 Signs, symptoms & indicators of Vitamin B12 Requirement: | |  | | | Symptoms - Aging |  Decreased ability to walk | Staggering can be caused by advanced B12 deficiency. |
Poor balance| | Difficulty with balance is a symptom of B12 deficiency. |
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Symptoms - Bowel Movements |
Chronic/recent onset diarrhea or diarrhea for 1-3 months |
Symptoms - Food - General |
Weak appetite |
Symptoms - General |
Constant fatigue |
Symptoms - Head - Mouth/Oral |
 A sore tongue
A swollen tongue| | Glossitis (inflamed tongue) is a possible sign of B12 deficiency. |
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Symptoms - Metabolic |
Major/moderate/very great unexplained weight loss |
Symptoms - Mind - General |
Reduced/poor mental clarity
Occasional/frequent confusion/disorientation |
Symptoms - Muscular |
Tender calf muscles
Individual weak muscles |
Symptoms - Nervous |
Numb/tingling/burning extremities| | If vitamin B12 deficiency becomes pronounced, the nervous system can be affected, causing progressive peripheral neuropathy (tingling of the fingers and toes), muscle weakness, staggering, tenderness in the calves, confusion. |
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Symptoms - Respiratory |
Shortness of breath
Always being short of/easily being short of breath |
Symptoms - Skin - General |
Lighter/paler skin color| | Pale skin, often with a lemon tint, can be a sign of vitamin B12 deficiency. |
(Possibly) jaundiced skin| | Pale skin, often with a lemon tint, can be a sign of B12 deficiency. |
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Conditions that suggest Vitamin B12 Requirement:
Risk factors for Vitamin B12 Requirement: | | | | | Autoimmune | Crohn's Disease
Gluten Sensitivity / Celiac Disease |
Digestion |
Hydrochloric Acid Deficiency |
Infections |
Helicobacter Pylori Infection |
Lab Values - Nutrients |
 Elevated urine MMA levels| | The UMMA test is a functional assay. UMMA reflects cobalamin (Vitamin B12) activity at the tissue/cellular level since MMA levels are directly related to a B12-dependent metabolic pathway. The conversion of MMA to succinic acid requires vitamin B12. The metabolic pathway is: MMA --> (coenzyme B12 ) --> succinic acid.
Vitamin B12 deficiency impedes this pathway and causes MMA levels to increase. Thus, as water builds up behind a dam, high UMMA levels indicate a vitamin B12 deficiency. |
(History of) B12 deficiency| | A urine MMA test is recommended for properly diagnosing B12 deficiency due to the possible lack of sensitivity of serum B12 tests. |
Counter-indicators:
 Normal urine MMA levels
Normal/elevated B12 levels| | A normal or high B12 level makes B12 deficiency less likely, but does not rule it out. |
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Organ Health |
Cirrhosis of the Liver |
Parasites |
Tapeworm Infection| | Large parasites like the beef tapeworm compete with us for nutrients by robbing us of micronutrients (such as vitamins) before they get to the things we don't really need. |
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Supplements and Medications |
PPI antacid use| | Prilosec (omeprazole) has been shown to decrease B12 absorption. |
(Past) H2-blocker antacid use| | H2-receptor blockers appear to impair the absorption of vitamin B12 from food. This is thought to occur because the vitamin B12 in food is attached to proteins. Stomach acid separates them and allows the B12 to be absorbed. |
Broad-spectrum antibiotic use| | Excessive use of antibiotics or anti-convulsants can lead to B12 deficiency. |
Much vitamin C supplementation
Copper supplementation
Counter-indicators:
 (Discontinued) multiple vitamin use
Much/some vitamin B12 supplementation
Routine/history of/frequent B12 injections |
Symptoms - Food - Preferences |
Short-term/long-term vegetarian/vegan diet| | Some 80% of those who have been vegan for 2 or more years suffer from some degree of B12 deficiency: B12 deficiency is surprisingly common amongst vegetarians. |
Vegan/vegetarian/raw food diet| | Vitamin B12 deficiency is the most common cause of megaloblastic anemia. Both long-term low dietary consumption and poor absorption are responsible for the final outcome of a B12 deficiency, namely megaloblastic anemia and neurological symptoms.
The authors of one study note that the vegan diet provides essentially no vitamin B12, and people following unsupplemented vegetarian diets may suffer from a deficit as well due to the lower levels in the diet. In addition, people consuming the vegan and vegetarian diets were in general also not getting adequate amounts of the essential amino acid methionine, due to the lower methionine content in plant proteins versus animal proteins. [Annals of Nutrition and Metabolism 2000;44: pp.135-8]
Serum vitamin B12 levels were 37% lower in the vegetarian group and 59% lower in the vegan group, compared with the omnivorous group. Serum B12 levels:In addition, B12 levels were low enough to be considered clinically deficient in:- 78% of the vegans
- 26% of the vegetarians
- 0% of the omnivores
Researchers compared homocysteine (Hcy) levels in 62 vegetarians, 32 vegans, and 59 people consuming an omnivorous diet. Compared to the omnivorous group, whose average Hcy levels were about 10.2 mmol/l, levels in the other groups were found to be:- More than 50% higher in the vegan group (15.8 mmol/l)
- About 30% higher in the vegetarian group (13.2 mmol/l)
Serum folate levels were within the normal range for all three groups, although they were significantly lower in omnivores. The authors conclude that "The results show that the mild hyperhomocysteinemia in alternative nutrition is a consequence of vitamin B12 deficiency." |
Not supplementing B12 or some B12 supplementation| | About 25% of all lacto-ovo vegetarians have a functional B12 deficiency, meaning their homocysteine is too high. The figure is more like 80% for those who have been vegan for 2 or more years. B12 deficiency is very common among vegetarians. |
Counter-indicators:
Omnivorous diet
Regular/frequent B12 supplementation |
Symptoms - Gas-Int - General |
Having had a small bowel resection| | Resection of the bowel increases the risk of vitamin B12 malabsorption. Even 7% to 10% of individuals with serum vitamin B12 levels in the 200-400pg/mL range have developed neuropsychiatric complications of vitamin B12 deficiency. Previously there was only concern when levels were below 200pg/mL. |
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Tumors, Malignant |
Liver Cancer |
Uro-Genital |
Pregnancy-Related Issues |
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Vitamin B12 Requirement suggests the following may be present: | | | | | Parasites | Tapeworm Infection| | Large parasites like the beef tapeworm compete with us for nutrients by robbing us of micronutrients (such as vitamins) before they get to the things we don't really need. |
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Recommendations and treatments for Vitamin B12 Requirement: | | | | | Intravenous |  Blood Transfusion| | In very severe cases, blood transfusion may be necessary. |
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Mineral |
Iron| | Extra iron may be needed in severe cases. |
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Vitamins |
 Vitamin B12 (Cobalamine)| | Treatment is highly effective. The form of vitamin B12 known as hydroxocobalamin is given by injection into a muscle twice during the first week and then weekly until the anemia and all other symptoms of deficiency have been fully corrected. It may be necessary to stay on a maintenance dosage of vitamin B12 every three months for life to stop the problem coming back. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | Weakly counter-indicative | | | Strongly counter-indicative | | | May do some good | | | Highly recommended |
GLOSSARY
Achlorhydria
The complete absence or failure of stomach acid secretion.
Amino Acid (Amino Acids)
An organic acid containing nitrogen chemical building blocks that aid in the production of protein in the body. Eight of the twenty-two known amino acids are considered "essential," and must be obtained from dietary sources because the body can not synthesize them.
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Celiac Disease (Gluten Sensitivity)
A digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten. Common symptoms include diarrhea, increased appetite, bloating, weight loss, irritability and fatigue. Gluten is found in wheat (including spelt, triticale, and kamut), rye, barley and sometimes oats.
Cobalamin (B12, B-12, Cobalamine, Vitamin B12)
Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Coenzyme
A heat stable molecule that must be associated with another enzyme for the enzyme to perform its function in the body. It is necessary in the utilization of vitamins and minerals.
Copper
An essential mineral that is a component of several important enzymes in the body and is essential to good health. Copper is found in all body tissues. Copper deficiency leads to a variety of abnormalities, including anemia, skeletal defects, degeneration of the nervous system, reproductive failure, pronounced cardiovascular lesions, elevated blood cholesterol, impaired immunity and defects in the pigmentation and structure of hair. Copper is involved in iron incorporation into hemoglobin. It is also involved with vitamin C in the formation of collagen and the proper functioning in central nervous system. More than a dozen enzymes have been found to contain copper. The best studied are superoxide dismutase (SOD), cytochrome C oxidase, catalase, dopamine hydroxylase, uricase, tryptophan dioxygenase, lecithinase and other monoamine and diamine oxidases.
Crohn's Disease (Crohn's)
Chronic inflammatory disease of the gastrointestinal tract. The most common symptoms are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia.
Diarrhea
Excessive discharge of contents of bowel.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Glossitis
Inflammation of the tongue.
Hydrochloric Acid (HCl)
An inorganic acidic compound, excreted by the stomach, that aids in digestion.
Ileostomy (Ileostomies)
An operation that makes it possible for stool to leave the body after the colon and rectum are removed. The surgeon makes an opening in the abdomen and attaches the bottom of the small intestine (ileum) to it.
Ileum
The lower two-thirds of the small intestine, ending in the ileocecal valve and emptying into the cecum of the colon. The last foot of the ileum is the only absorption site available for important dietary substances such as vitamin B12, folic acid, some essential fatty acids, fat soluble vitamins, and recycled bile acids.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Intrinsic Factor
One of two proteins secreted from the lining of the stomach whose sole purpose is (it seems) to cradle B12 and carry it through the digestive system until it reaches the absorption sites in the last foot of small intestine. There it slips from one protein to the other, and into the cell membranes where its handed over to the specialized blood protein that can carry it safely to the final target tissues (3 times out of 4, the bone marrow). Apparently cyanocobalamin (B12) has "parts that fall off", radicals that twirl around in five directions on three charge potentials, and is generally not very durable.
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Malabsorption
Improper utilization of needed and available nutrients, either from impaired digestive function (such as B12 being unabsorbed because of gastritis), impaired absorption (poor Vitamin E absorption because of an inflamed ileum) or impaired transport (the diminished blood proteins of the advanced alcoholic). There are other causes as well.
Megaloblast (Megaloblastic, Megaloblasts)
An abnormally large nucleated red blood cell found especially in people having pernicious anemia or certain vitamin deficiencies.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Methionine
Essential amino acid. Dietary source of sulfur and methyl groups. Important for proper growth in infants, nitrogen balance in adults, healthy nails and skin and the synthesis of taurine, cysteine, phosphatidylcholine (lecithin), bile, carnitine and endorphins. It is an antioxidant nutrient and lipotropic agent which promotes the physiological utilization of fat.
Milliliter (mL)
0.001 or one thousandth of a liter.
mol (mmol, nmol, pmol, umol)
Mole. The amount of a substance that contains as many atoms, molecules, ions, or other elementary units as the number of atoms in 0.012 kilograms of carbon 12. The number is 6.0225 × 10^23, or Avogadro's number. Also called gram molecule.
mmol: millimole: 0.001 or one thousandth of a mole.
umol: micromole: 0.000001 or one millionth of a mole.
nmol: nanomole: 0.000000001 or one billionth of a mole.
pmol: picomole: 0.000000000001 or one trillionth of a mole.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Neuropathy
A group of symptoms caused by abnormalities in motor or sensory nerves. Symptoms include tingling or numbness in hands or feet followed by gradual, progressive muscular weakness.
Parasite (Parasites, Parasitic, Parasitical)
An organism living in or on another organism.
Pernicious Anemia
Anemia caused by a vitamin B12 deficiency.
Picogram (pg)
0.000000000001 or a trillionth of a gram.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Pyridoxine
A B-complex vitamin that plays a role as a coenzyme in the breakdown and utilization of carbohydrates, fats and proteins. It facilitates the release of glycogen for energy from the liver and muscles. It also participates in the utilization of energy in the brain and nervous tissue and is essential for the regulation of the central nervous system.
Red Blood Cell (Erythrocyte, Erythrocytes, RBC, Red Blood Cells)
Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Small Intestine (Small Bowel)
The small intestine lies between the stomach and the large intestine. It is about 6 meters (20 feet) long and its primary function is to digest (break down) food and absorb nutrients (vitamins, minerals, proteins, carbohydrates, and fats). The small intestine makes up more than 70% of the length and 90% of the surface area of the gastrointestinal (GI) tract.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Urine MMA
The current gold standard for properly diagnosing B12 deficiency is the Urine MMA Level, due to the lack of sensitivity of the serum B12 test. The serum B12 test may produce false "normal" or "high" indications because of inactive B12 analogs in the blood from foods such as sea vegetables, or due to a body's last ditch dump from its bone marrow stores in response to severe deficiency. Available by mail from Norman Clinical Laboratories.
Vegan (Veganism, Vegans)
A person who consumes no animal products of any kind. In other words, vegans do not consume meat, fish, fowl, dairy products, eggs, honey, or products containing gelatin or any other animal-derived ingredients such as whey powder or food colorings.
Vegetarian (Lacto-Ovo-Vegetarian, Vegetarianism, Vegetarians)
A person who consumes no meat, fish or fowl (chicken, turkey, etc.), but who may consume animal products such as dairy products (milk, cheese, butter, etc.), eggs or honey.
Vitamin C (Ascorbic Acid)
A water-soluble antioxidant vitamin essential to the body's health. When bound to other nutrients, for example calcium, it would be referred to as "calcium ascorbate". As an antioxidant, it inhibits the formation of nitrosamines (a suspected carcinogen). Vitamin C is important for maintenance of bones, teeth, collagen and blood vessels (capillaries), enhances iron absorption and red blood cell formation, helps in the utilization of carbohydrates and synthesis of fats and proteins, aids in fighting bacterial infections, and interacts with other nutrients. It is present in citrus fruits, tomatoes, berries, potatoes and fresh, green leafy vegetables.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
Last updated: Sep 28, 2008
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