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An estimated 6% of people in the US and UK suffer from vitamin B12 deficiency. The condition has been recognized by the World Health Organization as a global health problem that can affect the lives of millions of people. B12 deficiency is commonly manifested by symptoms such as extreme fatigue, lack of energy, muscle weakness and even memory problems. Not only that, but it can cause a number of serious health problems, such as irreversible nerve damage, anxiety or depression, or disorders that affect coordination, balance, and speech.
While some B12 deficiency is caused by diet, the most common cause of low B12 levels worldwide is an autoimmune disorder called pernicious anemia. This is a chronic form of low B12 that can have serious health consequences if left untreated for a long time. However, because the symptoms of this condition typically look like those of other common conditions, it is often misdiagnosed as depression or anxiety. Not only does this condition cause physical suffering, but the stigma of living with this chronic condition can also cause serious psychological harm, as I have shown in my research.
Vitamin B12 – otherwise known as cobalamin – is a water-soluble vitamin found in animal byproducts such as meat, fish, and dairy. Other sources include fortified cereals, breads and plant milks. People who do not regularly consume animal products are at risk for B12 deficiency. To reduce this risk, vegetarians are recommended to consume at least three micrograms of B12 per day through fortified foods, or by taking a regular B12 supplement.
However, most low B12 levels are caused by pernicious anemia. This condition makes it difficult for people to process vitamin B12 because the immune system impacts the functioning of vital parietal cells within the stomach. These cells produce a protein called “intrinsic factor” that is essential for vitamin absorption. People with pernicious anemia will produce an antibody to intrinsic factor that will destroy any intrinsic factor produced. And so, without any intrinsic factors associated with food, they are unable to extract any B12. Without B12, the body is not able to produce enough healthy red blood cells. This condition can also be caused by a weak lining of the stomach. This may be due to atrophic gastritis, chronic inflammation in the stomach that eventually weakens the lining.
a lifelong condition
It is estimated that five in every 100,000 people in the UK have pernicious anemia. It affects people of all ages and symptoms can begin at any time. However, the condition is more common in people over the age of 60, as older adults are more likely to develop atrophic gastritis, increasing the risk of B12 deficiency. The number of people suffering from this condition worldwide may be higher than estimated. However, it is difficult to reliably estimate the level of B12 deficiency because there is no agreed definition of how low B12 levels need to be to be classified as deficient.
New guidelines have been created to address the problems with current diagnostic methods. He says that the patient's symptoms are the best indicator of any deficiency. It also states that if there is inconsistency between test results and the patient's reported symptoms, the patient should be treated with replacement B12 to prevent any potentially irreversible damage.
B12 deficiency causes a variety of debilitating neurological and physical symptoms. The most common symptoms of pernicious anemia are fatigue, memory loss, and concentration problems. However, the subtle, nonspecific nature of the condition's early symptoms can make it difficult for people to be properly diagnosed. A study interviewing members of the Pernicious Anemia Society found that almost half had been misdiagnosed. Another 20% had waited two years or more for a proper diagnosis. For many people, symptoms were initially attributed to a busy lifestyle or diagnosed as anxiety or depression.
Low levels of B12 can cause nerve damage, as the vitamin is essential for the production of myelin, which protects nerve cells from damage. Symptoms of low B12 may initially include tingling or numbness in the hands and feet or difficulty balancing. If pernicious anemia is not treated, symptoms can be debilitating and nerve damage may become irreversible. The term “harmful” was used to describe the condition because it historically resulted in death.
When vitamin B12 deficiency is caused by poor diet, it is treated by giving B12 tablets or hydroxocobalamin injections. Once the deficiency is corrected, levels can be controlled by making dietary changes or taking supplements regularly.
However, treatment for people with pernicious anemia is lifelong. In the UK, many people require repeated injections every 8 to 12 weeks to replace the vitamins. Despite this, many people continue to experience debilitating symptoms, or find that their symptoms return before the next scheduled injection because their treatment has not been adequate.
When patients raised concerns about inadequate treatment or requested more frequent injections, our research found that many health care professionals responded negatively, even questioning the validity of the patient's illness. These types of questions can increase psychological distress and impact quality of life.
Patients with pernicious anemia were also likely to experience higher levels of health-related stigma. Many people with chronic health conditions fear that their health condition will cause them to be devalued by wider society, or become a source of discrimination. Stigma not only impacts relationships with health care providers, but may also increase the incidence of anxiety and depression.
The lack of proper guidelines for the diagnosis and treatment of pernicious anemia is problematic and is in urgent need of review. It is important that both the general public and health professionals have increased awareness of the symptoms resulting from inadequate levels of B12 so that the condition can be diagnosed before long-term damage occurs.
Heidi Seitz, Senior Lecturer in Psychology, Cardiff Metropolitan University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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