There, in addition to shoulder pain from the fall, he complained of numbness in his feet, along with general weakness and fatigue in the preceding few weeks. Blood tests showed the man had mild anemia, prompting the doctor to check his vitamin B-12 level, which was also low. This was puzzling.
The patient was a 20-year-old, seemingly healthy Asian man, whose omnivorous diet should have provided enough B-12 to sustain normal blood levels. That meant that the next likely cause was poor B-12 absorption through the stomach or intestines.
Besides pernicious anemia, which is marked...
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