Vitamin B12 – (Cobalamin)

Vitamin B12 is important for the way the body works, and people who don’t have enough of it may feel tired or have a lack of energy

Vitamin B12 helps in the production of healthy red blood cells that carry oxygen around the body.

Not having enough vitamin B12 makes the body produce larger than normal red blood cells, which don’t do their job as well.

Once diagnosed, vitamin B12 deficiency can usually be treated successfully with B12 injections and with B12 tablets together with a change in diet.

Symptoms of vitamin B12 deficiency

Anaemia caused by a lack of vitamin B12 can result in symptoms which include:

• Extreme tiredness
• Being out of breath
• Feeling faint
• Tinnitus
• Lack of appetite

More specific symptoms linked to a lack of  B12 include:

• Yellowing of the skin
• Sore, red tongue
• Mouth Ulcers
• Changes or loss of some sense of touch
• Feeling less pain
• Walking problems
• Vision Problems
• Mood changes, irritability, depression or psychosis
• Symptoms of dementia

Causes of vitamin B12 deficiency

Vitamin B12 deficiency is more common in older people and affects around one in 10 over 75s.

The most common cause of vitamin B12 deficiency is pernicious anemia, an auto-immune condition that affects around one in 10,000 people.

B12 deficiency is risk for people who follow a strict vegan diet who don’t eat the major food sources of B12: meat, eggs and dairy products. Babies whose mums are vegetarians may have  B12 deficiency.

Other causes of vitamin B12 deficiency include:

• Atrophic gastric, or thinning of the stomach lining
• Stomach ulcers
• Surgery to remove part of the stomach or small intestine
• Digestive conditions such as Crohn’s, coeliac disease, bacterial growth or a parasite.
• Medication, including proton pump inhibitors (PPIs) for indegestion.

Diagnosis of vitamin B12 deficiency

Blood tests and examination of blood cells under the microscope assess haemoglobin levels, the size of red blood cells and the level of vitamin B12 in the blood. The levels of folate are also usually checked for the related condition folate deficiency anaemia.

Once the diagnosis is confirmed, further tests may be carried out to try to find out what’s causing the anaemia.

A referral may be made to a specialist, such as a haematologist for blood conditions, a gastroenterologist for digestive problems or a dietician for advice on eating food containing more vitamin B12.

How vitamin B12 or folate deficiency anaemia is treated

Most cases of vitamin B12 and folate deficiency can be easily treated with injections or tablets to replace the vitamin you are deficient in.

Vitamin B12 supplements are usually given by injection at first. Then, depending on whether your B12 deficiency is related to your diet, you will either require B12 tablets between meals or regular injections. These treatments may be needed for the rest of your life.

Folic acid tablets are used to restore folate levels. These usually need to be taken for four months.

In some cases, improving your diet can help treat the condition and prevent it recurring. Vitamin B12 is found in meat, fish, eggs, dairy products, yeast extract (such as Marmite) and specially fortified foods. The best sources of folate include green vegetables such as broccoli, Brussels sprouts and peas.

Anaemia symptoms

General symptoms of anaemia (where you have fewer red blood cells than normal or you have an abnormally low amount of a substance called haemoglobin in each red blood cell) include:

• extreme tiredness (fatigue)
• lack of energy (lethargy)
• breathlessness
• feeling faint
• headaches
• pale skin
• Palpitations
• Tinnitus
• loss of appetite and weight loss

Vitamin B12 deficiency

If you have anaemia caused by a vitamin B12 deficiency, you may have other symptoms in addition to those listed above, such as:

• a pale yellow tinge to your skin
• a sore and red tongue
• mouth ulcers
• pins and needles
• changes in the way that you walk and move around
• disturbed vision
• irritability
• depression
• changes in the way you think, feel and behave
• a decline in your mental abilities

B12 in Food

Vitamin B12  can only be manufactured by bacteria and can only be found naturally in animal products, however synthetic forms are available and can be added to food, such as cereals.

B12 can be eaten in large doses to no ill effect because any excess is excreted by the body or stored in the liver for use when needed for up to a year.

Great Sources of B12 Daily Value (%) per 100g

• Liver (Beef) DV 1,386%
• Fish – Mackerel 317%, Smoked Salmon 257%, Tuna 154%, Canned Sardines 126%, Trout 106%
• All Bran 333%
• Beef 100%, Lamb 45%
• Egg Yolk 33%

Canned Fish that are high in B12 (Again Daily Value % per 100g

• Atlantic Sardines 149 %
• Sockeye Salmon 92%
• Pink Salmon 83%
• Tuna in Water 50%
• Tuna in Oil  37%

Vegetarian sources of B12

• Cheese – Swiss Cheese 56%, Feta 28%
• Eggs – Goose 122%, Duck 63%, Chicken 33%
• Whey Powder 42%
• Milk and Yoghurt 10%
• Marmite (Yeast Extracts) 8%