can mono cause b12 deficiency

This finding can be the basis of a hypothesis that chronic, very low levels of vitamin B12 could be the cause of permanent, or at least refractory, changes in cognition and memory, which can lead to dementia. By Keri Wiginton Medically Reviewed by Jennifer Robinson, MD on January 14, 2023 Pernicious Anemia Age Intestinal Disorders Medication Stomach Surgery Vegan or. A high monocyte level may indicate inflammation, infection, blood disorders, and other health issues. Vitamin B12 Deficiency: Recognition and Management Vitamin B12 is naturally present in certain foods and is also available as a dietary supplement. Bailey R.L., Durazo-Arvizu R.A., Carmel R., et al. A more mathematical approach toward establishing vitamin B12 deficiency was proposed by Fedosov etal,42, 43 who calculated a single combined indicator of vitamin B12 status in which levels of total serum vitamin B12, holoTC, MMA, and homocysteine are taken into account. B. You need a healthy liver to store B12. Why Parkinson's research is zooming in on the gut. Nitrous oxide use can cause vitamin B12 deficiency, resulting in neurologic manifestations such as myeloneuropathy and subacute combined degeneration of the spinal cord. And you sometimes may not get enough of it. The following list of medications are in some way related to or used in the treatment of this condition. Vitamin B12 is essential for good health, but some people may not be getting enough. Iron deficiency causes decreased hemoglobin production, and folate or vitamin B12 deficiency can lead to megaloblastic anemia with increased Hgb A2. They can put B12 directly into your muscle with a needle. Velkova A., Diaz J.E.L., Pangilinan F., et al. Khan S., Del-Duca C., Fenton E., et al. Brings you eight B vitamins, including B-12 as methylcobalamin. Regland B., Forsmark S., Halaouate L., et al. Data sources include IBM Watson Micromedex (updated 3 July 2023), Cerner Multum (updated 2 July 2023), ASHP (updated 11 June 2023) and others. An important point to consider is that vitamin B12 deficiency can cause subacute combined deficiency, cognitive impairment due to white-matter disease, and peripheral neuropathy, which could certainly contribute to cognitive and gait impairment in PD; however, is by no means conclusive in patients with PD, and more evidence is needed. Here are some ways they can help. memory loss. High frequency of vitamin B12 deficiency in asymptomatic individuals homozygous to MTHFR, Shiran A., Remer E., Asmer I., et al. In some cases, no cause can be identified. Other possible causes of a vitamin B12 deficiency include: A person with Crohns disease may also benefit from other nutritional supplements. Medications that cause vitamin B12 deficiency. Elevated homocysteine levels are a risk factor for cognitive decline. Healthcare professionals will order laboratory tests to confirm a diagnosis. Cimetidine (Tagamet) - used to treat and prevent stomach ulcers. 2023 Healthline Media UK Ltd, Brighton, UK. Morris MS, Jacques PF, Rosenberg IH, et al. Research conducted in 2016 revealed that metabolic vitamin B12 deficiency was present in 10% to 40% of the population and is frequently missed, this could be easily treated if recognized early, and it may be an important opportunity to prevent dementia and stroke [21]. All rights reserved. Some people with Crohns disease may undergo surgical removal of part or all of the ileum, and this can also lead to difficulty absorbing vitamin B12. Plasma homocysteine as a risk factor for dementia and Alzheimers disease. This case is a classic example of how the assay for serum vitamin B12 can be wrong because of interference of the assay by IF autoantibodies. B12 deficiency and psychiatric disorders: case report and literature review. This issue raises questions about whether holoTC measurement is really superior to measurement of total serum vitamin B12 plus MMA for determining vitamin B12 deficiency41 but also indicates that MMA is a poor indicator of vitamin B12 deficiency. Some people refer to this as a B12 shot. Vitamin B12 is also available in tablets and lozenges that people place under the tongue. Hence, a vitamin B12 deficiency identified in a patient presenting with neurologic complaints should prompt healthcare providers to question the patient regarding . Effects on vibration perception and electrophysiologic measures were not consistent. Possible causes of such a common deficiency state could be gastritis-associated poor absorption, excessive use of other drugs (e.g., proton pump inhibitors), pernicious anemia, or nutritional deficiency due to poor socioeconomic status. There are some clues in the medical literature that support this concept. Considering serum homocysteine levels in our patients, 43 patients had serum homocysteine levels above 20 mol/L, 101 patients had levels between 15 and 20 mol/L, and 58 had levels between 8 and 15 mol/L. Hunt A., Harrington D., Robinson S. Vitamin B, Green R., Allen L.H., Bjrke-Monsen A.L., et al. Finally, the prevalence of neurologic symptoms was low. Foods that are high in vitamin B12 include: Learn more about foods that can increase and reduce vitamin B12 levels. Vitamin B12 Levels and Psychiatric Symptomatology: A Case Series Two years later, there were still bouts of pain, numbness, and paresthesia, but she was able to walk supported only by a walking stick. Long-term outcome of 4 patients with transcobalamin deficiency caused by 2 novel. But you dont make this nutrient on your own. The anemia has resolved completely. A recent intriguing study comes from US investigators, who demonstrated low vitamin B12 levels in the brain tissue of aged individuals, especially those older than 60 years, and of people with autism and schizophrenia.102 They speculate that on one hand vitamin B12 status in the brain compartment is distinctly regulated during aging from the rest of the body, while on the other hand may contribute to impaired brain function and in the etiology of neurologic disorders. Ethical Review and Research Committee of Jinnah Medical and Dental College issued approval JMC.ERC.1.0509.19. What Can Cause a B12 Deficiency? After neuroimaging (i.e., brain MRI), 14 patients were found to have a stroke, while five had a space-occupying lesion. Ferrand A., Siu V.M., Rupar C.A., et al. Serious nerve damage that lasts a year or longer may not go away. A vitamin B12 level of fewer than 200 picograms per milliliter indicates deficiency. Sudha S, Alexa B, Jacob S, Paul FJ, Rosenberg IH, DAgostino RB. Healton E.B., Savage D.G., Brust J.C., Garrett T.J., Lindenbaum J. Neurologic aspects of cobalamin deficiency. You can learn more about how we ensure our content is accurate and current by reading our. Berth M., Bonroy C., Guerti K., Uyttenbroeck W., Uytterhoeven M. Comparison of five commercially available ELISA kits for the determination of intrinsic factor antibodies in a vitamin B12 deficient adult population. The precise definition of MCI has long been controversial, but a diagnosis of MCI follows similar methods that are used to diagnose clinical dementia and Alzheimers disease. Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome. Alcohol misuse. Patients with MCI and low serum levels of vitamin B12 without any evidence of focal brain lesion or any major metabolic derangement and who had gradual development of cognitive impairment without any premorbid history of similar complaints were ultimately selected for inclusion into the study. Sun Y., Lai M.S., Lu C.J. Spence J.D. Celiac disease is one of the disorders in which vitamin B12 absorption may be restored after dietary adjustment with complete avoidance of gluten. Also, it has been documented that MMA levels are elevated in people with severely impaired renal function.30 Similarly, elevated homocysteine values can also be the consequence of folate or vitamin B6 deficiency, as well as impaired renal function, hypothyroidism, and certain medications.6 In a separate study, we calculated from the National Health and Nutrition Examination Survey and Lifelines epidemiological studies that MMA and/or homocysteine levels are elevated above current reference values (>300 nmol/L and 10 mol/L, respectively) in only 73% of people with low serum vitamin B12 levels of less than 140 pmol/L and in 28% of patients with serum vitamin B12 levels between 140 and 300 pmol/L (B.H.R.W., H.J.C.M.W., J.E. Cholestyramine (Cholybar, Questran) - used to lower high cholesterol levels in the blood. However, in developed countries, the causes of vitamin deficiency vary beyond consumption. Nevertheless, they are at high risk for development of symptoms. Graber J.J., Sherman F.T., Kaufmann H., Kolodny E.H., Sathe S. Vitamin B. Sloan J.L., Johnston J.J., Manoli I., et al. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). This case illustrates the difficulties of an incomplete diagnostic work-up and also the dangers of measuring serum vitamin B12 levels during parenteral administration. Older adults tend to have less of the stomach acid you need to absorb B12 from food. Smelt H.J., Smulders J.F., Said M., Nienhuijs S.W., Boer A.K. We conducted this study in a low socioeconomic area of Karachi in patients attending a neurology outpatient department with a variety of neurologic manifestations. An acquaintance mentioned to her the possibility of vitamin B12 deficiency. In 2014, a Dutch Viewpoint on Vitamin B12 Treatment was presented by the Dutch Organization of General Practitioners.106 Motivation to publish this Viewpoint was the observed increase in serum vitamin B12 testing and findings of abnormal test results. Clinical examination did not reveal major abnormalities. Long-term treatment with metformin in type 2 diabetes and methylmalonic acid: post hoc analysis of a randomized controlled 4.3year trial. Is the ketogenic diet right for autoimmune conditions? Symptoms of vitamin B12 or folate deficiency. Patient C is a 15-year-old girl. Research into the etiology of vitamin B12 deficiency was rather poor. Rogne T., Tielemans M.J., Chong M.F., et al. Vitamin B12 deficiency has been correlated to various neurologic problems; however, research has suggested that abnormally low levels of vitamin B12 can be the cause of significant cognitive dysfunction [1]. Repeated examination of the bone marrow specimen did not confirm a diagnosis of myelodysplastic syndrome and showed only a slight increase of erythropoiesis. A French study showed that among 172 patients with vitamin B12 deficiency, only 2% accounted for an inadequate dietary intake; therefore, the deficiency arises from other factors such as malabsorption, postgastrectomy state, bacterial overgrowth, and long-term use of medications for some comorbidities (e.g., proton pump inhibitors and H2 receptor-blocking drugs, which might interfere with the release of vitamin B12 from food sources) [14]. As our main focus in this study was on MCI, we assessed patients for clinical signs of MCI and used the Mini-Mental State Examination (MMSE), Backward Digit Span test (from the revised Wechsler Adult Intelligence Scale), and the East Boston Memory Test (EBMT). Indeed, in another study, both serum vitamin B12 and holoTC levels were weak predictors of abnormal MMA levels.23. Patients were randomized to receive 2000 g of oral cyanocobalamin administered with breakfast daily for 4 months or 1000 g of cyanocobalamin administered IM with increasing intervals. An additional factor that may have added to her protracted course was that she had been treated with high doses of folate. Hydroxocobalamin is not toxic, and successful treatment should not be stopped. Supports cognitive & neurological health . In discussions on the effect of hydroxocobalamin treatment, often the suggestion is made that part of the effect is that of a placebo. She was referred to our clinic for evaluation. After both MMA and homocysteine levels were found to be grossly elevated, it was realized that she had severe vitamin B12 deficiency. Other factors that may contribute to vitamin B12 malabsorption, hence deficiency, are certain medications like metformin and proton pump inhibitors,58, 59 H2 receptor blockers, and antacids. These observations are supported by a recent study that reported improvement of symptoms in children with autism spectrum disorder treated with frequent hydroxocobalamin injections.103 Finally, in a prospective study, Brito etal104 found that one injection of high-dose (10 mg) cyanocobalamin, pyridoxine, and thiamine increased several metabolic markers of mitochondrial function oxidative stress, nerve function, and myelin integrity such as acylcarnitines, plasmalogens, phospholipids, and sphingomyelins. Safety and side effects When taken at appropriate doses, vitamin B-12 supplements are generally considered safe. Ankylosing Spondylitis Pain: Fact or Fiction, https://www.ncbi.nlm.nih.gov/books/NBK441923/, https://medlineplus.gov/lab-tests/complete-blood-count-cbc/, https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease/definition-facts, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372971/, https://medlineplus.gov/lab-tests/homocysteine-test/, https://www.aafp.org/pubs/afp/issues/2017/0915/p384.html, https://medlineplus.gov/lab-tests/methylmalonic-acid-mma-test/, https://gut.bmj.com/content/68/Suppl_2/A87.2, https://www.crohnscolitisfoundation.org/diet-and-nutrition/supplementation, https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/, https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/treatment/, Smartwatches may detect Parkinson's up to 7 years before symptoms appear, Fluctuating cholesterol, triglyceride levels may influence dementia risk, Multiple sclerosis treatment could improve with discovery of genetic marker. McCaddon A, Regland B, Hudson P, et al. When serum total vitamin B12 levels are low or questionable, the combination of total vitamin B12, active vitamin B12, MMA, and homocysteine may be the best strategy, but the validity of this combined biomarker approach43 needs to be validated in larger prospective studies and especially validated against objective markers of treatment response. The site is secure. Implications for hyperhomocysteinemia: not homocysteine but its oxidized forms strongly inhibit neuronal network activity. Metformin use was associated with an increase in MMA and worsening neuropathy score in patients with type 2 diabetes.60 In addition, vitamin B12 malabsorption may be more prominent in older individuals, rendering these people at increased risk of symptomatic vitamin B12 deficiency.61, 62, Inadequate dietary intake is another important cause of vitamin B12 deficiency. 1 However, because of the cross-sectional design of our study, cause-effect relationship cannot be inferred, and the association could be primary or secondary to the psychiatric disorder, or incidental. Serum vitamin B12 concentrations within reference values do not exclude functional vitamin B12 deficiency in PKU patients of various ages. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Iqbal N., Azar D., Yun Y.M., Ghausi O., Ix J., Fitzgerald R.L. A vitamin B12 deficiency will likely result in a higher level of homocysteine in the blood. She presented at our outpatient clinic shortly thereafter and reported a severe increase of her symptoms. Internal Medicine, Jinnah Medical College Hospital, Karachi, PAK. What happens when you dont get enough vitamin B12? Associations of maternal vitamin B12 concentration in pregnancy with the risks of preterm birth and low birth weight: a systematic review and meta-analysis of individual participant data. These include: Food. Vidal-Alaball J., Butler C.C., Cannings-John R., et al. Jayabalan B., Low L.L. Along with other types of white blood cells, monocytes are a key element of your immune . Supplements that contain only vitamin B12 tend to contain doses in the range of 5001,000 mcg, whereas supplements that contain multiple B-complex vitamins provide 50500 mcg of vitamin B12. 8600 Rockville Pike Vitamin B12 and ulcerative colitis: Links, Supplements and vitamins for Crohn's disease, What to know about Crohn's disease and nutritional deficiencies. Food-cobalamin and malabsorption in elderly patients: clinical manifestations and treatment. Six months after diagnosis and initiation of high-dose hydroxocobalamin treatment, the patient still had considerable neurologic damage, loss of sensations in her feet and legs, and inability to walk without the use of a rollator walker. Digestive disorders. Low White Blood Cell Count: 6 Possible Causes for a Low WBC It is needed to absorb vitamin B 12. Pernicious anemia increases the risk of stomach or intestinal cancers. In older patients, malabsorption may be the main cause of the deficient state [11]. Causes of B12 Deficiency Because of uncertainty about the diagnosis, she was referred to our outpatient clinic 2 months later. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, https://pernicious-anaemia-society.org/research/more-good-news-step-forward-b12-research/, https://www.nhg.org/sites/default/files/content/nhg_org/images/nhg-standpunt_vitamine_b12-2.pdf, Thyrotropin receptor, thyroid-stimulating immunoglobulins, Glutamic acid decarboxylase 65, Islet antigen 2, zinc transporter 8, 17-Hydroxylase, side-chain cleavage enzyme, Aldehyde (retinal) dehydrogenases, selenium-binding protein 1, Various antigens of sperm cell or testicular basement membrane, Mitochondrial antigens, like subunits (E2) of the pyruvate dehydrogenase complex. Ispir E., Serdar M.A., Ozgurtas T., et al. A person with Crohns disease will experience abdominal pain and unintentional weight loss. Shots. The. Vitamin B12 and Crohn's: Possible links and more An absorption problem that affects B12 may also affect other vitamins and minerals - including folate and iron, leading to deficiencies in the vitamin or mineral affected, ie the cause of a B12 deficiency can also result in an iron deficiency. Willekens J., Hergalant S., Pouri G., et al. Vitamin B12: one carbon metabolism, fetal growth and programming for chronic disease. Vitamin B12 has a role in metabolism. As noted by Wong, there is no precise definition or gold standard test to diagnose vitamin B12 deficiency; rather, the diagnosis is usually based on identifying a low level of serum vitamin B12 along with the clinical evidence of deficiency, which response to replacement therapy [8]. Supplemental material attached to journal articles has not been edited, and the authors take responsibility for the accuracy of all data. Yildirim Z.K., Nexo E., Rupar T., Buyukavci M. Seven patients with transcobalamin deficiency diagnosed between 2010 and 2014: a single-center experience. Aparicio-Ugarriza R., Palacios G., Alder M., Gonzalz-Gross M. Areview of the cut-off points for the diagnosis of vitamin B. Solomon L.R. Six weeks later, the attending psychiatric resident ordered an additional serum vitamin B12 measurement. GUID:F7458B9C-983A-4121-8902-7AE216673AC9, Your serum vitamin B12 level is within the reference range of 140 to 450 pmol/L, Your serum vitamin B12 level is only moderately low, Your serum vitamin B12 level may be low, but your plasma level of methylmalonic acid is completely normal, Vitamin B12 deficiency only occurs in elderly people, Vitamin B12 deficiency never occurs in children, Oral therapy is as good as or even better than painful injections to alleviate neurologic symptoms, You may stop treatment because your serum vitamin B, You must stop treatment because your serum vitamin B, You must stop after 5 injections because vitamin B, You must stop the injections because your symptoms have worsened, CoA, coenzyme A; holoTC, holotranscobalamin; IF, intrinsic factor; IM, intramuscularly; MMA, methylmalonic acid. dried nori. Avitamin B-12 supplement of 500 g/d for eight weeks does not normalize urinary methylmalonic acid or other biomarkers of vitamin B-12 status in elderly people with moderately poor vitamin B-12 status. Colchicine - (ColBenemid) - used to prevent or treat attacks . They move throughout your body in your blood, looking for invaders. A lack of B12 can leave the body unable to make more red blood cells, which can result in symptoms such as weakness, tingling in the arms and legs, or a condition called pernicious anemia. Yang D.T., Cook R.J. Spurious elevations of vitamin B12 with pernicious anemia. This case illustrates that vitamin B12 levels within the reference range do not exclude symptomatic vitamin B12 deficiency. Fedosov S.N., Brito A., Miller J.W., Green R., Allen L.H. Vitamin B12 deficiency is common among people with Crohns disease. B12 deficiency: The warning sign in your legs that can occur 'just at However, dosage is important in this respect. For . Prevalence of vitamin B12 deficiency in hypothyroid patients. Vitamin B12 deficiency can be sneaky and harmful Vitamin B12 and folate perform several important functions in the body, including keeping the nervous system healthy. 2005-2023 WebMD LLC. Signs and symptoms | Diagnosis | Anaemia - B12 and folate deficiency The list of single-nucleotide polymorphisms associated with serum vitamin B12 concentration is gradually increasing, and a recent review reported 59 gene polymorphisms found in a wide variety of populations, although the majority were reported in people of Western European descent.37 Recent studies have found an association between homozygosity of the TT methylenetetrahydrofolate reductase C677T genotype and vitamin B12 deficiency.73, 74, 75 In the near future, dedicated evaluation of genetic mutations in genes that are associated with vitamin B12 metabolism, for instance with whole-exome sequencing, may shed light on familial cases. Your doctor can let you know which dose is right for you. Her primary care physician ordered a serum vitamin B12 measurement, which was 190 pmol/L, and subsequently advised her to start hydroxocobalamin injections. A CBC test will likely show a decrease in hemoglobin and hematocrit in a person with a vitamin B12 deficiency. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. In general, vitamin B12 levels decline with age, and therefore, the prevalence of vitamin B12 deficiency increases in the elderly population [7]. Additional laboratory examinations did not reveal any new abnormalities. Increases in homocysteine are related to worsening of stroop scores in healthy elderly persons: a prospective follow-up study. Stone R.E., Spies T.D. Pernicious Anaemia Society website. Acommon polymorphism in HIBCH influences methylmalonic acid concentrations in blood independently of cobalamin. Nasal spray. Vitamin B12 is absorbed in the small intestine, and people who have had surgery to remove sections of the small intestine . You might also have pale skin, heart . The most prevalent symptoms of vitamin B12 deficiency are neurologic, such as paresthesia in hands and feet, muscle cramps, dizziness, cognitive disturbances, ataxia, and erectile dysfunction, as well as fatigue, psychiatric symptoms like depression, and macrocytic anemia.1, 2, 7, 8, 9, 10 However, there is evidence that in the Western world as well as China, less than 20% of people with demonstrable low serum vitamin B12 levels have macrocytic anemia.11, 12, 13, 14 Although the demonstration of low serum vitamin B12 levels is considered diagnostic, there is a poor correlation between these levels and symptoms,8, 9, 15 and even people with vitamin B12 levels below 140 pmol/L may not have symptoms.16 This factor sheds a different light on the discussion regarding appropriate cutoff levels for serum vitamin B12 and related parameters. Further studies are needed to confirm and refine the observed associations over a larger scale and to determine whether these findings will translate to a reduction in cognitive decline. Among these 281 patients, 19 had a focal neurologic deficit. Herrmann W., Obeid R. Utility and limitations of biochemical markers of vitamin B12 deficiency. This topic has gained much interest recently, and studies evaluating this phenomenon are ongoing.105, Since the 1990s, interest in the possibilities of oral instead of parenteral administration has emerged. Managing Your Vitamin B12 Deficiency Carmel R., Agrawal Y.P. Methylmalonylcoenzyme A (CoA) mutase, which catalyzes the isomerization of methylmalonyl-CoA to succinyl-CoA, is one of the vitamin B12dependent enzymes, and impaired function will cause elevations of methylmalonyl-CoA and thereby MMA after cleavage of CoA. Older adults tend to have less of the stomach acid you need to absorb B12 from food. Limited value of testing for intrinsic factor antibodies with negative gastric parietal cell antibodies in pernicious anaemia. Massey T.H., Pickersgill T.T., Peall J.K. Nitrous oxide misuse and vitamin B. Buizert A., Sharma R., Koppen H. When the laughing stops: subacute combined spinal cord degeneration caused by laughing gas use. B12 deficiency can be caused by a number of factors, including medical conditions, medication use, and low dietary intake of the vitamin. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Crohns disease commonly affects the small intestine and the beginning portion of the large intestine. Iron deficiency does not cause B12 deficiency and vice-versa. In vitamin B12 deficiency, there is no evidence that recovery of megaloblastic anemia or normalization of elevated MMA levels as a consequence of hydroxocobalamin injections can be regarded as a placebo effect. Symptoms related to vitamin B12 deficiency may be diverse and vary from neurologic to psychiatric. Vitamin B12 is a water-soluble vitamin typically found in animal products. Vitamin B12 deficiency is a treatable condition that happens if you are not consuming enough vitamin B12 in your diet or if your body is not absorbing it properly. Appropriate diagnosis of mild cognitive impairment: just what is "normal"? Because vitamin B12 deficiency can often signal that something is amiss in your digestive tract, it's prudent to investigate an unexpected deficiency - particularly to rule out these common. The patient was discharged home 3 months later, but no follow-up appointment at our outpatient clinic was made. Her serum vitamin B12 level was 51 pmol/L (145-450 pmol/L). Content independently created by WebMD and supported by our partners.

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