Vitamin B12 is essential for brain and nervous health, DNA replication and numerous vital functions. It is also one of the most difficult vitamins for us to absorb and utilize. An estimated 20-40% of us do not have enough vitamin B12. There is a long list of common medications which lead to depleted levels, among them are antacids like Prilosec, Zantac and Nexium, the oral contraceptive pill and Metformin – a common diabetes medication. It is worth noting if your medication is hindering your vitamin B12. As we age our necessary digestive enzymes decline. Stress and illness can also reduce our production. Chronic stress can be a precursor for poor vitamin and mineral status due to reduced absorption and increased demand.

Deficiency symptoms are insidious – they develop slowly over time and when full-blown symptoms are present there has often been irreversible damage – particularly to nerves. Vitamin B12 requires multiple digestive steps for utilization. Anyone with a gastrointestinal complaint, poor stomach acid (or taking antacids), and those who have Helicobacter pylori infection (this is the bacteria responsible for most gastric ulcers, which is present in more than 50% of the over 60’s) are particularly vulnerable to absorption issues.

Vegans and strict vegetarians are frequently lacking in B12. So, whilst those on a plant-based diet have reduced cholesterol and other cardiovascular risk factors, the incidence of heart disease is not as low as would be expected and vitamin B12 is believed to be a key in this.

B12 is found predominantly in foods of animal origin. There are problems with vegetarian sources of B12 – main issues being extremely low and unreliable levels found in plant foods. The bacterial ‘contamination’ of foods is often what will provide the B12 and this is hard to predict. The plant foods that are accessible and we can rely on are nori (seaweed) sheets and shiitake mushrooms. Adding those to your diet regularly will give a substantial boost.

Spirulina and other plant based or vegan sources of B12 analogues, (chemicals that are structurally similar to B12), are yet to prove effective in human health. Fortification of vegetarian foods is usually done using synthetic B12 – cyanocobalamin. Methylcobalamin is the preferred form for supplementation (although still synthetic) as it is understood to be more absorbable and does not contain cyanide, a toxin present in cyanocobalamin.

Foods to boost vitamin B12 include sardines, scallops, organic lamb and good quality probiotic yoghurt. Interestingly humans produce B12 from bacteria in our gut, however the absorption mechanism is higher up in the system, so we simply excrete the B12 we have made.

Signs and symptoms of low B12 include a smooth sore tongue or ‘bald’ patches on the tongue, excessive tiredness, moodiness and menstrual disorders, confusion, depression, psychiatric illnesses, clumsiness, and tinnitus (ringing in the ears). Cognitive decline particularly in the elderly, learning difficulties, cardiovascular and immune dysfunction are also linked to low vitamin B12. Pernicious anemia is a type of anemia that is directly related to lack of vitamin B12.

Blood tests can pick up deficiency, but there are conflicting views as to the acceptable ranges. The medically trained authors of the book ‘Could It Be B12?’ believe that 550pg/ml (pg is a picogram = one-trillionth of a gram), should be the minimum acceptable level. Internationally less than half that amount is deemed adequate. There are various other tests that can help determine if B12 is being properly absorbed and utilized – if in doubt after receiving a ‘normal range’ blood test ask your naturopathic practitioner or GP for more extensive testing options.

When aiming to live a healthy lifestyle it is important to note that our diet and overall health may affect our vitamin status in surprising ways. Supplementation with folic acid, for example, can mask a B12 deficiency. This is only one of many nutrient interactions to be mindful of and emphasizes the importance of not self-prescribing supplements. Consultation with a naturopathic nutritional therapist will allow you to talk through your health goals and to receive personalized dietary and lifestyle advice which addresses your specific needs.

Article by Gemma Hurditch, BHS, Naturopath & Medical Herbalist

Articles on this website are based upon the opinions of their respective author(s). None of the information on this website is intended as medical advice nor replaces the advice of a qualified health care professional.