Vitamin B12 deficiency can be sneaky

We come across Vitamin B12 deficiency manifestations in patients of all age groups very frequently., though the presentations vary. A woman in her early 50s, with Diabetes Type II and Hypothyroidism presented with numbness, pins and needles sensation in his hands & extreme tiredness. She appeared to be highly emotional and exaggerating her symptoms. As usual physician did all the basic evaluations (including nerve conduction studies) and everything appeared normal.

She approached us for Diabetic management. On medical history evaluation, we found that patient already experiencing breathlessness while walking. Her Lab test revealed that she was severely Vitamin B12 deficient. She needed injectable Vitamin B12 short term and later with Oral supplementation and dietary adaption. Her symptoms disappeared in about 4 months.

Recommendation

The Recommended Dietary Allowance for men and women ages 14 years and older is 2.4 micrograms (mcg) daily. For pregnancy and lactation, the amount increases to 2.6 mcg and 2.8 mcg daily, respectively.

Food Sources: Vitamin B12 is naturally present in foods of animal origin, including fish, meat, poultry, eggs, and dairy products. For plant based eaters & vegans, there are fortified breakfast cereals and nutritional yeasts which are fortified with vitamin B12 that have high bioavailability. Bioavailability varies by type of food source, the bioavailability of vitamin B12 is about three times higher in dairy products than in meat, poultry & fish.? The bioavailability from dietary supplements is about 50% higher than that from food sources.

Vitamin B12 Deficiecny

Symptoms of Vitamin b12 deficiency

Vitamin B12 deficiency is sneaky, the symptoms mimic many other conditions such as hypothyroidism. Due to the non-specificity of symptoms, B12 deficiency may be overlooked in hypothyroid patients. A mild deficiency may cause no symptoms. But if untreated, it may lead to symptoms such as: weakness, tiredness, or lightheadedness, heart palpitations and shortness of breath, pale skin, a smooth tongue, constipation, diarrhoea, loss of appetite, or gas, nerve problems like numbness or tingling, muscle weakness, and problems walking, vision loss, mental problems like depression, memory loss, or behavioural changes. One sign that you lack enough B12 may be glossitis, or a swollen, inflamed tongue.

Who is at risk of Vitamin B12? deficiency?

It's important to do an initial evaluation for people who come with the h/o of fatigue, weakness, mild depressive symptoms, or constipation, diarrhea, loss of appetite, or gas or neuronal issues like numbness or tingling, muscle weakness, and problems walking. Also advisable to evaluate Vitamin B12 deficiency in Vegans, Vegetarians and also people with medical conditions like crohns, ulcerative colitis.

How to Diagnose the deficiency?

Screening average-risk adults for vitamin B12 deficiency is not recommended. Screening may be warranted in patients with one or more risk factors, Initial laboratory assessment should include a complete blood count and serum vitamin B12 level. Measurement of serum methylmalonic acid should be used to confirm deficiency in asymptomatic high-risk patients with low-normal levels of vitamin B12.

How is vitamin B12 deficiency treated?

Vitamin B12 deficiency can be treated with vitamin B12. It is often treated with cyanocobalamin, a man-made form of vitamin B12. Depending on the cause of the deficiency, the person may only have to be treated until their vitamin B12 levels are back to normal, or they may have to take vitamin B12 therapy for the rest of their life. Options for vitamin B12 treatment include, Vitamin B12 oral medication, Vitamin B12 intramuscular injections (a shot that goes into the muscle), Vitamin B12 nasal gel & Vitamin B12 nasal spray.

Practical tips for Vegetarians and Vegans:

Vegetarians and vegans must take particular care to consume enough?vitamin?B-12, as it is mainly found in meat, eggs, and dairy products. The only reliable vegan sources of B12 are foods fortified with B12 (Plant milk, BF cereals, Soy Products) or a supplement or B12 injections, or a high-dose oral vitamin B12 if they are deficient. People with mild deficiency, intake of a regular B vitamin complex supplement are often touted to boost energy levels and mood.

There is no evidence of benefit if people without a deficiency take extra B vitamins. People who eat a vegan diet are often told to include Brewers or nutritional yeast for its B12 content. However, yeast does not naturally contain this vitamin and will only be present if fortified with it. Be aware that certain brands, but not all, contain B12. Nori (purple laver), the dried edible seaweed used to make sushi rolls, is sometimes promoted as a plant source of vitamin B12. It does contain small amounts of active vitamin B12, but the amount varies among types of seaweed, with some containing none. Therefore it is not considered a reliable food source.

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