Vitamin B 12 Deficiency

Overview of Vitamin B 12 Deficiency

Symptoms may develop slowly and worsen over time.

• In mild Vitamin B 12 (Cobalamin) Deficiency, a person may feel tired and have a reduced number of red blood cells (anemia).
• In moderate deficiency, soreness of the tongue, aphthous ulcers, breathlessness, feeling that one may pass out, palpitations (rapid heartbeat), low blood pressure, jaundice, hair loss and severe joint pain (arthralgia) and the beginning of neurological symptoms, including abnormal sensations such as pins and needles, numbness and tinnitus may occur.
• Severe deficiency may include symptoms of reduced heart function as well as more severe neurological symptoms, including changes in reflexes, poor muscle function, memory problems, blurred vision, irritability, ataxia, decreased taste, decreased level of consciousness, depression, anxiety, guilt and psychosis. Infertility may occur.
• In young children, symptoms include poor growth, poor development, and difficulties with movement. Without early treatment, some of the changes may be permanent.

Indian epidemiology then other

Causes

Impaired absorption

• Inadequate absorption is the most common cause of Vitamin B 12 Deficiency. Selective impaired absorption of vitamin B 12 due to intrinsic factor deficiency.
• This may caused by the loss of gastric parietal cells in chronic atrophic gastritis or may result from wide surgical resection of stomach, or from rare hereditary causes of impaired synthesis of intrinsic factor.
• Untreated celiac disease may also cause impaired absorption of this vitamin, probably due to damage to the small bowel mucosa. In some people, vitamin B 12 deficiency may persist despite treatment with a gluten-free diet and require supplementation.
• Some bariatric surgical procedures, especially those that involve removal of part of the stomach, such as Roux-en-Y gastric bypass surgery.
• Bacterial overgrowth within portions of the small intestine, such as may occur in blind loop syndrome, may result in increased consumption of intestinal vitamin B 12 by these bacteria.
• The diabetes medication metformin may interfere with B 12 dietary absorption.
• A genetic disorder, transcobalamin II deficiency can be a cause
• Infection with the Diphyllobothrium latum tapeworm
• Chronic exposure to toxigenic molds and mycotoxins found in water damaged buildings.

Inadequate intake

• Inadequate dietary intake of animal products such as eggs, meat, milk, fish, and fowl can result in a deficiency state.
• Vegans, and to a lesser degree vegetarian, are at risk for B 12 deficiency if they do not consume either a dietary supplement or vitamin-fortified foods.
• Children are at a higher risk for B₁₂deficiency due to inadequate dietary intake.

Increased need

• Increased needs by the body can occur due to AIDS and hemolysis, which stimulates increased red cell production.

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

• Vitamin B₁₂deficiency causes particular changes to the metabolism of two clinically relevant substances in humans:

1. Homocysteine leading to hyperhomocysteinemia
2. Methylmalonic acid

• Methionine is activated to S-adenosyl methionine, which aids in purine and thymidine synthesis, myelin production, protein/neurotransmitters/fatty acid/phospholipid production and DNA methylation. 5-Methyl tetrahydrofolate provides a methyl group, which is released to the reaction with homocysteine, resulting in methionine. Additionally, This reaction requires cobalamin as a cofactor.
• The creation of 5-methyl tetrahydrofolate is an irreversible reaction.
• Besides this, If B₁₂is absent, the forward reaction of homocysteine to methionine does not occur, homocysteine concentrations increase, and the replenishment of tetrahydrofolate stops.
• Because Vitamin B 12 and folate are involved in the metabolism of homocysteine, hyperhomocysteinemia is a non-specific marker of deficiency. Methylmalonic acid is used as a more specific test of B_12.

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Sign & Symptoms of Vitamin B12 deficiency

The signs are often digestive and neurological problems caused by a develop of anemia; symptoms usually take time to appear before causes a pernicious anemia type.

The deficiency often appears due to poor absorption or genetic disorders, which are rare to occur with decreased intake; as anemia become more noticeable, symptoms may include:-

• Feeling constant tiredness and weakness
• Dizziness or feeling faint
• Sore red tongue
• Palpitations
• Breathlessness
• Pallor, low-grade fevers
• Shakiness and feeling constantly cold, cold hands and feet,
• A fall of blood pressure
• Stomach upset
• Nausea
• Loss of appetite
• Weight loss
• Constipation or diarrhea
• Angular cheilitis
• Mouth ulcers
• Bleeding gums
• Hair loss and weakness
• Premature greying
• A look of exhaustion and dark circles around the eyes
• As well as brittle nails. [1]

Severe deficiency symptoms

Left untreated or in prolonged cases of vitamin B₁₂ deficiency, it may damage nerve cells. If this happens, it may result:

• Abnormal sensations including tingling or numbness to the fingers and toes
• Mental problems, including personality changes, depression, Irritability, confusion, decrease level of consciousness, brain fog
• Changes in mobility
• Difficulty walking ,poor balance and loss of sensation in the feet
• Memory problems
• Blurred vision
• Muscle weakness, severe joint pain (arthralgia)
• Tinnitus, mood swings, anxiety, dysuria, fertility problems, psychosis, cognitive impairment and changes in reflexes.
• Vitamin B12 deficiency is also a major factor leading to megoblastic anemia, a condition in which the body doesn’t have enough healthy red blood cells, so tissues and organs don’t get enough oxygen, causing feelings of weakness and tiredness, breathlessness, headaches, looking pale, feeling faint, rapid heartbeat, and dizziness.
• Increased risk of bone fracture
• Osteoporosis

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Diagnosis of Vitamin B 12 (Cobalamin) Deficiency

• There is no substantive diagnosis to confirm vitamin B₁₂Serum levels of B₁₂ are often low in vitamin B₁₂ deficiency, but if there are clinical signs that conflict with normal levels of vitamin B₁₂; additional investigations are justified. Diagnosis often suspected first, as diagnosis usually requires several tests, these include:
• Complete blood count-A routine complete blood count shows anemia with an elevated mean corpuscular volume (MCV).
• Serum vitamin B 12 – A level below normally indicates a deficiency.
• Methylmalonic acid and/or homocysteine- If the serum vitamin B₁₂is at the normal level, methylmalonic acid also homocysteine assay is required. higher levels indicate a deficiency, indicators are usually more reliable.
• Intrinsic factor and parietal cell antibodies- The blood is tested for antibodies against intrinsic factor also the parietal cells of the stomach.
• If nervous system damage is present and blood testing is inconclusive, a lumbar puncture to measure cerebrospinal fluid B-₁₂levels may be done. On bone marrow aspiration or biopsy, megaloblasts are seen.
• The Schilling test was a radio-isotope method, now outdated, of testing for low vitamin B₁₂. [1]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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Treatment of Vitamin B 12 (Cobalamin) Deficiency

• Vitamin B12 can be supplemented orally or by injection or Nasal spray and appears to be equally effective in those with low levels due to deficient absorption of B 12.
• When large doses are given by mouth, B₁₂absorption does not rely on the presence of intrinsic factor or an intact ileum. Instead, these large-dose supplements result in 1% to 5% absorption along the entire intestine by passive diffusion.
• Nasal spray: 500 mcg (1 spray in 1 nostril) weekly; if the patient taking hot meals, the spray should be administered 1 hour before or after a meal.
• Generally, 1 to 2 mg daily is required as a large dose. Even pernicious anemia can be treated entirely by the oral route.
• The RDI for vitamin B12 ranges from 2.4 mcg for adults to 2.8 mcg for breastfeeding women.

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Homoeopathic Treatment for Vitamin B 12 Deficiency

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution, family history, presenting symptoms, underlying pathology, possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions. A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’.

The disease diagnosis is important but in homeopathy, the cause of disease is not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness are also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology is not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can be greatly improved with homeopathic medicines.

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy.

Homeopathic Medicine for Vitamin B 12 Deficiency :

Arsenic Album

To Manage Weakness, Tiredness i.e.

• Arsenic Album is a very effective homeopathic medicine to manage weakness, tiredness. In persons needing it weakness is felt from doing even least exertion. Mostly they have weakness in the night hours.
• Intense weakness is there in limbs that forces the person to lie down. They are also very anxious and restless, with a desire to move constantly.
• Apart from above, it is well-indicated medicine to manage tingling sensation felt in the fingers. Weakness, numbness in the feet is yet another symptom calling its use.

Aloe

For Managing Diarrhea i.e.

• This medicine is prepared from gum of the plant Aloe Socotrina. It belongs to family liliaceae. It is one of the best medicines in homeopathy to manage diarrhoea.
• In cases needing it there is passage of lumpy, watery stool. There is a desire to pass soon after eating or drinking. Urgency to pass stool is also present.
• A constant bearing down sensation is felt in rectum. The main indication for using it is morning diarrhea that makes a person rush out of bed and go to pass stool immediately upon rising in morning. [2]

Borax for Vitamin B 12 (Cobalamin) Deficiency

For Managing Mouth Ulcers i.e.

• In cases needing it, the ulcers can be present inside of the cheek or tongue. The ulcers are painful and tender. They also tend to bleed easily.
• Excessive heat and dryness of mouth can felt along with these features.

Custicum

For Muscle Weakness and Problem with Balance and Coordination i.e.

• It is a prominent medicine with marked action on the muscles. It is a top-grade medicine to help cases in which muscle weakness is prominent.
• Another major indication for using it is the problem with balance and coordination that cause unsteady walking and easy falling. It also works well to manage numbness in the hands.

Gelsemium for Vitamin B 12 (Cobalamin) Deficiency

To Manage Exhaustion and Dizziness i.e.

• A natural medicine prepared from the bark of the root of plant Gelsemium Sempervirens commonly known as yellow jasmine.
• This plant belongs to family Loganiaceae. This medicine helps manage complaints of exhaustion and dizziness. In cases requiring it dullness and drowsiness is also present.
• There is also a desire to lie down at all times. Dizziness may occur while walking. Also indicated for managing cases in which there occurs confusion of mind, thinking difficulty and problem in concentration 

Hypericum

For Tingling Sensation in Limbs i.e.

• Hypericum prepared from a plant Hypericum Perforate also known by the name of St. John’s Wort. This plant belongs to family hypericaceae.
• Use of this medicine if highly recommended to manage tingling and burning sensation in the limbs. Numbness in limbs may also be there in some cases.

Ipecac

For Managing Nausea and Vomiting i.e.

• Ipecac medicine prepared from the dried root of plant Ipecacuanha belonging to the family rubiaceous. It is very useful to manage nausea and vomiting.
• The nausea can be constant in persons needing it. Vomiting may occur of watery fluids, food or bile. The nausea may not get better even after vomiting.[2]

Ignatia for Vitamin B 12 (Cobalamin) Deficiency

For Managing Depression i.e.

• It is a very beneficial medicine in homeopathy for managing depression. People needing it feel sad all the time. This is accompanied with weeping also brooding spells.
• People who need this medicine do not wish to meet other people. They may also have dullness and weakness of mind.

Kali Phos

To Manage Fatigue, Memory Weakness, Numbness, Prickling i.e.

• It is an important medicine to help cases in which fatigue is present on both mental and physical spheres. Doing the slightest amount of work seems daunting.
• They have low energy levels.
  It is also a suitable medicine for managing weakness of memory, forgetfulness, dullness of mind. Other than these, it is also a significant medicine for managing irritability also depression.
• In such cases sadness, gloominess, is present. Other symptoms that can attend are weariness of life, negative thoughts in mind and fear of death. Lastly, it works well when there is numbness or prickling sensation in the hands and feet.[2]

Lycopodium for Vitamin B 12 (Cobalamin) Deficiency

To Manage Gas i.e.

• Lycopodium prepared from plant Lycopodium Clavatum commonly known as club moss that belongs to the family lycopodiaceae.
• This medicine works well in cases where excessive gas production is there. Furthermore, It results in abdominal bloating. After eating any food there occurs bloating. Abdominal pain also occur if the gas is not passed.  

Merc Sol

To Manage Inflammation of Tongue and Mouth Ulcers i.e.

• It is a highly valuable medicine for managing tongue inflammation. In such cases there is intense redness of tongue accompanied with pain.
• The pain is usually pricking in nature. Burning sensation can also occur with this.
  Next, it is very effective for cases of mouth ulcers. The ulcers can occur on the tongue, gums, inside cheeks when it is needed. These are dirty looking with undefined borders.
• Excessive salivation, metallic taste in mouth and offensive breath are some general symptoms that can appear with above complaints. 

Picric Acid

For Managing Pin and Needle Sensation i.e.

• This is a beneficial medicine for managing pin and needle sensation in the limbs. Weakness and tiredness in the whole body especially in the limbs can also be present in cases needing it.
• Some other indications for using this medicine include weakness of memory, forgetfulness and mental fatigue after doing least intellectual work.

Sarcolacticum Acidum

For Extreme Fatigue, Prostration i.e.

• It yet another indicated medicine for managing fatigue, prostration. For using it the muscle weakness is present in the back, neck and shoulders.
• It also felt in limbs when climbing stairs. Lastly weakness is felt in arms as if it has no strength in them.

Zincum Met

To Manage Numbness and Tingling i.e.

• Zincum Met is also very useful medicine for managing numbness and tingling sensation.
• Sometimes formation sensation is felt in feet and legs. Muscle weakness in the limbs may also be present [2]

Food to be avoided

• Folic acid-fortified foods: – However, too much folic acid can mask a vitamin B12 deficiency, suggests that high folate levels can even exacerbate the anemia and cognitive symptoms associated with a lack of vitamin B12.
• Alcohol:- Alcohol liver disease may falsely increased trusted source vitamin B12 test level. People with alcohol use disorder may need supplements to correct vitamin B12 deficiency and anemia.

Source of Vitamin B 12

Animal products, such as meat, fish, and eggs, contain vitamin B12 in varying amounts. The following list of good sources Trusted Source:

• Clams
• Liver
• Trout
• Salmon
• Canned tuna
• Beef
• Low fat yogurt
• Low fat milk
• Ham
• Eggs
• Chicken breast

A person should consume these foods in moderation as part of a healthful diet. Learn how to eat a healthful diet here.

Vegan sources:

• Foods that are sometimes fortified and may contain vitamin B 12 in varying amounts include:
• Plant milk, such as soy, almond, oat, cashew, and coconut milk
• Breakfast cereals
• Margarine and spreads
• Nutritional yeast
• Tofu
• Fruit juice
• Dairy-free yogurt [3]

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[1] https://en.wikipedia.org/wiki/Vitamin_B12_deficiency

[2] https://www.drhomeo.com/homeopathic-treatment/homeopathy-for-vitamin-b-deficiency/

[3] https://www.medicalnewstoday.com/articles/vitamin-b12-foods#vegan-sources