In most cases vitamin B12 deficiency can be prevented or mild deficiency can be reverted back to normal by maintaining a diet rich in meat, poultry, seafood, milk, cheese, and eggs. Remember vitamin B12 comes only from animal sources! In cases where someone is a vegan or medical condition preclude from consuming the aforementioned food products, an alternative will be to take oral supplements and eat food fortified with vitamin B12.
Vitamin B12 deficiency management is tricky in that patient response and requirement might vary during their lifetime. In mild forms of the disease (as described above) oral replacement over a period of time along with a balanced diet regimen are enough to tide over the deficiency. In acute and chronic forms of the disease, like in pernicious anemia, lifelong replacement is a prerequisite. Often intramuscular injections are required in such cases along with oral supplement to maintain the homeostatic level of the vitamin in the body. The frequency of injections usually starts at one per day to later on become more infrequent at once every week and then finally once every month. If deficiency diagnosis is made at a critical juncture, then blood transfusion is often recommended to tide over the crisis. If transfusions are actually given to a person, intensive care is needed to prevent co-morbidities like heart failure or pulmonary edema, which can result from a bad transfusion. A state-of-the-art treatment for vitamin B12 deficiency is the nasal spray Nascobal, which is expensive but highly efficient and can work without oral or injectible vitamin B12 supplementation. Generic version of Nascobal is still not available.
In cases where the deficiency is caused due to celiac disease, alcoholism or Crohn’s disease appropriate resolution of the diseases by appropriate treatment also attenuates the need for vitamin B12 supplement. Of note, neuronal damage caused due to vitamin B12 deficiency is irreversible even after corrective treatment. But neuronal damage progression can be prevented with replenishment of vitamin B12.
How to make the choice between oral supplement and injection in vitamin B12 deficiency?
The classical mode of treatment has always been intramuscular vitamin B12 injection to tide over chronic deficiency. But taking regular injections is never pleasant and a person may develop aversion towards injection if the protocol is maintained over a long period of time. Research has shown that some people respond as effectively to oral supplement as to intramuscular injections. So the correct mode will be to use pills first and if response is not as expected then resorting to intramuscular injections as the last resort. The good thing about using pills is there is no fear of getting an overdose. Vitamin B12 is water soluble, unlike the fat soluble vitamins (A, D, E and K), and hence any excess that is not absorbed or needed by the body will be excreted out through the urine. Hence it might be a good idea to consult your physician and discuss whether you can revert to oral supplement in case you are currently being administered intramuscular injections. Of note, follow up pathological tests are required if the deficiency is being treated with oral supplements to ensure the vitamin is actually being absorbed by the system. Also if taken in too much quantity once the deficiency is cured can cause increased risk towards lung cancer. Also taking it with other medication (like metformin for treating diabetes) can also lead to complications and hence proper consultation and treatment methodology should be strictly adhered to.
The Recommended Dietary Allowance (RDA)
In 1998 the Food and Nutrition Board (FNB) of the Institute of Medicine released new guidelines for the Recommended Dietary Allowance (RDA) for vitamin B12. The recommendations were especially modified for elderly people where intrinsic malabsorption of the vitamin is presumptuous. Fortified food or vitamin B12 supplements are recommended for anyone above the age of 50 years, even if the person is not currently suffering from vitamin B12 deficiency.