The B vitamins benefit your body by keeping your eyes, skin, hair, and liver healthy. Similarly, these vitamins improve nerve function and the efficiency at which your body burns fat and creates energy. However, regarding nerve health, the relevant literature gives vitamin B12 a particular emphasis. With a large body of clinical evidence, this vitamin has been proven to impact memory, cognitive function, and physical mobility.
Unfortunately, nearly half of all Americans have low levels of vitamin B12, with around 40 percent of people over 60 testing as B12 deficient. Most people do not realize they have this deficiency, as it cannot be diagnosed through a routine test. Moreover, the vitamin B12 supplements many people take are ineffective, as B12 is best absorbed sublingually (under the tongue). In other words, if you swallow a pill to supplement your B12 intake, you receive little benefit.
What is Vitamin B12?
Also known as cobalamin due to the presence of the cobalt element, B12 works closely with B9, commonly known as folate or folic acid. Together, these vitamins help create red blood cells, help your body use iron more efficiently, and help produce your body’s building blocks, DNA and RNA. In addition, B9 and B12 help strengthen immune function and even help regulate mood. Another B vitamin, B6, joins them in controlling homocysteine levels, commonly associated with heart disease.
One of B12’s primary functions is forming the protective sheath surrounding nerves, called myelin, and facilitating nerve function. This directly impacts communication between the brain and the nervous system. When this communication is obstructed, either due to vitamin deficiency or some specific ailment, supplementation with B12 may prove beneficial.
Diagnosing B12 Deficiency
The medical field in Japan and Europe considers a patient to have vitamin B12 deficiency if testing reveals levels below 500 pg/mL to 550 pg/mL. Meanwhile, the low end of “normal” in America is 200pg/mL to 350 pg/mL.
So what is considered low B12, considering these thresholds? Many experts disagree with America’s low vitamin B12 deficiency threshold, recommending treatment for patients testing below 450 pg/mL, especially if these patients also present other B12 deficiency markers. These include elevated urinary methylmalonic acid, holotranscobalamin, or homocysteine.
Some researchers speculate that Japan’s lower rates of dementia and Alzheimer’s disease may be due, in part, to its standards for B12 deficiency.
Furthermore, it is essential to note that certain groups are significantly more likely to suffer from vitamin B12 deficiency. Topping this list are vegetarians and vegans, as vitamin B12 is only found in animal products. Some sources claim you can find B12 in certain plant-based foods, such as seaweed and brewer’s yeast, but this is a very complex topic, and the simplification is largely incorrect.
Moreover, the B12 analogs found in these plant-based supplements (called cobamides) increase the body’s need for vitamin B12 while simultaneously blocking its ability to absorb it. In other words, ingesting bogus, plant-based B12 makes your vitamin B12 deficiency worse than if you had done nothing.
Who is at risk of vitamin B12 deficiency?
Vegan children, in particular, suffer from B12 deficiency, even if they eventually incorporate animal products into their diets. Studies reveal that vegan children experience difficulties with memory tests, spatial abilities, and fluid intelligence. You can still follow a vegan or vegetarian lifestyle. However, you must take a good vitamin B12 supplement and regularly test your levels.
Other groups at increased risk for B12 deficiency include people who:
- Are over age 60
- Have a history of miscarriage and/or infertility
- Have certain digestive issues, such as celiac, Crohn’s disease, IBS, and ulcerative colitis
- Regularly use acid-suppressing medications or PPIs
- Take certain diabetes drugs, such as metformin
The causes of vitamin b12 deficiency are manifold, which is why a proper diagnosis is essential. Discussing your symptoms and overall health and performing bloodwork analysis is often enough to pinpoint the exact issue before the start of treatment.
What are the Symptoms of Vitamin B12 Deficiency?
The signs of B12 deficiency occur over time, often leading to delayed diagnosis, especially when testing is not performed. Many of these symptoms mimic other health issues, including:
- Common signs of aging, such as memory loss, cognitive decline, Alzheimer’s, and dementia
- Cardiovascular disease
- Autoimmune disease
- Mental health issues, such as anxiety, depression, and bipolar disorder
- Pinched or trapped nerves
How do symptoms of B12 deficiency manifest? While the onset may be gradual and the symptom severity hard to evaluate due to subjective interpretation, patients may experience:
- Bleeding gums
- Diarrhea
- Dizziness
- Fatigue
- Heart palpitations
- Lack of appetite
- Mouth sores
- Muscle weakness
- Nausea
- Neuralgia, numbness, and/or tingling
- Shortness of breath
Once the deficiency is diagnosed correctly, treatment options may significantly reduce the number of symptoms, severity, and frequency. For example, many people report that their mood disorders dramatically improve once they are diagnosed with an underlying B12 deficiency and provided with adequate treatment.
How is Vitamin B12 Deficiency diagnosed and treated?
If you belong to one of the high-risk groups or experience any symptoms of vitamin B12 deficiency, talk to your doctor about performing a B12 test. If your insurance refuses to cover it, you may order a home test kit for around $60.
For patients with advanced B12 deficiency, treatment should include B12 injections. Remember, the body struggles to absorb vitamin B12 in pill form, making injections the most effective means of correcting a deficiency.
Some patients require regular B12 injections that will continue throughout their lives. You likely fall under this category if you suffer from digestive disorders such as Crohn’s disease.
If you want an oral supplement, remember to look for one that dissolves in your mouth rather than one you swallow whole. The type most commonly seen is cyanocobalamin, but this is not the best B12 supplement. Instead, look for hydroxycobalamin or methylcobalamin.
Similarly, levels of vitamin B12 in your body may be slightly elevated. Although less likely, there are situations where high vitamin B12 indicates severe health issues and should be addressed promptly. According to many sources, high levels can increase your risk for cancer or be a sign of liver disease and certain types of leukemia.
Can B12 deficiency cause permanent damage?
Depending on the severity and the associated issues, if the B12 deficiency is not resolved six months after symptom onset, it can cause serious health complications. Anemia, for example, can lead to a host of debilitating symptoms and eventually result in heart failure. Similarly, patients can damage their nerve endings beyond repair or deal with severe physical manifestations of neuropathy.
Luckily, interventional studies suggest that timely B12 treatment can immediately relieve symptoms associated with peripheral neuropathy.
What are the best dietary sources of vitamin b12?
Incorporating food sources rich in Vitamin B12 into your diet is an easy way to maintain healthy levels of this essential nutrient. Animal products such as fish, eggs, dairy, and meat are all reliable sources of B12. If you follow a plant-based diet, supplementation is essential.
High sources of Vitamin B12, with a trace amount per 100 grams, include:
• clams – 99 mcg
• organ meats such as liver and kidney – 18.9 mcg
• tuna – 10.9 mcg
• sardines – 8.94 mcg
• beef – 5.9 mcg
• trout – 7,5 mcg
• salmon – 3.2 mcg
• one egg – 0.5 mcg
When is the best time to take vitamin B12 supplements?
As a water-soluble vitamin, B12 is best taken on an empty stomach before a meal. This means at least 30 minutes before any meal or snack or two hours after eating. Conversely, higher doses of B12 injections are usually administered once every month. It is important to note that the resolution of symptoms may be gradual.
Often, patients don’t feel an immediate improvement, but that doesn’t mean they should discontinue their treatment. While oral supplements may take weeks to show benefits, injections usually take a couple of days.
Does vitamin b12 cause weight gain?
The evidence regarding this claim is scarce. While taking a supplement won’t lead directly to an increase in weight, a dramatic rise in B12 levels may improve appetite. Therefore, when patients start eating more due to treating their B12 deficiency, and the associated loss of appetite, there might be a slight increase in weight.
If you’d like more information on vitamin B12, other vitamin deficiencies, or testing, contact the team at Clancy Medical Group or work directly with your healthcare provider. We offer telemedicine services and the convenience of an on-site testing lab.