Treatment Options for Vitamin B12 Deficiency

Vitamin B12 deficiency is very treatable. Early diagnosis and treatment improves prognosis and can prevent serious complications such as nerve damage, anaemia, or dementia. Treatment is started if your serum vitamin B12 level is less than 148 picomols/L (<200 picograms/mL) or you have symptoms indicative of vitamin B12 deficiency. Clinical response and improvement in serum B12 levels during follow-up confirms vitamin B12 deficiency.

If you have vitamin B12 deficiency, the doctor will give supplements to replace the body’s depleted stores of vitamin B12.

Vitamin B12 can be given by the following ways:

Oral Vitamin B12 Supplement: This involves giving high doses of an oral vitamin B12 supplement. Most people with B12 deficiency are treated with an intramuscular B12 injection. However, this is highly surprising, as most studies have shown that oral B12 supplementation is as effective as intra-muscular B12 administration.

Vitamin B12 Injections: You may be given shots of vitamin B12 into a muscle. In the initial phase of treatment, injections may be given 2-4 days per week. After blood tests show improvement, injections may be continued on a monthly basis. Intramuscular injections are safe and inexpensive but have many drawbacks. Disadvantages of intra-muscular B12 supplementation as compared to oral B12 include:

• Injections are quite painful and can be distressful for patients.
• Increases the cost of treatment (as it must be given in either a healthcare facility or at home by a visiting healthcare professional).

People with conditions that prevent absorption of vitamin B12 may have to be given injections. These people may need life-long treatment.

Intranasal Vitamin B12: This involves giving vitamin B12 in the nose. The medication is placed in the nose.

Sublingual Vitamin B12: Vitamin B12 may also be given in sublingual form (i.e., it is placed under the tongue).

Diet modification: In addition to starting supplements, the doctor will also recommend including foods rich in vitamin B12 in your diet such as red meats, poultry, fish, and dairy products. Vegetarians may include breakfast cereal, soy foods (soy milk and tofu) and other foods fortified with vitamin B12. Vitamin B6 helps in proper absorption and storage of vitamin B12. So including foods rich in this vitamin such as spinach, walnuts, poultry, avocados, bananas and brown rice in your diet is recommended.

Other considerations

• Treatment with antibiotics: If your doctor suspects bacterial overgrowth in the intestines as the underlying cause of deficiency, you will be given antibiotics. The bacteria compete with the body to absorb the vitamin B12 in the intestines and thus lead to its deficiency.
• Avoid excessive alcohol: People with vitamin B12 deficiency because of excessive alcohol consumption should stop alcohol use. Alcohol leads to gastritis and damages the lining of the intestines. These can interfere with vitamin B12 absorption. Iron and folic acid supplementation: When treatment with B12 is started, it increases haematopoiesis and can lead to rapid depletion of folate and iron stores. If folate and iron become deficient, it can limit the expected recovery of Hb. Hence along with B12 replacement, the health care professionals start both iron and folate supplements.

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