Do you suffer from any of the following symptoms?
- Fatigue, tiredness, or light-headedness
- Rapid heartbeat or difficulty breathing
- Poor memory or difficulty concentrating
- Numbness and tingling of hands or feet
- Difficulty with balance, poor coordination
- Pale skin
- Sore tongue
- Easy bruising or bleeding gums
- Upset stomach
- Unexplainable weight loss
- Depression, irritability, paranoia, mania, hallucinations
If you answered “yes” to any of the above, it may be time to get tested for B12 deficiency.
What is vitamin B12 and what does it do?
The National Institute of health defines Vitamin B12 as a nutrient that helps keep the body’s nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 also helps prevent a type of anemia called megaloblastic anemia that makes people tired and weak.
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 attached in food. After this, vitamin B12 combines with a protein made by the stomach called intrinsic factor and is absorbed by the body. Some people have pernicious anemia, a condition where they cannot make intrinsic factor. As a result, they have trouble absorbing vitamin B12 from all foods and dietary supplements.
How common is vitamin B12 deficiency?
B12 deficiency is common and reported to affect up to 25% of the U.S. population. Up to 20% of people over the age of 60 years old show marginal B12 status. The CDC reports, one out of every 31 Americans over 50 are B12 deficient. Sadly the current lab values of serum B12 grossly underestimate the incidence by using a cut-off range far too low. Many researchers propose that we raise the lower limit of normal to 550pg/ml.
Am I getting enough vitamin B12?
Most people in the United States get enough vitamin B12 from the foods they eat. But some people have trouble absorbing vitamin B12 from food. Your doctor can test your vitamin B12 level to see if you have a deficiency.
Certain groups may not get enough vitamin B12 or have trouble absorbing it:
Many older adults, who do not have enough hydrochloric acid in their stomach to absorb the vitamin B12 naturally present in food. People over 50 should get most of their vitamin B12 from fortified foods or dietary supplements because, in most cases, their bodies can absorb vitamin B12 from these sources.
People with pernicious anemia whose bodies do not make the intrinsic factor needed to absorb vitamin B12. Doctors usually treat pernicious anemia with vitamin B12 shots, although very high oral doses of vitamin B12 might also be effective.
People who have had gastrointestinal surgery, such as weight loss surgery, or who have digestive disorders, such as celiac disease or Crohn’s disease. These conditions can decrease the amount of vitamin B12 that the body can absorb.
Some people who eat little or no animal foods such as vegetarians and vegans. Only animal foods have vitamin B12 naturally. When pregnant women and women who breastfeed their babies are strict vegetarians or vegans, their babies might also not get enough vitamin B12.
What foods provide vitamin B12?
Vitamin B12 is found naturally in a wide variety of animal foods and is added to some fortified foods. Plant foods have no vitamin B12 unless they are fortified. You can get recommended amounts of vitamin B12 by eating a variety of foods including the following:
- Beef liver and clams, which are the best sources of vitamin B12.
- Fish, meat, poultry, eggs, milk, and other dairy products, which also contain vitamin B12.
- Some breakfast cereals, nutritional yeasts and other food products that are fortified with vitamin B12. To find out if vitamin B12 has been added to a food product, check the product labels.
Who should be tested for B12 deficiency?
- Anemia with elevated MCV (mean corpuscular volume)
- Neurological symptoms, such as numbness, tingling, difficulty with walking or balance issues
- Changes in mental status, confusion, or disorientation
- Dementia or Alzheimer’s disease
- Bipolar, mania, or schizophrenia
- Gastrointestinal disorders with malabsorption, like pancreatic insufficiency
- Patients who have had gastrointestinal surgeries or gastric bypass
- Anyone over age 60 years old
- Restricted diets: vegans, vegetarians, macrobiotic diets
- Autoimmune disorders
- Children with autism spectrum disorders or developmental delay
- Breast fed infants of mothers at risk
- Eating disorders
- Family history of pernicious anemia
- Chronic use of PPI medications (Nexium, Prilosec, prevacid, etc.) or Metformin
- Occlusive vascular disorders (heart attack, stroke, blood clots)
So what if I do have a B12 deficiency?
B12 is nontoxic and water soluble so if you are deficient the good news is it is easy to replace! Traditionally B12 has been given in the form of intramuscular injections to ensure absorption but studies have shown that sublingual forms may be equally effective. B12 may come in the form of cyanocobalamin, methylcobalamin, hydroxycobalamin, and adenoxylcobalamin. You can discuss with your doctor which form is best for you.
Vitamin B12 can be found in large quantities in animal products, including meat, poultry, fish, seafood, eggs, and dairy products; and the consumption of these products is the most longstanding method by which human beings have taken vitamin B12 into their systems.
People should get most of their nutrients from the food they eat. If you do not eat animal proteins there are other food sources that are fortified with vitamin B12. Read food labels, and if you feel you need additional vitamin B12 it can be easily added by using a good multivitamin