Monday, June 13, 2011

VITAMIN B12 DEFICIENCY AND NEUROLOGICAL DISORDERS

Neurological Disorders due to Vitamin B12 Deficiency

Vitamin B12 is an important vitamin required for proper functioning of nervous system. Deficiency of vitamin B12 leads to anemia (low hemoglobin) causing generalised weakness, tiredness and fatigue. In addition, it is an important cause of various neurological disorders.

Common manifestations of vitamin B12 deficiency:

1. Tingling or numbness of feet and hands (due to involvement of peripheral nerves)
2. Imbalance while walking (due to spinal cord involvement)
3. Memory impairment
4. Dementia (due to brain involvement)
5. Psychiatric disturbances
6. Uncommonly, fits, tremors, parkinsonism, etc have also been reported.

Who are prone to get vitamin B12 deficiency?

1. Pure vegetarians- Vegetarian diet is a poor source of vitamin B12, hence, symptoms of vitamin B12 deficiency are more common in veg people.

2. Those with gastro-intestinal disorders such as malabsorption (where food is not properly absorbed after eating, manifested by diarrhea), after certain gastric surgeries, etc.

3. Those with other autoimmune diseases such as hypothyroidism (lack of thyroid hormone), vitiligo (white patches on skin), myasthenia gravis (manifested by muscular weakness and fatigue). This is because presence of auto-antibodies may inhibit the absorption of vitamin B12 in the gut.

How to prevent vitamin B12 deficiency?

1. Eating diet rich in vitamin B12 can prevent vitamin B12 deficiency. All animal sources are excellent sources of vitamin B12, such as meat, chicken, fish, shrimps, eggs, etc. Since, vitamin B12 can be stored in the body for long, 1-2 servings per week may suffice in normal people. No plant source is a good and reliable source of vitamin B12.

2. Regular check ups- If you notice any of the symptoms of vitamin B12 deficiency (as listed above), consult your family physician/neurologist so that it can be diagnosed and treated early.

How to diagnose vitamin B12 deficiency?

1. Vitamin B12 level can be estimated in blood. It is a simple investigation available in most labs.

2. Further tests may be required to see the effects of vitamin B12 deficiency on nervous system or to ascertain the cause of vitamin B 12 deficiency.

How is vitamin B12 deficiency treated?

Once vitamin B12 deficiency is establilshed (after clinical exam and blood tests), patients are started on vitamin B12 supplements. Initially, injections are given, so as to prevent the problem of less absorption. Then, maintenance treatment is given with oral tablets of vitamin B12.

What is the outcome of treatment?

Most patients who are diagnosed and treated early show a good recovery, which, however, may be prolonged over weeks to months.


Dr Sudhir Kumar MD (Medicine) DM (Neurology)
Consultant Neurologist
Apollo Hospitals, Hyderabad
Phone: 0091-40-23607777/60601066
Email: drsudhirkumar@yahoo.com

40 comments:

Gayatri said...

Thanks for the nice article. For pure vegs, is it OK to take oral B12 supplements periodically as a proactive measure to avoid the deficiency disorders?

Sudhir said...

@Gayathri, thanks for your comments. For eggetarians (vegetarians who eat eggs), no supplementation is necessary.However,for pure vegetarians, a few vitamin B12 tablets in a month would be fine. I would also like to point out that many non-vegetarians also get vitamin B12 deficiency, as they have antibodies in the gut, which prevent the absorption of vitamin B12.

Tammy said...

Hi Sir,
Your article is highly appreciated.
This particular article will help a lot of people who are unaware.
I will regularly follow your blogs for something new.
Please carry on your good work and pray that you remain in good health.

Anonymous said...

Nice article sir....

Mahesh said...

Dear Doctor
I am 48 years old and diagnosed with PD in 2008.

I read lot of information regarding PD and there may by 25% of people are wrongly diagnosed.

It is creating a doubt in me that I may also not have PD.

I am a pure vegetarian. There is no heredity of PD in my family.

For the last 17 years I have stressful life because of lot of family responsibilities.

And I was drinking alcohol since 1994. I am not a binge drinker although I used to have 2 pegs daily.

After reading your article about vitamin B12 I feel that I should explore the B12 deficiency.

Please guide me in this.

Thanks

Dr. Sudhir Kumar said...

@Mahesh, you could definitely get the level of vitamin B12 checked. If you want another investigation to confirm PD, you could go for PET (positron emission tomography) of brain (which is available at Apollo Hospital, Hyderabad)

Aryan said...

Hi Sir,
I am Ram Narayan. I had consulted you on deficiency of B12 one month earlier. After taking medicine, I once again gone for blood check, now level of b12 is >2000. Is there any side effects of this, b'coz it is around 2.5 times of maximum range. Due to some reason i was not able to meet you personally.

Mahesh said...

Hello Doctor,

Thanks for the reply and guidance.

What is the B12 low range for the neurological symptoms?

The normal range is 200 - 900 I guess.

I have 596.

Is it OK for neurological problems?

Somewhere I read 200 is too low for neurological problems. That is even 500 can be considered as low for neuro problems.

Please advice.

I am located in Bangalore and It is difficult to travel to Hyderabad to meet you.

Also guide me to undergo PET test in Bangalore if you know some references.

Thanks
Mahesh

venu said...

Hello Sir,

One of my relative get injured in accident and they went to one private hospital in Tirupati. They told us 2 nerves get damaged on the neck and they given some medicines to use up to one month. After that they will do operation. I need to know how much amount will require for that operation. They are saying 4.5 Lakhs. Also please let me know if you give some time we will meet by person for your advice.

madhu said...

any body in bangalore for consultation. my b12 is about 78

Dr. Sudhir Kumar said...

Hi Madhu,

you can consult Dr Murali Srinivas, MD DM Senior Consultant Neurologist at Manipal Hospital, Old Airport Road, Bangalore for treatment of your problem.

Best wishes,
Dr Sudhir Kumar Neurologist, Hyderabad

Anonymous said...

According to blood-haematology my serum VITAMIN B12 result is 213 pg/ml which is intermediate/low (or might be deficient) & as well as VITAMIN D31 (250H) result is 18.12 ng/ml which is deficient
having this symptoms having tingling & needling sensation in top & back side of head (Brain) as something is crawling on head I having feeling which is quite annoying with no headache , blurry vision, dizziness,severe Dry mouth since last more than 2 months. I done MRI scan of brain & spine also the result came out normal. Something might be there which is eating up B12 it might be because of candidiasis (yeast oral infection because of my prolong dry mouth) or might be Lyme diseases..??
According to search yeast steals b12 for its growth & survivals. After 7 doses of injections & extra medicine still having crawling, pins & needling sensation in brains could it be sign of stroke? . please help & suggest.

asr lakshmi said...

nice Article for pure vegetarian for deficiency b12 vitamin how to solved the problem in daily life style says very nice visit skin doctor in hyderabad

sandhya suri said...

Sir

Wat are the tests that needs to be done to confirm vitamin b12 deficiency and pernicious anemia

Aditya Changavalli said...

Hi Doctor,

I have exactly the same symptoms:
- Numbness of hands and feet
- Imbalance in walking

In addition, I am also experiencing blurry vision.

I am an eggitarian. I did not experience any of the warning signs of fatigue and exhaustion. After a bout of viral infection and consequent treatment, I suffered full-blown symptoms, including severe imbalance problem that lasted for a day.

Tests confirm a B12 level of 188 and I am on a course of injections and tablets.

Thank you for your post to put my mind at ease as to the diagnosis. I am still on the 3rd day of medication. Hopefully I will feel better soon.

Anonymous said...

For those struggling with B12 deficiency, I recently heard about a new oral prescription alternative to the injections called Eligen B12. I recently read that it works even if you don't have intrinsic factor (so even if you don't have normal gut absorption). Apparently it came out a month or two ago. Has anyone heard of it or tried it??

Anonymous said...

I am in the same boat. Crawling sensation in limbs, dry mouth (late night), jaw area having partial sensation all-day and whole face going numb even after one or two hours of sleep in the night, lips going partially numb. My B12 was 117 (even Vitamin D was low at 13). Started on Mecobalamin 500 mcg injections (one every other day for 6 injections) while simultaneously started on Nervigen (tablet, 750 mcg cobalamin). Post injections, B12 shot up to a healthy 1,137. But on just Nervigen alone, two weeks later my B12 crashed to 450 pg/ml so had to beg the doc to go back to injections (repeat the six but now follow up with once a week injections and watch). 3 injections in this second round are over. Hardly need 3 to 4 hours sleep these days. I sleep during the day to make up, though. Crawling and face numbing in the night still there. Thinking of consulting the neuro in Manipal that the Hyd doc recommended. Any breakthrough on your yeast infection or the Lyme front? Did you find a good doc who is aware of the latest developments in B12 treatment protocol (an authority figure like Sally Pachalok in US or Dr. Chandy in UK). Are you in Bangalore? If so, would love to meet.

Anonymous said...

I am in Bangalore as well. My B12 level was 117 when I was started on injections. Long story I wish to meet up with you.

Anonymous said...

Hi dr. I am a non vegetarian.But have this b12 deficiency. What could be the cause of such deficiency?Can masturbation cause vitamin b12 deficiency/

Dr. Sudhir Kumar said...

In non-vegetarians, there could be antibodies in the gut, which prevent absorption of Vitamin B12. These antibodies (anti-parietal cell and anti-intrinsic factor antibodies) can be tested in blood tests.

Masturbation does not cause vitamin B12 deficiency.

mohini gupta said...

Hello Doctor,

I was diagnosed with vitamin B12 Deficiency and i took injections after that, and it was recovered. But I am facing too much mental disturances like short term memory, poor concentration etc. Concentartion problem was there earlier, but memory problem occured some time before when B12 deficiency was diagnosed. It is affecting my career badly, I make a lot of mistakes in my daily activity due to forgetting the actual thing, Please tell me what to do as I am not able to move in my career because i can never focus on doing something. I works as a software engineer in bangalore.

Dr. Sudhir Kumar said...

Hi Mohini, memory and cognitive problems are known to occur with vitamin B12 deficiency. Please consult me at Hyderabad or a good neurologist in Bengaluru for treatment.

Anonymous said...

It effects memory

Dr. Sudhir Kumar said...

Vitamin B12 deficiency is a common cause of memory impairment.

kosuri said...

Hi sir,

I am 24 from hyderabad. I am diagnosed with vitamin b12 deficiency as my b12 levels are 169 pg/ml. And now i was advised to take b12 injections for every week. Is this deficiency due to the lack of intrinsic factor in my stomach or there could be any reason for this b12 deficiency and finally can these injections can cure this deficiency permanently ? Or I need to continue taking injections for the entire life time. Please advice

Anonymous said...

Hi Doctor,

I am a non-vegetarian and now i have vitamin b12 count as 171pg/ml. Do i need to giveup non veg foods and continue with only vegetarian foods ?

Dr. Sudhir Kumar said...

You need to continue non-veg and veg foods. However, vitamin B12 deficiency in a non-vegetarian means that the vitamin B12 is not getting absorbed from the gut. So, you require vitamin B12 injections.

Dr. Sudhir Kumar said...

Hi Kosuri,

Vitamin B12 deficiency can be caused due to lack in the diet, if you are vegetarian. If you are non-vegetarian, then, it is probably due to antibodies against intrinsic factor or parietal cells. In the second scenario, you would need vitamin B 12 injections for life.

Ashok Ahuja said...

Hi Doctor,

I am Mamta Ahuja from Mumbai. i am diagnostic with hyperthyrodism . T3 is 109.01, Total T4 is 4.60, Ultrasensitive TSH, Serum is 28.9978. I am also diagnostic with Vitamin B12 Defeceinecy and as per report Cobalamin is less than 83.

I am feeling nervous, low vision, no interest in daily activities. I have consult with physician doctor and he has prescribed Injection B12 of 500mcg (alternate days) , Tablet Thyronorm 100 mcg.

Kindly guide pls whether i have to go for second opinion, if yes any consultant at Mumbai for speedy recovery.

Dr. Sudhir Kumar said...

There is no need to go for second opinion. Please follow the advice of your physician.

Anonymous said...

Hello Doctor
I had some of the symptoms of B12 deficiency and got tested. The result show 152 pg/ml. I understand this is below the normal range and I wanted to see a doctor. I see you are in Hyderabad, can you please suggest me a good doctor in Bangalore ?

Dr. Sudhir Kumar said...

You can meet Dr Murali Srinivas at Manipal Hospital in Bengaluru.

Unknown said...

Hello Doctor, A friend of mine from Mumbai is having numbess in face from last two years, we are unable to find a consultant to cure it. Will you be able to suggest some consultant for Numbess in face in Mumbai.

Thanks
Raja
9092032729

Dr. Sudhir Kumar said...

Dr Gautam Tripathi, Neurologist at Hiranandani Hospital, Mumbai

Anonymous said...

Hello sir,m suffering from headache it extended to neck and shoulder (only right side)since 6-7 months..my b12 level is 213 ..what should I do

Dr. Sudhir Kumar said...

Your current symptoms are not due to vitamin B 12 deficiency. So, you need a proper evaluation to decide the cause and treatment of your problem.

Anonymous said...

Hello sir,
I am software engineer at Cisco systems, Bangalore. In April 2016, I was diagnosed with a b12 deficiency problem with an observed value of 125 for vitamin b12. From that day onwards, I initially took some injections and after that I am continuously taking b12 vitamin supplements. But unfortunately even after taking supplements, I am badly suffering from things like fatiqueness, habit of forgetting little daily life works, lazyness, always feel like keep lying on the bed, no hope for career. And the main tension I hve is my hair are so much white that i really feel bad and remain in tension. Could u plz suggest me any good doctor in Bangalore becoz u already consult with 2 3 doctors but it did not help me. I am very much tensed about my career, want to work hard but due to these problem not able..

Dr. Sudhir Kumar said...

NIMHANS is the best institute for neurological problems at Bangalore. You may consult there.

Tenzin dolma said...

Hello sir, i diagnosed with b12 deficiency which is 148 .. i took injection nd medicine also bt i have not found any recovery . My main problm is memory loss, is becoming worse now . Can u plz suggest me a good neurologist in delhi.

Dr. Sudhir Kumar said...

Hi Tenzin, You can meet Dr Vinit Suri at Apollo Hospital, New Delhi.