Vitamin B-12 is a water-soluble vitamin that contains the mineral cobalt, giving B-12 compounds the name of cobalamins. Vitamin B12 is naturally present in some foods, such as fish, meat, eggs, and dairy products. It can be added to food such as cereal, available as a dietary supplement or prescribed medication. A balanced and varied diet normally provides all the vitamin B12 your body needs.
Stores of B12 in your body can last around 2-4 years without being replenished, therefore it may take a while for any problems to develop after dietary change. Those following a vegan diet can control this by taking supplements.
Normal levels of B12 are between 180-1000pg/ml. Those with clear cut deficiency nearly always have levels under 150 pg/ml and are usually under 100 pg/ml.
Causes of B12
Any stomach conditions or operations such as a gastrectomy may prevent absorption of enough vitamin B12. Conditions such as Crohn’s or Coeliac disease can also lead to poor vitamin B12 uptake. Certain medications such as proton pump inhibitors (PPIs) or metformin can make vitamin deficiency worse. Normally your GP will monitor your B12 levels if you are on certain medications.
Some people may experience problems related to vitamin B12 deficiency despite showing normal levels in their blood. This is called Functional Vitamin B12 deficiency and is caused by a problem with the proteins that help transport vitamin B12 between cells. This can lead to neurological conditions.
Pernicious anaemia is an autoimmune disease which affects your stomach and is the most common cause of vitamin B12 deficiency in the UK. Vitamin B12 is combined with a protein called intrinsic factor in your stomach. This combination is absorbed into the body in the distal ileum part of the gut. As pernicious anaemia is an autoimmune disease, this means that your body attacks the cells that produce the intrinsic factor, therefore your body is unable to absorb Vitamin B-12.
Symptoms of deficiency
- Pale yellow tinge to your skin
- Sore and red tongue
- Mouth ulcers
- Changes in the way you walk and move around
- Disturbed vision
- Constipation
- Pins and needles, numbness or other strange sensations in the hands legs or feet
- Irritability
- Depression
- Psychosis
- Changes in how you think, feel, behave
- Decline in mental abilities, such as memory, understanding and judgement.
- General symptoms of anaemia such as fatigue, lethargy, breathlessness, faintness, and headaches.
Untreated
Left untreated, vitamin B12 deficiency symptoms can worsen. Regarding the neurological symptoms above; vision disturbances, memory loss, pins and needles, difficulty walking, damage to the nerves (peripheral neuropathy) particularly in the legs. These problems can be irreversible.
Vitamin B12 deficiency may result in women to be unable to fall pregnant, however this is usually treatable. Moreover, pregnant women with vitamin B12 deficiency may have increased risk of their baby developing serious birth defects.
If vitamin B12 deficiency is caused by pernicious anaemia, the risk of developing stomach cancer may be increased. There is also a risk of heart and lung complications including an elevated heartbeat and heart failure.
What to do if think I have Vitamin B12 deficiency?
If untreated, the symptoms of B12 deficiency can get worse, therefore it is imperative that you make an appointment with your GP as soon as possible.
The appointment will involve you getting blood tests which will measure levels of both B12 and folic acid (B9), as well as the size and concentration of haemoglobin within your red blood cells. Vitamin B12 deficiency can have the same symptoms of vitamin B9 (folic acid) deficiency, therefore the doctor will test for both.
On receipt of these results, your GP may refer you for some more tests for pernicious anaemia or refer you to a haematologist for further tests and treatment.
We have been involved in several cases regarding delayed diagnosis of Vitamin B12 deficiency. How much a case is worth will depend on various factors including the severity of injury, your loss of earnings and the cost of any additional care and accommodation you may need. In a recent case, liability was admitted by a local hospital and settlement was eventually agreed at £335,000, whilst another case settled recently against our client’s former GP in the sum of £750,000.
If you are B12 deficient and have concerns about the care and treatment you have received, please contact our Clinical Negligence team by calling 0114 218 4000.