Not getting enough B12 causes tiredness, weakness, changes in elimination, loss of appetite, and weight loss—all symptoms of megaloblastic anemia, a condition characterized by very large red blood cells. It comes on slowly, especially when compared to that of other types of anemia, so can be hard to diagnose in its early stages.
Numbness and tingling in the hands and feet can also occur. Other symptoms of vitamin B12 deficiency include problems with balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue. Chronic vitamin B12 deficiency can damage the nervous system even in people who don’t have anemia, so it is important to treat low B12 as soon as possible.
In infants, signs of a vitamin B12 deficiency include failure to thrive, problems with movement, and delays in reaching the typical developmental milestones. In the elderly, B12 deficiency is associated with memory loss, Alzheimer’s disease, and dementia.
How You Get B12
Animal products are the only natural sources for vitamin B12. Those who avoid red meat, but still eat fish and shellfish, will find clams, mussels and crab packed with B12. Those who eat poultry, but avoid meat and fish, will be surprised to learn that chicken and eggs have very low amounts of B12.
Sources of Biologically Active Vitamin B12
Source: National Institutes of Health
It is important for vegans, whose food choices provide almost no B12, to recognize that foods that contain pseudovitamin-B12 provide almost no B12 value. Pseudovitamin-B12 is found in health foods like Spirulina and Chlorella, but is not considered biologically active. However, some fresh sea algae like Nori (Porphyra yezoensis) have been reported to have vitamin B12 activity.
Two steps are required for the body to absorb vitamin B12 from food. First, hydrochloric acid in the stomach separates vitamin B12 from the protein to which vitamin B12 is bound in food. Then, unbound vitamin B12 combines with a protein made by the stomach called “intrinsic factor” so the body can absorb it. Pernicious anemia, a type of megaloblastic anemia, is a condition where a person cannot make intrinsic factor. As a result, they have trouble absorbing vitamin B12 from all foods and dietary supplements, and need injections, nasal spray, or patches.
The Folic Acid and B12 Link
Folic acid is a critically important nutrient and close partner with vitamin B12. Raw foodies, vegans, and mega green juicing enthusiasts get super high levels of folate from plants. I’ve never seen a vegetarian with folic acid levels other than high, and often off the chart. Of course, this is a good thing, unless your diet is low in B12.
Without enough vitamin B12, too much folic acid in the body can hide a vitamin B12 deficiency by correcting megaloblastic anemia. As a result, your blood count looks normal on the lab test, but you still feel tired and unwell. Also, folic acid alone does not correct the progressive damage to the nervous system that vitamin B12 deficiency causes. The two should be combined together.
Programing Chronic Disease B12
New research recently published in “Nature” suggests that vitamin 12 deficiency can influence life long health. In reviewing human and animal studies, the researchers found a link between maternal vitamin B12 on fetal growth and a programming effect for susceptibility to chronic disease.
Low maternal vitamin B12 levels, as well as folate status and protein intake, are associated with increased risk of neural tube defect, and also show to be associated with low lean body mass and excess adiposity, increased insulin resistance, impaired neurodevelopment, and increased risk of cancer in the offspring.
Ten Reasons Why You Need B12
- Prevent megaloblastic anemia.
- Prevent cancer.
- Prevent Alzheimer’s.
- Prevent inflammation.
- Improve energy.
- Improve memory.
- Improve metabolism.
- Healthy skin, hair, and nails.
- Protects against cardiovascular disease.
- Protects against neurological diseases including Multiple Sclerosis.
What’s Your B12 Number?
Vitamin B12 is accurately tested in a blood sample. LabCorp clinical ranges for B12 are 211-946 pg/mL. For my patients, below 350 pg/mL is too low. I like to see at least 650 pg/mL. Since vitamin B12 is without side effects, chronically ill patients made need B12 levels as high as 1,200 pg/mL.
Best Ways To Get Your B12
What’s the difference between an MD and an ND? When you go to your traditional MD for a B12 injection, you’ll likely get a shot of cyanocobalamin. When you go to an ND (Naturopathic Doctor), you’ll get a methylcobalamin shot.
Vitamin B12 comes in four forms: (1) cyanocobalamin, (2) methylcobalamin, (3) adenosylcobalamin, and (4) hydroxycobalamin. Although cyanocobalamin is the most commonly used form of vitamin B12 in supplements and injections, other forms absorbs better. In the body, cyanocobalamin is metabolized into two main active forms of B12: methylcobalamin and adenosylcobalamin, also known as dibencozide. Along with hydroxycobalamin, these are considered the coenzyme forms of vitamin B12.
All of these types are high efficiency forms of B12, but methylcobalamin is the most commonly used coenzyme B12. It absorbs easily from the gut, so capsules are an inexpensive and effective choice for supplementing vitamin B12. However, if you have trouble absorbing B12, you’ll find sprays and patches effective, as well as sublingual methylcobalamin.
Another active form of B12 present in body tissues is hydroxycobalamin. It is used as an injection for those who cannot metabolize methylcobalamin. These patients include those with chronic Lyme disease. Hydroxocobalamin is the most bioactive form of Vitamin B12 and is retained longer in the body so can be dosed less frequently. It is not available in oral forms, but can be found in nasal sprays.
A safe dosage of B12 is 1,000 mcg daily. However, if your B12 level as measured in a blood test are very low, you’ll need more. For chronic disease management and overcoming megaloblastic anemia, dosages upward to 5,000 mcg daily are required. For really fast results, consider weekly injections of methylcobalamin or hydroxycobalamin.
Remember, Vitamin B12 plays a key role in the normal functioning of the brain and nervous system, and for the formation of blood. Too little not only causes anemia, making you feel run down, but over time has an insidious negative impact on all aspects of your health.
Vitamin B12 has not been shown to cause any harm. However, it makes sense to get only what you need, and perhaps a little more. Don’t overdo any vitamin, including B12.
Dr. J. E. Williams is a pioneer in the field of integrative medicine, longevity, and natural health. Dr. Williams is the author of six books and more than two hundred articles. During his thirty years of practice, Dr. Williams has conducted over 100,000 patient visits. Formerly from San Diego, he now practices in Sarasota, Florida and teaches at the University of Miami Miller School of Medicine, Division of Complementary and Integrative Medicine, NOVA Southeastern University, and Emperor’s College in Los Angeles.
He is also an ethnographer and naturalist. Since 1967, he has lived and worked with indigenous tribes, and spends as much time in the high Andean wilderness and deep Amazonian rainforest as possible. In 2010, he founded AyniGLOBAL, a non-profit organization dedicated to protecting indigenous cultures, environments, and intellec¬tual rights. His current work is with the Q’ero people of the Peruvian Andes, where he teaches Earth-based wisdom and heart-centered spirituality.