“For several months during the summer of 2022, my dog Scout vomited every day at 3 am. If you have a dog, you know the sound. And each time, she would shake off her mess before I got to it, making it hard to figure out why,” shared Diane Kress, associate professor of nutrition and food science.
“The vet and I finally located the source of the problem on my hydrangeas – keeping Scout away from them didn’t work. She started looking tired all the time – in a very typical yellow sweaty puppy way.”
“Then one day Scout spit up a hairball – but not just any hairball. Hair passes easily through the digestive system in dogs, but this hairball was wrapped around a Brillo pad that was too large to move. After this foreign object was removed, Matau’s vomiting stopped. Scout still needed treatment, but for a different and strange reason, it prevented her body from absorbing vitamin B12 one step at a time. B12 is an essential nutrient involved in blood cells, nerves and other vital processes in the body.
Cress is a registered dietitian and teaches nutrition and food science to college students, but she still missed the B12 deficiency that caused her puppy to be lethargic. Doctors can be just as easily blinded by people – even though B12 deficiency is a common health problem that affects many people.
B12 is very rare in the diet, and it is only found in foods of animal origin. Fortunately, humans only need 2.4 micrograms of B12 per day, which is equivalent to one ten million ounces – a very, very small amount. Without enough B12 in the body, it will have a negative impact on overall health and quality of life.
Signs and symptoms
One of the main symptoms of B12 deficiency is fatigue – a level of tiredness or fatigue that profoundly affects daily activities.
Other symptoms are neurological and may include tingling in the extremities, confusion, memory loss, depression and balance problems. Some of these can be permanent if vitamin deficiency does not occur.
“However, because there can be many causes for these symptoms, health care providers may overlook B12 deficiency and fail to diagnose it. In addition, having a healthy diet can prevent any vitamin deficiency. Case in point: I knew Scout’s diet was healthy, so I didn’t think B12 deficiency was the source of her problems,” said the Wayne State University associate professor.
How to synthesize B12
Studies are clear that people who eat a plant-based diet should take B12 supplements at the same level as a regular multivitamin. However, millions of people who consume B12 may be at risk due to conditions that prevent their bodies from absorbing B12.
B12 absorption is a complex multistep process that begins in the mouth and ends at the end of the small intestine. When we chew, our food mixes with saliva. When the food is swallowed, the substance in the saliva, R-protein – a protein that protects B12 from being destroyed by stomach acid – goes into the stomach with the food.
Certain cells in the stomach, called parietal cells, produce two substances that are necessary for the absorption of B12. One is stomach acid – it separates food and B12, which allows the vitamin to combine with salivary R-protein. The other substance, called intrinsic factor, mixes with the contents of the stomach and travels with them to the first part of the small intestine – the duodenum. In the duodenum, pancreatic juices release B12 from R-protein and deliver it to the internal state. This pair allows B12 to enter the cells, which then helps protect neurons and create healthy red blood cells.
A B12 deficiency usually involves a breakdown at one or more of these points on the pathway to absorption.
Risk factors for B12 deficiency
Without saliva, B12 does not bind to salivary R-protein, and the body’s ability to absorb it is inhibited. And there are hundreds of different medications that cause dry mouth, resulting in very little saliva production. They include opioids used to treat anxiety, inhalants, decongestants, antidepressants, blood pressure medications, and benzodiazepines, such as Xanax.
The last three categories alone account for easily 100 million prescriptions in the United States each year.
Another possible contributor to B12 deficiency is low stomach acid. Millions of people take anti-ulcer medications that reduce stomach acids that cause ulcers. Researchers have strongly linked the use of these drugs to B12 deficiency – although this possibility may not outweigh the need for the drug.
Stomach acid production can decrease with aging. The over 60 population is at high risk of B12 deficiency – which can be exacerbated by the use of acid-reducing medications.
The production of gastric acid and intrinsic factor by specialized parietal cells in the stomach is essential for B12 absorption. But the damage to the stomach lining prevents the production of both.
In humans, a weakened stomach lining from gastric surgery, chronic inflammation or pernicious anemia – a medical condition characterized by fatigue and a list of many other symptoms.
Another common cause of B12 deficiency is inadequate pancreatic function. About one-third of patients with poor pancreatic function have B12 deficiency.
And finally, Metformin, a drug used to treat type 2 diabetes, has been linked to B12 deficiency for decades.
Treatment for B12 deficiency
While some health care providers routinely measure B12 and other vitamin levels, a typical screening test includes only a complete blood count and a metabolic panel, neither of which measure B12 status. If you have symptoms of B12 deficiency and you also have one of the risk factors mentioned above, you should go to a doctor for a diagnosis. Proper lab work and discussion with a physician is important to determine or rule out if inadequate B12 levels may be at play.
“In my dog Scout’s case, her symptoms led the vet to run two blood tests: a complete blood count and a B12 test. These are good starting points for humans. After a few months of oral B12 supplements, Scout’s symptoms disappeared, which is an active form of the vitamin folate. It contains,” Cress said.
“In humans, the type of treatment and recovery time depends on the cause and severity of B12 deficiency. Full recovery can take up to a year, but is very possible with proper treatment.
Treatment for B12 deficiency may be oral, sublingual, or nasal, or may require different types of injections. A B12 supplement or nutritional multivitamin may be enough to correct the deficiency, but it’s best to work with a health care provider to ensure proper diagnosis and treatment.
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