Many people in the United States suffer from what very well could be a vitamin deficiency. In fact it wouldn’t surprise me at all. With the food supply seriously lacking in essential nutrients and minerals it isn’t a surprise at all that people are having issues with things like lethargy, anxiety and depression, and even disorders such as Alzheimer’s. These are just a few problems associated with B12 (cobalamin) deficiency. So lets talk about it shall we?
B12 is a vitamin responsible for healthy nerves, blood cells, DNA production….essentially stuff to keep you alive. B12 is available in many foods including but not limited to; shellfish, liver, fish, meat, eggs, and dairy. It is very noteworthy that plant products don’t have significant amounts of B12. Don’t be fooled by claims that state otherwise. Many of these foods are fortified with B12, but don’t have it naturally occurring or at very small amounts. And the foods that do, like seaweed, have pseudovitamin B12, which competes for absorption with regular B12.  One exception may be green and purple lavers, a type of algae. 
This is corroborated by studies that show that vegetarians and vegans are 50% and 80% deficient respectively. [3,4]
If you choose to not eat any animal products whatsoever, you need to supplement. More about that in a minute.
As mentioned above, B12 is really important for certain functions in the body. One problem associated with low B12 is many people don’t even know they are deficient. Working in a clinic I do see lab tests a lot, mostly for CBC’s and Cholesterol or A1c’s for diabetics. I don’t see B12 tests unless the doctor suspects something like anemia. But if there is neurological dysfunction, I don’t see it. The point is that since it isn’t something routinely checked for, it gets missed.
As Chris Kresser pointed out in an article:
“In Japan and Europe, the lower limit for B12 is between 500-550 pg/mL, the level associated with psychological and behavioral manifestations such as cognitive decline, dementia and memory loss. Some experts have speculated that the acceptance of higher levels as normal in Japan and the willingness to treat levels considered “normal” in the U.S. explain the low rates of Alzheimer’s and dementia in that country.” 
The normal reference range in the USA by comparison is 247-911 pg/mL. That’s like the Rockies, one big mother range.
On top of that, a good deal of the population may have deficiency.  According to this study as many as 2/5 of America may have a problem. That’s around 125,000,000 people. While not everyone with deficiency show signs, it is still disconcerting. The article which I linked said that there was nothing to worry about though because we can get adequate B12 from more dairy and fortified cereals…..
Modern dietary advice giving us the only reasonable response.
Yeah because hey, fortified cereals are where it’s at nutritionally. ……NOT!
Make no mistake, the addition of niacin to the US flour supply was probably one of the very few smart things the federal government was able to do to actually influence in a POSITIVE manner the population’s health. By helping people get enough niacin they were able to eliminate pellagra, a very serious condition that resembles schizophrenia. The problem with fortified cereals are the only nutrition you get from them are the spray on vitamins. That might be helpful for some, but meat or liver or fish is probably the much better option.
Another issue is that people experience symptoms even when their levels on are on the lower end of “normal”. It’s entirely possible that our range, like many other medical ranges may be off and probably needs to be increased.
Lets Talk About Absorption Baby, Lets Talk about You and Me!
If you don’t remember back or are new to the blog, a few weeks ago I discussed the adverse effects of taking acid reducers chronically. Here’s the link:
Acid in the stomach is an important part of the process to get B12 absorbed in the body. Acid cleaves B12 from the carrier it resides on so that it can be attached to intrinsic factor, allowing for absorption. No acid, no cleavage, no absorption. Other drugs can cause problems too. If you’re diabetic, metformin is known to reduce not only B12 but the other B vitamins as well.
People that have leaky gut or other inflammatory processes going on in the gut may have impaired absorption as well. Don’t assume just because you are a meat eater you’re getting all the B12 you need. Fixing your gut is important for many reasons and B12 is definitely one of those reasons.
If you have problems with energy and have been able to rule out blood sugar dysregulation and sleep as potential problems, B12 might be a great place to look. People with anemia can have B12 or iron deficiencies. Since B12 is also required for myelin sheaths (the insulation on the nerves) it is thought that it is important for prevention of neurodegenerative disorders such as Alzheimer’s and Multiple Sclerosis. It may also play a part in anxiety and depression as well as autism and learning disabilities in children.
Maternal breast milk has a content of B12 that is linked with intake from mom. So if a mom is a vegetarian or a vegan, it is extremely important that she supplement to get adequate supplies for the baby.
You can find B12 in just about any B-Complex. It typically comes in the form of cyanocobalamin. I want to point out that this form of cobalamin is linked with cyanide, hence cyanocobalamin. This form is usually injected at a doctor’s visit. Methylcobalamin on the other hand seems to be the form that is most useful, especially in neurological problems.  This is the form most used by the Japanese. In fact they don’t use cyanocobalamin anymore because it doesn’t work very well if at all.
The British also don’t use cyanocobalamin. They use hydroxocobalamin. In a paper addressing some concerns about cyanocobalamin, researchers point out that hydroxocobalamin is preferrable to cyanocobalamin and that it’s use should be discontinued. 
Cyanocobalamin, methylcobalamin and hydroxocobalamin are the most common forms.
So if you need it, what do you use? I would recommend methylcobalamin in the oral form. There are sub-lingual tabs which absorb and bypass the gut altogether:
This would be a good option to start with if you use acid reducers or have gut problems. The one I listed is 1mg which is likely enough. For those fighting off peripheral neuropathies or trying for nerve regeneration much higher doses are likely required, as in doses used in injections.
I would stay away from cyanocobalamin if possible. I know it’s cheap and for a simple anemia where a low dose is effective then it might be ok. But to really maintain good health it’s better to use the other forms. Much like folic acid is synthetic and not naturally occurring folate, cyanocobalamin is cheap (yes I said cheap) and not as effective.
Get the best forms from your food. Fish, shellfish, meat, liver and dairy are good sources. If your gut is in need of help, get it the help it needs so you can get the B12 you need from food. If you are a vegetarian or vegan please make sure to get enough through supplements. I recommend food first of course.
1.Watanabe, Fumio, et al. “Pseudovitamin B12 is the predominant cobamide of an algal health food, spirulina tablets.” Journal of agricultural and food chemistry 47.11 (1999): 4736-4741.
2.Watanabe, Fumio, et al. “Characterization and bioavailability of vitamin B12-compounds from edible algae.” Journal of nutritional science and vitaminology 48.5 (2002): 325-331.
3.Antony, Aśok C. “Vegetarianism and vitamin B-12 (cobalamin) deficiency.” The American journal of clinical nutrition 78.1 (2003): 3-6.
4.Bissoli, L., et al. “Effect of vegetarian diet on homocysteine levels.” Annals of nutrition and metabolism 46.2 (2002): 73-79.
Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.