B-12 deficiency
Do you have a Vitamin B-12 deficiency?
Causes and factors that influence vitamin B-12 levels in the body
Vitamin B-12 is a type of water-soluble vitamin also called cobalamin. It is naturally present in some foods, to others it is added, and it is also available as a dietary supplement or prescription medication. This is a type of vitamin that takes part in red blood cell formation, function of the neurological system and DNA synthesis.
Vitamin B-12 can indicate different conditions in the functioning of the body. For example, if a person has levels of the vitamin which are out of range, that means that, this person requires some kind of a treatment. If a person has lower levels of vitaminB-12, that can cause some neurological symptoms such as fatigue, constipation, and weight loss. On the other hand, high levels of vitamin B-12 may indicate liver disease, diabetes and other illnesses.
Luckily, a person can easily check the levels of the vitamin in his body by doing a test. Abnormal levels of the vitamin in the body indicate different symptoms. There are a couple of cases when doctors order a person to check the level of B-12. For example, they suspect deficiency of the vitamin ,when a person is confused or shows signs of depression, dementia, problems maintaining balance, fast heartbeat, poor memory, sore mouth or tongue, numbness and tingling of the hands and feet.
Infants with B-12 deficiency fail to thrive. Their development may be delayed, and they could experience movement problems.
Doctors will also recommend the B-12 level test to a person that suffers from pernicious anemia. This illness causes low levels of red blood cells, which results in inability to absorb B-12. Constipation, weight loss, pale skin, weakness, loss of appetite, fatigue are some of the symptoms of pernicious anemia.
Pernicious anemia is an autoimmune condition that affects the stomach. This is a rare condition, with a prevalence of 1 percent in the general population and 1.9 percent in the people who are older than 60 years, according to a study from 2012 in the Journal of Blood medicine. The name “pernicious” comes from the time when this disease was “deadly”, and there was no cure for it. Today, though, it can be treated by adding a B-12 supplement to your diet or have regular check-ups and B-12 injections at your GP’s office.
One of the reasons that may cause not recognizing B-12 deficiency is having a high serum folate levels of folic acid in the blood. This condition can mask the symptoms of a B-12 deficiency, which makes its neurological symptoms worse.
High levels of B-12, on the other hand, can lead and show an early sign of liver disease, diabetes, and some forms of leukemia. If the test shows abnormally high levels of B-12 in the blood, you should definitely pay a visit to a doctor’s office – be it a GP or a specialist. People with digestive issues and low stomach acids are more likely to have B-12 deficiency. Body needs strong stomach acids to separate B-12 from the food so it can be easily absorbed.
There are a few categories of people which are kind of vulnerable in the case of B -12 deficiency. Children and older adults, vegans and long term vegetarians, diabetics, people with celiac disease, Crohn’s disease which a kind of diseases which cause low absorption of vitamin B-12, also people with gastric bypass surgery, breast-feeding mums, and people who take medications such as chloramphenicol proton pump inhibitors, or H2 blockers and others.
Atrophic gastritis, immune system disorders such as lupus or Graves disease, may also be a reason for developing a B-12 deficiency.
How can you do the B-12 level test? There are two ways you can check it: urine and a standard blood test. Normal range of the vitamin in the body is between 200-900 nanograms per milliliter ng/ml. Low range of vitamins is when levels show results under 200 nanograms per milliliter and high level status is the one above 900 nanograms per milliliter.
If the case is low B-12 vitamin levels or deficiency, found in the human body as mentioned before, this may be a sign of pernicious anemia, also an overactive thyroid, neurological symptoms may occur as well. Abnormal high levels of the vitamin may indicate presence of some types of leukemia, kidney problems or diabetes.
It is important to know that some of the medication we take may also affect the result of the test. That is why it is important to mention it to the doctor. Another important thing is discussing the results with your doctor because they may vary from one to another laboratory.
Medical issues are not the only factor that causes B-12 deficiency. Vegans and long term vegetarians for example do not get enough vitamin B-12 from their diet. Rich with B-12 vitamins are: meat, eggs ,fish and seafood dairy products, fortified plant-based dairy alternatives, fortified breakfast cereals, fortified nutritional yeast. Vegan diets are high in fiber and low in fat, but the biggest concern of the doctor is the lack of B-12 vitamin which is not a myth. Still, vegan or not, a healthy and balanced diet is essential for anyone. It is recommended for older adults to take supplements of B-12 vitamin because it is easier for them to absorb it when extracted, than from natural food. Recommended daily take of vitamin B-12 for adults and adolescents older than 14 years is 2.4 micrograms. Pregnant women are supposed to take 2.6 and breast- feeding mums 2.8 micrograms.
The average recommended amounts are:
- Infants up to age 6 months: 0.4mcg
- Babies age from 7-12 months: 0.5mcg
- Children age from 1-3 years: 0.9mcg
- Children age from 4-8 years: 1.2mcg
- Children age 9-13 years: 1.8mcg
- Teens age 14-18 years: 2.4mcg
Vitamin B-12 is essential for body functioning. Liver, beef, sardines, clams, dairy products, vitamin supplements and fortified food are the richest sources of cobalamin. So, whenever you want to increase your vitamin sources or prevent deficiency eating this food will improve your overall health.
Symptoms of Vitamin B-12 Deficiency
Vitamin B12 deficiency can have a number of different consequences for a person. Understanding the symptoms of vitamin B12 deficiency is important if you are to ensure that you remain fit and well. Furthermore, understanding the most notable and important symptoms of vitamin B12 deficiency is also important for helping to inspire you to achieve your daily intake of vitamin B12, be this through natural sources or supplements.
What is Vitamin B12?
Vitamin B12 is an essential part of our diet. Otherwise referred to as cobalamin, it is primarily used by the body for the production of red blood cells. It is also important for producing DNA in the body, thereby meaning it is essential for every aspect of life.
Vitamin B12 is readily found in animal products, such as meat, eggs, and dairy produce. Certain products are also fortified with vitamin B12, however this may not be a great enough amount for people who cannot take in enough of the vitamin from their diet.
Those who are most at risk of becoming deficient in vitamin B12 include the elderly, those who have undergone bowel surgery, and those who are following a very strict vegan diet. In addition, long-term antacids or metformin can also interfere with the body’s ability to absorb vitamin B12 from the diet.
If you are struggling with vitamin B12 deficiency, there are some signs that you should look out for. These signs could indicate that you might need to change your diet to incorporate more vitamin B12.
Key Symptoms of Vitamin B12 Deficiency
There are many different symptoms of vitamin B12 deficiency. A lot of these symptoms are similar to other conditions, too, so it is important that you make sure that you are suffering from a vitamin B12 deficiency and not something else.
#1 Anaemia Symptoms
Vitamin B12 deficiency will almost always lead to anaemia. As such, the symptoms of general anaemia are usually among the most notable of the symptoms of vitamin B12 deficiency.
There are numerous symptoms of anaemia, and since anaemia is arguably one of the most common symptoms of vitamin B12 (folate) deficiency, it is worth being aware of them. The most obvious symptoms of anaemia will include a loss of appetite and weight loss, coupled with pale skin due to a lack of red blood cells in the body making the skin appear whiter than usual.
Often, someone who is suffering from anaemia will feel more tired than normal, perhaps for no obvious reason. This fatigue is usually coupled as well with lethargy (a distinct lack of energy). A short period of exercise may leave you feeling breathless and faint. In addition to this, people suffering from anaemia often also experience headaches and heart palpitations, which result in noticeable heartbeats. Tinnitus—where the individual hears sounds coming from inside their own body, instead of the sounds that we usually hear around us—is also common.
#2 Jaundice or Pale Skin
One of the most common symptoms of vitamin B12 deficiency is discolored skin. This could either be pale skin, caused by anaemia as a result of the vitamin B12 deficiency, or could otherwise have jaundice like symptoms with pale yellow skin. Both of these skin discolorations could be indicative of a vitamin B12 deficiency, especially if you have other symptoms as well.
#3 Mouth Ulcers
Another common symptom of vitamin B12 deficiency is mouth ulcers. Mouth ulcers are incredibly common symptoms of a B12 deficiency and can be incredibly painful for someone to have to deal with.
#4 Irratibility and Declining Mental Abilities
One of the most notable symptoms of vitamin B12 deficiency is that of declining mental abilities. Someone who is struggling with a vitamin B12 deficiency will often find themselves feeling irritable and easily frustrated.
In addition to this, a lot of people struggling with the condition will often struggle with some of their basic mental abilities; these struggles can include memory difficulties, as well as trouble with understanding and making judgement calls. These symptoms are often concurrent with the common signs of dementia.
Depression can also be a sign in this regard. A lot of people who find themselves struggling with irritation and frustration resulting from the deficiency will also fall into depression at some point. This, in turn, can lead to further changes in the way that you think, feel and behave.
#5 Glossits
Glossitis is a condition that can often develop as a result of a vitamin B12 deficiency. The condition is characterized by soreness of the tongue and the mouth, resulting from inflammation and swelling.
It is similar in nature to some other conditions of the mouth, including the notable condition that is burning mouth syndrome. However it differs from this in the fact that glossitis causes obvious and visible changes to the surface of the tongue whereas burning mouth syndrome does not result in this sign.
#6 Vision Disturbance
One symptom of vitamin B12 deficiency that is worth considering is that of the vision disturbance that the condition can cause. Vitamin B12 deficiency can result in troubles with your vision, which often include an inability to focus normally as well as blurred vision.
This can have serious impacts for both your mental and physical wellbeing. It may, however, be a symptom of vitamin B12 deficiency that you do not necessarily notice until it has progressed. This is largely due to the fact that the change is usually gradual and so is not overly noticeable until the latter stages.
Treating Vitamin B12 Deficiency
Vitamin B12 deficiency is a frustrating condition to have to live with. Luckily, unlike some other types of conditions, increasing the amount of vitamin B12 in your diet isn’t necessarily a challenge.
There are numerous supplements available on the market for vitamin B12, and your doctor should also be able to help you find a way of absorbing more vitamin B12 from your diet as well. Doing this should help you to begin recovering from the deficiency.
Why and when should you check your vitamin B-12 blood levels?
One of the vital nutrients for maintaining good health is vitamin B-12. The body requires this essential nutrient at steady levels for carrying out several bodily functions like producing red blood cells and DNA along with sustaining brain health and proper functioning of the nervous system.
Most of the people who follow a well-balanced diet, rarely experience low vitamin B-12 levels. But there occur some reasons when these levels dip below the normal limit. Those with vitamin B-12 levels outside the normal levels will need treatment. An easy blood test will note if its levels are within the normal range, low or around in between.
Vitamin B-12 at low levels can result in neurological symptoms, in addition to fatigue, temporary infertility among women, weight loss, and constipation. Raised levels of B-12 can be an indication of diabetes, liver disease, or certain kinds of leukemia.
Why should you get your vitamin B-12 blood levels tested?
Vitamin B-12 blood levels help in diagnosing the cause of neuropathy or anemia, in evaluating the nutritional status among some population, and monitoring the efficacy of a treatment plan for folate or vitamin B-12 deficiency.
Vitamin B-12 test can also be ordered by your doctor in the presence of a condition that can predispose you to B-12 deficiency.
Moreover, this test can also be regularly recommended as a part of the treatment plan on a long term basis to those experiencing a condition that causes its chronic deficiency.
When should you get your vitamin B-12 levels checked?
The blood test for vitamin B-12 checks its concentration in the body’s bloodstream. The result of this test can help the medical professional in determining if the abnormal levels of B-12 are resulting in the symptoms.
The doctor can recommend testing vitamin B-12 in the following conditions:
Suspected Deficiency of Vitamin B-12:
Vitamin B-12 deficiency occurs very common among many people. Researchers agree that 1.5-15% of America’s population experience deficiency of B-12. Most people, particularly the elderly population and those with intestinal problems, face trouble in absorbing this nutrient from food as well as oral supplements.
The symptoms of its deficiency include:
- Numbness, tingling, or/and burning sensation in hands, feet, legs and arms
- Trouble in maintaining balance, dizziness
- Difficulty in breathing
- Racing heart rate
- Depression
- Forgetfulness or confusion
- Dementia
- Muscle weakness, fatigue
- Paranoia, irritability
- Decreased appetite
- Diarrhea
- Pale skin
- Sore mouth and tongue
Infants who experience B12 deficiency might fail in thriving and face movement problems along with delayed development as well.
Pernicious Anemia:
You might also have to take vitamin B-12 test if you have a condition called pernicious anemia. In this disorder, the intestines are unable to absorb B-12 that is essential for the production of red blood cells. Its symptoms do not usually occur in people below 30 years and is diagnosed at the age of 60 years on average.
Its symptoms include the following:
- Constipation or diarrhea
- Exhaustion
- Pale skin
- Decreased appetite
- Bleeding gums or inflamed tongue
- Weakness, fatigue
- Weight loss
Elevated levels of Serum Folate
Your doctor can also recommend testing vitamin B-12 in case of elevated levels of serum folate, which is the concentration of folic acid floating in your bloodstream. Folic acid plays an essential role in the growth of your body and in development and production of platelets, white blood cells, and red blood cells.
As per the National Institute of Health, raised levels of serum folate can mask your vitamin B-12 symptoms and further worsen them. In addition to this, they can spike the possibility of anemia as well.
Other Conditions:
The abnormally high levels of vitamin B-12 can be one of the early indicators for diabetes, liver disease, or certain kinds of leukemia. The test results of vitamin B-12 can help a doctor in forming their diagnosis.
What Vitamin B-12 Test involves?
Doctors usually order the blood test for checking the status of vitamin B-12; however, home urine testing is also available. The doctor may check B12 as a component of a basic blood test.
Though fasting isn’t necessary for testing vitamin B-12, the person might be required to in case the doctor also wants to use the test for looking at other health markers like cholesterol and glucose.
Furthermore, all individuals need to inform their doctor regarding the intake of any medications or supplements before taking the test, as some of these can influence the results.
Interpretation of Results
The range of vitamin B-12 results can vary a little from one lab to another, so it is important to ask your doctor about them. The results can be:
- Normal: Vitamin B-12 under normal conditions ranges from 200-900 nanograms per milliliter (ng/mL) in the bloodstream. Those on the lower limit of this level may need further testing, particularly if they are experiencing symptoms.
- Low: Vitamin B-12 level less than 200 ng/mL is considered low. This result proposes pernicious anemia, B-12 deficiency, hyperthyroidism, or internal parasite.
- High: The level of vitamin B-12 above 900 ng/mL is considered high. This may indicate diabetes, liver disease, kidney failure, or certain kinds of leukemia.
In certain cases, the doctor might test folate levels for further evaluation of B12 deficiency as low folate can result in similar symptoms as low vitamin B-12.
Moving Forward
In the presence of healthy levels of vitamin B-12, there is nothing to add but continue the intake of a well-balanced diet. Vitamin B-12 sources include eggs, dairy, meat, fish, and some other food items fortified with this nutrient, such as milk, cereal, and yeast.
However, if your B-12 levels are low, you will most likely require supplementation of B-12 through injections or with oral supplements relying on the ability of your stomach in absorbing this vitamin.
Elderly individuals, children, the ones taking medicines like proton pump inhibitors, H2 blockers, or chloramphenicol; breast-feeding mothers, people suffering from diabetes and conditions which decrease B-12 absorption, which include Crohn’s disease and celiac disease, and vegans are at a greater risk for developing low vitamin B-12 levels.
Who needs vitamin B-12 injections?
Things we need to know about Vitamin B-12
Vitamin B-12 is a nutrient which is needed for several things that keep our body going every day. First of all it is really important for brain function and it also keeps the body’s nerve and blood cells healthy.
On the other hand, our energy production is influenced as well by the level of B-12 vitamin in our bodies. It is a crucial B vitamin, and people who are over 14 years old should take more than 2.4 mcg ( micrograms) of Vitamin B-12 daily. This Vitamin can be found in every animal product and it does not usually occur in plant food, which leads to the fact that vegans are more likely to suffer from B-12 Vitamin deficiency. If you are a vegan for some time and didn’t take any vitamin B-12 supplementation, it is essential to consult a nutritionist and, most importantly, your GP in order to have regular check-ups and cobalamine levels drawn-up.
Who should take Vitamin B-12?
Vitamin B-12, as mentioned above, helps our brain and our nervous system to function normally and it takes care of the formation of red blood cells as well. Usually the people with vitamin B-12 deficiency are the ones that really need to take this vitamin. This deficiency occurs when the levels of vitamin B-12 in our body are at the low end or below. If we don’t look out for our vitamin levels it could result in irreversible and severe damage, especially to our brain.
Where can we find Vitamin B-12?
Vitamin B12 is a water-soluble vitamin that is present in some foods and it is also available as a dietary supplement and a prescription medication. When we consume animal-based food, during digestion, the Vitamin B-12 is separated from the protein and it is absorbed by the body and this is the way that we can accumulate this Vitamin from food.
There are some cases when this procedure is not happening and one of the reasons is that people could have pernicious anemia. This type of anemia is showing up by a lack of intrinsic factor.
Vitamin B-12 Injections
This kind of injections are helping our bodies to assimilate this vitamin really fast in case if our bodies can not get it from animal-based food. These injections contain a high level of cyanocobalamin, and this nutrient is a synthetic one. B-12 injections are easy to use and they can be self-administered or given by a doctor which is recommended.
Cyanocobalamin is available in three forms, liquid, tablet or capsule. B-12 shots can be only prescribed by the doctor and for that people need to go first through a consultation. Healthy people should not worry too much about their B-12 vitamin levels because the liver preserves a pretty big amount of Vitamin B-12 but a yearly check-up is always needed.
Signs of B-12 Vitamin deficiency
There are many signs that can point our attention to a B-12 deficiency and the most common one is a decreased cognitive function.
Decreased cognitive function means that we have some problems remembering things, understanding or even learning new stuff that we need in our lives. If you are always feeling tired and have regular headaches it can also be a sign of B-12 deficiency and it should not be mistaken by lack of sleep.
Other signs that can indicate a low percentage of Vitamin B-12 in our bodies are lethargy, constipation, difficulty maintaining balance, heart palpitations, vision changes and mouth ulcers. These are the common signs for having a low amount of Vitamin B-12 in our bodies.
Common B-12 deficiency issues
People who are smoking and drinking are more likely to have B-12 Vitamin deficiency or have one in the future.
The other big percentage of the people that could suffer from B-12 deficiency are the vegans and vegetarians because the main source of B-12 from our bodies is coming from animal-based food.
Older people or the ones that have certain gastrointestinal disorders ( Crohn’s disease) are also having trouble with their B-12 Vitamin levels.
Other risk factors that can increase the chance of developing B-12 deficiency are certain prescription medications, having an endocrine-related autoimmune disorder or pregnant and lactating women who follow strict vegetarian diets.
B-12 Injection benefits
One of the most important things in life is taking care of our health and B-12 shots can help us really much. There are so many reasons that people should at least consider taking B-12 shots now and then but the most clear one is if they have B-12 deficiency.
People can take B-12 shots preventive as well if they are getting the symptoms mentioned above. The injections can considerably reduce the risks of getting a heart disease or neurocognitive disorders.
Our brain function is the vital one in our lives and these shots are helping it keep a really good functioning throughout the years.
Risks that can occur while taking B-12 Shots
The possibility of an overdose is really low while taking B-12 shots so there is no limit of how much B-12 vitamin can our body take but the prescribed dose should be respected during the treatment.
Like every other medication, B-12 shots can result in some side effects. Several side effects can be mentioned. First of all there could be pain or itching at the site of the injection, swelling sensation or mild diarrhea.
More important symptoms are breathing difficulties, dizziness and sudden vision changes. If these three appear constantly people should see their doctor right away.
Interaction with other medication
Just like any medication, B-12 Vitamin can interact with other medication and if their doctor doesn’t ask, people should always ask for this kind of information which sometimes could be vital for their health.
Aspirin and antibiotics are the most common drugs that B-12 shots can interact with and the outcome for the patient is not healthy. Other drugs that B-12 injections can interact are oral contraceptives, metformin, H2 receptor antagonists and proton pump inhibitors.
Pernicious Anaemia: What it is and How to Treat It
Most people know what anaemia is, however, they may not be so aware of what pernicious anaemia is. Pernicious anaemia is a specific type of anaemia that is caused by a number of different conditions. It can have potentially serious implications for a person’s lifestyle and overall well being.
But what is pernicious anaemia? How does the condition differ from standard anaemia, and how can you work to treat the condition?
What is Pernicious Anaemia?
Pernicious anaemia is a highly specific form of anaemia that is generally caused by a few specific conditions. The condition itself is usually triggered by some form of dietary imbalance, such as a deficiency of iron or vitamin B12.
Anaemia, as standard, is a condition that is defined by the NHS as being “a condition where the amount of haemoglobin in the blood is below the normal level, or there are fewer red blood cells than normal. There are several different types of anaemia and each one has a different cause, although iron deficiency anaemia is the most common type.” In this scenario, where we are referring to pernicious anaemia, we are discussing one of the aforementioned “different types of anaemia”, as opposed to anaemia characterised primarily by a lack of iron in the diet.
Despite being categorically different to standard anaemia, which is caused by iron deficiency, pernicious anaemia still shares the same symptoms. Additionally, some other symptoms categoric of a vitamin B12 deficiency can also be seen by someone struggling with pernicious anaemia.
Symptoms Standard for Pernicious Anaemia
Anaemia and pernicious anaemia share a number of common symptoms. This is because both conditions cause a lack of (functioning) red blood cells in the body’s circulatory system, which trigger other problems as a result. This is largely because the red blood cells are responsible for transporting oxygen around the body; without this, the body’s muscles and systems are largely unable to function or will otherwise experience reduced efficiency.
#1 Weakness
As previously mentioned, anaemia and pernicious anaemia both cause a lack of functioning red blood cells in the body. This means that your body will struggle to cope to transport oxygen to your cells, which in turn can result in overwhelming weakness. This is especially the case for people who are trying to do exercise while struggling from anaemia, which can rapidly result in overwhelming weakness and potentially even collapse. In addition to this, people who are suffering from anaemia or pernicious anaemia will also be likely to have difficulty standing and walking.
#2 Headaches and Migraines
The notable lack of functioning red blood cells in the body can mean that your brain is also suffering from a lack of oxygen. This, in turn, may mean that you will begin to struggle with headaches and migraines, some of which may be debilitating. Especially in the case of severe headaches and migraines, you may have to take time off of work or school as a result as well—which can have complications down the line.
#3 Weight Loss
A common symptom of anaemia or pernicious anaemia is weight loss. Furthermore, for some people, the anaemia could be a result of weight loss, especially for people trying to severely limit their nutrient intake as part of a diet or eating disorder.
#4 Neurological Symptoms
In general, a diagnosis of pernicious anaemia will generally just result in weakness, headaches, and weight loss, as previously explained. However, in some more rare and extreme cases, neurological symptoms can also be a result of the condition.
Neurological symptoms of anaemia and pernicious anaemia can include an unsteady gait (for example, difficulty in maintaining a consistent speed or walking in a straight line), as well as spasticity (tight and stiff muscles, which may also be painful) and peripheral neuropathy which can cause numbness and a lack of sensation in the arms.
One especially concerning complication of pernicious anaemia is that of progressive lesions of the spinal cord. If left untreated, these can cause a great deal of damage in a patient. As such, treatment is absolutely essential if these have developed in a patient.
Furthermore, memory loss and dementia like symptoms can also be a common sign of anaemia or pernicious anaemia. A good diet is absolutely essential for normal brain, memory, and cognitive abilities and this will be hampered if you are not getting enough vitamin B12 in your diet. Confusion and difficulty remembering or concentrating are common in people who are struggling with the condition.
#5 Vitamin B-12 Deficiency Symptoms
Since pernicious anaemia is caused by a deficiency of vitamin B12, it is common that you will also be experiencing symptoms of vitamin B12 deficiency when suffering from pernicious anaemia. These symptoms can include nausea and vomiting; depression and anxiety, which may also include thoughts of suicide or self harm; constipation; a loss of appetite; or heartburn. Many of the symptoms noted above are also common symptoms seen in people struggling with a vitamin B12 deficiency.
Avoiding Pernicious Anaemia
If you have been struggling with pernicious anaemia as a result of vitamin B12 deficiency, the cause could be as simple as not getting enough vitamin B12 in the diet. Vitamin B12 is derived from a number of different sources, which can include animal products such as meat, shellfish, poultry, eggs, and dairy products. In addition to this, numerous products are fortified to provide additional vitamin B12 to the diet, including fortified milk alternatives (soy, nut, and rice) as well as supplements.
However, the cause of pernicious anaemia is not always an incorrect diet. If your body is not producing enough intrinsic factor—a protein that allows you to digest vitamin B12—then you will naturally not be absorbing enough. In addition, some people who have undergone bowel surgery or the elderly may also be at greater risk. An inability to digest vitamin B12 can also be caused by the use of long term antacids or metformin drugs. If you think that you fall into one of these categories, it is thus imperative that you contact a suitably qualified individual to discuss options for improving your vitamin B12 absorption.