Pernicious anaemia accounts for 80% of cases of megaloblastic anaemia due to impaired absorption of vitamin B12.

Vitamin B12 is present in meat and animal protein foods. Absorption occurs in the terminal ileum and requires intrinsic factor, a secretion of gastric mucosal (parietal) cells, for transport across the intestinal mucosa. In pernicious anaemia, intrinsic factor production is deficient. It is believed to be an autoimmune disease.

Parietal-cell antibody and antibodies to intrinsic factor are found in nearly all cases. 90% of patients have antibodies to parietal cells and their components, including antibodies to intrinsic factor and the proton pump H+/K+-ATPase. 50% of patients have thyroid antibodies.

Pernicious anaemia may be associated with simple gastric atrophy in 15% of people aged 40-60 years and 20-30% of the older population. Pathology shows gastritis with all layers of the body and fundus atrophied. The antrum is spared in >80% of patients (type A gastritis).

Helicobacter pylori infection has been mooted to be an initiating factor, with subsequent autoimmune changes affecting the gastric mucosa. Genetic susceptibility to this process has been suspected.
Epidemiology
The incidence of the disease is 1:10,000 in northern Europe. The disease occurs in all races. The peak age is 60, although it is starting to be recognised in younger age groups. [5] The condition is more common in those with blue eyes, early greying, a positive family history and blood group A. The condition has a female:male ratio of 1.6:1.0.
Presentation
• The onset is usually insidious as B12 stores in the liver are depleted, and starts with symptoms of anaemia, ie lethargy and breathlessness. The anaemia may be more severe than symptoms suggest, due to physiological adaptation.
• Other symptoms may include anorexia, weight loss, diarrhoea and dyspepsia. Glossitis may be an early symptom.
• Pernicious anaemia may first present as an incidental finding during the investigation of (reversible) diarrhoea.
• Neurological involvement may be present even in the absence of anaemia. This is particularly common in patients over the age of 60. The peripheral nerves are most commonly involved, followed by the spinal cord (subacute degeneration of the cord).
• Peripheral loss of vibratory sense and position are early indications of central nervous system (CNS) involvement, accompanied by reflex loss and mild-to-moderate weakness. Later stages may be characterised by spasticity, Babinski’s responses and ataxia.
• Other uncommon neurological symptoms include impairment of pain, temperature and touch sensations. The legs and feet are involved earlier and more consistently than the hands.
• Yellow-blue blindness may occur.
• Psychiatric symptoms (usually more prominent in advanced cases) may include depression, paranoia (megaloblastic madness), delirium, confusion and dementia.
• Signs may include anaemia and jaundice.
• Severely anaemic patients may present with heart failure, often triggered by an infection. Hepatomegaly and splenomegaly[8] may be present.
Differential diagnosis
Causes of vitamin B12 deficiency
• Poor-quality diet, vegetarian diet.
• Gastric causes – gastrectomy, congenital intrinsic factor deficiency.
• Intestinal causes – stagnant loop, congenital selective malabsorption, ileal resection, inflammatory bowel disease.
• Infestation – fish-tapeworm.
• Metabolic causes – transcobalamin II deficiency, nitrous oxide anaesthesia.
• Drugs causing decreased B12 levels – oral calcium-chelating agents,[3] aminosalicylic acid,[3] biguanides.
Causes of megaloblastic anaemia
• Folate deficiency – poor diet, goat’s milk,[9] gluten-induced enteropathy, tropical sprue, pregnancy, prematurity, chronic haemolytic anaemias (eg sickle cell anaemia), malignant disease, increased renal loss (congestive cardiac failure, dialysis), drugs (anticonvulsants, sulfasalazine).
Causes of macrocytosis
• Alcohol excess – the most common cause of macrocytosis in the UK; may co-exist with folate deficiency in spirit drinkers[11] (not seen in beer drinkers due to high folic acid content in beer[12]).
• Liver disease.
• Severe hypothyroidism.
• Reticulocytosis (eg post acute blood loss or haemolytic anaemia).
• Other blood disorders – red-cell aplasia, aplastic anaemia, myeloid leukaemia, myelodysplastic disorders.
• Changes in plasma proteins (eg increased paraprotein secondary to multiple myeloma) may cause a spurious rise in mean cell volume (MCV) without the presence of macrocytes.
• Drugs that affect DNA synthesis, e.g., azathioprine, hydroxyurea.

About Beer
Beer contains folate.
A 2005 Japanese study found that low alcohol beer may possess strong anti-cancer properties.
Moderate consumption of alcohol, including beer, is associated with a decreased risk of cardiac disease, stroke and cognitive decline.
Based on the following contents, the carbs in beer is higher with 0 fat (good fats are needed by the brain):
• Fat 0%
• Carbohydrates 90.9%
• Protein 9.1%
Brand Brewery Alcohol
(ABV) Calories 12 oz Carbohydrates (grams)
American Amber Lager Straub Brewery
4.1% 136 10.5g
American Lager Straub Brewery
4.1% 132 10.5g
American Light Straub Brewery
3.2% 96 7.6g
Anchor Porter Anchor
5.6% 209 *
Anchor Steam Anchor
4.9% 153 16.0g
Anheuser Busch Natural Light Anheuser Busch
4.2% 95 3.2g
Anheuser Busch Natural Ice Anheuser Busch
5.9% 157 8.9g
Aspen Edge Adolph Coors
4.1% 94 2.6g
Bard’s Gold (Gluten-Free) Bard’s Tale Beer Co
4.6% 155 14.2g
Bud Dry Budweiser
5.0% 130 7.8g
Bud Ice Budweiser
5.5% 123 8.9g
Bud Ice Light Budweiser
5.0% 115 7.5g
Bud Light Budweiser
4.2% 110 6.6g
Bud Light Lime Budweiser
4.2% 116 8.0g
Bud Light Platinum Budweiser
6.0% 137 4.4g
Budweiser Budweiser
5.0% 145 10.6g
Budweiser Black Crown Budweiser
6.0% 146 10g
Budweiser Select Budweiser
4.3% 99 3.1g
Budweiser Select 55 Budweiser
2.4% 55 1.9g
Miller Genuine Draft “64” MillerCoors
2.8% 64 2.4g
Milwaukee’s Best Light MillerCoors
4.2% 98 3.5g
Michelob Ultra Anheuser Busch
4.1% 95 2.6g

http://www.beer100.com/beercalories.htm

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Beauty tips: 5min to remove 5Million dead cells with redefine macroexfoliator. 2 months to erase dark spots, more affordable with Reverse regimen at http://www.clubalthea.myrandf.com, without the many healing days needed from a chemical peel.

2 min to care for your face before a shower in the morning and same in the evening. A beautiful face is important, wear it well even when we age. Vit C, A, D and E are important for your skin.

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for liquid iron, vegetarian with Vit C (taken in the morning as iron cancels the absorption of calcium)

————————-quote of the day—————————
One of my favorite American poets, Henry Wadsworth Longfellow, tells us: “He that respects himself is safe from others; he wears a coat of mail that none can pierce.” When we truly respect and love ourselves, it’s as if we have a shield of flexible armor made of metal rings and loops of chain that protects us.