Vitamin B12 deficiency is common… yet subtle. It can masquerade as another sickness or deficiency (source).
In fact, it's possible to eat enough B12 via diet, yet not absorb enough for the body's needs! To further compound the problem, doctors don't test for cellular B12. Instead, they test for serum B12, which can show high levels of Vitamin B12 in the blood — while the cells themselves are deficient.
Additionally, one practitioner notes,
[M]any doctors may be using the ‘standard' lab value reference range instead of the ‘optimal' reference range. Even if you do get a doctor to order your Vitamin B12 level they may still say it's normal or insist that taking Vitamin B12 is unnecessary and unlikely to help. There seems to be a trend among physicians that nutrients, vitamins and supplements have no place in the treatment of patients when in reality they can be an amazing part of a complete treatment plan. Even considering all of these factors you need to understand that checking vitamin B12 levels in the serum still isn't the best way to evaluate for B12 deficiency. (Source.)
And so, how do we best determine our Vitamin B12 status?
First, we should take multiple lab tests (see below for more info).
Second, we should match our symptoms to the B12 deficiency symptoms and see if any ring true.
Personally, I had 19 symptoms — not counting the lab tests, most of them previously unexplained — that matched with those of a Vitamin B12 deficiency. So I felt that supplementation was worth a try.
Symptoms Of Vitamin B12 Deficiency
- brain fog
- tingling or numbness in extremities
- shortness of breath with exertion or exercise
- dizziness or loss of balance
- weakened bones
- spotty vision
- low stomach acid
- impaired digestion
- constipation or diarrhea
- hair loss
- psychosis, bipolar disorder
- memory loss, Alzheimer’s, dementia
- learning disorders in children or autism
- cardiovascular disease
- hormone imbalances
- nerve damage
- multiple sclerosis (MS)
- a smooth, thick, red tongue
- weight gain or weight loss
- changes in skin pigmentation
- H. pylori
- Hashimoto’s or hypothyroidism
- autoimmune disease
- taking certain medications like Metformin
- taking PPIs or acid suppressing drugs
- being vegetarian or vegan
Additionally, the elderly or aging are likely candidates for being deficient. In fact, many signs of aging are actually signs of a B12 deficiency! (source)
Perhaps most alarming and important: There are no vegetable sources of Vitamin B12.
Instead, vegetable sources of B12 actually contain B12 analogs, which block the absorption of B12 and increase the body's need for it (source). Children raised without meat must supplement, or there will be a B12 deficiency even years after they begin eating animal products again. B12 deficiency in children manifests itself through impaired cognitive function (source).
Do You Have Vitamin B12 Deficiency? (Which Tests To Take)
Here are the tests to take when determining one's cellular B12 levels.
Keep in mind that even with these test results, there are inaccuracies. For example, anemia or low iron levels can skew the MCV test, leading one to believe that they aren't deficient in Vitamin B12 when they actually are. Patients with Hashimoto’s will often have both low iron and low B12, but the MCV results will only reflect their low iron levels.
#1 — Serum B12
Levels should be in the top 75 percentile of the lab reference range. Mid-range can be too low.
Low serum B12 (less than 1000) indicates a need for Vitamin B12. Experts also recommend treatment for patients with normal B12, yet elevated urinary methylmalonic acid (MMA). (Source.)
#2 — Homocysteine
Levels should be less than 9 to 10. High homocysteine indicates the need for Vitamin B12 and can also reflect an increased likelihood of stroke or heart disease.
#3 — Mean Corpuscular Volume (MCV)
This test measures the average size of red blood cells. The higher one's MCV, the larger one's red blood cells. (Iron deficiency can reduce one’s MCV and confuse this test result.)
Levels should be less than 92 — any higher, and you may need Vitamin B12.
Benefits Of Vitamin B12 Supplementation
What are the benefits of B12 supplementation?
First and foremost: increased energy!
For those struggling with a slow metabolism, B12 can help with weight loss.
Those who struggle with anxiety will notice a calming effect. Vitamin B12 improves mood, cognitive function, and concentration. Patients and practitioners notice balanced cortisol levels, hair growth, emotional stability, a heightened immune system, better sleep, improved thyroid function, reduced chronic pain, and more effective digestion.
Is It Safe To Supplement With Vitamin B12?
In a word, yes. For most patients it is not dangerous, although many doctors may tell their patients that supplementation is not necessary due to adequate serum B12 levels. As we've already discussed, however, serum B12 does not indicate B12 on a cellular level.
Consider how much there is to be gained if a deficiency exists! And if you aren't actually deficient, B12 is water-soluble. Any excess is simply expelled through urine.
NOTE: For those with kidney problems, it may be dangerous to supplement with B12. Consult with your healthcare practitioner.
Which Form Of Vitamin B12 Is Best?
Choose methylcobalamin instead of cyanocobalamin. The latter is a low-quality form that isn't metabolized well, especially by those with the MTHFR gene mutation (this is currently estimated to be about 40% of the population) (source).
Dosage Of Vitamin B12
If no GI issues are present, oral supplementation is effective for many patients (source).
Personally, I have switched over to giving myself B12 shots of 1000 mcg weekly. I plan to increase the dosage during the colder months as some practitioners recommend injections of up to 5000 mcg per week.
Often, patients will feel better within 1 to 2 weeks of supplementation. I felt better after only 1 dose, and wonderful after 2 doses! Vitamin B12 works fast.
After 10 weeks of supplementation, test your B12 levels again. Your length of treatment will be based on how long it takes for your test values to stay within optimum range. Watch for your serum B12 to increase, your homocysteine to decrease, and your MCV to increase, too.
B12 shots can be taken indefinitely to assure adequate levels for optimum health. If you stop taking B12 and symptoms return, this indicates you should maintain B12 supplementation.
Very occasionally, a patient will decrease in energy after B12 shots. This is likely due to detoxification. In this case, halve the dosage.
Sleep may also be adversely affected because B12 affects energy levels. For this reason, supplement with B12 in the morning rather than the afternoon or evening (source).
Shots Vs. Oral Vitamin B12?
Anyone who struggles to properly digest the oral ingredients — this includes anyone with constipation, SIBO, GERD, IBS, Crohn’s disease, ulcerative colitis, celiac, acid reflux or pathogen overgrowth — will benefit from taking Vitamin B12 shots instead (source).
This is because B12 requires proper digestion, without inflammation, to assimilate properly (source). Ingredients like xylitol and mannitol in the sublingual B12 supplements can cause gas or stomach discomfort.
It’s also been reported that oral B12 can be less effective for those with Hashimoto’s (source).
Other benefits of B12 shots? A lower required dosage and a slower, more stable release of the nutrients.
Have you tried B12 supplementation? Do you have any deficiency symptoms?
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