What is B12 Deficiency? Symptoms, Causes, and Treatment

B12 deficiency is a condition that occurs when the body does not receive or cannot absorb sufficient amounts of vitamin B12. Consequences of B12 deficiency include fatigue, memory problems, and nerve damage. Vitamin B12 is generally found in animal-based foods, and its deficiency may be seen more frequently in individuals following a vegan diet and in the elderly. If left untreated, it can lead to permanent nerve damage and neurological disorders in the long term.

What is B12 Deficiency?

Vitamin B12 deficiency is the body's inability to obtain the vitamin B12 it needs to function properly. This essential vitamin, the deficiency of which causes significant health problems in the body, helps keep the body's nerve cells and blood cells healthy. It also plays a role in the production of DNA, the genetic material in cells. The body does not produce vitamin B12 on its own. For this reason, it is important to consume foods and beverages that contain vitamin B12. Vitamin B12 is found in animal products that are eaten and drunk, such as meat, dairy products, and eggs.

How Does B12 Deficiency Occur?

B12 deficiency occurs as a result of insufficient levels of vitamin B12 taken into the body or absorption problems. Vitamin B12 found in food is released with the help of stomach acid to form a protein complex, which allows it to be absorbed in the intestines. However, when this process is disrupted, vitamin B12 deficiency occurs. Malnutrition, decreased stomach acid, or intestinal diseases negatively affect this process and lead to B12 deficiency. Some risk factors that can be effective in the occurrence of B12 deficiency are as follows:

Malnutrition: Vitamin B12 is mostly found in animal foods such as meat, dairy products, and eggs. Therefore, people who follow a vegan or vegetarian diet are at risk of B12 deficiency. Since vitamin B12 is not naturally found in plant-based sources, these individuals may experience a deficiency if they do not use B12 supplements.

Absorption Disorders: Conditions that lead to intestinal absorption problems, such as pernicious anemia, Crohn's disease, celiac disease, or gastric bypass surgery, can also impair B12 absorption. As a result of these conditions, B12 deficiency may develop, and the body cannot get the vitamin it needs.

Medication Use: Especially some diabetes medications or drugs that suppress stomach acid, such as proton pump inhibitors, can cause B12 deficiency when used for a long time. Since stomach acid helps release B12 from food, a decrease in stomach acid production can lead to absorption problems.

Aging: As you age, stomach acid production decreases, making it difficult to absorb vitamin B12. Thinning of the stomach lining and a decrease in intrinsic factor production in elderly individuals can also play a role in the occurrence of vitamin B12 deficiency.

Increased Need: During pregnancy and breastfeeding, women's need for vitamin B12 increases. During these periods, the body requires more B12 to meet the needs of both the mother and the baby. If sufficient B12 is not taken during this period, deficiency symptoms may appear more quickly. In addition, some chronic diseases or infections can also cause deficiency by increasing the body's need for B12.

Pernicious Anemia: Pernicious anemia is a disease that causes problems with vitamin B12 absorption as a result of the body's inability to produce sufficient amounts of intrinsic factor. Intrinsic factor is a special protein that allows B12 to be absorbed from the small intestines, and its deficiency can lead to severe vitamin B12 deficiency.

Gastritis: Gastritis is a common cause of vitamin B12 deficiency. It can cause discomfort due to the lack of hydrochloric acid in the stomach, which is necessary for vitamin B12 absorption. Chronic atrophic gastritis, in particular, makes it difficult for B12 to be released from food by reducing stomach acid production. This situation can cause the body's vitamin B12 stores to be depleted over time and lead to deficiency.

Surgery: Stomach or intestinal surgeries are one of the important reasons that can directly affect B12 absorption. Weight loss surgeries, such as gastric bypass, in particular, make it difficult for vitamin B12 to be absorbed by bypassing part of the stomach and small intestines. After surgery, B12 vitamin stores can be depleted rapidly, and deficiency symptoms may appear. In such cases, taking regular B12 supplements after surgery is important to prevent deficiency.

What Are the Symptoms of B12 Deficiency?

Physical, neurological, and psychological symptoms can be seen in people with vitamin B12 deficiency. Symptoms may develop slowly and worsen over time. Some people may have no symptoms at all. Symptoms of vitamin B12 deficiency may include:

Fatigue and weakness: Vitamin B12 plays an important role in the production of red blood cells. In case of deficiency, the body cannot produce enough red blood cells, which leads to fatigue, weakness, and a general loss of energy. The person may feel constantly exhausted and may be reluctant to engage in physical activities. Even simple daily activities, such as climbing stairs, can become challenging.

Shortness of breath and dizziness: B12 deficiency can lead to shortness of breath by causing a decrease in oxygen-carrying red blood cells. Breathing becomes difficult, especially during physical activity, and the person may experience dizziness. This condition is related to anemia, and as it progresses, symptoms such as a feeling of fainting may also appear. Since sufficient oxygen cannot be transported, the body's tissues cannot be nourished as they should be.

Skin pallor: In B12 deficiency, the skin may take on a pale and lifeless appearance because enough red blood cells cannot be produced in the body. This condition occurs due to a decrease in hemoglobin levels in the blood and is a prominent sign of anemia. This pallor in the skin can provide clues about general health status and can be an indicator that the deficiency is at a serious level. Skin pallor can be seen more clearly, especially on the face and hands.

Tongue and mouth sores: B12 deficiency can also negatively affect mouth and tongue health. The surface of the tongue may become smooth and take on a bright red color. In addition, painful sores in the mouth, a burning sensation, and a decrease in the sense of taste may also be seen. Such intraoral problems appear at an advanced stage of deficiency and can negatively affect daily life.

Nervous system problems: Vitamin B12 plays a critical role in the protection and regeneration of nerve cells. In case of deficiency, symptoms such as numbness and tingling in the hands and feet may be seen. Long-term deficiency can lead to more serious neurological problems such as balance disorders and difficulty walking. In addition, memory loss, forgetfulness, and difficulty concentrating are also among the effects on the nervous system.

How is B12 Deficiency Diagnosed?

Diagnosis of the condition can be difficult because symptoms are not always present or may resemble other nutritional deficiencies. Doctors often request routine blood tests for people at high risk of developing vitamin B12 deficiency. Some tests used in the diagnosis of B12 deficiency are as follows:

Blood test: The first step in diagnosing B12 deficiency is usually a complete blood count and measurement of vitamin B12 levels. These tests provide information about the number and size of red blood cells in the blood, as B12 deficiency can lead to the enlargement of red blood cells and anemia. In addition, serum B12 levels are checked to determine if vitamin B12 levels are low. A low B12 level is one of the most obvious signs of deficiency and may require further testing.

Homocysteine and methylmalonic acid (MMA) tests: In B12 deficiency, two substances called homocysteine and methylmalonic acid (MMA) can accumulate in the blood. An increase in homocysteine levels can be an indirect indicator of vitamin B12 deficiency because B12 is required for the normal metabolism of this substance. An increase in MMA levels in the blood or urine can be a direct sign of B12 deficiency. These tests can help identify the deficiency even if B12 levels are not low.

Pernicious anemia tests: If the doctor thinks that B12 deficiency is due to pernicious anemia, an intrinsic factor antibody test may be performed. This test determines whether the immune system is attacking stomach cells and preventing the production of intrinsic factor.

Endoscopy: In some cases, especially if there is a suspicion of absorption problems or gastritis, the doctor may examine the stomach and intestines with an endoscopy. This method is used to detect conditions that prevent B12 absorption, such as atrophic gastritis in the stomach lining. Damage seen in the small intestines or stomach lining may indicate that there is a problem with B12 absorption. More detailed examinations can be performed by taking a biopsy during endoscopy, and the cause of the deficiency can be confirmed.

How is B12 Deficiency Treated?

B12 deficiency treatment varies depending on the severity of the deficiency, the cause, and the person's general health status. The goal of treatment is to restore the B12 levels the body needs and to resolve the health problems caused by the deficiency. Depending on the cause of the deficiency, treatment under doctor supervision may be needed until vitamin B12 levels return to normal, or in some individuals, vitamin B12 treatment may be applied for the rest of their lives. Some of the B12 deficiency treatment methods are as follows:

Oral B12 supplements: In cases of mild B12 deficiency, doctors usually recommend B12 supplements taken orally. These vitamin pills help B12 levels in the body return to normal by being taken daily. Oral B12 supplements are an effective treatment method for people who do not have absorption problems. The dosage of the supplements may vary depending on the degree of the deficiency, and the effectiveness of the treatment is monitored with regular blood tests.

B12 injections: In cases of severe B12 deficiency or for people experiencing absorption problems, B12 injections may be a more effective treatment option. These injections are usually given intramuscularly and ensure that vitamin B12 is delivered directly into the bloodstream.

Dietary changes: People experiencing B12 deficiency are advised to consume foods rich in vitamin B12 under doctor supervision during the treatment process. Animal products such as red meat, fish, dairy products, and eggs are very rich in vitamin B12. Dietary changes are important to prevent the recurrence of B12 deficiency and to meet the vitamin the body needs through natural means.

Frequently Asked Questions

B12 deficiency can negatively affect many basic functions of the body, from energy production to the nervous system. Symptoms such as anemia, nerve damage, memory problems, and fatigue may occur. In cases of advanced deficiency, serious complications such as neurological disorders, balance problems, and mental confusion may develop. Those experiencing B12 deficiency should consume animal-based foods such as meat, fish, eggs, and dairy products. Vegan or vegetarian individuals can prefer foods such as B12-fortified cereals, plant-based milks, and yeast products. If sufficient B12 cannot be obtained through diet, B12 supplements should also be added with doctor's advice. In a healthy individual, the serum B12 level should be at least 200 pg/mL (picogram/milliliter). A drop in values below this level indicates the presence of a deficiency and potential health problems. One of the best ways to correct B12 deficiency is to consume foods containing B12 under doctor supervision and take vitamin supplements when necessary. In cases of severe deficiency, the doctor may recommend B12 injections. In addition, in B12 deficiencies caused by underlying diseases, the doctor may implement a treatment program for the condition. B12 deficiency usually does not cause weight gain, but low energy and a slowing of the metabolic rate can make weight control difficult. The person may feel tired and exhausted and move less, which can indirectly contribute to weight gain. B12 deficiency can cause circulatory and nervous system problems that can lead to headaches. Failure to transport enough oxygen to the brain and disorders in the nervous system can trigger headaches and migraines. B12 deficiency can lead to memory problems and forgetfulness. Deterioration in the nervous system can negatively affect brain functions and lead to cognitive decline. The damages of jock itch can be prevented by improving hygiene conditions, but other existing fungal infections and risk factors must be eliminated. Approaches such as avoiding tight and wet clothing, reducing sweating and friction, drying the area thoroughly, not sharing personal care items such as towels, not touching and scratching the infected area, and putting on socks first when getting dressed can reduce the risk of jock itch. B12 deficiency can lead to memory problems and forgetfulness. Deterioration in the nervous system can negatively affect brain functions and lead to cognitive decline.

Do Not Ignore B12 Deficiency Symptoms

If B12 deficiency is not noticed and treated in the early stages, it can lead to permanent nerve damage and serious neurological problems. If you have complaints such as constant fatigue, forgetfulness, dizziness, or numbness in the hands and feet, an expert evaluation is of great importance.

Hisar Hospital Intercontinental Internal Medicine (Internal Diseases) Department serves with a comprehensive laboratory infrastructure and an experienced physician staff in the diagnosis and treatment of B12 deficiency. You can secure your health by making an appointment for a personalized treatment plan.