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Vitamin B12 Deficiency Is A Common Health Problem That Can Have Serious Consequences – But Doctors Often Overlook It

For several months during the summer of 2022, my dog Scout vomited at 3 a.M. Nearly every day. If you have a dog, you know the sound. And each time, she gobbled up her mess before I could get to it, making diagnosis of the cause difficult.

The vet and I eventually settled on my hydrangeas as the source of the problem – but keeping Scout away from them didn't work. She started to seem tired all the time – highly concerning in a typically hyper yellow Lab puppy.

Then one day Scout vomited up a hairball – but not just any hairball. In dogs, hair normally passes easily through the digestive system, but this hairball was wrapped around a brillo pad that was too big to move through. Once this foreign object was removed, the overnight vomiting ended. Scout still needed treatment, though, for a different and surprising reason: The object had inhibited a step in her body's absorption of vitamin B12. B12 is an essential nutrient involved in proper functioning of blood cells, nerves and many other critical processes in the body.

I'm a registered dietitian, and I teach nutrition and food science to college students, but still I missed the B12 deficiency that was causing my puppy's fatigue. Doctors can just as easily be blind to it in people – even though B12 deficiency is a common health problem that affects an estimated 6% to 20% of the U.S. Population.

B12 is scarce in the diet, and it is found only in foods from animal sources. Fortunately, humans need only 2.4 micrograms of B12 daily, which is equivalent to one ten-millionth of an ounce – a very, very small amount. Without adequate B12 in the body, overall health and quality of life are negatively affected.

Signs and symptoms

One primary symptom of B12 deficiency is fatigue – a level of tiredness or exhaustion so deep that it affects daily life activities.

Other symptoms are neurological and may include tingling in the extremities, confusion, memory loss, depression and difficulty maintaining balance. Some of these can be permanent if the vitamin deficiency is not addressed.

However, since there can be so many causes for these symptoms, health care providers may overlook the possibility of a B12 deficiency and fail to screen for it. Further, having a healthy diet may seem to rule out any vitamin deficiency. Case in point: Because I knew Scout's diet was sound, I didn't consider a B12 deficiency as the source of her problems.

How B12 is absorbed

Research is clear that people who consume plant-based diets must take B12 supplements in amounts typically provided by standard multivitamins. However, hundreds of millions of Americans who do consume B12 may also be at risk because of conditions that could be hampering their body's absorption of B12.

B12 absorption is a complex multistep process that begins in the mouth and ends at the far end of the small intestine. When we chew, our food gets mixed with saliva. When the food is swallowed, a substance in saliva called R-protein – a protein that protects B12 from being destroyed by stomach acid – travels to the stomach along with the food.

Specific cells in the stomach lining, called parietal cells, secrete two substances that are important to B12 absorption. One is stomach acid – it splits food and B12 apart, allowing the vitamin to bind to the saliva's R-protein. The other substance, called intrinsic factor, mixes with the stomach's contents and travels with them into the first part of the small intestine – the duodenum. Once in the duodenum, pancreatic juices release B12 from R-protein and hand it to intrinsic factor. This pairing allows B12 to be absorbed into cells, where it can then help maintain nerve cells and form healthy red blood cells.

A B12 deficiency typically involves a breakdown at one or more of these points on the way to absorption.

Risk factors for B12 deficiency

Without saliva, B12 will not bind to the saliva's R-protein, and the body's ability to absorb it is inhibited. And there are hundreds of different drugs that can cause dry mouth, resulting in too little saliva production. They include opioids, inhalers, decongestants, antidepressants, blood pressure drugs and benzodiazepines, like Xanax, used to treat anxiety.

The last three categories alone account for easily 100 million prescriptions in the U.S. Each year.

Another potential contributor to B12 deficiency is low levels of stomach acid. Hundreds of millions of Americans take anti-ulcer medications that reduce ulcer-causing stomach acids. Researchers have firmly linked the use of these drugs to B12 deficiency – although that possibility may not outweigh the need for the medication.

Production of stomach acid can also decrease with aging. More than 60 million people in the U.S. Are over age 60, and some 54 million are over the age of 65. This population faces a higher risk of B12 deficiency – which may be further increased by use of acid-reducing medications.

Production of gastric acid and intrinsic factor by the specialized parietal cells in the stomach is critical for B12 absorption to occur. But damage to the stomach lining can prevent production of both.

In humans, impaired stomach lining stems from gastric surgery, chronic inflammation or pernicious anemia – a medical condition characterized by fatigue and a long list of other symptoms.

Another common culprit of B12 deficiency is inadequate pancreas function. About one-third of patients with poor pancreas function develop a B12 deficiency.

And lastly, Metformin, a drug used by around 92 million Americans to treat Type 2 diabetes, has been associated with B12 deficiency for decades.

Treatment for B12 deficiency

While some health care providers routinely measure B12 and other vitamin levels, a typical well-check exam includes only a complete blood count and a metabolic panel, neither of which measures B12 status. If you experience potential symptoms of a B12 deficiency and also have one of the risk factors above, you should see a doctor to be tested. A proper lab workup and discussion with a physician are necessary to discover or rule out whether inadequate B12 levels could be at play.

In the case of my dog Scout, her symptoms led the vet to run two blood tests: a complete blood count and a B12 test. These are also good starting points for humans. Scout's symptoms went away after a few months of taking oral B12 supplements that also contained an active form of the B vitamin folate.

In humans, the type of treatment and length of recovery depend on the cause and severity of the B12 deficiency. Full recovery can take up to a year but is very possible with appropriate treatment.

Treatment for B12 deficiency can be oral, applied under the tongue or administered through the nose, or it may require various types of injections. A B12 supplement or balanced multivitamin may be enough to correct the deficiency, as it was for Scout, but it's best to work with a health care provider to ensure proper diagnosis and treatment.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world.The Conversation is trustworthy news from experts. Try our free newsletters.

It was written by: Diane Cress, Wayne State University.

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Diane Cress does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Six Health Problems Your Child May Inherit From You

While tucking our sons into bed the other night, I was struck by how many of their physical attributes they've inherited from my husband and me. Eleven-year-old Nate has my heart-shaped face, large eyes, and cowlicky hair, along with my husband's mouth and freckles. Six-year-old Nicky, on the other hand, has the same green eyes and dirty-blond hair that I do, but my husband's nose and chin.

Nearsightedness, color blindness, and lazy eye are often inherited, according to a pediatric ophthalmologist.

But those aren't the only things we've passed on: Nate has acquired my propensity for headaches and hay fever, and Nicky got my husband's eczema in a bad way. Of course, many chronic conditions run in families, but family history alone doesn't guarantee that a child will develop one of them. Instead, it signals increased risk.

"Usually, it's a combination of genetics and environmental influences that triggers a condition," says Jennifer Shu, M.D., a pediatrician in Atlanta, Georgia, and coauthor of "Heading Home With Your Newborn." You can't change your kid's genes, but you can get familiar with a few of the most common health problems that affect families and learn how to protect yours. Parenting.Com: From asthma to whooping cough, identify childhood illnesses with our symptom checker

Vision Problems

Will the kids get them? Your child's view of the world could be quite similar to yours -- literally. Nearsightedness, color blindness, and lazy eye (amblyopia) are often inherited, says Stuart Dankner, M.D., a pediatric ophthalmologist in Baltimore, Maryland. If both parents are nearsighted, a child has a 25 to 50 percent chance. "Only females carry and transmit the gene for color blindness, but usually only males have the condition," Dankner explains. If the mother is a carrier of the gene, there's a 50 percent chance her son will have it.

Signs they got nabbed: If your child complains of headaches, or often squints or tears up, especially with reading, watching TV, or at the end of the school day, it's worth having her vision checked.

Children may not complain about nearsightedness until they're school-age, but it can be detected as early as age 3, says Dankner. That's when Crystal Smith's son, Cameron, began squinting to see things. "I knew there was a strong chance he'd have vision problems because my grandmother, aunts, mother, and I all wear glasses, but I didn't expect it to happen so young," says Smith, of Plainfield, New Jersey.

Lazy eye can emerge during the first year, but it can be difficult to catch unless the pediatrician screens for it. Don't worry too much if your infant's eyes cross now and then -- almost all kids' do in the first couple of months; if you notice crossing along with a difference in pupil size after that, schedule an exam. As for color blindness, you'll usually know by age 5.

What you can do: If eye problems run in your family (and actually, even if they don't), it's smart to start regular eye exams with a pediatric optometrist or ophthalmologist by age 1. This is especially important if your family history includes needing glasses at a young age or if you suspect lazy eye at any time. Early detection and correction of vision problems can help a child feel and function at her best -- and, in the case of lazy eye, which can lead to severely impaired vision if untreated, it could even save her sight.

Eczema

Will the kids get it? The odds are about fifty-fifty, the same as for allergies. That makes sense given that eczema is actually a type of allergic reaction. The condition can take parents by surprise, though, especially when neither parent actually has it. "The tendency or predisposition to allergic conditions is what's inherited, not the specific allergies," says Howard Saal, M.D., director of clinical genetics at the Cincinnati Children's Hospital Medical Center in Ohio.

However, eczema does have a couple of specific triggers: cold, dry environments can bring it on, as can highly allergenic foods such as dairy and eggs, says Shu. Stress can play a role as well: when young children's parents divorced or separated, the kids experienced a threefold increased risk of eczema during the next two years, according to research from the Technical University in Munich, Germany. Parenting.Com: Guide to skin and respiratory allergies

Signs they got nabbed: Eczema is pretty hard to miss. The dry, itchy skin or red, rough patches usually form on the cheeks, insides of the elbows, and backs of the knees. And when it's severe (or when the child scratches and scratches), little pus-filled sacs can develop. Of the allergic conditions, this one is most likely to make its debut first, even during infancy.

What you can do: See your doctor to confirm your suspicions and to develop a maintenance routine to help prevent more breakouts. Usually, staying on top of moisturizing (opt for one that's fragrance- and dye-free) can go far in keeping the condition in check; to ease the itching and inflammation of a flare-up, your doc may prescribe a topical steroid cream. If despite your best efforts your child scratches so much that an infection develops, antibiotics are usually in order.

Migraines

Will the kids get them? These debilitating headaches are often passed on: your child has as much as a 50 percent chance of developing them if one parent gets them, and an even higher chance if both do.

Signs they got nabbed: Symptoms often include some combination of throbbing pain (usually in the front or sides of the head), nausea or vomiting, and sensitivity to light or sound. Migraines typically show up around age 8, but some kids get them much sooner; in young children especially, the head pain is often associated with motion sickness.

What you can do: Do your best to identify your child's particular triggers (it can help to keep a log of what he was doing and eating, as well as how he was generally feeling, around the time the pain began). Common ones in kids include fatigue, overexertion, changes in routine, certain foods (aged cheese and processed foods like hot dogs and lunch meats are biggies), and caffeine.

Fortunately, kids' headaches are often relieved by going to sleep or taking ibuprofen or acetaminophen. If the strategies provided by your pediatrician don't bring relief, she may suggest seeking out a pediatric neurologist, says Saal. After all, unrelenting pain can have a powerful ripple effect on nearly every aspect of your child's life. In fact, a study by the Centers for Disease Control and Prevention found that children with frequent or severe headaches that go untreated have higher levels of emotional, conduct, and peer problems than their headache-free classmates. No wonder: Being a kid is hard enough without having to deal with pain. Parenting.Com: 5 common health conditions your pediatrician might miss

Irritable Bowel Syndrome (IBS)

Will the kids get it? There's a good chance. People who suffer from IBS are more than twice as likely to have a first-degree relative with the same symptoms, according to research from the University of Sydney in Australia. "It's very common to see colicky infants whose parents have IBS or reflux," says Dan Levy, M.D., a clinical assistant professor of pediatrics at the University of Maryland School of Medicine. "They may have a lower pain threshold than other babies."

Signs they got nabbed: The classic symptoms are frequent crampy abdominal pain or alternating bouts of constipation and diarrhea. IBS usually appears during the school years, but precursors, like colic, may be apparent earlier in a child's life. "There's also a big emotional component," says Tanya Remer Altmann, M.D., author of "Mommy Calls." Flare-ups are common during challenging transitions in a child's life, such as going to school or even just attending a party he doesn't want to go to, Levy says.

What you can do: If you suspect your child has IBS, have him checked out by your pediatrician. "IBS is a diagnosis of exclusion," Altmann says. "We want to rule out the possibility that something more serious is going on, like inflammatory bowel disease." If the problem turns out to be IBS, it can usually be managed with lifestyle changes. That may mean avoiding certain foods that might be triggers, adding probiotics (the healthy bacteria found in yogurt), and/or teaching kids some stress-management techniques, such as relaxation exercises or yoga.

Allergies

Will the kids get them? There's about a fifty-fifty chance they will if you or your spouse suffers; if you both have allergies, there's an even greater chance the kiddos will, too, says Saal. But don't expect them to be sensitive to the same things you are. Remember, we pass on only the susceptibility to allergies, which can manifest in myriad ways.

Signs they got nabbed: Frequent colds, sinus or ear infections, or a constantly runny, stuffy, or itchy nose can point to allergies. Same goes for itchy eyes, rashes, or hives. And wheezing or a chronic cough -- telltale signs of asthma -- may be the biggest tip-off that your child is destined to develop allergies because the two conditions so often go hand in hand. Parenting.Com: Great recipes for kids (and grownups!) with food allergies

What you can do: If any of these symptoms appear -- as they often do between the ages of 3 and 5 -- tell your pediatrician. For mild cases, he may suggest medications such as antihistamines (wait for the okay before giving one) and/or prescription nose drops, which may provide ample relief; if they don't, or if your child has severe symptoms such as trouble breathing, your doctor will want to pinpoint the problem with allergy tests -- either the skin-prick or blood-test type. If needed, other medications and immunotherapy (allergy shots) are available and can bring tremendous relief.

But sometimes it's a matter of finding the right approach for your family. "I have pretty bad allergies, and a few years ago, I started noticing that my then six-year-old son had circles under his eyes and seemed tired and snuffly all the time," recalls Diane Umansky, a mom of three in New York City. "The pediatrician recommended antihistamines, but the two we tried made him really hyper and interfered with his sleep in a major way. He finally got relief after we got allergy-proof bedding covers and began vacuuming religiously." In other words, do what works! Parenting.Com: Are we overmedicating our kids?

Emotions run deep

It's not just physical vulnerabilities that your child can inherit from you. Certain psychological and emotional issues can also be a family affair. In particular, there's a strong genetic component to attention deficit hyperactivity disorder, as well as to several mood and anxiety disorders, including depression, bipolar disorder, and obsessive-compulsive disorder.

While it may feel harder to reveal a history of mental health problems to your pediatrician, it's important that you do. That way, if your child develops certain warning signs, such as unusual sadness, irritability, anxiety, inattention, or a change in appetite, sleep, or ability to enjoy things, the doctor may be able to zero in on the cause -- and get your child help -- a lot sooner.

To learn more, check out:

• American Academy of Pediatrics: Parenting Corner Click on "behavioral health" in the topics menu.

• American Academy of Child & Adolescent Psychiatry Use the search tool to find a child and adolescent psychiatrist.

• National Institute of Mental Health Click on "mental health topics" for links to info on ADHD, bipolar disorder, depression, and more.

Try a FREE TRIAL issue of Parenting Magazine - CLICK HERE!

Copyright 2009 The Parenting Group. All rights reserved. Reproduction in whole or in part without permission is prohibited.

Stacey Colino lives in Chevy Chase, Maryland.

All About Eyesight and Eye Health • Eczema • Irritable Bowel Syndrome

Tamarac's $38,000 Dalmatian Sculpture Finally Takes Its Spot

"Speckles McFreckles" and Tamarac resident Adoni Wollaston who named the statue at Fire Station #36. {Sallie James}

By Sallie James

Speckles McFreckles, a much-touted Dalmatian sculpture whose existence has been shrouded in mystery, has surfaced.

The whimsical sculpture conceptualized in 2021 finally materialized in 2023, two years after the city held a formal naming contest for the perky pooch, picked a winner and awarded a prize.

After six weeks of creating the tile-covered piece, Puerto Rican artist Celso Gonzalez and his crew completed the towering $38,000 dog statue on Monday. The giant dog emerged from a custom mold which was poured with concrete, then encrusted with a mosaic of black and white tiles. The towering K-9 stands guard on the southeast corner of the station at 7499 Northwest 72nd Street.

Now, every day at station #36 is a dog day afternoon. But October 26 was especially "ruff."

The artist who created the sculpture fell from a scaffold during the construction and was transported to Broward Health North in Deerfield Beach with an abdominal wound. He is expected to recover completely, said Tamarac Fire Chief Michael Annese.

"It was a crazy fluke," Annese said. Gonzalez could not be reached for comment, but one of his co-workers said he was doing fine on Monday.

The project has been somewhat of a dog and pony show from start to finish.

The installation was initially delayed because the originally planned site on the west side of the fire station had drainage issues, said George Gadson, who directs the city's Public Art Program. Then COVID hit.

The design and installation of the art piece were paid through developer contributions to Tamarac's Public Art Fund and not through local taxes.

Tamarac resident Adoni Wollaston, who won the sculpture naming contest, viewed the giant dog statue for the first time on Tuesday and was duly impressed. He's grown up a lot since the contest took place.

"It's so big!" marveled Wollaston as he posed for a photo before the giant dog on Tuesday.

So is Wollaston.

After two years of waiting, Wollaston is now a Sawgrass Springs Middle School 8th grader who is 12 inches taller and seven shoe sizes larger than the diminutive Challenger Elementary 5th grader who made headlines with the unique name he chose for the sculpture.

Wollaston was honored at a June 23, 2021, City Commission meeting for his catchy name. At the time, Tamarac commissioners presented him with a tablet equipped with internet service and a $100 Visa gift card.

But he was never contacted again.

Wollaston learned that the wheels of government turn very, very slow.

"I'm sure the city had more important things to do," he said.

But his mother, Renata Richardson, said it was a doggone shame that no one from the city bothered to tell them what was up. She called Tamarac twice this year, trying to find out what was happening with the elusive sculpture, but never got any answers.

Richardson said she specifically sought out District 4 Commissioner Kicia Daniel for information but was "transferred from one person to another" without any luck. The city left her a voicemail once in August, assuring her they would keep her updated on the progress, but they didn't. Instead, she learned that the project was completed from Tamarac Talk.

Now the city is in the doghouse, thanks to its poor communication skills.

"It shouldn't take that many years to do something," Richardson said. At least the sculpture was completed before her son finished high school and graduated, she conceded.

Delays aside, Richardson gave the project a thumbs up.

"I love it," she said.

Stop by Fire Station #36, and you will see why it's unique for two reasons: it's the only fire station in the city that doesn't have a fire truck, and it's the only one that now has a gigantic K-9 mascot.

Par for the course, said city resident and activist Carol Mendelson, who is dog tired of complaining about the missing fire truck, which was finally ordered earlier this year.

"Like other unmentionable issues at fire station #36, it has taken two years to get the statue of the Dalmatian in place," Mendelson noted. "Now, how about a truck for him to ride on?"

Got News? Send it to Tamarac Talk. Don't miss reading Margate Talk, Coral Springs Talk, Coconut Creek Talk, and Parkland Talk.

Author Profile Sallie James Sallie James is a veteran reporter/blogger/copywriter who spent most of her writing career in South Florida, including 22 years at the Sun Sentinel. She has also freelanced for The Coastal Star, South Florida Gay News & Florida Weekly. Sallie is the mother of grown boy/girl twins, a Guardian ad Litem, an animal rescuer, and a longtime Tamarac resident. She earned a bachelor's degree in Journalism from Indiana University.

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