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Vitamin B12 deficiency is a very common disease, due to inadequate food intake or problems with its absorption into the body. This article will provide you with all the information you need about vitamin B12 deficiency, its causes, and its treatment.
◉ What does vitamin B12 deficiency mean?
This condition occurs when your body does not get enough vitamin B12 due to low dietary intake or an absorption problem. We typically begin discussing vitamin B12 deficiency when its levels drop below 200 pg/mL in your blood.
Vitamin B12 deficiency can lead to serious physical, neurological, and psychological problems. The treatment will mainly depend on the cause and the supplementation of vitamin B12.
Studies indicate that 20% of people over 60 in the U.S. and the U.K. have a deficiency in vitamin B12, and it is more common in vegan communities.
◉ What is vitamin B12?
Vitamin B12 is a water-soluble nutrient which has an important role in your body:
- It's important to keep your nerves and red blood cells healthy.
- It helps the body to make the genetic material (DNA).
- It has a role in energy production.
Vitamin B12 is not made by the body, so you have to take it in animal-based food like meat, dairy, fish, poultry, and eggs (More information about vitamin B12).
◉ The normal level of vitamin B12
The recommended daily intake of vitamin B12 for adults is 2.4 micrograms. However, individual requirements may vary based on factors such as age, gender, medical conditions, and dietary habits.
Normal values may slightly differ between laboratories, but generally:
- The normal level of vitamin B12 in the body is more than 300 pg/mL.
- When the level drops below 200 pg/mL (or 148 pmol/L), it is considered a deficiency in vitamin B12.
Note: Up to 10% of adults with true vitamin B12 deficiency may have vitamin B12 values in the low-normal range (200 to 300 pg/mL), and only metabolite testing with homocysteine and MMA will reveal the deficiency.
◉ The causes of vitamin B12 deficiency
Many factors can contribute to a deficiency in vitamin B12, including:
- Low intake of vitamin B12 through food.
- Inflammation in the stomach lining (gastritis), leading to a reduction in hydrochloric acid (HCL), which plays a role in vitamin B12 absorption.
- Pernicious anemia: a medical condition where the body is unable to produce intrinsic factors needed for the absorption of vitamin B12 in the intestines.
- Digestive diseases such as Crohn's disease, celiac disease, or tapeworm infections.
- Gastric surgeries, such as the surgical removal of part of the stomach (gastric bypass) or intestines.
- Immune system disorders, such as Graves' disease or lupus.
- Some medications interfere with vitamin B12 absorption, including esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole.
◉ Symptoms of vitamin B12 deficiency
Vitamin B12 deficiency often develops slowly and worsens over time; it may take months or even years to exhibit dangerous signs. The symptoms can manifest as physical, neurological, or psychological issues.
◉ 1- Physical symptoms
The physical symptoms of vitamin B12 deficiency are general and may include:
- Tiredness and fatigue.
- Nausea and vomiting.
- Weight loss.
- Yellow-colored skin.
- Stomatitis (inflammation in the mouth and tongue).
◉ 2- Neurological symptoms of vitamin B12 deficiency
The neurological signs may include:
- Numbness or tingling in your hands and feet.
- Muscle cramps or weakness.
- Mental confusion or memory problems.
- Difficulty walking normally (unsteady movements).
- Vision problems.
It's important to note that if neurological problems are not treated properly, they may become irreversible.
◉ 3- Psychological symptoms
Psychological symptoms may include
- Depression.
- Irritability.
- Changes in behavior.
◉ 4- Vitamin B12 deficiency anemia
Vitamin B12 deficiency can lead to anemia as it is essential for the formation of normal, mature blood cells. This type of anemia is characterized by large red blood cells and is known as macrocytic anemia.
If you have some of these signs you may have vitamin B12 deficiency anemia:
- Dizziness.
- Pale skin.
- Low appetite.
- Fast heart rate.
- Muscle pain.
- Mood swings.
- Tingling or numbness in hands or feet.
◉ Laboratory test to assess vitamin B12 deficiency
The laboratory tests commonly used to assess vitamin B12 deficiency includ:
- Low Serum vitamin B12 level .
- Serum Folate Test: Folate deficiency can contribute to similar symptoms
- Complete Blood Count (CBC): Increased MCV, high RDW, decreased RBC count, decreased hemoglobin and neutropenia.
- Intrinsic Factor Antibody Test: Detects antibodies against intrinsic factor, a protein needed for vitamin B12 absorption.
- Methylmalonic Acid (MMA) Test: Increased serum methylmalonic acid (MMA) is an early manifestation of a negative vitamin B12 balance.
- Increased Homocysteine level.
- Schilling Test: this test is made by using a radioactive form of vitamin b12 to see if there is enough amount of intrinsic factor in the body, or not.
- Serum gastrin leve: A normal serum gastrin level excludes the diagnosis of pernicious anemia.
- Blood film: We can found macro-ovalocytosis and hypersegmented PMNs, Howell-Jolly bodies, Cabot rings.
◉ Treatment of vitamin B12 deficiency
The treatment of vitamin B12 deficiency is done on two levels, firstly treatment of the cause and secondly vitamin B12 supplementation. For certain individuals, a healthy and diversified diet can restore and correct deficiency. However, supplementing with vitamin B12 may be necessary.
Depending on the cause and the severity of the deficiency, the doctor has several options for supplementing vitamin B12, including cyanocobalamin, hydroxocobalamin, methylcobalamin, and adenosylcobalamin. Additionally, various administration routes are possible, including oral, nasal, and intramuscular injections.
◉ Possible complications
In most cases, vitamin B12 deficiency is easily treated with few complications. However, untreated cases may lead to serious complications, such as:
- Memory loss.
- An accelerated heartbeat may cause heart failure.
- Ataxia with problems in walking and speaking.
- Serious damage in the central nervous system.
- Temporary infertility.
- Stomach cancer in case of vitamin b12 deficiency caused by pernicious anemia.
◉ Conclusion
In summary, vitamin B12 deficiency can affect various bodily functions. Early detection through regular check-ups and awareness of risk factors is crucial. Fortunately, B12 deficiency is often manageable with dietary changes and supplements.