B-12 Deficiency - Know the Symptoms

B-12 Deficiency – Know the Symptoms

February 21st, 2013 by Loretta Lanphier, NP, CN, CH, HHP

B-12 Deficiency – Know the Symptoms

Vitamin B-12 (cobalamin) is one of the 13 vitamins our body must have for good health and wellness. It is not only essential for the production of red blood cells but also supports the protection of a healthy nervous system.  It is also an essential element in the construction of our DNA. B-12 deficiency can damage your brain, spinal cord, peripheral nerves, and nerves of the eye.

In 1934, Whipple, Murphy, and Minot shared the Nobel Prize in Physiology or Medicine for their life saving discovery found in liver.  The disorder was referred to as “pernicious anemia” because before this discovery, death was inevitable.  In 1948, the substance in the liver was isolated and named cobalamin (vitamin B-12).

B-12 deficiency is more common than we hear about and reported to affect 25% of the U.S. population.  It strikes up to 15% (5.9 million) older adults > age 64.  The CDC now reports that one out of every 31 Americans above the age of 50 are B-12 deficient.  It’s interesting to know this report underestimates the incidence by using a cut-off range far too low.  The incidence of B-12 deficiency in infants and children is unknown, which is very concerning.

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Causes of Vitamin B-12 Deficiency

  • Decreased stomach acid
  • Atrophic gastritis
  • Autoimmune pernicious anemia
  • Helicobacter pylori
  • Gastrectomy, intestinal resection
  • Gastric bypass surgery
  • Malabsorption syndromes
  • Crohn’s disease
  • Celiac disease (gluten enteropathy)
  • Chronic pancreatitis
  • Bacterial overgrowth (small bowel)
  • Fish tapeworm
  • Alcoholism
  • Malnutrition—Eating disorders
  • Vegetarianism
  • Advanced liver disease
  • Transcobalamin II deficiency
  • Inborn errors of B12 metabolism
  • Certain drugs
  • Nitrous oxide

Signs and Symptoms of Vitamin B-12 Deficiency

Neurologic signs and symptoms:

  • Numbness—tingling
  • Weakness of legs, arms, trunk
  • Impaired vibration—position sense
  • Abnormal reflexes
  • Unsteady or abnormal gait
  • Balance problems
  • Difficulty ambulating
  • Dizziness
  • Tremor
  • Restless legs
  • Visual disturbances
  • Forgetfulness, memory loss
  • Dementia
  • Impotence
  • Urinary or fecal incontinence

Psychiatric symptoms:

  • Depression
  • Irritability
  • Paranoia
  • Mania
  • Hallucinations
  • Psychosis
  • Violent behavior
  • Personality changes

Hematologic signs and symptoms:

  • Anemia
  • Macrocytosis (enlarged red-blood cells)
  • Generalized weakness
  • Fatigue
  • Shortness of breath
  • Pallor

Signs & symptoms in infants and children:

  • Developmental delay or regression
  • Apathy—Irritability
  • Hypotonia
  • Weakness
  • Tremor
  • Involuntary movements
  • Seizures
  • Ataxia
  • Anorexia
  • Failure to thrive
  • Poor weight gain
  • Poor head growth
  • Poor socialization
  • Poor motor skills
  • Language delay
  • Speech problems
  • Lower IQ—Mental retardation
  • Anemia
  • Macrocytosis

Disorders with Possible Underlying B-12 Deficiency

  • Dementia—Alzheimer’s disease
  • Multiple sclerosis
  • Depression
  • Post-partum depression/psychosis
  • Bipolar disorder
  • Neuropathy (diabetic, CIDP)
  • Vertigo
  • Anemia
  • Congestive heart failure
  • Autism
  • AIDS dementia complex
  • Restless leg syndrome
  • Radiculopathy, chronic pain disorder
  • Chronic fatigue syndrome
  • Fibromyalgia
  • Chronic renal failure (hemodialysis patients)
  • Essential tremor—Parkinson’s disease
  • Erectile dysfunction
  • Infertility

Diagnostic Tests for B-12 Deficiency

  • Serum B-12
  • Methylmalonic acid
  • Homocysteine

Vitamin B-12 Deficiency

How To Know If You Might Be Vitamin B-12 Deficient?

Cobalamin Deficiency Criteria List (CDCL)

Read through the sections below to add up your score and determine your risk of B12 deficiency.

I. Neurologic Manifestations (score 2 for each symptom)

  • Numbness/tingling (including diagnosis of neuropathy)
  • Weakness of arms, legs, or trunk
  • Impaired vibration/position sense
  • Abnormal reflexes
  • Unsteady or abnormal gait
  • Balance problems
  • Difficulty ambulating
  • Dizziness
  • Tremor (including diagnosis of Parkinson’s)
  • Restless legs or diagnosis of restless leg syndrome
  • Visual disturbances
  • Forgetfulness/memory loss (including diagnosis of dementia or Alzheimer’s)
  • Mental status changes
  • Impotence/erectile dysfunction
  • Urinary/fecal incontinence
  • Developmental delay in infants & children (including diagnosis on the autism spectrum)

II. Psychiatric Manifestations (score 2 for each symptom)

  • Depression/suicidal ideations, post-partum depression or prescribed antidepressant/psychiatric medications
  • Irritability/anxiety
  • Paranoia
  • Mania
  • Hallucinations
  • Psychosis
  • Violent behavior
  • Personality changes

III. Gastrointestinal Risks (score 2 for each symptom)

  • Decreased stomach acid or atrophic gastritis
  • Autoimmune pernicious anemia
  • Helicobacter pylori
  • GERD or ulcer disease
  • Gastrectomy or intestinal resection
  • Gastric bypass surgery
  • Malabsorption syndromes
  • Crohn’s disease
  • Celiac disease (gluten enteropathy)
  • Chronic pancreatitis
  • Bacterial overgrowth (small bowel)
  • Fish tapeworm
  • Alcoholism
  • Malnutrition/eating disorders
  • Advanced liver disease
  • Transcobalamin II deficiency

IV.Hematologic Manifestations (score 2 for each symptom)

  • Anemia
  • Macrocytosis
  • Microcytosis
  • Hypersegmented neutrophils
  • Anisocytosis
  • Leukopenia
  • Thrombocytopenia

V. Other Signs and Symptoms (score 1 for each symptom)

  • Generalized weakness or fatigue
  • Shortness of breath, exertional dyspnea, or chest pain
  • Pallor
  • Hepatomegaly or splenomegaly
  • Loss of appetite/weight loss
  • Poor wound healing/decubitus ulcer
  • Cervical dysplasia
  • Tinnitus
  • Vitiligo
  • Glossitis

VI. Population at Risk (score 1 for each symptom)

  • Age 60 and over
  • Fall or fall-related injury in the past year
  • Vegan/vegetarian/macrobiotic diet
  • Autoimmune and/or thyroid disorders
  • Family history of pernicious anemia
  • Proton pump inhibitor use
  • Metformin use
  • Nitrous oxide administration or abuse
  • Cancer patients
  • Chemotherapy
  • Radiation therapy
  • Occlusive vascular disorders (MI, CVA, DVT, PE)
  • Pregnancy
  • Breast-feeding
  • Iron deficiency
  • Infertility
  • Seizures
  • AIDS patients
  • Fibromyalgia
  • Chronic fatigue syndrome
  • Chronic renal failure (hemodialysis patients)
  • Neck or back surgery

Cobalamin Deficiency Risk (CDR) Score

  • Low Risk:                    0 – 1
  • Moderate Risk:         2 – 5
  • High Risk:                    > 6

B-12 Deficiency – Frequently Misdiagnosed

  • Most doctors and health care providers don’t know the facts about B-12 deficiency.
  • Most patients who have B-12 deficiency symptoms or are at risk for B-12 deficiency never get tested.
  • The current standard for “normal” serum B-12 levels is actually far too low.
  • Doctors frequently don’t diagnose B-12 deficiency until the patient has enlarged red blood cells and/or macrocytic anemia—which are often late signs of advanced B-12 deficiency.
  • People over 65 are frequently misdiagnosed because doctors blame their B-12 deficiency symptoms on preexisting diseases and comorbid conditions (A comorbid condition refers to one or more diseases or conditions that occur together with the primary condition.)
  • The current Daily Required Intake (DRI) and Recommended Daily Allowance (RDA) for B-12 health for adults, during pregnancy, and during child growth and development are grossly outdated and insufficient.

B-12 screening should always be included for:

  • Older adults who fall or are at risk for falling.
  • Older adults who have cognitive changes or dementia.
  • Patients presenting depression or mental illness.
  • Patients who are pregnant or breastfeeding.

Methylcobalamin – Most Absorbable Form of B-12

The most absorbable form of B-12 is in the form of methylcobalamin. Evidence indicates methylcobalamin has some metabolic and therapeutic applications not shared by the other forms of vitamin B-12. Methylcobalamin is the active form of vitamin B-12 that acts as a co-factor for methionine synthase in the conversion of homocysteine to methionine, thus lowering blood levels of homocysteine.

As the circulating form, methylcobalamin can cross into the bloodstream sublingually, but only about 1% of the ingested (by pill) dose is absorbed. Methylcobalamin is also the most bioavailable form of B-12. It requires little to no conversion and easily crosses through every aspect of B-12’s metabolic pathway.

B-12 works best in a comprehensive formula with other B Vitamins. They are shown to have a greater synergistic effect together rather than individually. When using any form(s) of B Vitamins it is always recommended to add a B Complex, such as Max B-ND containing all the B Vitamins in a probiotic-fermented liquid.

I also recommend reading the book Could it Be B12? An Epidemic of Misdiagnoses (Second Edition) by Sally M. Pacholok, R.N., B.S.N., and Jeffrey J. Stuart, D.O.

References
(most information compiled from http://b12awareness.org/)

Loretta Lanphier is a Naturopathic Practitioner (Traditional), Certified Clinical Nutritionist, Holistic Health Practitioner and Certified Clinical Herbalist as well as the CEO / Founder of Oasis Advanced Wellness in The Woodlands TX. She has studied and performed extensive research in health science, natural hormone balancing, anti-aging techniques, nutrition, natural medicine, weight loss, herbal remedies, non-toxic cancer support and is actively involved in researching new natural health protocols and products.  A 14 year stage 3 colon cancer survivor, Loretta is able to relate to both-sides-of-the-health-coin as patient and practitioner when it comes to health and wellness. “My passion is counseling others about what it takes to keep the whole body healthy using natural and non-toxic methods.” Read Loretta’s health testimony Cancer: The Path to Healing. Loretta is Contributor and Editor of the worldwide E-newsletter Advanced Health & Wellness
†Results may vary. Information and statements made are for education purposes and are not intended to replace the advice of your doctor. Oasis Advanced Wellness/OAWHealth does not dispense medical advice, prescribe, or diagnose illness. The views and nutritional advice expressed by Oasis Advanced Wellness/OAWHealth are not intended to be a substitute for conventional medical service. If you have a severe medical condition or health concern, see your physician of choice.

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  • Lucia Ruocchio

    I had an overall score of 40 on this test….guess I’d better start taking B -12!

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  • Chloe

    I recently heard about a new oral prescription alternative to the injections called Eligen B12. I recently read that it works even if you don’t have intrinsic factor (so even if you don’t have normal gut absorption). Apparently it came out a month or two ago. Has anyone heard of it or tried it?

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