B12 Deficiency: Still America’s #1 Missed Diagnosis

Health Tips / B12 Deficiency: Still America’s #1 Missed Diagnosis
B12 Deficiency

Over the years of writing Health Tips, I was surprised to discover that one I’d written a few years ago about vitamin B12 deficiency had received the most comments and questions from readers. Since there have been some interesting developments in both the diagnosis and treatment of B12 deficiency, and since B12 deficiency remains so common, this seems like a good opportunity for some updates.

The symptoms of low levels of vitamin B12 can been pretty vague. You’re just not feeling right and you’re tired, maybe a little depressed, a bit achy. Your digestion might somehow feel off and you’re not thinking clearly. Balancing a checkbook becomes an exercise in higher math.

Your doctor’s empathetic, not at all dismissive of your symptoms, but after a physical exam and some apparently appropriate tests with normal results she can’t find anything really wrong. On the surface, this is reassuring. After all, the main reason we go to doctors is to ascertain that nothing serious is going on.

Still, could she be overlooking something?

All about B12

One of the eight B vitamins, B12 is involved in the metabolism of every cell in your body. Years ago B12 was called “maturation factor” because cells need B12 to mature from being young and ineffectual whippersnappers to fully functioning, mature cells. Imagine a child, about seven years old, who’s stuck at that age and can’t grow into adolescence and later adulthood. Now imagine a magical substance that will allow her to grow and mature. That’s vitamin B12.

In fact, B12 is so potent a factor in cell maturation that some of the original studies on it showed that cells in the bone marrow (where blood is manufactured) when deliberately deprived of B12 could mature in just a few hours when B12 was added. This phenomenon explained how B12-deficient patients reported feeling magically rejuvenated within a day or two of their first B12 injection.

Years ago, I read that the late Bruno Bartoletti, conductor of the Lyric Opera orchestra, would not go onstage unless he’d had a B12 injection earlier that day. At the time, I thought it was a placebo effect. Now I think differently.

B12 deficiencies

Three major systems in your body are affected by B12 deficiency: your blood, nervous system, and, less often, gastrointestinal tract. These three are targets because their cells either have a high turnover rate (blood and intestinal lining) or need a lot of B12 to function smoothly (nervous system). The symptoms of low B12 are related to each of these areas.

  • Low B12’s effect on blood is a specific type of anemia called megaloblastic anemia (as distinct from the more common iron deficiency anemia). A megaloblast is an immature, undeveloped red blood cell, large and bulky (megalo=large, blast=immature form). Remember, B12 is needed for this cell to mature, so with insufficient B12 megaloblasts accumulate in your bone marrow and large red cells called macrocytes appear in your blood. Symptoms are the same as for anemia from any cause: fatigue, breathlessness, and lightheadedness. Your skin becomes a pale yellow, most likely because the red cells that do make it to maturity are very fragile and easily broken, releasing their yellow bilirubin pigment.
  • In the nervous system, B12 deficiency causes symptoms affecting the nerves (numbness, tingling, tremors, balance problems) and the mind (depression, brain fog, mood swings, and, in rare cases, hallucinations and psychosis).
  • In the GI tract, deficiency can cause digestive symptoms and weight loss because you’re not absorbing food efficiently.

The irony is that with all these there’s usually just one predominant symptom, and making a connection to low B12 can easily be delayed until other symptoms start to appear. For example, if your only symptom is tingling in your hands, you might undergo all sorts of diagnostic tests before your doctor thinks “Maybe we should check her B12 level.”

But even if you manage to get your doctor to test your B12 level, you’re only halfway there because the blood test is just not very good.

The normal range for B12 in the US is 200 to 800 pg (picograms)/milliliter of blood. But it’s been shown that symptoms can begin as low as 400 pg/ml, so the US “normals” are definitely not OK. In Europe and Japan, anything below 550 pg/ml is considered abnormal. Therefore, if your level is, for example, 350 pg/ml, your doctor reads a printout for you that reports “normal B12” and she doesn’t initiate treatment. I’ve had patients come in with B12 levels of 201 pg/ml with the word “normal” scribbled across it by the doctor.

A far better test for early B12 deficiency is measuring your blood levels of methylmalonic acid (MMA) because this will show the very first sign that something’s amiss with B12. You can have a perfectly normal B12 level, but if your MMA is elevated B12 deficiency troubles are on the horizon. The real problem is that you’ll have to ask for an MMA test without sounding like a smartass who’s been spending too much time on the internet

What causes B12 deficiency?

The list of causes is lengthy, but by far the most common is dietary. Vegetarians who aren’t paying attention to the B12 in their food choices will have downward-drifting B12 levels, and virtually all vegans not taking vitamin B12 supplements ultimately develop deficiencies. Even vegan organizations acknowledge it’s not possible to get adequate B12 while following a strictly vegan diet, and that’s because the richest sources are animal products.

Other causes of B12 deficiency include pernicious anemia, an uncommon (and spookily named) autoimmune disease that destroys parietal stomach cells. These cells produce a substance called intrinsic factor, necessary for B12 absorption. Also, since you need stomach acid to absorb B12, long-term use of acid-suppressing proton pump inhibitors (such as Nexium, etc.) can lead to B12 deficiency, as can chronic intestinal conditions such as Crohn’s disease, celiac disease, and intestinal parasites.

The missed diagnosis

The main danger of missing a diagnosis of low B12 is that, while quite rare, the damage to your nerves and even brain can be permanent. Other serious consequences: your anemia can get so severe it causes heart failure and collapse. Or you could be misdiagnosed with a major depressive disorder or even psychosis and take unneeded psychiatric medications for months (or years) before someone notices you look yellowish and you’re finally diagnosed with megaloblastic anemia.

There are three reasons why this diagnosis is missed:

  1. Although it’s not an expensive test, B12 isn’t measured during routine blood tests. Doctors generally don’t order a B12 evaluation if there’s no evidence of anemia (which would be picked up on a routine blood test). However, the fatigue and nervous system and GI symptoms can precede anemia by months.
  2. Doctors rarely ask (and patients rarely volunteer) information about their eating habits. In medical school, we’re taught that the US diet is plenty good enough to prevent any vitamin deficiencies. To which I now respond, “Ha!” I agree most of us eat plenty of food (obesity levels are still on the rise), but it’s often food whose nutritional value has been castrated. Also, all vegetarians and vegans should be regularly tested for possible B12 deficiency, but if your doc doesn’t know your eating habits you won’t be tested.
  3. Taking the B vitamin folic acid (folate) or eating a lot of folate-containing foods without adding B12 can actually mask the symptoms of a developing B12 deficiency. Although folate will keep your blood count normal even if your B12 is falling, the folate will not protect your brain and nervous system. You’ll have no evidence of megaloblastic anemia (because of the folate), but symptoms of numbness, tingling, balance problems, and emotional issues will continue unchecked. By eating so many folate-containing green vegetables, beans, and lentils, vegetarians and vegans inadvertently mask their own slowly developing B12 deficiency.

Treatment is easy

It’s virtually impossible to take too much B12 as any excess of this water-soluble vitamin is eliminated via urine. Nutritional guru Alan Gaby, MD, has commented that the only way too much B12 will kill you is if you fill your bathtub with it and drown.

Foods high in B12 are animal products: meat, poultry, seafood, dairy, and eggs, with eggs having the least. Because all animals store B12 in their livers, eating liver is an excellent, though not particularly popular, treatment for B12 deficiency. Your grandmother or great grandmother likely remembers a time when her doctor told someone in the family to eat more liver.

Although B12 injections have been used for decades as the fastest way to raise B12 levels, the latest research is saying that well chosen forms of oral B12 will probably work just as well. The Integrative Therapeutics product B12 Active is a chewable, cherry-flavored tablet containing 1,000 mcg of methylcobalamin. Taken daily, it generally restores B12 levels to a normal range in one month.

This brings up another confusing point. Most B12 in both injections and pills is called cyanocobalamin, which, yes indeed, does contain a totally nontoxic form of Agatha Christie’s favorite murder weapon, cyanide. But what’s the difference between the two? When it comes to raising your personal B12 levels, both work equally well. To be honest, the main reason for the prevalence of cyanocobalamin is cost. Totally synthetic, cyanocobalamin is cheap to make.

Methylcobalamin, the natural B12 form that your body actually prefers because it doesn’t have to detoxify the cyano part, is simply more expensive to manufacture. However, there is one completely new cyanocobalamin product worth mentioning. Eligen B12 (available by prescription) contains B12 combined with a carrier called salcaprozate that enhances B12 absorption into the stomach. B12 levels go up as quickly as they do with injections so you can avoid your doctor’s needles. However, I suspect Eligen B12 is not superior to the Integrative Therapeutics product mentioned above.

I think this all answers most of the questions and comments that followed my previous B12 article, but if you have more send them along.

Be well,
David Edelberg, MD

88 thoughts on “B12 Deficiency: Still America’s #1 Missed Diagnosis

    Do you have any knowledge/experience with fecal incontinence being related to a B12 deficiency (around 200)? Or diarrhea or hair loss? Thx

    Amy A
    Posted March 1, 2023 at 8:25 am

      Hi Amy,

      B12 deficiency absolutely has an impact on both hair growth and the gastrointestinal tract. Loose stool and fecal incontinence can be a consequence of having low Vitamin B12.

      WholeHealth Chicago
      Posted March 10, 2023 at 10:35 am

    […] Read more – How To Treat B12 Deficiency […]

    B12 Deficiency: Still America’s #1 Missed Diagnosis – Vigour Rv
    Posted February 10, 2022 at 9:10 am

    A B12 deficiency is often misdiagnosed, yet the consequences of it can be fatal—especially for those who have contracted coronavirus and are already at high risk. Inadequate B12 levels can suppress the immune system and inhibit the body’s ability to produce antibodies to viral infections. Severe deficiencies can even cause hyperhomocysteinemia, a condition that can cause fatal blood clots to form in the brain, lungs, and lower leg. Smoking vitamin could also be helpful if you are comfortable with it.

    Smoking Vitamin
    Posted January 23, 2022 at 6:44 am

    For many years I’ve experienced bouts of diarrhea then it became more of a problem of constipation and Merilax is used regularly. Getting to sleep at night is a struggle. It may take several hours before I fall asleep. Tinnitus in both ears has been an annoyance for years. I retrospectively noticed having episodic balance issues lasting just a few minutes about 10 years ago,but in late 2017 the balance issue became protracted. I also have a family history of pernicious anemia,both my father and his mother had it. I have told my family practitioners of my father’s history and have seen my B12 scores go down from 456pg/ml in 2002 to 325 pg/ml in 2018.In early 2019 my internist retired and the new doctor hasn’t taken a B12 even though he knows my family history. At Christmas time in 2017, while playing with granddaughter,I turned my head upside down and I felt off- balance when I stood up. The feel of being off- balance lasted for a few days. So, in January 2018 I saw an ENT PA and they thought it may be was BPPV.
    He sent me to PT which didn’t change much.
    Eventually saw another ENT, for about a year being treated with Valium for the imbalance. But in 2019 his PA assessment concluded I didn’t have BPPV.
    I began to have symptoms more often, almost daily starting in early June 2019.
    I was then referred for a neurological exam. I wasn’t able to see him until mid- late September. He diagnosed it as Vestibular migraine. He had me try a couple different meds. The first one I took for a couple weeks didn’t work. So, by October, 2019 he put then me on Verapamil 120mg slow release and that seemed to take care of the symptoms. (But it may also have been just the time of year if it was weather related.) I took Verapamil prn for the next 18 months,but only needed it a couple times.
    It wasn’t until late March 2021 that I had a few episodes again. Then by mid April to early June I was asymptomatic again. But from early June until the present, I’ve had symptoms 24/7.
    I took Verapamil daily until September and was symptomatic feeling off-balance while standing, 24/7. So, by October, I stopped taking Verapamil and symptoms are similar, maybe somewhat less intense, but is still daily balance problems.
    Could this be somehow related to pernicious anemia?
    My neurologist insists it is a vestibular migraine w/o a headache and manifesting in an imbalance. Is it typical to have a migraine last 24/7 for months on end?
    I’m asymptomatic when sitting, lying or driving, but as soon as I stand,particularly, with movement the imbalance reoccurs.
    I’m at an impasse and need help.

    Posted November 9, 2021 at 11:24 pm

      Hi Anthony,

      B12 is definitely something to address if your numbers are below 500. At WholeHealth Chicago, these types of balance problems are things that I regularly treat patients for, and it sounds like after working with your ENT and physical therapy, you’re just in need of a good diagnosis of what’s going on. I would be happy to meet with you in person or remotely to discuss your history further and see if I can help in addition to any improvement you might see with adding more B12. Please call our patient services team at 773-296-6700 and they can schedule an appointment with me – either in person or using vide telemedicine.

      Best wishes, and I’ll look forward to meeting with you!

      Dr Maurer

      Posted November 11, 2021 at 3:51 pm

    Hi there!
    I have been having lightheadedness with feet/leg tingling and hands. I just pulled my old b12 bloodwork which was 165 and “normal”. I was so tired and stomach upset that I started taking a ton of vitamins.. plus immense anxiety from feeling off so long. I felt better for a bit but not 100%. I again started getting lightheaded but also not eating bc of it.
    My b12 from yesterday was 1456. Taking all kinds of sprays, under the tongue tabs and the tongue dissolving strips.
    Could all the supplements be masking the true b12 in my system? Or should I just continue if they’re helping but I’m not feeling any better. Can’t work and I’m a mom.
    I feel I would benefit from injections but no one will provide them.

    Posted September 14, 2021 at 6:27 am

      Hi Melanie,
      From your comment, it sounds like B12 might be part of the picture here, but it would be a good idea to take your entire health history into account. Myself or any of our functional medicine practitioners at WHC would be happy to help. Please call in and schedule an in-person or telemedicine visit with one of us. We can help you get to the bottom of these symptoms. Our patient services staff can help you schedule a visit by calling 773-296-6700.

      My best,
      Dr Maurer

      Posted September 14, 2021 at 4:45 pm

    Thanks for this great information. I have a question about high MMA and high B12. I started taking adenosylcobalamin due to a genetic mutation. I was told to also take methylated B12 at the same time. I’m nervous to do so because after a recent detox regimen I was on with very high levels of methylated B12, my MMA and B12 both increased significantly. Is it advised to take 2 forms of B12 (when there are genetic mutations or deficiencies in this cycle). Or is it better possible that if I take the adenosylcobalamin it could help lower the MMA and B12 in serum? Thank you

    Posted June 7, 2021 at 4:28 pm

    I have had tingling hands and feet/toes for 3 or 4 months. I was on proton pump inhibitor famotidine for about a month 4xday but they really messed my stomach up. Not long after this tingling started. I looked at list of foods high in B12 and I don’t eat any of those, plant-based diet for most part. Doc test B12 today and was 301. Should I be taking supplement? She has not called me about results yet, thinking she isn’t (saw it thru med web portal). 51 y/o male. Cheers

    Mike in Pittsburgh
    Posted March 3, 2021 at 5:55 pm

      Hi Mike

      It’s best to figure out the root of the problem here. Please cosnider scheduling a telemedicine visit with one of our functional medicine providers at WholeHealth Chicago. Our scheduling staff can be reached at 773-296-6700.

      Dr M

      Posted March 8, 2021 at 9:01 am

    Hello, I’m a 47 yr old male. Started having shortness of breath, Sept 2020 and diagnosed with strep. Since then, Ive had trouble swallowing, brain fog, vision problems, confusion, dizziness, mood swings, sensative to light/sounds, and confusion, constipation, and insomnia. Ive had several blood tests, ENT, CT scans of lungs, sinus’s, brain, thyroid panel, MRI of brain and neck, dysautonomia test neg, with xrays of chest/throat, colonoscopy/endoscopy. I still have a barium swallow test and sleep study upcoming, awaiting Lyme disease results. Neuro Dr did blood work and B12 levels were 358 pg/ml. Ive been on nexium, pantoprazole, omerprazole, etc for the last 20yrs for GERD. I havent been diagnosed with anything other than anxiety. Any suggestions or help would be appreciated.

    Mike G
    Posted March 3, 2021 at 1:27 am

      Hi Mike

      It’s best to figure out the root of the problem here. Please cosnider scheduling a telemedicine visit with one of our functional medicine providers at WholeHealth Chicago. Our scheduling staff can be reached at 773-296-6700.

      Dr M

      Posted March 8, 2021 at 9:02 am

    I’m trying to understand what b12 binding capacity is. I’ve been struggling with leg/foot pain & tingling for years. Depression, anxiety, heart palpitations and Barretts esophagus from reflux. My neurologist has tested for everything mentioned and everything comes back in the normal range. I look great on paper but feel terrible. I do have the MTHFR polymorphism heterozygous. I’ve been taking a methylated multivitamin in hopes of feeling better. The one blood test that was abnormal in 2019 was b12 binding capacity at 1500 from supplements I suspect. My neuro never commented on this and has since retired. I was taking a 5000 mg methyl b12 / day at the time per doctor’s recommendation just to see if it helped. Will these supplements cause a low b12 binding capacity? What is that exactly? I’m sure they’re the reason b12 was high but how do you know if you’re absorbing? I’ve since backed off of the supplements, I’m just taking methylated multivitamins now but may resume extra b12 for lack of anything else to try.
    Also is b6 a concern with MTHFR? What is a good daily quantity? My multi has 75mg. Several MMA tests have been normal too.
    5’4. 56 yrs. female. Undiagnosed, frustrated. Ruled out MS, Parkisons, I’m left with diagnoses of exclusion. Looking through bloodwork for any issues to revisit with new neuro.
    Thank you so much for any thoughts.

    Kim L.
    Posted February 15, 2021 at 8:54 pm

    B12 of 152 is low enough to merit B12 shots using methylcobalamin. I would ignore the MMA and set to work noralizing B12

    Dr E
    Posted February 1, 2021 at 7:34 pm

    I keep reading about normal B12 and high MMA but I cannot find anything about low B12 and normal MMA. I have B12 of 152 but my MMA was completely normal at 0.17 and normal is less than 0.4. My serum B12 is definitely low, it was tested twice, the other about a month previous with the same result. What does it mean if the MMA did not confirm the B12 deficiency but the B12 nevertheless is quite low?

    Posted January 30, 2021 at 2:45 pm

    Good evening! I started having angular cheilitis (diagnosed by a dermatologist) in early November of 2020. However, in May of 2020, I also had a very small, dry patch of skin just below my left eyebrow which eventually got better. The eyelids and under the brows did same a couple more times over the summer but were always better within 2-3 days. I have never had any skin problems prior to this. We have well water which is checked yearly by our water filtration system and everything checked out as usual (over the last 25 years) in mid July. Our well water is hard but we have a softener system. Fast forward 6 weeks and eyelids swollen and red again, allergist (first visit to one ever) did patch testing, thyroid testing – everything was negative. No allergies except slightly to ragweed which I knew. He suggested steroid cream to eyelids of which I am not a fan. I did so for 3 days and ended up with a rash around my mouth. Called him and he wasn’t sure why this was happening. I work from home as a medical editor so I do not need to wear masks daily. Dermatology visit was next in early November and I was diagnosed with angular cheilitis. I was given scripts for another steroid cream, Ketoconazole cream and told to layer each one and then finish with a heavy ointment over those. Once again, these were not working. Called the dermatologist again as now I had a rash all over chin and in the (ahem) wrinkles as I am 56 years old. I had not used any makeup nor anything as we were trying to figure this out. Our water was checked again as I started putting two and two together and apparently our pH had dropped quite a bit and we had to have new tanks installed as the softener was not working with the “media” that the water filtration system uses. I don’t know all the logistics about it but I do know that it clogs pipes/pores and can cause all kinds of skin/scalp problems. They will eventually clear up but it can take a good while to do so. Our water has only been correct since about December 20th. In the meantime, I stopped all scripted creams and dermatologist ordered B levels to be taken via blood. Also, all of my annual blood work was normal (taken at the same time). My B levels are B12 of 313, Folic Acid of 17.2, and B2 (whole blood) of 219. This weird rash went away (but not completely) over the last few weeks but reared its ugly head again this past week. I believe it is from a pillowcase I napped on and it chafed the already irritated but healing slowly left side of my face (eyelid area and chin/corner of mouth/nasolabial fold). I am also experiencing (for a few months now and attributed it to odd sleeping positions/getting older) numbness and tingling in hands/toes (no diabetic issues), anxiety, woke up at 4:00 a.m. in a panic with heart feeling like it was racing, have some stress right now with family but not too bad. All annual labs were good except for a cholesterol of 225 but down from 246 so I’m continuing to work on that! Blood pressure averages about 117/75. I am not on any prescription medications but I do take a one a day vitamin, a Krill oil pill and the occasional D3 and C supplement. Should I start taking a B12 methylcobalamin supplement of 500mcg? My one a day vitamin only has 6 mcg of B12. I am so thankful to have found your website. Here’s to a much better 2021 for all.

    Tammy White
    Posted January 10, 2021 at 9:26 pm

      Hi Tammy –

      This seems worthy of a telemedicine visit with one of our functional medicine practitioners. Please call our Patient Services staff and they can set this up for you so you can get some answers and have someone take a comprehensive view of your health. Patient services can be reached at 773-296-6700.

      Posted January 11, 2021 at 1:01 am

        Thank you for your quick response! Unfortunately, my insurance will not allow out of state visits. Do you think I should follow up with GP, dermatologist or allergist? It’s all so confusing! I really do think it could be a B12 deficiency as others above had the same level of 313 that I have and Dr. E recommended a supplement. What are your thoughts?

        Tammy White
        Posted January 11, 2021 at 8:45 am

    Good Morning,
    It would be nice if you would respond to my message but totally understand if you don’t.

    I am a 50yo woman who has suffered from chronic iron deficiency for my entire life. I can remember as a child being iron deficient. I finally asked my GP to refer me to a hematologist for my iron. This is where my B-12 was tested and my b-12 was on the low-normal side at 260pg/ml and my MMA was 465. My doctor decided to do b-12 injections once a week for a month then once a month and then recheck in a few months. I was also given 3 IV iron infusions. I have taken Zantac/Protonix as needed for the last five-plus years, ever since having H. pylori; which was treated and no longer present (recent endoscopy biopsy result negative). I have added all my levels below. Is it worth retesting my b-12 levels before my next appointment? Is there another test I should ask for? I keep reading about the Intrinsic Factor test, should I ask for this test? Also, is it okay to donate blood? Sorry for all the questions but this is all so confusing for me and there is not a lot of information out there.

    Blood work on 9/4/2020
    Hematocrit- 36.2
    MCV- 74.8
    Vitamin D-32.3
    Transferrin Saturation-3

    A blood test was done 12/9 after iron infusions

    Transferring Saturation-16

    THE last IV Infusion was -11/12/2020
    The Last B-12 Injection was – 11/12/2020

    Thank you! have a wonderful holiday season and a Happy and Healthy New Year!!

    Virginia Houle
    Posted December 24, 2020 at 5:55 am

      Hi Virginia –

      Your history and symptoms certainly deserve some additional exploration, and in order to properly address things, I recommend setting up a telemedicine visit with one of our functional medicine physicians. Please give our patient services staff a call and they can help you arrange a visit with someone who can help figure out which tests come next and how to proceed. They can be reached at 773-296-6700.

      Best to you,
      Dr M

      Posted December 28, 2020 at 10:00 pm

    I hope you are still responding, as I am at a loss as to what’s going on with me.

    I have been experiencing a feeling of being unbalanced for 4 years now. I have had vertigo several times, but this is not vertigo. It’s just a feeling of being off balance all the time but worse in the dark. I recently ended up in the ER due to waking up in the middle of the night with anxiety and unable to walk normally. I have looked over my past several years of labs and my Vitamin B-12 is always high with the most recent on being 1,313 but back in 2016 I had a Vitamin B-12 binding capacity unsat (transcobalamin) test and it was low at 287. I have had electrical shock feelings in my leg and my hands go numb at times. In the past I have had pins and needle feelings in my feet when I wake in the morning but this is not a constant. With these high vitamin B-12 levels but low in the B-12 binding, could it be a B-12 deficiency? I feel terrible most of the time.

    K. Wallace
    Posted November 10, 2020 at 3:18 pm

      Thanks so much for your comment – this is definitely worth exploring. Please consider calling to schedule with one of our functional medicine providers so that one of us can review your history in detail and help determine next steps. Appointments can be scheduled for telemedicine, and our patient services staff can be reached at 773-296-6700.

      My best,
      Dr M

      Posted November 15, 2020 at 10:08 pm

    Hi, I’m not sure if you’re still responding to comments on this thread but I’ll appreciate some feedback if you are.

    I am 41 years old with a 10 year history of burning sensation, numbness and tingling in my legs, palpitations, tinnitus and occasional muscle twitches.
    My symptoms have become worse over the past 3 months and recent tests showed a Vitamin B12 level of 62pg with MCV of 75fl and Hemoglobin of 11.5g/dl.
    I started Cyanocobalamin 1000ug shots daily for a week and alternate days for the second week after which I started weekly shots of 1000ug. However my symptoms seem to be getting worse and not better. After my first weekly shot burning and tingling have been worse than I have ever felt. Is there something we’re not doing right? What would you advise?

    Pearl B
    Posted October 30, 2020 at 7:53 am

      Hi Pearl,

      It sounds like you’ve put a lot of work into addressing these health issues. At this point, it’s important to go through your health history to make certain the B12 is the only thing that needs to be addressed. Please consider a telemedicine visit with our functional medicine nurse practitioner Rachel Gates. She may even be able to see you this coming week. You can schedule with her by calling 773-296-6700.

      I hope you’re able to get to the bottom of all of this.

      My best,
      Dr M

      Posted November 1, 2020 at 4:23 pm

    I am not sure if you are still responding on this thread or not but I would love an opinion from you as this article has some of the best information I have found!

    And this may be long winded!
    I am a 31 year old female, 5’5″ 140lb, I have been a vegetarian for 13 years, and about 10 years ago my doctor at the time told me I had low B12 (145pg) after I complained about being tired all of the time and to take a supplement and check it again in a few months – the next time I checked it it was somewhere around 500pg and he said it looks like I can absorb it from a supplement so I moved on and sort of forgot about it and just made sure I was always eating lots of eggs and taking a b12 supplement off and on.

    In the last 4 years I have had two ekg’s from two other doctors for heart pain and fluttering, and also told them I am extremely short of breath all of the time and both told me my heart looked fine and that I just have anxiety(I know how I feel when I have anxiety and this is not it), no bloodwork was ordered for this.

    I also went to the emergency department about 5 years ago due to numbness in one side of my face and I was concerned of a stroke(it lasted about a month – numbness with slight nerve pain), I had a CT scan and since it appeared fine I was told that I probably just had a virus on my trigeminal nerve and it was not investigated further.

    I have only had blood work a couple of times in the last 10 years and my doctor never mentioned anything looking off. I recently have been doing research because I know that something is not right with me, so I ordered an at home basic vitamin blood test and received my results last week and my b12 was 395pg – which I am aware that based on Canadian standards this is not considered “low”, but some people may still experience symptoms.

    So after this, I had my doctors receptionist send me my blood work from last November as this was the last time I had blood work done, just so I could begin to keep an eye on it myself, and at that time my B12 was 414pg – so again, no cause for concern on paper but I would still consider that marginally low especially where I try so hard to make sure I consume tons of eggs and take supplements..

    What concerned me when I received that blood work however were the other lines that showed up in red:

    Red blood count – 3.99
    Mean Corpuscular Hemoglobin – 31.3
    Platelets – 454

    Which again, are not severely out of the standards but I would think it would be something that we should be keeping an eye on? I know I was feeling better than usual at the time of that blood work as well.

    Other numbers within the standards were:
    Ferritin 17.04 ug/L
    Hemoglobin 125 g/L
    Hematocrit 37%

    I am aware that a higher consumption of folate can mask a B12 deficiency and I am wondering if this may be my problem that I have been having and how I should go about investigating this further(or whether you feel that I should try to investigate this further)

    A few other symptoms that I have always had (many of which from before I was a vegetarian):

    -Cognitive issues (extreme brain fog, feeling like I’m in a dream sometimes)

    -Memory loss(forgetting very basic things, memories don’t feel real and more like I dreamed the things that I did last month)

    -Extreme fatigue(Cannot wake up ever, and need naps often. I have slept through alarms and have been late for work – the last time it happened, just last week, I only woke up after 10am and I hadn’t even stayed up late the night before)

    -Numbness mostly in hands and feet

    -Migraines with aura, and regular headaches

    -Vision issues (sometimes a slight eye twitch that will last months on end, sometimes lettering on the tv will appear to be vibrating despite having 20/20 vision)

    -I have fainted on multiple occasions ( half of the times prior to being vegetarian)

    -I can hear myself blink from inside my head if that makes any sense!

    -People often tell me I look pale or tired

    -My resting heart rate is often high, like 90bmp, and if I stand up quickly it will shoot up to 130bmp – even when I was a kid if I stood up quickly my vision would sometimes go black.

    So, I feel like I am always complaining or making excuses for how I feel, and I’m sure I probably sound like a hypochondriac – but I just need to find some sort of answers for how I am feeling because I feel like this cant be normal!

    Based on all of this, do you feel like this is related to my b12? Or is there some sort of other test I should be asking for? I have been taking 2500mcg of b12 twice a day for the last two weeks but I am not feeling any better yet – I know this takes time though.

    I know I put a lot of info in there, and if I don’t get a response I totally understand but I figured it was worth a shot!



    Posted July 25, 2020 at 12:41 pm

      Hi Jill,
      This is certainly a complex history and deserving of much more than an email or post. Please consider scheduling a telemedicine visit with one of our functional medicine practitioners. They can go through your history and symptoms with you, recommend testing, and help you get to the bottom of this. You can schedule a telemedicine consultation by calling our scheduling staff at 773-296-6700.
      Hope this helps!
      -Dr M

      Posted July 27, 2020 at 10:23 pm

    Hi, I am a disabled chronic pain patient due to radiculopathy, myofascial pain syndrome, and degenerative disc disease. I also have chronic proctitis which I am currently working with my GI doctor to determine if it has progressed to another form of UC. In doing so, he ordered a series of tests one of which is B12; my result being 412. That is coming back as normal and within range, however, I came across your website and wanted to get your opinion to see if it is perhaps a possible deficiency. I have many of the symptoms similar to those indicated in your article: pain, numbness/tingling in extremities, hand tremors, unexplained falls, fatigue/painsomnia, brain fog, cold limbs, nausea, loss of appetite, poor digestion, and recently blurry vision (not sure if that might be related). I already take a daily vitamin that has B12 in it too (albeit only 6 mcg). I know this is probably a stretch, I’ve been desperately searching for something that could help with my various symptoms for years but, even if it could just help alleviate some of my symptoms I’d be extremely grateful. Thank you in advance for your time.

    ~ Hillary

    Posted January 2, 2020 at 1:13 pm

      Hi Hillary –
      Your B12 level is low enough to be concerning that it might be playing a role here. I recommend discussing different ways to supplement B12 with your primary care provider. If you’re in or around Chicago, feel free to schedule a consultation with one of our primary care providers at the Center. If you’re outside of the area, this is a good tool to help find a functional medicine provider: https://www.ifm.org/find-a-practitioner/

      I hope this helps, and wish you sincere luck.


      Posted January 5, 2020 at 1:21 pm

    My result of b12 is 390 pg and i still have symptoms like depression, brain fog, low energy, shortness of breath, anxiety poor concentration, and more.. Can someone give me a answer what should my lvls be to be symptoms free? Pls..

    Posted November 27, 2019 at 5:33 am

      Hi Goran –

      390 is quite low for B12, and we often see patients with similar symptoms who are in this range. I highly suggest working with your healthcare provider to improve this value, and also discuss other reasons you might be experiencing these symptoms. If you’re in the Chicago area, any of our physicians or nurse practitioners can see you for these issues for an outside opinion.

      Hope this helps,
      Dr M

      Posted November 27, 2019 at 12:13 pm

    Dear Drs,
    I hope it is not too late to write here asking for advice.
    In November 2018 I started experiencing fatigue, weakness, shortness of breath and irritability. For the following few months the symptoms were worsening to the point where couldn’t walk for 200m without muscle cramps and falling over my own legs. I was experiencing depressive and anxiety episodes, my arms and legs were shaking whenever at rest, my memory was gone and eyesight slightly deteriorating. I was honestly fearing an early onset of MS (I am 24 yo female) but then found online information about B12 and got tested. The results came back at 107, way below the norm, however my GP was deflecting my requests for help for two months until referring me to my endocrinologist because “either that is the cause or I need to go to a psychiatrist”.
    I have Hashimoto disease but my thyroid levels are all good (TSH oscillating 1.5-1.7, other markers good too). Thankfully the endocrinologist took me seriously and advised 1000mcg of methylocobalamin sublingually every day for a month, then every other day and after 2-3 months new tests to see whether it works. After a few weeks of supplementation I was feeling better but still not great, set my tests and appointment for two months later, just before I was set to move abroad. Unfortunately the office cancelled the appointment and tried to reschedule for the time I would be abroad already. Since then I’ve been trying to get help from local health services with no avail.
    I ended up taking the 1000mcg dose every day since April 2019 and over the summer months I was feeling acceptable. However now for the last couple of months I’ve been getting worse with the depression and anxiety returning, balance issues, shaking and weak legs, bad memory, shortness of breath, heart palpitations. I seem to forget what I was talking about in the middle of the sentence.
    On 9 Oct I was tested for serum B12 and basic blood – result B12 (231) in a test taken 24h after the last sublingual pill and blood tests all within range (MCV 87 so normal). The doctor says my level is “perfect” and that I can try taking two pills per day but it’s not the reason of my symptoms. She offered me a mix of SSRIs, muscle relaxants and beta blockers, saying that prescribing B12 shots to a person who doesn’t need them would be “unethical”.
    My question is, do you think my B12 is normal or could the symptoms be linked to that? I’ve been taking 2000mcg of methylocobalamin for the last 10 days and the heart palpitations have basically stopped as well as balance issues, but others remain.
    I guess I’m hoping for reassurance that I’m not crazy and for some direction about what to do next. As a poor student in a foreign country I only have access to that one student health services office.

    Posted November 18, 2019 at 11:21 am

      Hi Marta –

      This is quite a complex history, especially involving the Hashimotos diagnosis. It’s great news that you started feeling better after the sublingual treatment, but if you feel you have symptoms that have not been addressed and/or would just like a second opinion, I recommend discussing your complete health picture with a qualified functional medicine practitioner. If you’re in the Chicago, any of our physicians or nurse practitioners would be happy to see you for a thorough overview. These symptoms and conditions can overlap and become complex; your health certainly deserves a thorough work-up and conversation.

      Hope this helps,
      Dr M

      Posted November 27, 2019 at 1:11 pm

        As a patient with APS ( antiphospholipid syndrome) it might be worth checking antibodies.

        Hashimotos, low b12, balance issues, vision issues, often are hallmarks of APS . ( before it leads to clotting)

        Quite often patients are sent to neurologists for a work up to rule our MS befor arriving at a diagnosis of APS.

        Kelly Schlunegger
        Posted September 1, 2020 at 7:45 pm

    Hi, I have low B12, 266, so my regular dr. ordered me to take 500mcg daily. But, I’ve also had pins & needles for 14 years & bad OCD symptoms lately. At first, I was ordered to take 1000 of folic acid in the hospital, iron supplement, & then my regular Dr. after the hospital noticed my low B12 and ordered a supplement. So, my Dr. said she’ll recheck B12 in 3 months. Do I need any other tests now or just wait to retest in 3 months my B12?

    Posted November 11, 2019 at 11:06 pm

      Hi Nikki

      Your symptoms could be arising from a number of places but it makes sense to do a trial of B12 then retest before going down other diagnostic roads. If you’re in the area and would like a second opinion, I recommend our integrative nurse practitioner Wendy Ploegstra as someone who might be able to help.

      Take good care, and best wishes!
      -Dr M

      Posted November 18, 2019 at 10:53 am

    B12 of 236 is very low. Ask your doctor to test to see if you have the MTHFR gene which, if present, would mean you must use methylcobalamin instead of the usual cyanocobalamin. You need additional testing to see if you have a defect in absorbing B12 and you need your B12 administered by injection. The ‘nerve’ B12 symptoms may tale weeks to months to improve

    Dr E
    Posted October 8, 2019 at 9:09 pm

    Hello, I hope someone is able to help me with advice. After getting sudden panic attacks, anxiety, difficulty breathing and tingling sensations in my back, arms and fingers out of the blue and for 2 months I recently got tested and had the following lab results:

    b12 236
    VitD 44.34
    Hemoglobin 14.2
    MCV 89.4
    MCH 27.9
    MCHC 31.2

    (Everything else was well within range, including Thyroid markers.)

    Also a bunch of parasites including Giardia, Tenia Soleum, Blastocystis Hominis, Endolimax Nana and Campylobacter.

    The parasites have been eliminated and the panic attacks and anxiety are 95% gone, however Dr ordered daily sublingual 5000 mcg B12-lozenges for a month and I’ve been taking them for a couple of days but tingling and breathing symptoms seem to stay the same although intermittently (feel somewhat better after I have a large meal).

    Am I missing other tests/ doing something wrong or is it simply way too early to tell?

    Thank you!

    Posted September 30, 2019 at 2:35 pm

    Hi , do you know how long you have to be off a b12 supplement to check ur levels , to see if ur high b12 is coming from supplement or natural . Also what does a slightly low mma test mean if ur b12 ranged from normal to super high . ( also have mthfr ) but i have rediculous symptoms of zero energy neurological etc

    Posted July 26, 2019 at 4:25 pm

      Hi Nicky – A lot of this depends on how deficient you were and why you had the deficiency. Often times, B12 supplementation needs to be maintained. This is definitely a question suited for whomever recommended the B12 for you so that you get a response tailored to your situation.
      Dr M

      Posted July 29, 2019 at 3:33 am

    Great article! I received test results back with very very low B12 binding capacity, extremely high circulating b12, but lymphocyte levels of b12 in the deficiency status. Low RDW, and transferin saturation over 84%. It seems all the b12 I am taking- both oral hydrocobalamin and methyl are not actually getting absorbed in the cell. Do you have experience treating the binding capacity issue? I cannot find any articles or Doctors that reference treatment. Thank you in advance!

    Elise Phipps
    Posted July 22, 2019 at 9:38 am

      Hi Elise – When you refer to binding capacity is this for B12 or for iron? Typically when we talk about binding capacity in this context is is for iron. But in any case, if your B12 levels are not improving on oral supplementation, sometimes physicians at WHC will recommend periodic B12 injections instead.
      Hope this helps,
      Dr M.

      Posted July 29, 2019 at 3:37 am

    Hi Dino
    I think the B6 excess is the villain here. Your symptoms are common in patient who arrive with levels such as yours. Stop all supplement sources of B6 for 3 months and see how things go. Also get tested for MTHFR gener

    Dr E
    Posted June 18, 2019 at 8:38 am

    Dear Dr E.,

    You’re advise and help with the medical community is greatly appreciated from us all. I wanted to see if you perhaps had any advice for me here. I’ve been suffering severe neurological symptoms for the last 6-7 months – tingling, cramping, burning, muscle weakness, fatigue, pain particularly in legs and FEET. I was taking a multivitamin which had about 15 times RDA of B6, which I’m aware is linked to peripheral neuropathy through B6 toxicity. My blood level for B6 shows 65.3 on a scale of 2-21.7. Simultaneously, I am pretty much a vegetarian eater for years with small quantities of fish only, up until about 2 months ago when I started eating chicken and turkey again. My B12 blood level came back normal but high at 1050. I read about homocysteine and methylmalonic acid being the more trusted markers of B12 deficiency as B12 plasma can sometimes yield false positive normal or high results do to malabsorption or genetic mutation? My homocysteine is elevated normal at 10.8 (scale supposed to be less than 11.4) and methylmalonic acid is also elevated normal 317 (scale 87-318).

    At what point would you decide a patient like myself might be B12 deficient and advise supplementing with injection or pill. If malabsorption due to low stomach acid, etc is a factor, then would tongue dissolvable B12 supplements be a better suggestion? Is it safe for me to try supplementing daily even though my level is 1050 currently? If so, at what point would you advise retesting either MMA or homocysteine to see if those levels are dropping?

    Thanks for your advice in advance.



    Posted June 6, 2019 at 11:06 pm

    Have your doc give you weekly methylcobalamin injections at least for a month PLUS a prescription for Vit D3 50,000 IU weekly for 8 weeks. Then see if you feel better. Both treatments are harmless

    Dr E
    Posted May 27, 2019 at 5:11 pm

    Hi Dr. E… if you are still answering I would love to hear your thoughts. I have been experiencing some recent issues that I thought might be B12 deficiency. Numbness in left leg and foot and left arm. Exhaustion and complete loss of energy. Depression. I have had some health issue the last few months and had lost 30ish pounds and was eating a lot less mostly due to GERD concerns. I was put on high dosage of Omeprazole (40mg twice a day) about 2 months back by primary care and GI. I suspected b12 for a few reasons with the meds and the fact that I know my sister has MTHFR mutation. I started taking 5000mcg of methol b12 daily about a week ago and had a blood test come back as 623 today. Is there a chance that the supplement spiked my b12 and may be hiding the deficiency? I am curious what could happen to my numbers if I am carrier of MTHFR that started taking such a high dose of methyl b12 in just a few days.

    Also, for reference my d3 came back low (20) so I am starting to take that. Also for reference I am a fairly healthy 50 year old male who has never had issue with mood or depression before these last few months.

    Thank you in advance and for all your help!

    Posted May 21, 2019 at 7:48 pm

    Hi Molly
    Did you actually send that at 2AM?!
    For a female in that age group with”unexplained” neuro symptoms, MS needs to be considered. I suggest consulting with a neurologist. Over at Rush, you’ve got the best MSspecialists in the Midwest

    Dr E
    Posted April 10, 2019 at 8:27 am

    Hi Dr. Edelberg!
    I’m a new practicing provider (just graduated with my DNP from Rush actually 🙂 and was wondering if you could help me with a new patient case?
    – Pt is 32yo F with extensive PMH who presents with 8 month hx of pain, numbness & tingling in her BLE, and recently has worsened constant sensation of cold feet as well as worsening numbness causing periodic falls during her normal daily activity. Other medical hx includes (not limited to): fatigue, HA, IBS, vertigo, GERD, Back pain, Iron def anemia, constipation, adrenal insufficiency..
    Historically w/her chronic back pain, I ordered lumbar and c spine xrays, both normal besides mild degenerative disc space changes to c5-6.
    I then ordered an EMG- normal, no evidence of radiculopathy ,plexopathy, or mononeuropathy. Motor recruitment and units all normal.

    -Recent (limited) blood work 2/2019 :
    B12 binding capacity-636
    Hct 34.5 ( noticed this is the only CBC value consistently low for pt in past 5-6 yrs)
    All other values for CBC, TSH, Free T4, Iron, and Ferritin normal.
    In 2/2018 Folate- 16.8 & B12-640

    I will seeing this patient again soon for further workup, and the lab tests I’m thinking about around are:
    CMP, Vit D, Folic acid, ESR, Methylmalonic acid, serum homocysteine, IF antibody

    I’d SO appreciate your time and thoughts. Do you have any suggestions or corrections to those labs listed and/or my diagnostic workup-train of thought? (I want to make sure my ordered tests are appropriate and not ‘overboard’) Very curious to hear your input! Thanks Dr. E!

    Dr. Molly Clark, DNP, FNP-C
    Posted April 10, 2019 at 1:56 am

    You are B12 deficient and you would likely benefit from B12 injections

    Dr E
    Posted March 2, 2019 at 4:55 pm

    Hi Dr,
    I had a 313 b-12 serum, but with symptoms. I convinced my Dr to order the MMA and Homosysteine and the MMA was (493) and the Homosysteine was just 1 point over the high limit for the lab. I am still waiting on the IF factor results. Doctor has yet to speal with me, but am I still considered deficient if the homosysteine is just 1 point over high? These symptoms started 3 years ago and more symptoms have come up and gotten worse.

    Posted February 24, 2019 at 10:19 am

    His B12 dose is inadequate. He should be on 1,000 mcg injections every week until his blood level is between 900 and 1,000. He should be tested for failure to absorb B-12. The test is called Intrinsic Factor Antibody. If it is positive, once his levels are normal, he will need monthly injections for life.
    The symptoms are most likely B12 deficiency but may take weeks to months to resolve even if blood levels return to normal

    Dr E
    Posted December 15, 2018 at 1:07 pm

    Hi Dr. E,

    If you’re still active on this thread, I would highly appreciate your opinion on this.

    My husband has B12 deficiency, his levels are around 160.
    The doctor recommended B12 injections (50 mcg) once every month, but I wonder if that is the appropriate dosage since there’s been no improvement in his symptoms.
    He still has numbness and tingling in his hands and feet, fatigue, weakness in his legs.

    Also he has constant hip pain.. could this be related to the B12 deficiency? We went to the specialist for this issue and they said everything is fine, they don’t know where the pain could come from.

    Thank you!!

    Alina J.
    Posted December 13, 2018 at 12:15 pm

    Also, does MMA return to normal in B12 shots?

    Posted October 6, 2018 at 6:50 pm

    Hi Mary
    This may be due to you being in the third of patients who carry a gene called MTHFR. This is an easy test for your doctor to run and if you are ‘positive’ you may be taking the wrong form of B12, cobalamin instead of methylcobalamin. Discuss with your doctor

    Dr E
    Posted October 6, 2018 at 11:15 am

    If you are still around–is Methylmalonic acid level always elevated in B12 deficiency? Diagnosed with B12 neuromyelopathy but my MMA has always been normal (lower end of normal to be exact). Thanks if you see this and answer.

    Posted October 5, 2018 at 7:35 pm

    thanks. my vit D is low at 18 and so taking the booster weekly dose. thyroid is good (2.1). RBC WBS all are in range. Blood pressure/urine all are good. I never had these symptoms. Only began once I started with sublingual b12 (cyanocobalamin).

    Posted September 26, 2018 at 11:51 am

    After my annual exam, my b12 leve was 358, whihc is in range but on lower side. I am veggie, but do take dairy products daily. Doc advised to jsut take 1000mcg sublingual b12 supplement. I started taking it. but with 506 days I started getting weird sensation in my legs… its like sweetish pain/sensation/tingling…while walking its better but can feel more when resting bed. What is this?

    Posted September 26, 2018 at 9:01 am

      Hi Som. There are many possible reasons for your symptoms. Speak with your primary care physician for re-testing of B12 as well as vitamin D, CBC, CMP, and thyroid panel. Hopefully, you’ll be able to uncover some additional clues.

      Dr. R
      Posted September 26, 2018 at 11:11 am

    Hi Cecilia
    There are other causes for your symptoms than low B12. It sounds as if your neurologist is a good diagnostician. Tell him about these and let him choose what tests would be helpful

    Dr E
    Posted August 21, 2018 at 5:26 pm

    HI there, I have had low levels of b12 in the past and even had some neurological symptoms, which after ruling out others things via MRI etc the neurologist pointed to low B12 as the culprit (200s this was about 4 years ago). I have been having issues in my legs again (some burning, muscle cramping etc) and wanted to see if my levels were low again.Recently I have been taking b12 vitamins and wonder if this could somehow mask the blood results if I took a good amount of vitamins in the days leading up to the blood test? I asked about a MMA test and Homosystene test but my doc declined to do those unfortunately. My test last week read normal ( 700s)but I was taking the oral 5000 once daily in the few days leading up to it. I am a strict vegetarian and try to get all my vitamins through food clearly I have a history of running low. Just wondering if those other tests could indicate a deficiency even with a normal B12 serum? My hemoglobin was normal. Any suggestions or thoughts would be welcome. Thank you

    Posted August 20, 2018 at 12:46 pm

    My 11 year old son has a history of fevers, infections, night terrors and anxiety. His immunologist ran several tests to rule out immune deficiency; these tests included a B12 binding Capacity test. His serum B12 was normal and his Folic Acid levels were high, the binding test also came back low. What are our next steps here – the immunologist told us to refer to our primary care doctor…..and they also are not sure what to do???!!

    Posted July 31, 2018 at 9:31 pm

    Hello Dr Edelber,

    I found your article to be very enlightening. Have been suffering from a number if symptoms, but I find the breathlessness to be the most difficult to deal with. Lab results: MCV 98, MCH 32.6, MCHC 33.2, B12 206. Told there isn’t a problem with labs and referred for a sleep study. Have had lipid panel (all good), stress test (great results), but am wondering if I need to find a different doctor or if his advice seems within reason.

    Posted April 12, 2018 at 11:01 am

      Hi Jennifer. Your B12 is in the low range of normal. We’d usually recommend oral supplementation to raise your levels.

      Dr. R
      Posted April 12, 2018 at 11:46 am

    Hi P Marie
    Actually there are several causes of macrocytosis and B-12 deficiency is only one of them. Most macrocytosis is harmless but it might be worthwhile consulting with a hematologist (blood specialist)

    Dr E
    Posted March 27, 2017 at 4:50 pm

      I’ve seen two hematologist: one at Rush and one at Mayo. Mayo only was concerned about ruling out myeloprolific diseases, leukemias, etc.
      No one addressed my elevated MCV and macrocytes. RBCs on the low side.
      Been getting chest pressure. Cardiac ruled out.
      Also positive for the IFBA and MTHFR compound heterozygous.

      P Marie
      Posted March 27, 2017 at 8:37 pm

    Dr Edelberg
    Can you explain why my B12 level is over 2000, but my blood smear shows macrocytes and my MCV is 102 and the B12 binding capacity test is <80, done at Quest.

    My doctor says I'm not deficient because B12 is over 2000!

    P Marie
    Posted March 23, 2017 at 12:19 pm

    Hello Dr D.E.
    I really appreciate all your comments here it is very kind of you to take the time most sites ask for payment which I don’t have. I also thank those that pose the Q’s. It has made things a lot clearer. Even though I am still a little confused as to whether or not to have the injections my doc has said is the best and quickest way to bring my level back up or to ask if I could have the Eligin B12. I have read some reviews that patients say themselves…of being very unwell even wks and months after having the injections .. In fact all the same symptoms that I am having due to the lack of B12.. This I find very strange, one would think that these symptoms should / would be much less not worse! ( Or could it be that they are not absorbing the B12 from the injections?). On the other hand I read that the Eligin B12 is not as quick or as effective as the injections.
    I went for a pre op and they found my platelets low – 50 instead of 150. I then told them of all my symptoms which I put down to my poor / loss of appetite and age -62- Yet working and very active – family saying I was overdoing things. They took further blood test and said that everything was fine but for the B12 which was very low but did not give me a reading. Could you suggest … Injections or Oral.
    Kind Regards
    Bev 🙂 🙂

    Bev Dawn
    Posted May 28, 2016 at 7:59 pm

    Hi KS
    All your numbers are indeed excellent. The abruptness of the symptoms and their quick resolution sounds most like a hypoglycemic episode (low blood sugar). Think about what you ate (or did not eat) that day and see if this is a possibility

    Dr E
    Posted January 4, 2016 at 5:58 pm

      Thanks, Doc. I appreciate you taking the time to reply. It’s so odd, as the symptoms are intermittent across a few weeks now (although receding), with a burst of finger tingling (10 minute events occurring twice), sometimes accompanied by or followed by very anxious or negative thoughts. Never had a panic attack or reason for it (thankfully), but I wonder if that’s a cause for these symptoms over the past few weeks. I’ll keep a food log to watch the hypoglycemia angle too. Thanks again.

      Posted January 4, 2016 at 10:58 pm

    Hi. I had a strange event while driving a few weeks ago where I felt tingling in both hands (pinkies and thumbs), swimming vision (not blurry or fuzzy), weak knees/legs, and a flash of energy in my chest (without racing heart or pulse). For a few weeks before, I’ve had very negative thoughts (highly unusual for me, a very happy person). Symptoms are on-going and easing up (significantly after one session of acupuncture). Went to an integrative health cardiologist; EKG was normal. After researching your excellent site, I thought for sure this could be Vitamin B12 and/or D deficiency. Received blood test results today which are normal — no MTHFR mutation, B12 (623), D (300), TSH (2.05), T4 (5.4), T3 (83), Free T4 (0.98), Free T3 (2.31). Low omegas though (3.8). I have half my thyroid (no supplement) and stage IV endometriosis. Otherwise, “good” health. Ideas on what’s going on? Thank you.

    Posted January 4, 2016 at 11:35 am

    There is a wonderful liquid vegan safe B12 product by Global Healing Center. it has 2500 mcg of B12 as 80% methylcobalamin, 20% adenosylcobalamin. I have been taking this for a couple of months and have seen increased energy, and no more brain fog.

    It is recommended by Anthony William, Medical Medium as one of the most imp. supplements. He has a book coming out this month you might want to consider.

    Kathleen Hough
    Posted November 3, 2015 at 11:57 am

    I’ve been to 3 major Chicago universities and then Mayo, all in the last 8 months.
    I’m getting sicker and sicker and have lost 26 lbs in the last 7 weeks.
    I’ve now learned my serum B12 is >2000 BUT my transcobalamin or B12 binding capacity is critically low at <88 (normal range 65-1340). Hematologist doesn't know what to do with me. Bone marrow biopsy two weeks ago came back normal

    Pearl M
    Posted July 21, 2015 at 8:07 am

    I actually have been taking Eligen B12, the product you mentioned, since late March, because of my pernicious anemia, which caused my B12 levels to sink as low as 200 at one point. Since my doctor put me on it in late March my levels have been consistently around 2000pg/ml! I had been taking OTC B12 sublingual 1000mg but because of my condition my doc told me I was not absorbing the B12 and passing most of it, so my levels had not been improving.

    Robert S
    Posted June 24, 2015 at 5:58 pm

    Hi Karen C
    Although low B-12 can cause hair loss, your level is okay and should not be the culprit. The three commonest causes of hair loss are: stress; underactive thyroid (even minimally underactive thyroid); low iron.
    Have your doctor run appropriate tests if these have not been done

    Dr E
    Posted June 24, 2015 at 10:40 am

    I have been reading a lot about b12 deficiency and wonder if it can can cause hair loss? I had mine tested and it was around 450, but I do have other symptoms along with the hair loss.

    Karen C
    Posted June 23, 2015 at 9:26 pm

    Thank you for what you do . You really are the healer
    People need. I pray for you – you are the best!!!!!

    Kathleen pepsnik- good
    Posted May 2, 2015 at 6:23 pm

    If you have MTHFR you need to determine if you are an overmethylator or undermethylator. If you are an undermethylator you would take Methylcobalamin and methylfolate. If you are an overmethylator like I am you cannot take methyls. So I take Hydroxo B12 and folinic acid. I take a prescription called Leucovorin which is folinic acid.

    Cheryl T
    Posted April 28, 2015 at 12:21 pm

    Hi Debra
    The association between B12 and lithium is simply úncertain´at this point. An association is theoretically possible but not clinically evident.

    Hi Teresa
    Yours is a typical MTHFR story. If your doctor suspects B12 or folate deficiencies and the levels come back elevated, ask for an MTHFR test. If positive, you´ll need the methyl forms of both folate and B12 but you´ll need to start with low doses as you´ll be sensitive to the sudden rush as these nutritionals become available to your cells

    Hi Sam
    Basically, see the above note and get MTHFR testing.

    Hi Beth
    According to the published data, the answer to your question is ýes but look at the company´s website and as it is a small company, I suspect they´ll answer your question personally

    Hi Cathy
    The answer is ýes

    Dr E

    Dr E
    Posted April 28, 2015 at 10:32 am

      Thank you , Doctor for your response. I’ll let you know what happens.


      sam barbary
      Posted April 28, 2015 at 11:08 am

    Teresa Strong, it sounds like I might be in the same boat as you. How are you treating your MTHFR situation…your whole situation in general? Thanks!

    Davis S.
    Posted April 28, 2015 at 9:59 am

    Can low b12 cause hair loss? I had my colon removed and a jpouch made from the lower third of my small intestine due to ulcerative colitis. I

    Posted April 28, 2015 at 8:29 am

    Dr. E, is salcaprozate still effective if someone’s intrinsic factor is depleted?

    Posted April 28, 2015 at 8:14 am

      I have 390pg /ml b12 and my doctor says its normal but I’ve been experiencing planty of symptoms despite the normal result, depression, anxiety, disorientation double vision, balance problems, lack of focus, poor concentration, sensitive to light, dizziness if i try to lay down on othet bad numbness, tingling, tremors, hot sweats around my neck, insomnia and etc.. I’m 33 year old male. I desperately want to know how much shoud my b12 lvls be to be symptoms free.. I rly appreciate of some of u give me a proper answer.

      Posted November 25, 2019 at 2:14 pm

    Can you have a normal methymalonic acid level result which would indicate normal B-12 levela and still be B-12 deficient? I have heard that if one does not have the cofactors to synthesize B-12, symptoms of B-12 deficiency would still exist. So the real question is how do you know if you have the correct cofactors? Basically, you are deficient if your body cant absorb or sythesize it even though you consume enough B-12.

    Thank you


    sam barbary
    Posted April 27, 2015 at 6:04 pm

    Dr. E . . . Your articles are THE best… clearly understandable,
    with all the info needed so a person may incorporate a new plan of action, if they choose. I appreciate the time and energy you put into writing these articles . . . THANK YOU!!!!

    Irene Frederick
    Posted April 27, 2015 at 4:35 pm

    I have another story of how B12 deficiency can be missed. For a number of years, my doctors saw I had megoblastic anemia, but my b12 and folic acid were very high. It was finally discovered that I have MTHFR C677T genetic defect which can give you both B12 and folic acid deficiency while giving you high B12 and folic acid levels because your body cannot break down synthetic B12 and folic acid into useable forms.

    Teresa Strong
    Posted April 27, 2015 at 9:10 am

    Can you discuss the role of lithium, if any, in the absorption of B12 from blood plasma into cells? I was told that depending on their genetics, some people need more lithium or the B12 does not penetrate the cells and remains at high levels in the blood.

    Deb S
    Posted April 27, 2015 at 9:06 am

      For seven years I was experiencing off and on, hands and feet tingling, burning, pain, difficulty walking, extreme fatigue and depression. Countless visits to the ER and Dr. Office,checking for everything but B12. It then started where I had extreme difficulty getting dressed, had trouble feeding myself, could not write or hold a pen. Bending my neck sent electric shocks thru my body. Went to the hospital for MS testing. MRI, spinal tap, brain scan. After more testing, one Dr. checked my B12 level, it was 80. I spent 10 days in the hospital and 10 days in rehab. They were not sure if I would recover. Left untreated, B12 deficiency can cause permanent brain damage. I was lucky, everything reversed. Maybe if B12 METHYLCOBALAMIN were given early on, we might be able to help prevent MS and other brain and nerve related diseases.
      If that one Dr. didn’t check my B12 level,I would have been misdiagnosed with MS, because the symptoms are the same.
      B12 is vital for our health. It helps make DNA & RNA, your red blood cells.
      Helps with Depression,Dementia,Sleep Disorders.
      Helps with sleep-wake rhythm disorders (Circadian)
      Protects &a rebuilds the Myelin sheath covering your nerve fibers.
      Slows brain shrinkage up to 80%.
      Lowers Homocysteine levels associated with heart disease.
      If low levels are left unchecked, brain damage will occur and can become permanent.
      Helps with age related macular degeneration.
      By supplementing with sublingual Methylcobalmin B12 around 40 or 50 years of age, we could help prevent problems before they start.
      Everyone should supplement and maintain blood levels of B12 in the range from 600 to 2000 pg/ml in order to avoid and, if this is the case, help recover from the wide range of problems that result from B12 deficiency or insufficiency. Health care practitioners: this is the first thing you should check for every patient that comes in, independently of their age or condition

      Methylcobalamin: This is the neurologically active form of B12. It is technically a `coenzyme` of vitamin B12 and it is almost never prescribed by doctors despite being effective, readily available and inexpensive. It is also available in an injectable form. Degenerative neurological conditions are where methylcobalamin shows its greatest benefits over other cobalamin preparations. Brilliant news for MS’ers! Not only has Methylcobalamin been shown to work in neurologic diseases, it also helps with the elimination of toxic substances in the body.

      Kathleen Kazanjian
      Posted October 6, 2019 at 1:52 pm

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