Over the years of writing Health Tips, I was surprised to discover that one I\u2019d written a few years ago about Vitamin B 12 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 expansion on the original.<\/p>\n\n\n\n
The symptoms of low levels of vitamin B12 can be vague. You\u2019re just not feeling right and you\u2019re tired, maybe a little depressed, a bit achy. Your digestion might feel off and you\u2019re not thinking clearly. Balancing a checkbook becomes an exercise in higher math. <\/p>\n\n\n\n
When your B-12 numbers are low, any of the following can occur: <\/p>\n\n\n\n
Your doctor\u2019s empathetic, not at all dismissive of your symptoms, but after a physical exam and some apparently appropriate tests with normal results she can\u2019t 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. <\/p>\n\n\n\n
Still, could she be overlooking something?<\/p>\n\n\n\n
One of your eight B vitamins, B12 is involved in the metabolism of every cell in your body. Years ago B12 was called \u201cmaturation factor\u201d because your cells need B12 to mature from being young and ineffectual whippersnappers to fully functioning, mature cells. Imagine a child, about seven years old, who\u2019s stuck at that age and can\u2019t grow into adolescence and later adulthood. Now imagine a magical substance that will allow her to grow and mature. That\u2019s vitamin B12.<\/p>\n\n\n\n
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 to adult forms 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.<\/p>\n\n\n\n
B-12 absorption into the body was tough to grasp in medical school. Food (or a B 12 pill) might contain B-12 but once in your stomach, it can\u2019t get absorbed into your bloodstream on its own. The B-12 needs a specific protein in your stomach called \u2018intrinsic factor\u2019 to latch onto and carry all the way through the length of your small intestine and release at the very end, your ileum. If you didn\u2019t have the intrinsic factor, you get B12 deficiency. If you didn\u2019t have an ileum, as can occur in Crohn\u2019s Disease, you could also get B12 deficiency. This makes for great multiple choice questions. <\/p>\n\n\n\n
Years ago, I read that the late Bruno Bartoletti, conductor of the Lyric Opera orchestra, would not go onstage unless he\u2019d had a B12 injection earlier that day. At the time, I thought it was a placebo effect. Now I think differently. The stuff is powerful. B12 is the main ingredient in our very popular Myers\u2019 Cocktails.<\/p>\n\n\n\n
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. <\/p>\n\n\n\n
Low B12\u2019s 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). 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.<\/p>\n\n\n\n
In the nervous system, B12 deficiency causes symptoms affecting your nerves (numbness, tingling, tremors, balance problems and the ringing in your ears called tinnitus<\/em>) and the mind (depression, brain fog, mood swings, and, in rare cases, hallucinations and psychosis).<\/p>\n\n\n\n In the GI tract, deficiency can cause digestive symptoms and weight loss because you\u2019re not absorbing food efficiently. <\/p>\n\n\n\n The irony is that with B-12 deficiency there\u2019s usually just one predominant symptom, and making a connection to low B12 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 by a neurologist before your doctor thinks \u201cMaybe we should check her B12 level.\u201d <\/p>\n\n\n\n But even if you manage to get your doctor to test your B12 level, you\u2019re only halfway there because the blood test is just not very good.<\/p>\n\n\n\n The normal range for B12 in the U.S. is 200 to 800 pg (picograms)\/milliliter of blood. But it\u2019s been shown that symptoms can begin as low as 400 pg\/ml, so here in the US such \u201cnormals\u201d 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 will read a printout for you that reports \u201cnormal B12\u201d and she won\u2019t initiate treatment. I\u2019ve had patients come in with B12 levels of 201 pg\/ml with the word \u201cnormal\u201d scribbled across it by the doctor. At WholeHealth Chicago, we start treatment at 350 pg\/ml.<\/strong><\/p>\n\n\n\n The list of causes is lengthy, but by far the most common is dietary. Vegetarians who aren\u2019t 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\u2019s not possible to get adequate B12 while following a strictly vegan diet, and that\u2019s because the richest sources are animal products.<\/p>\n\n\n\n Other causes of B12 deficiency involve problems with absorbing B-12 itself. The intrinsic factor deficiency mentioned earlier necessitates a lifetime of monthly B-12 injections to keep B-12 levels healthy. 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\u2019s disease, celiac disease, and intestinal parasites. Up until the 1950\u2019s, Jewish grandmothers making gefilte fish would taste the partially cooked pike and carp which contained fish tapeworm (often growing to several feet long) which blocked B12 absorption. Fish inspection and thorough cooking ended this unusual source of B-12 deficiency. <\/p>\n\n\n\n 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.<\/p>\n\n\n\n There are three reasons why this diagnosis is missed:<\/p>\n\n\n\n Although it\u2019s not an expensive test, B12 isn\u2019t measured during routine blood tests. Doctors generally don\u2019t order a B12 evaluation if there\u2019s 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. (We order B12\/folate routinely at WholeHealth Chicago) <\/strong><\/p>\n\n\n\n 2. Doctors rarely ask (and patients rarely volunteer) information about their eating habits. In medical school, we\u2019re taught that the US diet is plenty good enough to prevent any vitamin deficiencies. To which I now respond, \u201cHa!\u201d I agree most of us eat plenty of food (You know our intake questionnaires ask about what you\u2019re eating!)<\/strong><\/p>\n\n\n\n 3. Very few primary care physicians ask about what supplements (if any!) their patients are regularly taking<\/p>\n\n\n\n It\u2019s 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.<\/p>\n\n\n\n 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.<\/p>\n\n\n\n B12 injections have been used for decades as the fastest way to raise B12 levels. The Quicksilver Spray is a fast oral spray containing 500 mcg of methylcobalamin per pump. Taken daily, it generally restores B12 levels to a normal range in one month. However, we do have many patients with absorption difficulties and prescribe B-12 self administration by injection, usually weekly until normal levels are reached, then monthly. <\/p>\n\n\n\n Methylcobalamin, the natural B12 form that your body actually prefers because it doesn\u2019t have to detoxify the cyano part, is simply more expensive to manufacture.<\/p>\n\n\n\n Quicksilver Methylcobalamin Oral Spray 90 day supply<\/strong><\/a><\/p>\n\n\n\n Perque Activated B-12 Guard 100 day supply<\/strong><\/a><\/p>\n\n\n\n Integrative Therapeutics Chewable 30 day supply<\/strong><\/a><\/p>\n\n\n\nWhat causes B12 deficiency? <\/strong><\/h3>\n\n\n\n
The missed diagnosis <\/strong><\/h3>\n\n\n\n
Treatment is easy<\/strong><\/h3>\n\n\n\n
Our most popular B-12 products:<\/strong><\/h3>\n\n\n\n