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If you have vitamin B12 deficiency, then it is important to recognize the symptoms of pernicious anemia, as low levels of B12 (cobalamin) may be caused by this form of megaloblastic anemia, a potentially life-threatening disease.
What is pernicious anemia?
Pernicious anemiais a digestive disorder that causes vitamin B12 deficiency. Because one of the side effects involves grossly misshapen and enlarged red blood cells, pernicious anemia has been classified as a type of megaloblastic anemia.
With pernicious anemia, your body is unable to digest vitamin B12 from food sources, due to a lack of the intrinsic factor digestive enzyme. As a result, after several years, your vitamin B12 stores plummet to a dangerous low.
Since vitamin B12 is crucial for all sorts of biochemical reactions, such as protecting your nerve cells through myelin production, converting fat into energy, and supporting red blood cell production, the results of pernicious anemia can be debilitating.
Avoid vitamin B12 deficiency
The best way to avoid getting vitamin B12 deficiency is to include animal-based protein foods in your diet, particularly beef liver, clams, oysters, poultry, eggs, milk, and yogurt.
Still, eating meat and dairy products does not guarantee you will not become deficient in vitamin B12, as there are many risk factors that can inhibit proper absorption of this vitamin.
Who’s at risk?
People at risk for developing B12 deficiency are:
people who exclude primary sources of vitamin B12 from their diet (vegans)
people who have had bariatric surgery
diabetics taking metformin
anybody using long-term medication for acid-reflux
individuals with gastrointestinal disease (IBD, celiac)
people who cannot produce intrinsic factor, a necessary hormone for digesting vitamin B12
Signs of megaloblastic (pernicious) anemia
The most common symptoms of pernicious anemia are:
Frequent tingling or numbness in your hands and feet, described as “pins and needles”
Difficulty walking balanced
Loss of appetite
Swollen, red tongue
Chronic fatigue, constant tiredness
What tests diagnose pernicious anemia?
The only way to find out if your vitamin B12 deficiency has turned into pernicious anemia is to request the following diagnostic tests:
Complete blood count (CBC)
Vitamin B12 blood levels
Methylmalonic acid (MMA) levels
Holotranscobalamin II levels
Bone marrow examination
What is the treatment for pernicious anemia?
Patients of pernicious anemia need to get routine doses of vitamin B12 supplements, usually in the form of vitamin B12 shots. The amount and frequency of B12 injections depend on the severity of the pernicious anemia symptoms.
For extra doses of vitamin B12 between doctor visits, B12-anemia patients have the option of supplementing with over-the-counter (OTC) vitamin B12, as well.
If you’re having trouble finding balance, B12 deficiency might be the culprit. Symptoms of vitamin B-12 deficiency- dizziness and nerve damage like ataxia (unsteady gait, difficulty keeping balance), and numbness or tingling in hands and feet require B12 supplements.
Vitamin B12 deficiency symptoms
Vitamin B12 occurs naturally in all meat, cheese, and egg products, but if you are one of millions of people who cannot absorb B12 efficiently, then you will start feeling symptoms of vitamin B12 deficiency. Some common emotional and cognitive signs of B12 deficiency are:
Chronic fatigue, sleepiness
Nerve damage caused by B12 deficiency
In addition to psychiatric symptoms, vitamin B12 deficiency causes severe damage to your nerves, notably subacute combined degeneration (SCD)of the spinal cord- a severe neurological disorder caused by B-12 deficiency. SCD causes damage in your spinal cord, brain, and peripheral nerves, beginning with the myelin sheathe.
1- The myelin sheathe- your nervous system’s “ozone layer”
The myelin sheath is a protective covering that surrounds many of your nerves, providing a shield from potential danger. The myelin sheathe also accelerates communication between your nerves and your many bodily sensors (hands, feet, tongue, nose, eyes). Vitamin B12 aids your body in maintaining this essential protective mechanism, and low levels of B12 often result in a breakdown of the myelin sheathe.
2- Communication breakdown
The nerves of your spinal cord rely on a steady inflow of information from your nerve sensors throughout your body. Messages from the nerves in your legs, for example, flow along the spinal cord and to the brain, thus controlling movements like running, walking, skipping, and tapping your feet. Nerve damage causes these signals to become misinterpreted, resulting in poor coordination, or gait ataxia.
3- Gait ataxia- taking the spring out of your step
A typical sign of abnormal neurological behavior resulting from B12 deficiency is gait ataxia, which is difficulty walking. Gait ataxia is also one of the symptoms of perniciousanemia, red blood cell disease associated with prolonged vitamin B-12 deficiency. Symptoms of gait ataxia are:
Unsteady gait, difficulty walking without stumbling
Difficulty staying balanced on one leg
Trembling awkward movements, clumsiness
Muscular weakness in the legs and arms
Hypotension (low blood pressure)
Vision problems, blurriness
4- Paresthesias- “pins and needles” and numbness sensations
An early sign of nerve damage related to vitamin B12 cobalamin deficiency is paresthesias, resulting in numbness and tingling in the hands and feet. Paresthesias is a kind of peripheral neuropathy that affects the peripheral nerves that run along your spinal cord and to your extremities, thus causing that pins and needles sensation that you often feel in your hands and feet.
Do you have vitamin B12 deficiency? Go ask a hematologist.
The only way to determine if you are indeed suffering from vitamin B12 deficiency is by getting a blood test. If a physician diagnoses you with dangerously low levels of B12, then he may recommend B12 injections, which will require a prescription.
Do you know how much vitamin B12 you need in order to avoid vitamin B12 deficiency? Unless you supplement, you could wind up with dangerously low vitamin B12 levels. Find out if your B12 blood levels are normal and how much you need to meet the FDA’s RDA for vitamin B12.
What are the symptoms of vitamin B12 deficiency?
Vitamin B12 (Cobalamin) is a water-soluble nutrient that your body gets from protein sources, such as beef, chicken, liver, fish, eggs, and dairy products. Your body uses vitamin B12 for DNA synthesis, protecting your nervous system, and strengthening cognitive skills. Symptoms that indicate a low vitamin B12level include constant fatigue, difficulty concentrating, memory loss, tingling or numbness in your hands and feet, depression, agitation, altered taste perception, and red, swollen tongue.
How much B12 is in my blood right now?
By performing a blood test, your doctor can tell you if you are deficient in vitamin B12, or if you have normal B12 levels. Vitamin B12 blood screening requires a 6-8 hour fast before testing. Laboratory tests will measure how many picograms (pg) of cobalamin you have per milliliter (ml) of blood in your body.
How much B12 should I have?
Scientists agree that a normal level of vitamin B12 in your blood is 200 – 900 picograms per milliliter (200-900 pg/ml).
Test results showing less than 200 pg/ml signal vitamin B12 deficiency.
For elderly adults, the recommended vitamin B12 level is much higher- Test results showing less than 500 pg/ml indicates B12 deficiency.
In order to find the cause of a vitamin B12 deficiency, doctors may perform a Schilling test.
What is the recommended dose of vitamin B12?
The FDA’s RDA of vitamin B12 for healthy adults is approximately three mcg daily for males and females alike, including pregnant and nursing moms.
For elderly individuals, the recommended dose of vitamin B12 is 25-100 mcg per day.
Scientific study proves that the RDA for B12 is off.
According to a study conducted in the Netherlands, elderly sufferers of vitamin B12 deficiency need more than the recommended daily allowance (RDA) in order to achieve normal levels of B12.
Using methylmalonic acid (MMA) levels as a gauge, scientists established that cyanocobalamin supplementation amounting to 200 times the RDA of vitamin B12 is required in order to stabilize B12 levels in patients showing signs of vitamin B12 deficiency.
How much vitamin B12 do you really need?
Vitamin B12 shots administering a daily doseof 1,000 mcg of cobalamin are prescribed for the first 10 days following diagnosis of vitamin B12 deficiency, continuing with a weekly dose of 1,000 mcg for a consecutive 4-week period.
If you’ve had bariatric surgery (gastric bypass surgery, lap band surgery), then you’re at risk for vitamin B12 deficiency. Weight loss surgery causes vitamin B12 malabsorption, in addition to difficulty absorbing other vitamins and minerals. Learn about vitamin B12 deficiency symptoms, and ways to get your B12 levels back to normal.
How many types of bariatric surgery procedures are there?
There are many types of weight loss surgeries, including gastric bypass and lap band surgery, but there are two general categories:
Malabsorptive surgery rearranges and/or removes part of your intestines so that you are unable to absorb vitamins from foods, thus bypassing the digestive process. There are no longer any strictly 100% malabsorptive weight loss surgeries, but many such as the Roux-en-Ygastric bypass include a combination of (mostly) malabsorptive and restrictive techniques.
Restrictive surgery shrinks your stomach, thus causing you to feel full earlier and avoid overeating. Examples are the gastric sleeve and gastric banding (lap band surgery).
Why do I need to take bariatric vitamins and minerals after having bariatric surgery?
If you’ve had weight loss surgery, then you are at a high risk for vitamin deficiencies, particularly vitamin B12 deficiency. There are two reasons for this:
If you’ve had malabsorptive surgery, such as a mini-gastric bypass or duodenal switch, then your body is unable to digest water-soluble vitamins such as vitamin B12 from food sources.
One of the procedures of malabsorptive bariatric surgery is the removal of the ileum, the part of your small intestine responsible for digesting vitamin B12.
The only way for you to receive enough B12 to avoid vitamin deficiency is to put it directly into your bloodstream, through vitamin B12 shots (Sublingual B12 pills are not your best option for absorbing vitamin B12.)
With restrictive surgery, such as gastric sleeve, your stomach is unable to contain enough food at one time to avoid vitamin deficiency.
What are the symptoms of vitamin B12 deficiency, and why should I be worried?
Vitamin B12 supports many important functions in your body- B12 boosts energy and mental clarity, aids in producing red blood cells, maintains your metabolism, protects your >nervous system, strengthens cognitive functioning, and reduces your risk of heartattack or stroke.
Vitamin B-12 (Cobalamin) originates in most protein foods, but even meat-eaters can get vitamin B12 deficiency. Absorbing vitamin B12 is a tricky process, and people who lack the intrinsic factor protein are unable to digest vitamin B12 from natural sources. Learning about B12 supplement absorption is essential for avoiding B-12 deficiency symptoms.
Vitamin B12- What is it?
Vitamin B12, a member of the B-complex family of vitamins, is a water-soluble protein. Most of the vitamin B12 that you eat comes from meat sources, as animal microorganisms produce it. Beef, liver, chicken, fish, and shellfish are some of the richest sources of vitamin B-12, in addition to eggs, cheese, and other dairy products. The only widely confirmed vegan form of B12 occurs in brewer’s yeast.
This is your Body on B12
The benefits of vitamin B12 for your body are expansive.
Vitamin B12 assists in producing oxygen-carrying red blood cells.
Vitamin B12 also protects the myelin sheathe, which protects your nervous system.
Vitamin B12 benefits cognitive functioning- Cognitive health treatments are essential for treating symptoms of autism, and to delay the early onset of dementia.
Supplementing with vitamin B12 boosts stamina, sustains the memory, enhances mental focus, and imparts feelings of well-being in individuals who suffer from vitamin B12 deficiency.
Long-term vitamin B12 deficiency causes depression, anxiety, fatigue, memory loss, and numbness/tingling in the extremities.
Vitamin B12’s journey through your body is a complicated, tricky procedure, and many things can go wrong.
1. When you consume dietary vitamin B12 (from food), it immediately clings to hydrochloric acid and pepsin, a gastric enzyme that your body makes- except for when it doesn’t. (More on this later.)
2. In your stomach, digestive acids separate vitamin B12 (cobalamin) from its protein part. Also in your stomach, gastric parietal cells produce a substance called intrinsic factor- a necessary glycoprotein for digesting B12.
3. Vitamin B12 combines with “R protein,” thus becoming B-complex. B complex, along with intrinsic factor, travels to the small intestine.
4. In the small intestine, R protein and B-complex separate. B12 then attaches itself to intrinsic factor.
5. The B12/intrinsic factor complex travels through the small intestine, finally arriving at the very bottom, where it reaches the terminal ileum. The ileum then absorbs the vitamin B12 and distributes it into your bloodstream, where it is then stored in the liver.
Things that can go wrong with vitamin B12 Absorption
Some people are unable to digest vitamin B12 properly from food, and must instead receive vitamin B12 injections, which go directly into the bloodstream, bypassing the need for digestion.
You don’t have intrinsic factor. Lack of intrinsic factor is an autoimmune response, in which autoantibodies destroy intrinsic factor proteins produced in the stomach. Since intrinsic factor is required in order to digest B12, the only way to avoid B12 deficiency is to bypass digestion by taking vitamin B12 supplements.
You are among the elderly. The majority of senior citizens don’t produce the amount of stomach acids needed to break down B12 for digestion. Even the minimum amount of vitamin B12 recommended by physicians is not enough to avoid dementia caused by B12 deficiency, so elderly individuals are a high-risk group. To prevent early-onset Alzheimer’s disease or neurological damage, transdermal vitamin B12 is advisable.
You take heartburn medication. As with the elderly, people who have GERD, or others who frequently take medicine for acid-reflux, including pregnant women, are susceptible to B12 deficiency.
You have had your ileum removed.Gastric bypass patients are at high risk for developing vitamin B12 deficiency, as are other patients of gastrointestinal surgery, such as sufferers of Crohn’s disease. Unfortunately, many surgeons neglect to warn their patients about complications regarding vitamin B12 deficiency, and many bariatric surgery patients don’t find out about it until the symptoms- depression, fatigue, brain fog- become too hard to ignore.
You are a vegan. The vegan diet is largely devoid of B-12 sources, so unless you are a vegetarian who eats eggs, fish, or dairy, then you must take regular vitamin B12 supplements in order to avoid B12 deficiency.
You are diabetic. Metformin, a diabetes drug, interferes with the absorption of vitamin B12.
You have an autoimmune disease. Many autoimmune diseases such as celiac disease, fibromyalgia, and chronic fatigue syndrome are highly correlated with B12 deficiency. Scientists are unsure as to the exact cause, but they have noted a decrease in symptoms such as fatigue, irritability, and depression with the inclusion of vitamin B12 supplements.