Having vitamin B12 deficiency means that your body does not have enough
of this vitamin. You need B12 to make
red blood cells, which carry oxygen through your body. Not having enough B12 can
lead to anemia, which means your body does not have enough red blood cells to
do the job. This can make you feel weak and tired.
people get more than enough B12 from eating meat, eggs, milk, and cheese.
Normally, the vitamin is absorbed by your digestive system—your stomach and
intestines. Vitamin B12 deficiency anemia usually happens when the digestive
system is not able to absorb the vitamin. This can happen if:
This anemia can also happen if you don't eat enough foods
with B12, but this is rare. People who eat a
vegan diet and older adults who don't eat a variety of
foods may need to take a daily vitamin pill to get enough B12.
The amount of vitamin B12 you need depends on your age.
Vitamin B12 is found in foods from animals, such as meat, seafood, milk products, poultry, and eggs. It is not in foods from plants unless it has been added to the food (fortified). Some foods, like cereals, are fortified with vitamin B12.
Supplements containing only B12, or B12 along with other B vitamins and/or folate, are readily available. Also, B12 is usually in multivitamins. Check the label to find out how much B12 is in a supplement.
If your vitamin B12
deficiency is mild, you may not have symptoms or you may not notice them. Some
people may think they are just the result of growing older. As the anemia gets
worse, you may:
If the level of vitamin B12 stays low for a long time, it
can damage your nerve cells. If this happens, you may have:
Your doctor will examine you and ask questions about your past health and
how you are feeling now. You will also have blood tests to check the number of
red blood cells and to see if your body has enough vitamin B12.
The level of
folic acid, another B vitamin, will be checked too.
Some people whose vitamin B12 levels are too low also have low levels of folic
acid. The two problems can cause similar symptoms. But they are treated differently.
Vitamin B12 deficiency anemia is treated with
supplements of vitamin B12. Taking supplements brings your level of vitamin B12 back to normal, so you do not have symptoms. To keep your level of vitamin B12 normal, you will probably need to take
supplements for the rest of your life. If you stop taking them, you'll get anemia again.
Your vitamin B12 supplements might be pills or shots. If you use shots, you can learn to give
them to yourself at home. For
many people, pills work just as well as shots. They also cost less and are
easier to take. If you have been getting shots, ask your doctor if you can
switch to pills. Another form of treatment is a vitamin B12 nasal spray (such as Nascobal).
You can take steps at home to improve your health
by eating a varied diet that includes meat, milk, cheese, and eggs, which are
good sources of vitamin B12. Also, eat plenty of foods that contain
folic acid, another type of B vitamin. These include
leafy green vegetables, citrus fruits, and fortified breads and cereals.
Most people can prevent this anemia by including animal products like
milk, cheese, and eggs in their diets. People who follow a vegan diet can
prevent it by taking a daily vitamin pill or by eating foods that have been
fortified with B12.
Babies born to women who eat a vegan diet
should be checked by a doctor to see whether they need extra vitamin
If you have a high risk of getting this type of anemia, your doctor can give you vitamin B12 shots or pills to prevent it.
The National Anemia Action Council (NAAC) helps raise awareness of the public and health professionals about the prevalence, symptoms, and treatment options of anemia. This nonprofit organization provides information to help improve the lives of people with anemia. Through education, the NAAC helps improve detection, evaluation, treatment, and patient health.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
The Office of Dietary Supplements (ODS) supports research and
disseminates research results in the area of dietary supplements. The ODS also
provides advice to other federal agencies regarding research results related to
CitationsFood and Nutrition Board, Institute of Medicine (2011). Dietary reference intakes (DRIs): Recommended dietary allowances and adequate intakes, vitamins. Available online: http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/New%20Material/2_%20RDA%20and%20AI%20Values_Vitamin%20and%20Elements.pdf.U.S. Department of Agriculture, Agricultural Research Service (2011). Nutrient data laboratory. USDA National Nutrient Database for Standard Reference, Release 24. Available online: http://www.ars.usda.gov/Services/docs.htm?docid=8964.Other Works ConsultedCarmel R (2006). Cobalamin (Vitamin B12). In ME Shils
et al., eds., Modern Nutrition in Health and Disease,
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Food and Nutrition Board, Institute of Medicine (2011). Dietary reference intakes (DRIs): Recommended dietary allowances and adequate intakes, vitamins. Available online: http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/New%20Material/2_%20RDA%20and%20AI%20Values_Vitamin%20and%20Elements.pdf.Gallagher ML (2012). Intake: The nutrients and their metabolism. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 32–128. St. Louis: Saunders.Green R (2010). Folate, cobalamin, and megaloblastic anemias. In K Kaushansky et al., eds., Williams Hematology, 8th ed., pp. 533–563. New York: McGraw-Hill.Heimburger DC, et al. (2006). Clinical manifestations
of nutrient deficiencies and toxicities: A resume. In ME Shils et al., eds.,
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595–611. Philadelphia: Lippincott Williams and Wilkins. Linker CA, Damon LE (2012). Blood disorders. In SJ McPhee, MA Papadakis, eds., 2012 Current Medical Diagnosis and Treatment, 51st ed., pp. 475–519. New York: McGraw-Hill.Office of Dietary Supplements, National Institutes of Health (2010). Dietary Supplement Fact Sheet: Vitamin B12. Available online: http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional.
August 15, 2011
E. Gregory Thompson, MD - Internal Medicine & Brian Leber, MDCM, FRCPC - Hematology
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