Address the Cause(s)
vegetarian/vegans,
malabsorption, poor gastric acid (now the commonest cause - reduces absorption of
food-derived but not
supplemental forms), PPIs, pernicious anaemia - rare
Dietary Advice
healthy
eating protein, meat, milk, fish, eggs
fortified foods some soya
milks bfast cereals, Flora Proactive
Supplement with appropriate amounts of
nutrient
Parenteral
Injections for severe deficiency (signs, anaemia or mental symptoms) or malabsorption (see NHS
Direct)
Mild deficit/poor diet
oral B1210-50ug/day - 2 months + retest
Consider need for other nutrients
Vegetarian/vegans
iron, zinc, calcium: elderly Ca/vit D
Once main deficiency corrected
Malabsorption/severe
deficiency parenterally - 2-3 months
Use multivitamin if poor
diet, elderly, some pregnant/lactating Caution if cancer especially prostate reassess need