Deficiency can result when levels of vitamin B-12 are too low. This can lead to irreversible neurological symptoms. In the United States (U.S.), it is now thought that around 40% of the population are currently diagnosed with vitamin B-12 deficiency. In the UK, between 10 and 30% of the population are believed to suffer with low levels of vitamin B-12.
Facts on vitamin B-12
- Vitamin B-12 is important for brain function the synthesis of red blood cells.
- Deficiency of vitamin B-12 can lead to neurological difficulties and anaemia.
- People over the age of 14 should consume more than 2.4 micrograms (mcg) of vitamin B-12 daily.
- Vitamin B-12 is naturally available in meats, but people who do not eat meat, such as vegans, can obtain vitamin B-12 in supplement form.
What is vitamin B-12?
Vitamin B-12 is a water-soluble vitamin, like all other B-vitamins.
This means it can dissolve in water and travel through the bloodstream. The human body can store vitamin B-12 for up to four years. Any excess or unwanted vitamin B-12 is excreted in the urine.
Vitamin B-12 is the largest and most structurally complicated vitamin. It occurs naturally in meat products and can only be industrially produced through bacterial fermentation synthesis.
Vitamin B-12 can be found naturally in animal products, such as fish, meat, eggs, and dairy products. It does not typically occur in plant foods.
Good dietary sources of vitamin B-12 include:
- fish, especially haddock and tuna
- dairy products, such as milk, cheese, and yogurt
- some nutritional yeast products
Some types of soya milk and breakfast cereals are fortified with vitamin B-12.
It is always better to maintain a balanced diet and receive healthful amounts of nutrients before active treatment is required. The symptoms of diet-related deficiency are easily avoided with a healthful diet.
Vitamin B-12 is crucial to the normal function of the brain and the nervous system. It is also involved in the formation of red blood cells and helps to create and regulate DNA.
The metabolism of every cell in the body depends on vitamin B-12, as it plays a part in the synthesis of fatty acids and energy production. Vitamin B-12 enables the release of energy by helping the human body absorb folic acid.
The human body produces millions of red blood cells every minute. These cells cannot multiply properly without vitamin B-12. The production of red blood cells reduces if vitamin B-12 levels are too low. Anaemia can occur if the red blood cell count drops.
Vitamin B-12 deficiency symptoms
Unfortunately, symptoms of a vitamin B-12 deficiency can take years to show up, and diagnosing it can be complex. A B-12 deficiency can sometimes be mistaken for a folate deficiency.
Low levels of B-12 cause your folate levels to drop. However, if you have a B-12 deficiency, correcting low folate levels may simply mask the deficiency and fail to fix the underlying problem.
Deficiency can intensify over time. It can also come on relatively quickly. Vitamin B-12 deficiency symptoms may include:
- strange sensations, numbness, or tingling in the hands, legs, or feet
- difficulty walking (staggering, balance problems)
- a swollen, inflamed tongue
- difficulty thinking and reasoning (cognitive difficulties), or memory loss
While an experienced physician may notice the symptoms and be able to detect a vitamin B-12 deficiency with a good interview and physical exam, a blood test is needed to confirm the condition.
It’s a good idea to ask your doctor about having your B-12 level checked if you are a strict vegetarian or have had weight-loss surgery or have a condition that interferes with the absorption of food.
Early detection and treatment is important. If left untreated, the deficiency can cause severe neurologic problems and blood diseases.
Causes of vitamin B-12 deficiency
With age, it can become harder to absorb this vitamin. It can also happen if you have had weight loss surgery or another operation that removed part of your stomach, or if you drink heavily.
You may also be more likely to develop vitamin B-12 deficiency if you have:
- Atrophic gastritis, in which your stomach lining has thinned
- Pernicious anaemia, which makes it hard for your body to absorb vitamin B12
- Conditions that affect your small intestine, such as Crohn’s disease, celiac disease, bacterial growth, or a parasite
- Immune system disorders, such as Graves’ disease or lupus
- Been taking certain medications that interfere with the absorption of B12. This includes some heartburn medicines including proton pump inhibitors (PPIs) such as rabeprazole, omeprazole, esomeprazole, lansoprazole and pantoprazole; H2 Blockers such as cimetidine, famotidine and ranitidine; and certain diabetes medicines such as metformin.
You can also get vitamin B-12 deficiency if you follow a vegan diet (meaning you don’t eat any animal products, including meat, milk, cheese, and eggs) or you are a vegetarian who doesn’t eat enough eggs or dairy products to meet your vitamin B-12 needs. In both of those cases, you can add fortified foods to your diet or take supplements to meet this need. Diet-related deficiency is more rare than mal-absorption.
Treating vitamin B12 deficiency
Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12.
There are 2 types of vitamin B12 injections
The NHS states that at first, you’ll have these injections every other day for 2 weeks or until your symptoms have started improving.
Your GP or nurse will give the injections.
After this initial period, your treatment will depend on whether the cause of your vitamin B12 deficiency is related to your diet or whether the deficiency is causing any neurological problems, such as problems with thinking, memory and behaviour.
The most common cause of vitamin B12 deficiency in the UK is pernicious anaemia, which is not related to your diet.
If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be prescribed vitamin B12 tablets to take every day between meals.
Or you may need to have an injection of hydroxocobalamin twice a year.
People who find it difficult to get enough vitamin B12 in their diets, such as those following a vegan diet, may need vitamin B12 tablets for life.
Although it’s less common, people with vitamin B12 deficiency caused by a prolonged poor diet may be advised to stop taking the tablets once their vitamin B12 levels have returned to normal and their diet has improved.
If you’re a vegetarian or vegan, or are looking for alternatives to meat and dairy products, there are other foods that contain vitamin B12, such as yeast extract (including Marmite), as well as some fortified breakfast cereals and soy products.
Check the nutrition labels while food shopping to see how much vitamin B12 different foods contain.
If your vitamin B12 deficiency is not caused by a lack of vitamin B12 in your diet, you’ll usually need to have an injection of hydroxocobalamin every 2 to 3 months for the rest of your life.
If you have had neurological symptoms that affect your nervous system, such as numbness or tingling in your hands and feet, caused by a vitamin B12 deficiency, you’ll be referred to a haematologist and may need to have injections every 2 months.
Your haematologist will advise on how long you need to keep taking the injections.
For injections of vitamin B12 given in the UK, hydroxocobalamin is preferred to an alternative called cyanocobalamin. This is because hydroxocobalamin stays in the body for longer.
If you need regular injections of vitamin B12, cyanocobalamin would need to be given once a month, whereas hydroxocobalamin can be given every 3 months.
Cyanocobalamin injections are not routinely available on the NHS as hydroxocobalamin is the preferred treatment.
But if you need replacement tablets of vitamin B12, these will usually be in the form of cyanocobalamin.
Do you have any symptoms?
If you are concerned about your own health, maybe you have some of the symptoms of vitamin B12 deficiency, you can book into Medcare for a blood test to check your level of vitamin B12 and folate. If your test results come back and confirm the deficiency, you will be put onto a treatment plan.
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