B-12 Deficiency | Risks & Symptoms
Who is at Risk of Low B-12?
Everyone. Everyone is at risk of being low in B-12. Take a look at this list of symptomologies of persons at risk.
| ☐ Anemia | ☐ Neurologic or motor symptoms |
| ☐ Hypothyroidism | ☐ Chronic Fatigue |
| ☐ Diarrhea | ☐ Constipation |
| ☐ Premature graying of hair | ☐ Tinnitus |
| ☐ Family history of pernicious anemia | ☐ Dementia or Alzheimer’s disease |
| ☐ Elevated MCV | ☐ Psychiatric disorders |
| ☐ Gastrointestinal disorders | ☐ Mental status changes |
| ☐ Gastrointestinal surgeries | ☐ Age 40+ |
| ☐ Gastric bypass surgery | ☐ Autism spectrum |
| ☐ Proton pump inhibitor use | ☐ Autoimmune disorders |
| ☐ Metformin use | ☐ Developmental delay |
| ☐ Vascular disorders | ☐ Breast fed infants of mothers at risk |
| ☐ Vegans | ☐ Eating disorders |
| ☐ Vegetarians, macrobiotic diets | ☐ Overweight/Obese |
Don’t take this list lightly. B-12 deficiency is seriously BAD for your health, but SO EASY to take care of. So why do we not recognize B-12 deficiencies?
B-12 Deficiency is a Mimicker
B-12 deficiency is a MIMICKER. This is one of the main reasons it is so tricky to recognize as a problem. This wide range of mimicry is also the reason we should be testing for it, and skillfully supplementing at appropriate levels!!!
It will mimic low energy, adrenal fatigue, depression, poor sleep, multiple sclerosis, chronic fatigue syndrome and postpartum depression/psychosis. It can make men and women infertile and cause developmental disabilities or autistic—like symptoms in children. B-12 deficiency can parade as pain from inflammation, poor digestion, constipation, poor coordination, and mood swings.
As you can see from the list above, other groups of people at risk for B-12 deficiency include vegetarians, vegans, persons eating a standard western (processed food) diet, persons over 40, people with celiac disease, Crohn’s disease, alcoholics, gastric bypass, anemia, autoimmune diseases and HIV/AIDS. The use of certain drugs such as proton pump inhibitors, antacids, metformin, H—2 blockers and nitrous oxide (from dental work or surgeries) can also cause B-12 deficiency.
What are the Signs of B-12 Deficiency?
Sally M. Pacholok, R.N., B.S.N. and Jeffrey J. Stuart, D.O. in their excellent book, Could It Be B-12? 2nd Edition have listed these signs that would manifest because of B-12 deficiency in various domains of your life experience:
Neurologic signs and symptoms:
| ☐ Numbness—tingling | ☐ Tremor |
| ☐ Weakness of legs, arms, trunk | ☐ Restless legs |
| ☐ Impaired vibration—position sense | ☐ Visual disturbances |
| ☐ Abnormal reflexes | ☐ Forgetfulness, memory loss |
| ☐ Unsteady or abnormal gait | ☐ Dementia |
| ☐ Balance problems | ☐ Impotence |
| ☐ Difficulty ambulating | ☐ Urinary or fecal incontinence |
| ☐ Dizziness |
Psychiatric symptoms:
| ☐ Depression | ☐ Hallucinations |
| ☐ Irritability | ☐ Psychosis |
| ☐ Paranoia | ☐ Violent behavior |
| ☐ Mania | ☐ Personality changes |
Hematologic signs and symptoms:
| ☐ Anemia | ☐ Fatigue |
| ☐ Macrocytosis (enlarged red-blood cells) | ☐ Shortness of breath |
| ☐ Generalized weakness | ☐ Pallor |
Signs & symptoms in infants and children:
| ☐ Developmental delay or regression | ☐ Poor weight gain |
| ☐ Apathy—Irritability | ☐ Poor head growth |
| ☐ Hypotonia | ☐ Poor socialization |
| ☐ Weakness | ☐ Poor motor skills |
| ☐ Tremor | ☐ Language delay |
| ☐ Involuntary movements | ☐ Speech problems |
| ☐ Seizures | ☐ Lower IQ—Mental retardation |
| ☐ Ataxia | ☐ Anemia |
| ☐ Anorexia | ☐ Macrocytosis |
| ☐ Failure to thrive |
Disorders With Possible B-12 Deficiency as an Underlying Cause:
| ☐ Dementia—Alzheimer’s disease | ☐ Post-partum depression/psychosis |
| ☐ Multiple sclerosis | ☐ Altered mental status/confusion |
| ☐ Depression | ☐ Bipolar disorder |
| ☐ Poor wound healing | ☐ Neuropathy (diabetic, CIDP) |
| ☐ Vertigo | ☐ Anemia |
| ☐ Congestive Heart Failure | ☐ Autism |
| ☐ AIDS dementia complex | ☐ Restless Leg Syndrome (RLS) |
| ☐ Radiculopathy, chronic pain disorder | ☐ Chronic Fatigue Syndrome (CFS) |
| ☐ Fibromyalgia | ☐ Chronic Renal Failure (hemodialysis patients) |
| ☐ Essential tremor—Parkinson’s disease | ☐ Erectile dysfunction |
| ☐ Infertility | ☐ Heart Disease |
B-12 Metabolism: Why You May Not Be Getting It
Here is why you might not be getting your B-12 with those other vitamins: There are so many steps to getting B-12 into your blood plasma and liver. Many of us have health challenges that make these important steps less effective, and thus we do not get our B-12. Here is how it goes:
1. When B-12 goes into the stomach, a stomach acids called pepsin and hydrochloric acid separate the B-12 from its protein source (animal protein).
2. The B-12 attaches to R-Protein, which is also secreted by your salivary glands and stomach.
3. The stomach releases a substance called intrinsic factor, which is secreted by the parietal cells in the stomach (the same cells that produce hydrochloric acid for digesting your food).
4. The B-12, attached to R-Protein, is liberated from the R-Protein in your small intestine
5. A B-12/intrinsic factor complex combines in your small intestine, where it is absorbed in the terminal ileum via ileal cells and the mucosal wall.
6. The absorbed complex is then transported via a blood plasma protein (transcobalamin II) to various cells in your body (a process that involves calcium), and excess B-12 is stored in your liver.
The interruption of any of these complex steps affects your body’s ability to absorb B-12.Deficiencies in pepsin, hydrochloric acid, R-protein, pancreatic enzymes, intrinsic factor, calcium and cell receptors can all lead to B-12 deficiency.
How Quickly Does B-12 Deficiency Develop?
The answer: Faster than you probably think. Even with a Masters in Nutrition, I thought it took five years. But research shows that B-12 levels can drop off significantly in just months.
To give you an idea of how fast B-12 levels can drop, one study has looked at changes in serum B-12 (sB-12) levels in new vegans. Crane et al (1994, USA)[1] had 13 students change from a Lacto-Ovo Vegetarian (dairy and eggs, no meat) to a Vegan diet (no dairy, eggs, or meat):
All 4 students with serum B-12 in the 600-900 range fell to below 500 pg/ml in just 2 months.
10 students followed the diet for 5 months and their average sB-12 went from 417 ± 187 to 276 ± 122 pg/ml.
After 5 months, 2 went from normal B-12 to below normal B-12.
Depending on which study you look at, 0.1-0.2% of the body’s B-12 stores are lost per day; the .2% loss occurs in those with pernicious anemia.[2] This loss is accelerated when eating a plant-based diet, according to the preponderance of evidence from the research.
Approximately 60% of total B-12 in the body is stored in the liver, and 30% is stored in the muscles. [3]
“The body has a special circuit between the digestive tract and the liver. Bile, which is made in the liver and needed to digest fat, is secreted into the beginning of the small intestine. It is then reabsorbed at the end of the small intestine (the ileum) and taken back to the liver where it is used again. This circuit is called enterohepatic circulation.”[4]
In a healthy physiology, one secretes approximately 1.4 µg/day of B-12 into the small intestines via bile from the liver. Consequently, healthy people can reabsorb about half of that, or .7µg B-12/day from their bile. [5] In some cases of low B-12 intake, reabsorption increases, which can delay the onset of apparent B-12 deficiency symptoms, up to 20-30 years. [6]
For persons who do not supplement, differences in this enterohepatic circulation may determine the rate at which B-12 deficiency symptoms develop.[7]
BUT MAKE NO MISTAKE, DEFICIENCY – AND POTENTIALLY DISLIKABLE SYMPTOMS – IS STATISTICALLY NEAR CERTAIN IF YOU DO NOT SUPPLEMENT.
Four Main Reason-Categories for B-12 Deficiency
When we are looking at all this B-12 information, remember that B-12 deficiency arises from four main reason-categories:
1. Dietary Sources are Inadequate
2. Digestion Issues
3. Toxicity
4. Lack of Absorption/Assimilation of B-12
I have COLOR CODED the above reasons, and will use these colors to highlight the causes/reasons for B-12 deficiency below. Let’s look more specifically at how these four reasons play out, and then what to do about it (supplement with B-12 appropriately!).
Causes and Contributing Factors for B-12 Deficiency
| ☐ Decreased stomach acid | ☐ Autoimmune pernicious anemia |
| ☐ Atrophic gastritis | ☐ Age 60+ |
| ☐ Helicobacter pylori | ☐ Malabsorption syndromes |
| ☐ Crohn’s disease | ☐ Gastrectomy, intestinal resection |
| ☐ Celiac disease (gluten enteropathy) | ☐ Gastric bypass surgery |
| ☐ Bacterial overgrowth (small bowel) due to Low Stomach Acid! | ☐ Processed Food Diet |
| ☐ Vegetarian/Vegan Diet | ☐ Overweight/Obese |
| ☐ Fish tapeworm | ☐ Malnutrition—Eating disorders |
| ☐ Processed/Industrialized Meat Diet | ☐ Alcoholism |
| ☐ Chronic pancreatitis | ☐ Certain pharmaceutical drugs |
| ☐ Advanced liver disease | ☐ Overuse of Recreational Drugs |
| ☐ Transcobalamin II deficiency | ☐ Nitrous oxide |
| ☐ Inborn errors of B-12 metabolism |
Now let’s look in more detail at a few of these listed above. If any of these apply to you that are not discussed here, GOOGLE SEARCH for the cause or contributing factor, and B-12, such as “Crohn’s Disease and B-12.”
But many of them are actually related to LOW STOMACH ACID, which we will cover first.
Decreased Stomach Acid
This possibility is HUGE. Decreased stomach acid is also known as “hypochlorhydria.” Low stomach acid is a rampant problem in westernized societies, largely due to the processed-food diet we eat. A reduction in stomach acids encourages the development of bacterial colonies in the stomach that produce non-human active analogues of vitamin B-12, which can accelerate or promote B-12 deficiency.
An EXCELLENT resource on the importance of stomach acid is the book, Why Stomach Acid is Good For You.
One reviewer on Amazon.com writes:
“A great, great book. I stopped taking my Prevacid before I finished the second chapter. Dr. Wright exposes how the medical profession treats the problem of a little bit of stomach acid in the wrong place (your esophagus) by almost completely neutralizing your stomach acid with powerful drugs. But without stomach acid, you can’t absorb nutrients properly, and you can’t prevent bacteria growth in your stomach! Thank God I found this book, or I would have taken those pills forever, and my symptoms weren’t even that bad. I needed to change a few eating habits, not get rid of stomach acid forever. I was honestly taken aback that doctors could be so ignorant of the importance of stomach acid for your health, and so willing to casually prescribe a powerful (and profitable) pill to simply make the symptoms go away without treating the cause.”
From V. Herbert et al:[10]
As pernicious anemia develops, the first loss usually is of gastric acid. Figure 3 (from Drasar and Hill, 23) shows that the achlorhydric stomach [one unable to produce hydrochloric acid] is usually heavily colonized with enteric bacteria.
The increased colonies of enteric bacteria in the achlorhydric stomach and small intestine of the pernicious anemia patient may produce analogue B-12 which may. . . accelerate the development of B-12 deficiency.
That’s right, low stomach acid causes bacteria to populate that make b-12 analogues – and that non-human active B-12 blocks your body’s ability to take up human-active B-12, resulting in deficiency.
Iron deficiency and low stomach acid also go hand-in-hand:
“The loss of gastric acids may also occur in iron deficiency. The iron in plant foods averages 3% absorbable [non-heme iron]; iron from animal foods averages 15% absorbable [heme iron]. Therefore, iron deficiency is twice as common in vegetarians as in omnivores (3, 4, 19). Because some vegetarians, especially those consuming restrictive diets, are at greater risk for deficiencies than omnivores (24), all vegetarians should be tested for iron disorders (25). Prolonged iron deficiency damages the gastric mucosa and promotes atrophic gastritis and gastric atrophy, including loss of gastric acid and I.F. [intrinsic factor] secretion, and therefore diminished vitamin B-12 absorption (3, 4, 19). This would cause vitamin B-12 deficiency in twice as many vegetarians as omnivores (3, 4, 19).” [11]
What can you do to raise stomach acid? Immediately, you can take Betaine HCl capsules before meals (as directed on bottle) to increase the strength of your stomach acid, and thus your body’s ability to digest proteins and assimilate some B-12 from foods – but given the research presented in this book, do not rely on food sources unless you have done the Gold Standard “Urinary MMA Test” to see if your B-12 levels are healthy.
You can strengthen your stomach acid by:
Drinking water: Low hydration weakens the stomach.
Add Fresh Lemon to your Water
Taking supplemental Zinc: Zinc nourishes the stomach cells that make gastric acid)
Take Betaine HCl as a supplement before meals
Exercise: This will get your stomach acids flowing!
Get Healthy Sun Exposure: heat will strengthen your “digestive fire.”
Drink Green Vegetable Juice: See www.JuiceFeasting.com for information on making delicious Green Vegetable Juice. The organic sodium in greens and vegetables will nourish your parietal cells, and increase stomach acid production.
READING THE BOOK WHY STOMACH ACID IS GOOD FOR YOU!!!
Heliobacter Pylori (H-Pylori)
It is estimated that more than 50 per cent of adults in developed countries are infected with the Helicobacter pylori bacterium.
H-pylori has been implicated in stomach ulcers, indigestion (dyspepsia), gastritis (inflammation of the stomach lining), stomach cancer, and MALT lymphoma.
Researchers at the Turkish Military Medical Academy now provide convincing evidence that Heliobacter Pylori and B-12 deficiency are linked.
A detailed study[12] of 138 patients with vitamin B-12 deficiency and anaemia discovered that 77 (58 per cent) of the patients had a H-pylori infection. Eradication of this infection successfully cured the anaemia and reversed the vitamin B-12 deficiency in 31 (40 per cent) of the 77 infected patients. The researchers conclude that an H-pylori infection can cause a vitamin B-12 deficiency and that this deficiency, in many cases, can be totally eliminated by eradicating the infection. “Helicobacter pylori is one of the most common causes of peptic ulcer disease worldwide and a major cause of chronic superficial gastritis leading to atrophy of gastric glands. It is suggested that there maybe a causal relationship between H-pyloriand food cobalamin malabsorption.”
And in suggesting a link between H-Pylori and Pernicious Anemia, the authors of the study write, “It has been proposed that pernicious anemia may represent the final phase of a process that begins with H pylori–associated gastritis and evolves through progressive levels of atrophy until parietal cell mass is entirely lost.”
Two other studies of note on H-Pylori and Vitamin B-12:
Stopeck, Alison. “Links between Helicobacter pylori infection, cobalamin deficiency, and pernicious anaemia.” Archives of Internal Medicine, Vol. 160, May 8, 2000, pp. 1229-30 (editorial)
“Histological and serological confirmed H.pylori infection is associated with lower B-12 levels; hyperhomocysteinemia and eradication of H.pylori lowers homocysteine and raises B-12.”[13]
See this article for much more: http://www.urbanwellnesspdx.com/site/1133urba/NDNR.articles.pdf
*(Care to Eradicate H-Pylori? Try Matula Tea. Google it!)*
Next up: Vegetarian, Vegan, and Raw Vegan Diets: The Research!
Stay Sharp,
David Rainoshek, M.A.
Master Coach & Author, B12 Exposed
Founder, JuiceFeasting.com
+ Introduction to the B-12 Exposed Course
+ What You Are Going To Do With This Course
+ View #1.1: B-12 Deficiency: Risks and Symptoms
+ View #1.2: Vegetarian, Vegan, & Raw/Vegan Diets: The Research
+ View #2: A Second Look: B-12 Deficient? Take This Test
+ View #3: The Gold Standard for Testing B-12
+ Healthy Ranges for B-12 Tests
+ Three Supplement Protocols for Vitamin B-12
+ Supplement Options: What You Need to Know
+ Nutrient Interactions with B-12
References and Citations
[1] Crane MG, Sample C, Pathcett S, Register UD. “Vitamin B-12 studies in total vegetarians (vegans). Journal of Nutritional Medicine. 1994;4:419-430.
[2] Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B-12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 2000.
[3] Messina M, Messina V. The Dietitian’s Guide to Vegetarian Diets. Gaithersburg, MD: Aspen Publishers, Inc., 1996.
[4] Online: http://www.veganhealth.org/B-12/dig
[5] Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B-12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 2000.
[6] Herbert V. Staging vitamin B-12 (cobalamin) status in vegetarians. Am J Clin Nutr. 1994 May;59(5 Suppl):1213S-1222S. Kanazawa S, Herbert V. Mechanism of enterohepatic circulation of vitamin B-12: movement of vitamin B-12 from bile R-binder to intrinsic factor due to the action of pancreatic trypsin. Trans Assoc Am Physicians 1983;96:336-44.
[7] Donaldson MS. Metabolic vitamin B-12 status on a mostly raw vegan diet with follow-up using tablets, nutritional yeast, or probiotic supplements. Ann Nutr Metab. 2000;44(5-6):229-34. And personal communication with author Jan 31, 2002.
[8] Kaptan, Kursad, et al. Helicobacter pylori – Is it a novel causative agent in vitamin B-12 deficiency? Archives of Internal Medicine, Vol. 160, May 8, 2000, pp. 1349-53
Stopeck, Alison. Links between Helicobacter pylori infection, cobalamin deficiency, and pernicious anaemia. Archives of Internal Medicine, Vol. 160, May 8, 2000, pp. 1229-30 (editorial)
[9] Kalikiri, P.C., and Sachan, R.S.G.S. Nitrous Oxide induced elevation of plasma honocysteine and methylmalonic acid levels and their implications. The Internet Journal of Anesthesiology 2004, 8(2).
Ostreicher, D.S. Vitamin B-12 supplements as protection against nitrous oxide inhalation: New York State Dental Journal 1994, 60(3):47-9
Quarnstrom, F. Nitrous oxide analgesia. What is a safe level of exposure for the dental staff? Dentistry Today 2002, 21(4):104-9.
[10] Herbert V, Drivas G, Manusselis C, Mackler B, Eng J, Schwartz E (1984) “Are colon bacteria a major source of cobalamin analogues in human tissues?” Transactions of the Association of American Physicians, vol. 97, pp. 161-171.
[11] Herbert V (1994) “Staging vitamin B-12 (cobalamin) status in vegetarians.” American Journal of Clinical Nutrition, vol. 59(suppl), pp. 1213S-1222S. Online: http://www.ajcn.org/content/59/5/1213S.full.pdf
[12] Kaptan, Kursad, et al. Helicobacter pylori – Is it a novel causative agent in vitamin B-12 deficiency? Archives of Internal Medicine, Vol. 160, May 8, 2000, pp. 1349-53
[13] Kutluanam U. Is there a possible relation between atrophic gastritis and premature atherosclerosis? Heliobacter Dec 10(6):623-9, 2005.
