1. Topic
Incidence of Vit B12
Deficiency among
employees---Occupational
Health
By-Dr.Ashok Laddha

2. Introduction
 Vit B12 deficiency is common in elderly and vegetarian, but
it is controversial if screening is carried out in entire
population. vitamin B12 is very common because of
widespread causative factors. The deficiency state has a
very wide presentation and can cause or exacerbate
neuropsychiatric and other vague symptoms. It has been
observed that vitamin B12 deficiency is far more prevalent
than expected in all age grp and in both vegetarian as well
as in non vegetarians and majority of the cases remain
undiagnosed. This puts everyone virtually at risk. However,
more wide spread study is required to detect the exact
prevalence among all age groups as well as in vegetarian
and non vegetarian.

3. Introduction
 The result revealed that 42% executives & 39% workers
found to be having Vit B12 deficiency In other
assessment we found that 48% vegetarian & 39% Non-
Vegetarians were having Vit B12 deficiency & we also
detected that nearly 36 % employees have one or other
psychiatric manifestation.

4. Key words
 : Vit B12, Vegetarian, Deficiency

5. Objectives
 To assess the prevalence of Vit B12
deficiency among employees
 To assess the prevalence of Vit B12
deficiency among Vegetarian and non
vegetarian
 To assess the psychiatric manifestation in
deficient group

6. Material & Method
 Retrospective study
 Group of 104 employees comprising the workers &
executives
 Computerized lab report
 Personal history data sheet
 Previous periodical medical records
 Collection of blood samples as per protocol

7. Discussion-1
 Deficiency of vitamin B12 is very common because of
widespread causative factors. The deficiency state has
a very wide presentation and can cause or exacerbate
neuropsychiatric and other vague symptoms. It has
been observed that vitamin B12 deficiency is far more
prevalent than expected in all age grp and in both
vegetarian as well as in non vegeterians and majority of
the cases remain undiagnosed. In early stage vitamin
B12 deficiency might present with subtle and slight
cognitive impairments. Hence early recognition
becomes crucial for preventing irreversible damage.

8. Discussion-2
 Many people say that the only foods which contain vitamin
B12 are animal-derived foods. This also is untrue. No foods
naturally contain vitamin B12 - neither animal or plant
foods. Vitamin B12 is a microbe - External B12 coming into
the body must be combined with a mucoprotein enzyme
named Intrinsic Factor, which is normally present in
gastric secretions, to be properly assimilated. If the
Intrinsic Factor is impaired or absent, B12 synthesis will not
take place, no matter how much is present in the diet. A
B12 deficiency can be caused by antibiotics (from the drugs
themselves and contained in milk and meat), alcohol
(alcohol damages the liver, so drinkers need more B12) and
smoking (and all high temp cooked food is smoky) and
stress also raises B12 needs).

9. Discussion-3
 Many nutritionalists and doctors does not believe that
a vitamin B12 deficiency is more widespread in vegans
or vegetarians - this is probably just another marketing
lie! In fact, many so-called studies 'showing vegans
deficient' have to be carefully studied themselves -
many of them do not prove vegans to be deficient at
all!

10. Discussion-4
 In the present study vitamin B12 measurement was
used as the first-line test and the definition of vitamin
B12 deficiency was based on low level of serum vitamin
B12 although measurements of metabolites such as
methylmalonic acid and homocysteine have been
shown to be more sensitive in the diagnosis of vitamin
B12 deficiency.

11. Discussion-5
 Vitamin B12 deficiency leads to several neurological
manifestations and affects all age groups . Vitamin B12
deficiency may present with fatigue, weakness,
numbness, decreased memory, irritability, confusion
and depression, although initial symptoms might
often be vague. The diagnosis is frequently made on
the basis of a low serum vitamin B12 level or
megaloblastic bone marrow or both . There has been
much debate over establishing a universally accepted
normal range for vitamin B12 and proper investigation
of B12 deficiency in the general population needs to be
done.

12. Causes of Vit B12 deficiency-1
 Pernicious anaemia
 Atrophic gastritis
 Surgery in which part of the stomach and/or small
intestine is removed.
 Conditions affecting the small intestine, bacterial
growth, or a parasite.
 Excessive alcohol consumption.
 Autoimmune disorders
 Smoking/Tobacco

13. Causes of Vit B12 deficiency-2
 Intrinsic factor Deficiency
 Drugs- Ranitidine, Metformin, Phynentoin
 Bariatric surgical procedures
 Hereditary causes
 Worm infestation
 Chemical Gases – chlorofluorocarbon, Nitrous oxide
 Antibiotics
 High Temperature

14. Causes of Vit B12 deficiency-3
 Stress
 Free radicals
 Chlorine
 Mercury
 Pentachlorophenol
 Pesticides

15. Causes of Vit B12 deficiency in
Non- Vegetarian
 High Alkaline and acidic condition
 Excessive use of Garlic
 Destruction of friendly bacteria in intestine
by constant putrefaction
 Naturally presence of putrefactive bacteria
in meat
 High temperature cooked food

16. Facts about vit-B12
 No food naturally contains Vit-B12
 Vit B12 is microbe-Yeast
 Vit B12 deficiency is more widespread in
vegan and vegetarian-a marketing lie

17. well-defined cut-offs for deficiency
 serum vitamin B12 can be broken down into 3
values:
 Likely vitamin B12 deficiency: <148 picomols/L
(<200 picograms/mL)
 Possible vitamin B12 deficiency: 148 to 258
picomols/L (201 to 350 picograms/mL)
 Unlikely vitamin B12 deficiency: >258 picomols/L
(>350 picograms/mL).

18. Category wise distribution of
employees
Category Strength %
Executives 48 46.15%
Workers 56
53.85%
Total 104
100%

19. Age wise distribution of employees
Age Strength
25-30 yrs 20(19.23%)
31-40 yrs 24(23.07%)
41-50 yrs
32(30.76%)
50 yrs and above
28(26.92%)
Total 104

20. Dietary habit wise distribution of
employees
Category Strength
Vegetarian
50(48.07%)
Non- Vegetarian
54(51.92%)
Total 104

21. Vit-B12 Deficiency wise
distribution of employees
Category Total Strength Deficient
Executives 48 20(41.66%)
Workers 56 22(39.28%)
Total 104 42

22. Dietary habit wise distribution of
Vit B12 deficient employees
Dietary
Habit(Category)
Total Strength Vit-B12 Deficient
Vegetarian 50 24(48%)
Non-Vegetarian 54 21(38.88%)
104 45

23. Psychiatric Manifestation
 Fatigue
 Decrease Memory
 Hallucination
 Irritability
 Confusion
 Anxiety
 Schizophrenia
 Capgras syndrome
 Delusion
 Depression
 Slow cerebration
 Acute psychotic stage

24. Psychiatric Symptom wise
distribution
Symptom Strength
Fatigue 3
Decrease Memory 2
Irritability 6
Confusion 4
Total 15(36%)

25. Conclusion
Vit B12 Deficiency is not just a lab,
findings but a clinical relevant issue
Further exploration is required
All age grp, Vegetarian or non
vegetarian, executives or workers are at
equal risk

26. Recommendations
 Inclusion of Vit B12 screening in routine as well as
in occupational health set up
 If possible ,inclusion of sensitive metabolites like
methylmalonic acid , homocystine &
holotranscobalamin for accurate diagnosis along
with clinical findings
 Awareness & education on imprtance of Vit B12
can improve quality of life.
 Large scale study

27. Limitation
Entire employees could not be assessed
Vit B12 measurement used as First line
test
Measurement of sensitive metabolites
like methylmalonic acid and
homocystine could not been done

28. References
 Gupta AK ,Damji A, Uppaluri A. Vitamin B12
deficiency among south asians at a toronto clinic.
Can Fam Physician,50:743-747,(2004)
 B12 article by Vagan society
 B12 article by vegetarian society
 Stabler SP, Allen RH. Vitamin B12 deficiency as a
worldwide problem .Ann Rev Nutr,24:299-326(2004)
 Baik HW, Russell RM. Vitamin B12 deficiency in the
elderly. Ann Rev Nutr,19:357-377(1999)

29. Acknowledgments
 I am most grateful for the ideas and constructive
comments from my colleagues.
 The author had no conflict of interest.

30. Lastly……….
Prevention is better than
cure
Thank-You