How is vitamin B12 deficiency treated?

Preventive Medicine Specialist David Katz, MD, MPH, explains how a vitamin B12 deficiency is treated. Learn more information on preventive medicine and overall wellness.

Transcript

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And so what can happen is B12 deficiency can be overlooked for months or even years. And there is a point at which you really can't treat it

00:08

effectively anymore. [MUSIC PLAYING]

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It starts, of course, with awareness, making sure that you know it is what's going on. And one of the things that's really important

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here is to be an empowered patient, for you to be thinking of it. Ideally, doctors will always be thinking

00:28

of all of the reasonable explanations and do all the right tests. But if you're fatigued, B12 deficiency

00:34

may not spring to mind. And if you have numbness or tingling, it may not spring to mind. And by the way, it may not be the answer. But it might be the answer.

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And if both you and your doctor are thinking about all the potential explanations, it makes it much less likely that something important

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will be overlooked. And this is really important because B12 deficiency can mimic a whole variety of other conditions.

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The neurological manifestations can mimic multiple sclerosis. The cognitive decline, the difficulty with concentration

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in thinking can mimic Alzheimer's. And so what can happen is B12 deficiency can be overlooked for months or even years.

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And there is a point at which you really can't treat it effectively anymore. If there is dementia due to B12 deficiency that

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goes on more than a couple of years, it's probably not fully reversible. So you never want to let that happen to you. If it's found early, the symptoms are reported,

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your blood test reveal it, it's easy to treat, one of several ways. If your stomach is working properly,

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if you're just not getting enough B12, you can take oral supplements. Often, that's as much as 1,000 micrograms a day, so a much higher dose than the RDA of 2

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and 1/2 micrograms a day. But now you're not trying to maintain a level. You're trying to fill up the tank, much higher dose to fill up the tank.

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Oral works well. There are also sublingual. You can take B12 under the tongue. But if the reason you're B12 deficient

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is that your stomach's not working right and you can't absorb it, then oral supplements won't do the job either. But then you can get it by injection.

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And the standard injection is something called cyanocobalamin. This is a form of vitamin B12, inexpensive, readily available.

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It's the one we typically use. Interestingly, there is a subset of the population deficient in B12 because they can't metabolize it.

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And we can actually do blood tests to detect the enzyme deficiency responsible for that. That group, and it's a much smaller group

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than the total B12 deficient population, actually needs to get the active form, methylcobalamin, often by injection as well.

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But whatever the problem is, there absolutely is a treatment. So this really does begin with awareness.

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Do I have risk factors for B12 deficiency? Am I over 50? Do I eat a highly processed diet? Do I take aspirin?

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Do I take a proton pump inhibitor? Does it run in my family? And then if you have a high level of suspicion,

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you'll be sensitive to symptoms that might be B12 deficiency, the level will be checked early, and then the problem is easy to fix.