Vitamin B12 Deficiency: All You Need to Know

Vitamin B12 is an essential nutrient that plays a crucial role in maintaining nerve function, producing DNA, and forming red blood cells. Despite its importance, vitamin B12 deficiency is surprisingly common and often goes unnoticed until it leads to severe health issues. That said, recognizing the early symptoms of this deficiency is vital for preventing long-term complications, which is why in this article, we explore the key signs of vitamin B12 deficiency, with an aim to empower you with the knowledge to take timely action and maintain optimal health. Let’s start with some basics. 

What is Vitamin B12 Deficiency?

Vitamin B12 deficiency occurs when there is an insufficient amount of vitamin B12 in the body. As vitamin B12 plays essential roles in maintaining nerve function, producing DNA, and forming red blood cells, its deficiency can adversely impact these functions., leading to various health problems.

How Common is Vitamin B12 Deficiency?

Vitamin B12 deficiency is relatively common, affecting a significant portion of the population worldwide. The prevalence can vary based on dietary habits, age, and health conditions. Studies suggest that up to 15% of the general population may have a vitamin B12 deficiency, with certain groups being at higher risk

Who is at Risk of Developing Vitamin B12?

Vitamin B12 deficiency can affect a wide range of individuals, but certain groups are at higher risk due to dietary, medical, and lifestyle factors. Understanding who is most susceptible can help in identifying and addressing the deficiency early.

Older Adults

As people age, their ability to absorb vitamin B12 from food decreases. This is often due to reduced stomach acid production, which is necessary for vitamin B12 absorption. Older adults are therefore more prone to developing a deficiency.

Vegetarians and Vegans

Vitamin B12 is naturally found in animal products such as meat, dairy, and eggs. Individuals who follow vegetarian or vegan diets may not consume enough B12 through their diet alone, increasing their risk of deficiency. Vegans, in particular, need to rely on fortified foods or supplements to meet their B12 needs.

People with Gastrointestinal Disorders

Certain medical conditions that affect the stomach and intestines can interfere with the absorption of vitamin B12. These include:

• Pernicious anaemia: An autoimmune condition that affects the stomach lining and reduces the production of intrinsic factor, a protein necessary for B12 absorption.
• Celiac disease and Crohn’s disease: These conditions damage the intestinal lining, impairing nutrient absorption, including vitamin B12.
• Gastric bypass surgery: Procedures that alter the digestive tract can reduce the ability to absorb vitamin B12.

Individuals with Certain Dietary Habits

People with diets low in animal products, such as those in certain cultural or religious practices, might be at higher risk. Additionally, those who consume highly processed foods lacking in essential nutrients can also be susceptible to B12 deficiency.

Pregnant and Breastfeeding Women

Women who are pregnant or breastfeeding have higher nutritional demands, including for vitamin B12. Those following vegetarian or vegan diets need to ensure they are getting enough B12 to support their own health and their baby's development.

Individuals Taking Certain Medications

Some medications can interfere with the absorption of vitamin B12, including:

• Proton Pump Inhibitors (PPIs): Used to treat acid reflux and heartburn, these medications reduce stomach acid, which is necessary for B12 absorption.
• Metformin: A common medication for type 2 diabetes, which can affect B12 absorption with long-term use.

Individuals with Excessive Alcohol Consumption

Chronic or excessive alcohol consumption can damage the stomach lining and interfere with nutrient absorption, including vitamin B12. This increases the risk of deficiency. 

Genetic factors

Some individuals have genetic mutations that affect their ability to metabolise vitamin B12, increasing their risk of deficiency even if their dietary intake is adequate.

What are the Symptoms of Vitamin B12 Deficiency?

Vitamin B12 deficiency can manifest in various ways, impacting multiple systems in the body. The symptoms may develop gradually and can be subtle initially, but they can become more pronounced and severe over time if the deficiency is not addressed.

Neurological Symptoms

• Numbness and tingling: Often starting in the hands and feet, these sensations are due to nerve damage.
• Balance issues: Difficulty maintaining balance and coordination.
• Memory loss: Problems with memory and cognitive function.
• Confusion: Mental fog, difficulty thinking clearly.
• Depression: Mood changes, including depression and irritability.
• Dementia: In severe cases, prolonged deficiency can lead to dementia.

Haematological Symptoms

• Fatigue: Persistent tiredness and lack of energy due to anaemia.
• Weakness: General physical weakness.
• Pale or jaundiced skin: Pale skin due to anaemia or a yellowish tint from increased bilirubin.
• Shortness of breath: Especially noticeable with physical exertion.
• Palpitations: Irregular heartbeats caused by the body's attempt to compensate for reduced oxygen-carrying capacity.

Gastrointestinal Symptoms

• Glossitis: Inflammation of the tongue, often described as sore and red.
• Mouth ulcers: Painful sores in the mouth.
• Loss of appetite: Reduced desire to eat, potentially leading to weight loss.
• Diarrhoea or constipation: Digestive disturbances.

Psychiatric Symptoms

• Mood swings: Unusual mood changes, including irritability and anxiety.
• Paranoia: Feelings of persecution without justification.
• Hallucinations: In rare, severe cases, individuals may experience hallucinations.

Developmental Symptoms in Infants

• Developmental delays: Infants may experience delays in reaching developmental milestones.
• Movement disorders: Difficulty with coordination and movement.
• Failure to thrive: Poor growth and weight gain.

Cardiovascular Symptoms

• Elevated homocysteine levels: This can increase the risk of cardiovascular diseases, including heart attack and stroke.

Recognizing these symptoms early and seeking medical advice can prevent long-term complications associated with vitamin B12 deficiency. If you suspect you have a deficiency, it is important to consult a healthcare provider for proper diagnosis and treatment.

How is Vitamin B12 Deficiency Diagnosed?

Diagnosing vitamin B12 deficiency involves a combination of clinical evaluation and laboratory tests. Healthcare providers consider a patient's symptoms, medical history, and dietary habits, along with specific blood tests to confirm the diagnosis. Here are the primary methods used to diagnose vitamin B12 deficiency:

Initial Assessment

• Symptom assessment: The doctor will evaluate symptoms such as fatigue, weakness, numbness, balance issues, and cognitive changes.
• Dietary review: Information about the patient's diet, especially regarding the intake of animal products, is important.
• Medical history: Any history of gastrointestinal issues, surgeries, or conditions that might affect nutrient absorption is considered.

Serum Vitamin B12 Test

This test directly measures the amount of vitamin B12 in the blood. Low levels confirm a deficiency. Normal serum vitamin B12 levels typically range from 200 to 900 picograms per millilitre (pg/mL), though the exact healthy range can vary.

Complete Blood Count (CBC)

A CBC can also be conducted to reveal signs of anaemia, such as a low red blood cell count or the presence of large, immature red blood cells (megaloblasts). In addition, doctors also check the level of MCV (mean corpuscular volume) as an elevated level indicates larger-than-normal red blood cells, which is characteristic of vitamin B12 deficiency anaemia.

Other Tests

In addition to the aforementioned, the doctor may also use various other tests such as:

• Methylmalonic Acid (MMA) test: Elevated levels of MMA in the blood or urine indicate a vitamin B12 deficiency, as this substance accumulates when B12 is insufficient.
• Homocysteine test: High levels of homocysteine in the blood are another indicator of vitamin B12 deficiency, as B12 is necessary for its metabolism.
• Holotranscobalamin (Active B12) test: This test measures the amount of vitamin B12 bound to transcobalamin, the form that can be used by cells, providing a more accurate assessment of B12 status.
• Intrinsic factor antibodies test: This test could be used to check for antibodies against intrinsic factor, a protein essential for vitamin B12 absorption, to help diagnose pernicious anaemia.
• Schilling test: Although less commonly used today, the Schilling test can determine whether the body properly absorbs vitamin B12. It involves administering a small amount of radioactive vitamin B12 and measuring its excretion in the urine.
• Bone marrow biopsy: In rare cases, a bone marrow biopsy may be performed to evaluate the production and development of blood cells, especially if severe anaemia is present and the cause is unclear.

Interpretation and Follow-Up

The healthcare provider interprets the test results in conjunction with clinical findings to confirm the diagnosis. If the initial tests suggest a deficiency, further tests may be conducted to identify the underlying cause, such as gastrointestinal disorders or dietary insufficiencies.

How is Vitamin B12 Deficiency Treated?

Treating vitamin B12 deficiency involves replenishing the body’s stores of the vitamin and addressing the underlying causes of deficiency. While the exact treatment approach depends on the severity of the deficiency, the presence of symptoms, and the cause of the deficiency, here are some primary methods used to treat vitamin B12 deficiency:

Vitamin B12 Supplements

• Oral supplements: For individuals with mild to moderate deficiency and no significant malabsorption issues, high-dose oral vitamin B12 supplements (typically 1,000 to 2,000 micrograms daily) are effective.
• Sublingual supplements: These are placed under the tongue and absorbed directly into the bloodstream, bypassing the digestive system. They are useful for those with mild absorption problems.
• Intramuscular injections: For severe deficiencies or when absorption is significantly impaired, vitamin B12 injections are administered. Initial treatment usually involves frequent injections (e.g., weekly) until levels normalise, followed by maintenance injections (e.g., monthly).

Dietary Changes

• Animal products: Increasing the intake of foods rich in vitamin B12, such as meat, fish, poultry, eggs, and dairy products, can help prevent and treat deficiency.
• Fortified foods: For vegetarians and vegans, consuming fortified cereals, plant-based milk, and nutritional yeast can provide necessary B12.
• Balanced diet: Ensuring a well-rounded diet that supports overall nutrient absorption and health.

Final Words

Vitamin B12 deficiency is a common yet often overlooked condition that can lead to serious health issues if left untreated. If you or someone you know has been experiencing symptoms of vitamin B12 deficiency or belongs to a high-risk group, waste no time in consulting a specialist at Max Hospitals, and receive world-class diagnostic, along with personalised treatment and guidance.