Vitamin b12 overview:- Vitamin b12, also called another name cobalamin, is an essential water-soluble vitamin. A compound is necessary for maintaining the health of all cells because it is essential for the production of DNA and RNA, which is the body’s genetic material. Vitamin B12 is particularly important in maintaining the health of the body’s nerve and blood cells. In particular, it is important to maintain healthy nerve cells and to support bone marrow production of red blood cells (RBCs).
Vitamin B12 helps to keep the nervous system and blood cells are healthy and prevents one type of anemia. Which is called megaloblastic anemia. Megaloblastic Anemia is larger than red blood cells and there are very few of them, so they do not carry oxygen around the body as well this should be done.
1. What is vitamin b12 or cobalamin deficiency
The deficiency of vitamin B12 can lead to serious complications in hematologic and neurologic systems. B12 (cobalamin) deficiency occurs when your body lacks sufficient healthy red blood cells due to insufficient amounts of cobalamin. Red blood cells carry oxygen and remove carbon dioxide from your body tissues. If you lack enough red blood cells, you may feel fatigued and experience shortness of breath. Treating Cobalamin (B12) deficiency immediately can help prevent serious complications, such as confusion and depression.
Neurological and psychiatric
- Lack of serum vitamin B12 levels can lead to a variety of neurological and psychiatric disorders.
- Cobalamin (B12) deficiency has been reported in about 15% of adults over 65 years of age.
- This is mainly believed to be due to an age-related decline in intestinal absorption.
- Approximately 98% of B12 absorption is facilitated by intrinsic factors. The remaining 2% is absorbed passively.
- Oral B12 supplementation in high doses has been found to be effective as intra-muscular vitamin B12 administration in malignant anemia.
Deficiency in Older Adults
- Vitamin B12 deficiency occurs frequently in older adults, especially those in their 70s and 80s, and is usually due to malabsorption of food-bound B12.
- As individuals age, atrophic gastritis and bacterial overgrowth of the GI tract can either individually or in combination cause reduced gastric acid production, resulting in malabsorption of food-bound B12.
- Hvas suggests age-related gastric atrophy also contributes to malabsorption. Chronic atrophic gastritis, which affects as many as 30% of older adults, is a condition that results in the degeneration and thinning of the stomach wall, leading to gastric cell atrophy and a decrease in the production of stomach acids, thus minimizing the body’s ability to absorb B12.
- Therefore, elderly individuals with a vitamin B12 deficiency might not be able to adequately absorb oral vitamin B12 replacements.
Deficiency in Vegetarians
- Vegetarians and vegans are at high risk for developing a vitamin B12 deficiency because they do not ingest foods of animal origin, such as meat and dairy products, which contain B12.
- It was once thought that only strict vegans lacked adequate intake of vitamin B12 containing foods, however, it is now known that deficiencies can be found among persons observing all types of vegetarian diets, including Lacto-Ovo vegetarians.
- Although vegetarians and vegans might vary in their consumption of the types of foods that contain vitamin B12, a vegetarian or vegan diet that does not allow for adequate amounts of B12 will influence their management plan.
In pregnancy deficiency
- Vitamin B12 is essential for cell multiplication during pregnancy due to its important role in DNA synthesis.
- Although pregnancy does not cause reductions, pregnant women with low vitamin B12 levels may be at high risk for giving birth to a child with adverse fetal and neonatal outcomes, mainly neural tube defects.
- Pregnant women are at the same risk of vitamin B12 deficiency as those who are at greater risk in the general population or due to dietary restrictions.
- However, identifying women with or at risk before pregnancy is important to ensure that necessary DNA synthesis can occur and to prevent or reduce adverse fetal outcomes.
- Patients with malignant anemia are at high risk for developing vitamin B12 deficiency.
- Pernicious anemia is an autoimmune condition characterized by the destruction of gastric parietal cells and the lack of intrinsic factor necessary to bind internal vitamin B12.
- Without intrinsic factor, vitamin B12 absorption is limited to very small amounts through passive diffusion. The absence of intrinsic factor can be a congenital or developed condition, as seen in atrophic gastritis.
- Those at risk of dangerous anemia are adults, women, and people of African or European descent, aged 50 to 60 years.
- The inability of individuals with fatal anemia to absorb vitamin B12 from food will also affect their management plan.
2. What are the causes?
Reasons for deficiency include insufficient intake, absorption, and transport. Recognizing a deficiency and providing prompt treatment is essential to prevent serious hematologic issues and possibly irreversible neurologic damage due to discontinuation.
Vitamin B12 deficiency causes reversible megaloblastic anemia, reduces neurologic disease, or both. Autoimmune gastritis (dangerous anemia) is the most common cause of the severe deficiency. Methodologic problems may compromise the sensitivity and specificity of prevailing cobalamin assays. Methylmalonic acid, homocysteine, or both are wont to confirm Cobalamin (B12) deficiency in untreated patients; A high level of methylmalonic acid is more sensitive and specific for diagnosis. For patients with malignant anemia or malnutrition, lifetime vitamin B12 therapy is indicated. High-dose oral B12 tablets (1000 to 2000 µg) taken daily are effective as intramuscular monthly injections. Correcting blood and neurological abnormalities.
3. What are the symptoms?
|Eyes: Loss of central vision; pale conjunctiva;|
|Oral: Enlarged inflamed tongue; mucosal ulceration(s);|
|Skin: Jaundice; pigment changes, Pale skin;|
|GI: Loss of appetite; digestive issues;|
|Neurological: Impaired gait and loss of balance; peripheral paresthesia and Numbness and tingling in your hands and feet; generalized weakness; loss of position and vibratory sense; dizziness;|
|Cognitive: Impaired memory and concentration;|
|Behavioral: Anxiety; depression;|
|Diarrhea, Constipation, Tiredness, Light-headedness, Lack of focus, Shortness of breath, Swollen, red tongue, Bleeding gums, Confusion, Dementia.|
4. What are the treatments for vitamin B12?
Treatment of vitamin deficiency anemia includes supplements and dietary changes. Treatment includes eating a healthy diet and taking folic acid supplements as prescribed by your doctor.
(QUANTITY in mcg)
|up to 6 months||0.4|
|7 to 12 months||0.5|
|1 to 3 years||0.9|
|4 to 8 years||1.2|
|9 to 13 years||1.8|
|14 to 18 years||2.4|
|teens and women||2.6|
|teens and women||2.8|
(A) DIETS MANAGEMENT
- Vitamin B12 is mostly found in foods of animal origin such as meat and dairy products, including liver, beef, chicken, pork, eggs, milk, cheese, and some varieties of fish.
- Many breakfast type cereals are also firm up to 100% of the daily value of vitamin B12.
- The RDA was prescribed by the Institute of Pharmaceuticals (IOM) at 2.4 µg/d to ensure absorption of 1 µg/d on average only about 50% of vitamin B12 is absorbed from food.
- The RDA for vitamin B12 in pregnancy is 2.6 µg/day, which is 0.2 µg/day higher than the RDA for non-pregnant women and adolescents.
- A balanced diet, however, offers somewhere between 7 and 30 ug/day.
- Many older adults have difficulty absorbing vitamin B12; Therefore, IOM recommends all adults over 50 to include B12-fortified foods or B12 supplements in their diet.
- Vegetarians and strict vegetarians, especially those who are pregnant or breastfeeding, are also encouraged to consume B12-fortified foods such as breakfast cereals, soy milk, and some soy analog meats, or their diet. Includes supplements.
(B) SUPPLEMENT MANAGEMENT
- Vitamin B12 supplements are available in many forms: injectable, oral, sublingual, and intranasal.
- Lack of treatment is determined by the patient’s choice and cost.
- Traditional treatment for B12 deficiency is intramuscular (IM) administration of cyanocobalamin, a synthetic form of B12.
- Cyanocobalamin therapy is usually started by administering 1,000 mcg IM every day for 1 or 2 weeks, followed by 1,000 mcg IM every week for 4-6 weeks.
- Later, a maintenance dose of 1,000 mcg IM will be required every month.
What to eat?
The following table tells you which foods are sources of vitamin B12:-
|FOOD & (QUANTITY)||Vitamin B12 (in mcg)|
|skim milk (1 cup)||1.3|
|Buttermilk or Chhaach (1 cup)||1|
|Chocolate, milk (1 cup)||0.9|
|Swiss or Emmental (50g)||1.7|
|Cottage Cheese (1 cup)||1.1-1.5|
|Feta, gouda, edam, gruyere,|
brie, cheddar, fontina,
mozzarella, provolone (50g)
|Processed cheese slices,|
|Yogurt [plain or greek]|
|Soy beverage, fortified (1 cup)||1|
|cooked liver (75g)|
[lamb, veal, beef]
|Kidney, lamb (75g)|
|Kidney, veal (75g)|
|Kidney, beef (75g)|
|Kidney, turkey (75g)|
|Liver (chicken, turkey, pork) (75g)|
|Fish and Seafood:-|
|cooked Clams (75g)||14.6|
|cooked Oysters (75g)||13.2-26.1|
|cooked mussels (75g)||18|
|cooked Mackerel [King, Atlantic]|
|Herring, Atlantic, kippered |
|Tuna, bluefin (75g)|
[raw or cooked]
|Roe [raw] (75g)||9|
|Crab, Alaska King (75g)|
|Sardines, canned in oil |
or tomato sauce (75g)
|Trout [cooked] (75g)||3.1-5.6|
|Salmon, red/sockeye (75g)|
|Salmon, pink/humpback, |
with bones, canned (75g)
|Salmon, Atlantic, wild (75g)|
|Tuna, light, canned in|
|cooked meatless (75g)|
[chicken, fish sticks,
|Soy burger (75g)||1.8|
|cooked egg (2 large)||1.5-1.6|
|Almond, oats |
or rice beverage (1 cup)