It is a well-known fact that a B-12 deficiency if left unchecked can damage your brain, spinal cord, peripheral nerves, and nerves of the eye. It can also cause concerns with energy production, blood sugar, digestion, and hormones. One of the 13 must-have vitamins in our body, Vitamin B-12 (cobalamin) is needed for good physical and mental well-being. It is not only essential for the production of red blood cells but also supports the protection of a healthy nervous system and is an essential element in the construction of our DNA.
In 1934, Whipple, Murphy, and Minot shared the Nobel Prize in Physiology or Medicine for their life-saving discovery concerning liver therapy in cases of anemia. The disorder was referred to as “pernicious anemia” because, before this discovery, death was inevitable. In 1948, the substance in the liver was isolated and named cobalamin (vitamin B-12).
A B-12 deficiency can suppress the immune system and impede the body’s ability to manufacture antibodies to viral infections. Acute deficiencies may also cause hyperhomocysteinemia which is a serious condition that can cause fatal blood clots to form in the brain, lungs, and lower leg. A recent study indicates that methylcobalamin supplements have the potential to reduce COVID-19-related organ damage and symptoms.
B-12 deficiency is more common than we hear about and reported to affect 25% of the U.S. population. It strikes up to 15% (5.9 million) older adults > age 64. The CDC now reports that one out of every 31 Americans above the age of 50 are B-12 deficient. It’s interesting to know this report underestimates the incidence by using a cut-off range far too low. The incidence of B-12 deficiency in infants and children is unknown, which is very concerning.
Causes of Vitamin B-12 Deficiency
- Decreased stomach acid
- Atrophic gastritis
- Autoimmune pernicious anemia
- Helicobacter pylori
- Gastrectomy, intestinal resection
- Gastric bypass surgery
- Malabsorption syndromes
- Crohn’s disease
- Celiac disease (gluten enteropathy)
- Chronic pancreatitis
- Bacterial overgrowth (small bowel)
- Fish tapeworm
- Alcoholism
- Malnutrition—Eating disorders
- Vegetarianism
- Advanced liver disease
- Transcobalamin II deficiency
- Inborn errors of B12 metabolism
- Certain drugs
- Nitrous oxide
Signs and Symptoms of Vitamin B-12 Deficiency
Neurologic signs and symptoms:
- Numbness—tingling
- Weakness of legs, arms, trunk
- Impaired vibration—position sense
- Abnormal reflexes
- Unsteady or abnormal gait
- Balance problems
- Difficulty ambulating
- Dizziness
- Tremor
- Restless legs
- Visual disturbances
- Forgetfulness, memory loss
- Dementia
- Impotence
- Urinary or fecal incontinence
Psychiatric symptoms:
- Depression
- Irritability
- Paranoia
- Mania
- Hallucinations
- Psychosis
- Violent behavior
- Personality changes
Hematologic signs and symptoms:
- Anemia
- Macrocytosis (enlarged red blood cells)
- Generalized weakness
- Fatigue
- Shortness of breath
- Pallor
Signs & symptoms in infants and children:
- Developmental delay or regression
- Apathy—Irritability
- Hypotonia
- Weakness
- Tremor
- Involuntary movements
- Seizures
- Ataxia
- Anorexia
- Failure to thrive
- Poor weight gain
- Poor head growth
- Poor socialization
- Poor motor skills
- Language delay
- Speech problems
- Lower IQ—Mental retardation
- Anemia
- Macrocytosis
Disorders with Possible Underlying B-12 Deficiency
- Dementia—Alzheimer’s disease
- Multiple sclerosis
- Depression
- Post-partum depression/psychosis
- Bipolar disorder
- Neuropathy (diabetic, CIDP)
- Vertigo
- Anemia
- Congestive heart failure
- Autism
- AIDS dementia complex
- Restless leg syndrome
- Radiculopathy, chronic pain disorder
- Chronic fatigue syndrome
- Fibromyalgia
- Chronic renal failure (hemodialysis patients)
- Essential tremor—Parkinson’s disease
- Erectile dysfunction
- Infertility
Diagnostic Tests for B-12 Deficiency
- Serum B-12
- Methylmalonic acid
- Homocysteine
How To Know If You Might Be Vitamin B-12 Deficient?
Cobalamin Deficiency Criteria List (CDCL)
Read through the sections below to add up your score and determine your risk of B12 deficiency.
I. Neurologic Manifestations (score 2 for each symptom)
- Numbness/tingling (including diagnosis of neuropathy)
- Weakness of arms, legs, or trunk
- Impaired vibration/position sense
- Abnormal reflexes
- Unsteady or abnormal gait
- Balance problems
- Difficulty ambulating
- Dizziness
- Tremor (including diagnosis of Parkinson’s)
- Restless legs or diagnosis of restless leg syndrome
- Visual disturbances
- Forgetfulness/memory loss (including diagnosis of dementia or Alzheimer’s)
- Mental status changes
- Impotence/erectile dysfunction
- Urinary/fecal incontinence
- Developmental delay in infants & children (including diagnosis on the autism spectrum)
II. Psychiatric Manifestations (score 2 for each symptom)
- Depression/suicidal ideations, post-partum depression, or prescribed antidepressant/psychiatric medications
- Irritability/anxiety
- Paranoia
- Mania
- Hallucinations
- Psychosis
- Violent behavior
- Personality changes
III. Gastrointestinal Risks (score 2 for each symptom)
- Decreased stomach acid or atrophic gastritis
- Autoimmune pernicious anemia
- Helicobacter pylori
- GERD or ulcer disease
- Gastrectomy or intestinal resection
- Gastric bypass surgery
- Malabsorption syndromes
- Crohn’s disease
- Celiac disease (gluten enteropathy)
- Chronic pancreatitis
- Bacterial overgrowth (small bowel)
- Fish tapeworm
- Alcoholism
- Malnutrition/eating disorders
- Advanced liver disease
- Transcobalamin II deficiency
IV.Hematologic Manifestations (score 2 for each symptom)
- Anemia
- Macrocytosis
- Microcytosis
- Hypersegmented neutrophils
- Anisocytosis
- Leukopenia
- Thrombocytopenia
V. Other Signs and Symptoms (score 1 for each symptom)
- Generalized weakness or fatigue
- Shortness of breath, exertional dyspnea, or chest pain
- Pallor
- Hepatomegaly or splenomegaly
- Loss of appetite/weight loss
- Poor wound healing/decubitus ulcer
- Cervical dysplasia
- Tinnitus
- Vitiligo
- Glossitis
VI. Population at Risk (score 1 for each symptom)
- Age 60 and over
- Fall or fall-related injury in the past year
- Vegan/vegetarian/macrobiotic diet
- Autoimmune and/or thyroid disorders
- Family history of pernicious anemia
- Proton pump inhibitor use
- Metformin use
- Nitrous oxide administration or abuse
- Cancer patients
- Chemotherapy
- Radiation therapy
- Occlusive vascular disorders (MI, CVA, DVT, PE)
- Pregnancy
- Breast-feeding
- Iron deficiency
- Infertility
- Seizures
- AIDS patients
- Fibromyalgia
- Chronic fatigue syndrome
- Chronic renal failure (hemodialysis patients)
- Neck or back surgery
Cobalamin Deficiency Risk (CDR) Score
- Low Risk: 0 – 1
- Moderate Risk: 2 – 5
- High Risk: > 6
B-12 Deficiency – Frequently Misdiagnosed
- Most doctors and health care providers don’t know the facts about B-12 deficiency.
- Most patients who have B-12 deficiency symptoms or are at risk for B-12 deficiency never get tested.
- The current standard for “normal” serum B-12 levels is actually far too low.
- Doctors frequently don’t diagnose B-12 deficiency until the patient has enlarged red blood cells and/or macrocytic anemia—which are often late signs of advanced B-12 deficiency.
- People over 65 are frequently misdiagnosed because doctors blame their B-12 deficiency symptoms on preexisting diseases and comorbid conditions (A comorbid condition refers to one or more diseases or conditions that occur together with the primary condition.)
- The current Daily Required Intake (DRI) and Recommended Daily Allowance (RDA) for B-12 health for adults, during pregnancy, and during child growth and development are grossly outdated and insufficient.
B-12 screening should always be included for:
- Older adults who fall or are at risk for falling.
- Older adults who have cognitive changes or dementia.
- Patients presenting depression or mental illness.
- Patients who are pregnant or breastfeeding.
Methylcobalamin – Most Absorbable Form of B-12
The most absorbable form of B-12 is in the form of methylcobalamin. Evidence indicates methylcobalamin has some metabolic and therapeutic applications not shared by the other forms of vitamin B-12. Methylcobalamin is the active form of vitamin B-12 that acts as a co-factor for methionine synthase in the conversion of homocysteine to methionine, thus lowering blood levels of homocysteine.
As the circulating form, methylcobalamin can cross into the bloodstream sublingually, but only about 1% of the ingested (by pill) dose is absorbed. Methylcobalamin is also the most bioavailable form of B-12. It requires little to no conversion and easily crosses through every aspect of B-12’s metabolic pathway.
B-12 works best in a comprehensive formula with other B Vitamins. They are shown to have a greater synergistic effect together rather than individually. When using any form(s) of B Vitamins it is always recommended to add a B Complex, such as Max B-ND containing all the B Vitamins in a probiotic-fermented liquid.
I also recommend reading the book Could It Be B12? An Epidemic of Misdiagnoses (Second Edition) by Sally M. Pacholok, R.N., B.S.N., and Jeffrey J. Stuart, D.O.
References
(most information compiled from http://b12awareness.org/)
†Results may vary. Information and statements made are for education purposes and are not intended to replace the advice of your doctor. Oasis Advanced Wellness/OAWHealth does not dispense medical advice, prescribe, or diagnose illness. The views and nutritional advice expressed by Oasis Advanced Wellness/OAWHealth are not intended to be a substitute for conventional medical service. If you have a severe medical condition or health concern, see your physician of choice.
