Vitamin B12 Deficiency and Neuropathy
B12 vitamin is important in the formation of red blood cells and the synthesis of DNA during cell division. When B12 deficiency occurs, all folate functions are blocked, which can create a neurological compromise of the peripheral nerves. Vitamin B12 deficiency symptoms, associated with nervous system disorders, is a common problem in the elderly and in people who diets are compromised such as alcoholics. Vitamin B12 (cobalamin) deficiency associated with neuropathy may occur in 5% to 40% of the general population. The prevalence has been found to be higher in the elderly, especially those in nursing homes.
Causes of Deficiency
One of the most common causes of vitamin B12 deficiency is a lack of a protein called intrinsic factor, which is produced by the parietal cells in the stomach. Some people are born without the ability to produce intrinsic factor, but most people develop the deficiency because of injury or stomach surgery. Medications used for treatment of gastric reflux can often interfere with B12 production. Vitamin B12 is bound to protein in food. Hydrochloric acid is needed to release the vitamin from food. During log-term use of reflux medication, stomach acid secretion is suppressed, which hinders the release of he B12 from roots.
Other causes of vitamin B12 deficiency include digestive diseases, infection, overgrowth of bacteria in the small intestine, medications and surgical removal of all or part of the small intestine. In less common cases, vitamin B12 deficiency can occur as a result of inadequate dietary intake.
Symptoms of B12 Deficiency
Symptoms of vitamin B12 deficiency include:
- Chest pain or heart palpitations
- Confusion, memory loss, or dementia
- Pernicious Anemia (numbness/coldness in hands and feet)
- Dizziness, trouble maintaining balance and fainting
- Fatigue or weakness
- Pale skin or jaundice (yellowing of skin and eyes)
- Poor appetite
- Shortness of breath
- Sore mouth and tongue
Testing for B12 Deficiency
Methylmalonic Acid Test:
While a simple B12 blood test is often done to help determine B12 deficiency, sometimes it will not tell the whole story. The methylmalonic Acid Test, also called an MMA Test, is really the only accurate for Vitamin B12 Deficiency that there is. Methylmalonate is a waste product that builds up in the blood and is excreted in the urine when Vitamin B12 is not available to transform the substance into the energy metabolite Succinic Acid. Because it begins to build up within ten days after a Vitamin B12 deficiency begins, it is not only the most accurate marker, but it is the earliest detectable marker of Vitamin B12 deficiency. Because Methylmalonic Acid is found in both blood and urine in amounts relative to the degree of deficiency, both urine and blood tests are excellent tests for Vitamin B12 deficiency, although your doctor may have their own preference.
Another useful test in helping to determine B12 deficiency is Homocysteine. Your doctor may order a homocysteine test to determine if you have a B12 or folate deficiency. The homocysteine concentration may be elevated before B12 and folate tests are abnormal. Some doctors may recommend homocysteine testing in malnourished patients, the elderly, who often absorb less vitamin B12 from their diet, and those with drug or alcohol addictions.
Folate is used in the metabolism of DNA and amino acids, which are your body’s protein building blocks. Folate is found in leafy green vegetables, and a synthetic form, called folic acid, is available as a nutritional supplement. Women are advised to make sure they’re obtaining enough dietary folate before becoming pregnant and during the early months of pregnancy, to decrease the risk of neural tube defects I the unborn children. Folate deficiency can also cause megaloblastic anemia.
The reason your doctor may test Folate with suspected B12 deficiency is because excess folate masks B12 deficiency. Maintaining an adequate, but not overly excessive, level of folate in your bloodstream is important in that getting too much folate can hide the symptoms and make it appear that the problem has been resolved. However, the neurological damage caused by B12 deficiency cannot be cured with folate, and if excessive folate they need until after the damage has occurred.
To B12 or Not to B12?
Whether or not to take B12 should be discussed with your doctor. Because neuropathy symptoms are often associated with B12 deficiency, it is a matter that should certainly be considered. (Please note: There are different ways to take B12, some more effective than others. Again, please consult your doctor which way is best for you).