Vitamin B12 Deficiency Symptoms and Treatment

In United States and the United Kingdom, 6%  people suffers from vitamin B12 deficiency. Among the over-65s, as many as one in four is affected. Possible consequences are fatigue, weakness, anemia and nervous disorders. Find out everything you need to know about the causes, symptoms and what you can do to combat the deficiency.

What do you need vitamin B12 for?

The human body needs vitamin B12 for energy metabolism, for the formation of blood cells and for building the nerve sheaths. However, humans cannot produce this vitamin themselves and absorb it primarily through animal products such as meat, fish, eggs and dairy products. In the body, vitamin B12 is then released by stomach acid and digestive enzymes. The protein “intrinsic factor” then transports the vitamin to the cells of the small intestine, from where it enters the blood and the nerves.

Causes of vitamin B12 deficiency

Vitamin B12 deficiency can occur when less of it is supplied or ingested than the body needs over a long period of time.

The main causes of vitamin B12 deficiency are:

– Strictly vegan diet

– anorexia

– Deficiency of the so-called intrinsic factor (protein necessary for the absorption of vitamin B12): Can occur due to (partial) removal of the stomach or in chronic gastritis.

– Certain medications such as omeprazole and metformin.

– Impaired absorption of vitamin B12 in the intestine, e.g., due to chronic inflammatory bowel diseases such as Crohn’s disease, ulcerative colitis, celiac disease, or partial removal of the intestine

– loss or increased consumption of vitamin B12 (can occur, for example, in chronic kidney or liver diseases and infestation with the fish tapeworm)

– an increased need (e.g. during pregnancy)

– heavy alcohol consumption

The human body can compensate for an undersupply of vitamin B12 secondarily by falling back on stored vitamin B. For this reason, in many cases it is quite possible that a vitamin B12 deficiency will not manifest itself for years.

The deficiency symptoms appear more quickly if a person has a very low vitamin B12 depot from the outset. This group of people includes, for example, breastfed infants, whose mothers eat a vegan diet during pregnancy and breastfeeding, and people who very rarely eat animal foods.

Furthermore, the risk groups for a vitamin B12 deficiency also include elderly people, alcoholics, pregnant women and nursing mothers.

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Symptoms of vitamin B12 deficiency

The symptoms of vitamin B12 deficiency are varied and often not easy to diagnose. Typical symptoms of an undersupply of vitamin B12 can be:

  • Skin changes, such as mouth corner cracks
  • Anemia and associated pallor, fatigue, exhaustion, headache, dizziness, weak and rapid pulse or shortness of breath.
  • Increase in the concentration of an amino acid called homocysteine in the blood. This is regarded as a risk factor for heart conditions such high blood pressure, stroke, or thrombosis.
  • Psychological abnormalities such as poor memory, poor concentration, fatigue, depressive moods, confusion
  • Demyelination (In this process, the protective sheath of our nerves is destroyed, which impairs the transmission of stimuli). As a result, there are sensory disturbances in the feet and hands (tingling, pain in the legs), incontinence or erectile dysfunction. In older people, the sensory disturbances and movement restrictions can lead to an increased risk of falls.
  • Doubled risk of Alzheimer’s dementia in the elderly.
  • Hair loss
  • Headaches, migraines
  • Food intolerances and allergies

– In infants: (severe) developmental disorders, muscle weakness, lethargy (abnormal sluggishness/sleepiness), problems eating, tremor (muscle tremors), anemia

Less typical symptoms of vitamin B12 deficiency include:

  • Inflamed, swollen tongue (glossitis)
  • Digestive disorders with reduced absorption of nutrients (malabsorption)
  • Thrombosis in the cranial region (sinus thrombosis)
  • Brown discoloration of the skin (hyperpigmentation)
  • Loss of visual acuity

Diagnosis of vitamin B12 deficiency

Several methods are available to determine vitamin B12 deficiency.

Holotranscobalamin: Holo-TC testing determines how much vitamin B12 is actually available to the body’s cells. In this way, empty vitamin B12 stores can be reliably detected at an early stage.

Methylmalonic acid: Methylmalonic acid (MMA) is increasingly formed as soon as too little vitamin B12 is available in the cells. As a result, increased MMA levels can be detected in blood and urine. These values therefore provide the earliest measurable indication of a vitamin B12 deficiency. The determination of MMA is useful if borderline or decreased holo-TC is found.

If a deficiency is actually present, further tests are recommended to clarify the cause. This is the only way to successfully treat the deficiency.

In certain cases, the vitamin B12 content in the brain is examined to find out how much of it reaches the brain, where it is urgently needed. In this way, doctors can rule out an absorption disorder of the vitamin.

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Self-therapy with dietary supplements, without a doctor’s consultation, is not recommended because it can cause side effects.

Treatment of vitamin B 12 deficiency

To avoid serious consequences such as anemia or nerve damage, a vitamin B12 deficiency should always be treated by a doctor. This can be done by oral or parenteral therapy.

In oral therapy, about 1000 micrograms (μg) per day are administered by tablets for the first three to four weeks.

In parenteral therapy, vitamin B12 is injected into the gluteal muscle via syringes (sometimes infusions). This involves administering 1000 μg two to three times each for the first two weeks. Depending on how quickly the condition improves, the rhythm is then adjusted to a monthly schedule.

Patients suffering from an absorption disorder can also be treated by rehabilitating the gastrointestinal tract, by probiotic support of the intestines or even by alkaline nutrition. In these cases, the medication may have to be administered for the rest of the patient’s life.

If the vitamin B12 deficiency is due to diet (especially with vegan diets), vitamin B12 supplements can be taken as a preventive measure.

Take regular blood count checks so that your doctor can monitor the success of the therapy.

How can vitamin B12 deficiency be prevented?

Vitamin B12 enters the body almost exclusively through animal foods such as meat, fish, eggs and dairy products. For this reason, vegans in particular have an increased risk of developing a deficiency. They should take dietary supplements as a preventive measure – around 500 micrograms (μg) a day.

Vegetarians can usually cover their requirements with eggs and dairy products, which is why a substitution is not absolutely necessary.

Which foods contain vitamin B12?

Vitamin B12 is mainly found in animal products such as meat, fish, seafood, eggs and dairy products. Plant foods do not contain vitamin B12 in most cases. Although seaweed (nori) and shiitake mushrooms contain vitamin B12 – the amount is variable and it is sometimes not in a form that the human body can process.

Small amounts of vitamin B12 can also be found in fermented foods such as sauerkraut. According to the German Nutrition Society, at least according to current knowledge, it is not possible to meet vitamin B12 requirements with plant-based or vegan foods alone. For this reason, one should cover one’s vitamin B12 needs in a vegan diet with appropriate dietary supplements.

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How much vitamin B12 does a person need per day?

The recommended daily requirement for an adult is around 4.0 micrograms (µg). For a pregnant woman, it is 4.5 µg.1 For orientation: 100 grams of beef contain 2.0 µg of vitamin B12, 30 grams of Emmental cheese contain 0.6 µg.

What to eat in case of vitamin B12 deficiency?

Vitamin B12 can only be produced by microorganisms. Good sources of vitamin B12 are meat, fish and seafood, eggs and dairy products. Vegans should resort to vitamin supplements.

How do you know you have a vitamin B12 deficiency?

In most cases, the symptoms of a vitamin B12 deficiency mainly affect the eyes, nerves, hair and muscles. Classic symptoms include skin changes, such as cracks at the corners of the mouth, and anemia (anemia).

How long does it take for vitamin B12 supplements to take effect?

How quickly the deficiency can be corrected depends on how severely the body’s stores are affected by the undersupply. In the case of a slight undersupply of vitamin B12, the condition improves after only a short period of taking supplements.

In which meat is the most vitamin B12?

The highest concentration of vitamin B12 is found in beef and veal liver (70-80 micrograms/100 grams) and pork liver (25 micrograms/100 grams). More than 10 micrograms of vitamin B12 can be found in one hundred grams of oysters and rabbit.

Should vitamin B12 be taken in the morning or in the evening?

Basically, it does not matter at what time of day you take the B12 vitamin. However, it should not be combined with a meal. If you take it in the morning 30 minutes before breakfast, the vitamin can provide an additional energy boost.

Does vitamin B12 have side effects?

The vitamin from food has no side effects. If the supply is supported in the form of injections or infusions, allergic shock may occur in rare cases.

In case of hypersensitivity, side effects occur very rarely even with external application (e.g. eczema or hives).

All information without guarantee.