The medical world has branched out into various specialisations. This has advantages but then also leads to tunnel vision. Doctors who look at a patient as one whole entity are few and far between. This is especially true with regard to the nutrition status of the population.
Nutrition is a vast subject, but it is important for the reader to consider the role of vitamins and their deficiencies, especially Vitamin B12. In some situations, vitamin B12 deficiency is also known as pernicious Anemia. Some recent studies estimate the prevalence of vitamin B12 deficiency in Indian populations at 47.19 %.
Function of Vitamin B-12
Vitamin B-12 is a nutrient that helps keep the body’s nerve, blood healthy and helps make DNA, and is crucial to the normal functioning of the brain. Every cell in the body depends on vitamin B-12, as it enables the release of energy in the body. Red blood cells cannot multiply properly without vitamin B-12. Anaemia can occur if the red blood cell count drops. Vitamin B-12 is involved indirectly, in the effective functioning of the thyroid, and prevents heart disease.
The recommended daily requirement of B-12 for adults is 2.4 micrograms per day. Deficiency of this vitamin is not marked with specific symptoms, rather they are non-specific. Sometimes the symptoms could be the pointers to a dangerous deficiency that could spell disaster for the patient if ignored. In many cases, the deadly process of destruction of the nerve sheaths has already started.
Such patients are misdiagnosed as having a neurological or psychological disease such as clinical depression, or Parkinson’s disease, dementia, or then multiple sclerosis or nerve disorders and unfortunately are treated with the wrong drugs for a long period when all they might have needed was to correct the B-12 deficiency.
A deficiency of vitamin B-12 could appear as, as tiredness, sleepiness, tingling sensation in hands of hands or feet, hair loss, depression, forgetfulness, confusion, inability to think clearly, unexplained bouts of diarrhoea, constipation, sore tongue, aches and pain, or even post-partum depression amongst mothers who have recently given birth.
In infants, signs of a vitamin B-12 deficiency include problems with movement, delays in reaching the typical developmental milestones, and megaloblastic anaemia.
Sources of Vitamin B-12 are found naturally in a wide variety of animal foods, dairy products and eggs, and is added to some fortified foods. Plant foods do not have the vitamin unless they are fortified. Even if you are taking enough B-12 containing foods, the body may not be absorbing it.
The following tests are required to properly diagnose deficiency 1) Holotranscobalamin test (This is more effective than the total B12 serum estimation test commonly carried out ) 2) Homocysteine test 3) Methyl Malonic Acid MMA test ideally in a urine sample 4) Complete blood count for the status of the red blood cells 5) Vitamin D3 profile 6) Thyroid function test.
Often even if the tests show normal levels of total serum B12, the patient may still have a hidden B-12 deficiency.
Types of treatment
You cannot overdose on B-12. Often it is wrongly believed that just a multivitamin capsule dose will erase deficiency. The reality is that intake B-12 is governed by many factors. Therefore sometimes only tablets may not work. In such cases, injections are required to lift the B12 level of a patient. These may be once a week or thrice a week or even daily, and these may have to be continued for 2-3 months. Recently oral dissolvable tablets – sublingual tablets have been seen to obtain better results than plain B-12 capsules. Other methods of treatment include IV infusion of B-12, skin patches, nasal drops and oral sprays.
A forgotten illness
Currently, vitamin B-12 deficiency has become an almost forgotten illness by the medical world or is treated as a less serious diagnosis. However, the outcome of this neglect by the medical fraternity results in a huge burden of expense borne by the patient. Considering the huge burden of erroneously treating patients with unnecessary expensive drugs, the government would do well to do the following.
1) Train medical personnel to diagnose and treat B12 deficiency effectively. 2) Educate the public, about this deficiency. 3) Fortification of foods with B12. 4) Ensure that all neurologists, psychiatrists, as well as related specialists start with testing for this deficiency before they consider other diagnoses.
(The writer is a senior research fellow at the Institute of Social and Economic Change)