Vitamin B-12 Deficiency

Vitamin B-12 Deficiency

  • About 3.5 million, people in the US have anemia, making the most common blood disorder.
  • About 47 million, people in the US may  have Vitamin B-12 Deficiency
  • There are several different types of anemia, but as much as 50% of people with the condition are iron- deficient, making iron diet–deficiency anemia the most common type of anemia.
  • Cardiologists have noted that anemia is a powerful independent predictor of cardiovascular problems for patients. 

Anemia is a decreased in the content of red blood cells (RBC) or a decreased in the in the hemoglobin inside the RBC–hemoglobin is the oxygen-carrying iron protein that attaches to oxygen in the lungs and carries it to tissues throughout the body.

Anemia is diagnosed when a blood test shows a hemoglobin value of less than 13.5 g/dL in a man or less than 12 g/dL in woman.  Children have values that vary with age.

Vitamin B-12  is a water-soluble B vitamin that is naturally present in some foods. The total amount of vitamin B12 stored in the body is between two and five milligrams in adults. Approximately 50% is stored in the liver but approximately 0.1% is lost each day, due to secretions into the gut.

Vitamin B-12  and folate function as a coenzyme or cosubstrate in single-carbon transfers in the synthesis of nucleic acids (DNA and RNA) and metabolism of amino acids. One of the most important folate-dependent reactions is the conversion of homocysteine to methionine in the synthesis of S-adenosyl-methionine, an important methyl donor. Another folate-dependent reaction, the methylation of deoxyuridylate to thymidylate in the formation of DNA, is required for proper cell division. An impairment of this reaction initiates a process that can lead to megaloblastic anemia, one of the hallmarks of folate deficiency. Because B12 and folate are involved in the metabolism of homocysteine, hyperhomocysteinuria is a non-specific marker of deficiency. Methylmalonic acid is used as a more specific test of B12 deficiency.

B-12 and DNA

Chemically speaking, methylation is the process of adding methyl groups to a molecule. A ‘methyl group’ is a chemical structure made of one carbon and three hydrogen atoms. Since methyl groups are chemically inert, adding them to a protein (the process of methylation) changes how that protein reacts to other substances in the body, thus affecting how that protein behaves. Enzymes, hormones, and even some components in genes are proteins and the process of methylation affects them all. In Genes,  this methylation process dictates the active or quiescence state of a gene. Most suppressors of inflammation and cancer-protective genes are methylated while inflammatory and cancer producing genes demethylated (without methylation).  Millions of these reactions occur every millisecond on cells. In some ways, methylation of proteins helps the body detoxify. For example, the methylation process helps convert the toxic amino acid (homocysteine) into a beneficial amino acid (methionine). If your body cannot methylate properly, toxins build up in your bloodstream and will eventually cause disease.

Methylation processes are fundamental in preventing numerous disorders, and folate and B-12 are principal actors in making it possible. Therefore, deficiency of folate and B-12 disrupts the methylation mechanism and as a result, cause disease which includes:

  • Heart Attack
  • Cancer
  • Stroke
  • Dementia
  • Depression
  • Migraines
  • Autism
  • Fertility
  • Anemia
  • Birth defects, and many more.

The potential protective roles of folate and the metabolically related B-vitamins (vitamins B12, B6, and riboflavin) in diseases of aging are of increasing research interest. The most common cause of folate and riboflavin deficiencies in older people is low dietary intake, whereas low B12 status is primarily associated with food-bound malabsorption, while sub-optimal vitamin B6 status is attributed to increased requirements in aging. Observational evidence links low status of folate and the related B-vitamins (and/or elevated concentrations of homocysteine) with a higher risk of degenerative diseases including cardiovascular disease (CVD), cognitive dysfunction and osteoporosis. Deficient or low status of these B-vitamins alone or in combination with hereditary disorders, including the common MTHFR 677 C → T polymorphism, could contribute to greater disease risk in aging by causing perturbations in one-carbon metabolism. Moreover, interventions with the relevant B-vitamins to optimize status may have beneficial effects in preventing degenerative diseases. The precise mechanisms are unknown but many have been proposed involving the role of folate and the related B-vitamins as co-factors for one-carbon transfer reactions, which are fundamental for DNA and RNA biosynthesis and the maintenance of methylation reactions.

Patients with-12 deficiency presents with a history of excessive alcohol intake with a concurrent poor dietary intake or may have underlying malabsorption.


What are the symptoms of anemia?

At the beginning of the deficiency, symptoms of anemia can be very difficult to detect.  But as it gets worse or progresses, oxygen becomes very deficient in your body and patients may experience severe fatigue and weakness.  It may also cause easy bruising or bleeding, including bleeding gums, gastrointestinal side effects including sore tongue, stomach upset, weight loss, and diarrhea or constipation. If the deficiency is not corrected, nerve cell damage can result. If this happens, vitamin B12 deficiency may result in tingling or numbness in the fingers and toes, difficulty walking, mood changes, depression, memory loss, disorientation and, in severe cases, dementia. All other symptoms include:


  • Weakness
  • Shortness of breath
  • Dizziness
  • Fast or irregular heartbeat
  • Pounding or “whooshing” in your ears
  • Headache
  • Cold hands or feet
  • Pale or yellow skin
  • Chest pain


Not having enough iron, vitamin B12, folate the body cannot produce enough of a specific type of protein call hemoglobin, which is inside the red blood cells and is very important in capturing the oxygen in the lungs and distributing into the tissues.  As a result of the insufficiency, some parts of the body do not receive the oxygen they need.  And this explains one of the most common symptoms of anemia… is that you are out of breath easily, and sometimes getting so little oxygen to your head you feel dizzy or lightheaded.

one of the most prominent symptoms of anemia is a general feeling of exhaustion, fatigue is one of the most predominant symptoms in many patients.  Some simply will fill more tired, all others will fill it while engaging in an activity.  The tiredness is caused by the same process that leads to shortness of breath and dizziness: Without enough iron or vitamin B12, there is not enough hemoglobin, and without enough hemoglobin, there is not enough oxygen to feel the body.

Some patients with anemia complain that their skin is looking to pale.  As your red blood cells become deficient and not healthy to fuel your organs with oxygen, you cannot expect your largest organ, your skin, to look healthy.  Without iron or vitamin B12, there might not be enough blood supply to the skin, resulting in a paler, and even yellow–looking appearance.

Anemia can also manifest with chest pain.  When there are few healthy red blood cells circulating the heart.  As a result, the heart beats faster than normal and you may start to feel the strain as chest pain.  Patients with coronary heart disease and anemia may have increased adverse cardiovascular events or even death.  Cardiologists have noted that anemia is a powerful independent predictor of cardiovascular problems for patients.



What are some of the key considerations in the risks for anemia?

Many people are at risk for anemia because of poor diet, intestinal disorders, chronic diseases, infections, and other conditions. Women who are menstruating or pregnant and people with chronic medical conditions are most at risk for this disease. The risk of anemia increases, as people grow older.

If you have any of the following chronic conditions, you might be at greater risk for developing anemia:

  •  Rheumatoid arthritis or another autoimmune disease
  • Kidney disease
  • Cancer
  • Liver disease
  • Thyroid disease
  • Inflammatory bowel disease (Crohn disease or ulcerative colitis)

The signs and symptoms of anemia can easily be overlooked. In fact, many people do not even realize that they have anemia until it is identified in a routine blood test.


What are the causes of B-12 Deficiency and anemia?

There are many forms of anemia.  Some people like those suffering from conditions like sickle cell anemia and thalassemia, or anemic from birth; the bodies genetically inherited difficulty producing red blood cells or a specific portion of red blood cells.  But the greatest portion patient suffering from anemia become anemic over it time through not consuming enough iron or vitamin B12, both of which, along with folate, are necessary for the production of healthy red blood cells.


Pregnant women are especially susceptible to anemia because the body must produce much more blood than normal to support the growth and development of a baby, and without enough iron, vitamin B12, or folate, there are fewer healthy red blood cells that can be made resulting in less oxygen to feel the organs of the mother and the baby. however, women who aren’t pregnant, men, and even children experiencing gastrointestinal conditions, such as ulcers, hemorrhoids, inflammation of the stomach, and cancer can have increased risk of anemia if their health conditions cause chronic bleeding.



What are the common types of anemia?

There are numerous types of anemia which include:
1.  Iron deficiency anemia is the most common type of anemia.  Iron deficiency is usually due to blood loss, poor absorption of iron, pregnancy, gastric bypass surgery.
2.  Vitamin deficiency anemia, which results from low levels of vitamin B12, folate, in most cases due to a poor dietary intake.  Pernicious anemia is a disorder in which vitamin B12 cannot be normally absorbed in the gastrointestinal tract due to gastric or small intestinal problems.
3.  Anemia of pregnancy.
4.  Aplastic anemia, myelodysplastic syndrome, or myeloproliferative disorders are rare blood cell disorder that affects the Bone marrow, as a result, there is insufficient or no production of red blood cells, white blood cells, and platelets.  There is a failure of the stem cells in the bone marrow.
5.  Hemolytic anemia results when red blood cells are destroyed in the bloodstream or in the spleen.  There are numerous causes of hemolytic anemia such as infections, autoimmune disorder shoulders, and congenital abnormalities in the red blood cells inherited abnormalities that affect the hemoglobin or the structure of the red blood cells.  Even mechanical causes like the ones found on leaky heart valves or aneurysms
6.  Sickle cell anemia and similar hemoglobin disorders such as hemoglobin C, thalassemia alpha, thalassemia beta.  Very often, in these disorders, the red blood cells are deformed and rigid, and as a consequence, they clogged the circulation because they are unable to flow through the small vessels.

7. Anemia caused by cancer. Most cancers of the gastrointestinal system may initially present with anemia

8. Anemia caused by kidney disorders leading to deficiency of the hormone erythropoietin–this hormone secreted by the kidneys stimulates the bone marrow to produce red blood cells.


 What is the treatment for anemia?

Treatment consists of using vitamin B12 by mouth or by injection; initially in high daily doses, followed by less frequent lower doses as the condition improve

Dr. Koduri says it’s impossible to get vitamin B12 from plant sources. As a result, the only way for those with vegan diets to consume an adequate amount of vitamin B12 is to regularly take a supplement,

Other nutritional anemias, such as folate or B-12 deficiency, may result from poor diet or from an inability to absorb vitamins in the gastrointestinal tract. Treatment varies from changing your diet to taking dietary supplements.

If your anemia is due to a chronic disease, treatment of the underlying disease will often improve the anemia. Under some circumstances, such as chronic kidney disease, your doctor may prescribe medication such as erythropoietin injections to stimulate your bone marrow to produce more red blood cells.

If you are diagnosed with aplastic anemia, your doctor may refer you to a hematologist for a bone marrow biopsy to determine the cause of the anemia. Medications and blood transfusions may be used to treat aplastic anemia, myelodysplastic syndrome, or myeloproliferative disorders

Hemolytic anemia occurs when red blood cells are destroyed in the bloodstream. This may be due to mechanical factors (a leaky heart valve or an aneurysm), infection, or an autoimmune disease. The cause can often be identified by special blood tests and by looking at the red blood cells under a microscope. The treatment will depend upon the cause and may include referral to a heart or vascular specialist, antibiotics, or drugs that suppress the immune system.

Talk with your doctor if you believe you may be at risk for anemia. Your doctor will determine your best course of treatment and, depending on your condition, may refer you to a hematologist, a doctor who specializes in blood disorders.

If you’re experiencing some of these symptoms of anemia and think that you might be anemic, it’s important to consult a doctor for an evaluation to discern exactly which type of anemia you have, and what you should do to cure it. Dr. Koduri warns against purchasing any over-the-counter anemia combatant because there is not a catch-all cure for all forms of anemia. The key is understanding the cause and the deficiency, so you can work with your doctor or hematologist to find the most effective treatment.


B-12 injections safe and probably much safer than most physicians realize. Proper utilization of this important therapeutic modality offers significant clinical benefits by reducing morbidity and mortality from many pathological conditions associated with anemia and vitamin B-12 deficiency.


At Hematology Oncology Care infusions are done in the privacy and harmony of our on-site suites.

On-site infusion has been proven a safe and effective alternative to inpatient care for many disease states and therapies.  For many patients, receiving treatment outpatient infusion suite setting is preferable to inpatient care.  Our infusion therapy suites which are ideally suited for certain patient-therapy situations.

The On-site infusion Patient approach to care offers numerous advantages such as medication use for appropriateness, effectiveness, safety, and adherence, with consideration of accessibility and cost; a collaborative approach to on-site infusion that involves the patient, oncologist, and other healthcare providers; and a focus on improving health outcomes



The information in this document does not replace a medical consultation. It is for personal guidance use only. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of the disease.

  • American Cancer Society
  • The National Cancer Institute
  • National Comprehensive Cancer Network
  • National Institute of Health
  • American Academy of Gastroenterology
  • National Institute of Health
  • MD Anderson Cancer Center
  • Memorial Sloan Kettering Cancer Center
  • American Academy of Hematology



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