Cause
Absorption disorders occur when vitamin B12 can no longer be sufficiently absorbed from the digestive tract.This may be due, for example, to the fact that parts of the gastrointestinal tract have been surgically removed, such as after a gastric or ilumectomy. Furthermore, chronic gastritis, i.e. chronic inflammation of the stomach, can prevent absorption of the vitamin. The stomach contains the so-called parietal cells (document cells), which produce the intrinsic factor.
This is necessary for the absorption of vitamin B12 in the intestines. In gastritis, the formation of this glycoprotein is also disturbed. Drugs can also cause a B12 deficiency if taken continuously: A well-known example is proton pump inhibitors, which are usually taken together with painkillers such as ibuprofen.
A representative of proton pump inhibitors (PPI for short) is pantoprazole. It reduces the production of hydrochloric acid in the stomach and thus protects the stomach lining. However, if taken continuously, it causes a B12 deficiency.
Other drugs that affect absorption include the anti-diabetic drug metformin and the H2-receptor antagonists (including ranitidine), which are also used to inhibit the secretion of gastric acid. These causes can underlie an absorption disorder. An absorption deficiency is particularly typical for vegans and vegetarians: Since vitamin B12 is almost exclusively absorbed through animal food, a deficiency can be expected in the long term in people who avoid meat products.
Thus for example in 100 gram calf liver the 20-fold of the daily needed quantity of Vitamin B12 is contained, in fruit, vegetable and Nssen however none at all. Therefore during a pregnancy a vegane nutrition should be renounced around damage by a possible vitamin and nutrient deficiency with the unborn child to avoid. Since vitamin B12 is formed by microorganisms in the intestinal wall, bacterial colonization of the intestine can also lead to a reduced absorption.
Excessive alcohol consumption or alcoholism, in which the intestinal and stomach mucous membranes are successively destroyed, also falls into this category. But also fish tapeworm infestation and coeliac disease lead to an intake deficit in the long run. Very often a vitamin B12 deficiency occurs due to excessive alcohol consumption.
The reason is that alcohol often causes inflammation of the stomach lining, usually chronic. This impairs the formation of the intrinsic factor necessary for vitamin B12 absorption and as a result the vitamin cannot be sufficiently absorbed from food. Heavy alcoholics also suffer from malnutrition.
As a result, only one-sided and vitamin-poor products are often consumed. A prolonged and chronic lack of vitamin B12 can lead to neurological abnormalities. These abnormalities are particularly pronounced in severe alcoholics.
Patients suffering from an alcoholic disease are always given vitamin B12 (usually by injection) to compensate for these neurological abnormalities. In the case of a long or severe vitamin B12 deficiency, mild and later also more severe abnormalities occur. Initially, a slight vitamin B12 deficiency is not noticeable.
The stronger it becomes and the more pronounced it is, the more complaints are added. The first symptoms are rhagades at the corners of the mouth (small tears) and an inflammatory swelling of the tongue (glossitis). A vitamin B12 deficiency also always leads to anemia.
In this respect, a severe deficiency has all the symptoms of anemia. These would be tiredness, concentration disturbances, weakness as well as increased susceptibility to infections. In the case of a severe and long-term deficiency, neurological symptoms may also be present.
The reason is that vitamin B12 is also involved in the transmission of nerve impulses. Severe deficiencies can cause gait and standing insecurities, tremors and muscular cramps. Vitamin B12 is also ascribed a participation in memory performance.
A prolonged or severe deficiency of vitamin B12 could also result in memory impairment. In the case of so-called funicular myelosis, there are also sensations, gait insecurity and memory problems. A common consequence of a vitamin B12 deficiency is anemia.
A certain concentration of vitamin B12 is necessary for blood formation and for the oxygen loading of the red blood cells and should not be undercut for a long time. If a vitamin B12 deficiency results in a reduced oxygen load of the red blood cells, the first symptoms appear. Those affected usually notice fatigue and lack of drive.
Sleeping times are extended, and waking hours can sometimes be maintained for only a few hours a day.Vitamin B12 deficiency also leads to concentration disorders, which then usually become noticeable at the same time. In addition to the symptoms mentioned above, the lack of oxygen also causes the skin to become pale, as well as pale conjunctival areas. Patients with a severe vitamin B12 deficiency anemia usually also appear with a depressed mood and speak slowly.
Immediate treatment should be initiated. After the vitamin B12 deficiency has been compensated, the general condition slowly improves. The administration of vitamin B12 should be carried out under regular laboratory controls for a few months.
