Vitamin B12 Deficiency: Symptoms, Causes, and Treatment

Vitamin B12 deficiency is a common problem among obese adults. Studies have shown that most overweight and obese individuals have low levels of vitamin B12, which is involved in proper brain function, DNA formation, energy production, and mood regulation, among others.

This essential nutrient is also responsible for the formation of red blood cells which carry oxygen throughout your body. If you lack vitamin B12, it means that you have fewer red blood cells than normal and your organs are receiving less oxygen, which is a condition known as vitamin B12 deficiency anemia.

While most people can get enough vitamin B12 through diet alone, those who are obese may need to take dietary supplements to meet their nutritional requirements. This is also true for vegan individuals who find it difficult to get enough vitamin B12 in a plant-based diet.

In this post, we will discuss the symptoms of vitamin B12 deficiency, its causes, its most common food sources, and available treatment options .

Vitamin B12 Deficiency Symptoms

The following are some of the most common symptoms associated with vitamin B12 deficiency:

  • Fatigue
  • Feeling dizzy or lightheaded
  • Looking pale
  • Sore tongue
  • Bruising easily
  • Bleeding gums
  • Upset stomach
  • Diarrhea or constipation

If left untreated, vitamin deficiency anemia may begin to affect your nervous system and even damage some of your nerve cells. This can lead to:

  • Tingling in the fingers and toes
  • Muscle weakness
  • Trouble walking
  • Mood swings
  • Increased heart rate
  • Depression
  • Advanced mental deterioration resulting in memory loss, disorientation, and dementia

Who’s at risk of Vitamin B12 and folate deficiency?

We get most of our vitamin B12 from our diet, which means that a vegetarian diet without the proper supplements can put you at risk of developing vitamin deficiency anemia. For reference, the recommended daily intake of vitamin B12 for healthy adults is 2.4 micrograms.

In some cases, people who consume enough vitamin B12 can still develop the condition. This may result from problems in their digestive system that don’t allow them to properly absorb vitamin B12.

Some individuals who may be at risk of Vitamin B12 deficiency anemia include:

  • Individuals with a family history of the disease and any related diseases
  • Patients who went through bariatric or weight loss surgery like sleeve gastronomy, gastric bypass surgery, or duodenal switch procedure, which can limit nutrient absorption and caloric intake
  • Individuals with pernicious anemia where the stomach produces lower amounts of a protein needed to absorb vitamin B12 called intrinsic factor
  • Individuals with atrophic gastritis, which is a common condition among older adults where the walls of your stomach suffer from inflammation
  • Individuals with autoimmune diseases such as type 1 diabetes, Graves’ disease, and lupus
  • Individuals with digestive problems such as Crohn’s disease, celiac disease, and the presence of harmful bacteria or parasites like tape worms
  • Individuals taking medicines that have potential interactions with vitamin B12 and decrease its absorption, such as antibiotics, anti-seizure medications, vitamin C supplements, and proton-pump inhibitors
  • Heavy drinkers or individuals who suffer from alcohol abuse since their bodies can’t absorb nutrients efficiently

Since all B vitamins are water soluble, the body does not store them unlike vitamins A, D, E, and K that are fat soluble. This is the reason why sometimes, vitamin B12 and vitamin B9 or folate deficiency may occur at the same time.

Like vitamin B12, vitamin B9 or folic acid is essential for proper brain function, and in our overall mental and emotional health. It works closely with B12 to aid in the production of DNA and the formation of red blood cells. Folic acid is also especially important for cell and tissue formation in crucial stages, like infancy, adolescence, and pregnancy.

Food Sources of Vitamin B12

If the cause of your vitamin B12 deficiency is diet-related, your doctor may prescribe daily supplements to increase vitamin B levels. But you may also improve by increasing your intake of these excellent sources of vitamin B12:

  • meat such as beef, liver, chicken, and turkey
  • fish and shellfish such as salmon, trout, tuna, cod, and clams
  • milk and other dairy products (low-fat milk, cheese, and yogurt)
  • eggs
  • fortified foods like cereals, plant-based milk, spreads, and fruit juices

Vitamin B12 Deficiency Treatment

Since the symptoms of vitamin B12 deficiency may be symptoms of other conditions, it’s best to see a health care professional for proper diagnosis. Generally, it starts with a physical examination to check your reflexes, as these are heavily associated with the condition.

Your doctor may also take some of these blood tests:

  • Complete blood test: to check the size, shape, and number of your red blood cells, as abnormal cells are much bigger than healthy ones
  • Vitamin B12 level: to check if you have enough vitamin B in your blood
  • Intrinsic factor (IF) antibody: to determine the cause of your condition and to check if you have pernicious anemia
  • Schilling test: to check if your body has enough IF and to know if your body absorbs vitamin B12 normally, which means that you may have pernicious anemia (this blood test is rarely used today)
  • Methylmalonic acid level (MMA test): to measure the amount of MMA in your blood since MMA count increases when you lack vitamin B12

In rare cases, your doctor may perform an internal exam of the stomach or small intestine to determine if you have a digestive problem that may cause vitamin B12 or folate deficiency.

Treatments for vitamin B12 deficiency vary depending on its cause. If it is diet-related, your doctor will most likely recommend increasing your consumption of B12-rich foods as mentioned above or taking daily vitamin supplements in the form of pills or nasal spray.

However, if you have problems with absorbing vitamin B12 either because of past surgery or other digestive issues, the best and recommended option is to administer higher doses of B12 injections. Depending on your condition, you may receive the shots as often as every other day up to just once a month.

Can Vitamin B12 Deficiency be Cured?

Vitamin B12 deficiency is a common health problem with individuals who follow a vegetarian diet, those who went through weight loss surgery, and those who have certain autoimmune and digestive health issues. It is generally treated with daily supplements, though more serious cases may require injections.

While it is easy to take supplements, it is also crucial to have a personalized nutrition plan that meets your nutritional needs. It is better to treat the underlying cause of the condition than just depending on supplements.

At Beltline Health, our team of nutrition counselors and registered dietitians will work with you to provide guidance and support in making healthy and appropriate dietary choices to satisfy your needs. We specialize in helping bariatric patients stick to the recommended post-surgery diet to avoid nutritional deficiencies in the long run.

Visit our website to schedule your consultation with one of our health care professionals to take the first step in improving the quality of your life. You may also check out this article where we highlight the importance of nutritional counseling. For other questions and concerns, you may call us at (470) 419-4380.


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