B Vitamins - Cobalamin (Vitamin B12)

COBALAMIN (VITAMIN B12) DEFICIENCY, ITS SYMPTOMS, DIAGNOSIS & TREATMENT

About Cobalamin (Vitamin B12)

Vitamin B12, is also known as cobalamin, is one of the B-complex vitamins. Your body does not make vitamin B12, therefore you need it in your diet. Plants does not make Vitamin B12, either. It is available in animal products, in some foods added with B12 or in supplement form.

Purpose of Cobalamin (Vitamin B12) in your body

Vitamin B12 is required to help your body to form healthy blood cells.

Vitamin B12 is required for development, myelination and function of your nervous system

Vitamin B12 is required because it helps to generate DNA, which is the basis of all cells in your body.

Availability of Cobalamin (Vitamin B12)

Vitamin B12 found naturally in meat, eggs, & dairy and may be added to other foods.

How Vitamin B12 is absorbed in your body?

When you consumes food that contains vitamin B12, the body takes two steps to absorb it.

In the first step, hydrochloric acid in the stomach unbinds vitamin B12 from the protein, which is bonded to in food. In the second step, the freed vitamin B12 then combines with a protein, called intrinsic factor produced by the stomach, and that is when the body absorbs them together.

What is Cobalamin (Vitamin B12) Deficiency

Cobalamin (Vitamin B12) Deficiency is also known as "Cobalamin Deficiency" or "Vitamin B12 Deficiency Anemia". It is a condition that develops when your body can't make enough healthy red blood cells (RBC) because it doesn't have enough vitamin B12. Your body needs vitamin B12 to make healthy red blood cells (RBC) , white blood cells (WBC) , and platelets. 

You can be deficient in vitamin B12 if you do not get adequate B12 from your diet or else your gut is not able to absorb B12 from your intake.

Mostly, you get sufficient vitamin B12 in your food and absorb it through the digestive system. However, some intakes and certain health disorders, particularly as you age, may lead to a deficiency of the said important vitamin B12.

Symptoms of Cobalamin (Vitamin B12) Deficiency:

Having low or deficient B12 levels can lead to a number of symptoms, some of which can be grave. It can result in permanent and possibly severe damage, mainly to the nervous system and brain. However, this is uncommon. Therefore, a person with vitamin B12 deficiency may develop anemia and other symptoms.

Considering the importance of B12 in human’s body, this article alerts how to recognize B12 deficiency, who is at risk, and how to treat or prevent it. 

a) Early symptoms of B12 deficiency - The early symptoms of cobalamin (Vitamin B12) deficiency are: 

• Weakness
• Constipation 
• Depression.

b) Symptoms of Anemia or Anaemia - Low B12 levels cause a kind of anemia, or low blood count. Sometimes the blood cells become immature & larger than usual. This affects their ability to deliver oxygen effectively to the body. The common symptoms of anemia are:

• Feeling tired or having low energy
• Pale or yellow skin
• Shortness of breath, especially with movement
• Having less of an appetite or losing weight without trying
• Headaches
• Feeling dizzy or like you might faint
• Fast or irregular heartbeat
• Heart palpitations
• Tinnitus (ringing in the ears)

And in some cases, people with B12 deficiency also have mouth sores or a swollen, painful tongue.

c) Symptoms of Nerve Damage - Vitamin B12 is also important for nerve cells to function. B12 deficiency can affect the central nervous system (the brain and spinal cord) or peripheral nerves that go to the rest of the body. The symptoms of nerve damage from B12 deficiency can be as follows:

• Numbness, tingling, or a pins-and-needles sensation in the hands & feet.
• Depression, irritability, or confusion
• Problems with thinking and memory
• Changes in vision
• Problems with balance

d) Neural Tube Defects (NTD's) or Birh Irregularities - When a pregnant woman does not have sufficient B12 and folate, a baby may be born with a neural tube defects. This happens when the brain or spinal cord develop incorrectly. Because, a breastfed baby whose parent has a low B12 level in breast milk could have delayed development, slow weight gain, or anaemia.

e) Vitamin B12 Verses DNA - Your cells need vitamin B12 for production of new DNA. But when cells are not able to create or repair DNA, they begin to divide incorrectly. Therefore, the low B12 and folate levels play a vital role in DNA damage, which may lead to diseases like cancer. It is assumed that low level B12 may affect heart disease, stroke, and dementia. However, there is not enough evidence to recommend B12 supplementation to prevent heart disease.

Form of Cobalamin (Vitamin B12) & How Your Body Uses

The body in certain forms more easily absorbs Vitamin B12. For instance, it is in meat, poultry, fish, and eggs but most easily used by the body in dairy products. In addition, vitamin B12 is more readily available for the body in supplement form than it is in foods. Vitamin B12 is also present in breast milk and added to infant formula. Extra B12 is stored in the liver, in case our cells need to use it in the future.

Causes of Vitamin B12 Deficiency & Interactions: The causes for you to be said Vitamin B12 deficient, if you do not consume enough or adequate amount of vitamin B12 in your diet or if your body is not able to absorb the required amount of vitamin B12 during digestion.

Some possible causes of vitamin B12 deficiency are as below:

a) Pernicious anemia or anaemia: Pernicious anemia is an autoimmune disease that affects the gut’s ability to digest vitamin B12. When a person has pernicious anemia, their immune system creates antibodies that attack the stomach’s lining and as a result, they damage cells that produce intrinsic factor. Therefore, the stomach cannot produce intrinsic factor. Without intrinsic factor, the intestines will be unable to absorb vitamin B12.

b) Bowel problems: Some of you may have problems in absorbing vitamin B12 into your bloodstream because of a disorder that affects their stomach or small intestine. The possible causes consist of the following.

• Crohn’s disease - Crohn’s disease is a chronic, or long-term, condition that causes inflammation in the digestive tract.  The symptoms of Crohn’s disease can include intestinal ulcers, discomfort, and pain but medication can help manage it),

• Celiac disease - In a person with celiac disease, exposure to gluten causes inflammation in the gut. Repeated exposure gradually damages the small intestine, which can lead to problems absorbing minerals and nutrients from food).

• Surgery - That reduces the size of the stomach or the length of the intestine or weight-loss surgery.

People with these conditions can experience malnutrition, as they cannot absorb enough vitamins, water, and other nutrients.

c) Diet: If you are a regular follower of vegan or vegetarian diet then you may have a higher risk of B12 deficiency. If you are a pregnant woman, then this may increase the risk of neurological damage in a foetus. Therefore, if you are a vegetarian then you need to supplement your B12 intake by eating fortified foods, such as nutritional yeast products.

d) Medications: At times, some medications can affect the body’s ability to absorb vitamin B12, leading to a deficiency. For instance the proton pump inhibitors (PPIs) and Histamine H2 receptor agonists (H2 blockers), which doctors prescribe to treat indigestion, heartburn, and gastroesophageal reflux disease (GERD) & taking metformin for diabetes may decrease B12 absorption. PPIs prevent the stomach from producing acid, but the body needs acid to absorb vitamin B12. Thats how the medication will to lead B12 deficiency.

e) Functional vitamin B12 deficiency: Some of you seem to have sufficient vitamin B12 in your blood, but do not have the proteins i.e., intrinsic factor to absorb the available vitamin B12. That means your body not able to use it properly. Therefore, you may develop neurological symptoms connected to B12 deficiency.

f) Alcohol: Drinking alcohol can restrict with the body’s ability to absorb enough B12.

Diagnosis

More likely to evaluate the vitamin B12 deficiency, a doctor will ask you:

About symptoms,

To carry out a physical examination,

To do a blood test to quantify B12 levels & check for anemia or anaemia,

To do other tests to dismiss other disorders and check for pernicious anemia or anaemia, if necessary,

To do regular testing especially for people with long-term gastrointestinal problems to ensure that B12 deficiency does not develop. Because some of these people will have no symptoms of B12 deficiency although found to be deficient.

Getting an early diagnosis can help prevent long-term complications.

Treatment

Depending on the severity and cause, there are oral, nasal, or injected forms of B12 treatment.

If the B12 deficiency is not severe and has caused by not consuming enough, at that point the doctor can give a treatment with a supplement that is taken by mouth.

If B12 deficiency is severe and has especially caused by an absorption problem or autoimmune condition, usually treated with B12 injections. This may continue for a certain period, or it may be for life long, depending on the disorders. A nasal spray is also available, but then again it is not absorbed as efficiently as the injectable form.

If medications or alcohol is interfering with absorption, then they should be restricted or stopped at any time if possible.

Prevention

Most of you can prevent B12 deficiency through dietary choices, but this is not always the case.

Those following a plant-based diet - If your diet is largely or wholly plant-based should make sure that B12 intake is sufficient. The dietary options for such person consists of fortified breakfast cereals, fortified nutritional yeast, fortified soymilk and many more supplements that are suitable for people on a vegan diet.

Those who eat meat or fish - If you have a balanced diet containing fish, meat, and dairy foods should have enough B12 for your requirements.

Other conditions and medical treatments - Anyone who has a chronic gastrointestinal condition or believes they may have symptoms of B12 deficiency should try to take a medical advice.

Then the doctor will try to identify the cause and treat it accordingly.

Dosage of Cobalamin (Vitamin B12)

Teens and adults need about 2.4 micrograms of Vitamin B12 per day.

Pregnant women need around 2.6 micrograms per day.

Lactating or Breastfeeding women need 2.8 micrograms per day.

Infants and children need 0.4 to 1.8 micrograms, depending on their age per day.

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