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You may have a B12 deficiency. That can cause all sorts of weird symptoms: fatigue, ringing ears, numb or tingling feet and hands, palpitations, balance issues, hair loss, and more.

One of the causes of B12 deficiency is pernicious anemia (PA). Other causes can be drugs that deplete B12 (PPIs, H2 blockers, metformin, others) and gastric surgery.

Pernicious anemia is detected by testing for antibodies to intrinsic factor. Intrinsic factor requires stomach acid to work, and extracts B12 from food. Destruction of gastric cells is usually found in severe cases of PA, and sufferers usually have various stomach problems because they have no stomach acid.

Pernicious anemia is known to run in families. The H pylori bacteria has also been linked to it. The true cause isn't really known.

A separate blood test needs to be run to look for B12 deficiency. The full blood test does not include this, and the marker for deficiency (the MCV value) isn't always elevated until the deficiency is very severe. So you must ask your doctor to test B12, they don't always think of it. And then if a B12 deficiency is found, the cause needs to be determined because if it is pernicious anemia then treatment is needed for life.

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