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Vitamin B12 Deficiency – Symptoms And Therapy

What Do We Need Vitamin B12 For, And What Are The Consequences Of A Deficiency?

Vitamin B12 (Cobalamin) is an essential, water-soluble vitamin that the human body cannot produce itself. So he is dependent on the constant intake of food.

The Three Forms

The vitamin acts in the human body in three forms:

  • Methylcobalamin works in the cytoplasm,
  • Adenosylcobalamin is the mitochondria (power plants of the cells),
  • and hydroxocobalamin acts in both blood and cytoplasm.

Methylcobalamin and adenosylcobalamin are both so-called “bioactive coenzymes.” The body can only utilize the vitamin directly in these two forms. The third in the league, the hydroxocobalamin, is not a coenzyme but mainly acts as a toxin and radical scavenger.


Vitamin B12 has a wide variety of tasks in the human organism. Cobalamin is involved in energy metabolism, blood formation, DNA synthesis, folic acid metabolism, homocysteine breakdown, myelin sheath production (nerve sheath; isolates the nerve fibers), and some neurotransmitters.


Cell Division, Blood Formation, DNA Synthesis

The best known is probably the effect of vitamin B12 on blood formation. A pronounced deficiency can lead to anemia. For cells to divide correctly, Cobalamin is just as important. Folic acid is also involved in this process. In the event of a deficiency, so-called transcription errors can occur during DNA synthesis, which can lead to an increased risk of cancer in the long term. Chronic illnesses are also associated with it.

The formation of red blood cells, also known as erythropoiesis, depends on the presence of the vitamin. Otherwise, this can lead to a disorder in the maturation of the red blood cells. These are then not able to absorb the necessary amount of oxygen. Symptoms such as weakness, dizziness, shortness of breath, and hypotension indicate this.

Energy Metabolism

Advertising tells us that a deficiency can lead to a lack of energy. This B vitamin has an impact on performance and energy level. Our organism needs energy for everything it does. For this food is essential. The energy obtained from this is stored and accessed when required. Vitamin B12 plays a significant role in this complicated process.

Structure Of The Cell Membrane

Vitamin B12 is involved in the formation of cell membrane lipids. However, this process has not yet been thoroughly researched. The membrane-forming lipids, however, are part of the myelin sheaths. These act like a protective cover around the nerves, comparable to the insulating layer of electrical cables. If these protective covers are missing, resulting from a vitamin B12 deficiency, those affected suffer from tingling, muscle weakness, paralysis, coordination disorders, or memory disorders. In return, it should also have a regenerative effect on nerves.

Nitrosative Stress

Nitrosative stress is a type of oxidative stress. However, it is not the oxygen radicals that are the bad guys here, but the nitrogen monoxide radicals (NO). Too many of them stress the body and can damage it. Nitrosative stress is caused by inflammation, chemicals, drugs, nicotine, psychological and physical stress. In average, balanced amounts, NO is essential. For example, this relaxes the inner walls of the blood vessels, which positively affects blood pressure that is too high. Vitamin B12, in the form of hydroxocobalamin, can assert itself against too many nitrogen monoxide radicals and makes NO harmless. This combats so-called nitrosative stress.


Homocysteine ​​is created during protein metabolism when the essential amino acid methionine is broken down (from proteins in food). Homocysteine ​​is oxidized in the blood and thereby attacks the inside of the blood vessels, which over time can lead to hardening of the arteries and later to a heart attack. Vitamins B6, B12, and folic acid can break down the dangerous homocysteine.

Synthesis Of Neurotransmitters

Neurotransmitters are messenger substances that are needed to transmit nerve impulses. It is essential for synthesizing various messenger substances such as serotonin, dopamine, adrenaline, noradrenaline, and acetylcholine.

What Cobalamin Can Do

Cobalamin provides sufficient energy and thus works against tiredness. The vitamin supports the growth of the nerves, is involved in the production of erythrocytes, ensures healthy cell division, protects the blood vessels, is essential for concentration, good memory, and mental energy, and has a positive effect on our mood. In addition to folic acid, vitamin B12 is necessary for pregnant women and successful conception.

The Interplay Of Vitamin B12 And Folic Acid

Vitamin B12 and folic acid (also called folate or vitamin B9) work closely together in the body. As already mentioned, both of them are massively involved in the breakdown of the harmful homocysteine. Cobalamin is necessary to activate folate (the natural, bioactive form of folic acid). This means that a functional folic acid deficiency can develop from a vitamin B12 deficiency.

The Vitamin In Food

The folate from food is bound to the so-called intrinsic factor in the human organism in the stomach. This is how it is transported to the terminal ileum (the last section of the small intestine), where the Cobalamin is then released into the bloodstream.

Causes: What Can Interfere With The Absorption Of Vitamin B12

The causes of impaired absorption of vitamin B12 include inflammation of the gastric mucosa, removal of parts of the stomach, so-called TYPE-A gastritis (an autoimmune disease in which the body attacks its stomach and thus the intrinsic factor is no longer adequately formed atrophic gastritis (atrophic changes in the mucous membrane, decrease in enzyme and hydrochloric acid production), medication (e.g., gastric acid blockers) and chronic intestinal inflammation or removal of sections of the intestine.

The Vitamin B12 Deficiency

In addition to the cases mentioned above, which can be the basis of a vitamin B12 deficiency. This includes:

  • insufficient intake with food, for example, through a strict vegetarian or vegan diet;
  • Malabsorption, in which the intestine cannot absorb the vitamin in the first place, as is the case, for example, with celiac disease and exocrine pancreatic insufficiency;
  • heavy alcohol consumption,
  • a fish tapeworm infestation,
  • destructive colonization of the intestine,
  • an increased need (for example, in the context of infection or during pregnancy),
  • Displacement by B12 analogues (e.g. Spirulina),
  • old age
  • or the genetic “Imerslund-Grasbeck syndrome”.

Symptoms Of Vitamin Deficiency

The liver can store folate for up to three years. Therefore, symptoms of vitamin deficiency usually only appear after a few years of persistent undersupply. These include, above all, tiredness, exhaustion, and paleness, triggered by pernicious anemia (vitamin B12 deficiency anemia).

The deficiency also affects nerve activity. As a result, complaints develop, such as abnormal sensations in the hands and feet, tingling, paralysis, and declining mental abilities. A well-known sign of deficiency is a smooth red tongue, along with a burning tongue and injuries to the oral mucosa. Further symptoms are immune deficiency, tendency to bleed, loss of appetite, and weight loss.

How A Deficiency Is Determined

The symptoms listed above usually lead to a doctor. This will order a blood test and a urine test based on a detailed anamnesis. The diet is discussed, possibly reconsidered, and changed.

A nutritional deficiency must be distinguished from an absorption-related lack. A special examination is necessary for this. Determining the cause is essential for later treatment. For example, parenteral delivery in the form of syringes or infusions may be required. In this way, the body is replenished in high doses at the beginning. This is followed by maintenance therapy, often in the form of tablets. An oral substitution can also be compensated for a deficiency that is not so serious.

The type of Cobalamin contained in the tablets is essential for oral therapy. Preparations containing methylcobalamin, hydroxocobalamin, and adenosylcobalamin are recommended. These three types are also found in natural foods and are required for different tasks in the body.


Folate is an essential, vital vitamin and is one of the B vitamins primarily responsible for nerves, the brain, and fitness. A deficiency can trigger quite far-reaching complaints and must be treated or eliminated. A diagnosis of the underlying disease is essential here. People who have been strictly vegetarian or vegan for a long time run the risk of developing cobalamin deficiency. A daily substitution with a suitable preparation may have to be considered here.

Scientific studies have also shown a connection between Helicobacter pylori and a deficiency in vitamin B12. Helicobacter pylori were found in the stomachs of more than half of people with a vitamin B12 deficiency. In 40 percent of the patients, the vitamin B12 level in the serum also rose after treatment for Helicobacter infection. B12 malabsorption resulting from Helicobacter pylori infections should be considered here as a possible trigger of vitamin B12 deficiency and hyperhomocysteinemia.

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