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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:
Are you at risk for developing vitamin B12 deficiency, one of the fastest growing forms of malnourishment today? Most people with B12 deficiency don’t even know they have it. Find out why vitamin B12 is important for healthy living. Are you are getting enough?
What are the symptoms of vitamin B12 deficiency?
Vitamin B12, an essential nutrient called cobalamin, occurs naturally in meat and other protein foods such as beef, poultry, fish, eggs, and milk. Vitamin B12 is one of the B-complex vitamins, and plays many important roles in your healthy lifestyle, and unless you get enough vitamin B12 from your diet or from vitamin B12 supplements, then you might experience the following symptoms:
Constant tiredness, fatigue for no apparent reason
Lack of appetite
Lack of concentration
Short-term memory loss
Tingling, numbness or pain in your hands and feet
Sore, swollen red tongue
Altered taste perception
Difficulty walking smoothly
Poor hand-eye coordination and motor skills
Untreated, vitamin B12 deficiency could lead to neurological damage, increased risk for heart attack and stroke, memory problems, and misdiagnosis of severe mood disorders.
Even if you eat plenty of meat and milk, you may be susceptible for vitamin B12 deficiency, as there are many other risk factors involved…
If you fit into any one of the following categories, then you are highly susceptible to vitamin B12 deficiency:
Do you have diabetes? If you are diabetic, and you take metformin, then you are vulnerable to B12 deficiency, since metformin blocks your ability to digest vitamin B12 properly.
Have you had weight loss surgery? If you have had any bariatric surgery such as gastric bypass, or any other gastrointestinal surgery that involves removing a piece of the small intestine called the ileum, then you need to take vitamin B12 supplements regularly. The ileum is the bottom-most part of the small intestine, and is principally responsible for absorbing vitamin B12.
Do you suffer from autoimmune disorders? If you suffer from any autoimmune disease that involves damage to the digestive system, then you are at risk for many forms of malnourishment, including vitamin B12 deficiency. Examples of autoimmune disorders that correlate with vitamin B12 deficiency are Crohn’s disease, celiac disorder, ulcerative colitis, irritable bowel syndrome (IBS), and lupus.
Are you a senior citizen? The elderly are highly susceptible to B12 deficiency. As you age, your body produces fewer stomach acids that are necessary for digesting vitamin B12 from the foods you eat. Also, older people tend to eat less and have sensitive stomachs, all of which can lead to malnourishment. In order to avoid B12 deficiency, it is crucial to include extra B12 supplements in your daily vitamin regimen.
Do you take heartburn medication? If you suffer from gastroesophageal reflux disease (GERD), or if just take many antacids, then you might become deficient in vitamin B12, as stomach acids are essential for digesting vitamins such as B12 from your food.
Are you an alcoholic? Frequent alcohol use inhibits your body’s ability to absorb nutrients like vitamin B12 properly, and causes malnourishment.
Does vitamin B12 deficiency or pernicious anemia run in your family? Some people are unable to produce intrinsic factor, an essential chemical your stomach makes to access and digest vitamin B12 from food sources. If you have this autoimmune disorder, then you must supplement with a form of vitamin B12 that dispenses the vitamin directly into your bloodstream.
How can I find out if I have vitamin B12 deficiency?
The only way to find out if you have vitamin B12 deficiency is to visit your doctor and ask for a vitamin B12 blood test. If you test positive, then he will likely prescribe a regimen of vitamin B12 supplements.
Read more about preventing vitamin B12 deficiency:
Difficulty absorbing vitamin B12 is sometimes caused by pernicious anemia. Chronic fatigue is one of many symptoms of vitamin B12 deficiency- pernicious anemia. In order to test absorption of vitamin B12, some blood tests are required.
What is vitamin B12 deficiency?
Vitamin B12 is a mineral that we absorb from animal products like meat, chicken, fish, eggs, and milk. Vitamin B12 is essential for your nervous system, red blood cell production, DNA synthesis, and cognitive functioning. Without it, you might experience symptoms like fatigue, memory loss, depression, tingling in the hands and feet, altered sense of taste, difficulty walking steadily, and decreased motor control. (Absorbing Vitamin B12, a Metabolic Gastrointestinal Journey)
Who is at risk for vitamin B12 deficiency?
Most people will never experience vitamin B12 deficiency. That is because generous amounts of B12 are stored in your liver. However, an increasing number of people are falling victim to low B12 levels- individuals who are unable to absorb vitamin B12 naturally from foods.
People who cannot absorb vitamin B12 are:
Individuals who cannot produce intrinsic factor, a protein required for vitamin B12 absorption.
Individuals who have had the part of the small intestine responsible for making intrinsic factor removed, as is common procedure in bariatric surgeries (gastric bypass) and gastrointestinal surgeries for Inflammatory Bowel Disease (IBD), such as Crohn’s disease.
Anybody who is unable to produce enough stomach acids in order to absorb vitamin B12- these include the elderly, sufferers of gastric autoimmune diseases, diabetes patients who take metformin, and people who take strong antacid medications for acid reflux, such as heartburn (GERD) sufferers or pregnant mothers.
What if I am not tested for vitamin B12 absorption?
Left untreated, vitamin B12 deficiency could result in red blood cell depletion. Other dangerous side effects that stem from being unable to absorb vitamin B12 are elevated risk for heart attack and stroke, neurological damage, and dementia.
If you suspect you might have vitamin B12 deficiency…
if you notice symptoms like being tired all the time, talking in slow, unpronounced speech, more difficulty remembering things than normal,
if you’ve been diagnosed with comorbid conditions like fibromyalgia, chronic fatigue syndrome, Crohn’s disease, Celiac disease, or hypothyroidism, or
if you’ve had weight loss surgery or another types of gastrointestinal procedure…
…then it’s crucial that you request a B12 blood test for vitamin B12 levels, in addition to a Schilling test that measures your ability to absorb B12.
The Schilling test is more than just a test for B12 levels. While the standard test for vitamin deficiency checks vitamin B12 levels, the Schilling test determines the reason for your problem with absorption of vitamin B12.
There are four stages of the Schilling test for B12:
In stage one, you take two doses of vitamin B12; one is an oral radioactive dose of cobalamin, and the other is a vitamin B12 injection. A urine test determines your absorption of B12
In stage two, you take another radioactive dose of vitamin B12- this time, with intrinsic factor.
Before going on to stage three, you are required to take antibiotics for two weeks. Next, a lab technician determines if bacterial growth is the cause of your lack of B12 absorption.
Finally, stage four determines if your vitamin B12 deficiency results from a pancreatic disorder. You will take pancreatic enzymes for a few days, followed by another radioactive dose of vitamin B12.