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About Vitamin B12


Who needs Vitamin B12?

  • Vegetarian and vegans (see below)
  • People over the age of 60 (see below)
  • Individuals with pernicious anemia (see below)
  • Individuals with Chronic Fatigue
  • Gastric bypass and gastrointestinal disorder patients (see below)
  • Athletes
  • Autoimmune disease patients
  • Chronic pancreatitis patients
  • Crohn's disease patients
  • People with Malabsorption syndromes
  • Thyroid disease patients
  • Individuals with symptoms suggesting multiple sclerosis (ms4a)

Symptoms of B12 Deficiency

Physical Symptoms:

  • Paresthesia
  • Weakness or fatigue
  • Muscle aches
  • Impaired vibration or position sense
  • Impaired pain or touch perception
  • Ataxia
  • Abnormal gait
  • Decreased reflexes
  • Unexplained vision or taste impairment
  • Impotence
  • Urinary or fecal incontinence
  • Lhermitte's sign (sudden electric-like shocks down the spine on flexing head)
  • Positive Romberg's sign (increased unsteadiness on feet when eyes are closed)

Psychological Symptoms:

  • Memory loss
  • Disorientation
  • Apathy
  • Irritability
  • Paranoia
  • Depression
  • Hallucinations
  • Violent behavior
  • Psychosis
  • Personality changes
  • Dementia

Vegetarians and Vegans

Vegetarians and vegans are at greater risk of developing vitamin B12 deficiency than non-vegetarians because natural food sources of vitamin B12 are limited to animal foods. Vegetarians and vegans need to consider taking vitamin B12 to avoid becoming B12 deficient. When adults adopt a strict vegetarian diet, deficiency symptoms can be slow to appear.

Older Adults

Gastric acid helps release vitamin B12 from the protein in food. This must occur before B12 binds with intrinsic factor and is absorbed in your intestines. Atrophic gastritis, which is an inflammation of the stomach, decreases gastric secretion. Less gastric acid decreases the amount of B12 separated from proteins in foods and can result in poor absorption of vitamin B12. Decreased gastric secretion also results in overgrowth of normal bacterial flora in the small intestines. The bacteria may take up vitamin B12 for their own use, further contributing to a vitamin B12 deficiency. Up to 30 percent of adults 50 years and older may have atrophic gastritis, an overgrowth of intestinal flora, and be unable to normally absorb vitamin B12 in food.

Individuals with pernicious anemia

Anemia is a condition that occurs when there is insufficient hemoglobin in red blood cells to carry oxygen to cells and tissues. Common signs and symptoms of anemia include fatigue and weakness. Anemia can result from a variety of medical problems, including deficiencies of vitamin B12, vitamin B6, folate and iron. Pernicious anemia is the name given more than a century ago to describe the then-fatal vitamin B12 deficiency anemia that results from severe gastric atrophy, a condition that prevents gastric cells from secreting intrinsic factor. Intrinsic factor is a substance normally present in the stomach. Vitamin B12 must bind with intrinsic factor before it can be absorbed and used by your body. An absence of intrinsic factor prevents normal absorption of B12 and results in pernicious anemia.

Gastric bypass and gastrointestinal disorder patients

Individuals with stomach and small intestinal disorders may be unable to absorb enough vitamin B12 from food to maintain healthy body stores. Intestinal disorders that may result in malabsorption of vitamin B12 include:

Sprue, often referred to as Celiac Disease (CD), is a genetic disorder. People with CD are intolerant to a protein called gluten. In CD, gluten can trigger damage to the small intestines, where most nutrient absorption occurs. People with CD often experience nutrient malabsorption. They need to follow a gluten free diet to avoid malabsorption and other symptoms of CD. Crohn's Disease is an inflammatory bowel disease that affects the small intestines. People with Crohn's disease often experience diarrhea and nutrient malabsorption.

Surgical procedures in the gastrointestinal tract, such as surgery to remove all or part of the stomach, often result in a loss of cells that secrete stomach acid and intrinsic factor. Surgical removal of the distal ileum, a section of the intestines, also can result in the inability to absorb vitamin B12. Anyone who has had either of these surgeries usually requires lifelong supplemental B12 to prevent a deficiency. These individuals would be under the routine care of a physician, who would periodically evaluate vitamin B12 status and recommend appropriate treatment.
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