Vitamin B12 is an essential vitamin in our body, involved in processes such as DNA synthesis, energy production and central nervous system function. Vitamin B12 is a water-soluble vitamin that is naturally found in a variety of foods. Although the vitamin is found in many foods, vitamin B12 deficiency is common. This is usually due to restricted diets, malabsorption, certain medical conditions or the use of medications that interfere with the absorption of B12.
How to recognize B12 (vitamin B12) deficiency?
For reference, B12 levels above 300 pg/mL are considered normal, levels of 200-300 pg/mL are considered borderline, and levels below 200 pg/mL are considered vitamin B12 deficiency.
The body needs 2-3 mcg of vitamin B12 daily. The daily vitamin B12 requirement is higher in pregnant and breastfeeding women. Since vitamin B12 is involved in very important biochemical reactions in the human body, the B12 value should be kept within the range of 500-800 pg/ml clinically. Values of 800 pg/ml and above indicate high vitamin B12 levels. Since vitamin B12 decreases with age, deficiency is more common in the elderly. This does not mean that children and young adults, including pregnant and breastfeeding women, cannot develop B12 deficiency.
Who should be tested for vitamin B-12?
Our bodies do not produce vitamin B-12 naturally. It is obtained from animal products such as fish, meat and dairy products. People at risk of vitamin B-12 deficiency include:
- The elderly,
- Children,
- Vegans
- Strict Vegetarians,
- Individuals with Diabetes,
- People who have had gastric surgery,
- People with Gastrointestinal Disorders such as Crohn’s or Celiac Disease
- People Taking Proton Pump Inhibitors for Chronic Heartburn
What Causes Vitamin B12 Deficiency? What are the Causes?
Pernicious anemia: Vitamin B12 is absorbed from the small intestine by combining with intrinsic factor secreted from the stomach. Pernicious anemia is an autoimmune disease and is among the causes of B12 deficiency.
In autoimmune diseases, the immune system fights against the body’s own cells instead of harmful microorganisms. As a result, damage occurs to the tissues that are the target of the immune system. In pernicious anemia, the immune system attacks cells in the stomach that secrete intrinsic factor. This reduces the secretion of intrinsic factor. Since intrinsic factor is reduced, it cannot form enough complexes with B12. As a result, B12 absorption decreases and serum B12 concentration decreases. Although the exact cause of pernicious anemia is not known, it is known to be common in the 60s. It is more likely to occur in people with another autoimmune disease such as vitiligo.
Diet: Inadequate B12 intake can also lead to vitamin deficiency. Foods such as meat, fish, milk and dairy products are rich in B12. People who do not consume enough of these foods in their diet may develop a deficiency. The effect of malnutrition may not appear immediately. B12 stores last for about 2 to 4 years.
Stomach problems: Vitamin deficiency may be seen in people who have had a stomach operation. Surgical procedures that reduce the internal surface area of the stomach, such as gastrectomy, can reduce B12 absorption.
Intestinal problems: Deterioration of the epithelium lining the lining of the intestine prevents the absorption of substances absorbed from the intestine. Conditions such as celiac disease and Crohn’s disease can reduce the absorption of B12 from the intestine.
Functional B12 deficiency: People with this condition have symptoms of deficiency even though their serum B12 concentration is at normal levels. The problem in these people is problems in the intercellular transport of B12.
What Causes B12 Deficiency?
Vitamin B12; Since it is involved in many reactions necessary for the body, symptoms involving many different organs can be seen in its deficiency. For example, B12 deficiency may come with headache symptoms or weight loss.
One of the most important symptoms of B12 deficiency is anemia. Anemia is the lack of red blood cells circulating in the blood and responsible for carrying oxygen to the tissues or problems in the production of the hemoglobin molecule responsible for carrying oxygen. As a result, the blood cannot carry enough oxygen to the tissues.
Symptoms of B12 deficiency anemia:
- Fatigue,
- Fatigue
- Don’t be out of breath,
- Don’t feel like fainting,
- Headache
- Pallor
- Heart palpitations
- Loss of appetite
- It can be listed as weight loss.
In addition to causing anemia, B12 deficiency can also cause symptoms:
- Pale yellow skin color,
- Painful and red tongue,
- Tingling
- Change in the way you walk, move,
- This can include impaired vision.
- Psychological symptoms of B12 deficiency:
- Irritability,
- Depression
- Change in thinking and behavior
It is a decrease in cognitive abilities such as memory, understanding and judgment.
How is B12 Deficiency Treatment?
There are different methods for the treatment of vitamin B12 deficiency. When choosing the appropriate treatment method, it is important to identify the condition that causes the deficiency. Once the underlying cause is determined, treatment of this cause should also be done. For example, people who eat a vegan diet may have insufficient dietary intake of B12. After treatment of B12 deficiency in these people, vitamin supplements may be recommended to prevent recurrence of the disease.
Treatment of B12 deficiency can be done orally (by mouth) and parenterally (by injection).
Oral treatment; 250-1000 mcg (micrograms) per day is given every day for 1 week, then 2 days a week for 2 weeks, then 1 time a week for 1-2 weeks. When using this treatment method, it should be checked whether the patient is continuing the treatment regularly. B12 level can be measured at certain intervals for control. It may be preferred in the elderly with mild to moderate B12 deficiency. It can be used in children as it provides ease of use.
Parenteral treatment, also known as B12 deficiency injection, is administered intramuscularly or subcutaneously at 100-1000 mcg per day, every day for 1 week, then 2 days a week for 2 weeks, then once a week for 1-2 weeks. B12 absorption is impaired in diseases related to the stomach and intestines. Oral treatment of these patients is not beneficial as absorption is impaired. In patients with neurological symptoms, maintenance therapy may continue longer.
What is good for B12 deficiency?
One of the most important factors that can be considered to avoid B12 deficiency is diet.
The amount of B12 that should be taken daily with diet; 0.5 mcg in infants up to 1 year of age; 1-2 mcg for 1-13 years of age; It has been recommended to be 2.4 mcg in people over 14 years of age. This amount increases to 2.6 mcg in pregnant women and 2.8 mcg in breastfeeding women.
If your diet is adequate in terms of vitamin B12, you will be protected from B12 deficiency unless you have an additional disease.
What to eat if you are B12 deficient: You can add B12-rich foods such as salmon, red meat, tuna, oysters, milk and dairy products to your diet to get rid of the deficiency and never suffer from B12 deficiency.
What people with B12 deficiency should not eat: Alcohol can reduce B12 levels in the body.
What are foods rich in vitamin B12?
Regular consumption of foods containing B12 is the most important step to prevent the development of deficiency. Foods rich in B12 are usually animal foods.
- Offal such as liver and spleen,
- Shellfish such as mussels, clams, shrimp,
- Trout, herring, mackerel and tuna,
- Milk, yogurt, cheese,
- Eggs are the leading source.
What are the consequences of B12 deficiency?
B12 deficiency can cause anemia. In patients with untreated deficiency and worsening anemia, the capacity to transport oxygen to tissues is reduced. To compensate for this reduction, the heart works faster and the pulse rate increases. If this continues for a long time, the heart loses its ability to contract strongly and heart failure may develop.
The patient may experience neurological changes. Problems with vision, memory loss, loss of coordination in movements and tingling are among the effects of B12 deficiency. Neurological changes are usually irreversible.
B12 deficiency can lead to temporary infertility. This usually resolves when the deficiency is corrected.
When the underlying cause of B12 deficiency is pernicious anemia, patients have an increased risk of stomach cancer.
B12 deficiency during pregnancy has serious consequences known as neural tube defects. These defects can include underdevelopment of the baby’s spinal cord and the absence of parts of the skull and brain.
B12 levels in pregnant women should be closely monitored and B12 levels should be kept within the normal range with the help of supplements when necessary.