In our earlier article we have written about role of Stomach acid in iron absorption and iron deficiency anemia. You must know that what you put in your mouth should be properly processed to be absorbed in your body. Otherwise how much you ingest will simply pass out through gastrointestinal tract. Vitamin B₁₂ and folic acid are two important nutrients for proper functioning of your body. Deficiency of which can lead to anemia apart from other health disorder. Megaloblastic anemia results from deficiency of either B₁₂ or folate. Although those nutrients don’t be absorbed in stomach, stomach plays important roles in processing them. Here you will know how stomach problems can cause anemia.

How stomach problems can cause anemia

Effects in vitamin B₁₂ absorption 

Vitamin B12 plays an important role in production of red blood cells. Lack of vitamin B12 impairs this process leading to form pernicious anemia along with some other health disoders.

Your body needs two important components to absorb vitamin B₁₂, gastric juice and intrinsic factor. Major food source of vitamin B₁₂ includes animal sources of food where it binds with protein. Your stomach acid or gastric juice should have normal ph level to separate it from protein binding of food. Antacid, proton pump inhibitor or other acid suppressing drug impair this process. (1,2,3)

And on the other hand parietal cells (the cells which secrete HCL in stomach) of the stomach secretes glycoprotein also called as intrinsic factor or gastric intrinsic factor. It prevents degradation of vitamin B₁₂ and combines with it and travels through small intestine. There it helps vitamin B₁₂ absorption in the small intestine. If your body unable to form intrinsic factor or if intrinsic factor unable to combine with Vitamin B₁₂, your body can’t absorb vitamin B₁₂. Intrinsic factor also present in gastric juice.

Conditions that impair B₁₂ absorption

Atrophic gastritis or inflammation in stomach lining mostly from bacterial infection mostly helicobacter pylori, impairs secretion of normal gastric juice and intrinsic factor.(4)

H. pylori infection causes loss of parietal cells which further impairs secretion of gastric juice and intrinsic factor. We have mentioned these in our previous article H. Pylori infection, and ulcers in stomach. In study, helicobacter pylori was detected in 77 (56%) of 138 patients with vitamin B₁₂ deficiency and eradication of H pylori infection successfully improved anemia and serum vitamin B₁₂ levels in 31 (40 %) of 77 infected patients. They concluded that H. Pylori infection is a causative agent in the development of adult vitamin B₁₂ deficiency. Eradication of H pylori infection alone may correct vitamin B₁₂ levels and improve anemia in this subgroup of patients.(5)

Surgical procedure of removing a part of stomach also increases risk of vitamin B₁₂ deficiency.(6)

So, for absorption vitamin B₁₂ normal function of stomach is necessary. Stomach infection or ulcer, weak gastric juice or inadequate secretion of intrinsic factor impairs the absorption process resulting to miss of the nutrient.

Folate or folic acid(B₉) absorption

Folic acid also has to be freed from its food binder to be absorbed in small intestine. And an environment of weak stomach acid and/or decreased ascorbic acid reduces folate absorption.(7, 8)

Atrophic gastritis results in malabsorption of folic acid but not in folate deficiency. But how can this be possible? (9)

In our earlier article we discussed about roles of stomach acid or gastric juice in relation to health complications including bacterial overgrowth. Weak stomach acid can make bacterial colonization in lower part or the stomach and also in small intestine. And small intestine is not designed for too much bacterial growth, so as the stomach. Some of bacteria in small intestine produce folic acid but some compete for intrinsic factor resulting to Vitamin B₁₂ deficiency. (10)Which is not a normal condition and responsible for developing anemia and some other health disorders.

Bottom Line:

So, processing of a nutrient in proper way in the body is very much important if you wish to get benefits from it. And in the same way although you ingest through mouth food with vitamin B₁₂ and folic acid you are likely to miss those nutrients if your stomach is not functioning properly. Earlier we have mentioned about roles of stomach acid or gastric juice in digestion, defense against pathogens, bacterial overgrowth and restoration which declines with age. However individual may have infection or ulcers in stomach. In most cases H. pylori plays the common role of stomach infection or ulcers. We also mentioned the roles of helicobacter pylori in infection in stomach and ulcers as well as natural ways of eradication of helicobacter pylori.

In such case individual having stomach infection or ulcers should go for restoration of gastric juice if tested low only after testing and removal the cause and healing from stomach infection or ulcers.

We hope this article will give an insight about how stomach problems can cause anemia.

Disclaimer: The above article is a generalized health information purpose only not for individual
with specific health condition. Individual may have varying experience to the same food based upon
heath condition, allergic reaction to foods.Any application of above methods should be under guidance 
of proper knowledgeable healthcare professional only.

Sources & references:
1.Harvard T.H.Chan, The Nutrition Source,Vitamin B12 Deficiency: Causes and Symptoms
2.Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12),Marcuard SP1, Albernaz L, 
Khazanie PG.,Ann Intern Med. 1994 Feb 1;120(3):211-5
3.Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with 
Zollinger-Ellison syndrome,Termanini B1, Gibril F, Sutliff VE, Yu F, Venzon DJ, Jensen RT.,
Am J Med. 1998 May;104(5):422-30
4.Autoimmune atrophic gastritis—pathogenesis, pathology and management,William L. Neumann,Elizabeth Coss,
Massimo Rugge, Robert M. Genta,Nature Reviews Gastroenterology & Hepatology volume 10, pages 529–541 (2013)
5.Helicobacter pylori—Is It a Novel Causative Agent in Vitamin B12 Deficiency?,
Kürşad Kaptan, MD; Cengiz Beyan, MD; Ali Uğur Ural, MD; et al,Arch Intern Med.  2000;160(9):1349-1353
6.https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/causes/
7.Absorption of Vitamin B12 and Folic Acid,Victor Herbert, M.D.,Department of Hematology, Mount Sinai Hospital
 and School of Medicine, New York, New York,Gastroenterology,January 1968Volume 54, Issue 1, Pages 110–115
8.Association of Helicobacter Pylori Infection and Serum Folate Levels in Sudan,Nazik Salah-eldin Ahmed1,
MahdiH. A. Abdalla,IOSR Journal of Dental and Medical Sciences (IOSR-JDMS),e-ISSN: 2279-0853, p-ISSN: 2279-
0861.Volume 16, Issue 5 Ver. X (May. 2017), PP74-76
9.Folic acid malabsorption in atrophic gastritis. Possible compensation by bacterial folate synthesis.,
Russell RM, Krasinski SD, Samloff IM, Jacob RA, Hartz SC, Brovender SR.,Gastroenterology. 1986 Dec;91(6):1476-82
10.Bacterial Overgrowth,Travis J. Rutland MD, Jack A. DiPalma MD, in GI/Liver Secrets (Fourth Edition), 2010

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