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and patients with pernicious anemia who have optic neuropathy COBALAMIN (Vitamin B12) Deficiency Causes – Vegetarians (dietary deficiency) – Older adults: atrophic gastritis affects 10% – 30% and leads to decrease in hydrochloric acid secretion in the stomach and decreased absorption of Vitamin B12 – The liver can store up to six years worth of Vitamin B12 so deficiencies are rare Effects of deficiency – Megaloblastic anaemia (pernicious anaemia) – Progressive demyelination of nerve cells – Elevation in levels of circulating homocysteine that leads to production of defective collagen and elastin with a negative impact on arteries, bone and skin – Deep vein thrombosis is associated with homocysteinemia that causes the activation of the intrinsic coagulation cascade – Symptoms include fatigue, weakness, constipation, loss of appetite and weight loss Numbness, tingling of the feet imbalance, depression, confusion, dementia, poor memory and glossitis