Vitamin B12 Deficiency

Vitamin B12 plays so many important roles in the body. One of its main jobs is to help the body make red blood cells. These red blood cells transport oxygen throughout your body and prevent anemia, which can make you feel tired, short of breath, and weak. While building red blood cells is a core function, B12 is also involved in making DNA and RNA (our genetic material).  In addition, it is needed for the function and development of nerve and brain cells, and even provides stress support.

The recommended daily intake of B12 is 2.4 mcg/day. Since it can’t be made by the body, it must either come from food or supplementation. Keep in mind the recommended daily intake is the minimum amount needed to avoid severe disease, it is certainly not the amount to keep you functioning optimally.  

So what foods have vitamin B12 in them? Animal products like milk, eggs, poultry, clams, meats and organ meats like liver are great sources of B12. It goes to say then that vegetarians and vegans are often deficient and require supplementation.

Symptoms of Vitamin B12 Deficiency

Without enough B12, you can become anemic because your body isn’t able to make enough red blood cells. With mild deficiency, there are often no symptoms. But if left untreated, B12 deficiency can lead to problems with your brain, nerves or heart like:

• Fatigue
• Weakness
• Lightheadedness
• Headaches
• GI symptoms like nausea, gas, or diarrhea
• Memory loss, depression, or other mental issues
• Decreased smell and taste
• Vision changes
• Glossitis (painful, red, smooth tongue)
• Numbness, tingling, or muscle weakness
• Shortness of breath
• Heart palpitations

One specific autoimmune disease that causes B12 deficiency is pernicious anemia. Pernicious anemia is an autoimmune condition that impacts your body’s ability to properly absorb B12. It causes the immune system to attack certain stomach cells that make a protein called intrinsic factor, or IF. IF is needed to absorb B12, so without it, less is absorbed. Treatment includes receiving B12 injections each week until levels are back to normal since people with this condition can not absorb oral forms B12. 

How To Diagnose Vitamin B12 Deficiency

There are a variety of tests your doctor can do to diagnose vitamin B12 deficiency. One such test is a B12 level, which is done through a normal blood draw. This checks to see how much B12 is in your blood.

Methylmalonic acid, or MMA, is another test that helps your doctor diagnose vitamin B12 deficiency. When the level of B12 is low in your blood, MMA rises so it can be a good indicator of deficiency. This test is also done via a blood draw and can also be checked in the urine.  There are also other tests that are not widely available yet such as holotranscobalamin. 

In addition to these two main blood tests, there are secondary things that can be picked up on blood work indicating. A high homocysteine level is one such indicator. Since vitamin B12 helps break down the amino acid homocysteine, high levels can indicate a B vitamin deficiency (commonly B12, folate, B2, B6). Additionally, looking at a complete blood count to check for big red blood cells (macrocytosis), is another way your doctor may pick up if there is a potential B12 or other B vitamin deficiency. 

Treatment For Vitamin B12 Deficiency

To treat a deficiency of vitamin B12, the body either needs to receive more of the vitamin through food, or it needs to be supplemented. While traditional oral supplements are normally thought of to help reverse vitamin deficiency, B12 shots are also available to help combat deficiency and provide high levels quickly.

But, the first step to treating vitamin B12 deficiency is changing what you eat and healing your gut, since inflammation and lack of enough stomach acid can also impair B12 absorption. This includes changing to a whole food, antiinflammatory diet and reducing alcohol intake.  Since plants don’t make this vitamin, you need to either eat foods fortified with B12 or foods from animal sources, such as meats, poultry, clams, eggs, or dairy. Strict vegetarians and vegans should ideally get B12 levels checked and supplement appropriately. 

While changing your diet is a great way to support your body in maintaining vitamin B12 levels in your blood, supplementation corrects deficiency quicker and more effectively. Supplementation is often needed while dietary changes are being made to help maintain healthy levels.  Supplementation with B12 can include pills or lozenges, or liquid drops by mouth or a weekly injection. We recommend an active B complex like this one, as it includes a variety of activated B vitamins like folate, while also including the methylcobalamin form of B12.

Forms of Vitamin B12

It’s important to know the four different types of vitamin B12 supplementation so you can choose the best for you – methylcobalamin, adenosylcobalamin, hydroxocobalamin, and cyanocobalamin. Both methylcobalamin and adenosylcobalamin are naturally found in food sources. Methylcobalamin is the most bioavailable and active form of B12, which is why it’s the form we recommend in our B complex and multivitamin supplements. This means the body absorbs it easily and does not have to do any conversion in order to use it. Here’s the Active B Complex we recommend with methylcobalamin and other active B vitamins to support carbohydrate metabolism, healthy methylation, nerve function, mood, and stress support. 

The other two forms of B12 are cyanocobalamin and hydroxocobalamin. Cyanocobalamin is a synthetic form of B12 and must be converted into the two types above before it can be used. Since it is the most cost effective form of B12, it’s often found in supplements. Lastly, hydroxocobalamin is the form usually used to treat severe deficiencies, and is generally administered through a shot or even an IV, but is also available in oral forms.

Support Your Health With Vitamin B12!

While there are some great products out there to support vitamin B12 in the body, it’s important to choose the methylcobalamin form of B12, as well as other activated B vitamins such as folate. That’s why we created an Active B Complex supplement – to make sure you get everything you need in your vitamin B12 supplement without any extra gunk. But, if you find you need even more support to feel your best, reach out to your functional medicine provider. At Arizona Wellness we work with clients just like you to create a plan to correct vitamin and mineral deficiencies, maximize your wellness, and help you feel your best.