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Could you have B12 Deficiency? How the new NICE guidelines can help you get diagnosed and treated faster

by Laura Palmer

Have you been lacking in get-up-and-go? Your energy levels are always low, no matter how well you sleep. You keep mislaying the car keys, or forgetting what you went to the shops for. And constant pins and needles and a sore mouth are driving you mad! Lots of people put these kinds of complaints down to getting older, or a busy lifestyle. But did you know all these things can be symptoms of B12 deficiency?

You might be aware that as you get older, you're far more likely to become B12 deficient. Research shows as many as 1 in 5 of those over 80 aren't getting enough B12. But it's also extremely common in younger people too. Studies from the US and Netherlands have revealed that around 1 in 30 young adults are lacking in B12, creeping up to 1 in 25 of the middle-aged population.

Considering just how prevalent B12 Deficiency is, it's perhaps no surprise that NICE (National Institute for Health and Care Excellence) has come up with the first ever guidelines for diagnosing and treating the condition.

What are the new B12 Deficiency recommendations NICE has drafted?

The new recommendations are currently in draft form (you can have a nosey at them here). But one of the most groundbreaking directives is that a B12 blood test should be offered to anyone with one symptom and one risk factor of B12.

This is a big step forward because some doctors are currently reluctant to test your B12 levels unless you're elderly, or have a few of the most obvious symptoms of B12 deficiency. These more overt signs can take years to develop, by which time your health can take a huge hit. The new guidelines will ensure B12 deficiency is on your doctor's radar and help you to get a test when you need one (hopefully earlier on).

Another helpful recommendation is NICE suggest treatment for B12 Deficiency should be considered even if your test results are inconclusive. So if you and your Doctor think you're lacking in B12, but this doesn't show up in your blood tests, you should still be able to get B12 injections or supplements to get you back to your best again.

There’s also guidance on testing and the best ways to treat low B12 levels. But one of the most game-changing things about the guidelines is that they provide a framework on B12 Deficiency you can refer to before you visit your doctor. Empowering you to get the right tests and treatment and feel well – hurrah!

What causes B12 Deficiency and what happens if you don't treat it?

You'll find B12 in foods like meat, fish, milk, and eggs. But it can be tricky for your body to absorb. If you have any type of bowel issue: Crohn's, IBS or you're coeliac, you might struggle to take in enough. The same goes if you have low levels of stomach acid (around 20% of us according to studies). Or you're taking certain medications like antacids, and anti-seizure medicines.

And if you follow a vegetarian or vegan diet, where foods naturally rich in vitamin B12 are a no-no, you're also much more likely to have B12 deficiency.

How well you absorb B12 is also down to something called the 'intrinsic factor', a protein made by the cells in your stomach. Your body needs this protein to combine with vitamin B12 to ensure it is properly absorbed into your gut. Lots of people don't make enough of the intrinsic factor because they have an autoimmune condition like thyroid disease or type 1 diabetes. You also produce much less intrinsic factor with age, which may be why B12 deficiency becomes more common as you get older.

You need B12 to produce red blood cells, the good guys essential for transporting oxygen around your body, and for the normal function of your brain and nervous system. Not getting enough can leave you feeling exhausted and breathless, and make you anaemic.

Low B12 also negatively affects the development of the myelin sheath (the protective covering) of the nerves, which has been linked to Alzheimer’s Disease. In some rare cases, extremely severe cases of B12 deficiency have led to paralysis and death. So you can see why it's so important to recognise and treat low B12.

What are the main symptoms/risk factors?

Unexplained fatigue is a very common symptom of B12 deficiency. You might also experience cognitive issues, like brain fog and struggling to remember things. Or it might affect your mood, triggering anxiety or depression. Other telltale signs include a sore and inflamed tongue. Neurological symptoms like feeling wobbly and struggling with balance. Or constantly getting pins and needles, or numbness in your hands and feet. You could also develop blurry vision, which isn't fixed by a trip to the opticians.

All these symptoms can be caused by other health problems. So it's also worth thinking about whether you have any of the risk factors associated with B12 Deficiency too. For example, following a meat-free or vegan diet. Or living with an autoimmune condition or chronic stomach problems like Crohn's or IBS. A family history of B12 deficiency, taking antacid medications, and being over-65 years old can also make you more likely to be low in B12. As can bowel surgery of any kind and (a new one!), using laughing gas (nitrous oxide) recreationally.

What are the best treatments for B12 Deficiency?

Currently, NICE recommendations suggest either regular B12 injections or high dose tablets as the best way to treat B12 deficiency. Who gets what treatment and why is still being furiously debated and may change before the recommendations go from draft to final. But as things stand, if you're older and have a severe deficiency, you're much more likely to get B12 intravenously.

Regular injections generally work really well, but won't be prescribed to everyone. And most people need them every 2-3 months. If you aren't lucky enough to get the golden ticket, you can have B12 injected privately, but this can be pricey. Or perhaps you aren't a big fan of needles and can't think of anything worse than an injection 4 times a year?!

The NICE sanctioned alternative is a high dose oral supplement. But these can be ineffective if you have gut problems which make you unable to absorb B12, you're taking antacids, or you have low levels of intrinsic factor. B12 mouth sprays are another option, but they don’t work for everyone either – sigh.

Are there any other options?

The good news is that B12 patches are an excellent way to up your B12. Our B12 Plus Patch delivers the active ingredients via your skin. The B12 goes directly into the bloodstream, completely avoiding your gut -so it’s much more likely to boost your B12 levels effectively.

Patches are unique in that they have a slow-release action which releases B12 gradually, throughout the 8 hours you wear them. This is much easier for your body to absorb than the levels of B12 you get from high dose tablets or mouth sprays. What's the point of taking a supplement to improve your B12 intake if most of it ends up down the toilet?!

It's also worth remembering that once you’ve been diagnosed with a B12 deficiency you're likely to have to supplement for life. A real pain (quite literally!) if you have to have injections, not such a biggie if you're popping on a patch each morning.