What is the Cause of Deficiency of Vitamin B12?

Vitamin B12 Deficiency written on board

Deficiency of vitamin B12, also known as cobalamin deficiency, can occur due to various factors, including:

  • Dietary insufficiency: Vitamin B12 is primarily found in animal-derived foods such as meat, poultry, fish, eggs, and dairy products. Vegetarians and vegans who do not consume adequate amounts of these foods may be at risk of vitamin B12 deficiency if they do not supplement their diet with fortified foods or B12 supplements.
  • Malabsorption: Absorption of vitamin B12 occurs in the small intestine, specifically in the ileum. Certain conditions that affect the absorption of nutrients in the gastrointestinal tract can lead to vitamin B12 deficiency, including:
    • Pernicious anemia: An autoimmune condition characterized by the destruction of parietal cells in the stomach, which produce intrinsic factor, a protein necessary for vitamin B12 absorption.
    • Atrophic gastritis: Chronic inflammation and thinning of the stomach lining, which can impair the production of intrinsic factor.
    • Surgical procedures: Surgeries involving the stomach or small intestine, such as gastric bypass surgery or surgeries to remove parts of the stomach or ileum, can reduce the body’s ability to absorb vitamin B12.
    • Intestinal disorders: Conditions such as Crohn’s disease, celiac disease, or bacterial overgrowth in the small intestine can interfere with vitamin B12 absorption.
  • Inadequate intake by infants: Breastfed infants of mothers with vitamin B12 deficiency or strict vegetarian diets may develop vitamin B12 deficiency if they do not receive supplemental vitamin B12 or consume fortified foods after weaning.
  • Medications: Certain medications can interfere with vitamin B12 absorption or utilization. Examples include proton pump inhibitors (PPIs) and H2 receptor antagonists used to treat acid reflux and peptic ulcers, as well as metformin, a medication used to treat type 2 diabetes.
  • Age-related decline in absorption: As individuals age, their ability to absorb vitamin B12 from food may decline. This can contribute to an increased risk of vitamin B12 deficiency, particularly in older adults.
  • Alcoholism: Chronic alcohol consumption can impair vitamin B12 absorption and increase the risk of deficiency.
  • Rare genetic disorders: Inherited genetic disorders affecting vitamin B12 metabolism, such as transcobalamin deficiency or methylmalonic aciduria, can lead to vitamin B12 deficiency.

Symptoms of vitamin B12 deficiency can vary but may include fatigue, weakness, pale or jaundiced skin, shortness of breath, dizziness, tingling or numbness in the hands and feet, difficulty walking, cognitive changes, and mood disturbances. Treatment typically involves vitamin B12 supplementation, either orally or by injection, depending on the severity and underlying cause of the deficiency.

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