By Dr. Mercola
According to the U.S. Department of Agriculture (USDA), nearly 40 percent of the U.S. population have marginal vitamin B12 status and 9 percent are deficient.1 Vitamin B12 insufficiency and deficiency increase your risk of serious health problems, many of which mimic more serious neurological diseases and can easily lead to misdiagnosis and improper treatment.
Neurological problems, in particular, are a possibility even at the “low normal” range at or just below 258 picomoles per liter (pmol/L). A level of 148 pmol/L or less is considered a deficiency state. As noted by the USDA:2
“Deficiency can cause a type of anemia marked by fewer but larger red blood cells. It can also cause walking and balance disturbances, a loss of vibration sensation, confusion and, in advanced cases, dementia. The body requires B12 to make the protective coating surrounding the nerves. So, inadequate B12 can expose nerves to damage.”
Indeed, vitamin B123 is vital for many functions throughout your body. B12 is required for:
|Producing adrenal hormones||Metabolizing folate|
|Digestion and metabolizing fat and carbs||Formation of red blood cells|
|Iron absorption||Proper blood circulation|
|Reproductive health||Modulation of gut microbial ecology4|
|Nervous system function||Nerve growth and function|
|Synthesizing of DNA||Regulation and coordination of cell growth5|
B12 Deficiency Mimics Many Serious Neurological Disorders and Diseases
As noted in the featured video, B12 deficiency can look exactly like multiple sclerosis, Alzheimer’s disease and autism. The film is made by registered nurse Sally Pacholok, a leading advocate for B12 deficiency awareness.6 According to the National Institutes of Health (NIH), a deficiency can even affect a woman’s Pap test, which screens for cervical cancer.
Low B12 can affect the appearance of cervical cells, which can result in a false positive.7 Deficiency also raises your risk of heart disease. Vegans or strict vegetarians who abstain from animal products and do not supplement their diet with vitamin B12 will typically become anemic. Nervous and digestive system damage can also result.8
Claims that B12 is present in certain algae, tempeh and brewer’s yeast fail to take into account that the B12 analogues present in these foods are not bioavailable. The only reliable and absorbable sources of vitamin B12 are animal products. However, even animal foods have become a questionable source thanks to modern farming practices and, for this reason, many experts now believe most people really need to take a B12 supplement to ensure healthy B12 status.9
B12 Deficiency Widespread Even Among Meat Eaters
Interestingly, research shows no association between B12 blood levels and consumption of meat, poultry and fish — the primary sources of B12.10 According to the researchers, rampant B12 insufficiency is not due to lack of meat consumption. Rather, the vitamin simply isn’t being properly absorbed. B12 is tightly bound to proteins and high acidity is required to break this bond. In essence, a lot of people simply do not have sufficient stomach acid to separate the B12 from the protein.
The researchers speculate that the widespread use of antacids plays a significant role, especially among younger people. In a previous article,11 Dr. Jennifer Rooke, assistant professor in the department of community health and preventive medicine at Morehouse School of Medicine, also notes that factory farmed meat simply does not contain the B12 levels we’re used to.
The reason for this is because animals raised in concentrated animal feeding operations (CAFOs) aren’t fed their natural diet. Cows are fed corn and grains, most of which are genetically engineered (GE) and loaded with pesticides, rather than grass. The same goes for chickens, the natural diet of which are insects, worms, seeds and berries, not GE corn.
“It is true that animal products contain B12, and strict vegetarians/vegans are at risk for B12 deficiency, but absorbing B12 from animal products is a very complex process and people who eat meat may be at equal or greater risk for B12 deficiency,” Rooke writes. The reason CAFO animals don’t produce as much B12 is because B12 is made by bacteria that live in both soil and the guts of animals. Cows and chickens raised on pasture obtain the vitamin from the dirt on their food.
Pesticides also kill off soil bacteria, which is why conventionally grown grains are not a good source of B12, and CAFO animals are routinely given antibiotics, which also kill of these beneficial microbes. “In order to maintain meat a source of B12 the meat industry now adds it to animal feed; 90 percent of B12 supplements produced in the world are fed to livestock.
Even if you only eat grass fed organic meat you may not be able to absorb the B12 attached to animal protein. It may be more efficient to just skip the animals and get B12 directly from supplements,” Rooke writes.
Pregnant Women Beware: B12 Deficiency Can Cause Severe Neurological Damage in Your Child
While vegans are urged to augment their B12 intake by stocking up on nutritional yeast, coconut oil and fortified coconut milk, a strict vegan or even vegetarian diet is not recommended. In fact, there are cases in which a deficiency causes serious brain abnormalities. Women of childbearing age also need to be aware that B12 deficiency will place their offspring at risk.
If you’re deficient and breastfeed, your child will also be deficient, and may develop neurological symptoms — symptoms that are frequently misdiagnosed as autism and/or other neurological diseases. It’s really critical to catch a B12 deficiency early, as impaired brain and nerve development can be very difficult to correct once the damage is done. In adults, B12 deficiency can develop in about six years.12 That’s how long it takes to deplete your body’s B12 stores.
Babies, however, do not have B12 stores, especially if the mother was deficient during pregnancy, so side effects can develop far more rapidly. Babies whose moms had a B12 deficiency during pregnancy also have a higher risk of developing Type 2 diabetes and other serious metabolic problems.13
A deficiency can be corrected by weekly shots of vitamin B12 or daily high-dose B12 supplements. Mild cases may also be corrected by increased intake of vitamin B12-rich foods. A detailed list of the B12 amounts of different foods can be found on the NIH website.14Some of the richest sources include clams, beef liver, wild rainbow trout and wild sockeye salmon.
B12 Deficiency Plays a Role in Depression and Other Psychiatric Conditions
Aside from symptoms mimicking autism and Alzheimer’s, B12 deficiency also contributes to depression and other psychiatric conditions. (Other B vitamins, including niacin (B3), B6, biotin (B8) and folate (B9) deficiencies can also produce psychiatric effects.) For example, research has shown vitamin B12 deficiency can trigger confusion, agitation, depression, mania, psychosis and paranoid delusions.15,16
One study17,18 found vitamins B6, B8 (inositol) and B12 in combination were very effective for improving schizophrenic symptoms when taken in high doses — more so than standard drug treatments alone. Low doses were ineffective. One of the reasons for this may be related to the fact that schizophrenics tend to have abnormalities in their B12 and glutamate pathways.19
Low B12 Implicated in Migraines
B12, along with B6 and folic acid, has also been shown to reduce the frequency, severity and disability of migraines. In one study,20daily vitamin supplements produced a twofold reduction in migraines over a six-month period. Certain gene mutations and dysfunctions can lead to higher levels of homocysteine production, which can make you more susceptible to migraine attacks.
Vitamins B6 and B12 help to optimize your homocysteine levels. The scientists also found that depending on your genotype, you may need a higher or lower dose to benefit. People with TT genotypes, which have a lower enzymatic rate, metabolize less homocysteine than those with C allele carriers. As a result, the former experience less of a benefit from the supplementation and require higher doses.
Signs of Vitamin B12 Deficiency
If you’re frequently beset by fatigue and general lack of energy, you may be experiencing the onset of B12 deficiency. Other seemingly unrelated symptoms such as poor memory, shortness of breath, loss of taste and smell, depression and tingling in your extremities, can be indicative of low B12.
Anxiousness and depression may occur because a B12 shortage depresses the brain chemical serotonin, a neurotransmitter linked to your brain’s pleasure centers, and dopamine, the mood regulator registering memory and mood. Unless there’s an intervention, low B12 levels may even lead to paranoia, delusions and hallucinations. Other signs and symptoms include:21
|A numb, tingly, “pins and needles” sensation in your hands, legs or feet, which may indicate possible nerve damage.|
|A red, swollen, “beefy” tongue with fewer papillae “bumps” containing taste buds.|
|Blurry or double vision, or shadows in your field of vision, caused by optic nerve damage from a B12 deficiency.|
|Yellow skin (jaundice), an indication that your red blood cells are degrading, which releases a yellow pigment in the process.|
|Unstable, wobbly and dizzy feelings, which are signs there may not be enough oxygen in your blood, related to low B12.|
|Memory loss, which may be a red flag when it has no other potential cause.|
Most People Are at Risk for B12 Deficiency
There are a number of key reasons for a B12 deficiency, including the following. Unfortunately, doctors frequently overlook these common contributing causes, and B12 deficiency is frequently misdiagnosed as something far more serious.
Needless to say, when a deficiency is misdiagnosed as depression, Alzheimer’s, autism or other serious disease, the root cause remains unaddressed, and no amount of treatment will be significantly effective. So, if any of these situations apply to you, be particularly mindful of your B12 status, especially if you have symptoms associated with deficiency.
|Vegetarians and vegans are susceptible since B12 is derived from animal products.|
|People who regularly drink alcohol, as B12 is stored in your liver.|
|Anyone with an autoimmune disease like Crohn’s or celiac, which may prevent your body from being able to absorb B12.|
|People who drink more than four cups of coffee daily are more prone to vitamin B deficiencies than non-coffee consumers.22|
|Those who’ve had gastric bypass surgery and therefore have altered digestive systems, as this may impair B12 absorption.|
|People exposed to nitrous oxide (laughing gas), which can wipe out whatever B12 reserves you may have in your body.|
|Adults over 50, because as you grow older, your ability to produce intrinsic factor decreases.|
|People with helicobacter pylori infection. Intrinsic factor is a protein made by stomach cells that’s necessary for B12 absorption. H. pylori bacteria can destroy intrinsic factor, thereby preventing B12 absorption.|
|People who take antacids, which have a tendency to interfere with B12 absorption, especially over time.|
|Patients who take metformin for low blood sugar, as the drug interferes with B12 absorption, doubling your risk of deficiency.23|
|Anyone taking a proton-pump inhibitor (PPIs) like Prevacid or Nexium or H2 blocker such as Pepcid or Zantac. Research24 shows taking PPIs for more than two years increases your risk of B12 deficiency by 65 percent.|
|Women taking birth control pills for an extended period of time, as the estrogen impairs absorption.25|
|People who have taken antibiotics, as these drugs have been shown to induce vitamin B12 deficiency.26|
How Much Vitamin B12 Do You Need and Which Type Is Best?
The recommended dietary allowance for vitamin B12 is:27
- 0.4 to 1.8 micrograms (mcg) for newborns and children up to 13, depending on their exact age
- 2.4 mcg for people age 14 and older
- 2.6 mcg for pregnant women
- 2.8 mcg for breastfeeding women
Fortunately, you don’t need to worry about overdosing on B12 because it’s water soluble, so your body will simply flush out any excess. The type of B12 you use, however, is a factor worthy of consideration. While cyanocobalamin is the form of B12 found in most supplements, this form is far from ideal and does not occur naturally in foods. As explained by Dr. Peter J. D’Adamo:28
“As the name implies, cyanocobalamin contains a cyanide molecule. Most people are familiar with cyanide as a poisonous substance. Although the amount of cyanide in a normal B12 supplement is small and from a toxicology point, viewed as insignificant, your body will still need to remove and eliminate this compound. This removal is accomplished through your detoxification systems with substances like glutathione being very important for the elimination of the cyanide.”
A far better form of B12 — especially for the support of nervous system health and healthy vision — is methylcobalamin, which is the naturally occurring form found in food. It’s more absorbable and your body retains it in greater amounts than cyanocobalamin.29Considering the many health risks associated with B12 deficiency, and the fact that CAFO animal products — which is what most people eat — tend to be low in B12, it may be wise for most people to take a high-quality methylcobalamin supplement.
- 1, 2 USDA, Vitamin B12 Deficiency
- 3 Eating Our Future, Vitamin B12 Deficiency
- 4 Cell Metabolism November 4, 2014; 20(5): 769–778
- 5 PNAS February 14, 2017; 114(7): E1205-E1214
- 6 B12awareness.org
- 7 Health.com March 27, 2018
- 8 The Nutrition Almanac, 3rd ed. p. 32-33; Garrison, R. & Somer, E. The Nutrition Desk Reference, 3rd ed., (Keats Publishing; CT), p. 126
- 9 European Journal of Nutrition 2017 Feb;56(1):283-29
- 10 USDA, Vitamin B12 Deficiency
- 11 Baltimore Post-Examiner October 30, 2013
- 12 Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, Estimation of the
- 13 Science Daily November 7, 2016
- 14 NIH.gov, Vitamin B12 Fact Sheet
- 15 British Medical Journal 956 Dec 15; 2(5006): 1394–1398
- 16 British Medical Journal 956 Dec 15; 2(5006): 1394–1398 (Full article, PDF)
- 17 Psychological Medicine February 16, 2017, DOI: https://doi.org/10.1017/S0033291717000022
- 18 Medical News Today February 16, 2017
- 19 PeerJ Journal 3:e1140
- 20 Pharmacogenet Genomics. 2009 Jun;19(6):422-8
- 21 Harvard, Vitamin B12
- 22 Clinical Chemistry August 2008
- 23 American Family Physician 2017 Sep 15;96(6):384-389
- 24 JAMA 2013;310(22):2435-2442
- 25 Health.com March 27, 2018
- 26 Effects of Antibiotic-Induced Vitamin B12 Deficiency With and Without Oral Administration of Vitamin B12 (PDF)
- 27 NIH.gov, Vitamin B12 Fact Sheet
- 28 DaDamo.com, Cyanocobalamin versus Methylcobalamin
- 29 Just Vitamins, Cyanocobalamin versus Methylcobalamin