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Ever wonder why vitamin B12 deficiency is so rampant among humans, yet you never hear of animals or marine life having difficulty absorbing vitamin B12? Is vitamin deficiency something unique to humans, or is it bigger than we’ve imagined? Here are some interesting tidbits about vitamin B12 deficiency along the food chain.
Scientists discover vitamin B12 sea sponge
Recently, scientistsin the Antarctica discovered something all of us suffering from vitamin B12 deficiency wish we had- a way to extract vitamin B12 from the environment and absorb it into our digestive system.
It’s called cobalamin acquisition protein 1 (CBA1), and it’s a special protein that sea algae use to grab vitamin B12 (cobalamin) from the ocean water and ingest it, kind of the way a sponge soaks up fluids.
Apparently, certain single-celled bacteria and microorganisms are able to replicate this essential protein whenever they happen to need more vitamin B12, and thus avoid acquiring vitamin B12 deficiency.
Getting vitamin B12 from water- isn’t that like trying to squeeze orange juice from a rock?
Well, vitamin B12 occurs naturally in protein foods like beef, chicken, and fish, in sufficient amounts for us land-dwellers to avoid becoming deficient.
But if you happen to be a one-celled microorganism, then you can get just the right amount of vitamin B12 from seawater, provided you are able to make this miracle protein, CBA1.
Where’s my “B12 claw?”
Why don’t we have this lifesaving mechanism, something to grab vitamin B12, latch onto it, and escort it through our digestive system, so that we never have to worry about vitamin B12 deficiency?
We do, actually.
It’s called intrinsic factor, and it’s a special digestive enzyme that we produce for the express purpose of completely digesting vitamin B12 into our body. Intrinsic factor bonds itself to vitamin B12 from your food supply, protects it from harm as it races through your small intestines, and helps to deliver it into your blood stream.
Unfortunately, if you have a certain autoimmune disorder, pernicious anemia, then you are either unable to make intrinsic factor, or you cannot utilize it efficiently. Without intrinsic factor, you are like the algae on the ocean floor, only without the B12 sponge- surrounded by all the nutrients you need, but unable to reach them.
If you eat plenty of meat, dairy products, and eggs, but you constantly feel tired, lethargic, and “out to lunch,” then you might be a candidate for autoimmune vitamin B12 deficiency.
To find out, ask your doctor for a blood test that checks vitamin B12 levels. Although they are not 100% accurate in diagnosing true pernicious anemia, the standard B12 tests will tell your doctor if your total stores of vitamin B12 are dangerously low.
If you feel fatigued, and suspect B12 deficiency, then see your doctor immediately. Before diagnosing vitamin B12 deficiency or pernicious anemia, your doctor will run a vitamin B12 blood test for vitamin B12 levels in your blood, in addition to measuring your red blood cells and homocysteine levels. Here are ten tests still used today to diagnose vitamin B12 and pernicious anemia.
Vitamin B12 deficiency symptoms:
Vitamin B12 deficiency can be difficult to catch, because it masks itself as many other conditions. Sometimes, B12 deficiency occurs as a secondary side effect of a primary illness like fibromyalgia, Crohn’s disease, or celiac disease. Other times, vitamin B12 deficiency symptoms are overlooked because of underlying conditions such as depression or diabetes.
The most common symptoms of vitamin B12 deficiency and pernicious anemia are:
Constant fatigue that is not relieved by sleep and does not result from overexertion
Aggressive behavior that is unusual
Difficulty focusing or paying attention
Forgetting words on “tip of tongue”
Forgetting numerical codes like phone numbers or PINs
Painful tingling and numbness in extremities (hands, feet, arms, and legs)
“Pins and needles”
Painful tingling or burning sensation in tongue and mouth
10 Tests that diagnose vitamin B12 deficiency and pernicious anemia
1)Serum vitamin B12 level: First, your physician will request a vitamin B12 blood test to determine if your vitamin B12 blood (cobalamin) levels are indeed low. Usually, if test results are positive, then vitamin B12 supplementationbegins immediately.
The vitamin B12 blood screening is the most important test for diagnosing vitamin B12 deficiency, and if you respond well to vitamin B12 supplements, then further testing is not usually required.
However, if your doctor suspects pernicious anemia, then he might order one or more of the following additional tests:
2)Complete blood count (CBC): A blood test to screen the amount of red and white blood cells. With pernicious anemia, your red blood cells become engorged and misshapen, resulting in low distribution of red blood cells throughout your body.
3)Serum folate level: Many people who have vitamin B12 deficiency also are deficient in the B vitaminfolate.
4)Serum lactate dehydrogenase (LDH): Your doctor might order a blood test measuring LDH levels.
5) Reticulocyte count: This test looks for reticulocytes (slightly immature red blood cells).
6) Homocysteine test: High homocysteine levels in your blood may indicate vitamin B12 deficiency, folate deficiency, or vitamin B6 deficiency.
7) Gastrin level: a test measuring the amount of the hormone gastrin in your blood may help doctors diagnose the cause of vitamin B12 deficiency.
8) Methylmalonic acid (MMA) test- With vitamin B12 deficiency, methylmalonic acid levels go up. The MMA test provides more proof of the existence of vitamin B12 deficiency.
9) Intrinsic factor antibody test: Pernicious anemia is an autoimmune disorder in which sufferers are not able to product intrinsic factor, a necessary hormone for absorbing vitamin B12. Before diagnosing pernicious anemia, your doctor has to confirm the existence of an antibody in your system that inhibits intrinsic factor production, thereby causing vitamin B12 deficiency.
10) Bone marrow staining: Sometimes, your physician might require a bone marrow biopsy in order to determine other potential causes of pernicious anemia or general red blood cell disorders.
What about the Schilling test for vitamin B12 deficiency?
In the past, doctors have used the Schilling test to diagnose vitamin B12 deficiency. The Schilling test involves swallowing harmless, radioactive doses of vitamin B12 and tracking its progress in your body. However, because it involves fasting and the use of low-dose radiation, and because it may cause side effects like nausea, the Schilling test is rarely used.
Schilling test—a test in which a harmless amount of radiation is used to assess whether a vitamin B12 deficiency exists (rarely used)
Vitamin B12 supplementation
Once diagnosed with vitamin B12 deficiency, your doctor will likely prescribe vitamin B12 shots, beginning with 1000 mcg of vitamin B12 per week.
These B12 shots are only available upon prescription.
After the first month, B12 shots may be decreased to once per month, upon doctor’s orders.
If B12 deficiency symptoms (fatigue, muscular pain, and brain fog) continue despite vitamin B12 injections, you may supplement with additional over-the-counter (OTC) vitamin B12.
Once your vitamin B12 levels are normal, your doctor will likely stop vitamin B12 shots in favor of OTC vitamin B12.
Sublingual vitamin B12 are an OTC option that may require supplementation two or three times per day. Side effects may include unpleasant taste and burning, tingling sensation on the tongue.
Note: Sublingual vitamin B12 must be dissolved under the tongue as indicated; if they are chewed or swallowed, then vitamin B12 will not be absorbed.
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Aside from taking the blood test for vitamin B12, have you received any of the other tests mentioned?
Please share your experience with vitamin B12 supplementation.
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Read more about vitamin B12 deficiency and pernicious anemia:
The richest food sources of vitamin B12 come from meat, fish, and milk sources. Some vegan vitamin B12 sources are available, but for maximum vitamin B12 benefits, you would have to eat a lot of tofu to get close to 1000 mcg of vitamin B12 per week. How can you avoid vitamin B12 deficiency on a vegan diet?
Are you getting enough vitamin B12?
The RDA for vitamin B12 is minimal- only a few mcg of B12 per day. However, according to various scientific studies, people who receive doses upwards of 1000 mcg of vitamin B12 per week reported experiencing increased stamina, mental focus, and feelings of wellbeing.
Non-vegan sources of vitamin B12:
Clams: One 3-ounce serving of cooked clams contains 84.1 mcg of vitamin B12.
Liver: After clams, liver is the richest source of vitamin B12. A 3-ounce serving of cooked lamb liver contains a whopping 72.8 mcg of vitamin B12.
Fish eggs: A 3-ounce serving of whitefish caviar provides 56.4 mcg of vitamin B12.
Mackerel: Mackerel has 19 mcg of vitamin B12 per 100 grams.
Vegan sources of vitamin B12:
Soymilk: An 8-ounce cup of soymilk provides a mere 2 mcg of vitamin B12, give or take.
Tofu: A typical serving of tofu provides 1.86 mcg of vitamin B12.
Marmite: Yeast spreads contain 0.5 mcg of vitamin B12 per 100 grams, or 0.03 per teaspoon.
Are you at risk for vitamin B12 deficiency?
There are many ways to get vitamin B12 deficiency, but they generally boil down to this:
Either you don’t eat enough foods that have vitamin B12, or you eat plenty of fish and meat, but you’re not digesting the B12.
Lack of intrinsic factor (a hormone necessary for digesting vitamin B12)
Drug interaction (metformin, PPIs)
Gastrointestinal surgery (gastric bypass)
Getting extra vitamin B12
If you don’t have B12 deficiency, but you want to boost stamina, maintain a healthy weight, or enhance cognitive functioning by increasing vitamin B12 levels, then your choices are:
Become a seafood lover, or
Supplement with vitamin B12 for life.
Which B12 supplements are available?
There are different kinds of B12 vitamins, some of which require a doctor’s prescription.
Vitamin B12 shots: If diagnosed with vitamin B12 deficiency or pernicious anemia, then your doctor might prescribe 1000 mcg of vitamin B12 injections per week, or as needed. A prescription is required, and many patients find that their fatigue symptoms return before the next scheduled vitamin B12 shot.
Sublingual vitamin B12: Vitamin B12 tablets that dissolve under the tongue are available with or without prescription. Vitamin B12 pills are not efficient ways to access vitamin B12, and they often require you to take 3 doses throughout the day.
Side effects of sublingual vitamin B12 may include burning sensations on tongue and unpleasant taste.
Please tell us…
How do you get your vitamin B12- from supplements in pill form, vitamin B12 shots, or otherwise?
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You might be surprised to know that vitamin B12 deficiency can cause symptoms like depression, fatigue, and anxiety. Vitamin B12 benefits your body in many ways, and when you don’t get enough, you can start to feel sluggish, nervous, and depressed, in addition to suffering many neurological disorders. Sometimes, depression from B12 deficiency mimics clinical depression, interfering with a proper diagnosis.
Do you have vitamin B12 deficiency?
The only way to be certain if your B12 levels are low is by getting a blood test. This will indicate if you need more vitamin B12, even if it doesn’t necessarily explain why your B12 levels are lower than normal.
Here are some typical signs of vitamin B12 deficiency that “masquerade” as mental illness:
Depression that lingers
Neurological symptoms of B12 deficiency include:
Painful tingling in your legs, hands, and feet
Frequent clumsiness and tripping
Altered sense of taste
How many types of depression are there?
Here are some of the most common types of depression:
Major depressive disorder: The National Institute of Mental Health (NIMH) characterizes major depression as a “combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once-pleasurable activities.” Most people who suffer from major depression will experience several episodes of depression in their lives, but it is possible to experience it only once. With major depressive disorder, medication is required for treatment of symptoms.
Dysthymic disorder: Dysthymia is depression that lingers over several years. With dysthymia, depression is less severe than major depression, and not as likely to interfere in one’s ability to work or study. Still, dysthymic disorder causes feelings of sadness and disquiet. People with dysthymia may suffer from episodes of major depression, as well.
Minor depression: Minor depression is diagnosed when one has a short interval of depression over a few weeks. Minor depression itself is not debilitating, but untreated may escalate into major depression.
Bipolar disorder: Manic-depressive illness is less common than major depression, and involves swift mood changes that alternate from exhilarating highs to deep depression.
Psychotic depression: Depression that accompanies other forms of severe mental illness, such as hallucinations or delusions, is called psychotic depression.
Postpartum depression: About 10%-15% of women suffer from postpartum depression after giving birth, which is caused by shifting hormones and overwhelming lifestyle changes.
Seasonal affective disorder (SAD): During the winter months, it is common for some people to suffer from seasonal affective disorder because of decreased exposure to sunlight. Still, antidepressants and psychotherapy are more effective at treating SAD than light therapy.
Depression from vitamin deficiency: Vitamin B12 deficiency and folate deficiency are directly linked to some incidences of depression. According to NIMH, “depression and poor response to antidepressant medication have been linked to deficiency in the vitamins folate and B12.”
In other studies, elevated homocysteine levels were associated with increased risk for depression. Vitamin B12 and folate supplementation, which decrease homocysteine levels in the blood, were instrumental in treating depression.
What’s the connection between vitamin B12 and depression?
Vitamin B12 (cobalamin) is necessary for various biochemical functions, such as DNA synthesis, red blood cell distribution, production of myelin, which protects your nerve cells, and breaking down homocysteine. In addition, vitamin B12 also helps to maintain healthy cognitive functioning.
When vitamin B12 levels are low, your brain suffers. You begin to experience severe memory loss, fatigue, difficulty concentrating, and emotional problems like depression, anxiety, paranoia, feelings of hostility, and moodiness.
Vitamin B12 food sources include meat, fish, milk, and egg products. However, if you suffer from pernicious anemia or other autoimmune disorders, you probably cannot digest vitamin B12 from foods, and must supplement with sublingual vitamin B12 or vitamin B12 shots.
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Many studies show similarities between the symptoms of Vitamin B12 deficiency and multiple sclerosis (MS). There is also a very high rate of B12 deficiency among people diagnosed with MS. How, then, does one differentiate between pernicious anemia (vitamin B12 deficiency)and multiple sclerosis?
What is MS?
Multiple sclerosis is a disease that affects your central nervous system- your brain and spinal cord. It typically strikes young adults between the ages of 20-40, most of them women.
The exact cause of MS is unknown, but most scientists believe it is an autoimmune disorder. With multiple sclerosis, an autoimmune reaction attacks myelin, a fatty substance that insulates your nerve fibers responsible for transmitting messages to the rest of your body.
Signs of demyelination are random lesions,or plaques (sclerosis) in the brain and spinal cord, in multiple areas, thus the term “multiple sclerosis.”
What is B12 deficiency?
Vitamin B12 deficiency occurs when your body is unable to maintain sufficient stores of vitamin B12 (cobalamin) in the blood. There are several reasons this may happen, such as not eating food sources of vitamin B12 (meat, fish, and milk), or having a gastrointestinal disorder that interferes with vitamin B12 absorption.
With pernicious anemia (PA), your body cannot make intrinsic factor (IF), a protein necessary for digesting vitamin B12, due to an autoimmune disorder.
Among its many other benefits, vitamin B12 is essential for building up the fatty myelin sheath. One of the symptoms of PA is demyelination, the same type of brain damage that occurs with MS.
*Multiple sclerosis and vitamin B12 deficiency- pernicious anemia are both autoimmune disorders.
*Multiple sclerosis and vitamin B12 deficiency-pernicious anemia both involve damage to the nervous system’s myelin sheath.
What are the symptoms of multiple sclerosis?
The earliest symptoms of MS may include:
Muscular weakness in one or more limbs
Tingling or numbness
Loss of balance
Vision problems or eye pain
As the disease advances, symptoms worsen, including:
Chronic fatigue, despite getting plenty of rest and not overexerting yourself
Hypersensitivity to heat, such as hot showers or baths
Muscular spasms in the legs and arms
Bladder or bowel control problems
Lightheadedness, or vertigo caused by nerve damage
Cognitive impairment- “brain fog,” slowed thinking, lack of concentration, or memory loss
Vision problems- blurring or graying of vision, or temporary blindness in one eye
Painful “pins and needles” sensations, numbness, itching, or burning
Speech and swallowing problems caused by damaged nerves
Difficulty walking without stumbling, caused by muscle weakness, spasticity, or loss of balance from vertigo
What are the symptoms of vitamin B12 deficiency?
The most common symptoms of B12 deficiency and pernicious anemia are:
Painful “pins and needles” or numbness in hands and feet
Sore, swollen red tongue
Burning mouth sensation
Difficulty walking without stumbling
Short-term memory loss
Shortness of breath
*Multiple sclerosis and vitamin B12 deficiency-pernicious anemia both cause nerve damage, including painful tingling or numbness in the hands and feet and impaired gait.
*Multiple sclerosis and vitamin B12 deficiency-pernicious anemia both cause cognitive impairment, like brain fog, memory loss, and low concentration.
Which tests diagnose multiple sclerosis?
There is more than one test used to confirm MS, and your doctor will need to use the process of elimination to exclude other illnesses. Some common tests and indicators are:
MRI scan indicating at least two incidences myelin damage- scar tissue (lesions)
Evoked potentials, an electrical test of your nervous impulses
Which tests diagnose vitamin B12 deficiency?
Only one test is required to diagnose vitamin B12 deficiency- a blood test indicating low blood serum levels of vitamin B12. Patients of pernicious anemia require routine blood tests in order to monitor their B12 levels.
What’s the best treatment for multiple sclerosis?
There is no cure for MS, but various medications are helpful for dealing with the symptoms.
Some prescribed medicines work by controlling your body’s autoimmune response, thus reducing the frequency and severity of MS symptoms.
Deep brain stimulation (DBS) is a controversial surgery used to treat debilitating tremors in people with MS. Complications may include paralysis, loss of vision, or loss of speech.
Alternative medicine options that benefits MS patients include physical therapy, exercise like yoga or tai chi, acupuncture, aromatherapy, meditation, massage, and vitamin supplementation.
What’s the best treatment for vitamin B12 deficiency?
There are many kinds of B12 supplements on the market, but it’s important to be certain if you are able to digest vitamin B12 in the stomach. If you lack intrinsic factor, or if you’ve had gastrointestinal surgery like gastric bypass, then you will not benefit from dietary forms of vitamin B12.
Physicians normally prescribe a series of B12 shots for patients with pernicious anemia. These vitamin B12 injections require a prescription, and not all health care providers cover extensive supplementation of vitamin B12 shots.
Sublingual vitamin B12 pills that dissolve under the tongue are another option, although they are not very effective, and they often require dosages of three times per day.