Vitamin B12 (cobalamin) is one of the 13 vitamins our body must have for good health and wellness. It is not only essential for the production of red blood cells but also supports the protection of a healthy nervous system. It is also an essential element in the construction of our DNA. B12 deficiency damages the brain, spinal cord, peripheral nerves, and nerves of the eye.
In 1934, Whipple, Murphy, and Minot shared the Nobel Prize in Physiology or Medicine for their life saving discovery found in liver. 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 B12).
B12 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 B12 deficient. It’s interesting to know that this report underestimates the incidence by using a cut-off range far too low. The incidence of B12 deficiency in infants and children is unknown, which is very concerning.
Causes of B12 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 B12 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 B12 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 B12 Deficiency
- Serum B12
- Methylmalonic acid
- Homocysteine
Are You B12 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
B12 Deficiency – Frequently Misdiagnosed
- Most doctors and health care providers don’t know the facts about B12 deficiency.
- Most patients who have B12 deficiency symptoms or are at risk for B12 deficiency never get tested.
- The current standard for “normal” serum B12 levels is actually far too low.
- Doctors frequently don’t diagnose B12 deficiency until the patient has enlarged red blood cells and/or macrocytic anemia—which are often late signs of advanced B12 deficiency.
- People over 65 are frequently misdiagnosed because doctors blame their B12 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 B12 health for adults, during pregnancy, and during child growth and development are grossly outdated and insufficient.
B12 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
B-12 works best in a comprehensive formula with other B Vitamins. They have a greater synergistic effect together than individually. This is why I recommend and personally use which was created to bypass the digestive tract, providing an infusion of B vitamins directly into the bloodstream. Methylcobalamin B-12 Select nutritionally supports a healthy nervous system and cardiovascular performance.
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/)
