Vitamin B12 deficiency: Stroke the soles of the feet to check if you have very low levels

Dr Dawn Harper on signs of vitamin B12 and vitamin D deficiency

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Dr Laurence Knott pointed out that pernicious anaemia, an acquired autoimmune disorder, can be the culprit behind a vitamin B12 deficiency. The onset of symptoms are usually gradual. As such, the early indicator of lethargy can be overlooked, as can diarrhoea and a smooth tongue (glossitis). By the time neurological complications have developed, you may have noticed a feeling of muscle weakness.

Later, the Babinski’s reflex can occur, which is when the big toe moves upwards while the other toes fan out in response to being stroked on the sole of the foot.

Experts at the National Library of Medicine expanded: “This reflex is normal in children up to two years old.”

In adults, however, the Babinski’s reflex is usual a sign of a central nervous system disorder.

What causes pernicious anaemia?

Dr Knott explained that the absorption of vitamin B12 “requires a substance called intrinsic factor, secreted by parietal cells [in the stomach]”.

He elaborated: “In pernicious anaemia, intrinsic factor is lacking. Pernicious anaemia may also be associated with gastric atrophy.”

Gastric atrophy is the partial or complete absence of parietal cells, “which is found in 15 percent of people aged 40 to 60 years, and 20 to 30 percent in older patients”.

Dr Knott added: “The peak age of presentation is 60 years and is more common in patients with blue eyes, blood group A, early greying and a positive family history.”

Vitamin B12 deficiency symptoms:

• Dyspnoea (laboured breathing)
• Dyspepsia (indigestion)
• Weight loss
• Loss of reflexes
• Ataxia (loss of muscle control)

“In severe cases, some patients may present with heart failure or hepatomegaly,” said Dr Knott.

“In these cases, psychological changes can occur, including depression, paranoia and delirium.

“Most conditions can be ruled out by measuring serum vitamin B12 level. Levels below 150ng/l generally indicate deficiency.”

The NHS expanded on the blood tests carried out to identify a vitamin B12 deficiency.

Blood tests check for levels of haemoglobin, the size of red blood cells, vitamin B12 levels, and folate.

Further blood tests check for pernicious anaemia, where the immune system attacks the parietal cells in the stomach, meaning the protein intrinsic factor cannot be made.

“Tests for pernicious anaemia are not always conclusive, but can often give your GP a good idea of whether you have the condition,” the NHS stated.

People diagnosed with pernicious anaemia will usually be treated with injections of hydroxocobalamin.

Hydroxocobalamin is a synthetic version of vitamin B12 that may be administered every three months.

Such treatment is likely to be lifelong as the body will be unable to create intrinsic factor.

Further blood tests may be needed to make sure the treatment is effective.

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