Effective Treatments for Vitamin B12 Deficiency

Vitamin B12 deficiency can be addressed by restoring its levels in the body, with treatment strategies varying depending on the underlying cause. Doctors may recommend vitamin B12 supplements in pill form, monthly injections, dietary changes, or treating related conditions such as celiac disease, alcoholism, or Crohn’s disease. Below is an overview of common treatment approaches for vitamin B12 deficiency:

Vitamin B12 Injections

Vitamin B12 injections are often administered frequently at the beginning of treatment to rapidly replenish liver stores, providing the body with enough vitamin B12 for several months. After this initial phase, injections are typically given every two to three months. For patients without neurological complications from pernicious anemia, the usual regimen is three injections per week for two weeks, followed by one injection every three months. In cases with neurological symptoms, injections may be given every other day initially, then monthly.

A small number of patients might experience a recurrence of deficiency symptoms before the usual three-month interval, requiring extended injection schedules. Consultation with a healthcare professional is crucial in such cases. Injections are essential for treating pernicious anemia, one of the most common causes of vitamin B12 deficiency. Subsequent treatment depends on whether the deficiency is diet-related or due to other causes.

Oral Vitamin B12 Supplements

Oral vitamin B12 supplements can be effective for individuals whose deficiency stems from inadequate dietary intake, such as vegetarians. These supplements are taken daily between meals. For those without severe deficiency or neurological symptoms, doses of 1000 to 2000 micrograms per day are often sufficient, as the body can absorb high doses even without intrinsic factor.

In cases of severe deficiency, patients might receive 1 milligram of vitamin B12 one to four times weekly for several weeks until blood abnormalities improve, then monthly thereafter. Blood irregularities usually improve within six weeks, though neurological symptom relief may take longer. Treatment typically continues lifelong unless the underlying physiological cause is resolved.

It is important to note that infants born to vegetarian mothers should receive vitamin B12 supplementation from birth.

Dietary Adjustments

Vegetarians who avoid meat, dairy, and eggs are at higher risk for vitamin B12 deficiency since animal products are the richest natural sources of this vitamin. Some fortified foods like nutritional yeast and cereals provide B12, but the vitamin is not naturally present in plant-based sources.

Vegetarians consuming eggs and dairy usually ingest less than half the recommended adult intake of 2.4 micrograms daily. Furthermore, vitamin B12 from animal sources is absorbed much more efficiently than from non-animal sources, making dietary supplementation or fortified foods important for those avoiding animal products.

Causes of Vitamin B12 Deficiency

Pregnant and breastfeeding vegetarians face increased risk due to insufficient cobalamin in plant-based diets. Pernicious anemia causes deficiency by impairing production of intrinsic factor, a protein critical for B12 absorption. Crohn’s disease, gastritis, inflammatory bowel diseases, and celiac disease can reduce nutrient absorption, leading to deficiency.

Metformin, a common diabetes medication, may reduce vitamin B12 absorption, requiring monitoring. Surgical removal of the stomach or parts of it can exacerbate deficiency. Conditions like diabetes, scleroderma, intestinal narrowing, or diverticula can slow intestinal transit, promoting bacterial overgrowth that consumes vitamin B12 before absorption.

Autoimmune diseases such as Graves' disease and lupus, as well as long-term use of antacids, can also contribute to deficiency.

Symptoms of Vitamin B12 Deficiency

Symptoms develop gradually and may initially go unnoticed. As deficiency worsens, signs can include fatigue, weakness, dizziness upon standing or exertion, rapid heartbeat, shortness of breath, swollen or inflamed tongue, gum bleeding, nausea, constipation or diarrhea, appetite loss, weight loss, pale skin, and irritability.

Complications of Untreated Deficiency

Prolonged vitamin B12 deficiency can cause irreversible nerve damage, leading to confusion, mental status changes, dementia, numbness in hands and feet, difficulty concentrating, balance problems, hallucinations, difficulty walking, muscle weakness, memory loss, depression, and psychosis.

Other complications include:

• Neurological disorders: Vision problems, peripheral neuropathy, ataxia, speech and gait difficulties, which may become permanent.
• Temporary infertility: Deficiency can cause reversible infertility that improves with treatment.
• Stomach cancer risk: Particularly in patients with pernicious anemia, due to immune attacks on stomach cells.
• Neural tube defects in infants: Deficiency during pregnancy increases risks of spina bifida, anencephaly, and encephalocele in newborns.

Recommended Daily Vitamin B12 Intake

About Vitamin B12

Vitamin B12, or cobalamin, was discovered in 1849 and is structurally related to the element cobalt. It is one of the largest and most complex vitamins, water-soluble, and vital for cellular metabolism, nervous system function, DNA synthesis, and red blood cell formation.