Dr. Roach: Poor B12 absorption could be pernicious anemia

Keith Roach
To Your Health

Dear Dr. Roach: My stepdad is 84 years old and having problems with B12 deficiency. He is taking B12 shots, 1,000 mcg once a week, in addition to taking a 5000 mcg B12 vitamin daily. The numbers come back below 200. None of our doctors can figure it out. Any advice on to what is causing this?

— R.B.

Dear R.B.: Vitamin B12 deficiency can be caused by low intake, although this is unusual. It’s seen occasionally in very strict adherence to a vegan diet without taking supplements. Otherwise, the major cause is poor absorption, especially by an autoimmune disease called pernicious anemia. Treatment can be either with B12 injection or very high dose of oral B12, and either is usually effective. Your stepfather is being treated with both, and his level below 200 in the blood confirms the lack of effect.

Unless he has been mistakenly given something other than B12 — double-check the labels for expiration and content — or the lab test has been done wrong, I cannot figure out why he should not be responding, and my literature search does not give any help.

Since I often get great advice from my readers, I would be happy to hear from any medical experts or smart laypeople on possible causes: email me at toyourgoodhealth@med.cornell.edu or post on my page at facebook.com/keithroachmd.

Dear Dr. Roach: I’m a 72-year-old female and have been taking Aldactone for several years for hair loss. I started losing hair when I was 55 years old. I read an article about Aldactone in a magazine and asked my primary doctor about the drug. He said I could try it. He started me at 25 mg and it worked. Now I’m on 100 mg, because over the years I needed more for it to be effective.

Please tell me the pros and cons of this drug. I’m afraid to stop and see what will happen. I don’t have any side effects other than being a little lightheaded right after I take the pill in the morning.

— V.C.

Dear V.C.: Spironolactone (Aldactone) is a commonly used diuretic. It is often used because unlike most diuretics, which lower blood potassium levels, spironolactone usually raises them. It has also been shown to be useful in some people with heart failure. However, it also blocks an androgen receptor and blocks the formation of testosterone. It is therefore used in some cases of female pattern hair loss. The most commonly used dose is 200 mg. It is effective in about half of women who try it.

Because of its diuretic effect, it can cause some lightheadedness. Potassium levels should be checked periodically. Some women will notice a decreased libido due to the decrease in androgens, and headache can be a problem. Women who still have their periods may notice irregularities.

My experience is that hair loss is such an important cosmetic issue for both men and women that they are often willing to put up with some side effects for effective treatment.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.