Vitamin b12 deficiency symptoms tinnitus ear,ear infection treat pain,ringing ears and foggy head numbness - Step 1

The symptoms of vitamin B12 deficiency can impair a wide range of bodily functions, including your neurological, metabolic, and emotional health. A vitamin deficiency is what occurs anytime your body doesn’t have enough of a nutrient that it needs in order to fulfill your basic needs.  Vitamin B12 deficiency is one such type of malnourishment that is sometimes caused by diet, but can also result from other factors, such as autoimmune disorder, medications, illness, or surgical procedures.
Even if you are a meat-eater, you may still be at risk for suffering a slow depletion of vitamin B12. Also, if you regularly suffer gastrointestinal problems, such as diarrhea, vomiting, acid reflux, or stomach ulcers, then you may need to replenish your vitamin B12 levels.
Patients of gastric bypass surgery or ileostomy should also be on the alert for warning symptoms of vitamin B12 deficiency, as removal of the ileum interferes with vitamin B12 absorption. The symptoms of vitamin B12 deficiency manifest themselves in many areas of the body, as vitamin B12 is crucial for a wide range of biochemical functions. Vitamin B12 protects your nervous system by maintaining healthy myelin, a coating that encases each nerve cell, enhancing intercellular communication and preserving nerve cell integrity. Vitamin B12 also regulates DNA synthesis, in supporting formation of healthy red blood cells.
Vitamin B12 also promotes cognitive health, as it helps to delay the onset of dementia caused by old age.
Here is a short list of the most common symptoms of vitamin B12 deficiency, ranging in order from the mild deficiency to severe depletion. If you found this article helpful, then please share with your friends, family, and coworkers by email, Facebook, or Google+. Reproduction in whole or in part in any form or medium without express written permission is prohibited.
Vitamin B12 deficiency is one of the common conditions in the elderly population leading to confusion, depression, memory loss and balance problems.  Unfortunately there is no gold standard test for the diagnosis of cobalamin deficiency and a wide range of variation in reference levels according to country, and laboratory assay used. Vitamin B12 also known as cobalamin, is an essential micronutrient required for proper functioning of the body cells. In the United Kingdom during the period 2008-20094 according to NHS statistics 1152 hospital admissions due to vitamin B12 deficiency resulted in finished consultations, whereas 375 were emergency cases another 873 required hospital admission resulting in a total of 3092 bed days and another 376 were put on a waiting list.
This shows vitamin B12 can be diagnosed in a primary care setting and introduction of screening in carefully targeted risk groups seems sensible.
In the UK as it happens in many other countries the fact remains that vitamin B12 deficiency is often misdiagnosed or under diagnosed. In fact there are no figures to prove the misdiagnosis but the fact that so many older people are presenting with vitamin B12 deficiency suggest there is a tendency to under diagnose this condition. The biggest reason for misdiagnosis is due to the strikingly similar neurological symptoms these conditions share with one another. Now as vitamin b 12 stores may take 5 to 10 years to be depleted so clinicians may miss the diagnosis as serum B12 levels which is the primary diagnostic test may appear normal. Considering all the facts above Vitamin B12 levels may be screened but as this could be costly making it possible only to  screen risk groups who are either prone to develop severe neurological symptoms or are already developing them so follow ups should be encouraged in those who have mild symptoms.
Pregnant women who have vitamin B12 deficiency may give birth to vitamin B12 deficient babies. Neurological signs and symptoms such as pins and needles, numbness, loss of balance, falls, loss of pain and vibration sensations, memory loss, decreased power of limbs or peripheral neuropathy which is mostly symmetrical.
Cardiovascular symptoms and signs such as murmurs, heart failure and syncope are also seen. Complications are Peripheral neuropathy's specially symmetrical mostly involving lower limb but can ascend to upper limbs as well, Other neuropathy's are encephalopathy's, myeloencephlopathy's, myelopathy's. Unfortunately only primary tests are widely available such as routinely performed complete blood picture and serum B12 levels. Serum B12 deficiency can occur without Macrocytic anaemia and blood changes as patients with neurological deficits due to vitamin B12 deficiency have absent haemotogical features.
If there are blood changes B12 Haemoglobin may or may not be decreased, Mcv may or may not  be raised and if raised, it indicates further evaluation  of vitamin B12 deficiency. Anisocytosis, basal stippling, poikilocytosis, abnormal platelets, hyper-segmented neutrophils, thrombocytopenia and presence of Howell jolly bodies.
There are various tests that maybe used for purpose of screening such as serum B12, holo tc, homocystein, serum or urine Methylmalonic acid (MMA) but out of them none is a gold standard and all have certain advantages, and disadvantages. Serum B12 is the primary test routinely used which can give inaccurate results in high folate levels, and vitamin C intake.22 In cases of low Folate levels, Oral contraceptives, pregnancy, multiple myeloma, transcobalamin 1 deficiency, Aplastic anaemia, hairy cell leukaemia, Waldenstorms macroglobinaemia and despite showing vitamin B12 deficiency may be presumed not to be B12 deficient.
MMA or Methylmalonic acid is a more specific test being suggested as a gold standard but very seldom performed though is widely available but usually reserved for borderline cases, deteriorating neurological status or for follow-up. Another test is the active B12, more commonly known as holo transcobalamin or the holoTC test. This test though not as specific as the urinary methyl malonic acid or MMA Test but is more superior to the serum B12 assay.
Homocystein levels are also a better indicator of vitamin B12 deficiency as compared to serum B12 values as blood index Mcv has been found to have a direct relationship with Homocystein levels.
Pernicious anaemia is an autoimmune disease as well as end stage of Atrophic body gastritis that causes acquired vitamin B12 deficiency.

If either history or examination even apparently minor symptoms such as tingling, pins and needles always rule out vitamin B12 Deficiency first. In cases of memory loss or neurological symptoms of vitamin B12 deficiency should be ruled out. Most cases of multiple sclerosis and dementia, atrophic gastritis, Crohn's disease, Coeliac disease ,intestinal or gastric resection, certain drugs such as proton pump inhibitors,H2receptor blockers, Metformin especially long-term will mostly have poor vitamin B12 status and treatment with vitamin B12 may benefit these patients.
Never forget to ask about dietary habits and intake of folate, vitamin c and supplements as if serum B12 is low and urine MMA or shillings test as appropriate may be considered later. If a screening programme was introduced to detect individuals suffering from dementia in care homes what outcomes would be expected? This journal is a member of and subscribes to the principles of the Committee on Publication Ethics.
Vitamin B12 deficiency symptoms may vary for each individual, but the most common symptoms are consistent with the level of vitamin B12 (cobalamin) depletion.
Of all forms of malnourishment, vitamin B12 deficiency symptoms are the most common in the US. If you regularly include plenty of meat, poultry, fish, eggs, and milk in your diet, then you probably won’t develop symptoms of vitamin B12 deficiency, as your body is able to store several years’ worth of vitamin B12 in the liver at one time.  If you are a vegan, then you must supplement with vitamin B12 regularly, in order to prevent vitamin B12 deficiency symptoms. People with a family history for pernicious anemia, a condition sometimes caused by autoimmune disorders, should check their vitamin B12 levels regularly, in addition to looking out for symptoms indicating vitamin B12 deficiency. Illnesses such as Crohn’s disease, migraines, celiac disease, fibromyalgia, and chronic fatigue syndrome are all high risk factors for vitamin B12 deficiency symptoms. This poses a problem in diagnosing this condition making it a commonly misdiagnosed medical entity. Highest figures aetiology wise were for intrinsic factor deficiency and according to age in above 75 years (Table-1). If detected earlier, prognosis may improve as randomised studies on elderly had shown that daily intake of 1-2mg of cyanocobalamin resulted in normalisation of metabolic signs and improvement in neurological symptoms in terms of power, gait, memory, vibration sensations and parasthesia's5 but in some trials it was argued that such long term oral supplements were not effective in reversal of haematological features such as macrocytosis, basal stippling etc. The most common conditions, it is confused with are multiple sclerosis, Alzheimer's disease, lateral amyotrophic sclerosis and peripheral neuropathies. One also has to bear in mind that the vitamin B12 levels can be low independent of Macrocytic anaemia.6 Undoubtedly it is also costing the Nhs a lot of money due to number of admissions preventable as well as costs that incur if complications develop. The incidence of neonatal vitamin B12 (cobalamin) deficiency because of maternal deficiency was determined by a research group surveying United States newborn screening programmes.
Positive Babinskis sign and rarely signs of autonomic dysfunction such as urine incontinence and impotence may be encountered.
Psychiatric symptoms such as depression, personality change, mania, hallucinations delusions, irritability, mood changes may develop. Optic neuropathy's, though uncommon, are visual evoked potentials can be abnormal in even up to 77 percent of patients.  Other more common complication' are Macrocytic anaemia and sub acute combined degeneration of spinal cord. It may rise even before fall in haemoglobin levels but its absence does not rule out B12 deficiency and it is not a specific marker as using it solely would miss 84 percent cases. Serum B12 assay though widely used has the disadvantage that it does not differentiate between the active B12, which constitutes roughly 20 percent of B12 bound to Transcobalamin 2 and the inactive form which is 80 percent.
Holo tc levels are decreased when B12 levels decrease signifying a direct relationship between holo tc and B12. Methyltetrahydrofolate and vitamin B12 (cobalamin) are required for remethylation of homocystein (Hcy) to methionine, which is mediated by methionine synthase and methionine synthase reductase.33 Therefore, intracellular availability of vitamin B12 influences total Hcy (tHcy) plasma concentrations.
It is associated with many other autoimmune diseases such as diabetes and autoimmune thyroditis. It has been hypothesized that changes in holo-TC in response to a supplemental dose of vitamin B-12 may be used to assess vitamin B-12 absorption.
It is easier and more efficient to treat vitamin B12 deficiency as other nutritional deficiencies in the preoperative stage and can be prevented. Referral to a neurologist may be indicated in such cases where severe neurological deficit is present. Butler CC, Vidal-Alaball J, Cannings-John R, McCaddon A, Hood K, Goringe A, Mcdowell I, et al. Hinton CF, Ojodu JA, Fernhoff PM, Rasmussen SA, Scanlon KS, Hannon WH.Maternal and neonatal vitamin B12 deficiency detected through expanded newborn screening--United States, 2003-2007. Weisfeld-Adams JD, Morrissey MA, Kirmse BM, Salveson BR, Wasserstein MP, McGuire PJ, et al. This blog is dedicated to providing up to date research, news and resources pertaining to vitamin B12, general health information surrounding the benefits of vitamin B12. Here are some warning signs that may indicate the earliest or most advanced stages of vitamin B12 deficiency, including pernicious anemia.
There is current emphasis on need for clearer guidelines and much research is still being done to pave ways to determine better reference values for serum B12 and other screening tests. It takes part in two known reactions of body cells as a coenzyme and is involved with myelination of nerves ensuring conduction of nerve impulses and formation of red blood cells.
Vitamin B12 deficiency may result in complications such as sub combined degeneration of spinal cord.

The results indicated on an average 30 percent less brain shrinkage was seen in those receiving vitamin B12 being 50 percent in those who started on highest dose of vitamin B12. Nerve conduction studies show abnormal peroneal and sural nerve conduction and Tibial somatosensory evoked potential may show abnormality.
The tests lack sensitivity as the B12 levels depletion as well as Macrocytic anaemic picture may take years to develop despite the risk being there .Also the cut off levels for different laboratories are different. Absence of B12 causes accumulation of methylmalonyl-CoA and subsequent conversion to Methylmalonic acid (MMA), resulting in elevated serum MMA levels in B12 deficiency states.25 Specificity is 98 percent and can be false positive in case of deteriorating renal status. Imurseland-Grasbeck syndrome is a rare inherited autosomal disorder characterised by vitamin B12 deficiency with selective absorption of B12 and proteinurea is another cause of malabsorption.
Comparison of clinical and electro diagnostic features of vitamin b12 deficiency neurological syndromes with and without antiparetal bodies. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. Homocysteine lowering by B vitamins slows the rate of accelerated brain atrophy in mild cognitive impairment: a randomized controlled trail. Newborn screening and early biochemical follow-up in combined methylmalonic aciduria and homocystinuria, cblC type, and utility of methionine as a secondary screening analyte.
Atrophic glossitis from vitamin B12 deficiency: a case misdiagnosed as burning mouth disorder. Subacute combined degeneration of the spinal cord with involvement of the anterior columns: a new MRI finding. Vitamin B12 deficiency neurological syndromes: a clinical, MRI and electrodiagnostic study.
Diagnostic value of the mean corpuscular volume in the detection of vitamin B12 deficiency. In vitamin B12 deficiency, higher serum folate is associated with increased total homocysteine and methylmalonic acid concentrations. Masked deficit of vitamin B12 in the patient with heterozygous beta-thalassemia and spastic paraphrases. Influence of cobalamin deficiency compared with that of cobalamin absorption on serum holo-transcobalamin II. Increases in Plasma Holotranscobalamin Can Be Used to Assess Vitamin B-12 Absorption in Individuals with Low Plasma Vitamin B-12. Renal impairment compromises the use of total homocysteine and methylmalonic acid but not total vitamin B12 and holotranscobalamin in screening for vitamin B12 deficiency in the aged. Solid phase sample extraction for rapid determination of methylmalonic acid in serum and urine by a stable isotope dilution method. Influence of oral S-adenosylmethionine on plasma 5-methyltetrahydrofolate, S.adenosylhomocysteines, homocysteine and methionine in healthy humans. Erythrocyte mean cellular volume and its relation to serum homocysteine, vitamin B12 and folate.
Learn from, and contribute to information on B12, vitamin B12 and other connected subjects.
It is advised that screening methods are used adjunctively for the purpose of screening individuals.
Moreover people having pernicious anaemia are at a very high risk of developing gastric carcinoma. Visual evoked potentials have been found to be abnormal18 but mostly don't clinically become apparent showing that B12 tissue damage manifests at later stages of vitamin B12 deficiency. It is estimated that this method used alone may result in up to 50 percent misidagnosis26 whereas the holo tc test is more specific only picking up the active B12 which is subjected to tissue intake making it a more valuable test. It results in recurrent infections and failure to thrive mostly appearing at childhood and results in megaloblastic anaemia as well as neurological symptoms which can be screened for in childhood. Assessment of the diagnostic utility and cost-benefit analysis of methylmalonic acid determination in relation to current diagnostic strategies. Pernicious anaemia which is considered to be an autoimmune disease itself is specially associated with autoimmune disorders.3 Knowledge of important key points pointing to the diagnosis of this condition is essential for every clinician so we will try to highlight some significant diagnostic criteria in this review. Sometimes this fact may result in missing vitamin B12 deficiency if a more specific test such as the MMA is never done. Advantages of this test besides being an early B12 marker, are that it is a comparatively better marker of long term status and does not show great circadian variation. Possibly neurologists could screen vitamin B12 deficiency but the problem is MMA is not a cost effective way of screening and yet no agreed consensus exists on a single screening method.

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