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  • Writer's pictureDr. Alla Arutcheva

B12 deficiency. Are you at risk?

Updated: Nov 20, 2018

Vitamin B12 (cobalamine) deficiency is one of the most common vitamin deficiencies. The human body needs vitamin B12 to make red blood cells, nerves, DNA, and carry out other functions. Vitamin B12 can’t be made by the body.

Recognizing a B12 deficiency

Vitamin B12 deficiency can be slow to develop, causing symptoms to appear gradually and intensify over time. It can also come on relatively quickly.

Vitamin B12 deficiency may include numerous problems:

· Blood disorder – pernicious anemia

· Mental problems - paranoia or hallucinations, depression, dementia, difficulty thinking and reasoning (cognitive difficulties), memory loss

· Brain and nerves problems - strange sensations, numbness, or tingling in the hands, legs, or feet; difficulty walking (staggering, balance problems); neuralgia

· Weakness and fatigue

· Skin disorders – hyperpigmentation, dermatitis (including eczema), vitiligo, psoriasis,

· Tongue inflammation, loss of taste

Cause of deficiency

Plants don’t make vitamin B12. The only foods that deliver it are meat, eggs, poultry, dairy products, and other foods from animals.

Major causes of vitamin B12 deficiency

While an experienced physician may notice the symptoms and be able to detect a vitamin B12 deficiency with a good interview and physical exam, a blood test is needed to confirm the condition.

Early detection and treatment are important. “If left untreated, the deficiency can cause severe neurological problems and blood diseases,” says Dr. Bruce Bistrian, chief of clinical nutrition at Harvard-affiliated Beth Israel Deaconess Medical Center [Harvard Health Lett. 2010 May].

When vitamin B12 level should be checked

If you:

· are over 50 years old

· take a proton-pump inhibitor (such as Nexium or Prevacid) or H2 blocker (such as Pepcid or Zantac)

· take metformin (a diabetes drug)

· are a strict vegetarian

· have had weight-loss surgery or have a condition that interferes with the absorption of food

· have atrophic gastritis, IBS, celiac or Crohn’s disease

· have overgrowth of intestinal bacteria, SIBO

· have infertility problem

Pernicious anemia

Pernicious anemia is one of the vitamin B12 deficiencies’ manifestations.

Without enough vitamin B12, red blood cells don't divide normally and are too large. The most common symptom of all types of anemia is fatigue because your body doesn’t have enough red blood cells to carry oxygen to its various parts.

A low red blood cell count can cause shortness of breath, dizziness, headache, coldness in the hands and feet, pale or yellowish skin, and chest pain.

Pernicious anemia also can cause other problems, such as nerve damage, neurological problems (such as memory loss), and digestive tract problems.

People who have pernicious anemia also may be at higher risk for weakened bone strength. It is a higher risk for stomach cancer.

Research suggests a link may exist between autoimmune disorders and pernicious anemia. Pernicious anemia can run in families.

Blood test for pernicious anemia. A CBC checks hemoglobin and hematocrit levels. Hemoglobin is an iron-rich protein that helps red blood cells carry oxygen from the lungs to the rest of the body. Hematocrit is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia. The CBC also looks at mean corpuscular volume (MCV). MCV is a measure of the average size of the red blood cells. In pernicious anemia, the red blood cells tend to be larger than normal. High levels of homocysteine and methylmalonic acid body are also a sign of pernicious anemia.

Cutaneous Manifestations of Cobalamin Deficiency

There are various cutaneous findings associated with cobalamin deficiency. Skin

hyperpigmentation may be the first manifestation of vitamin B12 deficiency The pattern of hyperpigmentation is mostly seen in flexural areas, palms, knees, elbows soles, and the oral cavity.


Vitiligo can be a manifestation of cobalamin deficiency.

Researchers found that the vitiligo group had higher homocysteine and hemoglobin levels and lower levels of vitamin B12 [Karadag AS et al. Clin Exp Dermatol. 2012 ]. Vitamin B12 as a therapy for vitiligo has yielded contradictory results in the literature. In a study of 15 patients with vitiligo, eight of the patients experienced

repigmentation with prolonged oral folic acid and ascorbic acid and parenteral vitamin B12 supplementation [Montes LF et al.1992].

Aphthous Stomatitis

Recurrent aphthous stomatitis can be a chronic and debilitating

disease. In a randomized, double-blind, placebo-controlled trial, a 1,000 mcg dose of sublingual vitamin B12 was an effective therapy for the treatment of recurrent aphthous stomatitis [Volkov I et al. J Am Board Fam Med. 2009 ].


It was found that patients with acne vulgaris treated with Isotretinoin have a reduced level of vitamin B12, folic acid, and holotranscobalamin levels while elevating their homocysteine. It was suggested that this cobalamin deficiency may account for the side effects of Isotretinoin therapy.

Atopic dermatitis

Topical vitamin B12 has shown as a safe treatment for atopic dermatitis (eczema). Therapy with 0.07% cyanocobalamin cream for 8 weeks is well tolerated and works effectively for eczema.

Thus, it was found that associations exist between vitamin B12 and dermatological diseases.

A serious vitamin B12 deficiency can be corrected in two ways: weekly shots of vitamin B12 or oral high-dose B12. A mild vitamine B12 deficiency can be corrected with a standard multivitamin. A standard multivitamin delivers 6 micrograms, more than enough to cover the average body’s daily needs.

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