Vitamin B12 deficiency

Vitamin B12 plays a crucial role in:

• The formation of red blood cells.
• Maintaining healthy nerve cells and supporting normal brain function.
• DNA synthesis, contributing to overall cell division and growth.

Since the body relies on vitamin B12 to carry out these important bodily functions, a deficiency may cause some of the following symptoms:

• Extreme tiredness
• Pale or jaundiced skin
• Sore and red tongue
• Mouth ulcers
• Numbness and tingling
• Joint pain
• Muscle weakness
• Disturbed vision
• Dizziness and lightheadedness
• Poor balance and coordination
• Mood changes
• Memory problems and cognitive difficulties
• Digestive issues such as nausea, diarrhea, constipation, or loss of appetite
• Hyperpigmentation of skin (a condition where certain areas of skin are darker)

If you are experiencing any such symptoms, do not neglect them. Book a Vitamin Check Test.

Vitamin B12 is naturally found only in animal products like eggs, meat, fish, and dairy.

It adheres to the proteins in these food items, and then hydrochloric acid and enzymes in the stomach release it into its free form.

It also requires a special agent called intrinsic factor to be absorbed in the small intestine.

Vitamin B12 deficiency is caused by a lack of dietary intake or problems in its absorption. The various risk factors associated with these causes are discussed in the next section.

1. Inadequate dietary intake

• Animal-based foods, such as meat, fish, eggs, poultry, and dairy products, are high in vitamin B12. Deficiency is usually seen in:
• Adults: Vegans and vegetarians who do not consume these items
• Infants: Breastfeeding in infants with vitamin B12-deficient mothers
• Malnourishment

2. Insufficient absorption

This is the most common cause of vitamin B12 insufficiency. The following factors can contribute to insufficient absorption:

• Lack of intrinsic factor (a protein made in the stomach needed to absorb vitamin B12)
• Pernicious anemia (an autoimmune condition in which the body's immune system mistakenly attacks the cells in the stomach that produce the intrinsic factor)
• Gastritis (inflammation of the stomach lining leading to insufficient hydrochloric acid, which is required for vitamin B12 absorption)
• Decreased stomach acid (common among older people)
• Gastric bypass surgery
• Weight loss surgeries (bariatric surgery)
• Bacterial overgrowth in the small intestine
• Fish tapeworm infection
• Certain medications such as:
• Metformin (used to treat diabetes)
• Proton pump inhibitors (used to treat GERD and peptic ulcers)
• Histamine H2 blockers (used to reduce the amount of acid the stomach produces)
• Oral contraceptives (oral birth control pills)
• HIV infection

3. Increased requirement

In certain circumstances, your body may have increased requirements for folate, which can lead to a deficiency if you are unable to meet these demands. These include:

• Pregnancy
• Breastfeeding
• Hyperthyroidism
• Infancy
• Malignancy (cancer)

4. Conditions

• Crohn’s disease
• Celiac disease
• Diabetes
• Sjögren's syndrome
• Blood disorders like sickle cell anemia (an inherited condition affecting the abnormal development of red blood cells)
• Battling an infection or health condition characterized by high inflammation

Note: Premature babies (born before the 37th week of pregnancy) are also more likely to develop a folate deficiency because their developing bodies require higher amounts of folate than normal.

5. Age

Being an older adult due to poor nutrition, memory loss, rigid diet, or lack of access to care.

6. Family history

A family history of conditions like pernicious anemia can be a risk factor for vitamin B12 deficiency due to genetic predisposition.

Listen to our expert breakdown of Vitamin B12 deficiency for you. Watch the video.

Vitamin B12 deficiency can be diagnosed through a combination of clinical symptoms, medical history, physical examination, and laboratory tests. Here are the steps involved in diagnosing vitamin B12 deficiency:

1. Medical History and Physical Examination

Your doctor will ask you about your symptoms, medical history, and any relevant factors such as your diet and lifestyle. They will also perform a physical examination to check for signs associated with vitamin B12 deficiency.

2. Laboratory Tests

• Serum Vitamin B12 Test: Measures the total amount of vitamin B12 in your blood, including both active and inactive forms.
• Complete Blood Count (CBC): Measures the number of red blood cells, white blood cells, and platelets in your blood. Vitamin B12 deficiency can lead to anemia, and a CBC can help determine if your red blood cell count is low.
• Holotranscobalamin (holoTC) Test: Measures the active form of vitamin B12 in the blood to assess B12 deficiency more accurately.
• Functional Markers of B12: Testing methyl malonic acid (MMA) and homocysteine levels to evaluate vitamin B12 deficiency. Elevated MMA and homocysteine levels indicate potential B12 deficiency-related health risks.
• RBC Folate Test: A blood test that measures the level of folate (a B vitamin) stored in red blood cells. It is sometimes done alongside vitamin B12 testing because low folate levels can mimic the symptoms of vitamin B12 deficiency.
• Antibodies to Intrinsic Factors and Parietal Cells: Blood tests used to diagnose pernicious anemia, a common cause of vitamin B12 deficiency.
• Serum Gastrin Test: Checked in vitamin B12 deficiency to assess gastric health and rule out pernicious anemia, as abnormal levels may indicate autoimmune gastritis, which can lead to B12 malabsorption.

3. Imaging Tests

• X-rays: Used to assess bone density, which can be affected in severe cases of B12 deficiency, leading to conditions like osteoporosis.
• Magnetic Resonance Imaging (MRI): Can be used to examine the brain and spinal cord, particularly if symptoms like numbness, tingling, or balance problems are present. It can help identify structural changes related to B12 deficiency.
• Endoscopy: Involves the use of a flexible viewing tube to directly examine internal structures. It may be done to check for the destruction of stomach cells that produce intrinsic factors.

Book your tests with Tata 1mg.

Here are a few tips suggested to avoid vitamin B12 deficiency:

1. Add vitamin B12-rich foods to your diet

   The Recommended Dietary Allowance (RDA) for vitamin B12 is as follows:

   • For men and women, 14 years and older: 2.4 micrograms (mcg) daily.
   • During pregnancy: 2.6 mcg daily.
   • During lactation: 2.8 mcg daily.

   To meet these requirements, include animal-based sources of vitamin B12 in your diet. Good sources include:

   • Meat
   • Eggs
   • Poultry
   • Fish
   • Shellfish
   • Dairy products

   Fortified plant-based foods like cereals, plant-based milks, and nutritional yeast are great for vegetarians. Note: Currently, there is no established daily maximum dose of vitamin B12, as it is not toxic and has no harmful side effects in most individuals.

2. Consider vitamin B12 supplements

   If you're following a strict vegetarian or vegan diet, or have undergone gastric bypass surgery, B12 supplementation is necessary.

3. Be cautious of alcohol and certain medications

   Excessive alcohol consumption and long-term use of specific medications can interfere with vitamin B12 absorption. It is advisable to either stop or limit alcohol consumption. Consult your doctor for alternatives to medications that may cause vitamin B12 deficiency.

4. Take care of your gut

   A healthy gut microbiome can support the proper absorption of vitamin B12. Include fiber-rich foods in your diet and ensure to incorporate probiotics, which are beneficial bacteria capable of synthesizing B-group vitamins.

   Some examples of probiotic foods are:

   • Pickles
   • Traditional buttermilk
   • Fermented dairy products such as coconut milk yogurt and almond milk yogurt
   • Kefir (fermented milk drink)
   • Sauerkraut (fermented cabbage)
   • Miso (made from fermented soybeans, barley, or rice)
   • Tempeh

The duration and route of treatment vary depending on the underlying cause of the deficiency and the severity of the symptoms. Here are some common methods used to treat vitamin B12 deficiency:

• Dietary changes: If the cause of the deficiency is related to your diet, increasing your consumption of foods that are rich in vitamin B12 can be beneficial for mild cases of deficiency. Read more about diet in the prevention and home care sections.
• Oral Vitamin B12 supplements: For mild to moderate vitamin B12 deficiency, oral supplements are typically prescribed in the form of tablets or capsules. Shop for Vitamin B12 supplements.
• Systemic (Intravenous/I.V.) and Intranasal Vitamin B12 supplements: In cases of severe B12 or intrinsic factor deficiency, systemic B12 supplements may be prescribed. These supplements are administered directly into the bloodstream (Intravenous/I.V.) to bypass the digestive system and ensure absorption. Another option is a prescription nasal gel, which can be sprayed into the nose. Get guaranteed delivery of all your medications with India's most trusted and largest online pharmacy.

To obtain the recommended intake of vitamin B12, it is advisable to consume a diverse selection of foods, including the following options:

• Yogurt (Dahi): A great choice for vegetarians as it contains high levels of vitamin B12. Including yogurt in your diet can help alleviate symptoms of vitamin deficiency.
• Milk and other dairy products: Milk, along with cheese and paneer, is rich in vitamin B12, protein, calcium, and minerals. It is easily and rapidly absorbed in the stomach compared to other sources.
• Fortified cereals: Bran and whole wheat oats are excellent choices for vegans seeking vitamin B12. Regular consumption of fortified cereals helps raise vitamin B12 levels in the body.
• Fortified non-dairy milk: Soy and almond milk, though not naturally containing vitamin B12, are fortified to provide this essential nutrient.
• Nutritional yeast: Enriched with vitamin B12, fortified yeast adds a nutty flavor to food.
• Fermented foods: Comparable to tofu and high in vitamin B12, these can be eaten as a side dish with curries or soups.
• Eggs: An excellent source of vitamin B12, especially the egg yolks, which contain higher levels of the nutrient compared to the whites.
• Animal-derived food products: Foods such as fish (salmon, trout, sardines, and tuna), shellfish (like oysters and clams), meat (beef, lamb, pork, and chicken), and organ meats like liver are especially high in this vitamin.

Eating nutrient-rich food is not enough. Ensure your body can absorb these nutrients effectively. Try these tips:

Vitamin B12 deficiency can lead to various complications and health problems. Here are some potential complications associated with vitamin B12 deficiency:

• Anemia: Without sufficient vitamin B12, the body is unable to produce an adequate number of healthy red blood cells, leading to a condition known as megaloblastic anemia. Individuals who experience severe anemia are exposed to the following risks:
• Fast heartbeat (tachycardia)
• Heart failure (when the heart does not pump enough blood around the body)
• Neurological problems: Prolonged deficiency can lead to nerve damage, spinal cord damage, and various neurological complications that affect mental health.
• Risk of gastric cancer: The chances of developing stomach cancer may increase if you have a vitamin B12 shortage caused by pernicious anemia.
• Pregnancy complications: Vitamin B12 deficiency during pregnancy raises the chances of developmental issues and neural tube defects in the baby. It also heightens the risk of preterm birth, low birth weight, and other complications.
• Infertility: Vitamin B12 deficiency can sometimes cause erectile dysfunction in men and infertility or the inability to conceive in women. This usually improves with adequate vitamin B12 supplementation.
• Autoimmune disorders: The risk of developing an autoimmune disorder (a condition where your immune system attacks healthy cells) like type 1 diabetes, myasthenia gravis, Hashimoto disease, or rheumatoid arthritis can increase with this deficiency.

The following alternative and complementary approaches should not replace medical advice and can be used as an adjunct to conventional medical care:

• Homeopathy: Some homeopathic remedies are suggested for symptom relief in Vitamin B12 deficiency. It is essential to consult a homeopathic practitioner before starting any homeopathic remedy.
• Stress Reduction Techniques: Chronic stress can impact digestion and nutrient absorption. Engaging in stress reduction techniques such as meditation, deep breathing exercises, yoga, or mindfulness may support overall well-being and potentially enhance nutrient absorption.

Living with a vitamin B12 deficiency requires careful management and attention to your diet and overall health. Here are some suggestions to help you live with a vitamin B12 deficiency:

• Get diagnosed: Visit a healthcare professional to confirm the deficiency and determine the severity. They may recommend further tests to identify the underlying cause of the deficiency.
• Take supplements regularly: To restore your levels, your doctor may prescribe oral or injectable B12 supplements. Follow their dosage and frequency recommendations.
• Monitor your diet: Maintain a food diary to track your B12 intake and discover any inadequacies. This might assist you in identifying patterns and making appropriate adjustments.
• Go for regular check-ups: Schedule regular appointments with your doctor to monitor your B12 levels and overall health. They can guide you on necessary adjustments to your treatment plan.
• Be aware of symptoms: Stay vigilant for any symptoms of B12 deficiency and report any new symptoms to your doctor as soon as possible.
• Educate yourself: Learn about B12 deficiency, its causes, symptoms, and management options. This knowledge will empower you to make informed decisions about your health and work effectively with your healthcare professional.