Abstract
Most of us may believe that we have most of the necessary information about vitamin B12 and that we also use it correctly in differential diagnostic considerations as well as in therapy. This article aims to summarize the knowledge about vitamin B12, and above all, to mention several new approaches.
Of these, the most important one is emphasising the possibility of oral vitamin B12 administration. This is possible mainly due to the confirmed absorption by passive diffusion even in the absence of the intrinsic factor.
When administered orally, an adequate dose (1,000 μg) is necessary for passive diffusion. The title of this article could probably be expanded as: Why we should be interested in vitamin B12 deficiency, when and in what situations we should be mindful about B12 deficiency and finally, how we should compensate B12 deficiency.
Why should we be interested in vitamin B12 deficiency? There are essentially two reasons. The primary reason is differential diagnosis of various conditions.
Vitamin B12 deficiency can manifest as fatigue, loss of performance, but also as paraesthesia or depression and memory disorder. Second, when vitamin B12 deficiency is determined as the cause of these conditions, we have the opportunity to effectively treat the patient, not only with the well-known parenteral form, but now also with the oral form of vitamin B12.
When should we consider (when to be mindful about) the possibility of vitamin B12 deficiency? The list of these situation is lengthy, of course. Let's mention at least some of them: Elderly sickly patients, vegetarians and vegans, diabetics treated by metformin, patients using proton pump inhibitors in a long-term, patients after resections of the digestive tract, and many others.
How? First, we need to determine the level of vitamin B12 and subsequently start the treatment. Up until now, arenteral administration has been considered the standard form. (The patients often knew what the red ampoules were, which resulted in a placebo effect.) Today, we should consider the option of oral B12 administration and present it to the patient.
It should be emphasized that for perfect absorption and achievement of sufficient concentrations, an adequate dose of 1,000 μg is required. Patients need to be advised to not rely on the advertising on the internet, but that they should trust the products prescribed by their doctor.
The vitamin B12 example shows that even today, traditional and seemingly well-known approaches are sometimes marginalized, even in situations when the patient's condition can be improved by administrating a single tablet a day.