Vitamin B12 is a popular subject nowadays although reasons for deficiency are usually not linked to insufficient intake from food. A person with mixed diet gets vitamin B12 from food manyfold compared to daily suggested dosing and due to long half-life we have B12 stores in the liver and kidneys for many years. Main sources of vitamin B12 for such people are meat, dairy and fish. Risk group includes vegans and vegan-mothers´ babies because whole plant-based food without vitamin B12 supplements and/or food enriched with vitamin B12 does not include the active form of vitamin B12 . Also people with mixed diets and their babies suffer more and more from vitamin B12 deficiency due to lower intake of animal products but at the same time no good sources of vitamin B12 are added to replace the animal products (e.g. plant-based “milk”, “yoghurt”, “cheese” and B12 enriched yeast etc.). Vitamin B12 is found from certain type of seaweed but due to uncertain amount of iodine, seaweed is not recommended as a source of vitamin B12 for regular consumption .
B12 DEFICIENCY IS OFTEN LINKED TO MALABSORPTION:
- malabsorption in case of stomach or small intestinal diseases or after surgeries due to insufficient amount of intrinsic factor glycoprotein needed for vitamin B12 active absorption. Also removal of intestine´s certain part may lead to malabsorption of vitamin B12. Read more about the absorption of vitamin B12 from HERE.
- (chronic) atrophic gastritis, i.e. inflammation of stomach mucosa may lead to malabsorption. The reason behind atrophic gastritis may be autoimmune disease (pernicious anemia) or Helicobacter pylori infection (very common).
- pernicious anemia, i.e. lack of intrinsic factor – a person lacks the ability to synthesize intrinsic factor glycoprotein that is needed for B12 active absorption.
- small intestinal parasites (e.g. diphyllobothrium that belongs to the family of tapeworms)  .
WHAT HAPPENS IN CASE OF VITAMIN B12 DEFICIENCY?
Unlike iron deficiency anemia, when red blood cells are smaller in size, in case of long-term vitamin B12 deficiency megaloblastic anemia can develop – red blood cells are bigger in size than normal, which is diagnosed by blood test. Vitamin B12 is also needed for normal development of myelin (a substance surrounding nerve fibers). In case of vitamin B12 deficiency myelin is damaged and transmission of nerve impulses is disturbed, thus a person may suffer from nervous system disorders  . If a person uses folate or folic acid in big amounts, megaloblastic anemia may not develop but body still lacks of vitamin B12. Myelin damage can develop to permanent nervous damage .
WHAT ARE COMMON SYMPTOMS OF VITAMIN B12 DEFICIENCY?
Different nervous system disorders (due to myelin damage), tongue inflammation (rasberry red sour tongue) and macrocytosis of blood cells, i.e. abnormally big red blood cells that can be diagnosed by blood test. A person may also suffer from paleness, loss of appetite, diarrhea, lack of power and tiredness that are usually linked to anemia.
Vitamin B12 deficiency is diagnosed by blood test. In case of already developed megaloblastic anemia, low hemoglobin and hematocrit level, low amount of red blood cells and abnormally high red blood cell indices (MCV, MCH and MCHC) are common. Leukopenia (lack of white blood cells) and trombocytopenia (lack of trombocytes) are also common. Vitamin B12 level is low and homocysteine level may have increased. As in case of iron deficiency, which we have covered a lot, it is also important to find out the reason for vitamin B12 deficiency  .
Nôgel VITAMIN B12 DROPS FOR INFANTS AND CHILDREN
- developed in co-operation with famous Estonian children neurologist
- 1 drop consists of 100 μg of MecobalActive® methylcobalamin – one of the purest vitamin B12 forms produced in an environmentally friendly way
- only three ingredients: water, B12 and organic lemon juice to guarantee shelf life
- the first pure liquid methylcobalamin product in Estonia that consists of a small amount of vitamin B12 and is meant specifically for infants and toddlers -> it is easier for medical staff to make dosing guidelines and the risk for over- or underdosing (when one drop is given less or more) is small
- methylcobalamin is the safest form of vitamin B12 for infants, toddlers, pregnant and nursing women
- thanks to its pink colour (methylcobalamin´s powder is pink) it is easy to see if a drop is missed
- suitable for all family members (the amount of vitamin B12 can be changed according the daily amount of drops)
- 1 bottle = 330 drops
- product is meant for oral consumption for absorption through small intestine (drop on the tongue) or to dose below tongue for absorption through mucosa
TREATMENT OF VITAMIN B12 DEFICIENCY
Depending on the reason of vitamin B12 deficiency, doctors prescribe treatment. If the reason is insufficient intake from good, a person should eat good sources of vitamin B12 and if needed use vitamin B12 supplement for some time. If the reason is not linked to food but due to malabsorption, treatment can be for the entire life and includes usually injections  . Vitamin B12 is regarded as a safe vitamin, toxic effects have not been found even in high daily doses. Therefore e.g. in Estonia there is no maximum daily amount of vitamin B12 .
 A. Aro, M. Mutanen, M. Uusitupa. Nutrition Science, 4.–7.volume, 2017.
 Pernicious anemia. Tartu University Hospital Hematology-Onkology Clinic.