Digital Clinic LLC
Barbara Hoefener, FNP (2.11.21)
Vitamin B12 deficiency is present in 5%-20% of the elderly population.
Vitamin B12 (cobalamin) is necessary for hematopoiesis and normal neuronal function. In humans, it is obtained only from animal proteins and requires intrinsic factor (IF) for absorption. The body uses its vitamin B12 stores very economically, reabsorbing vitamin B12 from the ileum and returning it to the liver; very little is excreted.
Deficiently of vitamin B12 can lead to abnormal neurologic and psychiatric symptoms including ataxia (shaky movements and unsteady gait), muscle weakness, spasticity, incontinence, hypotension, vision problems, dementia, psychosis, and mood disturbances.
Vitamin B12, or cobalamin, is crucial for DNA synthesis in cells, particularly those with rapid turnover, such as hematopoietic cells, which are vital to the optimal function of the immune system. Demands for vitamin B12 increase during times of physical stress. Exogenous sources of B12 are meat and dairy products, which provide the B12 that we absorb daily in the presence of an acidic stomach and intrinsic factor.
Vitamin B12 deficiency is one of the major causes of macrocytic anemia but may also be present in normocytic patients. A deficiency of vitamin B12 promotes neurologic deficits, such as bilateral paresthesia’s of the lower extremities, loss of vibratory sensation, and disequilibrium. Memory loss, irritability, and dementia may also be caused by axonal degeneration in the central nervous system. Glossitis, vaginal atrophy, and mild diarrhea are among many other symptoms that might be associated with vitamin B12 deficiency.
Vitamin B12 deficiency is commonly caused from malabsorption (decreased intrinsic factor with age, IBS, or from gastric bypass or ileal resection), prolonged use of PPIs or Metformin.
Vitamin B12 deficiency frequently causes macrocytic anemia (incl low folate), glossitis, peripheral neuropathy, weakness, hyperreflexia, ataxia, loss of proprioception, poor coordination, and affective behavioral changes. These manifestations may occur in any combination; many patients have the neurologic defects without macrocytic anemia. Pernicious anemia is a macrocytic anemia caused by vitamin B12 deficiency that is due to a lack of IF secretion by gastric mucosa. Serum methylmalonic acid and homocysteine levels are also elevated in vitamin B12 deficiency states.
Increased serum vitamin B12 Decreased serum vitamin B12
Ingestion of vitamin C Pregnancy
Ingestion of estrogens Aspirin
Ingestion of vitamin A Anticonvulsants
Hepatocellular injury Colchicine
Myeloproliferative disorder Ethanol ingestion
Uremia Contraceptive hormones
. Smoking
. Hemodialysis
. Multiple myeloma
Lab result
<150 = Deficient in B12
150-400 = Borderline Deficient
401-1100 = Normal
Frequency: Vit B12 shots are most effective when taken at regular intervals. We recommend injections weekly x 4 weeks, then monthly (you can also take Vit B12 pill). We also recommend you take a B-Complex and Vit D3 10,000U daily. (yes, safe for pregnancy)
Possible Benefits: Improved neurologic function including muscle weakness, Improved energy, mental alertness/ improved mental clarity, improves mood stability, improved sleep quality/ chronic fatigue syndrome, decreased headaches, higher metabolism, balanced immune system/ reduced allergies.
Possible Side Effects: Vit B12 injections are basically safe and generally have no side effect, even in higher doses. Any redness or swelling should improve within 48 hours. In rare cases, B12 can cause Arthralgia, dizziness, headache, nasopharyngitis, diarrhea, itching, blood clots, redness, feelings of swelling and allergic reactions.
Do not take Vit B12: If you have sensitivity to cobalt and/or cobalamin. If you are taking Chloramphenicol or warfarin, have Leber’s optic atrophy Disease. If you have increased red blood cells or megaloblastic anemia. If you have chronic liver or kidney disease.
Source: Medscape.com, mayocliniclabs.com, and questdiagnostics.com