GPs could recommend over-the-counter B12 supplements or suggest oral treatment or intramuscular injections for vitamin B12 deficiency, under new draft NICE guidelines.

And patients should be offered a blood test for vitamin B12 deficiency if they have one symptom and at least one risk factor, NICE has said.

The advice forms part of the first-ever draft guideline on B12 deficiency diagnosis and management, published this week (11 July) and open to a six-week consultation.

It offers guidance on how to diagnose the condition in primary care, and which treatment option to use depending on the cause of the deficiency.

B12 deficiency can lead to a wide range of symptoms and complications, including mental health problems and neurological problems such as cognitive impairment, NICE said.

Its guideline aims to improve diagnosis and management, reduce complications and ‘improve quality of life for patients with suspected and confirmed deficiency’.

Vitamin B12 deficiency is more common in older people and is thought to affect around 5% of 65-74-year-olds and over 10% of over-75s. It can be caused by a diet lacking in B12; problems with absorption from the gastrointestinal tract; as well as recreational nitrous oxide use.

The draft guideline recommends:

  • If one sign or symptom and one or more risk factors are present, a blood test should be offered. Risk include age, previous surgery of the digestive system and autoimmune conditions.
  • A methylmalonic acid (MMA) should be used to confirm diagnosis, if initial testing is inconclusive.
  • Treatment should be considered if their test is indeterminate and vitamin B12 deficiency is suspected, with or without doing an MMA test.
  • Recommended treatments include intramuscular injections of vitamin B12 or oral replacement for the treatment of deficiency, depending on the cause.
  • In cases where diet is the cause, GPs should offer advice on changes to diet and advice on OTC supplements.

Untreated vitamin B12 deficiency can lead to health complications including anaemia and tiredness, eyesight problems such as blurred vision, mobility problems such as impaired balance, and delirium.

The consultation closes at 5pm on Tuesday 22 August.

This article first appeared on our sister publication, Pulse.