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  Anemia, Megaloblastic  
 
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Megaloblastic anemia is a blood disorder characterized by red blood cells that are larger than normal resulting from certain nutritional deficiencies, absorption problems or other conditions. Problems with vitamin B12 and folic acid are the most common causes of megaloblastic anemia.

CAUTION: It is always important to discover the underlying deficiency that is causing a megaloblastic anemia. Higher doses of folic acid (greater than 1mg per day) may improve or mask the anemia caused by a B12 insufficiency. Unless the B12 deficiency is corrected, permanent nervous system damage may result. In other words, don’t treat a B12 deficiency with high doses of folic acid!
Pernicious Anemia
People with pernicious anemia loose their ability to make intrinsic factor (IF), a substance that enables vitamin B12 to be absorbed from the intestine. The result is vitamin B12 deficiency, which gradually affects sensory and motor nerves, causing neurological, gastrointestinal and cardiovascular problems. The disease can affect all racial groups, but the incidence is higher among people of Scandinavian or Northern European descent. Pernicious anemia usually does not appear before the age of 30, although a juvenile form of the disease can occur in children and is evident before the child is 3 years old.

Between 50 and 75% of patients with pernicious anemia have antibodies to IF, and 93% have antibodies to parietal cells which means this is another autoimmune disorder. Intrinsic factor and hydrochloric acid are produced by the parietal cells in the stomach. B12 from foods is released from its protein complex by the action of hydrochloric acid and enzymes. The secreted intrinsic factor then binds to B12 and this complex travels to the end of the small intestine where it attaches and is actively transported into the blood. B12 is stored in the liver after it is absorbed, and any excess is excreted in the urine. The body contains roughly a 3-year supply and 30% of that found in food is typically destroyed by cooking. The RDA for infants and children is 0.4 to 1.8mcg, for adults 2.4mcg, and for nursing and pregnant women 2.8mcg.

Causes of vitamin B12 deficiency

  • Deficiency of intrinsic factor (Pernicious anemia)
  • Stomach removal surgery
  • Pregnancy
  • Malabsorption (celiac disease, Crohn's, etc.)
  • Achlorhydria
  • H. Pylori infection
  • Being elderly
  • Unsupplemented vegan or raw food diets
  • Tapeworms
  • Excessive antibiotics or anti-convulsants
  • Megadoses of vitamin C and/or copper
  • Liver disease or cancer
Signs and Symptoms
  • Classic pernicious anemia due to lack of intrinsic factor
  • Progressive peripheral neuropathy with pronounced anemia
  • Fatigue
  • Depression
  • Confusion
  • Memory loss
  • Psychosis
  • Glossitis (inflamed tongue)
  • Impaired white blood cells response
  • Spinal degeneration and large red blood cells
Vitamin B12 Deficiency
Sometimes people who have adequate intrinsic factor may not get enough B12 in their diet. After many years, a B12 deficiency may show up on a B12 test or as anemia. This usually happens only on an animal-product-free (vegan, fruitarian, etc.) diet that is unsupplemented in some form with vitamin B12.

Food Sources of Vitamin B12
The best sources of B12 are liver, meat, salt-water fish, oysters, milk, eggs, aged cheese such as Roquefort, and fortified brewer's yeast. Vitamin B12 occurs naturally in the soil and on the surface of unwashed fruits and vegetables. Those on an animal-free diet may wish to eat unwashed, organic produce whenever possible.

There is debate over the reliability of non-animal sources of Vitamin B12. It was found that people on vegan diets had lower levels of serum B12 levels than the general population. In particular, infants breast-fed or fed a macrobiotic diet directly are at a great risk of developing B12 deficiency.

Non-animal sources which claim to have significant amounts of B12 such as tempeh, micro-algaes (spirulina, chlorella), miso, tamari, and sea vegetables (nori, arame, kombu, wakame) have been found to have negligible amounts or B12 analogues that show up on lab tests, but don't have the activity of real B12.

It should be noted that there are different techniques for measuring the B12 content of foods. Furthermore, the B12 content in fermented foods, such as tempeh, may be different due to varying production techniques. In Indonesia, traditionally-produced tempeh is loaded with B12-producing bacteria which grow on the molds commonly growing on the food. In the U.S., however, large scale production and improved sanitation decreases the mold and bacteria and the subsequent B12 content of the food. The most reliable non-animal, but natural, source of B12 seems to be fortified brewers yeast.

Nitrous oxide, a general anesthetic commonly used in dental offices and hospital operating rooms, can inhibit the action of B12 when tissue stores are low. This has become a health problem particularly for the elderly undergoing surgery that have been either undiagnosed or untreated for a deficiency. For this reason, doctors are encouraged to check for vitamin B12 deficiency by measuring both vitamin B12 as well as MMA in patients prior to surgery.

Nitrous oxide abuse remains a concern among certain medical personnel, teenagers and young adults who use it for its euphoric effects. Such abuse can lead to severe neurological damage to the spinal cord or peripheral nerves. [Science Daily November 5, 2004]

Folic Acid Anemia
Anemia from a folic acid deficiency occurs when folic-acid levels are low, usually due to inadequate dietary intake or faulty absorption. The need for this vitamin more than doubles during pregnancy. This is often not met by the diets of pregnant women, so a supplement of 400mcg to 1mg per day of folic acid is recommended throughout pregnancy.

You should ensure sufficient folic acid intake even when you plan to become pregnant. Adequate folic acid should be in your system when you conceive and during the first month you are pregnant. Low folic acid intakes have been associated with low birth weight and neural tube defects, such as spina bifida in babies. Folic acid deficiency can lead to infertility and an increased risk of infection. Also, a deficiency of this vitamin is seen frequently among elderly women, especially those who have poor diets.
 

 
 

Signs, symptoms & indicators of Anemia, Megaloblastic:
 
 
Lab Values - Cells  Macrocytic red cells
  Elevated MCH
 Decreased MCH is associated with microcytic anemia and increased MCH is associated with macrocytic anemia.


Counter-indicators:
  Normocytic/microcytic red cells

Lab Values - Common

  Rapid pulse rate

Lab Values - Nutrients

  Low folic acid level or history of folic acid deficiency

Counter-indicators:
  High/normal folic acid level

Symptoms - Cardiovascular

  Pernicious anemia or pernicious anemia, no longer treated

Counter-indicators:
  Absence of pernicious anemia

Symptoms - General

  Constant fatigue

Symptoms - Head - Mouth/Oral

  A sore tongue

Symptoms - Metabolic

  Having a slight/having a high/having a moderate fever

Symptoms - Nervous

  Numb/tingling/burning extremities
 A wide range of conditions including vitamin B12 deficiencies can damage peripheral nerves (peripheral neuropathy) and cause paresthesia.

Symptoms - Respiratory

  Always being short of/easily being short of breath

Symptoms - Skin - General

  Lighter/paler skin color
 
 

Conditions that suggest Anemia, Megaloblastic:
 
 
Autoimmune  Gluten Sensitivity / Celiac Disease
 Mild malabsorption may result in a vitamin B12 deficiency.

  Chronic Thyroiditis
 Pernicious anemia is more common in people who have other autoimmune diseases such as thyroiditis.

  Myasthenia Gravis
  Vitiligo

Digestion

  Hydrochloric Acid Deficiency
 An item called "intrinsic factor" may be in short supply because it also is made by the parietal cells which produce hydrochloric acid and pepsinogen. Intrinsic factor makes the absorption of vitamin B12 possible, and without it B12 deficiency sets in. This disease is called pernicious anemia. The hypochlorhydric stomach often makes insufficient amounts of intrinsic factor so B12 levels should be checked and a series of vitamin B12 injections given if needed.

  Atrophic Gastritis
 Gastric autoimmune disease has been classified into types A and B, based on the changes in different portions of the stomach. Patients with antibodies to parietal cells (PCA) or intrinsic factor, or both, have atrophy of the fundal mucosa (Type A) and a very high rate of pernicious anemia, often associated with other autoimmune endocrine disorders. In cases of Type B gastritis, PCA are lacking and there is no association with pernicious anemia or other autoimmune endocrine disorders.

Hormones

  Hypothyroidism
 Pernicious anemia is associated with other autoimmune conditions such as Hashimoto's disease, a form of hypothyroidism.

Immunity

  MGUS
 Some doctors believe that the fundamental cause of MGUS and Multiple Myeloma, without which all the diverse known risk factors [from benzene to paints and solvents, from hair dyes and asbestos, to pesticides and radiation] may not be potentiated, is a chronic, sometimes subtle deficiency of vitamin B12. Further details about this hypotheses can be reviewed here.

Doing things that could reduce the incidence of multiple myeloma may reduce the risk of MM associated with MGUS. These include increasing pacreatic enzyme intake, and the use of selenium and B12.

  Canker Sores (Aphthous Ulcers)
 See the link between apthous ulcers and iron deficiency.

Infections

  Yeast / Candida
 Vitamin B12, B6, biotin and folate help maintain candida in its non-invasive form. A B12 deficiency is one of several conditions that can stimulate candida growth.

Mental

  Depression
 700 women over 65 (most in their mid-70s) in the Women's Health and Aging Study were interviewed and had blood samples taken for analysis. Overall, 14% were mildly depressed and 17% were severely depressed. Blood tests revealed that a deficiency in vitamin B12 was relatively common. Of the severely depressed women, 27% were deficient in the vitamin, compared with only 17% of the mildly depressed women and 15% of their happier counterparts. [American Journal of Psychiatry 2000;157: pp.715-72]

Metabolic

  Tinnitus
 In one report, 47% of people with tinnitus and related disorders were found to have vitamin B12 deficiencies. Supplementation may therefore be of benefit. [Vitamin B12 deficiency in patients with chronic-tinnitus and noise-induced hearing loss. Am J Otolaryngol 1993;14: pp.94-9]

Musculo-Skeletal

  Osteoporosis / Risk
 March 3, 2004 – Older women with low levels of vitamin B-12 are more likely to experience rapid bone loss, according to new research published in The Journal of Clinical Endocrinology & Metabolism. The new findings help to establish the importance of vitamin B-12 in the bone health of women as they age.
 
 

Risk factors for Anemia, Megaloblastic:
 
 
Autoimmune  Hyperthyroidism
 Hyperthyroidism is one of the minor causes of B12 deficiency.

  Diabetes Type I
 Relatives of people with Type 1 Diabetes, as well as the sufferers themselves, run a risk of developing celiac disease. The resulting inflammation and tissue damage reduces vitamin B12 absorption and may lead to Pernicious anemia, which occurs in approximately 1 in 50 adults with Type 1 Diabetes.

  Autoimmune Tendency

Drug Side Effects

  Chemotherapy Side-Effects/Risks
 Some chemotherapy agents are known inhibitors of folic acid enzymes and as such can induce a megaloblastic anemia.

Infections

  Parasite Infection
 Different types of parasites can cause a deficiency of vitamin A, vitamin B12, and iron.

  Dysbiosis, Bacterial
 Abnormal bacterial populations may consume cobalamin, contributing to B12 deficiency states and resulting in megaloblastic anemia.

Lab Values - Chemistries

  High serum iron
 Elevated serum iron can occur as a result of pernicious anemia.

Lab Values - Nutrients

Counter-indicators:
  Elevated/normal B12 levels

Lab Values - Scans

  Having white matter lesions

Medications

  Birth Control Pill / Contraceptive Issues

Supplements and Medications

  PPI antacid use
 Prilosec (omeprazole) has been shown to decrease B12 absorption.

Omeprazole therapy will decrease the absorption of vitamin B12 by preventing its cleavage from dietary proteins. However, these data are insufficient to infer that clinically significant deficiency will occur over time. In fact, some of the studies suggest that the simple addition of juices or other acidic drinks into the diet may dramatically increase cobalamin absorption. Clearly, well-designed clinical trials are needed to evaluate this theory over an extended follow-up period to determine the clinical significance of omeprazole-associated vitamin B12 deficiency and possibly identify patients at risk for deficiency. In conclusion, the possibility of dietary vitamin B12 malabsorption should be considered in patients receiving chronic omeprazole treatment and presenting with signs and symptoms of deficiency. All healthcare workers should be made aware of the potential clinical complications of omeprazole-associated vitamin B12 deficiency since it may go unrecognized and is easily corrected. This is particularly relevant for elderly patients with poor dietary intake of vitamin B12, impaired vitamin B12 stores, and certain gastrointestinal disorders. [Ann Pharmacother. 1999 May;33(5): pp.641-3]

  (Past) H2-blocker antacid use
 H2-receptor blockers appear to impair the absorption of vitamin B12 from food. This is thought to occur because the vitamin B12 in food is attached to proteins. Stomach acid separates them and allows the B12 to be absorbed.

  High/typical Metformin use
 In a study of 390 patients with diabetes (type 2), the use of metformin, in addition to insulin, reduced serum folate and vitamin B12 concentrations and increased homocysteine levels, compared with placebo and insulin. [J Intern Med 2003;254(5): pp.455-463]


Counter-indicators:
  Routine/frequent B12 injections
  Vitamin B12 supplementation
  (Past) multiple vitamin supplement use

Symptoms - Food - Intake

  Dairy product consumption
 Vitamin B12 is generally found in foods of animal origin (meat, fish, poultry, eggs and dairy products).

Symptoms - Food - Preferences

  (Partial) vegetarian diet or vegan/raw food diet
 Vitamin B12 deficiency is the most common cause of megaloblastic anemia. Both low dietary consumption and poor absorption are responsible for the final outcome of a B12 deficiency, namely megaloblastic anemia and neurological symptoms.

The authors note that the vegan diet provides essentially no vitamin B12, and people following vegetarian diets may suffer from a deficit as well due to the lower levels in the diet. In addition, people consuming the vegan and vegetarian diets were in general also not getting adequate amounts of the essential amino acid methionine, due to the lower methionine content in plant proteins versus animal proteins. [Annals of Nutrition and Metabolism 2000;44: pp.135-138]

Serum vitamin B12 levels were 37% lower in the vegetarian group and 59% lower in the vegan group, compared with the omnivorous group. Serum B12 levels:
  • Vegetarians - 214.8 pmol/l
  • Vegans - 140.1 pmol/l
  • Omnivores - 344.7 pmol/l
In addition, B12 levels were low enough to be considered clinically deficient in:
  • 78% of the vegans
  • 26% of the vegetarians
  • 0% of the omnivores
Researchers compared homocysteine (Hcy) levels in 62 vegetarians, 32 vegans, and 59 people consuming an omnivorous diet. Compared to the omnivorous group, whose average Hcy levels were about 10.2 mmol/l, levels in the other groups were found to be:
  • More than 50% higher in the vegan group (15.8 mmol/l)
  • About 30% higher in the vegetarian group (13.2 mmol/l)
Serum folate levels were within the normal range for all three groups, although they were significantly lower in omnivores. The authors conclude that "The results show that the mild hyperhomocysteinemia in alternative nutrition is a consequence of vitamin B12 deficiency."

Nori, the seaweed, does appear to contain bioavailable forms of vitamin B12. [Br J Nutr 2001;852: pp.699-703]

Symptoms - Gas-Int - General

  Having had a small bowel resection
 Resection of the bowel increases the risk of vitamin B12 malabsorption. Even 7% to 10% of individuals with serum vitamin B12 levels in the 200-400pg/mL range have developed neuropsychiatric complications of vitamin B12 deficiency. Previously there was only concern when levels were below 200pg/mL.

  Had typical/had severe gastric bypass
 Since GBP surgery is both a restrictive and malabsorptive procedure, some vitamin and mineral deficiencies are to be expected by virtue of the surgical procedure itself. Vitamin B12 and iron are most often recognized as a potential deficiency after surgery, but more data are accumulating that copper, thiamine, calcium and vitamin D also bear monitoring. As both
obesity and the need for GBP surgeries rise, frequent assessment and treatment plans for nutrient deficiencies need to be established. [http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/nutrition-support-team/nutrition-articles/ODonnellArticle.pdf]

Tumors, Malignant

  Leukemia
  Multiple Myeloma
 
 

Anemia, Megaloblastic suggests the following may be present:
 
 
Autoimmune  Autoimmune Tendency
  Microscopic Colitis (Collagenous Colitis / Lymphoc

Cell Salts

  Cell Salt, Calc Phos Need

Drug Side Effects

  Chemotherapy Side-Effects/Risks
 Some chemotherapy agents are known inhibitors of folic acid enzymes and as such can induce a megaloblastic anemia.

Tumors, Malignant

  Leukemia
  Multiple Myeloma
 
 

Anemia, Megaloblastic can lead to:
 
 
Mental  Schizophrenia
 Mental symptoms of B12 or folic acid deficiency includes confusion, fatigue, poor memory, difficulty concentrating or learning, and mental lethargy. It can be mistaken for Alzheimer’s in older patients. Additional mental disturbances include: loss of alertness, drive, self-confidence, and independence, social withdrawal, nervous irritability, headaches, insomnia, moodiness, severe agitation, lack of coordination, anxiety, delusions of persecution, and mania. Deficiency may also induce auditory hallucinations, psychosis, and paranoia.
 
 

Recommendations for Anemia, Megaloblastic:
 
 
Lab Tests/Rule-Outs  Test for B12 Levels
 A vitamin B12 deficiency is the most common cause of megaloblastic anemia. When testing facilities are not available or cannot be afforded, intramuscular or sublingual B12, with or without folic acid, can be used to see if symptoms improve.

  Test CBC (Complete Blood Count)
 Often, the MCV (mean corpuscular volume) reported in a CBC will be elevated when a B12 or folic acid deficiency is present. As this is a common chosen screening test, it could be used as an indirect measure of a possible B12 or folic acid deficiency when the MCV is elevated.

  Test Folic Acid Levels

Vitamins

  Vitamin B12 (Cobalamine)
 Megaloblastic anemia is usually caused by a B12 deficiency, and only secondarily by a folic acid deficiency.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
Likely to help
Highly recommended







GLOSSARY

Achlorhydria:  The complete absence or failure of stomach acid secretion.

Amino Acid:  An organic acid containing nitrogen chemical building blocks that aid in the production of protein in the body. Eight of the twenty-two known amino acids are considered "essential," and must be obtained from dietary sources because the body can not synthesize them.

Anemia:  A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.

Anesthetic:  Agent causing loss of sensation by neurological dysfunction or a pharmacological depression of nerve function.

Antibody:  A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.

Anxiety:  Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.

Autoimmune Disease:  One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.

Bacteria:  Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.

Biotin:  An essential coenzyme that assists in the making of fatty acids and in the burning of carbohydrates and fats for body heat and energy. It is also essential for function of red blood cells and hemoglobin synthesis.

Calcium:  The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Candidiasis:  Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge.

Cardiovascular:  Pertaining to the heart and blood vessels.

Celiac Disease:  (Gluten sensitivity) A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.

Chemotherapy:  A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Cobalamin:  Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).

Copper:  An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.

Crohn's Disease:  Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.

Diabetes Mellitus:  A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.

Enzymes:  Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.

Folic Acid:  A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.

Gastritis:  Inflammation of the stomach lining. White blood cells move into the wall of the stomach as a response to some type of injury; this does not mean that there is an ulcer or cancer - it is simply inflammation, either acute or chronic. Symptoms depend on how acute it is and how long it has been present. In the acute phase, there may be pain in the upper abdomen, nausea and vomiting. In the chronic phase, the pain may be dull and there may be loss of appetite with a feeling of fullness after only a few bites of food. Very often, there are no symptoms at all. If the pain is severe, there may be an ulcer as well as gastritis.

Gastrointestinal:  Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.

Hallucination:  A false or distorted perception of objects or events, including sensations of sight, sound, taste, smell or touch, typically accompanied by a powerful belief in their reality.

Helicobacter Pylori:  H. pylori is a bacterium that is found in the stomach which, along with acid secretion, damages stomach and duodenal tissue, causing inflammation and peptic ulcers. Although most people will never have symptoms or problems related to the infection, they may include: dull, 'gnawing' pain which may occur 2-3 hours after a meal, come and go for several days or weeks, occur in the middle of the night when the stomach is empty and be relieved by eating; loss of weight; loss of appetite; bloating; burping; nausea; vomiting.

Hydrochloric Acid:  (HCl): An inorganic acidic compound, excreted by the stomach, that aids in digestion.

Hyperthyroidism:  An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.

Hypochlorhydria:  The condition of having low hydrochloric acid levels in the stomach, often the cause of digestive disorders.

Hypothyroidism:  Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.

Insulin:  A hormone secreted by the pancreas in response to elevated blood glucose levels. Insulin stimulates the liver, muscles, and fat cells to remove glucose from the blood for use or storage.

Iron:  An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.

Macrobiotics:  A lifestyle and diet adapted from the Far East and made known in America by Michio Kushi. The principles of the diet consist of balancing the yin and yang energies of foods. In brief, yin foods, such as water, are expansive, while yang foods, such as salt or meat, are constrictive. For the most part, the diet consists of whole grain cereals, millet, rice, soups, and vegetable dishes, with beans and supplementary foods depending on the individual and the condition. Different types of cancers are considered either yin or yang, and the macrobiotic program must be adapted to each individual.

Metabolism:  The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.

Methionine:  Essential amino acid. Dietary source of sulfur and methyl groups. Important for proper growth in infants, nitrogen balance in adults, healthy nails and skin and the synthesis of taurine, cysteine, phosphatidylcholine (lecithin), bile, carnitine and endorphins. It is an antioxidant nutrient and lipotropic agent which promotes the physiological utilization of fat.

Microgram:  (mcg): 1/1,000 of a milligram in weight.

Milligram:  (mg): 1/1,000 of a gram by weight.

Millimeter:  (mm): A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.

Mineral:  Plays a vital role in regulating many body functions. They act as catalysts in nerve response, muscle contraction and the metabolism of nutrients in foods. They regulate electrolyte balance and hormonal production, and they strengthen skeletal structures.

Mucosa:  Mucous tissue layer lining tubular structures (nasal passages, ear canal, etc.).

Nervous System:  A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.

Neural Tube:  The tube of tissue that lies along the central axis of the early embryo. It gives rise to the brain, spinal cord, and other parts of the central nervous system.

Neuropathy:  A group of symptoms caused by abnormalities in motor or sensory nerves. Symptoms include tingling or numbness in hands or feet followed by gradual, progressive muscular weakness.

Parasite:  An organism living in or on another organism.

Paresthesia:  A skin sensation, such as burning, prickling, itching, or tingling, with no apparent physical cause.

Pernicious Anemia:  Anemia caused by a vitamin B12 deficiency.

pg:  Picogram: 0.000000000001 or a million-millionth of a gram.

Placebo:  A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

RDA:  Recommended Daily Allowance of vitamins or other nutrients as determined by the FDA. U.S. RDAs are more widely used than RDAs, and focus on 3 age groups: Infants of 0-12 months; Children of 1-4 years; Adults and children of more than 4 years.

Red Blood Cell:  Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.

Selenium:  An essential element involved primarily in enzymes that are antioxidants. Three selenium- containing enzymes are antioxidant peroxidases and a fourth selenium-containing enzyme is involved in thyroid hormone production. The prostate contains a selenium-containing protein and semen contains relatively large amounts of selenium. Clinical studies show that selenium is important in lowering the risk of several types of cancers. In combination with Vitamin E, selenium aids the production of antibodies and helps maintain a healthy heart. It also aids in the function of the pancreas, provides elasticity to tissues and helps cells defend themselves against damage from oxidation.

Serum:  The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

Spina Bifida:  A nerve tube defect present at birth that results in a gap in the bone that surrounds the spinal cord. Spina bifida is relatively common, occurring about 10 to 20 times per 1,000 births.

Stomach:  A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.

Thiamine:  (Vitamin B-1): A B-complex vitamin that acts as a coenzyme necessary for the conversion of carbohydrates into glucose, which is burned in the body for energy. It is essential for the functioning of the nervous system.

Tinnitus:  A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.

Ulcer:  Lesion on the skin or mucous membrane.

Vitamin A:  A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.

Vitamin B6:  Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.

Vitamin C:  Also known as ascorbic acid, Vitamin C is a water-soluble antioxidant vitamin essential to the body's health. When bound to other nutrients, for example calcium, it would be referred to as "calcium ascorbate". As an antioxidant, it inhibits the formation of nitrosamines (a suspected carcinogen). Vitamin C is important for maintenance of bones, teeth, collagen and blood vessels (capillaries), enhances iron absorption and red blood cell formation, helps in the utilization of carbohydrates and synthesis of fats and proteins, aids in fighting bacterial infections, and interacts with other nutrients. It is present in citrus fruits, tomatoes, berries, potatoes and fresh, green leafy vegetables.

Vitamin D:  A fat-soluble vitamin essential to one's health. Regulates the amount of calcium and phosphorus in the blood by improving their absorption and utilization. Necessary for normal growth and formation of bones and teeth. For Vitamin D only, 1mcg translates to 40 IU.

White Blood Cell:  (WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.

Yeast:  A single-cell organism that may cause infection in the mouth, vagina, gastrointestinal tract, and any or all bodily parts. Common yeast infections include candidiasis and thrush.