Vitamin B12 deficiency | Causes, Treatment | Nutrition

Vitamin B12 deficiency

What is Vitamin B12 deficiency anemia?

This type of anemia means that your body does not have sufficient healthy red blood cells because it is low in vitamin B12. These cells carry oxygen through the body. You need vitamins, including B12, to produce them.

When you don’t have sufficient red blood cells, your body doesn’t get the oxygen it needs to function the way it should. Anemia can make you feel exhausted, weak, and short of breath.

Causes of vitamin B12 deficiency

You can get vitamin B12 deficiency anemia if you don’t get enough B12 in your diet from foods like milk, eggs, and meat. You are more likely to be low in this vitamin if you are older or on a vegetarian diet. It can also happen if your body cannot absorb enough of the food you eat.

Your intestines absorb vitamin B12 from food. A protein your stomach makes called “intrinsic factor” helps your body absorb it. When you don’t have enough, you have a type of vitamin B12 deficiency anemia called “pernicious anemia.”

You can develop pernicious anemia if:

  • You have an autoimmune disease that causes your immune system to attack the cells in your stomach that make intrinsic factor.
  • You have surgery to remove part of the stomach, where the intrinsic factor is made.

Your body may also not absorb enough vitamin B12 deficiency if:

  • You have a disease that affects the way nutrients are absorbed in the intestines, such as Crohn’s disease, HIV, or some infections.
  • You have convinced bad bacteria in your intestines.
  • Take some medications, such as antibiotics and anticonvulsants.
  • You have had surgery to eliminate part of your intestines.
  • You have been infected with a tapeworm.

Risk factors

There are many causes of vitamin B12 deficiency. Surprisingly, two of them are practices that are often done to improve health: a vegetarian diet and weight-loss surgery.

Plants do not produce vitamin B12. The only foods that deliver it are meat, eggs, poultry, dairy products, and other foods of animal origin. Strict vegetarians and vegans are at high risk of developing a B12 deficiency if they do not eat grains that have been fortified with the vitamin or take a vitamin supplement. People who have weight-loss surgery are also more likely to have low levels of vitamin B12 because the operation interferes with the body’s ability to extract vitamin B12 from food.

Conditions that interfere with nutrient absorption, such as celiac or Crohn’s disease, can cause problems with vitamin B12. The same goes for the use of commonly prescribed heartburn medications, which reduce the production of acid in the stomach (acid is needed to absorb vitamin B12). The condition is more likely to occur in older people due to the reduction in stomach acid production that often occurs with aging.

Symptoms of vitamin B12 deficiency

Vitamin B12 deficiency can take time to develop, causing symptoms to appear gradually and intensify over time. It can also appear relatively quickly. Given the variety of symptoms that a vitamin B12 deficiency can cause, the condition can be overlooked or mistaken for something else. Symptoms of vitamin B12 deficiency can include:

  • Odd sensations, numbness, or prickly in the hands, legs, or feet
  • Difficulty walking (staggering, balance problems)
  • Anemia
  • A swollen and inflamed tongue
  • Difficulty thinking and reasoning (cognitive difficulties) or memory loss
  • Weakness
  • Fatigue

While a knowledgeable physician may notice symptoms and be able to detect a vitamin B12 deficiency with a good interview and physical examination, a blood test is needed to confirm the condition.

It’s a good idea to ask your doctor to check your B12 level if you are a strict vegetarian, have had weight-loss surgery, or have a condition that interferes with the absorption of food. Early detection and treatment are important. If left untreated, the deficiency can cause serious neurological problems and blood diseases.

Boosting your B12

A severe vitamin B12 deficiency can be modified in two ways: weekly vitamin B12 injections or everyday high-dose B12 pills. A mild B12 deficiency can be modified with a standard multivitamin.

In many persons, a vitamin B12 deficiency can be prevented. If you are a strict vegetarian or vegan, it is important that you eat bread, cereals, or other grains that have been fortified with vitamin B12 or that you take a daily supplement. A standard multivitamin provides 6 micrograms, more than enough to meet the body’s daily needs.

Diagnosis of vitamin B12 deficiency

Often times, a GP can make a diagnosis of vitamin B12 deficiency or folate deficiency anemia based on your symptoms and the results of blood tests.

Blood test

Different types of blood tests can be done to help identify people with a possible vitamin B12 or folate deficiency.

These tests verify:

  • If you have a lower than normal level of hemoglobin (a substance that carries oxygen)
  • If your red blood cells are larger than usual
  • The close of vitamin B12 in your blood
  • The closes of folate in your blood

But some people may have problems with their normal levels of these vitamins or may have low levels despite having no symptoms. That is why it is important that your symptoms are taken into account when making a diagnosis. One particular drawback of testing vitamin B12 levels is that the blood test that is widely used today only measures the total amount of vitamin B12 in the blood.

If a significant amount of vitamin B12 in your blood is inactive, a blood test may show that you have normal levels of B12, even though your body cannot use much of it. There are some kinds of blood tests that can help determine if your body can use vitamin B12 in your blood, but they are not yet widely available.

Identifying the cause

If your symptoms and blood test consequences suggest a vitamin B12 or folate deficiency, your GP may arrange further tests. If the cause can be identified, it will help determine the most appropriate treatment. For example, you may have additional blood tests to check for a condition called pernicious anemia.

This is an autoimmune disorder, where your immune system produces antibodies to attack healthy cells, which means it cannot absorb vitamin B12 from the food you eat. Pernicious anemia tests are not always conclusive, but they can often give your GP a good idea of ​​whether you have the disease.

Referral to a specialist

You may be mentioned to a specialist for further testing or treatment.

This can include:

  • A specialist in the treatment of diseases of the blood (a hematologist): if you have anemia due to vitamin B12 or folate deficiency and your GP is not sure of the cause, you are pregnant or the symptoms suggest that your nervous system has been seen affecting
  • A specialist in conditions affecting the digestive system (a gastroenterologist) – if your GP suspects that you do not have enough vitamin B12 or folic acid because your digestive system is not absorbing it properly
  • A nutritionist (a dietitian) – if your GP suspects that you have a vitamin B12 or folate deficiency caused by poor diet
  • A dietitian can design a personalized meal plan to increase the number of vitamin B12 or folic acid in your diet.

Treatment for vitamin B12 deficiency

Treatment for this disorder involves replacing the missing vitamin B12. People who cannot absorb B12 need regular injections. When the first injections are given, a patient with severe symptoms may receive five to seven during the first week to restore the body’s stores of this nutrient. A response is usually seen within 48 to 72 hours, with vigorous production of new red blood cells. Once B12 stores reach normal levels, vitamin B12 injections will be needed every one to three months to prevent symptoms from recurring. People who cannot absorb vitamin B12 should endure eating a well-balanced diet that provides other nutrients (folic acid, iron, and vitamin C) necessary to produce healthy blood cells. Sometimes people can take high doses of oral B12 to replace them instead of getting injections, but a doctor must monitor it closely.

In people whose vitamin B12 deficiency is linked to intestinal bacteria overgrowth, treatment with oral antibiotics, such as tetracycline (which is sold under several brand names), can stop the overgrowth of bacteria and allow absorption of the bacteria. vitamin B12 back to normal. Vitamin B12 deficiency resulting from insufficient dietary intake is the easiest to treat. The condition can be reversed by taking vitamin B12 supplements by mouth and adding foods that contain B12. When anemia is severe and the red blood cell count is extremely low, blood transfusions may be necessary for the first few days until the vitamin B12 injections begin to work.


Being deficient in vitamins increases your risk for many health problems, including:

Complications of pregnancy

Pregnant women with folate deficiency may be more likely to experience complications, such as premature delivery. A developing fetus that doesn’t get enough folic acid from its mother can develop birth defects of the brain and spinal cord.

If you are thinking about getting pregnant, ask your doctor if you should consider taking folic acid supplements so that your body’s folate stores are sufficient to support your baby.

Nervous system disorders

While vitamin B12 deficiency is important for red blood cell production, it is also important for a healthy nervous system.

Untreated vitamin B12 deficiency can lead to neurological problems, such as persistent tingling in the hands and feet or problems with balance. It can lead to mental misperception and forgetfulness because vitamin B-12 is essential for healthy brain function.

Deprived of treatment for vitamin B-12 deficiency, neurological complications can become permanent. Vitamin B-12 deficiency can cause these and other health problems beforehand it leads to anemia.


Vitamin C deficiency can lead to scurvy. Signs and symptoms of this rare disease contain bleeding under the skin and around the gums.


Choose a healthy diet

You can prevent some forms of vitamin B12 deficiency anemias by choosing a healthy diet that includes a variety of foods.

Foods rich in folic acid include:

  • Dark green leafy vegetables
  • Walnuts
  • Fortified cereal products, such as bread, cereals, pasta, and rice.
  • Fruits and fruit juices

Foods rich in vitamin B-12 include:

  • Eggs
  • Fortified foods, such as breakfast cereals
  • Milk, cheese, and yogurt
  • Meat and seafood

Foods rich in vitamin C include:

  • Broccoli
  • Citrus fruits and juices
  • Strawberries
  • Green peppers
  • Tomatoes

Most adults need these everyday dietary amounts of the following vitamins:

  • Vitamin B-12 – 2.4 micrograms (mcg)
  • Folate or folic acid – 400 mcg
  • Vitamin C – 75 to 90 milligrams
  • Pregnant and lactating women may require more of each vitamin.

Consider a multivitamin

If you are concerned about getting enough vitamins from the foods you eat, ask your doctor if a multivitamin may be right for you. Most people get enough vitamins from the food they eat. But if your diet is restricted, you may want to take a multivitamin.

Do not smoke

Smoking interferes with the absorption of nutrients, such as vitamin C, so it can increase the risk of a vitamin deficiency.

If you smoke, stop it. If you don’t smoke, don’t start. If you have tried to quit smoking on your own and have been unsuccessful, talk to your doctor about strategies to help you quit.

Drink alcohol in moderation, if you drink it

Alcohol can contribute to vitamin deficiency anemia. If you select to drink alcohol, do so in moderation. For healthy adults, moderate alcohol consumption is generally considered to be:

  • Two snacks a day for men under 65
  • One drink a day for males over 65
  • One drink a day for females of any age.
  • One drink is 12 ounces (355 milliliters) of beer, 5 grains (148 milliliters) of wine, or 1.5 ounces (44 milliliters) of 80 proof distilled spirits.
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