Detect and treat vitamin B12 deficiency on time

What Does the Body Need Vitamin B12 For?

Vitamin B12, also known as cobalamin, is a water-soluble vitamin essential for many metabolic processes in the body. It supports:

• Cell division and blood formation
• Breakdown of fatty acids
• Detoxification of cells
• Conversion of folic acid into its active form, which is vital for overall health

According to the guidelines of the German Nutrition Society (DGE), healthy people aged 15 and over should consume around 4.0 micrograms (µg) of vitamin B12 daily. Pregnant and lactating women require higher amounts: 4.5 µg and 5.5 µg, respectively.

Causes: How Does a Vitamin B12 Deficiency Arise?

A deficiency occurs when:

• Your diet lacks sufficient vitamin B12
• Your body produces too little intrinsic factor, a protein essential for absorbing vitamin B12 through the intestinal wall

Other causes include:

• Increased need (e.g., pregnancy, breastfeeding, chronic stress)
• Various diseases affecting the gastrointestinal tract (such as Crohn’s disease, ulcerative colitis, gastritis, celiac disease, and pernicious anemia)
• Advanced age, which often reduces the ability to absorb B12 and sometimes leads to dietary changes like avoiding meat

What Leads to a Vitamin B12 Deficiency?

A vitamin B12 deficiency can have very different causes, including:

• insufficient intake of the vitamin through the diet,
• increased need,
• various diseases as well
• advanced age.

Because the body can't produce vitamin B12 itself, we have to take it in with food. B12 is mainly found in meat and fish, but also in eggs and dairy products, but in much smaller quantities. Especially vegetarians and vegans don't get enough of the classic B12 sources.

If you are pregnant or breastfeeding or under persistently high stress, you need significantly more vitamin B12. You should adjust your diet accordingly or use appropriate preparations.

Because vitamin B12 enters the body through the gastrointestinal tract, chronic and acute diseases of the gastrointestinal tract restrict B12 supply. Your body can't absorb enough vitamin B12, for example in diseases such as ulcerative colitis or Crohn's disease, gastritis, celiac disease or pernicious anemia, which destroys the stomach lining

In old age, several factors can promote a B12 deficiency.

• Many older people have difficulty chewing. To avoid pain or other inconveniences, stop eating meat and therefore B12.
• The body can't utilize the vitamin B12 ingested sufficiently because medication causes gastrointestinal problems or old age diseases impair the absorption of the vitamin into the body.
• In general, the ability to absorb and utilize vitamin B12 from food decreases in old age.

Who is susceptible to a vitamin B12 deficiency?

Certain groups of people are particularly vulnerable to a lack of B12. These are:

• Vegetarians or vegans,
• Older people,
• People suffering from diseases of the gastrointestinal tract
• People who are under constant stress
• Patients who are taking certain medications.

Symptoms: How Does a Vitamin B12 Deficiency Show Itself?

The symptoms of a vitamin B12 deficiency often only appear after a few years, because a healthy person can store cobalamin in the liver for up to three years. The shortage only becomes noticeable when the reserves are used up. At first, the symptoms are rather inconspicuous and very diverse. They do not always lead to the correct conclusion straight away.

These signs can indicate a vitamin B12 deficiency:

• General exhaustion,
• Lack of drive,
• Severe fatigue,
• Increased susceptibility to infections and
• Great need for rest.

The following symptoms also often occur:

• Memory and concentration disorders,
• Mood swings,
• Circulatory problems,
• Dizziness,
• Increased risk of falling due to wobble and dizziness.

Consequences of a B12 deficiency

• One consequence that should not be underestimated is pernicious anemia. This type of anemia (anemia) affects the production of red blood cells; it manifests itself in a particularly pale complexion.
• Digestive problems can be both a trigger and a consequence of a B12 deficiency.
• If treatment is missed or starts too late, some symptoms can't be resolved. This can be hair loss or loss of sense of your smell and taste.

How is Vitamin B12 deficiency diagnosed?

A temporary vitamin B12 deficiency is not life-threatening if it is diagnosed early. The doctor can determine the deficiency in different tests, including:

• Blood test: Measures total vitamin B12 (cobalamin) in the blood
• Holo-TC test (Holo-Transcobalamin): Assesses the bioactive form that enters cells
• Urine test: Detects methylmalonic acid (MMA); elevated levels can indicate deficiency

If you suspect a vitamin B12 deficiency, a blood test is recommended first. The value of the cobalamin in the blood is determined. Even if this value is still just within the normal range, you can't rule out a B12 deficiency, especially if you are a senior citizen.

Then the Holo-TC (Holo-Transcobalamin) test is recommended. It is a version of the B12 that transports the nutrient from your blood into the cells. A blood test has shown sufficient cobalamin, but that alone is not yet meaningful enough.

A good option is also a urine test. Your morning urine will be examined for methylmalonic acid. If this value is too high, this indicates a vitamin B12 deficiency.

How to Remedy a Vitamin B12 Deficiency

Dietary Sources of Vitamin B12

Vitamin B12 is mainly found in animal-based foods. Here's a breakdown of rich sources:

Animal-Based Sources (Best Natural Sources)

• Shellfish: Very high in B12
• Organ meats (e.g. liver and kidneys from beef, lamb, veal): Extremely rich in B12
• Lean beef (100 g, cooked): ~4.5 µg B12 — exceeds daily adult requirement
• Salmon (70 g, cooked): ~2.9 µg B12

Vegetarian Sources (Moderate B12 content)

• Camembert cheese (2 servings, 60 g): ~1.9 µg B12
• Mozzarella (100 g): ~2.0 µg B12
• Eggs and milk also contain smaller amounts of B12

Vegan Diets

Vitamin B12 is rarely found in plant-based foods, but some trace sources include:

• Mushrooms (certain types)
• Algae (like nori or spirulina, but may contain inactive forms)
• Fermented vegetables (e.g. sauerkraut)
• Unpeeled, unwashed root vegetables (e.g. carrots, beetroot), small and unreliable amounts

Note: These vegan sources are not reliable to meet daily needs. Supplementation is usually necessary for vegans.

Supplementation for Vitamin B12 Deficiency

Vitamin B12 deficiency can be effectively treated using various Vitamin B12 supplementation methods, tailored to the severity of the deficiency and individual absorption needs.

• Oral tablets/capsules: 1000 µg daily for mild/moderate deficiency
• Sublingual drops/sprays: Absorbed under the tongue, good for mild absorption issues
• Injections: For severe deficiency or absorption problems (e.g., pernicious anemia)
• Typically 1000 µg weekly initially, then monthly maintenance

What Needs to Be Considered When Dosing Vitamin B12?

1. Reason for Supplementation

• Prevention: Lower doses (10–100 µg daily) are usually sufficient to maintain normal levels.
• Treatment of Deficiency: Much higher doses (1000–5000 µg daily) are needed initially to replenish the body's stores.

2. Absorption Ability

• Some people (e.g., those with pernicious anemia or gastrointestinal diseases) have trouble absorbing B12 from food or oral supplements because they lack intrinsic factor or have intestinal issues.
• In these cases, higher oral doses or B12 injections may be necessary to bypass absorption problems.

3. Form of Vitamin B12

• Oral tablets, capsules, sprays, or drops are common and effective for many people.
• Injections are typically reserved for severe deficiencies or malabsorption.

4. Duration of Treatment

• For deficiency, high doses are usually taken daily for 3 to 6 months.
• Maintenance doses can then be lower and taken long-term.

5. Safety and Side Effects

• Vitamin B12 is water-soluble, so excess amounts are excreted via urine.
• This means overdose is very unlikely, and side effects are rare even at high doses.

6. Special Populations

• Pregnant or breastfeeding women may need slightly higher doses.
• Older adults and those under chronic stress or with certain diseases may require tailored dosing.

For more details, check out our comprehensive blog on Vitamin B12, covering its effects, side effects, food sources, dosage recommendations, and risks of overdose.