Today we will talk about Vitamin B12 Deficiency anemia. Anemia is a condition in which the number of red blood cells or hemoglobin in the blood is low. I can also be defined as a lower ability of the blood to carry oxygen. A person who has anemia called anemic. Many of the symptoms of anemia are caused by decreased oxygen delivery to the body’s vital tissues and organs.

Anemia is measured according to the amount of hemoglobin — the protein within red blood cells that carries oxygen from the lungs to the body’s tissues.

Anemia affects more than 1.6 billion people around the world. Women and people with chronic diseases such as cancer have the highest risk of developing anemia.

Today we will discussed about red blood cells and one of the major cause of anemia in Vegan people. That is Megaloblastic Anemia (Vitamin B12 deficiency).

What is Megaloblastic Anemia? (Vitamin B12 Deficiency)

Anemia-Vitamin B12 Deficiency
Megaloblastic Anemia (Red Blood Cells Changes)

Megaloblastic anemia is a form of anemia characterized by very large red blood cells and a decrease in the number of those cells. Megaloblastic anemia is a distinct type of anemia characterized by macrocytic red blood cells and erythroid precursors, which show nuclear dysmaturity. Common causes are deficiency of vitamin B12 (cobalamin) and folic acid. 

Cobalamin deficiency folate trap and secondary folate deficiency, which affects the cells that are dividing rapidly. Clinically this affects bone marrow and erythrocyte formation, leading to megaloblastic anemia.

The incidence varies with dietary practices and socioeconomic patterns. A study has estimated the incidence of folate deficiency as 6.8%, vitamin B12 32% and combined deficiency as 20% in north Indian children.

Causes of Megaloblastic Anemia

The two most common causes of megaloblastic anemia are vitamin B12 deficiency (cobalamin) and folic acid deficiency.

Vitamin B12 deficiency can be caused by decreased ingestion, impaired absorption (e.g. intestinal parasites, intrinsic intestinal disease, failure to release vitamin B12 from protein, intrinsic factor deficiency), or impaired utilization (e.g. congenital enzyme deficiencies: orotic aciduria). 

Folate deficiency can occur during prolonged parenteral nutrition and hemodialysis, as folic acid is lost in dialysis fluid. History of autoimmune disorders may be found in patients of pernicious Anemia.

Nutritional deficiency is more common in vegan families (vegetarian with little or no dairy products) and those consuming only goat milk (folate deficient).

Symptoms of Anemia

Symptoms of anemia may include the following:

Fatigue

Decreased energy

Weakness

Shortness of breath

lightheadedness

Palpitations (feeling of the heart racing or beating irregularly)

chest pain, angina, or heart attack

dizziness

Fainting or passing out

Rapid heart rate

glossitis (inflammation of the tongue; smooth, beefy, red tongue),

Mild jaundice,

Symptoms of malabsorption,

Weight loss and anorexia.

Numbness or tingling of the extremities and an ataxic gait (only B12 deficiency)

Pernicious anemia (Megaloblastic anemia with neurological symptoms)

Reasons of Vit. B12 deficiency

Inadequate dietary intake (strict vegetarians)

Inadequate production of intrinsic factor (pernicious anemia, congenital lack) malabsorption (disorders in absorption)

Reasons of folate deficiency:

Inadequate dietary intake (teenagers, infants, old age, alcoholics)

Malabsorption (coeliac disease, partial gastrectomy)

Excess demand (pregnancy, lactation, infancy, malignant tumors).

Vitamin B12 Daily Requirement 

Age Male Female
0-6 Month 0.4 mcg daily 0.4 mcg daily
7-12 Month 0.5 mcg daily 0.5 mcg daily
1-3 Year 1.2 mcg daily 1.2 mcg daily
4-8 Year 1.8 mcg daily 1.8 mcg daily
9-15 Year 1.8 mcg daily 1.8 mcg daily
16+ Year 2.4 mcg daily 2.4 mcg daily

In Pregnancy daily requirement of Vitamin B12 is 2.6mcg.

In Lactation or Breast Feeding Mother daily requirement of Vitamin B12 is 2.8mcg.

Vitamin B12 is absorbed in the stomach with the help of a protein called intrinsic factor. This substance binds to the vitamin B12 molecule and facilitates its absorption into your blood and cells.

Your body stores excess vitamin B12 in the liver, so if you consume more than the RDI, your body will save it for future use.

You may develop a vitamin B12 deficiency if your body does not produce enough intrinsic factor, or if you don’t eat enough vitamin-B12-rich foods.

There is lot of confusion what should and should not be eaten a vegetarian people in Vitamin B12. 

Vitamin B12 Diet Chart for Vegetarian People and Non vegetarian people

FOOD PORTION VITAMIN B12 (mcg) Description
Milk, (Fat Free Milk) vitamin b12 100ml 0.5mcg You can consume 200ml milk for 1.0mcg.
Yogurt vitamin b12 100gm 0.8mcg 200 gm yogurt can give you 1.6mcg vitamin B12
If you are vegetarian you can consume 200 ml fat free milk and 100gm of yogurt. This is a sufficient value of your daily vitamin B12 requirement. As i have mentioned above, the recommended daily diet is 2.4mcg.
Cheese vitamin B12 100gm 0.8mcg Cheese & Butter is also a good source of Vitamin B12.
Butter vitamin b12 100gm 0.2mcg
Corn flakes vitamin b12 100gm 5.4mcg If You have consume 50gm corn flakes  daily this sufficient value for a pregnant women
Non- Vegetarian diet (Non-veg food is a good source of Vitamin B12)
Egg Yolk vitamin b12 100gm 2.0mcg Non-Veg food is a good source of Vitamin B12. Those people who are non vegetarian it is very rare that they are found to be deficient in vitamin B12. 
Chicken vitamin b12 200gm 0.6mcg
Beef 100gm 2.6mcg
Beef Liver vitamin b12 100gm 18.7mcg
Mutton Lamb vitamin B12 100gm 2.6mcg

Some Other Vegetarian source of Vitamin B12 Available in Market

1- Malt-O-Meal High Fiber Bran Flakes: Contains 8.2 mcg of Vit B12.

2- Kellogg’s Corn Flakes: contains 2.7 mcg of Vit B12.

3- General Mills, Total Corn Flakes: Contains 6 mcg of Vit B12.

4- Kellogg’s All-Bran With Extra Fiber: Contains 24 mcg of Vit B12.

5- General Mills Multi Grain Cheerios: Contains 21 mcg of Vit B12.

6- Kelloggs Complete Oat Bran Flakes: Contains 20 mcg of Vit B12.

7- Kellogg’s Low Fat Granola without Raisins: Contains 12 mcg of Vit B12.

Fruits that should form part of an

Anemia diet include:

Bananas

Apples

Pears

Dark grapes

Apricots

Vegetables that form part of an anemia diet include:

Spinach

Green onions

Other source of Vitamin B12

Vitamin B12 found in meat and other non-veg foods, and these should be added to daily food intake to ensure the vital level of Vitamin B12 is supplied to the body.

Many of the sources of Vitamin B12 are sea food like shellfish, liver of cattle, mackerel fish, sardines, tuna, salmon, cod, shrimp, scallops, crab, and red meat.

Diagnosis Of Vitamin B12 Deficiency

Diagnosis of vitamin B12 deficiency is based on CBC and vitamin B12 and folate levels. CBC usually detects megaloblastic anemia. Tissue deficiency and macrocytic indexes may precede the development of anemia. A vitamin B12 level < 200 pg/mL (< 145 pmol/L) indicates vitamin B12 deficiency. If you are vegetarian and your hemoglobin is very low you should must done your Vitamin B12 test. Tt can be megaloblastic anemia.
Treatment for B12 deficiency Anemia

Treatment for folic acid and B-12 deficiency involves dietary supplements and increasing these nutrients in your diet. If your digestive system has trouble absorbing vitamin B-12 from the food you eat, you may need vitamin B-12 shots. At first, you may receive the shots every other day. Eventually, you will need shots just once a month, which may continue for life, depending on your situation.

Anemia of chronic disease:

There is no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. If symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by

During this period, all three meals should consist of fresh fruits taken at five hourly intervals. Thereafter, a diet of fresh fruits and milk should be followed for the next fifteen days. The only difference during this period is the addition of milk to each meal of fruit, starting with 2 pints of milk every day and moving up to four or five pints every day in ½ pint increments. Thereafter, a well-balanced diet consisting of fruits, vegetables, whole grains, seeds and nuts can be followed.

A careful dietary history is essential to the diagnosis of megaloblastic anemia. The type and quantity of foods should be documented. Medication intake and history of any other contributing medical disorders and infestation needs to be taken. Anemia, anorexia, irritability and easy fatigability are clinical features common to other causes.

Medical Treatment

Treatment depends on the underlying cause. If the cause is not identified, therapeutic doses of folate (1-5 mg/day) and vitamin B12 (1000 µg) are administered. Only folate therapy may correct the anemia, but will not correct cobalamin deficiency-associated neurological disorder and result in the progression of neuropsychiatric complications.

Folate deficiency due to dietary insufficiency or increased demands is best treated with folate supplements. Folate deficiency due to use of anti-folate medications is managed by reducing or eliminating the implicating agent and supplementation with folic acid.

Folate is available as 5 mg tablet and overdose is not associated with any adverse effects; a dose of 1-5 mg/day is recommended for 3-4 weeks.

Parenteral vitamin B12 at a dose of 1 mg (1000 µg) is given intramuscularly; lower doses (250 µg) can be used in infants.

A decrease in MCV, reticulocytosis and higher platelet and neutrophil counts is observed within a few days of therapy.

In patients with pernicious anemia and malabsorptive states, vitamin B₁2 (1000 µg) should be given IM daily for Essential 2  weeks, then weekly until the hematocrit value is normal and then monthly for life. Patients with neurological complications should receive 1000 µg IM every day for 2 weeks, then every 2 weeks for 6 months and monthly for life.

Oral supplements can be administered; however, absorption is variable and may be insufficient in some patients. In dietary insufficiency, no standard duration of therapy has been defined. Dietary counseling is advised, along with vitamin B12 supplements (oral daily or parenteral dose every 3-12 months).

Conclusion

There is a lot of confusion in the mind of people regarding anemia. Patient who are sufferings from anemia they do not understand that the reason of low blood level, but vitamin b12 deficiency can also be occur. People keep taking iron medicines for a long time and there is no difference in them because they don’t know that the cause of anemia can be else. 

If your hemoglobin has been running low for a long time, you are tired of eating iron medicines, then one thing must be done for your Vitamin B12 Test.

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