Could it be B12 Deficiency?

Could your Symptoms be due to B12 Deficiency?

It’s a commonly overlooked cause of illness and can look like many other diseases, including dementia, multiple sclerosis, early Parkinson’s disease, ASD (Autistic Spectrum Disorder), neuropathy or chronic fatigue syndrome. It can cause and/or contribute to depression and mental illness, infertility and developmental disabilities in children, premature ageing, cancer and autoimmunity.

Not having sufficient B12 can affect nearly every cell in the human body, and it can often take some time for symptoms to manifest meaning by the time a person presents with deficiency symptoms, they will likely have been low in B12 for some time.

Signs & Symptoms of B12 Insufficiency/ Deficiency

Some signs that you may be B12 deficient are fatigue, weakness, weight loss, loss of appetite, numbness or tingling in the hands or feet, a sore mouth or tongue, and neurological symptoms such as poor balance, depression, mood swings/temper outbursts, poor memory, confusion, and dementia. There are stages of B12 deficiency, and it is often only in the final stage, Stage IV, that clinical sign and symptoms become evident, by which time it may be too late to reverse some of the neurological symptoms.

Sources and Supplements

B12 is found abundantly in animal products and some bacterial synthesis in the gut. Some foods are fortified with B12.
There are different forms of B12, some are more bioavailable (better absorbed and utilised) than others.

• Methylcobalamin: This is the most active form of B12, your body can readily use it, and essential for many processes in the body, such as folate (B9) metabolism, and conversion of homocysteine to methionine, which is essential for cardiovascular health.
• Hydroxycobalamin: Helps with the metabolism of carbohydrates and fats, and also is important in supporting detoxification.
• Adenosylcobalamin: Essential for energy metabolism, it is used by our mitochondria (the powerhouses of our cells, responsible for energy production).
• Cyanocobalamin: is a synthetic form of B12, it’s often used in fortified foods, and supplements. It is cheap to manufacture and is a more demanding process for the body to utilise and convert into Methylcobalamin and Adenosylcobalamin, so not the most ideal form to use.

Generally, if supplementation is needed, most adults do well on about 1000mcg (1mg) sublingual methylcobalamin a day. There are some people who don’t tolerate supplemental methylcobalamin and will tolerate hydroxocobalamin better.

Deficiency Risk Factors

• People following a vegan vegetarian diet- it is very important to supplement if you consume little to no animal products
• People with low stomach acid, which often decreases with age
• People with gastrointestinal conditions such as ulcers, Crohn’s disease, celiac disease, IBS, or other malabsorption syndromes
• People who have had intestinal or bariatric surgeries
• People with eating disorders
• Excessive alcohol consumption
• Women taking oral contraceptives
• Bacterial overgrowth or the presence of parasites in the intestines
• People with a family history of pernicious anaemia, an autoimmune disorder that reduces the amount of intrinsic factor available in the stomach, which is needed for B12 absorption.
• People who regularly use medications that reduce stomach acid such as proton-pump inhibitors (Prilosec, Prevased), antacids
• Metformin or other diabetes drugs, or other medications that can interfere with absorption
• Some people have a genetically higher requirement for B12
• Chronic pancreatitis
• People with a folate deficiency
• Anti-seizure medications such as phenytoin can decrease folate by blocking folate absorption
• Methotrexate, an anti-cancer drug, affects body metabolism and use of folate.

Testing for B12

You might say well I went to my doctor and he tested my serum (blood) B12 and my levels were fine. However, your serum levels can be fine and you can still have a B12 deficiency. This is because sometimes the B12 isn’t getting from your blood and into your cells, where it is needed. One reason for this is due to deficiencies in other nutrients needed to transport B12 into the cells.

You can get a better indication of B12 status by looking at other markers on a full blood panel such as an elevated pattern of MCH, MCV, RDW, LDH (these markers look at weight, size and other characteristics of red blood cells to determine many health factors) & serum iron can indicate a deficiency in B12, Folate or both.
Elevated homocysteine levels can also be an indicator of B12 deficiency, but not used as a stand-alone assessment, as it can also indicate a B6 and Folate deficiency, therefore needs to be investigated with further testing.
The current gold standard of B12 testing is to test Methylmalonic Acid (MMA), because this metabolite increases in concentration when vitamin B12 is deficient. This can be measured in the serum or the blood, but results can be skewed by other health conditions. Kidney disease can increase the levels in urine, and an overgrowth of bacteria in the small intestine called SIBO (Small Intestine Bacterial Overgrowth) can raise levels in the serum.

As with all forms of testing, the bigger picture needs to be considered. Not all tests are 100% foolproof, it’s not that black and white. And so all tests should be considered in light of a person’s health history and symptomology. So if a person presents with some of the symptoms of B12 deficiency, plus blood tests indicate similarly, then it is highly likely. However, if tests indicate B12 deficiency without any symptoms it warrants further investigation into other possible causes.

Fixing the problem

If you’ve discovered B12 deficiency to be the cause of your symptoms, that’s great, however, it doesn’t really fix the problem. Yes, you may need to supplement to get your levels up to a healthy range, but what you really need to do is investigate why you became deficient in the first place. Ideally, you don’t want to be relying on supplements for the rest of your life.
It may be a simple fix through diet, by adding more B12 rich foods, if your diet was previously lacking. And if you are a vegan or vegetarian, fortified foods and a good B12 supplement is your best choice as although many people believe they can get B12 from plant sources like seaweed, fermented soy, spirulina, brewer’s yeast, many of those plant foods actually contain B12 analogues called cobamides that block the intake of and increase the need for true B12. Or it may be that you need to get the support of a practitioner, such as a Functional Medicine Practitioner to help you uncover the underlying cause of your B12 deficiency.

In either case, it’s treating the root cause of imbalance that restores health. If you’d like to dive deeper into the topic I can recommend this book, which is considered one of the most comprehensive resources on B12.

‘Could it be B12?: An Epidemic of Misdiagnoses’ by Pacholok, Sally M., Stuart, Jeffrey J. 2nd (second) Edition (2011)

Sources:

• The Nutrient Bible, 9th Edition, 2010. Henry Osiecki.
• Linus Pauling Institute. Vitamin B12 https://lpi.oregonstate.edu/mic/vitamins/vitamin-B12
• B12 Awareness.org. Sally Pacholok, R.N. http://b12awareness.org/