Anemia/vitamin B12 deficiency

Overview – There is lower than the normal amount of vitamin B12 levels in the body which causes a lack of healthy red blood cells.

Vitamin deficiency can occur because of nutritional deficiency, or it can occur if your body has trouble absorbing or processing these vitamins. Some of the conditions associated with vitamin B12 deficiency are Crohn’s disease, celiac disease, pancreatic insufficiency, bacterial overgrowth, fish tapeworm infection, autoimmune conditions, genetic disorders, pernicious anemia.

Pernicious anemia is the most common cause of vitamin B12 deficiency. This occurs because of the lack of a substance called intrinsic factor. Intrinsic factor is a protein that helps in the absorption of vitamin B12 from the intestine into the bloodstream. Without intrinsic factor, vitamin B-12 can’t be absorbed.

Medications such as metformin, proton pump inhibitors, histamine receptor antagonists are also associated with vitamin B12 deficiency.

Gastrectomy (surgical removal of part or whole of the stomach) and bariatric surgery (surgery performed on the stomach or the intestines to induce weight loss) can decrease the absorption of vitamin B12.



  • Fatigue
  • Shortness of breath
  • Palpitations
  • Dizziness
  • Numbness or tingling in your hands and feet
  • Unsteady movements
  • Confusion or forgetfulness



  • Severe anemia can lead to heart failure, myocardial infarction (heart attack),
  • Besides anemia, vitamin B12 deficiency also causes persistent tingling in your hands and feet or problems with balance, mental confusion, and forgetfulness. If vitamin B12 deficiency is not corrected these neurological problems can become permanent.



  • Anemia due to vitamin B12 deficiency is diagnosed with a blood test to look for the number and appearance of the red blood cells, hemoglobin levels, vitamin B12 levels. A hemoglobin <13.5 g/dL represents anemia in men, and a value <12.0 g/dL, respectively, represents anemia in women.
  • Additional tests may be done to determine the cause of vitamin B12 deficiency.
  • Pernicious anemia is identified by testing for autoantibodies to intrinsic factor.


Lifestyle management

  • Follow the healthy diet and exercise program recommended by your doctor. Your doctor will prescribe a diet rich in vitamin B12 such as meat, eggs, and milk. People who consume a vegan or strict vegetarian diet generally should take supplemental vitamin B12 to ensure adequate stores. This is especially important in women who are pregnant or may become pregnant since the unborn baby also requires adequate vitamin B12.
  • Ask your doctor whether a multivitamin may be right for you if you’re concerned about getting enough vitamins from the food you eat.
  • Do not drink alcohol or drink alcohol in moderation. Alcohol interferes with the absorption of vitamins.


Medical management

  • Injections of vitamin B12 are recommended for people with pernicious anemia, gastrectomy, bariatric surgery.
  • For milder forms of vitamin B12 deficiency, vitamin B12 supplements or changes in the diet is recommended.

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