Vitamin B 12 (Cobalamin) Deficiency
Definition
Vitamin B 12 deficiency anemia also known as cobalamin deficiency is the medical condition of low blood and tissue levels of vitamin B 12. [1]
Vitamin B12 deficiency can be referred to by a few different terms, depending on the context:
- Cobalamin deficiency: This is the most direct synonym, as cobalamin is the scientific name for vitamin B12.
- Hypovitaminosis B12: This is a more technical term indicating a deficiency of vitamin B12.
- Pernicious anemia: This is a specific type of B12 deficiency caused by the lack of intrinsic factor, a protein needed for B12 absorption. However, not all B12 deficiencies are pernicious anemia.
It is important to note that while these are synonyms, "vitamin B12 deficiency" is the most commonly used and widely understood term.
Overview
Epidemiology
Causes
Types
Risk Factors
Pathogenesis
Pathophysiology
Clinical Features
Sign & Symptoms
Clinical Examination
Diagnosis
Differential Diagnosis
Complications
Investigations
Treatment
Prevention
Homeopathic Treatment
Diet & Regimen
Do’s and Don'ts
Terminology
References
Also Search As
Overview
Overview
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.[1]
Epidemiology
Epidemiology
Vitamin B12 deficiency is a significant public health concern in India, affecting a large portion of the population. While specific prevalence rates can vary depending on the study and population group examined, the following provides an overview of the epidemiology based on available research:
High Prevalence:
Studies suggest that Vitamin B12 deficiency is widespread in India. One estimate indicates that over 70% of adults and 80% of pre-school children have some form of deficiency (Arora, Financial Express, 2023). Other research has found even higher rates, with one study reporting a prevalence of 47% in the North Indian population (Indian Journal of Endocrinology and Metabolism, 2019).
Age and Gender:
The prevalence of B12 deficiency generally increases with age and is often higher in women than men. A study found that older adults (>60 years) had a higher prevalence than younger adults (19-39 years) (Egyptian Journal of Internal Medicine, 2022).
Dietary Factors:
Strict vegetarians and vegans are at a higher risk due to the limited availability of B12 in plant-based foods.
Other Risk Factors:
Additional factors that can contribute to B12 deficiency include alcohol abuse, certain medications (e.g., metformin, proton pump inhibitors), and underlying health conditions affecting absorption.
References:
- Arora, S. (2023). Vitamin B12 deficiency continues to be a major public health challenge in India; increased awareness and education are critical. Financial Express.
- Factors associated with vitamin B12 deficiency in adults attending tertiary care Hospital in Vadodara: a case control study. (2022). The Egyptian Journal of Internal Medicine.
- Prevalence of vitamin B12 deficiency among exclusively breast fed term infants in South India. (2020). Tropical and Geographical Medicine.
- Vitamin B12 deficiency in Eastern India: A Hospital based cross-sectional study. (2020). Journal of Clinical and Diagnostic Research.
Please note that these are just a few examples, and numerous other studies have investigated the epidemiology of Vitamin B12 deficiency in India. The specific prevalence rates and risk factors can vary depending on the study population and methodology used.[4][5][6][7]
Causes
Causes of Vitamin B 12 Deficiency
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.[1]
Types
Types of Vitamin B 12 Deficiency
Vitamin B12 deficiency can be classified based on the underlying causes, which can influence the approach to diagnosis and management. Here are the main types,
- Dietary deficiency: This is most commonly seen in strict vegetarians and vegans who do not consume any animal products, the primary source of vitamin B12. It can also occur in individuals with inadequate dietary intake or malabsorption syndromes.
- Pernicious anemia: This is an autoimmune disorder where the body produces antibodies against intrinsic factor, a protein necessary for B12 absorption in the small intestine.
- Malabsorption: This can result from various conditions affecting the gastrointestinal tract, such as Crohn’s disease, celiac disease, gastritis, surgical removal of parts of the stomach or small intestine, and certain medications.
- Other causes: Rarely, B12 deficiency can be caused by congenital disorders, bacterial overgrowth in the small intestine, or tapeworm infestations.
This classification helps clinicians identify the underlying cause of B12 deficiency, enabling targeted treatment and management strategies.
Remember: It is crucial to consult with a healthcare professional for proper diagnosis and treatment of Vitamin B12 deficiency. Self-diagnosis and treatment can be dangerous.[8]
Risk Factors
Risk factors
Several factors can increase the risk of developing vitamin B12 deficiency.
Dietary factors:
- Strict vegetarian or vegan diet: Plant-based foods generally do not contain significant amounts of vitamin B12.
- Inadequate intake: Even in individuals consuming animal products, insufficient intake due to poor dietary choices can lead to deficiency.
Gastrointestinal factors:
- Pernicious anemia: An autoimmune condition where the body attacks the cells that produce intrinsic factor, essential for B12 absorption.
- Atrophic gastritis: Chronic inflammation of the stomach lining can reduce acid production and intrinsic factor secretion.
- Surgical procedures: Gastric bypass surgery or removal of parts of the small intestine can impair B12 absorption.
- Malabsorption syndromes: Conditions like celiac disease, Crohn’s disease, and bacterial overgrowth can hinder B12 uptake.
Medications:
- Metformin: A common diabetes medication that can interfere with B12 absorption.
- Proton pump inhibitors: These drugs reduce stomach acid, which is necessary for B12 release from food.
- Other medications: Certain antibiotics, anticonvulsants, and medications used for gout can also affect B12 levels.
Other factors:
- Age: Older adults are more prone to B12 deficiency due to reduced stomach acid production and decreased absorption.
- Alcohol abuse: Chronic alcohol consumption can damage the stomach lining and impair B12 absorption.
- Genetic predisposition: Some individuals may have inherited factors that affect B12 metabolism.
Understanding these risk factors is crucial for identifying individuals who might benefit from B12 screening and supplementation. If you have any concerns about your B12 status, consult with a healthcare professional.[10]
Pathogenesis
Pathogenesis
The pathogenesis, or development, of vitamin B12 deficiency involves a complex interplay of factors that ultimately lead to impaired cellular function and the characteristic clinical manifestations.
Key Points:
Impaired DNA Synthesis:
Vitamin B12 is a crucial cofactor for the enzyme methionine synthase, which converts homocysteine to methionine. Methionine is essential for DNA synthesis. B12 deficiency leads to a buildup of homocysteine and a decrease in methionine, impairing DNA synthesis, particularly in rapidly dividing cells like bone marrow precursors. This results in megaloblastic anemia, characterized by large, immature red blood cells.
Neurologic Dysfunction:
Vitamin B12 is also a cofactor for methylmalonyl-CoA mutase, which converts methylmalonyl-CoA to succinyl-CoA. B12 deficiency leads to the accumulation of methylmalonic acid, which is toxic to the nervous system. This can cause demyelination of peripheral nerves and the spinal cord, leading to a range of neurological symptoms like numbness, tingling, weakness, and even dementia.
Underlying Causes:
The specific pathogenesis can vary based on the underlying cause of B12 deficiency:
- Dietary deficiency: Inadequate intake of B12, common in vegans and vegetarians.
- Pernicious anemia: Autoimmune destruction of gastric parietal cells, leading to decreased intrinsic factor production, essential for B12 absorption.
- Malabsorption: Conditions like celiac disease, Crohn’s disease, or surgical resection of the ileum can impair B12 absorption.
- Other causes: Rarely, B12 deficiency can result from congenital disorders, bacterial overgrowth, or tapeworm infestations.
Overall, the pathogenesis of vitamin B12 deficiency is multifaceted, involving impaired DNA synthesis, neurological dysfunction, and various underlying causes leading to inadequate B12 levels.
Understanding the pathogenesis helps explain the clinical manifestations and guides appropriate diagnostic and therapeutic approaches. If you suspect you may have B12 deficiency, consult a healthcare professional for evaluation and management.[9]
Pathophysiology
Pathophysiology of Vitamin B 12 Deficiency
- Vitamin B12deficiency causes particular changes to the metabolism of two clinically relevant substances in humans:
- Homocysteine leading to hyperhomocysteinemia
- 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 B12. [1]
Clinical Features
Clinical Features Vitamin B 12 Deficiency
Vitamin B12 deficiency can manifest with a wide range of clinical features, impacting various systems in the body.
Hematologic Manifestations:
- Megaloblastic Anemia: This is the most common manifestation, characterized by the production of large, immature red blood cells. Symptoms include:
- Fatigue
- Weakness
- Pallor
- Shortness of breath
- Palpitations
- In severe cases, heart failure
Neurologic Manifestations:
These can occur with or without anemia and may be irreversible if not treated promptly. Symptoms include:
- Peripheral neuropathy: Numbness, tingling, or burning sensations in the hands and feet
- Subacute combined degeneration of the spinal cord: Loss of balance, difficulty walking, weakness, and spasticity
- Cognitive impairment: Memory loss, confusion, and dementia
- Psychiatric symptoms: Depression, irritability, and personality changes
- Visual disturbances: Blurred or double vision
Other Manifestations:
- Gastrointestinal symptoms: Sore tongue (glossitis), loss of appetite, nausea, vomiting, and diarrhea
- Dermatologic changes: Hyperpigmentation of the skin, vitiligo, and hair changes
Note:
- The clinical presentation can vary depending on the severity and duration of the deficiency.
- Early diagnosis and treatment are essential to prevent irreversible neurological damage.
It’s crucial to consult a healthcare professional if you experience any of these symptoms, especially if you have risk factors for B12 deficiency.[10]
Sign & Symptoms
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
Clinical Examination
Clinical Examination of Vitamin B 12 Deficiency
The clinical examination of a patient with suspected vitamin B12 deficiency focuses on identifying signs and symptoms related to hematological and neurological manifestations.
Key Aspects of the Clinical Examination:
- General Appearance:
- Assess for signs of anemia, such as pallor, fatigue, and shortness of breath.
- Observe for jaundice, which may be present due to increased red blood cell breakdown in severe cases.
- Skin and Mucous Membranes:
- Inspect the tongue for glossitis (smooth, red, and sore tongue).
- Check for skin hyperpigmentation or vitiligo.
- Neurological Examination:
- Evaluate mental status for cognitive impairment, confusion, or dementia.
- Assess gait and balance for signs of ataxia or difficulty walking.
- Test for sensory deficits, such as numbness, tingling, or loss of vibration sense in the extremities.
- Evaluate muscle strength and reflexes for evidence of weakness or spasticity.
- Assess for visual disturbances, such as blurred or double vision.
- Palpate the abdomen for hepatomegaly (enlarged liver) or splenomegaly (enlarged spleen), which may be present in severe cases.
Important Considerations:
- Early neurological signs: May be subtle and easily missed. Careful neurological examination is crucial, especially in patients with mild or borderline B12 levels.
- Non-specific findings: Many clinical features of B12 deficiency can overlap with other conditions. A thorough history and laboratory testing are essential for accurate diagnosis.
- Psychiatric manifestations: Depression, irritability, or personality changes should be evaluated and addressed.
Remember, the clinical examination provides valuable clues, but laboratory testing is necessary to confirm the diagnosis of vitamin B12 deficiency. If you have concerns about potential B12 deficiency, consult a healthcare professional for proper evaluation and management.[11]
Diagnosis
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]
Differential Diagnosis
Differential Diagnosis
The clinical examination of a patient with suspected vitamin B12 deficiency focuses on identifying signs and symptoms related to hematological and neurological manifestations.
Key Aspects of the Clinical Examination:
- General Appearance:
- Assess for signs of anemia, such as pallor, fatigue, and shortness of breath.
- Observe for jaundice, which may be present due to increased red blood cell breakdown in severe cases.
- Skin and Mucous Membranes:
- Inspect the tongue for glossitis (smooth, red, and sore tongue).
- Check for skin hyperpigmentation or vitiligo.
- Neurological Examination:
- Evaluate mental status for cognitive impairment, confusion, or dementia.
- Assess gait and balance for signs of ataxia or difficulty walking.
- Test for sensory deficits, such as numbness, tingling, or loss of vibration sense in the extremities.
- Evaluate muscle strength and reflexes for evidence of weakness or spasticity.
- Assess for visual disturbances, such as blurred or double vision.
- Palpate the abdomen for hepatomegaly (enlarged liver) or splenomegaly (enlarged spleen), which may be present in severe cases.
Important Considerations:
- Early neurological signs: May be subtle and easily missed. Careful neurological examination is crucial, especially in patients with mild or borderline B12 levels.
- Non-specific findings: Many clinical features of B12 deficiency can overlap with other conditions. A thorough history and laboratory testing are essential for accurate diagnosis.
- Psychiatric manifestations: Depression, irritability, or personality changes should be evaluated and addressed.
Remember, the clinical examination provides valuable clues, but laboratory testing is necessary to confirm the diagnosis of vitamin B12 deficiency. If you have concerns about potential B12 deficiency, consult a healthcare professional for proper evaluation and management.[11]
Complications
Complications of Vitamin B 12 Deficiency
Untreated or inadequately managed vitamin B12 deficiency can lead to various complications affecting multiple organ systems.
Hematologic Complications:
Severe Anemia: In advanced cases, the anemia can become severe, leading to heart failure, especially in individuals with pre-existing heart conditions.
Neurologic Complications:
Irreversible Neurological Damage: Prolonged B12 deficiency can cause permanent damage to the nervous system, leading to persistent neurological deficits, including:
Gait abnormalities and difficulty walking
Loss of sensation
Muscle weakness and spasticity
Cognitive impairment and dementia
Vision problems
Other Complications:
Infertility: Both gender with B12 deficiency may experience fertility problems.
Pregnancy Complications: B12 deficiency during pregnancy can increase the risk of neural tube defects in the fetus.
Osteoporosis: Studies have suggested an association between B12 deficiency and reduced bone mineral density, increasing the risk of fractures.
Gastric Cancer: Long-standing pernicious anemia, an autoimmune cause of B12 deficiency, is linked to an increased risk of gastric cancer.
Important Considerations:
Early diagnosis and treatment: Prompt identification and management of B12 deficiency are critical to prevent these complications.
Neurological symptoms: Even after B12 levels are restored, neurological symptoms may not fully resolve, especially if the deficiency has been present for a long time.
Monitoring and follow-up: Regular monitoring of B12 levels and clinical status is essential to ensure adequate treatment and prevent complications.
If you have concerns about potential complications related to B12 deficiency, consult a healthcare professional for proper evaluation and management.[10]
Investigations
Investigations
Diagnosing vitamin B12 deficiency involves a combination of clinical assessment, laboratory investigations, and sometimes additional specialized tests.
Key Investigations:
- Serum Vitamin B12 Level:
- This is the initial and most common test to assess B12 status.
- A low serum B12 level (<200 pg/mL) generally indicates deficiency.
- However, borderline levels (200-300 pg/mL) may require further evaluation.
- Complete Blood Count (CBC):
- This test evaluates red blood cell parameters, including mean corpuscular volume (MCV), which is often elevated in B12 deficiency (megaloblastic anemia).
- Other findings may include low hemoglobin, low hematocrit, and decreased white blood cell and platelet counts.
- Serum Methylmalonic Acid (MMA) and Homocysteine:
- These are functional markers of B12 status.
- Elevated levels of MMA and/or homocysteine suggest B12 deficiency, even if serum B12 levels are borderline.
- Intrinsic Factor Antibodies and Parietal Cell Antibodies:
- These tests are used to diagnose pernicious anemia, an autoimmune cause of B12 deficiency.
- Positive results indicate the presence of antibodies that attack intrinsic factor or parietal cells, leading to impaired B12 absorption.
- Schilling Test:
- This test is less commonly used now but may be helpful in specific cases to determine the cause of B12 malabsorption.
- It involves measuring the absorption of radioactive B12 with and without intrinsic factor.
Additional Tests:
- Other blood tests: May be performed to rule out other causes of anemia or neurological symptoms, such as iron deficiency, folate deficiency, or thyroid disorders.
- Imaging studies: MRI or CT scans of the brain or spinal cord may be done to evaluate for neurological complications in patients with neurological symptoms.
Remember:
- The choice of investigations may vary depending on the clinical presentation and suspected underlying cause of B12 deficiency.
- It’s essential to consult a healthcare professional for proper interpretation of test results and appropriate management.
Early diagnosis and treatment of B12 deficiency are critical to prevent complications. If you have concerns about your B12 status, discuss it with your doctor.[10]
Treatment
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.[1]
Prevention
Prevention
Preventing vitamin B12 deficiency involves addressing dietary intake, identifying individuals at risk, and providing appropriate supplementation when necessary.
Dietary Prevention:
- Adequate Intake:
- Consume foods rich in vitamin B12, such as meat, poultry, fish, eggs, and dairy products.
- For vegetarians and vegans, consider fortified foods (cereals, plant-based milk) or B12 supplements.
- Dietary Diversity:
- Ensure a balanced diet with a variety of food groups to minimize the risk of nutritional deficiencies.
Identifying At-Risk Individuals and Supplementation:
- Screening: Individuals with risk factors for B12 deficiency (e.g., vegans, older adults, those with gastrointestinal conditions) should be screened regularly.
- Supplementation:
- For those with confirmed deficiency or at high risk, B12 supplementation is recommended.
- Oral supplements are generally effective, but in cases of malabsorption, intramuscular injections may be necessary.
- Dosage and frequency should be determined by a healthcare professional.
Other Preventive Measures:
- Managing underlying conditions:
- Addressing gastrointestinal disorders or other conditions that can impair B12 absorption can help prevent deficiency.
- If taking medications known to affect B12 levels, discuss alternative options or monitoring strategies with your doctor.
- Lifestyle factors:
- Limit alcohol consumption, as excessive alcohol intake can interfere with B12 absorption.
Key Points:
- Prevention is key, especially for individuals at high risk.
- Dietary modifications and supplementation are effective strategies.
- Regular screening and monitoring are essential for those at risk.
Always consult a healthcare professional for personalized advice on preventing and managing vitamin B12 deficiency.[12]
Homeopathic Treatment
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.
Which includes
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]
Diet & Regimen
Diet & Regimen
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]
Do’s and Don'ts
Do’s & Don’ts
Vitamin B12 Deficiency Do’s and Don’ts
Do’s:
- Consume B12-rich foods: Include meat, poultry, fish, eggs, and dairy products in your diet.
- Consider fortified foods: If you’re vegetarian or vegan, choose cereals, plant-based milk, and other products fortified with B12.
- Consult a healthcare professional: If you suspect you have B12 deficiency, seek medical advice for diagnosis and treatment.
- Take B12 supplements: If prescribed, take supplements as directed by your healthcare professional.
- Get regular checkups: If you’re at high risk, regular monitoring of B12 levels is important.
- Address underlying conditions: If you have a condition affecting B12 absorption (e.g., Crohn’s disease), work with your doctor to manage it effectively.
- Be mindful of medications: If you’re taking medications known to affect B12 levels, discuss them with your doctor.
Don’ts:
- Ignore symptoms: Don’t dismiss fatigue, weakness, numbness, or other potential signs of deficiency.
- Self-diagnose or self-treat: Don’t attempt to manage B12 deficiency without proper medical guidance.
- Rely solely on a vegan or vegetarian diet: Unless you’re carefully planning your diet and taking supplements, a vegan or vegetarian diet may not provide enough B12.
- Assume normal B12 levels: Even if you eat animal products, you may still be at risk, especially if you have other risk factors.
- Disregard medical advice: Follow your doctor’s recommendations regarding B12 supplementation and any underlying conditions.
Remember, early detection and treatment of B12 deficiency are crucial to prevent complications. If you have any concerns about your B12 status, don’t hesitate to talk to your doctor.
Terminology
Terminology
Here are some terminologies commonly used in articles about Vitamin B12 deficiency, along with their meanings:
General Terms
Vitamin B12: Also known as cobalamin, it’s a water-soluble vitamin essential for various bodily functions.
Deficiency: A state where the body lacks sufficient levels of a particular nutrient, in this case, Vitamin B12.
Megaloblastic Anemia: A type of anemia characterized by the presence of large, immature red blood cells due to impaired DNA synthesis, often associated with B12 deficiency.
Pernicious Anemia: An autoimmune disorder where the body attacks the cells in the stomach that produce intrinsic factor, a protein needed for B12 absorption.
Neurological Symptoms: Nervous system-related problems like numbness, tingling, weakness, and difficulty walking, which can occur in B12 deficiency.
Cognitive Impairment: Problems with thinking, memory, and concentration, which can also be linked to B12 deficiency.
Malabsorption: The inability of the intestines to properly absorb nutrients from food, which can contribute to B12 deficiency.
Dietary Terms
Vegan: A person who doesn’t consume any animal products, including meat, dairy, eggs, and honey.
Vegetarian: A person who doesn’t eat meat but may consume dairy or eggs.
Fortified Foods: Foods that have nutrients added to them that are not naturally present or present in insufficient amounts.
Medical Terms
Intrinsic Factor: A protein produced by the stomach that binds to B12 and enables its absorption in the small intestine.
Parietal Cells: Cells in the stomach lining that produce intrinsic factor and hydrochloric acid.
Homocysteine: An amino acid whose levels can rise in the blood due to B12 deficiency.
Methylmalonic Acid (MMA): A substance whose levels in the blood and urine can increase due to B12 deficiency.
Demyelination: Damage to the protective covering (myelin sheath) of nerves, which can occur in B12 deficiency.
Serum B12 Level: The amount of B12 measured in a blood sample.
Other Terms:
Prevalence: The proportion of a population that has a specific condition at a given time.
Risk Factors: Conditions or behaviors that increase the likelihood of developing a disease or condition.
Supplementation: Taking additional vitamins or minerals, often in pill form, to meet the body’s needs.
Intramuscular Injection: Administering a medication directly into a muscle.
Remember, this is not an exhaustive list, and you may come across additional terms in articles on Vitamin B12 deficiency. Always feel free to look up any unfamiliar terms for better understanding.
References
References
- https://en.wikipedia.org/wiki/Vitamin_B12_deficiency
- https://www.drhomeo.com/homeopathic-treatment/homeopathy-for-vitamin-b-deficiency/
- https://www.medicalnewstoday.com/articles/vitamin-b12-foods#vegan-sources
- Arora, S. (2023). Vitamin B12 deficiency continues to be a major public health challenge in India; increased awareness and education are critical. Financial Express.
- Factors associated with vitamin B12 deficiency in adults attending tertiary care Hospital in Vadodara: a case control study. (2022). The Egyptian Journal of Internal Medicine.
- Prevalence of vitamin B12 deficiency among exclusively breast fed term infants in South India. (2020). Tropical and Geographical Medicine.
- Vitamin B12 deficiency in Eastern India: A Hospital based cross-sectional study. (2020). Journal of Clinical and Diagnostic Research.
- "Hematology: Basic Principles and Practice" (7th Edition, 2018) by Ronald Hoffman, Edward J. Benz Jr., Leslie E. Silberstein, Helen Heslop, Jeffrey I. Weitz, and John Anastasi.
- "Robbins & Cotran Pathologic Basis of Disease" (10th Edition, 2021) by Vinay Kumar, Abul K. Abbas, and Jon C. Aster.
- "Harrison’s Principles of Internal Medicine" (21st edition, 2022) by Dennis L. Kasper, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Joseph Loscalzo.
- "Bates’ Guide to Physical Examination and History Taking" (13th Edition, 2022) by Lynn S. Bickley and Peter G. Szilagyi.
- "Krause’s Food & the Nutrition Care Process" (15th Edition, 2022) by L. Kathleen Mahan and Janice L. Raymond.
Also Search As
Also Search As
People can search for homeopathic articles on vitamin B12 deficiency using various online resources and strategies. Here are some effective ways:
Search Engines
Use specific keywords: Try phrases like "homeopathy vitamin B12 deficiency", "homeopathic treatment for B12 deficiency", "vitamin B12 deficiency homeopathic remedies", or "homeopathic articles on vitamin B12".
Include relevant terms: Add search terms like "symptoms", "causes", "prevention", or "treatment" to narrow down the results.
Explore different search engines: Try various search engines like Google, DuckDuckGo, Bing, or specialized search engines for health and wellness.
Homeopathic Websites and Forums
Visit reputable homeopathic websites: Look for websites of homeopathic organizations, clinics, or practitioners that provide articles and information.
Participate in online forums: Join online forums or communities dedicated to homeopathy and search for discussions or articles related to vitamin B12 deficiency.
Social Media
Follow homeopathic pages and groups: Follow social media pages or join groups related to homeopathy to stay updated on the latest articles and research.
Use relevant hashtags: Search social media platforms using hashtags like #homeopathy, #vitaminB12deficiency, #homeopathicremedies, or #naturalhealth.
Online Libraries and Databases
Access online libraries: Explore online libraries or databases that offer access to homeopathic journals and publications.
Search for peer-reviewed articles: Look for research articles or case studies on homeopathic treatment of vitamin B12 deficiency.
Tips for Effective Searching
Be specific: Use precise search terms to get relevant results.
Filter results: Use advanced search options to filter by date, language, or type of content (e.g., articles, blog posts).
Evaluate the source: Check the credibility of the website or author before relying on the information provided.
Consult a homeopathic practitioner: For personalized advice and treatment options, consult a qualified homeopathic practitioner.
Remember: While homeopathy is a popular alternative medicine system, it’s important to consult with a healthcare professional before starting any new treatment, especially if you have a diagnosed vitamin B12 deficiency. Homeopathy should ideally be used as a complementary therapy alongside conventional medical treatment.
There are several ways to search for information about Vitamin B12 deficiency:
Online Search Engines:
Use search engines like Google, Bing, DuckDuckGo, etc.
Use relevant keywords:
"Vitamin B12 deficiency"
"B12 deficiency symptoms"
"Causes of B12 deficiency"
"Vitamin B12 deficiency treatment"
"B12 deficiency prevention"
Health and Medical Websites:
Reputable health websites: Mayo Clinic, WebMD, Healthline, Cleveland Clinic, etc.
Government health websites: Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH)
Specific organizations: The Vegan Society, Vegetarian Resource Group (for information on B12 and plant-based diets)
Academic Resources:
PubMed: Search for scientific articles and research papers on Vitamin B12 deficiency.
Google Scholar: Another resource for scholarly articles and research.
Books and Libraries:
Medical textbooks: Check your local library or bookstore for medical textbooks discussing Vitamin B12.
Nutrition books: Look for books on nutrition and healthy eating, as they often include information on vitamins and deficiencies.
Other Resources:
Ask your doctor: Your healthcare provider is the best source for personalized information and advice about Vitamin B12 deficiency.
Registered Dietitian: A registered dietitian can help you plan a diet that ensures adequate B12 intake.
Support groups: Online or in-person support groups can connect you with others facing similar health challenges.
Additional Tips:
Be specific in your search terms: The more specific you are, the more relevant your results will be.
Use quotation marks: Putting phrases in quotation marks will ensure the exact phrase is searched, helping to filter results.
Use the minus sign: Exclude certain words from your search by using the minus sign (e.g., "Vitamin B12 deficiency -vegan" to exclude results about veganism).
Check the source’s credibility: Make sure the information you are reading is from a reliable and reputable source.
Remember, if you suspect you have a Vitamin B12 deficiency, consult a healthcare professional for diagnosis and appropriate treatment.
Frequently Asked Questions (FAQ)
What is Vitamin B 12 Deficiency?
Vitamin B 12 deficiency or Vitamin B 12 deficiency anemia also known as cobalamin deficiency is the medical condition of low blood and tissue levels of vitamin B 12.
What is the main cause of Vitamin B12 deficiency?
- Impaired absorption
- Inadequate intake
- Increased need
Who is at risk of developing Vitamin B12 deficiency?
People at higher risk include older adults, vegans and vegetarians, individuals with gastrointestinal disorders (e.g., Crohn’s disease, celiac disease), and those taking certain medications (e.g., metformin, proton pump inhibitors).
Homeopathic Medicines used by Homeopathic Doctors in treatment of Vitamin B 12 Deficiency?
Homoeopathic Medicine For Vitamin B12 Deficiency
- Arsenic Album
- Aloe
- Borax
- Custicum
- Gelsemium
- Hypericum
- Ipecac
- Ignatia
- Kali Phos
What are the symptoms of Vitamin B12 deficiency?
- Feeling constant tiredness and weakness
- Dizziness or feeling faint
- Sore red tongue
- Palpitations
- Breathlessness
- Pallor, low-grade fevers
- Loss of appetite
- A fall of blood pressure
- Stomach upset
- Nausea
