Living with a urostomy, you already know how important it is to stay on top of your health. One nutrient that deserves special attention is vitamin B12 – a ‘powerhouse’ vitamin that plays a crucial role in your overall well-being. Whether you’re newly adjusting to life with your stoma or have been managing it for years, understanding B12 could make a big difference in how you feel day to day.
Here are some frequently asked questions about this vital vitamin, its effect on health and why it’s especially relevant to urostomates.
What is vitamin B12 and why do I need it?
Vitamin B12 is essential for:
- red blood cell formation
- brain function and mental clarity
- energy production
Think of vitamin B12 as working behind the scenes, quietly helping your body run smoothly. Without enough B12, everything from your energy levels to your memory and mood can begin to flag. Some people who have a urostomy may experience a decrease in their levels of vitamin B12. This is because the part of the small intestine that absorbs B12 may have been removed during your surgery.
What are the signs and symptoms of B12 deficiency?
B12 deficiency can sometimes be tricky to spot, and symptoms often develop gradually. Also, many people mistake the symptoms as part of the aging process. Common signs include:
- extreme fatigue
- brain fog or memory problems
- numbness or tingling in hands and feet
- mood changes or depression
- pale or jaundiced skin
- shortness of breath
- balance or co-ordination issues
If you experience these symptoms or suspect a B12 deficiency, it is important to contact your GP for a diagnosis as soon as possible. If the deficiency is caught early, symptoms usually improve with treatment.
How is B12 deficiency diagnosed?
The good news is that a simple blood test arranged by your GP can detect a B12 deficiency. The tests measure total B12 (serum cobalamin) or active B12 (serum holotranscobalamin).
Due to your urostomy putting you at increased risk of B12 deficiency, your GP may recommend periodic testing to check levels, even if you are not experiencing symptoms. Regular monitoring can help catch a deficiency before it starts to cause problems.
Sometimes, low vitamin B12 levels don’t show up on standard blood tests. That’s why new guidance from NICE (the National Institute for Health and Care Excellence) advises that if you’ve had bowel surgery – like a urostomy – and you’re getting symptoms of B12 deficiency, you should still be offered B12 injections, even if your test results look normal. If this sounds familiar, it might be worth showing this information to your GP.
If I’m found to be B12 deficient, what are the treatment options?
In patients with a urostomy, the reason for B12 deficiency will almost always be due to the surgery you have had. This will mean that the part of your bowel that absorbs vitamin B12 isn’t available to do its job anymore. For this reason, taking vitamin B12 supplements orally won’t be effective, so you will need injections.
Your GP or nurse will give the injections, usually at a higher dose and more frequently for the first few times, then this will be maintained with injections every three months.
If you follow a vegan or vegetarian diet, you can have B12 deficiency which isn’t related to your urostomy surgery. If this is the case, a B12 supplement taken orally is a good idea.
Can I prevent a deficiency in the first place?
Your body doesn’t make vitamin B12 on its own and absorption of B12 happens in the part of the bowel which is often used to form a urostomy. If you don’t have the part of the bowel that absorbs vitamin B12, it doesn’t matter how much B12 you consume from food or supplements, because you can’t absorb it. That said, making sure your diet contains adequate amounts of foods containing B12 is still a good idea.
Foods rich in B12 include:
Animal-derived products: red meat, fish, poultry, eggs, milk and other dairy products all contain vitamin B12.
Fortified foods: certain breakfast cereals, nutritional yeast, plant milk and certain bread. Be sure to check the food label to see if the food has been fortified with vitamin B12. Consuming sufficient fortified foods is especially important if you are following a strict vegetarian or vegan diet.
Vitamin B12 supplements: Many multivitamins have vitamin B12. There are also supplements that only have B12. Ask your healthcare provider or pharmacist to help you choose the supplement that is best for you.
Are there risks in taking too much vitamin B12?
B12 is a water-soluble vitamin, meaning excess amounts are usually excreted in urine. It’s generally considered safe, even in high doses.
Is there anything else I should know?
Always check with your GP before starting any new supplement, especially if you have other medical health conditions. And be aware that some medications, like metformin or proton pump inhibitors, can interfere with B12 absorption.
Final thoughts
Vitamin B12 might be small, but its impact is mighty, especially for urostomates whose bodies may not absorb it as efficiently. If you think you might be B12 deficient, don’t ignore the signs. If you’re feeling more tired than usual, experiencing tingling, or just not feeling like yourself, a simple blood test could reveal the root cause.
Staying proactive will help you keep well, with the energy you need to enjoy life to the full.
- Our thanks to Sophie Medlin for her contribution to this article. Sophie is Director and Specialist Dietitian at CityDietitians and Chair of the British Dietetic Association for London.
