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Vitamin B12 Deficiency: The Under-Reported Epidemic

by — 2014-01-20 in Nutrition & Dieting
Reviewed by Medical Team — 2023-07-21
It is the most common disease you have never heard of: Vitamin B12 deficiency. Easily corrected once it is detected, vitamin B12 deficiency can cause shocking disability and death, even though the condition can be corrected at a cost of less than $100.

All of these disease conditions have one thing in common, a well-known, well-documented nutritional deficiency.

  • Attention deficit hyperactivity disorder (ADHD).
  • Alzheimer's disease.
  • Anemia.
  • Autism.
  • Bipolar disorder.
  • Cancer.
  • Cardiovascular disease.
  • Depression.
  • Homocysteinuria, high homocysteine levels, leading to inflammation of blood vessels and the brain.
  • Infertility, both male and female.
  • Lupus.
  • Multiple sclerosis.
  • Rheumatoid arthritis.
The symptoms of all of these conditions overlap with vitamin B12 deficiency.

Chronic shortages of available vitamin B12 in the bloodstream are not an obscure condition no doctor has ever heard of. Known as pernicious anemia, every textbook of internal medicine and every introduction textbook of nutrition explains B12 deficiency in detail. However, because the vitamin B12 deficiency used to be detectable only after it had already become "pernicious," that is, the final stages of anemia made death inevitable, many clinicians fail to detect the vague symptoms of deficiency that overlap with many other diseases while the deficiency can be easily corrected.

Just How Common Is Vitamin B12 Deficiency?

For over 40 years, scientists at Tufts University in Boston have been conducting ongoing observations of lifestyle and nutrition with their health outcomes in the town of Framingham, Massachusets.

When they did vitamin B12 measurements in adults aged 26 to 83, they found that:

  • 40% had "low normal" levels,
  • 16% had "near deficiency" levels, and
  • 9% had clear deficiency of vitamin B12 and needed treatment.

Most common in people of Celtic (English, Scottish, Welsh, Irish) and Scandinavian descent, full-blown pernicious anemia only occurs in 1 in 70 to 1 in 150 peoplein a lifetime.

But milder forms of the disease, scientists now know, can cause a variety of symptoms that masquerade as other diseases, or that aggravate other diseases.

It is not unusual for people to develop lower than optimal levels of B12 and then to develop a psychiatric condition, or have a heart attack, or just to feel or act a little "off" without any obvious reason. And doctors often fail to test for the deficiency.

How Can I Know I Have a B12 Deficiency?

Vitamin B12 levels are measured with a blood test. B12 exists in just picograms, billionths of a gram, in each milliliter of blood.

In Japan and Europe, a B12 level of 500 to 550 picograms per milliliter is recognized as associated with memory loss, attention deficit disorder, and cognitive decline, especially in children (who may not have lived long enough for their livers to store enough B12) and the elderly (who can have digestive disorders than keep their stomachs from producing enough of the intrinsic factor that helps the gut absorb B12).

But in the USA, B12 levels of just 200 to 450 picograms per mililiter are thought to be "normal." Unfortunately, cognitive decline in the elderly is increasingly considered to be normal, too.

When your doctor runs a test for vitamin B12, there may also be orders for testing:

  • Homocysteine, an indication that a deficiency of B12, B6, or folic acid is causing your body to accumulate this inflammatory compound, and
  • Methylenetetrahydrofolate reductase, an enzyme that helps your body use vitamin B12. If you don't have this enzyme, then just getting more B12 won't be enough.

Read More: Vitamin B-Complex: Health benefits

These tests are usually covered by insurance, but even if you arrange them for yourself, they should cost $60 or less.

Testing can be arranged online from testing companies such as Direct Labs even without a doctor's prescription.

What Can I Do If I Have A Vitamin B12 Deficiency?

The customary remedy for vitamin B12 deficiency is a vitamin B12 injection. The needle used for this injection is the same used for the old-style flu shots. Vitamin B12 injections are typically administered when there is a severe deficiency or when oral supplementation is not effective. Injections allow for direct delivery of the vitamin into the bloodstream, bypassing any absorption issues that might occur in the digestive tract. 

The injections are typically given in the muscle (intramuscular injection) and can be performed by a healthcare professional or as prescribed by a doctor. The frequency of injections and the dosage depend on the severity of the deficiency and the individual's specific needs. If you rely on your doctor to get your B12 levels up to normal, a shot is what you are almost certain to get, although there are scientific studies that show that B12 levels can brought back to normal with nasal sprays and vitamin B12 supplements.

Vitamin B12 injections are generally safe and well-tolerated when administered by a healthcare professional. However, like any medical treatment, there may be potential side effects or risks associated with the procedure. Common side effects of vitamin B12 injections may include mild pain or redness at the injection site.

The kind of B12 you take, or you are given, makes a difference.

Most doctors in the USA will prescribe the form of the vitamin known as cyanocobalamin. The hydroxycobalamin form used in Europe, however, starts to work faster, and the methylcobalamin form used in Japan is available to the brain and nerves without the body's having to process it through several steps requiring enzymes that may be in short supply (and which are not available from food).

But do you have to keep on taking vitamin B12, or is one treatment enough?

Not Found in Plant Foods

Vitamin B12 is the only vitamin that is not found in plant foods. Plants don't need vitamin B12, so they don't make it. Animals need B12, so the vitamin is found in meat and dairy products, particularly in liver.

It used to be thought that vitamin B12 was found in spirulina. Unfortunately, the compound found in spirulina is a "B12 lookalike" that actually interferes with the body's absorption of the real thing. 

It also used to be thought that vegans didn't need vitamin B12.

After all, millions of vegans and vegetarians in India do not have pernicious anemia or other B12 deficiency diseases. Then when pernicious anemia became common among observant Hindus who had moved to London, it was learned that vegans in India actually got their B12 from tiny lice and other insects that washing could not remove from the vegetables they ate.

That is why up to 50% of vegans and vegetarians are B12 deficient. Children raised on vegan diets to age 6 are often B12 deficient even if they are given the vitamin later. 

However, that does not mean that vegans need to eat dairy or meat. B12 can be provided by supplements that are not of animal origin, although it is necessary to make sure to take them, especially when children are given a vegan diet.

Who Else Needs Supplemental B12?

Certain health conditions interfere with the body's ability to absorb B12. 

People who have conditions such as the following need to take B12 shots or supplements on a regular basis:
  • Atrophic gastritis or hypochlorhydria (low stomach acid),
  • Crohn's disease,
  • Irritable bowel syndrome, or
  • Ulcerative colitis.

Certain medications interfere with the body's ability to absorb B12, and people who take these medications on a regular basis will need shots or supplements:

  • Alcohol.
  • Nitrous oxide, whether as anesthetic or recreationally.
  • Metformin, which is primarily used to treat diabetes or polycystic ovarian disease (PCOS). 
  • Proton pump inhibitors, which are used to treat peptic and duodenal ulcers and gastroesophageal reflux disease.
  • Histamine H2 Receptor Antagonists, drugs like ranitidine and famotidine, used to reduce stomach acid production.
  • Chloramphenicol, an antibiotic that can interfere with the production of red blood cells and impact B12 metabolism.
  • Colchicine, used to treat gout, colchicine may disrupt B12 absorption and lead to deficiency.

Read More: Do Vitamin B12 Injections Help for Weight Loss?

B12 shots may be needed for life by women who have had multiple miscarriages or who have ever had preeclampsia or eclampsia, by vegans and vegetarians, and by just about any over the age of 60.

But for just a few pennies a day, some of the most debilitating diseases of the later stages of life may be avoided.

Sources & Links

  • Dharmarajan TS, Adiga GU, Norkus EP. Vitamin B12 deficiency. Recognizing subtle symptoms in older adults. Geriatrics. 2003 Mar. 58(3):30-4, 37-8.
  • Watanabe F, Katsura H, Takenaka S, Fujita T, Abe K, Tamura Y, Nakatsuka T, Nakano Y. Pseudovitamin B(12) is the predominant cobamide of an algal health food, spirulina tablets. J Agric Food Chem. 1999 Nov.47(11):4736-41.
  • Mindmap by steadyhealth.com
  • Photo courtesy of Saltanat ebli by Wikimedia Commons : en.wikipedia.org/wiki/Vitamin_B12

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