Vitamin B12 is required for the bone marrow to create enough healthy red blood cells. Only animal foods (meat and dairy products) and yeast extracts (such as brewer's yeast) contain vitamin B12. Vitamin B12 insufficiency is characterized by low amounts of stored B12 in the body, which can lead to anaemia (a lack of red blood cells).
Vitamin B12 insufficiency can occur for a variety of reasons:
Intrinsic factor deficiency is commonly known as pernicious anaemia. Intrinsic factor is a protein produced by cells in the stomach lining. It binds to vitamin B12 and transports it to the small intestine for absorption. The most prevalent cause of pernicious anaemia is a lack of intrinsic factors. Atrophic gastritis, or weakening of the stomach lining, is frequently related to a lack of intrinsic factors. Elderly persons of African-American or Northern-European heritage are most likely to have atrophic gastritis. Pernicious anaemia strikes these persons around the age of 60.
Reduced intrinsic factor levels in children can be a hereditary (genetic) disorder. When this happens, kids under the age of ten develop signs of juvenile pernicious anaemia as a result of low intrinsic factor levels.
Graves' illness, hypothyroidism (under-functioning thyroid gland), thyroiditis (thyroid inflammation), vitiligo, and Addison's disease are all disorders connected to immune system problems (adrenocortical insufficiency).
Stomach removal or destruction – Vitamin B12 insufficiency can develop in persons who have had part or all of their stomach removed.
Overgrowth of bacteria — Some persons become deficient in vitamin B12 as a result of diseases that delay food passage through the intestines (diabetes, scleroderma, strictures, diverticula), allowing intestinal bacteria to proliferate and overgrow in the upper section of the small intestine. Rather than enabling B12 to be absorbed by the body, these bacteria take it for their own use.
Vegans (strict vegetarians who do not eat any meat, fish, eggs, or dairy products) are at risk of developing vitamin B12 deficiency due to a lack of vitamin B12 in their diets. Vitamin B12 deficiency can also be linked to diet in individuals with bulimia or anorexia nervosa. However, because your liver can retain vitamin B12 for up to five years, anaemia caused by diet is uncommon.
Symptoms appear gradually and may not be detected right away. Common symptoms as the disease progress include:
Weakness and exhaustion
Dizziness and light-headedness
Heart palpitations and a fast pulse
nauseousness or a loss of appetite
Loss of weight
Skin and eyes have a yellowish tint to them.
If low levels of B12 persist for a long time, the disease can cause permanent nerve cell damage, resulting in the following symptoms:
In the hands and feet, there is numbness and tingling.
Difficulty in walking.
Loss of memory
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Your doctor will inquire about your nutrition as well as any anaemia in your family. Your doctor will also go through your medical history for any medical conditions (diabetes, immunological diseases) or operations (such as stomach removal) that might cause B12 deficiency.
Based on your medical history and symptoms, your doctor may believe that you are deficient in vitamin B12. He or she will evaluate you and request laboratory testing to confirm the diagnosis. Your doctor will check for a red, meaty tongue, pale or yellowish complexion, a fast pulse, and heart murmurs caused by anaemia-related increased blood flow demands on the heart during the physical examination. The following tests will be performed at the laboratory:
Standard blood tests to determine the number and appearance of red blood cells — In vitamin B12 deficiency, red blood cells are abnormally big and seem abnormal.
Blood tests to screen for B12 deficiency — Iron and folate levels may also be checked to see whether these elements are deficient.
When a person has a B12 deficiency, the quantity of methylmalonic acid in their blood rises.
Intrinsic factor antibody blood tests – To identify if you have pernicious anaemia, your doctor may conduct specific antibody levels blood tests. These antibodies are seen in the blood of most persons who lack intrinsic factors in their stomach.
Bone marrow biopsy — A bone marrow biopsy is sometimes used to confirm a diagnosis. A tiny sample of bone marrow is obtained by putting a needle into the pelvic bone right below the waist on both sides of the spine during this operation. A laboratory examines the bone marrow sample for possible causes of anaemia and red blood cell abnormalities.
Symptoms of vitamin B12 deficiency recover within a few days with adequate therapy. Oral B12 supplements and a diet intended to enhance vitamin B12 consumption should treat B12 deficiency in vegans and other persons who have a diet-related B12 deficit. Pernicious anaemia patients and those who are unable to absorb vitamin B12 from their intestines will require vitamin B12 injections every one to three months indefinitely.
Vegans should take enough vitamin B12 supplements to compensate for the lack of vitamin B12 in their diet to avoid vitamin B12 insufficiency.
The disease cannot be prevented in those who are unable to absorb B12. However, once diagnosed, monthly vitamin B12 injections will keep symptoms from recurring.
The missing vitamin B12 must be replaced as part of the treatment for this disease. People who are unable to absorb B12 must receive injections regularly. When injections are first given, a patient with severe symptoms may require five to seven injections in the first week to replenish the body's nutritional reserves. Within 48 to 72 hours, a reaction is generally seen, rapidly creating new red blood cells. Once B12 stores have returned to normal, vitamin B12 injections will be required every one to three months to keep symptoms from reappearing. People who are unable to absorb vitamin B12 should continue to consume a well-balanced diet that includes other nutrients such as folic acid, iron, and vitamin C. Instead of receiving injections, patients can take large doses of oral B12 to give replacement, but this should be done under the supervision of a physician.
Treatment with oral antibiotics, such as tetracycline (available under various brand names), may reduce bacterial overgrowth and allow vitamin B12 absorption to return to normal in patients whose vitamin B12 insufficiency is caused by intestinal bacteria overgrowth.
The easiest to cure is vitamin B12 insufficiency caused by insufficient food intake. Taking oral vitamin B12 pills and eating B12-rich foods can help to reverse the condition.
Blood transfusions may be required for the first few days until the vitamin B12 injections start working if the anaemia is severe and the red blood cell count is severely low.
When should you see a professional?
If you have unexplained exhaustion, palpitations, shortness of breath, sore tongue, or any other signs of vitamin B12 insufficiency, see your doctor for a medical checkup. This is especially true if you're a vegan, over 50, and of African-American or Northern-European ancestry, or if you have diabetes, an autoimmune condition, or have had your stomach removed.
Because this kind of anaemia responds well to therapy, the prognosis is favourable. It's conceivable, though, that nerve cell damage will be irreversible. People who sought therapy late in the disease may have some lingering nervous system impairment.