B12 deficiency – A silent epidemic with serious health consequences stalks millions across the globe.
What do all of these diseases have in common?
- Alzheimer’s, dementia, cognitive decline, and memory loss (collectively referred to as “aging”)
- Multiple sclerosis (MS) and other neurological disorders
- Mental illness (depression, anxiety, bipolar disorder, psychosis)
- Cardiovascular disease
- Learning or developmental disorders in kids
- Autism spectrum disorder
- Autoimmune disease and immune dysregulation
- Male and female infertility
Answer: they can all mimic the signs and symptoms of vitamin B12 deficiency and B12 deficiency can be a contributory factor in the worsening of these diseases.
Despite its significance, it’s often under-rated, a deficiency can go undiagnosed for years, individuals can display symptoms before actual blood test results fall outside the accepted parameters.
An easy diagnosis or a mysterious illness?
Symptoms can vary, they typically are, a greyness to the skin, fatigue, pins and needles especially to the extremities, irritability, cold, numbness memory loss, and difficulty concentrating, confusion, heat, dryness. A deficiency is more common than you think.
B12 is so common and so commonly ignored in general practice that I decided it was important to write about. More importantly, ranges in the UK for this blood test has increased, meaning that there is potential for even more people to be suffering, missed diagnosed or take unnecessary medications for conditions they might not actually have.
B12 seems poorly understood, yet it is written about in lots of scientific literature. A deficiency in B12 is more common than health care practitioners and the public realise. It’s entirely possible that some symptoms we attribute to ‘normal’ aging such as memory loss, cognitive decline, lethargy, slower mobility are at least in part caused by B12 deficiency.
Why is B12 deficiency so under-diagnosed?
B12 deficiency is often missed for two reasons. First it is not routinely tested and second the low end of the laboratory reference range is too low. Many B12 deficient people have so called “normal” levels of B12.
We often accept the general practitioners (GP) advice of “everything is normal” without obtaining our actual test results.
Why is obtaining our test results important?
If you know where your actual result sits within the laboratory reference ranges (set by the national institute of medical excellence (NICE) you have a baseline in which to measure the status of your health and a comparator for future testing, which provides a benchmark in which to make health and lifestyle choices to improve your health status.
What is vitamin B12 and why do you need it?
Vitamin B12 works together with Vitamin B9 (Folate) in the syntheses of DNA and red blood cells which carry oxygen through your blood.
B12 also has an involvement in producing the myeline sheath which protects the nerves and assists in the conduction of nerve impulses.
Severe B12 deficiency in conditions like pernicious anaemia (an autoimmune condition where the body destroys intrinsic factor, a protein necessary for the absorption of B12) used to be fatal until scientists realised death could be prevented by feeding patients raw liver (which contains high amounts of B12). But anaemia is the final stage of B12 deficiency. Long before anaemia sets in B12 deficiency causes several other problems, including fatigue, lethargy, weakness, memory loss and neurological and psychiatric problems.
B12 deficiency occurs in four stages: –
Stage 1 declining blood levels of the vitamin
Stage 2 low levels of cellular concentration
Stage 3 an increased blood level of homocysteine and a decreased rate of DNA synthesis
Stage 4 macrocytic anaemia (a special blood disorder in which the body is not able to form enough blood cells because it lacks necessary nutrients)
- B12 is Essential for Brain Health: Vitamin B12 is essential for maintaining proper brain health and function. Studies have shown that a deficiency in this nutrient can lead to memory loss and even dementia.
- Vegans and Vegetarians are at a Higher Risk of Deficiency: As Vitamin B12 is primarily found in animal products, vegans and vegetarians are at a higher risk of deficiency. Fortified cereals, nutritional yeast, and plant-based milk can be good sources of this nutrient for those who avoid animal products.
- It Helps with Red Blood Cell Production: One of the main functions of Vitamin B12 is the production of red blood cells. Without enough of this nutrient, the body cannot produce healthy and functional red blood cells, leading to anaemia.
- Aging Affects Absorption: As we age, our body’s ability to absorb Vitamin B12 from food decreases. This can lead to an increased risk of deficiency, particularly in older adults.
- It May Improve Mood and Energy Levels: Vitamin B12 has been shown to improve mood and energy levels in some people, due to its role in the production of red blood cells and the conversion of food into energy.
The significance of Vitamin B12 becomes even more critical. B12 can help reduce stress by promoting healthy nervous system function, but studies have shown that stress can also deplete the body’s Vitamin B12 stores.
So, it’s really important to make sure that we get enough Vitamin B12 in our diet to maintain our physical and mental health. Some good sources of Vitamin B12 include fish, meat, dairy products, and fortified cereals. Vegetarians and vegans can also find it in fortified cereals, nutritional yeast, and plant-based milk.
Vitamin B12 is a crucial nutrient that plays a vital role in our body. By including Vitamin B12-rich foods in our diet and seeking medical attention if needed, we can ensure that we maintain optimal health and well-being.
So why is B12 deficiency so common?
The absorption of B12 is complex and involves several steps – each of which can go wrong,
Causes of B12 malabsorption include: –
- Intestinal dysbiosis
- Leaky gut
- Atrophic gastritis or hypochlorhydria (low stomach acid)
- Pernicious anaemia (autoimmune condition)
- Medications (especially PPI’s, proton pump inhibitors block the actions of an enzyme in the stomach and reduce the amount of acid made in the stomach) and other acid-supressing drugs.
- Exposure to nitrous oxide (during surgery or recreational use)
- Certain pollutants can also block the absorption of B12 such as lead, or cadmium found in nicotine.
This explains why B12 deficiency can occur even when eating large amounts of B12-containing products.
Who are more at risk of B12 deficiency?
- Vegetarians and vegans
- Those aged 60 or over.
- People who regularly use PPIs or acid supressing medication
- People on diabetes drugs like metformin
- People with Chron’s disease, ulcerative colitis, celiac or IBS
- Women with a history of infertility and miscarriage
Treating B12 deficiency
The great news is that B12 diagnosis and treatment is easy and cheap especially when compared to treatment of the disease B12 deficiency can cause. A B12 test can be performed by any laboratory.
Adequate treatment depends on the underlying mechanism causing the problem, those suffering with pernicious anaemia or inflammatory bowel disorders like Crohn’s disease may have impaired absorption and may require B12 injections indefinitely.
Experts who specialise in B12 deficiency such as Sally M Pacholok RN and Jeffrey J Stuart DO suggest treating all patients who have levels below 450 pg/mL and are symptomatic
If you are suffering with fatigue, foggy brain, pins and needles, stress or feeling overwhelmed, the first thing to do is get tested, your local GP should easily accommodate this. If you are B12 deficient the next step is to identify the underlying cause. Once the mechanism is identified the appropriate form of supplementation along with dose and term of treatment can be selected.
Whilst you can purchase B12 from the high street it is not advised to take any supplementation without knowing that you need it. Nutrition is a science and taking a supplement without knowing if it is needed could be harmful or can deplete other nutrients in the body.