Vitamin B12 is a water-soluble vitamin. Since it contains the mineral cobalt, this vitamin is also called “cobalamin.”The human body needs vitamins in small amounts. They act as catalysers, enabling specific chemical reactions in the body. Vitamin B12 is particularly required for nerve and brain health, red blood formation, and DNA synthesis. It is also needed for the production of methionine through the conversion of an amino acid named homocysteine. Methionine is an essential amino acid for hundreds of biological processes.[1]
In foods, vitamin B12 is mainly bound to proteins. Vitamin B12 is unique because it is among the few vitamins dependent on specific compounds for absorption. Vitamin B12 needs an intrinsic factor produced by parietal cells (large oval cells responsible for gastric acid secretion) in the stomach to be absorbed in the small intestine.[2]
Humans generally only need this vitamin in minute amounts. In the US, the recommended daily intake of vitamin B12 for adults is 2.4 mcg. In India, as per the 2020 report by ICMR (Indian Council of Medical Research) & NIN (National Institute of Nutrition), the recommended daily intake for adults is 2 mcg. However, the requirements during pregnancy and lactation are slightly higher. Thus, the recommended daily intake of vitamin B12 for lactating women is 2.8 mcg.[3]
Vitamin B12 Consumption in India
- About 50% of Indians do not consume sufficient amounts of vitamin B12.
- 70-90% of Indians with chronic health issues like diabetes or heart disease are vitamin B12 deficient.
- More than half of the older adult population in India is vitamin B12 deficient.
- Vitamin B12 deficiency is a major concern among most vegetarians due to the lack of vitamin B12 in plant-based diets.
The statistics suggest that vitamin deficiencies in general are very common in India, with a particularly high deficiency rate for vitamin B12. In contrast, vitamin B12 deficiency rates in developed economies like the US are significantly lower. The typical Indian diet tends to be lower in vitamin B12, and there are also fewer B12-fortified food options available in India compared to the US.
For example, a study by Singla and colleagues that analysed the health records of almost 12,000 patients found that more than 47% of them were vitamin B12 deficient. This implies that nearly half the patients visiting these clinics are deficient in vitamin B12.[4]
Similarly, a study in South India revealed that 35% of adults were deficient in vitamin B12. This study also revealed that the deficiency rate rose to 54% among vegetarian adults, and showed an increase in vitamin B12 deficiency with age. Notably, this research was conducted among healthy adults, indicating that even those in apparent good health may still experience this deficiency.[5]
India, being a massive and diverse country, sees a variety of dietary preferences. Nonetheless, one thing is clear: many people in India don’t consume enough vitamin B12. In fact, over one-third of generally healthy adults have a vitamin B12 deficiency. However, the situation is particularly concerning among older adults, individuals with chronic health problems, or those who follow a vegetarian diet, with more than half of these populations not receiving the necessary amount of vitamin B12.
It is important to note that this data only pertains to overt vitamin B12 deficiency cases in India. However, many more adults continue to live with mild or subclinical cases of vitamin B12 deficiency.
Vitamin B12 Deficiency – Health Impact
Understanding how to navigate a vitamin B12 deficiency has to start with understanding its health impact. Vitamin B12 deficiency can arise from three primary causes: autoimmune conditions that impact intrinsic factor production in the stomach, malabsorption issues (as seen in gastric bypass surgery), and inadequate dietary intake.[2]
A deficiency in vitamin B12 can give rise to a range of health concerns, including:
- Anaemia
- Heart disease
- Severe neurological problems
- Peripheral nerve disease
- An elevated risk of specific types of cancer
- Higher risk of autoimmune disorders like rheumatoid arthritis
Even in cases where vitamin B12 deficiency doesn’t lead to severe health problems, it can still result in a substantial decrease in energy levels and persistent fatigue.[1,2]
Furthermore, an insufficient intake of this vitamin heightens the risk of various endocrine disorders, such as diabetes, thyroid issues, and other hormonal imbalances.[4]
Heart Disease
There is mounting evidence to suggest that inadequate vitamin B12 intake plays a significant role in many of the unique health issues faced by Indians. For example, heart disease: Research indicates that individuals of South Asian descent have a higher predisposition to heart disease.[7]
It appears that insufficient vitamin B12 intake causes chronic inflammation and thus increases the risk of heart disease. It’s not surprising then that a study conducted in New Delhi discovered that individuals who experienced heart attacks had notably lower vitamin B12 levels compared to their healthy counterparts.[8]
Moreover, a study conducted by Mahalle and colleagues in Pune unearthed a striking connection – over 80% of individuals suffering from heart disease were also found to be deficient in vitamin B12.[9] This underscores the potential impact of vitamin B12 intake on heart health among the Indian population.
Stroke
Stroke risk is another health concern that appears to be influenced by low vitamin B12 intake. In fact, research indicates that insufficient vitamin B12 can lead to elevated levels of homocysteine, which in turn triggers inflammation. This effect is particularly pronounced among vegetarians, as they are more likely to be vitamin B12 deficient. A study led by Wadia and colleagues in Pune revealed that over 90% of stroke patients they examined were found to be deficient in vitamin B12.[10]
Nerve and brain health
Vitamin B12 plays a pivotal role when it comes to nerve and brain health. A study conducted at a neuropsychiatric institute in South India shed light on the connection between mental health and brain disorders like dementia, Parkinson’s, schizophrenia, bipolar disorder, and other cognitive problems. It appears that these conditions are more prevalent among those who are vitamin B12 deficient, thereby indicating that a deficiency may accelerate the ageing process.[11]
Complications during pregnancy
For pregnant and lactating women in India, vitamin B12 deficiency is a common concern. This deficiency increases the risk of pregnancy-related complications and denotes a higher likelihood of inborn errors.[12,13]
Causes Behind Vitamin B12 Deficiency
Vitamin B12 deficiency is a significant concern in India, with levels soaring at around 50%, much higher than the sub-10% levels seen in the United States. Now, let’s dig into why this deficiency is so rampant in India:
Vegetarianism
In India, a big reason behind the high vitamin B12 deficiency is the widespread practice of vegetarianism. Most Indian diets are mainly vegetarian, and even those who eat some animal products do it sparingly. Surprisingly, though less than half of Indians are strict vegetarians, a whopping 80% limit their meat intake.[14]
Research, both in India and abroad, has shown that vegetarians are more prone to vitamin B12 deficiency. For instance, a study on German vegans revealed that over 60% of them were deficient in vitamin B12.[15]
Now, why do vegetarians often find themselves low on vitamin B12? It’s pretty straightforward: plant-based foods simply don’t contain much vitamin B12. Since this crucial vitamin is only found in animal products, vegetarians may not get sufficient vitamin B12 in their diet. However, vegetarians who include milk and other dairy products in their diet may still get some vitamin B12. For strict vegans, who don’t consume any animal products, the easiest way to increase their vitamin B12 intake is through fortified foods or supplements.[1]
Lack of Awareness
When it comes to nutrition, it’s best if you don’t believe everything you read on the Internet. For example, there are several claims on the Internet that almonds, pistachios, and other dry fruits contain high levels of vitamin B12. A little bit of digging shows that this information is easily debunked – dry fruits contain virtually no vitamin B12 [16]. So, if you’re on the lookout for reliable nutrition info, it’s best to trust research articles, professional advice, or solid data sources like the nutrition database of the US Department of Agriculture. In India, you can also turn to the Nutrition Information Communication and Education of the Department of Health Research, Ministry of Health and Family Welfare, for trustworthy information. It’s important to be cautious and rely on credible sources for accurate details about your nutrition.
Consequences of Ageing
As we age, our bodies might struggle with absorbing vitamin B12 because of diminished acid secretions in the stomach. This makes older adults more prone to B12 deficiency. Also, people dealing with conditions like pernicious anaemia, chronic gastrointestinal diseases, or those who’ve had gastric surgery face a higher risk of vitamin B12 deficiency.[1]
Medication
Medications can also play a role in increasing vitamin B12 deficiencies. Some drugs that reduce stomach acid production, like omeprazole or ranitidine, might interfere with B12 absorption. Similarly, one of the most common antidiabetic drugs, metformin, is known to cause vitamin B12 deficiency.[1]
Overcoming Vitamin B12 deficiency
Whether through supplementation or dietary adjustments, below are some practical ways to ensure you get the vitamin B12 your body needs.
Supplements
Fortunately, vitamin B12 deficiency is relatively easy to treat due to the widespread availability of vitamin B12 supplements. You can find vitamin B12 in most vitamin B-complex or multivitamin supplements. While general multivitamins have some vitamin B12, it’s often better to go for specific supplements with higher vitamin B12 dosage to tackle a deficiency.
For vegans and vegetarians, vitamin B12 supplementation may be the most reliable way to manage their deficiency. Our bodies can store a significant amount of B12 in the liver, lasting anywhere from one to three years. [1] Therefore, once the deficiency has been treated, intermittent supplementation of vitamin B12 is enough.
Diet
If you’re a vegetarian, increasing your intake of milk products like yoghurt, dahi, and paneer can help meet daily B12 requirements. However, they might not be enough to treat a severe deficiency [1]. Other sources include yeast, foods prepared with yeast, and fortified products like certain juices. It’s important to note that fruits, vegetables, dry fruits, pulses, and grains, while great for overall health, don’t contain much vitamin B12.
For those who include animal products in their diet, options like meat, eggs, and fish are rich in B12. Organ meats, especially animal liver, stand out as exceptionally high in vitamin B12. However, bird meat isn’t as rich in this essential vitamin.
Vitamin B12 deficiency is a widespread issue in India, mainly because of low dietary intake, a culture of vegetarianism, and a higher occurrence of gastrointestinal disorders. Vitamin B12 deficiency tends to develop slowly over time due to years of insufficient intake. The good news is that treating this deficiency is quite manageable with supplements and some adjustments to your diet, although supplements tend to be more effective.
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