If you are a vegetarian, read closely. If you are a vegetarian and have diabetes sit up and take note. Along with a large swathe of you fellow citizens, you are likely to be deficient in vitamin B12—one of the essential vitamins that the human body procures from non-vegetarian sources and plays a key role in healthy blood cells, energy production and nerve function preservation.
Recent studies have found that people with diabetes are often low in B12. Hence, if you have diabetes, and happen to be deficient in vitamin B12, you are particularly vulnerable. The good news is, awareness and vitamin supplementation are safe approaches to prevent deficiency-related complications, especially among people with diabetes.
A vitamin that does key jobs
B vitamins are particularly important for overall health. And vitamin B12, also known as cobalamin, is a key micronutrient that your body needs to function well. It supports several chemical reactions inside the body, that are critical to maintain healthy nerve cells, proper brain function, for DNA synthesis, amino (part of protein) and fatty acid (part of cholesterol) metabolism. Older people who don’t get enough vitamin B12 may be at higher risk for anaemia and infections. Symptoms of anaemia deficiency include a sore mouth, diarrhoea and pasty or yellowing skin.
B12 helps in red blood cell production and iron function in the body along with folate (vitamin B9). With vitamins B9, B6 and other nutrients, it controls blood levels of the amino acid homocysteine (a common amino acid in your blood, high levels of which are linked to the early development of heart disease, often associated with low B12 levels). The homocysteine amino acid has also been linked to cognitive decline in Alzheimer’s and Parkinson’s disease. Vitamin B12 has been found to protect against dementia, heart disease, stroke, and osteoporosis. There’s more to B12. Read on to find out:
Vegetarian and deficient
India has more vegetarians than the rest of the world put together. As estimated by surveys of the Food and Agriculture Organization (FAO), vegetarianism is somewhere in the range of 20–42 per cent. The numbers do not reflect the reality, because even Indians who do eat meat, do so infrequently, with less than 30 per cent consuming it regularly.
Studies now show vitamin B12 deficiency is widespread in people with diabetes: a 2016 study from Maharashtra finds about 81 per cent people belonging to urban middle classes in the survey with low vitamin B12. Yet another 2019 study finds vitamin B12 deficiency among 47 per cent with diabetes in a North Indian population. Recent studies from the Madras Diabetes Research Foundation also report the prevalence of B12 deficiency in people with type 2 diabetes in South India.
The average adult should get about 2.4 micrograms of vitamin B12 a day. But B12 can’t be made by the body and has to be procured from food or supplements. The problem is: some people don’t consume enough vitamin B12 to meet their needs, some can’t absorb enough, no matter how much food they consume, and most don’t know if they consume enough or not. As a result, vitamin B12 deficiency is relatively common, especially among people who are vegetarian, elderly and those with diabetes.
Symptoms can be sneaky
Vitamin B12 deficiency symptoms are wide-ranging, affecting both physical and mental wellbeing. The symptoms may be mild at first and not always obvious because B12 deficiency shows up in sneaky ways: numbness, or tingling in the hands, legs, and feet, severe joint pain, recurrent falls, balance problems and troubled walking, anaemia, lightheadedness, heart palpitations and shortness of breath, swollen and inflamed tongue, difficulty thinking, reasoning and remembering, weakness and fatigue. Severe vitamin B12 deficiency can lead to deep depression, paranoia and delusions, memory loss, incontinence, loss of taste and smell, and more. (see Spot The Symptoms)
Diabetes and B12
Insufficient amounts of vitamin B12 can result in a range of disorders such as anaemia, neuropathy abnormal lipid profile and increased risk of heart disease. Long-term depletion is now being linked with Alzheimer’s disease.
Low B12 tends to be associated with homocysteine and increase the risk of heart disease and stroke. Vitamin B12 deficiency is also associated with adverse lipid profiles, especially higher triglyceride levels and lower “good” HDL cholesterol levels—both are early features of heart disease (especially, atherosclerosis or fatty plaque deposition on inner walls of arteries).
About 30 per cent people with diabetes show signs of neuropathy, meaning damage and dysfunction of nerves that typically result in numbness, tingling, muscle weakness and pain, frequently starting in hands and feet. Vitamin B12 can reverse neurologic symptoms, often inappropriately attributed to hyperglycaemia.
Diabetes increases fracture risk interferes with bone formation and impairs fracture healing. Rise in homocysteine levels is known to weaken bones, putting people at risk for osteoporosis. Vitamin B12 has an important role in bone-cell formation and deficiency has been linked to low bone mineral density, which leads to balance disturbances and recurrent falls and osteoporosis.
If you have diabetes — either type 1 or type 2 — you have an increased risk of developing depression. B-vitamins, including vitamin B-12, have been linked to depression. Researchers have found substantial evidence that a decrease in vitamin B12 correlates with an increase in depression. They also state that high vitamin B12 status may be associated with better treatment outcome of depression. One possible connection is the effect of vitamin B-12 on the levels of the mood-regulating hormone serotonin in the brain.
Early detection and treatment is important. Fortunately, if you have a B12 deficiency, it’s relatively easy to get a diagnosis and start a treatment plan. If left untreated, though, the deficiency can cause severe problems. Vitamin B12 deficiency can be slow to develop, causing symptoms to appear gradually and intensify over time. It can also come on relatively quickly. Given the array of symptoms a vitamin B12 deficiency can cause, the condition can be overlooked or confused with something else.
While an experienced physician may detect vitamin B12 deficiency, type 2 diabetes is frequently treated by primary care physicians. And vitamin B12 deficiency is often overlooked, despite the fact many people with diabetes are at risk for this specific disorder. It’s a good idea to ask your doctor about your B12 levels if you are a strict vegetarian.
Diet is the best way to get B12. Naturally found in animal products, including fish, meat, poultry, eggs, yogurt and milk, most healthy non-vegetarians get sufficient B12 from their diet. The good news is that that vitamin B12 is one of the easiest vitamins to supplement when it’s taken in the right form and dosages.
SPOT THE SYMPTOM
- exhaustion or fatigue
- rapid heartbeat
- shortness of breath
- brain fog or difficulty concentrating
- confusion or impaired thinking
- weakness and fatigue
- dizziness and lightheadedness
- a pale yellow tinge to the skin
- a sore and red tongue
- mouth ulcers
- pins and needles
- changes in the way that you walk and move around
- disturbed vision
- agitation, irritability and mood change
- depression and insomnia
- changes in the way you think, feel and behave
- decline in mental abilities, memory, understanding and judgement
- ringing in your ears