Vitamin B12 is essential for our body to function correctly and stay alive.
Naturally, we get what we need from our diet, from meat, fish, and dairy products.
Deficiency can occur with restrictive diets, such as being vegan or vegetarian
or several medical conditions. So, if you want to learn more about
Vit B12, the symptoms of deficiency and how we replace it keep watching.
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What is Vitamin B12 and why is it so important?
Vitamin B12, also known as cobalamin, is an essential vitamin we need to stay alive.
B12 plays an imperative role in cell development,
particularly red blood cells and nerve myelin sheaths.
Under normal circumstances, we get all the vitamin B12 we need from our diet.
The best sources of vitamin B12 are: Meat and meat products
Eggs, Milk and dairy products Fish and fish products
Yeast products and fortified vegetable extracts Fortified Breakfast cereals
Causes of Deficiency
The most common cause of B12 deficiency is malabsorption in the gut.
A lack of the b12 carrier protein, intrinsic factor, is a crucial element.
Intrinsic factor plays an essential role,
binding with B12 promoting absorption within the small bowel.
The process helps B12's transport into the bloodstream, ready for use by your body.
An autoimmune condition, called pernicious anaemia, can reduce the amount of
intrinsic factor protein available in the body. Your immune system creates antibodies that can
attack the intrinsic factor protein or the cells responsible for their production in the stomach.
The reduction in intrinsic factor then limits your body's ability to
absorb any Vitamin B12 in the gut. Why this occurs, we do not know.
However, it's more common if you have a history of other autoimmune
conditions, a family history of pernicious anaemia, are female or over the age of 50.
Some other causes include:
Dietary deficiency Vitamin B12 is not naturally
present in plants and vegetables. Therefore, if you are a vegan or
strict vegetarian, you will not get your requirements from your diet.
However, you are unlikely to experience symptoms of B12 deficiency
as your symbiotic gut bacteria will synthesise B12 for you.
Excessive alcohol consumption can also reduce your bodies ability to absorb B12
Some medications such as:
Long-term metformin use common in type 2 diabetes management can increase the risk of deficiency.
Neomycin - an antibiotic also has effects on many vitamins and essential nutrients,
inclusive of vitamin B12. Colchicine - A medication used for gout
prevention, reduces the efficiency of intrinsic factor & b12 receptors in the small bowel.
Stomach problems affecting Intrinsic factor production
Post-surgery – where you have had all or part of your stomach removed,
here you will produce less intrinsic factor.
Congenital deficiency of intrinsic factor - a condition rarely seen and present from birth.
Small bowel conditions affecting your body's ability to absorb B12
Again, Post-surgery – if you have had portions of your small bowel removed,
your body will be less efficient in absorbing B12. Crohn's disease – an autoimmune disease-causing
inflammation within the bowel, can affect the bowel's ability to absorb a variety of nutrients.
What are the symptoms of B12 deficiency?
Because Vitamin B12 is essential for red blood cell production, people with
deficiency commonly develop macrocytic anaemia. With macrocytic anaemia, not only do you have
fewer circulating, abnormally large, red blood cells.
Anaemia, essentially the lack of blood cells, reduces the blood's ability to carry oxygen.
Therefore, symptoms are associated with this. You may become easily fatigued, breathless
or you may feel tired all the time. In compensation for fewer circulating
red blood cells, your heart will beat more forcefully and at a faster rate.
So, some will experience a heart-racing sensation, known as palpitations.
Secondly, B12 is essential for the development of the outer sheaths of nerve cells.
Therefore, where a deficiency exists, individuals may report unusual nerve and
psychological symptoms. Such as:
Pins and needles, numbness, Poor co-ordination, headaches, and even
Changes to your vision. Phycological symptoms may include
Confusion, forgetfulness, poor memory and even dementia
low mood, even depression Paranoia
How will my doctor diagnose B12 deficiency?
Your doctor may already have a suspicion of anaemia or B12 deficiency.
Especially where you are experiencing any symptoms described earlier or have any risk factors.
Blood tests are essential in the diagnosis of B12 deficiency.
Typically, the laboratory will report a low number of abnormally
large red blood cells with b12 deficiency.
Your doctor can request an analysis of the circulating levels of vitamin B12.
However, a low level of circulating B12 doesn't always correlate to symptoms experienced.
Additionally, there are individuals with low levels of circulating B12 who are asymptomatic.
Limitations in current testing mean we cannot identify how much
of the B12 in your blood is active. Folate levels will also be checked,
as a deficiency in folate can also give a similar laboratory result.
Further tests are going to be required to help identify a cause for your B12 deficiency.
Additional blood tests will assess for intrinsic factor antibodies
suggestive for the autoimmune condition pernicious anaemia.
Referral to a specialist may be required should the cause for
your B12 deficiency has not been identified or you have evidence of neurological symptoms.
Amongst individuals where a dietary cause is suspected,
your GP or primary care physician can organise a review by a dietician.
Treatment
Treatment regimens will vary depending on whether you are experiencing any neurological symptoms.
If you have neurological symptoms, treatment needs to be guided by a haematologist.
A Haematologist is a specialist in treating disorders of the blood.
The remaining patients, without neurological symptoms,
will usually receive treatment from their GP or Primary care physician.
Initially, hydroxocobalamin, a synthetic form of Vitamin B12,
is injected into your muscle three times a week for two weeks.
This initial boost helps to replenish the B12 reserve in your liver.
If your B12 deficiency is related to your diet, subsequent supplementation
can be in the form of tablets. Alternatively, injectable B12 can be given
twice-yearly as hydroxocobalamin. Hydroxocobalamin is a longer-acting
version of synthetic B12. If your B12 deficiency not
diet-related, it will likely be due to issues regarding absorption from the gut.
In this case, oral supplementation will not work, and you will need three monthly injections of
Hydroxocobalamin lifelong. What about prognosis?
Once identified, B12 deficiencies are easily treatable.
You are very unlikely to have any long-term complications of B12 deficiency unless the
condition has been present for some time. Should neurological symptoms have developed,
irreversible damage to the nerves may have occurred.
Therefore, symptoms may persist even after your B12 levels return to normal levels.
Additionally, patients who have been anaemic for some time risk developing heart failure.
In these circumstances, your heart has worked overtime to compensate for the
reduced oxygen-carrying capacity of the blood. So, should you experience any of the symptoms
discussed, you should make an appointment with your doctor.
Early diagnosis and treatment are associated with better treatment outcomes.
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Outro
Of course, this video does not provide individual
medical advice and is intended for informational purposes only.
Do not consider this as a substitute for professional medical advice,
diagnosis or treatment.
Please do not ignore professional medical advice
in seeking treatment because of something you have heard here.
If you believe you may have a medical emergency, immediately call your doctor or ambulance service.
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