Vitamin B12 deficiency (विटामिन बी 12 की कमी), also known as cobalamin deficiency, is the medical condition of low blood levels of vitamin B12. In mild deficiency, a person may feel tired and have a reduced number of red blood cells (anemia). In moderate deficiency, soreness of the tongue may occur, and the beginning of neurological problems including abnormal sensations such as pins and needles. Severe deficiency may include reduced heart function and greater neurological problems. Infertility may occur. In young children, symptoms include poor growth, poor development, and difficulties with movement. Without early treatment, some of the changes may be permanent. Siddha Spirituality of Swami Hardas Life System considers our readers to read this article and appeal that Vitamin B12 deficiency should not be neglected.
Vitamin B12 deficiency Symptoms (विटामिन बी 12 की कमी के लक्षण)
Vitamin B12 deficiency can lead to anemia and neurological disorders. A mild deficiency may not cause any discernible symptoms, but as the deficiency becomes more significant, symptoms of anemia may result, such as:
- Rapid heartbeat
- Rapid breathing
- Pale color to the skin
- Easy bruising or bleeding
- Bleeding gums
- Gastrointestinal side effects e.g. sore tongue, stomach upset, weight loss, and diarrhea or constipation
Nerve cell damage can result if the deficiency if not corrected on time. If this happens, vitamin B12 deficiency may result in:
- Tingling or numbness to the fingers and toes
- Difficulty walking
- Mood changes
- Memory loss
- In severe cases, dementia
Types of vitamin B12 deficiency anemia (विटामिन बी 12 की कमी से एनीमिया के प्रकार)
The main type of vitamin B12 deficiency anemia is pernicious anemia. It is characterized by a triad of symptoms:
- Anemia with bone marrow promegaloblastosis
- Gastrointestinal symptoms
- Neurological symptoms – deficiency symptoms in children include developmental delay, regression, irritability, involuntary movements, and hypotonia
The presence of peripheral sensory-motor symptoms or subacute combined degeneration of spinal cord strongly suggests the presence of a B12 deficiency instead of folate deficiency. Methylmalonic acid, if not properly handled by B12, remains in the myelin sheath, causing fragility.
Dementia and depression have been associated with this deficiency as well, possibly from the under-production of methionine because of the inability to convert homocysteine into this product. Methionine is a necessary cofactor in the production of several neurotransmitters.
Neurological complex symptoms (मस्तिष्क संबंधी जटिल लक्षण)
Each of those symptoms can occur either alone or along with others. The neurological complex, defined as myelosis funicularis, consists of the following symptoms:
- Impaired perception of deep touch, pressure, and vibration, loss of sense of touch, very annoying and persistent paresthesias
- Ataxia of dorsal column type
- Decrease or loss of deep muscle-tendon reflexes
- Pathological reflexes — Babinski, Rossolimo, and others, also severe paresis
Vitamin B12 deficiency can cause severe and irreversible damage, especially to the brain and nervous system. These symptoms of neuronal damage may not reverse after correction of blood abnormalities, and the chance of complete reversal decreases with the length of time the neurological symptoms have been present.
Higher risk for elderly (बुजुर्गों के लिए अधिक जोखिम)
Elderly people are at an even higher risk of this type of damage. In babies, a number of neurological symptoms can be evident due to malnutrition or pernicious anemia in the mother. These include:
- Poor growth
- Having no desire for food
- Developmental regression
Only a small subset of dementia cases have been found to be reversible with vitamin B12 therapy. Tinnitus may be associated with vitamin B12 deficiency.
Vitamin B12 deficiency Causes (विटामिन बी 12 की कमी के कारण)
Inadequate dietary intake (अपर्याप्त आहार का सेवन)
Inadequate dietary intake of vitamin B12. Vitamin B12 occurs in animal products (eggs, meat, milk, fish) and in some edible algae. B12 isolated from bacterial cultures is also added to many fortified foods, and available as a dietary supplement.
Vegans, and to a lesser degree vegetarian, may also be at risk for B12 deficiency due to inadequate dietary intake of B12 if they do not supplement. Children are at a higher risk for B12 deficiency due to inadequate dietary intake, as they have fewer vitamin stores and a relatively larger vitamin need per calorie of food intake.
Absorption of Vitamin B12 (विटामिन बी 12 का अवशोषण)
Selective impaired absorption of vitamin B12 due to intrinsic factor deficiency, which may cause by the loss of gastric parietal cells in chronic atrophic gastritis. However, it may result from wide surgical resection of the stomach or from rare hereditary causes of impaired synthesis of intrinsic factor.
B12 deficiency is more common in the elderly because gastric intrinsic factor, necessary for the absorption of the vitamin, is deficient, due to atrophic gastritis.
Impaired absorption (बिगड़ा हुआ अवशोषण)
Impaired absorption of vitamin B12 in the setting of more generalized malabsorption or maldigestion syndrome. This includes any form due to structural damage or wide surgical resection of the terminal ileum (the principal site of vitamin B12 absorption).
Forms of achlorhydria (including that artificially induced by drugs such as proton pump inhibitors and histamine 2 receptor antagonists) can cause B12 malabsorption from foods since acid is needed to split B12 from food proteins and salivary binding proteins.
The most common cause of low B12 in the elderly often has some degree of achlorhydria without being formally low in the intrinsic factor. However, the process does not affect the absorption of small amounts of B12 in supplements such as multivitamins since it is not bound to proteins, as is the B12 in foods.
Removal of the small bowel (छोटी आंत का निष्कासन)
Surgical removal of the small bowel (for example in Crohn’s disease) such that the patient presents with short bowel syndrome and is unable to absorb vitamin B12.
Use of ranitidine hydrochloride (रैनिटिडिन हाइड्रोक्लोराइड का उपयोग)
Long-term use of ranitidine hydrochloride may contribute to a deficiency of vitamin B12.
Celiac disease (सीलिएक रोग)
Untreated celiac disease may also cause impaired absorption of this vitamin, probably due to damage to the small bowel mucosa. In some people, vitamin B12 deficiency may persist despite treatment with a gluten-free diet and require supplementation.
Surgical procedure (शल्य चिकित्सा की प्रक्रिया)
Some bariatric surgical procedures, especially those that involve removal of part of the stomach, such as Roux-en-Y gastric bypass surgery. Procedures such as the adjustable gastric band type do not appear to affect B12 metabolism significantly.
Small intestine bacterial overgrowth (शल्य चिकित्सा की प्रक्रिया)
Bacterial overgrowth within portions of the small intestine, such as may occur in blind loop syndrome, may result in increased consumption of intestinal vitamin B12 by these bacteria.
Diabetic medication (मधुमेह की दवा)
Diabetes medication metformin may interfere with B12 dietary absorption.
Genetic disorder (आनुवंशिक विकार)
A genetic disorder, transcobalamin II deficiency can be a cause.
Alcoholism – if a “diet” of excessive alcohol intake is substituted for a diet adequate in sources of B12.
Water damaged building (पानी से क्षतिग्रस्त इमारत)
Chronic exposure to toxigenic molds and mycotoxins found in water-damaged buildings.
Increased needs by the body due to AIDS, or hemolysis the breakdown of red blood cells.
Vitamin B12 deficiency Mechanism (विटामिन बी 12 की कमी तंत्र)
The total amount of vitamin B12 stored in the body is between two and five milligrams in adults. Liver stores approximately 50%, but almost 0.1% is lost each day. The liver can store three to five years worth of vitamin B12 under normal conditions and functioning. However, the rate at which B12 levels may change when dietary intake is low depends on the balance between several variables.
Vitamin B12 deficiency Diagnosis (विटामिन बी 12 की कमी का निदान)
Diagnosis is typically based on vitamin B12 blood levels below 120–180 pmol/L (170–250 pg/mL) in adults. Elevated methylmalonic acid levels (values >0.4 micromol/L) may also indicate a deficiency.
Vitamin B12 deficiency Tests (विटामिन बी 12 की कमी के लिए टेस्ट)
If nervous system damage is suspected, B12 analysis in cerebrospinal fluid is possible, though such an invasive test should be considered only if blood testing is inconclusive.
Vitamin B12 deficiency Treatment (विटामिन बी 12 की कमी का इलाज)
Supplementation of B12 is by pill or injection. It appears to be equally effective in those with low levels due to deficient absorption of B12. Generally, 1 to 2 mg daily is required as a large dose.
Even pernicious anemia can be treated entirely by the oral route. These supplements carry such large doses of the vitamin that 1% to 5% of high oral doses of free crystalline B12 is absorbed along the entire intestine by passive diffusion.
Vitamin B12 deficiency Epidemiology (विटामिन बी 12 की कमी महामारी विज्ञान)
Vitamin B12 deficiency is quite common and widespread. In the US and UK, as around 6 percent of people have the deficiency, and this rises to around 20 percent in those over the age of sixty.
In less developed countries the rates are higher. For example across Latin America 40 percent, in some parts of Africa 70 percent, and in some parts of India 70 and 80 percent.
Vitamin B12 deficiency in other animals (अन्य जानवरों में विटामिन बी 12 की कमी)
Ruminants, such as cows and sheep, absorb B12 synthesized by their gut bacteria. Sufficient amounts of cobalt and copper need to be consumed for this B12 synthesis to occur.