Poor B12 absorption could be pernicious anemia

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 this?

— R.B.

ANSWER» Vitamin B12 deficiency can be caused by low intake, although this is unusual. 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.

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.

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 started me at 25 mg and it worked. Now I’m on 100 mg.

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.

— V.C.

ANSWER» 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. 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 hair loss is an important cosmetic issue for men and women they are often willing to put up with side effects for effective treatment.

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Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.

Keith Roach