B12 deficiency or low B12 levels have been estimated to affect about 40% of people over 60 years of age, and about 40% of the general population may be on the lower end of normal.
Vitamin B12 deficiency can look like the signs and symptoms of diseases that are commonly associated with aging, such as Alzheimer’s, dementia, cognitive disorders, multiple sclerosis, Parkinson’s, and other neurological problems; depression and anxiety; cardiovascular disease; cancer; and low libido. If someone you love has these symptoms, best to get their B12 levels checked and supplement accordingly to help reduce symptoms.
Supplementing with an active form of B12 can help reduce inflammation, which has improved symptoms of arthritis and eczema.
Vitamin B12 works with folate to make DNA, red blood cells, and plays an important role in normal nerve function. This is one of the reasons why, when I inject B12, I always include methylated folate with it.
Causes/Risks of B12 deficiency
- Vegan/vegetarianism
- Intestinal malabsorption due to low stomach acid
- Celiac disease
- Crohn’s disease
- Pernicious anemia (an autoimmune condition affecting our ability to absorb B12)
- Atrophic gastritis (usually H. pylori infection in the elderly)
- Long-term use of Proton Pump Inhibitors (PPIs)
- People on Metformin therapy
If someone you know or love falls into any of these categories, it’s best they get tested even if they don’t have symptoms, as deficiency can start before the symptoms show up.
Symptoms of B12 Deficiency
- not much if it’s mild
- weakness
- fatigue
- strange sensations
- numbness, or tingling in hands, legs, or feet
- difficulty walking, such as staggering or balance problems
- anemia
- a swollen, inflamed tongue
- yellow skin
- jaundice
- difficulty thinking and reasoning
- memory loss
- paranoia or hallucinations
Read More: Vitamin B12 and Cancer: Why High (and Low) Levels May Be a Warning Sign
Testing for B12
It is easy to run a B12 test; however, there are other blood and urine markers that can provide a more complete picture, such as methylmalonic acid (MMA) and homocysteine. MMA is considered a particularly sensitive marker of vitamin B12 status, while homocysteine can also rise as B12 levels decline but is less specific because other factors can affect it.
When I run tests, I look at things from a functional medicine perspective and this may involve the more complete profile.
If there is an absorption issue suspected, we need to identify and correct that, if possible. Further testing and treatment may be required to do that.
The results of the tests are also interpreted differently when you come to see me. I look at things from a functional range – your optimum level of performance – not the point at which you have disease. The conventional medical system generally considers B12 levels below approximately 200 to 250 pg/mL to be low. However, neurological symptoms can sometimes occur before B12 levels fall below that threshold, which is one reason I prefer to take a more proactive approach. In my practice, I prefer to see B12 levels somewhere over 550 pg/mL.
Sources of B12
Best to get B12 from hormone-free, responsibly raised animal-based sources – strongest providers are the organ meats (liver, kidney) and seafood like oysters and clams. To get ahead quickly or to supplement a vegan or vegetarian diet, you will need activated B12, so hydroxy- or methyl-based cobalamin are the best. If you have intestinal absorption issues, you’ll need a pill that dissolves under the tongue or an injection to provide the boost. What I carry in the clinic is an activated form of B12/B complex, so it absorbs easily.
B12 Injections
At the clinic, B12 injections are available. Research has shown that sublingual tablets are equally effective as injections; however, I find that for those suffering from mood slumps, poor energy, shingles, or nerve pain, the injections can be like night and day. The formula I use includes methylated folate to ensure the B12 gets into the red blood cells and also to provide an additional energy boost. Even one shot can make a difference. Typically, once a week for a month and then once a month for a few months gets people on their way to better health.
About Dr. Laura M. Brown, ND
Dr. Laura M. Brown is a regulated Naturopathic Doctor dedicated to helping patients restore health and vitality through personalized, evidence-informed care.
With a special focus on digestive health, hormone balance, emotional well-being, and energy, she looks beyond symptoms to uncover root causes and support the whole person—body, mind, and spirit.
A graduate of the Canadian College of Naturopathic Medicine, Dr. Brown is a published author of Beyond Digestion: How GUT Health Connects to Your Mind, Body, and Soul, educator, course creator, and internationally featured podcast guest. She combines modern science with traditional naturopathic wisdom to guide patients toward lasting wellness.
This article has been republished with permission from Dr. Laura M. Brown, ND. You can learn more about her work and her approach to naturopathic care on her website.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.