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Multiple Myeloma, Pernicious Anemia, PCD and B12 Deficiency

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Vitamin B12 deficiency was prevalent in patients with PCD (multiple myeloma), especially in patients with the IgA subtype. Serum vitamin B12 measurements should be part of the initial evaluation and subsequent workups for anemia in patients with PCD.

Living with multiple myeloma, in my opinion, requires many types of therapies- FDA approved conventional therapies of course, but also evidence-based, non-conventional therapies such as exercise, nutrition, supplementation and other lifestyle therapies. Vitamin B12 may be one such therapy.

When it comes to any therapy that hasn’t been prescribed by your oncologist, it is difficult to know what is truly important and what may be a fad or anecdotal. This is why blog posts on PeopleBeatingCancer contain links and excerpts to research and other forms of content that talk about what I am blogging about.

Vitamin B12 is an example of one of the therapies that is not thoroughly studied by conventional oncology and therefore can be regarded with skepticism. Is it really essential to supplement with vitamin B12?  Or is B12 something that isn’t really important to MMers. Why or why not?

If you read the first two studies linked and excerpted below, low serum levels of vitamin B12 do not cause multiple myeloma. But low B12 levels in a person’s body are associated with multiple myeloma.

Like vitamin D3, research has not shown a direct link between vitamin B12 and MM. The challenge of each MMers then is to think about risks and rewards. Low blood levels of vitamin B12, D3, other vitamins, and minerals, may increase the risks of health problems. But many MMers reading this may already take various supplements and may want more reasons for adding one more capsule to their supplement regimen.

I decided to research the impact of low vitamin B12 blood levels for those health issues that are important to me as well as most MMers.

Like many supplements, it is less about how much a person supplements daily and more about how much of the supplement is absorbed into one’s bloodstream. Therefore you have to undergo a blood test in order to learn your blood levels of B12, vitamin D3, etc. I use Labcorp. for my DIY blood testing because it is inexpensive and convenient to me but there are other methods as well.

I prefer sublingual B12 to enhance absorption. I consume several nutritional/food forms of B vitamins and therefore supplement a relatively low dose of only 1 mg. I take Life Extension B12.

Did you have low serum B12 levels when you were diagnosed with MM? Did you have anemia when you were diagnosed? Please scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Pernicious Anemia: Symptoms, Diagnosis, and Treatment

“The deficiency of the type B12 vitamin that occurs from the uptake of impaired vitamin B-12 results in Pernicious anemia. This basically occurs due to the presence of very little B12 vitamin in the body. The B12 vitamin helps in making healthy red blood cells. Besides creating red blood cells it also keeps the nerve cells healthy. This type of vitamin is generally found in different animal foods including fish, meat, milk, eggs and even dairy products. One of the major causes behind the occurrence of pernicious anemia is the loss of the stomach cells…”

Rapid Onset of B12 Deficiency in the Setting of Worsening Multiple Myeloma: Correlations between B12 Deficiency and Multiple Myeloma.

“A 67-year-old female with a relapse of multiple myeloma after being in remission for approximately 2 years following autologous stem cell transplant presented with worsening pancytopenia, over a three-month period. There was an increase in her monoclonal spike at 3.13 g/dL on serum protein electrophoresis, low serum B12 levels, and positive intrinsic factor antibodies.

Three months before, she had normal B12 levels and a significantly lower monoclonal spike of 1.07 g/dL. She was diagnosed with B12 deficiency with pernicious anemia in the setting of her worsening myeloma. Multiple myeloma (MM) has been linked with B12 deficiency and pernicious anemia.

Several mechanisms have been described regarding the pathogenesis of B12 deficiency in such patients. Increased tumor activity can further perpetuate the development of B12 deficiency in such patients. With regard to our case, the increase in tumor activity and the onset of pernicious anemia could have contributed to the rapid development of B12 deficiency. In contrast to this, a rapid development of B12 deficiency could also signify relapse or worsening of the myeloma as seen in our case. Physicians ought to consider B12 deficiency in patients with worsening pancytopenia and myeloma.”

Prevalence of vitamin B12 deficiency in patients with plasma cell dyscrasias: a retrospective review.

“To the authors’ knowledge, the prevalence of vitamin B12 deficiency among patients with plasma cell dyscrasias (PCD) is largely unknown. Identifying this vitamin deficiency in such patients could help improve their anemia and increase their tolerance to potentially neurotoxic agents

Results: Of the 664 patients whose medical charts were reviewed, information on vitamin B12 status was available for 522 patients (78%). Among these 522 patients, 71 (13.6%) had laboratory-defined vitamin B12 deficiency and the remaining 451 patients (86.4%) did not…

Conclusion: Vitamin B12 deficiency was prevalent in patients with PCD, especially in patients with the IgA subtype. Serum vitamin B12 measurements should be part of the initial evaluation and subsequent workups for anemia in patients with PCD…”

Vitamin B12 deficiency anemia

Vitamin B12 deficiency anemia, of which pernicious anemia is a type,[8] is a disease in which not enough red blood cells are present due to a lack of vitamin B12.[5] The most common initial symptom is feeling tired.[4] Other symptoms may include shortness of breath, pale skin, chest pain, numbness in the hands and feet, poor balance, a smooth red tongue, poor reflexes, depression, and confusion.[4] Without treatment, some of these problems may become permanent.[5]

Pernicious anemia, due to lack of intrinsic factor, is not preventable.[10] Vitamin B12 deficiency due to other causes may be prevented with a balanced diet or with supplements.[10] Pernicious anemia can be easily treated with either injections or pills of vitamin B12.[7] If the symptoms are severe, injections are typically recommended initially.[7] For those who have trouble swallowing pills, a nasal spray is available.[7] Often, treatment is lifelong.[11]

Sublingual/intranasal delivery[edit]

Sublingual treatments have also been postulated to be more effective than oral treatments alone. A 2003 study[59] found, while this method is effective, a dose of 500 micrograms of cyanocobalamin given either orally or sublingually, is equally efficacious in restoring normal physiological concentrations of cobalamin…”

Plasma cell dyscrasia

Plasma cell dyscrasias (also termed plasma cell disorders and plasma cell proliferative diseases) are a spectrum of progressively more severe monoclonal gammopathies in which a clone or multiple clones of pre-malignant or malignant plasma cells (sometimes in association with lymphoplasmacytoid cells or B lymphocytes) over-produce and secrete into the bloodstream a myeloma protein, i.e. an abnormal monoclonal antibody or portion thereof…

At one end of this spectrum of hematological disorders, detection of one of these myeloma proteins in an individual’s blood or urine indicates the presence of a common and clinically silent disorder termed MGUS, i.e. monoclonal gammopathy of undetermined significance. At the other end of this spectrum, detection of the myeloid protein indicates the presence of a hematological malignancy, i.e. multiple myeloma, Waldenström’s macroglobulinemia, or other B cell-associated neoplasm, that derives stepwise from its MGUS precursors.[1][2]..”



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