Vitamin B12: Who’s at Risk for Deficiency? Symptoms, and Treatments

by Melinda Burris

Why BI2 is Important

Vitamin B12, or cobalamin, plays important functions in making sure the body runs as it should.¹ Without the proper amount of B12 in your system, your body can’t adequately distribute oxygen, which must be delivered to all parts of the body. Vitamin B12 is also key in the production of myelin, which provides a barrier that protects the central nervous system (CNS).

This article discusses how B12 is consumed, known conditions and medications that can interfere with your body’s ability to properly process B12, leading to a deficiency in this crucial vitamin. Groups that are most at risk for B12 deficiency are identified as are common symptoms of B12 deficiency. Prevention and treatment in case of B12 deficiency are discussed and a warning is issued regarding prolific, unsubstantiated claims on the internet asserting Vitamin B12 can provide cures to any number of conditions people are desperately seeking relief from.
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Natural Sources of Vitamin B12

Vitamin B12 can easily be consumed by eating a variety of animal-based foods. Some examples include poultry, fish, shellfish, and dairy products such as milk and eggs. B12 is also available for those who stick to a plant-based diet through the consumption of specific kinds of dried mushrooms and grains products that have been fortified with the vitamin. Individuals can also opt to take B12 in the form of a supplement.^1,3

Those Most at Risk for B12 Deficiency

Many factors can contribute to B12 deficiency, which means people in a number of categories are at an increased risk of not getting enough of this essential vitamin:

• People over the age of 50. Experts estimate that approximately 2% of adults aged 50 or above have extremely low levels of Vitamin B12.² As much as 20% of this demographic “may have a borderline vitamin B₁₂deficiency.”²
• Patients who have been operated on and had part of the bowel removed where the body absorbs your intake of B12.¹ Vitamin B12 deficiency is common for two reasons: 1) Many people do not regularly consume a diet that provides the necessary amounts of B12 the body must have to function properly. For others, due to necessary medical procedures or health conditions, they simply can’t ingest or absorb enough of this vitamin, no matter how much the dosage is increased.²
• People following a strict vegetarian or vegan diet.^1, As mentioned earlier, Vitamin B12 is most commonly available in meat, eggs, dairy, poultry, and additional foods sourced from animals. Since plants do not produce Vitamin B12, strict vegetarians and vegans have limited options for ensuring they consume an adequate amount. Often vegetarians and vegans will choose to either take a supplement or add grains that have been enriched with B12 to their diet.²
• Weight loss surgery patients. These individuals face a B12 absorption challenge because the surgery hinders the body’s natural process of extracting B12 from nutrients.²
• Those taking certain medications or suffering from digestive diseases, which will be discussed in more detail in the section below:

Disease States and Medications That Inhibit Proper Absorption of B12

Patients with celiac or Crohn’s disease are at risk for B12 deficiency because their conditions make it difficult for them to absorb vitamins present in foods.² Overconsumption of antacid drugs can also interfere with the body’s ability to get an adequate supply of B12. This class of medications decreases the level of acid present in the stomach, giving the patient relief from conditions such as heartburn and indigestion. The drawback is that continued use of antacids lessons the amount of stomach acid to the point that B12 can no longer be properly absorbed because the absorption process for this vitamin depends on a certain amount of gastric acid.² Metformin, a drug commonly prescribed for diabetes, also interferes with the body’s ability to absorb B12.¹

Common Symptoms of Vitamin B12 Deficiency

Like most vitamin insufficiencies, Vitamin B12 deficiency generally develops gradually over time, with symptoms and discomfort becoming more pronounced as the deficiency worsens. However, every case is different, and in some instances, a Vitamin B12 deficiency develops rapidly. There are a number of symptoms associated with Vitamin B12 deficiency that are also typical of other conditions, making it easy to overlook or misdiagnose.²

Common symptoms of Vitamin B12 deficiency can include:

• Nerve damage that is often described by patients and doctors alike as a “pins and needles sensation” that occurs in the feet, hands, and legs. It is a common sign your body isn’t getting enough vitamin B12. This feeling occurs because the nerves are being exposed. Vitamin B12 plays a large role in the body’s creation of myelin, which is best described as a casing wrapped around nerves to protect them from exposure. When your body lacks the Vitamin B12 necessary to properly produce myelin, your nervous system is affected, leading to the “pins and needles sensation”. The medical term for this condition is paresthesia.¹
• Decreased mobility and difficulty with coordination and balance.¹
• Anemia, which is characterized by weakness and fatigue.^1,2 Your body becomes anemic because it lacks the proper amount of Vitamin B12 to create red blood cells, which carry oxygen throughout the body.¹
• Glossitis, the medical term for inflammation of the tongue is also a frequently cited symptom in Vitamin B12 deficiency. Glossitis can alter the shape and color of your tongue and make it difficult to speak. In some cases, the tongue takes on a smooth appearance and the ability to taste is lost because it causes your taste buds to change shape and recede.^1,2

How Can Vitamin B12 Deficiency Be Prevented?

You can prevent B12 deficiency by making sure you eat foods that deliver the recommended daily allowance of this essential vitamin. As has been discussed, those who eat meat and dairy products will find it easier to get the B12 they need from foods. However, strict vegetarian and vegans can still take steps to make sure they get an adequate amount of B12 each day by (as mentioned earlier) consuming a supplement or adding grains enriched with the B12 to their diet.²

As previously mentioned, those age 50 and up are at a higher risk of developing B12 deficiency. To prevent this, it is the recommendation of the Institute of Medicine that these individuals should take a daily B12 supplement. Most standard multivitamins contain the extra amount of B12 recommended for this demographic.²

Vitamin B12 Treatment Options

If you have already developed a major B12 deficiency, your healthcare provider will either prescribe weekly injections of B12 or a high-dose B12 supplement to be taken once a day. Less severe cases can be corrected by changes in diet to include more foods rich in B12 and taking a daily multi-vitamin.²

Beware of the Latest Vitamin Supplementation Craze: B12

Every few weeks it seems there is a new cure-all supplement heavily hyped online as a miracle worker that can solve a wide range of medical problems from minor conditions like fatigue to life-threatening conditions like heart disease to progressive illnesses with no known cure such as Alzheimer’s Disease (AD).²

Patrick J. Skerrett, Former Executive Editor, Harvard Health, offers a great example of a fact with some scientific truth to it being skillfully twisted by dishonest marketers looking to make a quick buck by making it seem like any one supplement (in this case Vitamin B12) is the answer to cure whatever ails you, even a condition as degenerative and in many ways mysterious as Alzheimer’s Disease (AD). Skerrett explains that scientific studies have noted that patients suffering from AD and other forms of cognitive decline present with diminished Vitamin B12 levels.²

However, while those pushing sales of Vitamin B12 as a possible cure for these serious illnesses are happy to highlight this link that has been noted; they fail to mention the numerous clinical trials where patients diagnosed with AD and other cognitive disfunction have been prescribed elevated doses of Vitamin B12. In some studies, participants have received dosages of up to 1000 micrograms without demonstrating any cognitive function improvement.² To put this into perspective, the normal recommended daily adult dosage of Vitamin B12 is 2.4 micrograms.⁴ Many continue to suffer from AD, a particularly cruel condition, and new research is being conducted all the time into how to prevent and effectively treat the disease. However, there is still much to learn, and treatment options are extremely limited.

References:

1. West, H. (7 October 2017). 9 Signs and Symptoms of Vitamin B12 Deficiency.
2. Skerrett, P.J. (11 February 2019). Vitamin B12 Deficiency Can Be Sneaky, Harmful.
3. Watanabe, F. (2013). Biologically Active Vitamin B12 Compounds in Foods for Preventing Deficiency Among Vegetarians and Elderly Subjects.

Mayo Clinic. (1998-2020). Vitamin B12.
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