cooking process and that by eating more raw fruits, vegetables and nuts more vitamin B-12 will be saved.
Some animals, such as fowl, get cobalamin by eating manure which is a rich source. Ruminants are furnished B-12 or cobalamin by microorganisms which produce it in their digestive tracts; but in slighted man, vitamin B-12 is only synthesized by microorganisms in the large bowel where it can't be absorbed. Absorption of vitamin B-12 in man, we are taught, takes place mainly in the terminal ilium. It seems that man has no alternatives except to take pills or eat dead animal organs or worse yet, become a coprophagist and eat feces, or die of pernicious anemia. If we have to become coprophagists and eat dung, activated sewage sludge, dried estuarine mud, dead parts of animals, and vitamin pills to derive so-called essential nutrients for life, strength and health, then something is surely wrong. Nature did not look out for man.
A few years ago nutritionists urged people to take calcium and phosphorus because that's the stuff teeth and bones are made of. Now recent studies say we can't make teeth even if we have an abundance of calcium and phosphorus, without magnesium. The fact is the chemistry of the body is almost as unknown today as it was a hundred years ago. No one can get into a live cell and watch the chemical activities going on, so no one really knows what man needs or the proportions that he needs these things in. We only know that a simple natural uncooked diet of green vegetables, fruits and nuts grown in good soil without sprays, will furnish all the necessary vitamins and minerals, and in the proper proportions. If man observes proper food combining and does not hamper digestion in any way, and maintains emotional poise, then he will be able to extract from live foods all the elements necessary for health, strength and long life.
While producing commercial aureomycin, the organism streptomyces aureofaciens is grown in a culture medium to induce the production of the largest amount of the antibiotic. The antibiotic is then extracted from the total products of the bacteria, thus leaving a residue. Naturally, all chemists serving commercial interests, must find some use for the residue. Vitamin B-12 was part of the residue; hence, a market must be made for it. Could this be one of the reasons why we must either eat flesh or take vitamin pills?
Let us get back to pernicious anemia. Before the medical profession had liver, liver extract and vitamin B-12, pernicious anemia was "progressively and uniformly" fatal under their care. Under Hygienic care, as far back as 60 years ago, Weger says: "The only cases of pernicious anemia that fail to respond favorably to Hygienic methods are those in which the heart muscle has degenerated and in which a general dropsical condition has existed for a long time, accompanied (as is often the case) by cerebral manifestations or mania and profound hemolytic jaundice. These advanced symptoms indicate that the organism has passed beyond the power of recuperation because of nutritional devitalization." Dr. Hay in his Health Via Diet tells of his 101 cases of pernicious anemia where only eight failed to recover. Dr. Hay says of these: "The blood during a fast undergoes no visible changes as to cell count unless markedly abnormal when the fast is begun in which case there is a return to normal." For most of two weeks (in progressive pernicious anemia) the red erythrocyte count continues to fall before there is a regeneration in the blood-making organs; then gradually the microscopic picture begins to show round erythrocytes with regular edges, no crenations or irregularities, and soon there is noticeable increase in the number of these with gradual disappearance of the adventitious cells present in the beginning.
"Not unusually there is a gain during the succeeding two weeks that brings the total back to the normal five million erythrocyte count, even though this may have been at, or below, one million in the beginning." At the Tilden Health School 75 per cent of the cases recovered and of the deaths he says: "The deaths, which represent the 25 per cent, occurred within a few days of admission to the institution. These cases were so far gone that nothing could be done, and no treatment was attempted, as they were dying when admitted." Medical treatment makes of the patient a physiological cripple. It does not remove the cause of the disease; hence, the gastric condition is not corrected so that his nutritional status remains poor, to say the least, and the gastric condition which is not corrected very often progresses to cancer and an early death.
Dr. Virginia Vetrano