For several months during the summer of 2022, my dog Scout vomited at 3 am almost every day. If you have a dog, you know the sound. And each time, she swallowed her mess before she could get to him, making it difficult to diagnose the cause.
The vet and I finally decided my hydrangeas were the source of the problem, but keeping Scout away from them didn’t work. She began to appear tired all the time, something very worrying in a typically hyper yellow Lab puppy.
Then one day, Scout vomited up a furball, but not just any furball. In dogs, hair normally passes easily through the digestive system, but this hairball was wrapped around a pad of glitter that was too big to move. Once this foreign object was removed, the overnight vomiting stopped. However, Scout still needed treatment for a different and surprising reason: the object had inhibited a step in her body’s absorption of vitamin B12. B12 is an essential nutrient involved in the proper functioning of blood cells, nerves, and many other critical processes in the body.
I am a registered dietitian and I teach nutrition and food science classes. to college students, but I still missed the B12 deficiency that was causing my pup’s fatigue. Doctors can easily ignore it in people, even though B12 deficiency is a common health problem that affects an estimated 6% to 20% of the American population.
B12 is scarce in the diet and is found only in foods of animal origin. Fortunately, humans only need 2.4 micrograms of B12 per day, which equals one ten-millionth of an ounce, a very, very small amount. Without an adequate amount of vitamin B12 in the body, general health and quality of life are negatively affected.
Signs and symptoms
A primary symptom of vitamin B12 deficiency is fatigue, a level of tiredness or exhaustion so profound that it affects activities of daily living.
Other symptoms are neurological and can include tingling in the extremities, confusion, memory loss, depression, and difficulty maintaining balance. Some of these can be permanent if vitamin deficiency is not addressed.
However, since there can be so many causes for these symptoms, health care providers may overlook the possibility of a B12 deficiency and fail to detect it. Also, having a healthy diet seems to rule out any vitamin deficiencies. Case in point: Since I knew Scout’s diet was good, I didn’t consider vitamin B12 deficiency the source of her problems.
How B12 is absorbed
Research is clear that people who eat plant-based diets you should take B12 supplements in amounts typically provided by standard multivitamins. However, hundreds of millions of Americans who consume B12 may also be at risk due to conditions that could be hindering the absorption of B12 into their body.
The absorption of B12 is a complex multi-step process It starts in the mouth and ends at the other end of the small intestine. When we chew, our food is mixed with saliva. When food is swallowed, a substance in the saliva called R protein — a protein that protects B12 from being destroyed by stomach acid — travels to the stomach along with food.
Specific cells in the lining of the stomach, called parietal cells, secrete two substances that are important for the absorption of vitamin B12. One is stomach acid: it separates food and vitamin B12, allowing the vitamin to bind to the R protein in saliva. The other substance, called intrinsic factor, mixes with the stomach contents and travels with them to the first part of the small intestine: the duodenum. Once in the duodenum, pancreatic juices liberate B12 from the R protein and deliver it to intrinsic factor. This pairing allows B12 to be absorbed into cells, where it can then help maintain nerve cells and form healthy red blood cells.
A vitamin B12 deficiency usually involves a breakdown at one or more of these points on the path to absorption.
Dr. Darien Sutton explains the symptoms of vitamin B12 deficiency in this December 2021 segment of the ABC television show ‘Good Morning America.’
Risk factors for B12 deficiency
Without saliva, vitamin B12 will not bind to the R protein in saliva and the body’s ability to absorb it is inhibited. And there are hundreds of different medicines that can cause dry mouth, resulting in very little saliva production. They include opioids, inhalants, decongestants, antidepressants, blood pressure medications Y benzodiazepinesLike Xanax, it is used to treat anxiety.
The last three categories alone easily account for 100 million prescriptions in the US each year.
Another potential contributor to vitamin B12 deficiency is low levels of stomach acid. Hundreds of millions of Americans take anti-ulcer medications They reduce stomach acids that cause ulcers. Researchers have strongly linked the use of these medications with B12 deficiency — although that possibility may not compensate for the need for the drug.
Production of stomach acid. may also decrease with aging. More than 60 million people in the US. older than 60 yearsand some 54 million are over 65 years of age. This population faces a higher risk of vitamin B12 deficiency, which can be further increased by the use of acid-reducing medications.
The production of gastric acid and intrinsic factor by specialized parietal cells in the stomach is critical for B12 absorption to occur. But damage to the stomach lining can prevent the production of both.
In humans, alteration of the stomach lining is due to gastric surgery, chronic inflammation, or pernicious anemia — a medical condition characterized by fatigue and a long list of other symptoms.
Another common culprit for B12 deficiency is insufficient pancreas function. About a third of patients with a malfunctioning pancreas develop a vitamin B12 deficiency.
And finally, metformin, a drug used by around 92 million Americans to treat type 2 diabetes, has been associated with Vitamin B12 deficiency for decades.
Treatment for B12 deficiency
While some health care providers routinely measure levels of B12 and other vitamins, a normal screening exam includes only a complete blood count and metabolic panel, neither of which measure B12 status. If you are experiencing potential symptoms of a B12 deficiency and you also have one of the risk factors above, you should see a doctor for testing. A proper laboratory analysis and discussion with a doctor is needed to discover or rule out whether inadequate B12 levels could be at play.
In the case of my dog Scout, her symptoms led the vet to run two blood tests: a complete blood count and a B12 test. These are also good starting points for humans. Scout’s symptoms disappeared after a few months of taking oral B12 supplements that also contained an active form of the B vitamin folate.
In humans, the type of treatment and the duration of recovery depend on the cause and severity of the vitamin B12 deficiency. Full recovery can take up to a year, but it is quite possible with proper treatment.
Treatment for B12 deficiency it can be taken orally, applied under the tongue or administered through the nose, or it can require various types of injections. A balanced multivitamin or vitamin B12 supplement may be enough to correct the deficiency, as it was for Scout, but it’s best to work with a health care provider to ensure proper diagnosis and treatment.
diane cressAssociate Professor of Nutrition and Food Sciences, Wayne State University
This article is republished from The conversation under a Creative Commons license. Read the Original article.
