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Detect and treat vitamin B12 deficiency on time

Vitamin B12 deficiency and its consequences

22 Feb 2023

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Detect and treat vitamin B12 deficiency on time

What does the body need vitamin B12 for?

B12, also cobalamin, is a water-soluble vitamin that your body needs for numerous metabolic processes. B12 enables, for example

  • cell division and blood formation,
  • the breakdown of fatty acids,
  • the detoxification of the cells as well
  • the conversion of the folic acid stored in the body, which is very important for your health.

According to the


of the German Nutrition Society (DGE), healthy people aged 15 and over should take sround 4.0 micrograms (µg) of B12 daily. Pregnant and lactating women have a higher need, which is at 4.5 µg and 5.5 µg.

Causes: How does a vitamin B12 deficiency arise?

A deficiency arises when

  • Your diet does not contain enough vitamin B12, or
  • Your so-called intrinsic factor is too low: Vitamin B12 binds to the transport protein intrinsic factor. With this, it is passed through the intestinal mucus wall and thus made available to the body cells.

What leads to a vitamin B12 deficiency?

A vitamin B12 deficiency can have very different causes, including:

  • insufficient intake of the vitamin through the diet,
  • increased need,
  • various diseases as well
  • advanced age.


Because the body can't produce vitamin B12 itself, we have to take it in with food. B12 is mainly found in meat and fish, but also in eggs and dairy products, but in much smaller quantities. Especially vegetarians and vegans don't get enough of the classic B12 sources.

Increased need

If you are pregnant or breastfeeding or under persistently high stress, you need significantly more vitamin B12. You should adjust your diet accordingly or use appropriate preparations.


Because vitamin B12 enters the body through the gastrointestinal tract, chronic and acute diseases of the gastrointestinal tract restrict B12 supply. Your body can't absorb enough vitamin B12, for example in diseases such as ulcerative colitis or Crohn's disease, gastritis, celiac disease or pernicious anemia, which destroys the stomach lining


In old age, several factors can promote a B12 deficiency.

  • Many older people have difficulty chewing. To avoid pain or other inconveniences, stop eating meat and therefore B12.
  • The body can't utilize the vitamin B12 ingested sufficiently because medication causes gastrointestinal problems or old age diseases impair the absorption of the vitamin into the body.
  • In general, the ability to absorb and utilize vitamin B12 from food decreases in old age.

Who is susceptible to a vitamin B12 deficiency?

Certain groups of people are particularly vulnerable to a lack of B12. These are:

  • Vegetarians or vegans,
  • Older people,
  • People suffering from diseases of the gastrointestinal tract
  • People who are under constant stress
  • Patients who are taking certain medications.

Symptoms: How does a vitamin B12 deficiency show itself?

The symptoms of a vitamin B12 deficiency often only appear after a few years, because a healthy person can store cobalamin in the liver for up to three years. The shortage only becomes noticeable when the reserves are used up. At first, the symptoms are rather inconspicuous and very diverse. They do not always lead to the correct conclusion straight away.

These signs can indicate a vitamin B12 deficiency:

  • General exhaustion,
  • Lack of drive,
  • Severe fatigue,
  • Increased susceptibility to infections and
  • Great need for rest.

The following symptoms also often occur:

  • Memory and concentration disorders,
  • Mood swings,
  • Circulatory problems,
  • Dizziness,
  • Increased risk of falling due to wobble and dizziness.

Consequences of a B12 deficiency

  • One consequence that should not be underestimated is pernicious anemia. This type of anemia (anemia) affects the production of red blood cells; it manifests itself in a particularly pale complexion.
  • Digestive problems can be both a trigger and a consequence of a B12 deficiency.
  • If treatment is missed or starts too late, some symptoms can't be resolved. This can be hair loss or loss of sense of your smell and taste.

How is vitamin B12 deficiency diagnosed?

A temporary vitamin B12 deficiency is not life-threatening if it is diagnosed early. The doctor can determine the deficiency in different tests, including:

  • Blood test
  • Holo TC test
  • Urine test

If you suspect a vitamin B12 deficiency, a blood test is recommended first. The value of the cobalamin in the blood is determined. Even if this value is still just within the normal range, you can't rule out a B12 deficiency, especially if you are a senior citizen.

Then the Holo-TC (Holo-Transcobalamin) test is recommended. It is a version of the B12 that transports the nutrient from your blood into the cells. A blood test has shown sufficient cobalamin, but that alone is not yet meaningful enough./p>

A good option is also a urine test. Your morning urine will be examined for methylmalonic acid. If this value is too high, this indicates a vitamin B12 deficiency.

How can a vitamin B12 deficiency be remedied?

The best way to treat or prevent a B12 deficiency is to eat consciously: Above all, animal foods provide B12. The richest B12 sources are

  • Shellfish
  • Innards, such as liver and kidney from beef, lamb and veal

An overview of foods containing vitamin B12, including non-animal products, can be found here.

You can already consume around 4.5 µg B12 with a lean piece of cooked beef (100 g), which is even more than the daily requirement for an adult. A portion of cooked salmon (70 g) contains around 2.9 µg B12 and forms a good basis. For vegetarian diets, choose dairy products: two servings (60 g) of Camembert (30% fat in dry matter) offer around 1.9 µg B12. A portion (100 g) of mozzarella (20% fat in part) comes to 2.0 µg B12.

As a vegan, it is much harder to reach the recommended daily value because there are hardly any vegan sources of vitamin B12. Foods that still contain traces of the vitamin include mushrooms, various types of algae, unpeeled and unwashed root vegetables (carrots, beetroot) and fermented vegetables (such as sauerkraut).

Which preparations treat the vitamin B12 deficiency?

Alternatively or additionally, food supplements with B vitamins or folic acid promote a balanced vitamin balance, especially for vegetarians and vegans. Because you can't always prevent a B12 deficiency through the food consumed. Do not wait until the deficiency shows up with the first symptoms. You can act preventively with B12 preparations, which are available in various dosage forms:

  • as tablets or lozenges and capsules,
  • as a spray or drops or even
  • in the form of injections.

The latter only comes into consideration in the case of severe absorption disorders for B12. They have a storage effect, which is why four injections per year can be sufficient. Taking tablets and capsules is easier.

Read here which B12 forms and preparations are recommended and when.

What needs to be considered when dosing?

The dosage depends on the reason for the treatment: If there is a deficiency, you need a larger B12 dose than for the prevention of a deficiency. If you want to replenish your body's storage due to a deficiency, you should consume about 1000 µg per day for three to six months, alternatively 5000 µg for a period of four weeks. The recommended daily dose for stabilizing your B12 level is between 10 and 1000 µg.

You don't have to worry about an overdose because your body excretes any excess, for example via the kidneys. Therefore, you don't have to expect unwanted side effects, even when taking high-dose preparations.

Related articles


Vitamin B12 - What you should know!

Vitamin B12 is an essential and water-soluble vitamin that fulfils many important functions in the body. This includes the support in the production of red blood cells, as well as in the development and function of the nervous system. Vitamin B12 is ingested through food; vitamin B12 is only present in food of animal origin. Vegans and vegetarians are therefore particularly at risk of suffering from a vitamin B12 deficiency. This also applies to older people, as the ability to absorb and utilise vitamin B12 from food decreases with age.

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