B12 deficiency: a silent epidemic with serious consequences

Sad lonely pensive old senior woman

What do all of these diseases have in common?

  • Alzheimer’s, dementia, cognitive decline and memory loss (collectively referred to as “aging”)
  • Multiple sclerosis (MS) and other neurological disorders
  • Mental illness (depression, anxiety, bipolar disorder, psychosis)
  • Cardiovascular disease
  • Learning or developmental disorders in kids
  • Autism spectrum disorder
  • Autoimmune disease and immune dysregulation
  • Cancer
  • Male and female infertility

Answer: they can all mimic the signs and symptoms of vitamin B12 deficiency.

B12 deficiency: an invisible epidemic

B12 deficiency isn’t a bizarre, mysterious disease. It’s written about in every medical textbook and its causes and effects are well-established in the scientific literature.

However, B12 deficiency is far more common than most health care practitioners and the general public realize. Data from the Tufts University Framingham Offspring Study suggest that 40 percent of people between the ages of 26 and 83 have plasma B12 levels in the low normal range – a range at which many experience neurological symptoms. 9 percent had outright deficiency, and 16 percent exhibited “near deficiency”. Most surprising to the researchers was the fact that low B12 levels were as common in younger people as they were in the elderly.

That said, B12 deficiency has been estimated to affect about 40% of people over 60 years of age. It’s entirely possible that at least some of the symptoms we attribute to “normal” aging – such as memory loss, cognitive decline, decreased mobility, etc. – are at least in part caused by B12 deficiency.

Why is B12 deficiency so under-diagnosed?

B12 deficiency is often missed for two reasons. First, it’s not routinely tested by most physicians. Second, the low end of the laboratory reference range is too low. This is why most studies underestimate true levels of deficiency. Many B12 deficient people have so-called “normal” levels of B12.

Yet it is well-established in the scientific literature that people with B12 levels between 200 pg/mL and 350 pg/mL – levels considered “normal” in the U.S. – have clear B12 deficiency symptoms. Experts who specialize in the diagnosis and treatment of B12 deficiency, like Sally Pacholok R.N. and Jeffery Stewart D.O., suggest treating all patients that are symptomatic and have B12 levels less than 450 pg/mL. They also recommend treating patients with normal B12, but elevated urinary methylmalonic acid (MMA), homocysteine and/or holotranscobalamin (other markers of B12 deficiency).

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.

What is vitamin B12 and why do you need it?

Vitamin B12 works together with folate in the synthesis of DNA and red blood cells. It’s also involved in the production of the myelin sheath around the nerves, and the conduction of nerve impulses. You can think of the brain and the nervous system as a big tangle of wires. Myelin is the insulation that protects those wires and helps them to conduct messages.

Severe B12 deficiency in conditions like pernicious anemia (an autoimmune condition where the body destroys intrinsic factor, a protein necessary for the absorption of B12) used to be fatal until scientists figured out death could be prevented by feeding patients raw liver (which contains high amounts of B12). But anemia is the final stage of B12 deficiency. Long before anemia sets in, B12 deficiency causes several other problems, including fatigue, lethargy, weakness, memory loss and neurological and psychiatric problems.

B12 deficiency occurs in four stages, beginning with declining blood levels of the vitamin (stage I), progressing to low cellular concentrations of the vitamin (stage II), an increased blood level of homocysteine and a decreased rate of DNA synthesis (stage III), and finally, macrocytic anemia (stage IV).

Why is B12 deficiency so common?

The absorption of B12 is complex and involves several steps – each of which can go wrong. Causes of B12 malabsorption include:

  • intestinal dysbiosis
  • leaky gut and/or gut inflammation
  • atrophic gastrits or hypochlorhydria (low stomach acid)
  • pernicious anemia (autoimmune condition)
  • medications (especially PPIs and other acid-suppressing drugs)
  • alcohol
  • exposure to nitrous oxide (during surgery or recreational use)

This explains why B12 deficiency can occur even in people eating large amounts of B12-containing animal products. In fact, many of my patients that are B12 deficient are following a Paleo diet where they eat meat 2-3 times a day.

In general, the following groups are at greatest risk for B12 deficiency:

  • vegetarians and vegans
  • people aged 60 or over
  • people who regularly use PPIs or acid suppressing drugs
  • people on diabetes drugs like metformin
  • people with Crohn’s disease, ulcerative colitis, celiac or IBS
  • women with a history of infertility and miscarriage

Note to vegetarians and vegans: B12 is found ONLY in animal products

B12 is the only vitamin that contains a trace element (cobalt), which is why it’s called cobalamin. Cobalamin is produced in the gut of animals. It’s the only vitamin we can’t obtain from plants or sunlight. Plants don’t need B12 so they don’t store it.

A common myth amongst vegetarians and vegans is that it’s possible to get B12 from plant sources like seaweed, fermented soy, spirulina and brewers yeast. But plant foods said to contain B12 actually contain B12 analogs called cobamides that block intake of and increase the need for true B12.

This explains why studies consistently demonstrate that up to 50% of long-term vegetarians and 80% of vegans are deficient in B12.

The effects of B12 deficiency on kids are especially alarming. Studies have shown that kids raised until age 6 on a vegan diet are still B12 deficient even years after they start eating at least some animal products. In one study, the researchers found:

…a significant association between cobalamin [b12] status and performance on tests measuring fluid intelligence, spatial ability and short-term memory” with formerly vegan kids scoring lower than omnivorous kids in each case.

The deficit in fluid intelligence is particularly troubling, the researchers said, because:

…it involves reasoning, the capacity to solve complex problems, abstract thinking ability and the ability to learn. Any defect in this area may have far-reaching consequences for individual functioning.

I recognize that there are many reasons why people choose to eat the way they do, and I respect people’s right to make their own choices. I also know that, like all parents, vegetarians and vegans want the best for their children. This is why it’s absolutely crucial for those that abstain from animal products to understand that there are no plant sources of B12 and that all vegans and most vegetarians should supplement with B12. This is especially important for vegetarian or vegan children or pregnant women, whose need for B12 is even greater than adults.

Treatment of B12 deficiency

One of the greatest tragedies of the B12 epidemic is that diagnosis and treatment is relatively easy and cheap – especially when compared to treatment of the diseases B12 deficiency can cause. A B12 test can be performed by any laboratory, and should be covered by insurance. If you don’t have insurance, you can order it yourself from a lab like DirectLabs.com for $60.

As always, adequate treatment depends on the underlying mechanism causing the problem. People with pernicious anemia or inflammatory gut disorders like Crohn’s disease are likely to have impaired absorption for their entire lives, and will likely require B12 injections indefinitely. This may also be true for those with severe B12 deficiency causing neurological symptoms.

Some recent studies have suggested that high dose oral or nasal administration may be as effective as injections for those with B12 malabsorption problems. However, most B12 experts still recommend injections for people with pernicious anemia and advanced B12 deficiency involving neurological symptoms.

Cyanaocobalamin is the most frequently used form of B12 supplementation in the US. But recent evidence suggests that hydroxycobalamin (frequently used in Europe) is superior to cyanocobalamin, and methylcobalamin may be superior to both – especially for neurological disease.

Japanese studies indicate that methylcobalamin is even more effective in treating the neurological sequelae of B12 deficiency, and that it may be better absorbed because it bypasses several potential problems in the B12 absorption cycle. On top of that, methylcobalamin provides the body with methyl groups that play an role in various biological processes important to overall health.

If you suspect you have B12 deficiency, the first step is to get tested. You need an accurate baseline to work from. If you are B12 deficient, the next step is to identify the mechanism causing the deficiency. This is something you’ll probably need help with from a medical practitioner. Once the mechanism is identified, the appropriate form (injection, oral, sublingual or nasal) of supplementation, the dose and the length of treatment can be selected.

So, next time you or someone you know is “having a senior moment”, remember: it might not be “just aging”. It could be B12 deficiency.

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Comments Join the Conversation

  1. Jesse says

    You may be right, but assuming I don’t want to just take your word for it, where can I find evidence that anyone besides vegans and old people have to be concerned about adequate B12 intake?

    • Ann says

      I’m your evidence. I eat meat everyday, have done since I was a kid, and at age 29 was diagnosed with extreme B-12 deficiency/pernicious anemia. This after going to a neurologist because they thought I had MS. I have permanent nerve damage as a result of not being diagnosed earlier, a simple test would have prevented this when I first complained to a doc at age 23. If you have any symptoms of deficiency take a test, it’s cheap and simple, as is correcting the issue.

      • Jesse says

        Fair enough, Ann and Phyllis. It makes sense that there are people who are genetically inclined to have trouble absorbing B12 (and, if I recall correctly from my parasitology class, Scandinavian women who are infected with a certain Diphyllobothrium tapeworm should be concerned too). I may have misread the article, interpreting it as suggesting that B12 deficiency is a widespread problem that could strike anyone any time.

          • Tori says

            Now I don’t feel so bad. I read that it usually happens in people over 60. I was just diagnosed and I’m 17

            • Chuck says

              My daughter who just turned 20 was just diagnosed today. It would not have been something she would have been tested for but she was having neuropathy type symptoms in her feet.

              • Cathy says

                I went to the doctors because I’m having trouble walking there calling it a sensory perception problem. They have discovered my B12 is at 380. I am taking 1,000 B12
                pill every day for 4 weeks now no difference. Is there anything that can be done to help me. I’m having so much trouble walking?

                • Chris Kresser says

                  Sounds like you aren’t absorbing oral B12. You may want to switch to a sublingual form of methylcobalamin at a higher dose.

                • Freddd says

                  Trouble walking is serious. Is it balance or lack of awareness of where your foot/leg happens to be or it’s position or inability to feel the leg or foot?

                  I got to the point of falling because I couldn’t feel where my leg and foot were or their position. Effective aggressive treatment was required to keep me from ending up in diapers and a wheelchair. It is urgent to do it correctly ASAP as each day increases the amount of potentially permanent damage.

                • Beth says

                  PS: what the doctors are not telling you. Some people cannot process or absorb manmade supplements and synthetics and/or shots. The body recognizes B12 from natural sources. I started eating beef liver every day. It changed my life…healed my anemia and auto immune disease. No more pills…no more steroids. Email me if you have questions. bethagutierrez@yahoo.com

                • Helen says

                  Yes! Get B12 shots. It makes a world of difference!

                  I have neuropathy too and taking the B12 sublingually didn’t help at all – except my blood tests. As soon as I started taking the shots my nerves started to heal.

                  You can get the syringes and B12 online if your doctor is uncooperative.

                • Adele says

                  My son (16 yrs. old) had a migraine at school. He had never had one before this. (It was complete with fuzzys from the corners of his eyes which vanished when he tried to look at them and a lot of other bizarre eye stuff) I took him to a neurologist, who ordered all of the usual blood work. His B12 was at 284, we were told that this was causing the constant headache. After 2 months of every other day shots, the level was finally brought up to a whopping 450 (the Dr. really wanted it to be at least 500) My son will need to take B12 supplements for the rest of his life. For all of the things in life that can be wrong, this is an easy and inexpensive fix and the consequences of ignoring it are horrible. Just one pill a day is not that hard to swallow.

                • Rajeev says

                  Hi Cathy,

                  I am also suffering from the same problem and it is so difficult to walk even for shorter distances. My feet have become thinner and there seems to be loss of fat pads from down below. I am also suffering from diabetes which has definitely potentiated the symptom in my case. Please get yourself checked for diabetes mellitus too, as poor glycemic index too can cause peripheral neuropathy.

                  New Delhi

                • Eil says

                  I have Pernicious anemia, I get an injection every 3 months because my body cant absorb B12. Might be that your body is the same.

                • patricia says

                  i too have the same issue. i have been doing my own injections of B12..you may find better results with B12 injections.talk to your Doctor..hope this helps.

                • San says

                  I was recently diagnosed. Have had one injection and take 5,000 units sublingually a day. I will have two more monthly injections, then retesting. I feel MUCH better…the shot gave me a real boost after a week.

                • Ana says

                  It takes time. I had severe B-12 deficiency during my pregnancies and walking was so painful (like walking on knives). It took almost six months of daily shots of B-12 before I saw true results. I would suggest switching to injections. I believe your body might absorb it better if it’s injected directly into your muscles. Good luck.

                • Joni says

                  You always need to take folic acid as well when taking vit B12. Deficiency in one vitamin can mask dificiency in the other. 400-800 mcg per day. You might try higher doses of B12 – I’ve read it’s extremely safe even in high doses. You could try up to 5000 mcg per day.

                  Of course your B12 is not terribly low. Your sensory perception problem might have another cause – go back to the neurologist for further tests.

                • Jay says

                  Wow!! That’s crazy. My b12 level is at 120 and I kept wondering why toes and fingers kept going numb all the time. It’s crazy cause all the doctors refuse to give me b12 injections and insist I take half the dose of what you are taking in pills!!!

                • Gennie says

                  I am now learning how to walk again . I was in the hospital for 5 days because I woke up one morning couldnt see well and couldnt hardly walk. my son took me to the hospital where they said my medication stored in my body hen released all at one time causing toxicity. It caused damage to my brain (equilibrium.) which now Means have to start over. I couldnt even feed myself, walk, stand. but I know can do it. Its about training my brain. I have come along ways in 3 months I can almost walk by myself, I can do everything els just balance and mentally I have trust issues but m so much better.. They just tested me thinking was low on vitamin and yes B12 was way low.. I now take injections but no one will say that is why all this happened.I hope is not to bad. Anyone know how long this will go on for?

                • yvonne says

                  I am not a doctor or anything like that, but I have been through this and almost died. I had to figure out what was wrong for myself and tell the doctors even though they knew I had been a strict lacto ovo vegetarian for 15 years. They were convinced I had MS but were puzzled not to find it in the MRI’s. I couldn’t walk straigt. My urinary system was not working right. I was losing vocabulary and logical thinking. I was losing my short and long term memory. I was having visual halucinations. I was having vibrating sensations where I was convinced My phone was vibrating or the furniture was vibration or something was moving inside of me. Needless to say it was very scary. It has been a while so I can’t remember how low my numbers were when they tested but the Doc said I should have been in a Coma. B-12 pills did not work at all, sublingual did not work and gave me blisters in my mouth but the doc prescribed injections weekly for a while and then monthly and it worked wonderfully and even helped with all the bruises and soreness I was having that they thought was the beginning of Fybromialgia. Insist the doctors do their jobs and do your own research and they can not ignore you. If they do find another doctor. Go to a neurologist if you have to. Have them check your Iron levels and vitamin D and magnesium levels too because these things travel in groups sometimes and reak havvock! Good luck and just know you are not alone.

                • Arthur says

                  I’ve been told by a neurologist that taking pills for b-12 do not work as well as the injections.

                • Nils says

                  Have you talked to your doctor about B12 injections (if he or she is convinced that low B12 is the cause of your walking problems)? Injections can very quickly raise your levels. And some people with B12 deficiencies have written that eating organ meats like beef liver, in large quantities, or taking the methyl form of B12 (methylcobalamin) sublingually, helped raise their B12 levels. Jarrow makes a 5000 mcg sublingual methylcobalamin supplement.

                • Diana says

                  I’ve been taking B12 injections for years now and they help tremendously. Problem is…..they are slowing down and will eventually stop the production of it.

                • JERRY BOUCHER says

                  What’s happening is that your myelin sheath on your nerves has been compromised and the only way to fix this is by taking massive doses of methyl B12 until the problem is fixed and if you don’t have good blood sugar control the B12 will not work. It could take as long as 3 years to rebuild the myelin sheath

                • Cinnamon says

                  After years of numbness and no feeling in my feet a lower legs, 3 shots of cyanocobalamin I’m starting to get the feeling back! Perhaps the form you are taking is not one you can absorb. Talk to your doctor again, you really may be on the right track.

                • ApotheCarey says

                  Just wondering, are you taking statin drugs? Those can also cause symptoms like that.. neuropathy, not always feeling your feet, etc.

                • AnnF says

                  Hi Cathy,
                  I know it’s been awhile, but I originally started taking 20,000 mcg a day, and now have to still take 10,000, otherwise, pain and lack of balance returns.
                  I have to tell you, though, after taking my B12, I stopped walking into walls, but recently started taking Milk of Magnesia tablets as a Magnesium supplement, and after about a month, I could stand on my toes, stand on one foot, and my lightheadedness is all but gone. So you may also need more than B12.

              • Miriam says

                I had the same symptoms which is what tipped the doctor off to have me tested. I had fallen a couple of times and was having issues with my memory. When the test results came back my levels were below the lowest level. I’ve been taking shots once a month for three months and I’m currently waiting for the results of my last blood test to see what improvement there is. Next month I’m to be tested for pernicious anaemia.

                • Lily says

                  April 2013 – note to readers of this thread:

                  CHRIS KRESSER HAS WRITTEN A FOLLOW-UP ARTICLE ABOUT B12 DEFICIENCY – He posted it on JANUARY 18, 2013. Unfortunately the site has not linked these two articles together, and the second article doesn’t have any tags on it, so it can’t be found by searching for “B12″ on his site.



                  THE DIRECT LINK TO IT IS: http://chriskresser.com/what-everyone-especially-vegetarians-should-know-about-b12-deficiency

                • Chris Kresser says

                  If you search for B12 using the search box in the footer of the site, the article you mention is the second one listed. But thank you for providing the link to others.

                • colleen says

                  Hi Mike,thanks so much for the information, it makes alot of sense to me now.i was having banans when i first started injections as i heard potassium can drop but didnt continue.wouldnt benefit like supplementing it would anyway.As for the magnesium i did have it on my lists to be tested along with vitamin D. I wasnt aware my vitamin D was tested recently & was good levels being 90.i didnt feel comfortable asking for more blood tests as i feel my Dr thinks its all unnecessary & over testing.will definately get vitamins for both ASAP & test for potassium & magnesium in my next lot of tests.i do experience bit of twitching & cramping so im all for trying to see what helps .

                  thanks again

                • Colleen says

                  Just got on line to order some more B12 oil but the site is no longer operating due to issues with supply and payment.ive nearly run out as my daughter is also using it now.does anyone know if the sites closed permanently or if i can get it from another supplier.In Australia nobody has heard of it in the city i live in.

                • Greg says

                  Hi Arthur,
                  Your neurologist is absolutely correct.
                  Another surprising bit of information is that even for high dose oral tablets, particularly of MeCbl, apparently the environment in the stomach and the small intestine is sufficiently harsh to remove the methyl group off most of the dose. This doesn’t happen with injections or with the new topical formulations

                • Madge says

                  Hi Arthur,
                  Your neurologist is absolutely right. Of the doctors that do know about nerves and VB12, I would say that the neurologists have the best idea. So yes you will need high dose VB12 to recover. I wouldn’t waste your money on the sub-liguals. Apart from potentially rotting your teeth, there is no way that they can deliver enough VB12 to overcome your deficiency. As you can see from Annie’s comment, she needed injections for months. There was a high dose topical product available from Transdermoil.com, but they have temporarily withdrawn it due to some issues with other competitive web-sites trying to copy their product. I have been told that another site will open soon.
                  In the meantime, if you are going to have injections, avoid the cyanocobalamin injections. It has been shown that up to 50% of people don’t respond to them at all!!
                  You could try the hydroxycobalamin, or wait for the mixed Ado/MeCbl to come back on sale

                • Madge says

                  Hi Cinnamon, retry the site, looks like the tornadoes have affected the web, somehow. The b12oils.com site appears to be working now.

              • Mitch says

                Hi Chuck,
                I have been diagnosed with the same peripheral neuropathy. The neurologist could not identify the cause however.
                You should demand a blood AND Urine mercury test

                I learned that this is the number 1 symptom of mercury poisoning.
                The Dr initially refused to allow me to test, BUT at my insistence and informing him of the countries that had banned Amalgam she relented.
                My blood test came bacl normal, BUT my urine test was OFF the charts !!!!
                Simply stated the medical training here in NZ does not cover Mercury/toxicity in any shape or form, hence they are as ignorant as Joe public about its ramifications.
                Quite unbelievably the neurologist did not consider (or if he did, he did not convey to me, which is bloody suprising as it effects the nervous system> testing me for mercury.
                Subsequent to my discovery, he has refused to comment on my emails that I have sent to him.. I will persue this don’t you worry.
                Good luck

              • Jessica says

                I’m 19 and I’ve just been diagnosed today. Like your daughter I was having the same neuropathy symptoms!
                How is she being treated?

            • catherine says

              my nan and her sister both had pernicious anemia never took much notice as they have passed away. in the last 2 weeks my sister 47 my daughter 36 my niece 16 have all been diagnosed with B12 deficiency they will have needles for the rest of their life.many family members are now being tested

              • colleen says

                after myself ,my 16 year old daughter & other family members being diagnosed B12.ive had my 6 & 8 year old tested .my 6 year olds reading is 372 , my 8 year old is 293 and according to our DR they are good levels.they are still rather low i think and wondering if i should give them vitamin B12 tablets to boost their levels.my 3 children have ADHD ,the 6 year old aspergers syndrome.many of the symptoms which occur in B12 deficiency. their condition may improve some if their B12 levels were higher.id also be interested in testing them again in 6 / 12 months to see if their body absorbs it as we have injections due to the body not absorbing B12.

                • Judy says

                  Hi Colleen,
                  Eight years ago, I started having numbness and tingling in my toes and went to see a nuerologist. He took a MRI and bloodtests thinking I had MS. But tests showed I didn’t. within those next two years I went to other nuerologists, even having more MRIs, bloodwork even a spinal tap, still nothing. My condition was getting worse, fatigue,peripherual neuropathy and numbess and tingling in my legs and my balance was bad. I went a internal medicine dr. and he tests and found out my B12 level was 41.He started me on a regime of B12 injections for years. My level went up but my symptoms didn’t get better, there was permanent damage cuz they didn’t find it soon enough. I’ve been evaluated and I’m unable to work. But now instead of injections, I take a nasal spray called Nascobal and my level has been in the 700′s.Just keep getting the levels checked and hope they don’t get too low.

                • colleen says

                  Hi Judy,im hoping to keep my levels around 700 as the last testes they were 1476pmol/L..meant to have more injections end of november but i wont be waiting til than.i get tests results for MTHFR next week ,will have my bloods done than im going to start using the red B12 oil .i feel my levels are low again already as i lost my car today in the shopping centre under ground car park.was pushing a trolley full of groceries around and accidently come across it thank goodness as i was going to be late for school pick up.now i understand more why this happens and dont feel im going totally nuts.im hoping the oil will have good results like ive heard,will take some weeks i guess but hope i get energy and less fatigued.will keep you updated about the oil .Hope you keep improving and levels stay up for you :)

                • Judy says

                  Hi Colleen
                  Thanks for answering me back. I received an email about RedB12 oil and I’m sending a copy to my doctor to see what he has to say about it. If it’ something that can somewhat help the the numbness and tingling in my legs and feet–I am willing to try it. Please let me know how it works for you. Is this something you order online or is it a prescription?

                • Finndian says

                  Judy, have you tried potassium? Tingling and numbness of extremities is also a sign of potassium deficiency.

                • colleen says

                  Hi Judy, not sure why theres no reply link near our comment so ive used the one above.i went on line and purchased the B12 oil.i used the link from this site .received the package in less than a week.

                • Sue Turnbull says

                  All my kids had the symptoms of ADHD, doctor wanted to completely medicate them.
                  However my husband had severe asthma, and thought it could be diet related. We went through lots of elimination diets with no help from medical professionals (this was 1978) He was allergic to wheat (not gluten) dairy products and colourings flavourings and MSG.

                  He now runs marathons and the kids have had no treatment for ADHD. It was expensive, my food bills were double, and a lot of tears from the kids not being able to eat same food as their friends. It may help you to try I hope it does, I can always send you some weird recipes …Good Luck

                • Judy says

                  Hi Colleen
                  I was just wondering if you’ve tried the redB12 oil yet and if you’ve noticed any change.

              • Greg says

                Hi Catherine, and Colleen,
                You show a very interesting genetic linkage with the pernicious anemia.
                There also appears to be a linkage to red/blonde hair and blue eyes.
                Don’t know if anyone else has seen this.
                You no longer need to take the needles. There is vitamin B12 lotion that you can rub on and get better results.
                Check out http://transdermoil.com . The product is Red B12, it has both natural forms of vitamin B12, adenosyl and methylcobalamin.
                You can find out much more about VB12 deficiency at http://www.vitaminb12deficiency.net.au
                There you will see many of the other potential problems that you can have with sub-clinical deficiency.
                You might actually think that by treating with VB12 you more frequently you can avoid many other problems.

                • colleen says

                  i have read there seems to be a linkage blue eyes and blood group A.we are blood group A ,i have green eyes and everyone else has very blue eyes.

                • colleen says

                  Hi Greg, thanks for replying.Catherine and I are sisters.
                  after her daughter was diagnosed b12 deficient Cath strongly encouraged me
                  to get tested.i went to my Doctor to get test results for my daughter and I & to requests
                  b12 tests.thankfully she had written b12 to be tested.i was surprised when she said my 16 year
                  old was more deficient than me.she eats meat each week and i have been a vegetarian for 12 years .must be an
                  absorption problem .i also have an hypoactive thyroid ,have been on thyroxine for 16 years.i hope this doesnt stop my b12
                  from working as good as it should.im very interested in the lotion .i have lots to learn & this great site is helping wonderfully.


                • Greg says

                  Hi Colleen,
                  Interesting familial linkage that you have, although often it can be due to the same diet leading to the same problems. Being a vegetarian, depending upon you diet it can take years to be overtly VB12 deficient, although you may be sub-clincally (<400 ng/L, pg/ml) deficient way before you feel any signs. As for the meat consumption, this is very dependent upon type of meat. You would need to eat 4 lb (2 kg) of chicken each day to get your daily allowance, for instance. I have a table of values on my b12 deficiency site. You will be surprised how little VB12 there is in most things we eat.
                  See http://www.vitaminb12deficiency.net.au
                  Hypoactive thyroid can make you feel like you don't have much energy as well, which compounds and disguises the problem. It is also involved in the folate cycle, so a double whammy.
                  The oil is available from http://trandermoil.com
                  Yes I agree, many things are discussed on this site that are not generally known, particularly to physicians.

                • Judy says

                  How did you find out about this Transderm oil (Red oil). I went on the website and it sounds interesting. Has it been approved by the FDA. I’m going to mention it to my doctor next visit and see what he says about it.

                • Colleenhickmott says

                  Hi Judy,I have been using the oil for about 6 weeks now.have been very tired but get bouts of energy some days that I hadn’t had for years.its a slow process and I even had an hydroxocobalabin injection 2 weeks ago to keep me going til the oil really gets working.I guess it could be months before I feel true results.I have also discovered I have MTHFR C667T gene .may take longer for me to sort levels out ,still have lots to learn it just keeps getting more complicated.good luck Judy I think the oil is good.

                • AnnF says

                  If you are white with Northern European ancestry (North of Southern Spain from what I can tell), or even are dark, but have some Northern European ancestry, you are at a greater risk for having low B12.

                • Cinnamon says

                  I tried your link and got crazy domain, buy your domain name now. Is there another way to find this oil?

              • Judy says


                eight years ago I was diagnosed with a B12 level of 41. Dr.’s didn’t catch it in time and I now have nerve damage in my legs, feet and hands. Balance is also bad. But I gave myself injections for years until I discovered a B12 nasal spray you use once a week and my level has been in the 700′s. Hasn’t improved my nerve damage cuz it’s permanent, but it’s better than needles for the rest of your life. If you have any question for me about this my email is jmotika@zoominternet.net

                • Greg says

                  Hi Judy,
                  what form of VB12 were you taking. My reading on this is that in order to get your neurones better you will need both methyl and adenosylCbl. The methyl is required for formation of proper myelin basic protein, which coats the neurones, and which is slowly replaced over time. The Adenosyl is required to “fix” the mitochondria which seem to become shrunken and mishappen in the absence of VB12. So this takes some time. Nextly (not sure if it is a work, but we’ll go with it), in cases of adenosyl cobalamin lack there faulty lipids incorporated into the myelein sheath. Now these lipids have a very slow turn over rate, and take years to replace. So in order to fix all this damage you need both methyl and adenosyl cobalamin in high doses (higher than the spray can deliver) and it needs to go into the CNS. (Measuring serum levels is not a true indication of what is in the CNS, furthermore it doesn’t tell you if you have active or inactive forms of VB12, nor if the VB12 is bound to TCII, which it has to be to be effective.) On top of this you have to “cure” the cause of the deficiency in the first place. If you don’t do all of this together, you will only get relief rather than cure.

            • colleen says

              my daughter was diagnosed b12 deficiency the week she turned 16..as her cousin was diagnosed the week before her we went to the doctors to get results of previous routine blood tests and requests her b12 levels be checked.luckily her doctor had checked them without us even asking her to.she has been on b12 shots and is a diffrent girl .happy ,fun ,enthusiasm etc is all starting to come back.


            • drgoody says

              I was 16 – walked out the front door to go to school and had to sit down on the steps. I just ran out of “go.” Pernicious anemia. Mother was humiliated but I had been eating a healthy diet. B-12 shot and I felt like I could climb a mountain within 30 minutes. Had to eat liver for breakfast and drink brewers yeast and I forgot what else. That was in 1962 or 63.

            • colleen says

              Good that youve found out now Brandt & not years later.i believe i had symptoms at your age ,im now 47 & just been diagnosed.

        • Kathy Stocker says

          My Doctor just did a DNA swab test and now a blood test called MTHFR. My body is unable to metabolize any folic acid whatsoever. No matter how much supplements I take or green leafy vegetables I eat my body is unable to absorb it. Now at the age of 50 I have a tremendous amount of health problems including colon resection, anemic, nerve damage, two knee replacements, stenosis in neck and on and on. Found out that my daughter at age 11 lumbar had a crack in it and had to get spinal fusion and troubles ever since. Son learning disabilities and both children with chronic migraines all because my body was unable to metabolize folic acid. Im not sure if that’s the reason for all their problems but, we all are getting the blood work done called MTHFR. I am currently on Deplin which is a medical food that my doctor ordered for me in order for my body to metabolize the folic acid and now at the age of 51 I’m finally waking up and have ambition to get things done. I had to be on ADD meds all these years thinking that was my problem when all along it was because I could not metabolize the folic acid. No B 12 shots B 6 shots ever helped because my Doctor explained to me about how the molecule in my body would reject it. Now I wonder if this is why my children have had their problems. So, my advice to everyone is ask their Doctors about DNA swab tests and the MTHFR blood work to be done. Not being able to absorb folic acid(folate) all B’s believe me can cause so many problems and I am an example of it. To bad we didn’t know about this 24 years ago. Good Luck to all and if I can get at least one person to get this test done and have them have a better life then I’m a happy girl. Doc also said that this is the leading cause of women having miscarriages and unable to conceive and also one main reason for alztimiezers. I apologize for the spelling errors. One symptom of B deficiency! One more thing to remember no matter how many shots, supplements or green leafy vegetables you consume, it won’t help! Need Deplin, medical food. These test will tell you what your lacking and what meds you need and what meds don’t work for your body. I also found out that no pain meds work for me, so why bother taking them, they go straight to my liver with no relief. Also found out that I get zero seratonion and neonephrine(sorry no spell check) to my brain and need Luvox Cr. Only med that will work for me personally regarding DNA test. Pretty amazing information.

          • Freddd says

            Kathy, You have the same paradoxical folate deficiency as I do. I found that if I take 4mg (half a 7.5mg Deplin-Metafolin) with each meal and another quarter a tablet a couple of times a day without food that I can eat a normal amount of veggies and have zero folate insufficiency symptoms. The sores at the corner of mouth are completely gone. IBS is completely gone. Peeling skin at the tips of my fingers and around my finger nails is gone. These three things start coming on in 2-3 days if I slip into folate deficiency and so I correct my diet or timing or whatever. I’m not perfect, I miss doses from time to time. I have noticable symptoms in 1-2 days and building to IBS at day 5. It reverses in a similar fashion. It took me about 6 months of changing trials to come upon how much and what timing was needed to overcome this result. You almost certainly would react with a large amount of healing with a 5 star brand of methylb12 taken properly and adb12. You woul dalso likely have a reaction of low potassium signalling the onset of healing. The two active b12s will also likely correct the neirotransmitter problem. For you, like me, green leafy veggies and many others are a problem. I take 15mg of Metafolin (Deplin) daily in a total of 5 doses (short serum halflife). When healing starts with a bang and you start having heart arrythmias and itching and muscle spasms in the middle of the night and other such things, potassium is needed, usually in daily quantities totalling 2000mg or more in several divided doses. Best of luck.

            • Paul says

              Hmmm, you make B12 deficiency testing sound easy. I was having a host of nerve problems for years starting in my early 30′s. I suspected B12 although no doctors mentioned it despite me telling them I hadn’t eating red meat in 12 years at that point. I was taking cobalamin so of course the the serum testing you mention showed that not only was my B12 level adequate but the doctors said it was too high and advised me to stop.

              Fast forward 5 years and my voice becomes hoarse for no reason and within 48 hours my voice is gone. I had developed a idiopathic paralyzed vocal cord… a nerve problem similar to Bell’s palsy. Looking for answers I had my DNA testing done and see the MTHFR and MTH issues mentioned here. I switched immediately to injectable methylcobalamin (against my doctors wishes) and metafolin. The doctor comments that my recovery is quickest he’s ever seen.

              The ONLY test that showed or hinted at a profound B12 deficiency in me was an Amino Acid panel that indicated a long term B12/Folate and this DNA testing. The serum testing was useless and misleading especially if you are not absorbing all this B12 and folate that is circulating in your blood stream.

              I am restored and the side benefit has been that my life long problem with canker sores has vanished and no amount of citrus can give me one. There is a Harvard study showing that B12 prevents cankers. So… I’ve been borderline a very, very long time and no serum test ever even came close to detecting it.

              • Freddd says

                Hi Paul, With the right tools b12 deficiency detection is very easy. The international list of symptoms I developed used as a questionaire will detect most cases of all 4 kinds of b12 deficiency; adb12-CNS, adb12-body, methylb12-CNS and methylb12-body as well as methylfolate deficiency. Further simply taking one tablet of a 5 star methylb12; Jarrow 1mg, 5mg or Enzymatic Therapy 1mg. Taking one tablet of any of these three and holding it under the upper lip for 45-120+ minutes will absorb at 15-25% typically and produce a noticeable response in 5 to 120 minutes for 85% of the people with these symptoms. Adding a 3mg Country Life Dibencozide (with folic acid, beware) or Source Naturals 10mg Deibencozide (adenosylb12) also for 45-120+ minutes) will up that 85% to 90%. Adding Metafolin dose 30 minutes before the mb12/adb12 will up that to about 95% response. SOme people only have a hard to get to CNS/CSF cobalamin deficiency. Holding 10x5mg 90-180 minutes (more than 1 batch of tablets, overlapping) of Jarrow 5mg will detect 40% of the CNS B12 deficiencies. 51-60mg of either of the two adenosylb12 forms will produce about 40% response the next day after the mb12 50mg trial. Then the next day about 125mg of L-carnitine fumarate will detect the another 40% including many with no response to the prior adb12 trials. These 50-60mg doses are based on the Japanese neurological disease trials for which this was the neurological healing upregulating dose of mb12. One can have separate responses to each adb12 and mb12 spearately. The 50mg sublingual dose as proven itself equivalent to a 7.5-12.5mg SC injection of mb12 or adb12 by trial and by urine colorimetry. The beauty of these tests is that EVERYBODY who responds is deficient and will start healing with the correct program. There are no false positives. The one time trial may have HUGE results in which case a person needs to titrate carefully. B12 alone does not make a program. A low potassium state will almost always occur and can be dangerous. It starts typically on day 3 after methylatoin startup. Further the 50mg Jarrow sublingual plus 10mg of Enzymatic Therapy B12 Infusion dose is the gold standard of mb12 quality. Make sure your injected mb12 is just as effective against CNS symptoms like not being able to walk or feel your legs as the 60mg Jarrow/ET gold standard test. You will typically feel the difference in 4-6 hours or less if all the needed cofactors (basic, essential and critical vitamins, minerals and supplements) are in place.

                In addition, about 15% of people who say “I have none of those symptoms” change their story after 2 hours of trial and say “Oh, I had forgotten about all those indefinite symptoms the doctor said I could forget about” as soon as those symptoms are affected. Nobody has a response who isn’t functionally deficient.

                Detexting is easy and not terribly expensive. You just can’t rely on expensive lab tests becasue they were all standardized on a chronically deficient population and reflect “deficient” as “in range”.

                • Mark says

                  Thanks for the info Freddd – where can I find the symptom list you mention at the top of your post ?

                • Freddd says

                  Hi Mark

                  http://forums.phoenixrising.me/showthread.php?11522-Active-B12-Protocol-Basics post #24 is the symptoms list. I’ll be posting a new version in a week or so with more items added. It is an international list from countries using cyanocbl, hydroxycbl, methylb12 and avaialble in English. Further, often the same thing is there as symptoms and signs. Things like “neuropathies” have been expanded to many symptoms so progression and stages of problems are can be distinguished. Muscle pain has 10 or more entries distinguishing CNS and BODY. mb12, adb12 and Metafolin. Also included are symptoms that respond readily to the active b12s but not hydroxcbl and/or cyanocbl. This is the most complete list I know of. I had over 200 of them 9 years ago.

                • Mark says

                  Thanks Freddd – out of interest do you offer any kind of phone / skype consultation service ?


                • Freddd says

                  Mark, Many have asked that question. I’m going to get something set up. I was a consultant for 30 years before becoming to disabled to continue. Now that I am well, I am itching to get back at it.

                • Mark says

                  thanks Freddd – when do you think you’ll be ready to offer this service and where will be be announced – there are so many threads now it’s hard to figure out when to look and keep on top of….


                • Mark says

                  Hi Freed

                  I have a question…..I was tested in Feb and my serum level was at 156 and I had Neuro symptoms. i started taking the Jarrow 5000 and they mostly cleared up. Now (from two weeks ago) I’m adding 5000mcg of Ab12 twice a week and on the days I take that I’m getting pain in my thighs and pins and needles all over my body – it that a good sign inasmuch as I possibly had a CNS deficiency of both meth B12 and AB12 and the pins and needles are my body ‘waking up’ to the parts that only AB12 can reach, or is it a potentially bad sign ??

                  Thanks Mark

                • jodi says

                  Fred, Wow! That is a lot of info. Can you brake that down into layman’s terms please. I would love to be able to understand all that.

              • jodi says

                Hello Paul, I have had some problems for awhile different one’s that seemed unrelated to each other. Then about 6 months ago I noticed my nails splitting then my lips chapping and final straw my hair is falling out. So I went thru a slew of process of ellimination ideas and finally came up with Iron deficiency or B12 and sure enough it is B12 my count is 209. Now it makes so much sense all of my other sysmtoms fit perfectly. My question to you or anyone else that might have an answer is this: I am giving myself cyanaocabalamin injections everyday for the last week and a half and now I am reading that cyanaocablamin also has absorbtion issues I should be injecting Methylcobalamin is this true? If so where can I order (Methylcobalamin) online to inject it myself? I have found only one site and it is really expensive at it seems they are a fairly new company. Please help.

                • Amber says

                  Hi Jodi,
                  Not sure if you found an answer to your question on methyl-B12 injections, but just wanted to say it’s available in sublingual form and that is what I’ve seen Chris, Freddd, and others recommend using. I myself am just starting on Enzymatic Therapy B12. Even though it says “chewable” it’s supposed to be held under the tongue or lip for 45 min or longer to be absorbed directly into the system (according to Freddd).

            • Veronica says


              I have a few questions for you.

              Because B-12 and folate seem to work together, would you recommend that everyone suffering from symptoms of a B-12 deficiency have their folate level checked? I do have may symptoms of a folate deficiency as well. If so, what kind of test do you think should be done for this–an mthfr test? (From my research, a lot of people, 1 in 3, cannot properly utilize folate, especially in its folic acid form).

              If one is deficient or insufficient in both B-12 and folate, would you recommend that they both be administered via injection? I know many people who are deficient in B-12 have a B-12 malabsorption problem and I’m wondering if its possible to have a folate malabsorption problem as well, which would require folate being taking intramuscularly. Though I have never had my B-12 or folate levels checked, I suffer deficieny symptoms of both, and would like to have things things checked. I am gluten-sensitive, have Candida, reverse T3 dominance, adrenal fatigue syndrome, and clinical depression. Furthermore, I have reason to believe that I have no intrinsic factor as the likely result of hypochlorhydria/ achlorhydria seeing as after taking the betaine hcl test, I do not get the burning sensation in my stomach that is supposed to be felt. This being said, I’ve taken both sublingual methylcobalamin and methylfolate supplements, but feel these have been of no real avail to me even at high dosages.

              If it turns out that I am deficient in both B-12 and folate, do you know of any doctors who would work with me to prescribe methylcobalamin injections (or methylfolate injections, if there is such a thing?) Or, can these injections be ordered anywhere without a prescription?

              • Julie Hill says

                Veronica, did you ever find the answer to your question? I have the same issues as you and have been on early intro GAPS diet unable to progress for almost 9 months now. (My daughter who is two also hasn’t been able to progress.) We can’t tolerate many of the healing foods like eggs, sauerkraut, yogurt etc. We eat liver but it doesn’t seem to help us. Were you able to find a source of folic acid that helped you metabolize b vitamins?

          • says


            Go to: MTHFR.Net “Your Expert Resource on MTHFR Gene Mutation”

            Dr Ben Lynch is a leading researcher and his site is one of the best resources about this genetically-based problem with folic acid metabolism. In addition, he has a store where he sells supplements SPECIFICALLY formulated for people with this genetic mutation! His prices are very fair and the product information is very detailed. I suggest you do this ASAP.

            I’m a registered dietitian of over 30 years and a psychotherapist, and just heard him give a 1 hour webinar about THIS subject. He’s VERY knowledgeable, but, he is no longer accepting new clients. I suggest you go to his site and look around, but, mostly, be sure to look at the supplements for your disorder.

            You can also refer your physician to his web site to help you figure out which one(s) might suit you best. I believe you can also inquire about what product would suit you, through the web site, but, Dr. Lynch won’t be the person to reply.

            Hope this helps. Feel free to contact me through my website http://flamingbrainiac.com.

            All the best.
            Miriam Landau

          • colleen says

            Hi Kathy ,im waiting on blood tests results for the MTHFR (677 and 1298) are the two they tests for.im not sure if it covers it all but thats all they do.Can you tell me if thats what your tests for MTHFR involved or is there more i should test for .i had my first b12 shots in june as my levels were 175 and last lot of tests were1476 pmol/L.im not picking up as much as i hoped .,very low on energy and fatigued .ive had a underactive thyroid for years and neck problems also. my three children all have learning difficulties and the youngest Aspergers Syndrome ,i do wonder if its because of my deficiency .i read up on stenosis in the neck,very imteresting i have all those symptoms and been attending chiropractic visits for years to have my neck cracked.although the last 2 visits they couldnt get my neck back in on the left side.it feels very uncomfortable and alot of pressure.they usually crack it both sides before i feel relief.with a combination of thyroid,B12 deficient and neck problems its complicated to work myself out.i was being tested for ADHD and Aspergers Syndrome as my concentration span was getting worse.realising what b12 deficiency does i believe that was the problem.dont think ill ever fully recover but improved signifantly.

            • says

              Have you looked into Ehlers-Danlos syndrome? That could explain your neck problems and for some reason EDS and Asperger’s also have connection – women with EDS seem to get kids with AS more often even if they don’t have AS themselves. EDS is connected to malabsorption issues and some believe there’s also a link to MTHFR mutations.

        • whitney says

          Glad to read that. I had a large tapeworm. (33 years old and have not been out of the country) Could have been from sushi?? And now b12 deficient. Even though my dr.’s say I’m just a little low on my levels, I’ve had major fatigue, neuropathy, anxiety etc. I’ve been getting a b12 shot and feeling better.

        • Alexander says

          I’m also 23 and was just diagnosed with severe B12 deficiency. Funny thing is that my doctor didn’t think to check for it until my third blood test, where he could have checked for it the first time for the cost of practically nothing and saved me a year of my life in the grip of a deep depression. Have only been taking sublingual methylcobalamin for a week and feel like an entirely different human being already.

          • Judy says

            Hi Alexander
            After reading your story, I too, had a severe B12 deficiency level 41 and it took two years before a dr. tested me for B2. By then permanent damage was done especially to my legs and feet. My balance is very bad, severe stiffness, numbness and tingling in my legs. I have to use a cane or when I go out to places a walker.
            I’ve been like this going on 9 yrs.
            I was giving myself B12 injections then I started on a nasal spray which keep my levels up, but does nothing for my symptoms.
            I’ve heard about methyl/adensol cobalamin and hydroxycobalamin, but my dr. doesn’t know a lot about these and won’t prescribe these. If you or anyone else know more about these I’d appreciate more info.

            • Madge says

              Hi Judy,
              It is not surprising that your doctor does not know about the normal vitamin B12 analogues in the body, which are adenosyl and methylcobalamin. I don’t know what they teach them in Med school, but it isn’t this. If you are only being given cyanocobalamin it is possible that you (and many others) cannot convert this to adenosyl and methyl in the body. There is a mixed adenosyl/methyl cobalamin oil available from http://b12oils.com/ I would try this. It has been fantastic for me.

              • Judy says

                Hi Madge,
                Thank you for the info. I’ve heard a lot about this and have been researching it. Of course I talked to my dr. about it and he didn’t know about it so he wouldn’t prescribe it.
                What symptoms do you have. Mine are severe stiffness, spasms,
                numbness, tingling, and very bad balance. I have to use a cane or walker to get around. I don’t want to get my hopes up, like about everything else with my b12, but if this would help, I would start to have my life back. Thanks!

                • Lynn_M says


                  The B12oil available at b12oils.com does not require a prescription. You can order it yourself directly from the company.

                  If you want to have your life back, I suggest thinking outside the box of what your doctor will prescribe.

              • Judy says

                Hi Madge,
                I went on the website you gave me and entered my name, address, etc. and ordered the red B1 oil, but and submitted it and they never asked
                me for payment method or anything. I haven’t her back from them since. It’s been two days and I’ve contacted them again and still no response. Is this a real website or a scam? Is this a real website to order the metynol/adenosyl oil?

                • Lynn_M says

                  Judy, if you’re talking about the http://b12oils.com website, it definitely is a real company selling a real adenosyl/methylB12 oil. They would have asked you for your shipping information, and then you should have been switched over to PayPal for invoicing. PayPal sends a confirmation email when payment has been made. Their Contact Us gives 2 ways to contact them. Have you tried both ways? their

                • Madge says

                  Hi Judy,
                  That sounds rather strange. I know that they are there did you try enquiries@b12coils.com? They should answer. I know that Greg from B12 oils normally monitors the traffic. If he is there maybe he can help.

                • Judy says

                  Hi Madge,
                  Just wanted to let you know, I did receive an answer from Greg about ordering the B12 oil and I received it already. I hope it helps even a little.

                • Madge says

                  Hey Judy, That is great. Just remember to rub it in well. It is very red. Let us know how you go.

        • AnnF says

          You don’t even have to be predisposed genetically. Take too many aspirin, or take any of the new acid blockers, and you are most likely deficient.
          B12 supplements are extremely safe, so why not take them?

        • Maureen says

          So I have a deficieny in B-12 because everytime I go to the dr office, they don’t n e ny B-12. It appears to be back ordered n I haven’t hd it for at lest 3 months.
          I hd gastric by ss nd once that is dont your body can’t bus orb the B-12 thru food, etc hence the Ron for the shot

      • Kelly says

        Ann, you might want to google “Fred Davis” and “B12 is commonly misdiagnosed”…or google “Freddd” and “B12″, as Freddd is the name he goes by online. He was sick, b12 deficient for over 30 years, and was able to restore/resolve his neuropathy with HIGH doses of methylb12, and methylfolate, but he must take them every day. His story is really remarkable.

        • Kelly says

          It should be emphasized that while Fred’s story is remarkable and commendable, he does indeed have to take massive doses of mb12 and mbfolate every single day, and unfortunately has a bad habit of almost ‘bullying’ those who don’t completely agree with his high-dose suggestions, or his insistence that glutathione is ‘toxic’.

          • Chris Kresser says

            I agree. Fredd likely has some rare genetic polymorphisms that make his situation unusual. I think his protocol is probably overkill for most people, and may even cause harm if used inappropriately (i.e. it can lead to overmethylation). I think Rich Van Konyenberg’s protocol is a better starting place for most. And the idea that glutathione is toxic is difficult to accept, to say the least.

            • Dewey Stuve says

              Hi Chris,

              I was diagnosed with pernicious anemia a year ago. I was diagnosed with anemia for 6 yrs before they ran the test. I am now on B12 self injections of 1000mcg. I am still exhausted, and just no motivation. I am also HIV+ and have artificial heart valve due to birth defect. i am worried my Pernicious anemia was caught too late. What should I discuss with my doctor? I am currently 49.

            • Freddd says

              Chris Kessler, There is all sorts of nonsense out on the web. I assure you glutathione is quite dangerous and can cause Subacute combined degeneration in 6 weeks. I repeat the warning frequently because glutathoone has bexome a FAD. It is quackery and dangerous to the neurological health of anybody taking it. The people claiming “relief” are having an effect on symptoms by destroying all active b12 in the body that isn’t in the mitochondria and causing massive folate deficiency via “methyl trap”. The people having relief have very strong responses to mb12, adb12 and Metafolin becasue they are desperately low. They get rid of the troublesome b12 and block methylfolate , their nerves numb out and they have relief. It is a very dangerous relief caused by damaging the the nervous system, both peripheral and central. The glutathione combines amost instantly to any unbound b12 converting it to glutathionylcobalamin and flushing it out in the urine very visibly and very quickly. I can demonstrate this very easily in anybody willing to volunteer risking something that will cause brain and cord damage. It is 100% predictable and repeatable if the directions are followed precisely. In people not currently in folate or b12 deficiency acute folate deficiency symptoms can start showing up in 2 hours, mb12 deficiency in 3 days and adb12 deficiency in 30-60 days. We ran a 10 subject trial. All 10 were having good results with the Active B12 Protocol. All 10 has the same response with timing variations. This was equally true for IV g;utathione, oral reduced glutathione, glutathione precursor pairs like NAC & l-glutamine (including commercially paired supplements), whey and NAC all by itself. The only difference was speed of onset which was based on dosage of glutathione and/or precursors. Further anybody already on it was 100% prevented from having any benefit from mb12,adb12 or Metafolin and these people were able to start healing after takling corrective doses of adb12, mb12 and Metafolin after discontinuance of glutathione. People getting all upset about theoretical possibility of a few mg of mb12 causing mercury toxicity were at the same time taking somethiong doing genuine brain damage to themselves. You know, In this game of YOU BET YOUR LIFE we each have to be self responsible and weed out what works and what is bogus information. Your life and quality of life depends upon the choices you make. Choose wisely. Now if you wish to characterize a delivery of information as bullying, that’s your choice. You are welcome to pursue dangerous fads if you want. If you want to ignore what works, that is your choice too. The information reaches far more than you.

              As far as “rare gentic” polymorphisms, let;s consider that. The only one I can truely admit to being pragmatically proven is that like 20% of the population I can’t convert folic acid to methylfolate, or maybe like 30% of population I can only convert a small amount of folic acid to methylfolate leaving lots of unconverted folic acid in my system that competes with methylfoalte effectively blocking it. As the other 50% of population can only convert about 800mcg max of folic acid to methylfoalte they too can have folic acid blocking and outrun the converted folate supply in the body if they actually take some mb12 and Metafolin and switch on healing. Some of us also can’t convert folinic acid and that is even worse in it’s blocking effectiveness. Both folic acid and folinic acid can block up to 10 or more times as much Metafolin. As folini acid is the major folate in veggies, eating too many veggies can also put me into folate deficiency or insufficincy (same symptoms, not as severe). As this type of folate deficiency will always hinder b12 retention and use in the body, b12 deficiency always follows. This makes it very difficult to determine whether I actually have any b12 related polymorhisms at all. I appear to have the most serious form of folate polymorphisms, and this can be demonstrated. As I share that with at least 20% of population I wouldn’t exactly call that “rare”. You are repeating biased hearsay by Rich, somebody trying to protect their theories of a disease cause and treatment, which doesn’t work. He also does not suggest using glutathione but he is very careful not to step on the toes of true believers. I foresee a class action lawsuit in the future on glutathione and NAC” therapies” from people damaged by them. I think that Cerefolin with NAC is a time bomb of neurological damage I can tell you how to demonstrate each and everything I have said. It is highly predictiable and easily demonstrable. The main occurance with a 5 star mb12 and Metafolin is that it turns on healing, about 50mcg of mb12 is quite sufficient for that, and most people need 1500-3000mg of additional potassium for cell formation or they become symptomatic of low potassium even with serum potassium as high as 4.2 or 4.3, and there is usually an induced folte insufficiency. A typical startup pattern for somebody titrating starting at or below 50mcg is that the healing staeted by 50mcg requires 2000-3000mg of potassium supplement and 2-3mg of Metafolin.

              As the effectiveness of the simplified methylation protocol is < 1:10,000 in producing actual recovery and that of the active b12 protocol is more like 1:2-1:10, I would love to see some suitable matched pair A-B crossover trials. The basic problem is that hydroxcbl is 100 to 10000 time less effective for EVERYBODY than a 5 star mb12 and adb12. Metafolin is 100% effective for 100% of population whereas folic acid and folinic acid are about -100% effective for some unknown percentage of poputation, 0% effective for at least 20%, 20% effective for 30% of population and perhaps 50% effective for 50% of population. It would appear that almost everybody with ME/FMS/CFS has one or more of the troubling folate polymorphisms. Research has shown that those with CFS/FMS have low Cerebral Spinal Fluid cobalamin along with those with ALS, MS, Parkinsons' Alzheimer's, Supra Nuclear Palsy. The pragmatic test for detecting these CSF deficiencies is easy. They can be spotted decades in advance of diagnosis. People who are on 1mg injection of cyanocbl a month for pernicious anemai are barely liveing zombies on that can be fully restored to health with mb12, adb12, metafolin, l-carnitine fumatate and the usual vitamins and minerals needed as a backround with avoidance of folic acid and folinic acid. Vegetable food folate problems can be overcome by taking 4mg of Metafolin at each meal. An perceived intensification of symptoms occurs as soon as mb12 starts working (5 minutes to a couple of hours) and is normal startup. People with anxiety as a symptom need to start titrating at 10mcg of 5 srtar mb12 and adb12 or so, others can start with 1mg of a 5 star mb12. The neurological damage pattern is different for those with anxiety. Admittedly I'm more comfortable with a database of a million or so persons. However, as the Active B12 protocol works in almost everybody with a selection of the 300 symptoms that it affects, you can hardly miss. It doesn't affect anybody in any way who doesn't have symptoms. Low potassium appears on the third day after methylation startup and cell reproduction startup, which occurs in hours after consumption.

              • Cate says

                Freddd, very interested in what you’ve had to say about b12 deficiency. I am on anxiety meds and have b12 deficiency, but just taking oral supplements 1000mg daily. Used to be on injection every 3 months but not any more. Like you mentioned I have a heap of symptoms and had tests done for MS (but no lesions on brain), and various blood tests, was found to be vit D deficient. I have poor balance and lean to the left, numbness all over body, including burning sensations that ache alot, very weak when lifting things in hands and drop things all the time. My concentration is hindered as the numbness is bad on right side of my head and affects my right eye, ears face neck. I’m always rubbing the areas as they are itchy as well, have had tinitus for many years and regularly get lesions in my mouth (overnight new ones form). Feel like I’m falling apart. I have two teenage children and worry I won’t be around to see them grow up as I worry all the time as to whats wrong with me.

                What do you suggest dosage wise, with Mb12, and adb12 and metafolin and potassium. I want to make sure I’m taking the right things to heal my nervous system before its too late. Doctors dont listen or help me, because no tests ever come back with any major concerns. Also how can I purchase these items (I live in australia), and have trouble obtaining. Is there a certified (genuine) website I can purchase them from. Thanks so much … Cate (44 yr old)

                • GregRJ says

                  Hi Kate, sorry to heat that your oral high dose supplements have not worked (think you mean 1000 ug/day, but no matter). Vitamin B12 uptake into cells requires special transport molecules, if the vitamin B12 does not get onto these molecules it is wasted and will not have lasting effects. This is why the injectable form of vitamin B12 only lasts for a short period of time. Similarly with the high dose vitamin B12 for oral, you get a very small amount across, but it is not on the transporter to take it into the cells that you need it in, so you will simply pee most of it out. Furthermore, as you elude to, you actually need the MeCbl and the AdoCbl (two different types of vitamin B12). For energy, the best is the AdoCbl.
                  I have heard of a topical (for the skin) rub-on for the AdoCbl, which uses neat technology to get the vitamin into the skin. I would suggest that you try this.

            • Freddd says

              Chris Kresser, As to “overmethylation”, I have done a throrough analyssis of all the symnptoms said tpo result from “overmethylation” and esenntially 100% of them are the same active b12 and amethylfolate deficiency symptoms as the “undermethylators have. In fact most people with these deficiencies have approximately equal numbers of symptoms form both lists. To use the hypothetical risk of “overmethylation” (never ever seen it demonstrated even once in thousands of peole taking active b12s) to justify using hydroxycbl which at best paritaly corrects a few of the hundreds of actual symptoms and DOES NOT HEAL ANYBODY instead of taking the mb12/adb12 (adb12 is in no way connected with methylation but still gets blamed by true believers since it turns on the mitochondria and produces ATP and an energized feeling that gets attributed to methylation) which will correct, with the right cofactors most all of hundreds of symtpms, except actual damage which can heal to a large extent. I’m not in a wheelchair wearing diapers because I take 10mg sc injections 3 times per day of mb12. This has reversed subacute combined degenration in place since 1990 about 80-90% and has succeeded at holding it in remission for some years now, except for glutathione trial which furthered damage that has never recovered. Mb12 has one donatable methyl group comprising 1.3% of the molecular mass. The actual amount of methyl groups in b12 is almost inconsequential. If a person is concerned they can limit comsumption to the lowest zone of healing and only take 100mcg gross, perhaps 15mcg absorbed sublingually. That is the amount theoretically converted from hydrozcbl except that 100mxcg of mb12 plus Metafolin will start methylation in less than a week and healing and the signal potassium drop 3 days later. Hydoxycbl rarely starts healing and the time is unpredictable. When it does there is the usual potassium drop which is often called “detox”. Low potassium is dangerous and so misidentification of low potassium by calling it detox can cause problems up to and including death. It is also the 100% indicator that healing has started. Game theory would indicate that one is more likely to heal with something that starts the healing predictably instead of something that rarely starts the healing and never does much. A broken methylation system prevents healing as it prevents DNA replication with the mb12 and methylfolate as needed factors. Hydroxcbl has to be converted to mb12 first, and also needs the ATP genertated by adb12 for the enzyme to work. This turns into a vicious cycle as the pathway is hydroxycbl + enzyme + ATP > mb12 +enzyme and ATP > adb12. When there is MMA instead of ATP getting made, no conversion.

              • DDC says

                Hi Freddd
                I am a 48 year old female with an eight year history of Vit B12 deficiency. It started out as a numb and tingling right leg with serum B at 103. Weekly shots of cyano cobalamin and now eight years later, tremors, ataxia, muscle weakness and spinal cord degeneration. I also have a serious megaloblastic anemia. I have taken folate in the past, sporadically. I have taken vitamins, magnesium, calcium glucarate, Fish oil, etc.I am athletic, not overweight, have eliminated all toxins from the diet, and am still getting worse. my neurologist has put me on 1000 mcgs/day cyano and thinks I have cervical cord compression also. I am a chiropractor, and understand all nuances of spine and brain functions., and read everything there is to know about this disease, but cannot figure out the formula for healing myself. My MMA was less than 1.0 and my homocysteine was 7.9. I cannot whistle or sing anymore due to the spasm of my facial muscles. Pushups are no longer possible due to bicep misfiring. This is making me crazy, and really interfering in my life. With our vast knowledge of this topic, what would you recommend for me…. I have access to pretty much whatever I want from my doctors because they know I know what I am talking about. Thanks for any info on this crappy deadly disease.

                • Freddd says

                  Hi DDC,


                  This has all the basic information about the active b12 protocol. Having been on cyancbl for a while you will likely react with great vigor to mb12/adb12/metafolin. Before you can test for low CNS cobalamin you need to get at equilibrium in the body. Beware of low potassium around 3rd day after starting mb12 when all the delayed cell formation starts up. Have all the basic vitamins, minerals and in your vbody before starting the mb12. You can titrate from 50mcg or less if you have extreme reactions to mb12, adb12 or l-carnitine fumarate. Also, there will often be an induced low folate, worse if paradoxical folate deficiency exists too and Metafolin may need to be titrated along with the potassium. On that same Methylation menu as the BASICS list is a decision tree for identifying potassium and/or folate induuced deficiencies.

              • Kelly says


                The problem with your hypothesis, is that you base most of your conclusions on your own case history, especially the ‘extended’ list of deficiency symptoms, many of which can be attributed to other vitamins. Just one example is angular chelitis, which is one of the main symptoms of riboflavin deficiency. Riboflavin is a key co-factor in many processes, and could very well be severely depleted in you due to your high intake of mb12, adb12, and methylfolate. I know you have others who have healed, at least on a temporary basis, as well, but please admit that most of your experiments, especially the ‘glutathione is toxic’ one, came about due to a trial of NAC (which is not glutathione) that you undertook yourself.

                A Dr. Perlmutter has used glutathione injections to bring Parkinson’s patients ‘back to life’, for years now, with none of the negative effects you mention. As Chris said above, you likely have an inherited genetic disorder that has created a special situation for yourself and a small percentage of others. But that doesn’t mean that glutathione is “toxic” or creates a folate deficiency. Otherwise, these people getting monthly injections would drop dead on the spot. Doesn’t make sense.

              • Madge says

                I totally agree with Fredd about over-methylation. It doesn’t happen. Even if one of your enzymes was more active, there is no way that you would stop taking methylCbl, as you would stop all of the other good methylations going on, like the production of methylArg in myelin basic protein, the synthesis of L-carnitine, creatine, etc, etc. To think that you can selectively stop one reaction is ludicrous.

            • shane says

              Question for Dr. Chris Kesser,

              I also have a polymorphism defect called MTHFR (I believe I have C677 and A1298, I need to do another test to confirm A1298 but I have all the symptoms and respond to the treatment protocol (this one is much more serious than the C677 (I think, IMO) because it has to do with not converting the BH2 to BH4 (Tetrahydrabiopterin) which causes a lot of neurological issues….

              Can acupuncture help with genetic polymorphism mutations ??? That would great if it could….

              • Chris Kresser says

                Hi Shane,

                Just want to clarify: I’m not a doctor.

                I can’t see how acupuncture would help with a genetic polymorphism.

        • Freddd says

          Ali O., The ONLY test that is actually useful is going through that symptoms list on the Active B12 protocol basics and doing a trial of one of the two effective brands of mb12 and the adb12. That will give you the answer, between the symptoms list and the trial, 99% of the time. People without symptoms don’t have ANY response to mb12 or adb12 or metafolin or l-carnitine fumarate. Many people have responses who have forgotten about the symptoms long ago. None of the lab tests will tell you if mb12/adb12 will be effecrive for healing for a person. They only tell you when you are allready in terrible trouble and damaged. And that should be a “duh” since by then a person has 50-200 symptoms. I was dying from the deficiencies and damage and my test results were always “in range” or close, “nothing to be concerned about” said the docs.

      • Deb says

        May I ask, What were your first symtoms? How low were you levels? My children are low 300 & 400 although know Doctor will listen. I take prescribed shots weekly. I am great now after 10 years of constant medical issues, including possible MS, almost having my colon removed and much more. I was in the 100′s.
        I have a couple videos- http://goo.gl/0mOtb and http://goo.gl/eTCnc I don’t know if you seen them. I want to help my children 18 and 22 before they end up like I did.

        • Moongirl says

          Your videos are an absolute inspiration. I suffered from IBS for years along with vomiting, joint and muscle pain, an overwhelming sense of “malaise” all over my body, migraines and intense fatigue. I too would go between 20-30 times a day, sometimes as many as 15 days out of a month. I thought my life was over. There was no damage shown in my colonoscopy. I also had GERD for years and was on PPIs. I stopped the PPIs in January when I suspected that they were making me sick. Between Jan and March I was the sickest I have ever been. I finally found a Doctor who sat down and listened to me and ordered huge amounts of tests. Out of all the tests, my B12 and D were very low. My B12 was on the “low end of normal” but she gave me B12 shots anyway and I am doing so much better. Between the Vitamin D3 supplements and the B12 shots, I am starting to get better. I have lost 30 pounds since going off the PPIs and starting the shots. When I look back, my symptoms were always there, but I think when I was younger, I ate more of a variety of foods and was just stronger. I am now 40. My mother died when I was 32, but I remembered recently that she had been on B12 shots too. She didn’t get diagnosed until she was 60.
          Making a video like that is a great idea. If I continue to improve, I will do the same. It is so inspiring to see the physical transformation, as well as the smile on your face. Thank you for sharing your story.

          • Deb Hickey says

            Thank you for watching. People like you truly inspire me also!It has been a while may I ask how you are doing? I hope you do make a video!!! I lost my Father 18 years ago he was 54 and his mother passed at 43. I to this day wonder if if they had the deficiency, unfortunately I will never know. Please let me know how you are doing you can contact me thewinneroflifeuc@gmail.com if you would like. I wish you well!

      • CW says

        Ann, If you don’t mind me asking…..What made your neurologist think you had MS? I have recently been diagnosed with extremely low B-12. Just started getting shots once a week for 4 weeks and will soon have more tests done to try to figure out why it’s happening or whats causing the problem. I was seeing a neurologist myself for headaches, but they never mentioned MS with my issues.

      • david says

        Ann, I understand what you are going through. I was just diagnosed with extreme b12 deficiency and have had tons of nerve pain in hands, fingers, arms, legs and have to have shots and oral. I am worried that this pain is permanent because others have stated it doesn’t come back. I have had pain for years and it would come and go but the last year it has been really bad and now my hands and fingers ache all the time. My wife is a RN and doesn’t seem to believe it when it comes to pain, I have had several broken bones, lacerations, operations, kidney stones, and other conditions but I have healed this condition states nerve damage doesn’t reverse itself. Prayers for both of us

      • alicia says

        i feel your pain im 28 just finding out now that i have a b12 issue im devastated that i wasnt diagnosed sooner considering the amount of bloodwork i had done during my pregnancy it makes me furious my level was 106 how did nobody catch this i havent felt myself at all for months and im afraid that its to late to fix all my cognitive issues :(

      • Michelle says

        I was recently diagnosed with extremely low B12 levels. I was also diagnosed with MS in 2001. I found a new doctor recently and he wanted blood work done before I could get my yearly Rx re-done and that is when he discovered I was B12 deficient. I have been taking injections for 7 weeks now and the feeling in my hands have almost returned to normal. It has been over ten years since I have felt the tips of my fingers. Wow eh.

        • Greg says

          Hi Michelle,
          What a great story. Have you conveyed this to the local MS society. Generally they totally ignore all the data that suggests the MS can be correlated with low VB12 levels. You must be ecstatic to get your feeling back. Do you know what form of VB12 you were injected with, and the dose? Are you going to stay on the injections, or what has he suggested?

      • sharon says

        hi ann
        I also have the same diagnosis as you, life can be so miserable must admit lots of symptoms and this defeciency is on the rise.

      • says

        This article does not give any signs or symptoms that i suffered from the last two months,…tingling, numbness of toes on both feet, burning sensations for hrs. On the tops f both feet,,, at first i thought it was my MS , then others suggested diabetes but i did not have any other symptoms of diabetes…then i thought it was related to Mortons neuroma but foot doctor ruled that out.. I did more research and found that since i had not been eating right it was a B-12 deficiency.. I then went to pharmacy and bought B-12 vitamins and just about 3 days after taking them the burning sensation stopped, numbness in toes went away too after 5 days.. i then started to eat better, eggs for breakfast every day, meat, chicken, veggies fruits…tuna, fiber foods
        . I had been taking multi vitamins but then found out they only have 2.6 mg of B-12 …you need more then that if you are not eating properly like I was…

        • jerry adams says

          My neurologist says my nerves are dead – irreversible. I must learn to live with pain management for the rest of my life, she says. I am hopeful that she is wrong, but …. suppose the nerves regenerate. Which ones will come back: the ones that cause the pain now so my pain will increase or the one that MIGHT make the pain go away? I’m not positive I want to take the chance that the pain would be worse if the nerves regenerate. Who knows what will happen? Maybe it’s better to live with the devil I know than risk the devil that I don’t know. Anybody out there got any input? I welcome some encouraging words.

          • Madge says

            There is a product sold by b12oils that has a curcumin derivative in it (which is supposed to stimulate nerve growth), plus Ado/MeCbl plus vitamin D. All of these have potential to stimulate nerve growth – I believe.

          • Molly Malone says

            I am not a doctor, but nerves will heal and they DO regenerate. Feed your body what it needs, including supplements, and it will perform as best it is able, which is usually a lot better than people believe. Nobody can say to what extent you can heal, but you can heal.

            Nerves don’t work the way your statement implies, please don’t worry. There aren’t special pain nerves. “Few, if any, of the receptors of heat, cold, and pain are specialized transducers. Rather they are sensory neurons whose plasma membrane contains transmembrane proteins that are ion channels that open in response to particular stimuli. A single neuron may contain several types of these ion channels and thus be able to respond to several types of stimuli.” Go ahead and heal as much as you are able, don’t stress yourself further over something that isn’t even true.

            I have read that malic acid (sometimes called apple acid because it is found in apples) helps with pain. I bought some off Amazon, in bulk so it is pure powder, and use 1/4t once or twice per day. It does help with pain a bit, not a total cure for me. Also 5-HTP (5-Hydroxytryptophan) helps. It elevates serotonin in the brain naturally, which chronic stress depletes. It helps people to sleep better as well. These bits of info are from Billie J. Sahley, Ph.D, CNC and her book “A Natural Approach to Fibromyalgia and Chronic Fatigue”, P. 12, 14, 20-25. I recommend her books, they are on Amazon or elsewhere online.

            The herb/spice turmeric is both pain relieving and anti-inflammatory. It works well, but over time it thins blood. This may or may not matter, depending on how much a person uses, and for how long, but here’s my experience: My husband used turmeric and vitamin E to thin blood, and it worked so well that after 10 months he began to have spontaneous nose-bleeds. Not really dangerous but not a lot of fun either. We reduced the E, then the turmeric and he was fine. The higher dose was 6 capsules from Organic India in divided doses, and 4 of A.C. Grace’s Unique E. He now takes half of each, 2 of vitamin E and 3 of turmeric. This and a few other changes has kept him off meds after 2 heart attacks and a massive stroke. I hope something here helps.

      • Will says

        Hello I can’t post on the main page for some reason.

        I’ve been suffering from ms like symptoms for some about 2 and a half years now. I’ve had mri with some white stops present. But spinal tap normal. And still seeing nuro regularly.

        However about 4 years ago my b12 levels where low. And recently after some blood test my b12 levels are low 171 however my gp says I am not b12 deficient because my red blood cells are normal. Can you be b12 deficient and have normal red blood cells? Also what other reasons could be causing this. I am a meat eater and always have been. Many thanks will

        • Madge says

          Hi Will, the first thing I would do is to get another doctor who actually knows anything about B12 deficiency. You definitely are B12 deficient from you levels. Sub-clinical deficiency starts at 340 ng/L (250 nmol/L). It will be almost impossible to get your levels up by any oral supplementation with B12, so you will either needs injections of B12 (which you will need a doctor for) or if I was you I would use the oils from b12oils. You may not be able to convert OHCbl to the active forms Adenosyl and methylB12, so you will do best with the mix of Ado/MeB12. FYI by the time you are so low that your RBC data is low you are very, very, very deficient.

    • Phyllis says

      I’m one of the pieces of evidence. I was diagnoses with pernicious anemia 8 months ago. By B12 level was 119. Other blood factors confirmed it was pernicious anemia. I’ve been taking monthly shots ever since and feel much better. I’m not a vegan or an older person.

      • Saf says

        I was diagnosed with it nearly a year ago, when I was 20. I’m 21 now. My level was 89 I think? The blood test was for something else but it picked up the deficiency. I didn’t feel the effects of the deficiency at all, but am now.

    • Dana says

      From a lab test. $60 now versus who knows how many thousands later because you didn’t catch it in time.

      • Jesse says

        But with that logic, apart from knowledge of how likely the condition actually is, you could spend thousands on all sorts of tests for hundreds of rare conditions that just might cost you thousands later if you happen to have them.

        • Chris Kresser says

          Jesse: what are you talking about? The test costs $16 (when I order it for patients, at least). I referenced the Framingham Offspring Study in the article, and a few others. If you want more references, go search Pubmed. You’ll see how common B12 deficiency is and how often it is misdiagnosed. Read the book “Could it Be B12″ that I referenced – plenty of references in there. You can do what you want, but I think most people exhibiting signs and symptoms consistent with B12 deficiency would prefer to spend about fifteen bucks to rule it out than go years undiagnosed and suffer irreversible neurological damage – as some people who’ve commented very sadly have.

          • gregory barton says

            If the condition is not rare, as you claim, and the effects are potentially severe, simple common sense would dictate spending the money irrespective of the symptoms. How many times would one need to do the test? Presumably once would be sufficient.

            I am amazed how many simple tests are omitted in my annual blood checkup. Thyroid tests, for one, are not on the list. Yet the test is inexpensive and simple to do.

            I would appreciate a list of basic blood tests to consider as part of an occasional checkup.

            • says

              The problem here lies with the efficacy and accuracy of the tests currently being used. The serum B12 test doesn’t differentiate between ‘Active B12′ and ‘Inactive B12′ – Holotranscobalamin and Holohaptocorrin. A person can have as much as 90% of their total B12 as the Inactive type – that plays no part in the biological processes involved and just, as one physician put it, “hangs around the liver doing nothing”.
              Similarly the Intrinsic Factor Antibody Test is only around 30 – 40% accurate. I tested negative twice before testing positive. Not many patients get tested three times and if they test negative on the first test they are routinely diagnosed with something else. 14% of the Pernicious Anaemia Society’s members were wrongly diagnosed with having Depression and 30% remained undiagnosed or wrongly diagnosed for over ten years.
              There are serious problems with the tests being used and this is leading to people, lots of people, being wrongly diagnosed.

                • Jacquie says

                  Hi i live in the uk and was diagnosed with B12 aneamia in october 2011. My B12 levels was 133. GP put me on 1 B12 injection a week for 10 weeks (i had the last one on 3rd jan 2012). I was then retested for FBC,B12,Folate & COAG on 10th jan 2012. My B12 count has now come in at 884 and my doctor was shocked at the high levels and has now said i cant have another B12 injection until 3 months time. I had every symptom for pernicious aneamia but within 3 weeks of starting the injections they started to dissapear gradually. I have now not had a B12 injection for 2 weeks and am back to square one – all the symptoms are back, they started to slowly come back the day after i would have normally had my weekly injection. I have been up since 2.30 this morning with insomnia, pain all down my left side (legs,arms,hip,hand and fingers), headache and i just sat there crying. I thought i was getting somwhere and now back to where i started. My intinsic factor was tested and this came back negative. Any advise would be great.

                • Kira says

                  Chris, then what would be THE VERY BEST TEST you can do to determine is you are deficient? I have been having tingling and pins and needles sensation in my left leg, really scary, and my Doc wanted to test me for MS… which is very expensive and exhausting and I am not convinced this is the answer. Thnx for everything!

              • Rose says

                Hi Martyn

                I don’t disbelieve you about 90% of a B12 test showing inactive B12, but where did you get this information from? Can you direct me to a legitimate site so I can present this info to my doctor as I believe I am B12 deficient. Although my reading is way over the top end of normal for B12, my RBC count has been tracking downwards for 3 years and is now only just above the lowest end of normal. I started taking sublingual drops of methymalonic B12 yesterday, but only 5mcg.

                • Rose says

                  Oops. Slight mistake. The sublingual drops I’m taking are 50mcg and I’ve decided to take 1000mcg a day. My B12 test result was 1360 but I have to assume this is wrong as my RBC count is only 4 and I am as white as a sheet. Also my hands and feet are tingling. Am I irresponsible taking 1000mcg of B12 a day?

                • says

                  Go to the website of the Pernicious Anaemia Society (watch the spelling). In the Download Section are a series of Powerpoint slides that prove this. There are also presentations by Prof. John Scott of Trinity College Dublin and Dr. Anne Malloy of TC Dublin that prove this.

                • Martyn Hooper says

                  The Active B12 Test is now available in London. It costs slightly more than the normal and misleading serum B12 test.
                  4th Floor
                  North Wing
                  St. Thomas’ Hospital
                  Westminster Bridge Road
                  SE1 7EH

                  Office Hours Tel. 020 7188 4778 Out of Hours Tel.020 7188 7188

                • Freddd says

                  The bound active b12 test is no better. Most of the healing is accomplished with unbound active b12 at 1000 times the level of the bound b12.

                  If you try a 1mg or 5mg 5 start b12 you will know within 2 hours if you have any response in 85% of everybody who will benefirt from active b12s. It takes effect that fast. Take the rest of the bottle for a month and most everybody else that doesn’t find out in 2 hours will know in 30 days. The symptoms list used as qustionaire can identify body-mb12, body-adb12, CNS-adb12 and CNS-mb12 deficiencies along with folate deficiencies.

              • Nan says

                Hurrah Martyn! I was going to post similar information then read your reply.

                I was told twice, after having taken the serum B12 test, that my levels were fine, meanwhile my heart was pounding*, my brain struggling, and my body aching BECAUSE I had pernicious anemia.

                The heart pounding was so severe I went to a cardiologist who ran me through tests and found a blockage – I was rushed into surgery where they performed a heart cath then realized it must have been breast tissue that appeared as a blockage. An expensive and unnecessary procedure all because of my pounding heart and because that darned serum test gives misleading results.

                Fortunately a thyroid doctor ran the Intrinsic Factor Antibody Test which uncovered the pernicious anemia.

                I have tried all three forms and have had to shop for a doctor who would prescribe hydroxo and methyl.

                Cyano – left my body wanting;
                hydroxo – the shots hurt even when compounded but my body liked;
                methyl – my body responds well to.

                I believe this condition developed because of undiagnosed celiac disease which, in retrospect, hammered me for years.

          • Jason Ibe says

            In regards to spirulina, have you come across any significant evidence confirming any benefits of taking this on a daily basis? I take this first thing in the morning on a daily basis and do feel good from it. Enjoy your work and the podcast!

            • Chris Kresser says

              No, I haven’t come across any peer-reviewed research indicating a benefit. My main concern about it would be the source and whether it’s reliable. I remember reading a news article a while back about a sample of spirulina they tested that had neurotoxins in it.

              • Beth says

                Dr Louisa Williams (www.radicalmedicine.com), who tests supplements in numerous ways for purity and effectiveness, recommends a form of algae she calls “Russian Algae” or BioSuperfood, and something called Quinton Marine Plasma.

                • Lynn_M says

                  The literature on BioSuperfood does make it sound like a wonderful product. Since it’s grown in an enclosed bioreactor, I felt very comfortable with it’s purity, so I purchased it. Spirulina Pacifica and Spirulina Platensis are two of the four ingredients in BioSuperfood. I have since read that the B12 in spirulina is an analogue to the form we need. Not only can our bodies not use the analogue, but the analogue competes with the forms our bodies can use.

                  So I stopped taking it for now, because I am homo for the MTHFR A1298C mutation and I don’t want to take a chance of having the BioSuperfood compete with the methylcobalamin and adenosylcobalamin I take.

                  Does anyone know if taking spirulina would be deleterious to someone that is dependent on supplementing the active forms of B12?

          • R says

            I agree with Chris

            I got vitamin b12 injection couple of days ago and renewed energy is amazing. Its a game changer. I also feel less depressed, more energetic and raring to go . I am mostly vegetarian and never realized i need b12 till now. Injections work better than oral vitamin supplement.

          • Tracy says

            I’m 46 and was diagnosed with Pernicious Anemia 3 years ago. I have been on the IM injections for all this time and my symptoms are still getting worse. I can’t lift a tea pitcher with 1 hand anymore and every 2 hours I need a nap or will black out. My hands and feet are almost always asleep feeling and just getting up to stand is problematic. Should I be talking to my doctor about upping my dose of B-12 or am I now in what is called the “end stage” of the disease? I remember being hyperactive and full of energy as if it was someone life other than my own. This disease is real and people should be checked. My arthritis doctor was the only person that thought it could be this and was very aggressive in treating me but I feel that I’m losing this fight. Any ideas of what I need to do to try and get back to some normality if life?

            • Tracy says

              I should also say that my Pernicious Anemia was caused because I developed ulcers in my stomach that were severe at age 15 and have been on stomach meds ever since. I have no absorption through the abdominal regions at all.

        • Phyllis says

          This is not really a rare condition. Unfortunately, it took years for me to be diagnosis, seeing multiple doctors and really pushed to get any of them to take me serious. The doctor that finally did some tests was shocked and apologetic when we got the results of the tests. None of the doctors thought I was at risk because I eat so well and live a very healthy life style. I’m not the only one that has encountered these obstacles.

          • gregory barton says

            Further evidence for the proposition that one must take ultimate responsibility for one’s health and not delegate the responsibility to doctors.

    • TMAC says

      My father just got diagnosed with B12 deficiency and will need monthly injections for the rest of his life. He is in his mid-60s. He has an active lifestyle, he’s a butcher, and we eat meat EVERY day (we might skip meat twice a year max). Nevertheless, his level was 88 which is VERY low. Trying to find out next doctor’s visit if it’s linked to pernicious anemia. I’m in my mid-30s, I grew up eating meat every day (never fish, usually chicken, pork or beef). In university, for convenience and lack of cooking equipment, I switched to mainly chicken (almost daily) and within 6 months I was diagnosed with low iron levels. I’m frequently tired, have a lack of energy and other symptoms but the doctors usually try to talk me out of or refuse to get full blood work done and just tell me to eat more red meat or eat when I get unusually and quickly tired for no apparent reason. These issues DON’T only affect the old or vegetarians, they are very real and have had a very real impact on our lives both as individuals and as a family.

      • Chris Kresser says

        That’s absolutely right. I should point out that most of my patients eat meat (Paleo type of diet), but several have B12 deficiency caused by absorption problems.

        • Dee says

          I was recently Diagnosed with B12 deficiency, I am lactose intolerant and tended to stay away from red meat as my family has a history of heart disease. So I suppose those who are also lactose intolerant may also be at a higher risk as well.

      • Jane says

        Hi TMAC

        I was 43 when I started having symptoms of fatigue, numbness and tingling but was still active. Drs. thought it was MS and all the tests they did all came back negative. Two years went by not knowing what was causing this until a dr. wanted to help me and did more tests this time including a b12 test. And that was the cause. My level was 41. Drs. have never seen someone with that low b12 and still functioning or alive. The downside is my nerves were damaged permanently and I have other symptoms too. I take Nascobal now a nasal spray along with oral folic acid and my level has benn in the 800′s. I’m now 50 and have to use a cane or rollator when out. My balance is extremely bad.
        But I also eat alot of red meat (i can’t stay away from it). Does your dad have gait problems?

        • Zena says

          I’m 42 and just found out my B12 level is 40 and reading your message, I’m trying to get information and knowledge from people who have this or how it affects people, with other medical issues I’m slightly overwhelmed, so any advice or info will be gratefully received :)
          thank you

    • Angela says


      Many people can be Vitemin B-12 Deficient, not only the elderly and vegans, but those who eat meat and the young as well. I am 23 years old and suffer from severe B-12 deficiency and must be given B-12 shots for the remainder of my life. I am not vegan nor am I vegetarian, the problem lies within. My body lacks the ability to absorb B-12 from my food. I have suffered from terrible headaches, twitches, trembles, muscle weakness, stiffness, body pain, random large bruises, short-term memory loss, blue skin under the nails, low red blood-cell count and I do not have the sensation of needing to urinate until it feels as though my bladder is about to burst. I will be undergoing more tests soon to learn what the low B-12 has damaged. Please do not think only the elderly or malnourished people get this disease, be tested!

      • patineuse says

        Im very interested by your comment about random bruises. I had a bllod test in Spetember which showed slight B12 deficiency (142)- I have had fatigue and depression symptoms plus I now have a “rash” that looks like dark brsuising behind my Knees- these patches have been there for some months . I am wondering if it could be a symptom of the b12. My doctors has not given me injections – she asked me to up my food intake of B12 ( I am a veggie but was eating lots of cheese and milk – i have now added back fish)) for 3 months then we will see what my next bllod serum level is in December.

    • jane Mckinney says

      I have had injections for the past 12 years for B12 deficiency im not a vegetarian and dont come under any of the catorgories mentioned they did test after test but i simply cant keep it in my system.

    • Tori says

      I’m living proof you don’t have to vegetarian or vegan to have B12 deficiency. I’m 17 and I was just diagnosed and the first question my doctor asked was how long I had been vegetarian and I was kind of confused because I’m not and I eat eggs and meat daily.

      • Helen says

        But you might be gluten-intolerant and the gluten could be causing malabsorption. That’s what happened to me. Gluten ruined my intestines so I wasn’t absorbing much of anything. I had been low on iron for several years, with no explanation, because I ate meat 3x per day. BTW, my B12 tests were low too, and so I was supplementing with sublingual but it wasn’t enough. I ended up with neuropathy along with several other symptoms. My doctor was useless. Scoffed at the idea of a gluten-free diet and never suggested a B12 shot.

        • Moltened says

          Thats a fine theory but keep in mind that suboptimal thyroid function could be causing lack of enzymes and weak stomach acids that can’t break down the gluten protein and perhaps there is a progression to more of a leaky gut situation that might have occurred. The whole proteins are making it into the blood stream by passing through an inflamed stomach lining where they are attacked by the immune system causing detectable antibodies.

          Thyroid disfunction is notorious for causing low iron and there is often a B vitamin issue as well. This is my situation.

          • Kim says

            Hello, this sounds like me, and I also have Rheumatoid Arthritis on top of this, and definitely a leaky gut. I am suppose to go for a Myers Cocktail injection, B injections. I do have the MTHFR factor as well. Any suggestions, for me, I have been taking HCI for my stomach acid and enzymes too. I want to heal my gut and inflammation, and the Natural doctors don’t seem to be helping me fast enough. I eat nothing processed only fresh foods. My thyroid is off again, I have anemia, and malabsorbtion problems and eat organic.

            Any help would be great!

            • Sharon says

              I woluld start taking kelp. It is a natural source of iodine and should help your thyroid and it is amazing when your thyroid gets enough iodine how much better you feel. Your hair gets lustrous and your skin gets better. a majority of people in USA are deficent in magnesium so you might try taking that.

    • Sharon says

      I too have eaten meat and had a deficiency though it is worse when I don’t eat meat. But before it was diagnosed I had other health issues for years that doctors didn’t understand or know what to do with. These promptly disappeared when I started methyl b12

    • Amanda says

      Hi Jesse,

      Anyone taking Losec or any other antacid (even over the counter ones) will also have issues absorbing B12, also, people who have had stomach surgery that affects production of intrinsic factor, such as a gastric sleeve or gastric bypass, stomach cancer survivors who have lost part of their stomach, also people with bowel disorders such as IBS, Crohns or Coeliac Disease as the foods rich in B12 tend to go right past the small intestine section that absorbs the B12, people who don’t eat much red meat and prefer to eat chicken or fish, people like myself with pernicious anaemia.

      B12 is a really safe supplement to take so boosting your intake isn’t going to cause any harm and may end up bringing an overall improvement to energy levels, sleep, mood and in my case, also stops me randomly passing out and falling over like a drunk person. :)


    • Karen says

      Low stomach acid (Hypochlorhydria) or no stomach acid (achlorhydria) is a common cause of b12 deficiency. If you don’t have enough stomach acid you can’t break down the proteins in foods and extract the b12 (as well as other stuff such as calcium iron and d3) It is estimated that as many as 30% of a population is low in stomach acid and therefore have the potential to be b12 deficient whether symptomatic or not. How you would want that evidencing I’m not sure.
      My b12 deficiency is due to hypochlorhydria.
      The test used to establish if you have it is the salivary VEGF test. It’s available in the UK but I’m not sure about anywhere else.

    • fhman says

      You are smart to question the claims written here since at least some of them are false.

      The claim that B12 comes only from animal sources is false. Firstly B12 is only synthesized by bacteria and Archaea. No animal or plant can synthesize it. We can get B12 from anywhere that has the right bacteria growing. The issue is our over clean modern environment has removed a lot of these sources.

      Studies such as the one linked to below show that in the right circumstances natural non animal sources can be utilized


      • Molly Malone says

        Did you actually read that entire study? Online I can only access the abstract, which 1 – claims that there were 6 test subjects which is hardly a large or significant population. 2 – we know precious little about the testing method done: “In addition, their serum vitamin B12 levels and other data (red blood cell count, hematocrit, hemoglobin, etc.) were determined in the laboratory.” All we really know is that their blood serum level was measured. Haven’t we learned here that some of these methods are highly suspect and often highly inaccurate? We actually know nothing about the testing methods used. ‘Nuff said.

        “Because bacteria produce vitamin B12 and fermented foods are generally fermented using bacteria, there are many rumors regarding vitamin B12 being in fermented foods. To my knowledge, no vitamin B12-producing bacteria is required for any fermented food and, therefore, any fermented food that contains vitamin B12 does so via contamination. Because the human colon contains vitamin B12-producing bacteria, it is possible for B12-producing bacterial contamination to occur during food preparation, particularly in places that do not have high levels of cleanliness. To my knowledge, no fermented plant food in Western countries has been found to contain relevant amounts of vitamin B12 analogues.” [http://www.veganhealth.org/b12/plant]

        In their conclusions it was stated “Unless uncleaned, organic produce is shown to lower MMA levels, it is unjustified to claim that B12 can be obtained in such a manner, or to claim with certainty that humans have ever relied on it as a source of B12.” [http://www.veganhealth.org/b12/plant]

        At http://www.breathing.com/articles/vitamin-b12-vegan.htm several studies were looked at where the opposite of your statement turned out to be true: “Davis points out Dagnelie’s21 1991 study showing that nori and spirulina did not improve B12 status. Until better methods are found, Davis suggests that the adequacy of B12 in algae must be measured by whether it can reverse B12 symptoms. According to Davis, so far, no algae has been shown to do this and two have failed in their initial testing. Dagnelie24 (1997) also responded to Rauma et al., pointing out that the available evidence indicates that B12 in algae is not bioactive in humans.”

        “B12 is found almost exclusively in animal foods such as liver, kidney, meat, fish, shellfish, milk products and eggs but the original source of B12 in nature is bacteria, the only creatures able to manufacture this vitamin. In humans and animals, these bacteria produce B12 in the colon; however, little if any is absorbed across the colon wall so we must get our B12 from animal foods. Bivalves such as clams, mussels and oysters contain high levels of B12 because they siphon large quantities of vitamin B12-synthesizing microorganisms from the sea. Production of B12 supplements involves fermentation procedures similar to those used for penicillin and other antibiotics.
        Interestingly, while eggs contain B12, they also contain substances that block absorption, a fact that leaves only milk as a good source of B12 for vegetarians. Some studies indicate that B12 is better absorbed from milk than from meat. However, one source indicates that B12 in milk is destroyed by boiling. Analysis of B12 in pasteurized milk reveals only a 10 percent loss; however pasteurization deforms the milk proteins that aid in B12 absorption.”

        Veganism is as good a belief to hold as any other, but unless the diet is supplemented properly it is a dangerously health damaging one just for the B-12 deficiency alone. While it is true that there are vegan populations in India, this is neither a healthy nor a clean country and their B-12 and protein status has been attributed to the contamination of their food with insects.

        Eat any way you see fit, but take care when you do so, particularly if you eliminate an entire group of foods, fully half of all that people traditionally eat.

        • Greg says

          I totally agree, although I would add that the B12 that you obtain from meat, whether it originally be derived from gut bacteria or not is almost entirely methyl and adenosylcobalamin, which are the two biologically active (in man) analogues. One must be very careful about the claimed identity of B12 in any food stuffs other than lamb, beef, pork or other meats. Many of these alternative B12 sources are cross-reactive in B12 binding assays, but are not biologically active in man and may in fact contribute to the haptocorrin-bound corrinoids that lead to faulty high readings in many subjects. The presence of these “corrinoids” can actually be detrimental as they can compete for uptake of ado and MeCbl from dietary meat and milk. In such foods the B12 is generally bound to one of the intracellular binding proteins. It must be released from these proteins by the action of gastric acid and pepsin, otherwise it is not bioavailable in humans. This is the reason that ant-acids are such a problem, especially PPIs. They stop the release of the acid that is responsible for break-down of the binding protein. In addition they also stop the secretion of intrinsic factor that it required for uptake via the IF receptor.

    • Jane says

      8 years ago I started feeling tired, had numbness an tinglingling in my feet. I went to a couple different neurologists they thought it was MS. After having blood trests, spinal tap and a couple MRI’s, they could not find what causing this. Two years went by and I went to an internal medicine dr. and he did an MRI and bloodwork but this time checked my B12 level and my B12 level was a
      severe low of 41. He started me on B12 shots but by then there was permanent nerve damage. For eight years I have trouble walking even with a cane or walker and my balance is extremely gotten worse. Instead of taking injections I take a B12 nasal spray called nascobal. My B12 level has been in high 800′s. I wish they could’ve caught it in time cuz it’s very hard for me to do the things I used to do. Dr.’s I’ve seen have said they have never seen anyone with a severly low B12 level as mine was and was still doing things and still alive.

      • shirley says

        Hi! Jane I have just been diognosed with B12 deficiency of only 11.I am just starting injections twice a week. No wonder I didn’t feel all there

    • Vicki Glasbrenner says

      People with MTHFR mutations cannot use B 12 from foods, myself included. 40 to 70% of the population has one or more mutations.

      • Madge says

        I wouldn’t hang your hat on getting much from mushrooms. If you get the absolute highest supply there is around 1 ug/100 gm dry weight, so around 1 ug/kg of mushrooms. Now the European guidelines suggest you should have 6 ug/ day, so that is around 6 kg of mushrooms, which is quite a big wok to cook them in. Now if you get the low levels mushrooms, there is only 0.02 ug/100 gm, so you would need to eat 300 kg of mushrooms. You wouldn’t stop eating, plus the environmental impact of every vegan eating mushrooms to get sufficient B12 would be horrendous. Still you have to explore these avenues.

        • Greg says

          I agree with Madge, although it was a bit strong. One of the real problems with the mushroom work is that they often don’t definitively state which vitamin B12 analogue it is. As far as I know (and please let me know if I am wrong), I have never seen any paper suggesting that adenosyl and methyl cobalamin are in mushrooms. I am happy to be corrected though. The other problem is that often there are bacteria associated with the mushrooms and we know that they can make vitamers (analogues) of vitamin B12. I

    • Deena key says

      I am 66 years old and was diagnosed with CMT 20 years ago. I had them check my B 12 many times and it was always high. Two years ago I stopped eating Gluten and all leg pain stopped. After hearing you explain the connection I got some B12 shots from Pic Med. the first one made my legs hurt all night. The next day was wonderful. That night and for six weeks I slept like a baby. Deep sleep. After Five days my toes that would not move bent completely over. I told my Dr. They sent me to Hematologist that found low in Folic Acid but nothing else. He discouraged me about taking more shots. After one week I will feel very tired again. I have been taking one once a week. I took one everyday for two months. I want to continue getting better. I could not walk outside the house without AFO’s now I am going shopping. Any help would be greatly appreciated. Thanks for your video you have without it I would not be getting better. Deena Key

    • Nan L says

      I’m also your proof!! I along with so many others are proof if you take some time to investigate the net. I was recently diagnosed with B12 autoimmune disease with nerve damage as well. I started complaining in my late 20′s, I’m now 46. About 2 years ago i went to my doctor and told him i can’t take the pain anymore; after testing he told me i had fibromyalgia. Recently however, it got to the point where i couldn’t walk with ease. I was using walls to lean against, anything to help me walk. Standing was difficult, i felt like i was going crazy. I went back to my md and he did the b12 blood work – sure enough, I have B12 autoimmune. As so many other, the nerve damage could have been prevented with better blood work testing! Since the medical standard sets the line far too low for B12 limits I feel rather ripped off from what should be healthy years of my life! I say a class action suit would surely get someones attention here, this is my life, your life…it’s insane that i/we have to live with this now. Anyhow, i receive injections monthly, am on a daily supplement and in the process of figuring out why I have the dificiency but am told i will require shots for life and the hope is to eventually eleviate the pain. Here’s hoping! All the best to you and your situation.

      • Greg says

        I agree about the levels. I don’t know about your class action, but something definitely needs to be done to educate the doctors. There are many, many papers stating that sub-clinical deficiency starts at 340 ng/ml (250 pmol/L). Data on brain shrinkage shows that even at 400 ng/ml (300 pmol/L) the brain shrinks by 2% per annum in those over 50. The trouble is that the pathology labs average up their data and they only flag your data if you are outside their 95% confidence limits. This is why the definition of deficiency is different from country to country and from diet group to diet group. It makes you wonder why bodies such as NIH don’t step in and have it changed. As they say “go figure”. It is up to the group to educate others. Another problem is that even in the general community most B12 deficiency signs are passed off as ageing.

    • laura says

      I’m living proof too. I’m 24 I was diagnosed with b12 and folate deficiencies after colonoscopy and endoscopy which showed that I had helicorbactor pylori. I had underlying b12 before this stomach virus but had more issues such as pins and needles, memory loss, fatigue etc. After the eradication therapy.

  2. Elisabeth says

    As I see it, the greatest problem with B12-deficiency is the fact that the condition so easyly gets irreversible. If it isn´t discovered in time, there will be a lifelong problem. It´s horrible to see a confused person, full of diffuce anxiety, wandering about in it´s depressed condition…and nothing helps when it reaches this stage

    • Chris Kresser says

      I agree, Elisabeth. This is particularly tragic in light of the fact that B12 deficiency can be so easily and cheaply diagnosed.

    • sandi says

      so, is this and your comment saying, that if we find we have a deficiency, it is impossible to rectify by taking Vit B12 supplements? this is irreversible?

      • Chris Kresser says

        Low B12 levels are correctable through supplementation – either sublingual or via injection. The damage caused by B12 may or may not be reversible, depending on where that damage has occurred.

        • joanna says

          HI Chris.
          I was going to my Dr, for years,with pains achs and pure tiredness,falling asleep all the time!i lost my baby boy over B12 deficiency ,so for me and mine,it doesnt really matter if its reversible,my son would of been 12 in april.. no one ever thought about looking for it untill it was way to late,Doctors should test for it!if only i were given the test before it was to late!and a painless injection,Seth would be here with mme now

          • joanna says

            V-12 Def …. is a life changing problem as i said i lost my baby but also i lost my family,the loss tore my family apart,my husband couldnt take the stress,so he left and we lost everything,including our home!..ppl plz push ur doc on testing!

        • Jane says

          If they catch the B12 deficiency in time symptoms can get better. In my case, drs. didn’t and I have permanent nerve damage. Apparently, my body cannot absorb Vitamin B12 orally’ so that’s why I started shots and now I’m on Nascobal a B12 nasal instead of the shots and it has worked as well as the shots for me. When your body can’t absorb B12 orally it’s called the intrinsic factor, which is what I have.

          • Judy says

            Hi Jane,
            I have the same problem you had. They didn’t catch my B12 level in time cuz they took a lot of tests, foe other things, MRI’s, Bloodwork and a spinaltap. And found nothing causing all my symptoms. Two years later a dr. did some tests and found my B12 level was 41. By that time the nerve damage was permanent.I took B12 injections and now take Nascobal.
            My levels are always up but no change with my symptoms. So I’m looking into MeCbl/AdoCbl
            to help the central nervous systems.Possibly TransderOil which I read about on this site.
            But my body too can’t absorb B12 orally which before 8 yrs. ago I took supplements and then that’s when all this started.

    • sharon says

      thats exactly me, i get my jabs every 10 weeks and they last for 6. then i decline i dont recognise myself, i cant cope with people, i have to take a step back and watch my every move i cry everyday .

  3. Evan says

    Great article. For those with intestinal disease/absorption problems, do you think daily doses of fermented cod liver oil ala Weston Price would be sufficient?

    • Chris Kresser says

      FCLO does not contain significant amounts of B12. I recommend approximately 1 mg/d of sublingual methylcobalamin for those with intestinal absorption issues.

      • Phyllis says

        Unfortunately, it won’t work for people who can’t absorbed it through the digestive track.

          • Sandra Brigham says

            Yes, that’s why if the cause of deficiency can’t be found, a sublingual is recommended because it doesn’t go through the digestive tract, it goes directly into the blood stream, as I understand it. So lack of absorption or storage and/or release don’t come into play.

            Thanks for the book recommendation Dr. Kresser. I just requested it from inter-library loan. Maybe it’ll answer some questions for me.

  4. says

    Thanks for getting this information out, Chris. Not only am I a vegetarian, but I am also genetically “challenged” at assimilating B-vitamins (I took a genetic test. That’s how I found out). Lovely, huh? So I am acutely aware of this issue, and I attempt to “spread the word” as best I can. I will be pointing people to your post as a way of doing just that.

  5. says

    A bit off topic, but I was wondering if you knew, Chris, how freezing liver might affect the vitamin content. I eat raw liver regularly (1/4 lb per week), but I can only access frozen, grass-fed beef liver from my local farmer. Thanks, Chris. I love your blog and podcast, by the way … very insightful.

      • Sandra Brigham says

        I do this for the dog and is good for up to one year; at 114 lbs, he gets 2 oz every other day (chicken or beef). I still give him his B Complex Vit though since he can’t tell me how he feels.

        I make liver pate for myself and freeze them in 2 oz servings.

  6. Kim says

    I recently read a story from the CDC that a young vegan man was treated for a psychotic episode involving schizophrenia. It was discovered that he was severely b-12 deficient. After being treated with b-12 and a short-term course of anti-psychotics, he recovererd. Makes me wonder 2 things: did he finally get the message that a vegan diet was not nutritionally sound? And secondly, how many mentally ill people such as schizophrenics and other’s being treated with powerful and dangerous drugs are really just nutritionally deficient or celiac?

  7. says

    Hi Chris,
    I am curious, I have a supplement called Florivit (canadian based company called Salus), and it says it has B12 in it. Do you have any experience with the effectiveness of this vitamin supplement. It is commonly prescribed for Vegans/Vegetarians…..Arnie Lade in Victoria originally suggested I use it from time to time.

    • Chris Kresser says

      Irene, I don’t have any experience with it. But I recommend methylcobalamin in general.

      • Rose says

        I am 30 and am very depressed always freezing hands feet nxiety I order and 2 years ago very horrible panic attacks I can’t live my life or have any motivation too I m nderweight and 30 please guide me I don’t feel well always home don’t get my period ever only 4 times in m life n take levoxyl for hypothyroid yesterday I fleet so irritable like i was craling out of my skin and going crazy :( I took under the tongue b12 and felt so much better now I am confused. Esp about peopl getting sick off the shots nd numb ness altho my hbds nd feet are numb already Please advise
        Bless u,

  8. Sandra Brigham says

    At the young age of 43 (3 yrs ago), I was diagnosed as B12 deficient (120). I was lethargic, having extreme memory problems, falling asleep at my desk at the firm, painful thighs, numbness and tingling in extremities and the scariest of all – spatial disorientation (tunnel vision – needed to hold the railing in stairs ’cause if I looked up to see where I was going my feet tripped but if I watched my feet I didn’t know where I was going; I also had to let my hand drag along walls as I walked down a hall to guide me since I had to watch my feet, like to make sure I picked them up), tingling scalp (couldn’t tie my hair up w/scrungies ’cause I’d get migraines if I did); driving on the wrong side of the road cursing the oncoming drivers for driving the wrong way!, standing at the ATM while it’s beeping at me not knowing what I’m supposed to do, trying to consistently open the front door with my remote car control, forgetting my age, word recall difficulties (I’d say “window in the ceiling” for skylight) and knew it was happening, after it was called to my attention, but was ok w/it since I was still communicating but I’d get weird looks!!, doom and gloom and the list goes on. Initially they referred me to Psyche but I refused and demanded blood testing for B12 and IF.

    We ruled out not having IF & anemia and parasitic infections, not a vegan, never had abd surgery or used PPI. All I had was a family history of colitis (mother) and Crohn’s (son). So we never determined the cause of my deficiency but a couple of shots and then sublinguals abated the neuro stuff and most of the fatigue (not falling asleep every few hours). I continued to complain of extreme fatigue and unrefreshing sleep so Infectious Disease did a PE, negative, and referred me to Psyche. Dr. Deans must make a killing off these types of referrals!

    It wasn’t until I went Paleo/Archevore Jan 2011 that every last bit of fatigue just went away (after the carb-flu). I’ve regained, by my home-spun estimates, 6+ lbs of muscle and taken inches off all body parts, slow but steady. The only issues that remain are some word recall problems and left foot tingling. Would B12 affect cortisol or adrenals? I may have some of that going on too.

    But it was SAD and chronic cardio (42+miles on trails/wk for 8 yrs) that were killing me!

    This post was timely as I had stopped taking my B12 sublingual and was going to have MD test levels in the Fall to see if my dramatic protein increase (from 2-4 oz/day to 12+ oz/day) made a difference. But if a lot of your patients that are Paleo are deficinet, maybe I should resume my sublingual (1000mg).

    Great post Dr. Kresser.

    • says

      Thanks for leaving your experience, Sandra. I was never diagnosed with b12 deficiency before I started the paleo diet because I never had a doctor that had a clue but I had many of the symptoms you described which is what prompted me to start the paleo diet to begin with. The symptoms cleared up quite quickly when I changed my eating habits but I have always noticed that they return to some degree when my digestion is impaired (when I deviate from the diet).

      Thanks Dr. Kresser for the thorough and informative post! I think this information will help many people who are suffering from undiagnosed conditions.

    • says

      I had all these symptoms still have the effects take a shot a week Doctor said I had nerve damage from it daughter has hypo thyroid she wanted mine checked thought it could be that also havent heard from all the blood work yet but the endo doctor has already called in 50,000 units of vitamin D once a week im also vitamin d depleted these make me have much more energy but still have the sensations really dont think they will ever go away

  9. Monte Diaz says

    What is a good dosage range for maintenence Chris, assuming a person doesn’t have absorption issues. Do you think sublingual or liquid forms are any better than pill form? Thank You.

    • Chris Kresser says

      I don’t see a need for ongoing supplementation for those without deficiency or absorption problems, assuming adequate dietary intake.

      • Elisabeth says

        Oh, yes…those who had som kind of a stroke, had any kind of brainsurgery etc they will always benefit from 1-5 mg a day of B12…as protection. I have known this for a long time (years), but never saw the real proof in knewer studies, just can´t remember where I read that, yesterday…

      • Sandra Brigham says

        The sticky thing is, as my doctor explained it to me, we don’t know whether there is an absorption problem (barring IF issue) or not. And, according to her, there is no way to tell if it is a storage and/or retrieval problem (liver). My extensive review of the literature, lay person here, revealed nothing she missed.

        But if one goes Paleo and stops supplementing then takes a serum test, wouldn’t that tell if Paleo made the difference if levels are good. Of course, then begs the questions: how long would you have to be on Peleo for serum to change, how long do you have to be off supplements before taking the test becomes the question and are serum tests valid, *enough*?

        So my MD recommends B12 supplementation for life. Easy enough I guess, but since liver and pancreatic cancer runs heavily in my paternal family’s history, I’d like to know WHY I was/am deficient in B12. It may be epigenetics, MD postulates, as I come from the most northern tip in Maine where potato agriculure has been our (Canadian/Maliseet Indian) way of life since colonization, and thus there is nothing to find on exam…

        So now, I worry about my liver all the time.

  10. Adam says

    Hi Chris,
    I’ve relatively recently found your website and have been enjoying your posts and podcasts. In this article you say that Autism Spectrum Disorder can be caused by B12 deficiency. Do you have any proof of this, any studies you can point me towards? Are you implying that it can be a deficiency in the mother during pregnancy or some deficiency in the infant that can bring it on?
    As someone diagnosed with Aspergers I must say I’m interested but also skeptical. Autism has a clear genetic component and I while it is plausible that an environmental factor can trigger a genetic predisposition to it I doubt there is any firm evidence out there that proves that B12 can be a cause (or anything else at this stage).
    Thanks for all your great work, but I need more convincing on this one.
    Cheers, Adam.

    • Chris Kresser says


      There’s an entire chapter on the possible B12-Autism connection in the book I referenced in the post (Could It Be B12). It is well-established that maternal B12 deficiency causes developmental delay, hypotonia, failure to thrive, reduced IQ and mental retardation in the mother’s offspring. Young kids with B12 deficiency exhibit delays in speech, language and social development, as well as problems with motor control. The signs and symptoms of B12 deficiency are very similar to those of ASD. There are anecdotal reports from ASD specialists that B12 injections improve symptoms in a significant percentage of ASD patients. One pilot study found that the rate of elevated urinary MMA in autistic kids was 20%. Granted, this is not proof of causality nor would I or the authors of the book claim that B12 deficiency is the sole contributing factor to ASD (that’s ridiculous, of course). But there may very well be a connection, and it’s worth pursuing further IMO.

      • mrs marie cooper says

        hi chris my name is marie im a 39year old mother of 5 children and i have recently been told i have a b12 defeciency after having a blood test which confirmed i have pernisious anemia? previous to this blood test i had a scan of my belly because of gastro problems which i was told i had an enlarged live which has a cyst on it after having a second blood test my levels were the same which all my doctor did was write me a perscription for some folic acid told me a list of food to eat and told me to come back in 3 months time to have my blood done again but im worried as my symptoms are more noticeable to me im so tired all the time and iv got tingling in my hands and feet ackey bones dizzyness etc im even more worried now also reading a post on your page concerning autism as i have a 15 year old son who has traces of aspergus and adhd do you think there is a connection from me having b12 this is all so new to me i dont know what to think or do and feel as if i have been left in limbo…..

  11. says

    Chris, brilliant stuff as usual!
    I see so much conflicting B12 data all over the web and I have concerns about my own B12 intake! For the last 2 years I was a Raw vegan only and started to get really weak & tired, then moved to about 75% raw, now eating cooked yams/sweet potatoes a little white rice and daily I eat either sardines or mackeral.
    I was told I need 10mcg of B12 a day, without consuming red meat or liver etc am I ok on a fish source only for B12?
    Your thoughts kindly appreciated!
    Keep up the great work!

    • Chris Kresser says

      Simon: 10 mcg is an inconsequential dose of B12. 500 – 1000 mcg in methycobalamin form each day would be a more suitable dose.

      • Elisabeth says

        B12 is stored in the liver, I always thought about it as something from old, real old times, when you coluldn´t be sure of good hunting everytime. So, when starving times one wouldn´t be without B12.

        B12 and folic acid are both known to have good effects in psychiatric problems, but in mega-doses it´s called ex juvantibus and was widely used before we had so many diffrent drugs, even thyroxin i mega-dosis was used. That I find very interesting.

        And Simon…you really need to store up a lot of B12 in your liver.

      • says

        Wow! Chis, as I said so much info out there you don’t know where to turn! When I followed the Raw vegan diet, I was told at the time just have some raw honey which has had a few bees or other insects fallen into it, you won’t taste them and you’ll get all the vitB12 you need! Damn was I so naive!
        Thank you.

  12. Heidi says

    So glad I found your website, Chris.

    My question is, would it be Ok to just supplement for awhile and note if any of the symptoms went away? Could you comment on Elisabeth’s comment about people who’ve had a stroke or brain surgery.

    Thank you for all of this great information!

    • Chris Kresser says

      Yes, supplementation with B12 is safe since toxicity is extremely rare, especially if you avoid cyanocobalamin. Unfortunately, some damage from B12 deficiency is irreversible.

        • Chris Kresser says

          Because in the rare cases that B12 supplementation causes a negative reaction, it happens with cyanocobalamin, and because it is the least well absorbed form as I pointed out in the article.

          • Sandra Brigham says

            I didn’t understand your sentence – some word is missing I think. But since I have been using for cyanocobalamin for 3 yrs and have some residual foot tingling I guess I should seek out the methyl B12 supplement version.

            • Sandra Brigham says

              Well, on 5/23rd I started using methyl B12 and ditched the cyano B12. After 17 days of using methyl, the neuropathy in my left leg and foot are all but gone! I now only feel a slight tingling sometimes but the numbness/pain are gone. I figure the slight tingling will be gone in a few weeks.

              Thank you so much for this wonderful post. I just can’t believe my MD never suggested mention methyl to begin with.

            • Monte Diaz says

              It actually makes sense Bridgett. Cyanocobalamin is an unnatural synthetic version of B-12. Our bodies may not be fully adapted. Therefore, in addition to not being absorbed well, it also may cause negative reactions in what little is absorbed.

              I liken this to the situation with trans-fats: Where they impersonate normal fats and when the body tries to use them (put them to work) they act dysfunctional and reek havoc.

              Of course, I’m just a layperson and may be wrong on all of the above.

              • Vicki Glasbrenner says

                Cyanocobalamin is the most commonly supplemented form of vitamin B12, but you might be surprised to discover that this form of vitamin B12 does not actually occur in plants or animal tissues. In other words, outside of the chemically synthesized cyanocobalamin that you encounter as B12 in most vitamin supplements, you would be extremely hard pressed to find this compound in nature (in fact you would not be able to find it). As the name implies, cyanocobalamin contains a cyanide molecule. Most people are familiar with cyanide as a poisonous substance. Although the amount of cyanide in a normal B12 supplement is small and from a toxicology point, viewed as insignificant, your body will still need to remove and eliminate this compound. Lovely.

                • Greg says

                  I agree on the cyanocobalamin. Not generally found in nature. It was an artefact of the original purification method of vitamin B12. Many, many studies have now shown that it is not used anywhere nearly as effective as adenosyl and methyl cobalamin. Furthermore, if your intracellular glutathione is low you can’t reduce the Cobalt atom to remove the cyanide. Thus, in many people who have been B12 deficient for years the CN-Cbl is not very effective, if at all.

        • Freddd says

          It’s also the least effect most worthless form of cobalamin that at best will keep somebody crippled and limping along.

  13. EL66K says

    Chris, have you heard about the Fredd protocol? It was made by a guy suffering from severe b12 deficiency, and it apparently has helped a lot of people. He talks about specific brands of sublingual methyl-b12 being vastly superior to others in terms of absorption (specially if you use them the right way), and about the need for other nutrients to be obtained in tandem for the therapy to be most effective. I personally tried one of the brands he recommended (jarrow’s) and my b12 got above 2000 pg/mL in a few weeks. The doctor got scared.

    Here are the links: http://forums.wrongdiagnosis.com/showthread.php?t=62327 http://forums.wrongdiagnosis.com/showthread.php?t=9948

    The second one was actually started by Sally Pacholok.

    Also, you didn’t mention one of the conditions in which b12 has been shown to be very helpful: peripheral neuropathy. There are many articles in pubmed about it helping people with that condition, mainly diabetics.

  14. Alex says

    Hey Chris,

    So it seems like even when eating a paleo diet there are many nutrients one can still be deficient in, such as Vitamin B12, Vitamins A/D/E, selenium, magnesium, iodine, etc. That being said, why not recommend a well-rounded multivitamin for most people as insurance? I know you’ve talked about the dangers of high dose multivitamins and antioxidants, but it seems like a basic one or two a day multi would have far more benefits than potential risks. Your thoughts?

    • Sandra Brigham says

      Yes, this plagues me every day. Should I take that B12 sublingual and the multi concurrently that my MD emphasized had to be taken with a B12 for the B12 to be effective now that I’m Paleo/Archevore. I ditched the BCP as a possible cause, and to go Paleo, even though GYN swears BCP doesn’t cause B12 deficiency. Gave up the Vit C but kept the magnesium though. It gets very confusing – TMI!

    • Chris Kresser says

      I think Nutrient 950 with vitamin K from Pure Encapsulations is a good choice. It’s one of the few I’ve found that has the ratios and amounts of each nutrient that I’d recommend.

      • gregory barton says

        Do you recommend 4 to 6 capsules per day, as the product information requires?

        Do you have any one per day alternative?

        Would you recommend the variety ‘without iron’?

        • Chris Kresser says

          Because iron is a pro-oxidant and in excess quantities can be dangerous. Most people get enough if they’re eating meat. Dosage of 4-6 capsules is fine.

  15. DJ says

    Hi Chris,

    Thanks for writing about this important topic. I have read the book you referenced “Could It Be B12?” and if I remember correctly, the authors pretty much concluded that serum B12 was not accurate and recommended urinary MMA. I remember being alarmed that my B12 level was so high (887 pg/ml), but then thought maybe it was because I had taken a multivitamin containing B12 the day before the test.

    Two questions:
    (1) Do you agree that serum b12 is not really valid becauses it does not indicate whether it is actually being absorbed and utilized in the body?
    (2) Do you agree that everyone should stop taking supplements for 2-3 days before having bloodwork done, so they don’t affect serum levels like b12, iron, etc?

    Love this blog!

    • Chris Kresser says

      No, that wasn’t their conclusion. In fact, they said that B12 is accurate but the reference range is too low. They suggest that if the cutoff of 450 or 500 pg/mL were used, urinary MMA, homocysteine and HoloTC may not be necessary. However, they also mention that they would treat if urinary MMA and/or homocysteine are abnormal but B12 is normal. In my practice I’ve been running urinary MMA, homocysteine (a useful marker for other reasons) and serum B12.

  16. says

    Hi Chris,

    I’ve heard you mention the frozen-liver-pill idea a few times now, both on podcasts and on your blog. Can you talk about the quantities that you recommend, i.e. how many grams or ounces on a daily/weekly basis?


  17. says

    Dr. Kresser,

    What dosages should vegans and vegetarians be taking as supplements? I currently market a twice daily NSF certified multivitamin containing 22.5 mcg of Vitamin B12 (Cyanocobalamin) and a 0 sugar, 0 carb low calorie energy drink containing 294 mcg of Vitamin B12 (Cyanocobalamin). Are these products suitable to help round out a vegetarian diet?

  18. Stephanie Alexander says

    Thanks for this great post. I had a sub-lingual B12 supplement and read that it was vegetarian — likely not going to help me at all.

    I have been searching for a B12 with Folate since they seem to both be required and not abundant in the diet. However, all I find are supplements with Folic Acid.

    Any suggestions?

    • Chris Kresser says

      Designs for Health has Super Liquid Folate and there are many brands of liquid B12 with methylcobalamin. I haven’t found one that combines the two in sufficient doses yet.

  19. Peter says

    Theoretically, methylcobalamin may participate in the methylation of inorganic mercury released from dental amalgams, thus increasing its absorption in the mucosal & digestive tracts. This effect may vary according to oral pH and bacterial type/count.

    I have dental amalgams and get frontal headaches after a couple of weeks on 2,000mcg sublingual methylcobalamin daily. Coincidence?

  20. James says

    Hey there Chris!

    Sorry to make this comment here but I figured it would never get seen if I made it in the thyroid-gut article.

    You say to restore gut integrity you put your patients on the GAPS diet. This is not necessarily a low carb diet, but from the food choices and how it is set up it generally turns into a low carb diet for most (probably 100 grams or lower). Would going on the GAPS diet worsen issues in someone with already high cortisol throughout the day? Would you advise fixing the cortisol first, or do you need to fix the gut before you can hope to fix the cortsiol?

    • Chris Kresser says

      It’s a bit of chicken and egg, so they need to happen together, but I generally think fixing the gut is the highest priority.

  21. Tyler says

    Great post! My wife has B12 deficiency despite the fact that we’ve been eating paleo for one year. We’re not sure what the cause is, but her doctor just said to take a B12 supplement. I’m worried it could be a symptom of a more serious issue.

    • Chris Kresser says

      Always good to do that detective work. If she has pernicious anemia, a B12 supplement isn’t going to do a thing (she’d need injections). That’s also why re-testing is so important.

      • Tyler says

        What would be useful detective work for people with confirmed B12 deficiency? A Schilling test? A blood test for gluten antibodies?

  22. James says

    Thanks. Just posting on various sites I have numerous people telling me that low carb paleo eating (or GAPS diet eating) causes stomach problems/digestive, food allergies, messes with cortisol, etc. Is there any truth to that or for the most part has it helped those you use it on?

    My problem now is more so sluggish elimination/difficulty going, some food issues (bloat and water retention), etc.

  23. simona says

    Unfortunately, methyl and hydroxy cobalamin are hard to find as they are more expensive and manufacturers don’t put them in multis. How can one find out if they have methylation problems?

    • ApotheCarey says

      Take the MTHFR gene mutation test if you like! Also, Jigsaw makes a B-complex that was recently improved to include methylated forms of folate and b12 in one place. Chris, do you think someone with the mutation and digestive issues would have trouble absorbing this? I like that it’s all in one place, but I sometimes add a Pure Formulas Methyl B12 Plus sublingual to the mix (has methylated folate and B12 and that’s it). However I don’t like that it has Metafolin, made by Merck, who is now, according to a natural healing blog, trying (via the FDA and a rider in legislation) to get a monopoly on methylated folate and prevent supp co.s from using the term “folate”. There’s a petition out there about it.

  24. Stephanie Alexander says

    I am confused — if there are no vegetarian sources of B12 and methylcobalamin is a naturally occurring source of vitamin B12, how can it be Vegan? I think I have missed something…?

    • Dan says

      You are confused because Chris wasn’t being honest. B12 is produced by bacteria. B12 supplements are manufactured without using animals and is a more reliable source than eating contaminated plant-foods (soil has b12, feces have B12, sewage has B12…).

      Just grab a vegan b12 supplement or eat b12 fortified foods (assuming you don’t have a GI problem), and you’ll be fine.

  25. Dr K says

    The methyl trasnfer issue is a large one and you have touched on it here a bit. I think your may have also failed to mention to adequately close the B12 gap it requires high levels of vitamin C as a cofactor in many of the reactions. High enough that oral Vitamin C often does not cut it. Somehow I think you know it but once you go back and look at the pathways biochemically it becomes a real rate limiting cofactor in the real folate issue.

  26. Jen says

    Hi, I have an immunologist who uses Metanx for B12, B6, and folate. She has been using it for years with good results. It is supposed to provide the vitamins in their more active forms. Not sure about it’s effectiveness, as I didn’t have my B-12 levels tested, but my homocysteine levels have always been fine. Hope this can help someone and that it’s a good product.

  27. Sharon says

    Chris, would you suppose a serum B12 level of ~300 *could* cause deficiency symptoms?

    Your blog = great stuff, per usual!

  28. Inge says

    Great post!
    My Mom, now 78, was low (very low) on B12 two years ago. It was diagnosed via lab test, but the doctor did not thought B12 would be of much importance. He was only interested in the cholesterol levels (LDL o. k., HDL triple of normal) and put her on statins, like many years before. For luck there is the internet and I just looked up all lab results and became aware of the low B12 level. My mom took same information to the doc and he informed himself and she got treated by a row of vitamin shots. The difference they made is almost not to believe. My mom was depressive and sick in many ways and the change started only after a few shots. No she is active, interested in live, started sports and having fun again. By the way, she dumped the statins.

  29. James says

    When do you trial and introduction of safe starches for someone on the GAPS diet. Would you just have them on it for a few weeks then introduce it? Also, would it be a good idea to start out with the less dense starches (calories wise) such as yucca, rutabagas, parsnips, etc, for a while before trying the denser starches like yams or white rice?

    • James says

      And wouldnt it be harder to set up the proper flora levels in the gut including starch in the diet ( I thought that is why she cuts it out)? Or do you only include starch after a certain amount of time has passed and you believe that the flora levels have normalised and some gut healing has taken place? Also, are rutabagas GAPS legal, I know turnips are.

  30. mary ann says

    B12 shots are among the most popular biomedical treatment for autism. Another thing to consider is gene polymorphisms such as MTHFR that affect B vitamin metabolism. People with MTHFR have to supplement with activated forms of B6, B12, and folate (not folic acid). Most people with the diseases you listed at the top have MTHFR.

  31. Jan says

    I, unfortuately, am a prime example of a person who has been a victim of B12 misdiagnosis. I was diagnosed with MS and the Dr. had a level in front of him for me of 261. The next year, the level shows at 232, for some reason, there is not a reading for the next year, but Dec of 2010, which is the fourth one, my level had dropped to 151, and a new Dr. replaced the orig Dr. at the clinic I attend. She immed. caught this. By this time, I have lost all feeling in my feet and hands, all of my reflexes are gone, knees, elbows etc, my cognitive processes, awful and intimate life is shot. I lost my career as a finan. planner, my life may very well be forever changed as this. I gave myself B12 injects every day for one week, once a week now for a mo, and will go to monthly I assume for life. My symptoms, thus far, have gotten worse. I am in immense pain. I understand it may be 3-6 mos before I will know if this will turn around my symptoms, but I do not have a good feeling. I have severe gastro issues, have been hospitalized twice during this dance passing blood. It is like no one talked to anyone else. They are doing a full work up with a colonoscopy and endocopy in two weeks, but damn it all, I begged to find out why I was stricken with ischemic colitis suddenly at 54. No one cared. I never knew about the B12. Even though the Dr who left was testing me for it, when I got copies of my blood, it was on a seperate form and not provided, but with our system showing normal ranges of 200-900, it would not have raised a flag. That needs to be changed. I am just lost now. I am 59, lost all my securities licenses, am awaiting the results of a lumbar punch to rule out MS totally, and see what my job’s disability insurance will do. I am set to lose everything.

    • Helen says

      Jan – Have yourself checked for gluten-intolerance. Better yet, go on a gluten-free diet. All of my malabsorption issues stemmed, IMHO, from gluten ruining my gut. I’m still dealing with some neuropathy, memory problems & muscle spasms but they are clearing up after only 3 months on B12 shots. BTW, I’m injecting cyanocobalamin since methyl is hugely expensive, 500mcg every other day. I ordered the syringes & B12 off the web. I don’t care what my blood tests show now since I’ve gotten a lot better in 3 months. Sometimes, though it seems like I’m regressing, then a spurt of progress. Don’t lose hope. Recovery isn’t in a straight line, it’s a jagged line.

  32. Jan says

    This is all very confusing and scary to me. I have no idea what kind of Dr. to see. I can remember my tongue losing all the coating on it and turning bright red back to 2000, and no one knew why, as well as the corners of my mouth cracking and being sore. I know now that this could very well have been B12. Now, with my B12 level at 151, and after giving myself shots of cyanocobalamin, 1 ml daily for a week, then once weekly for a mo, it was at 457 after two weekly shots. What does that say to you? I think that it should have been much higher? What should I be doing, what kind of dr? Do I go to a hematologist, still to my MS neurologist, my Primary care, who? I am just now finding you, and this site. I have lost all feeling in my feet and most of it in my hands. I have these large lumps that have arisen on the tops of my feet, that had turned dark brown and the skin was thickened six years ago. These lumps just came now. Why? I lost my legs today, and fell. I am confused, went through a horrible confession from my spouse of almost forty years three yrs ago, and I am angry. If this could have been prevented by the simple intervention of treating my B12 deficiency, and I would have my feet and life, my God. I see the three kinds of B12 and it seems I am taking the wrong kind? Am I spinning my wheels? Am I just going to keep going down, end up dead? What stage am I and how is that determined? Is 151 a really low number? I really do not like liver, but should I be eating that? Where do I turn? I need help desperately. Is my life over at 59.

    • Elisabeth says

      Jan, I think it´s important that you also take folic acid/folate and B6 with your B12, for your MS, you must take vitamine D3, mega-doses.

      • Jan says

        Thank you for replying Elisabeth. It seems that the lumbar ruled out MS. Not 100% because there was protein in the punch but a huge amount. I have a brain tumor in my brain stem, one that the prev. MS doctor told me was gone. On the report it says that it is there, in the midbrain, located near the aquaduct but not clogging it. Well, it may be changing. See when they ordered the punch, I asked them, are you sure since I have this thing on my brain and you are not supposed to do that to someone with that. The brain surgeon said, no, it is ok. Only when there is one that is causing pressure or blocking the flow. Well, he as also saying the place was not a glioma (tumor) but a hamartoma (malformation from birth) and not a problem. Well, he backed off of that when he saw the large amt of protein. He said it is a glioma, that would account for the protein. And, may be it is affecting the flow. My God. This is like being on a horror show of “we said this, but we really meant this” and all your enemies are in the audience laughing their asses off. It does not stop. When I had ischemic colitis in 06, I begged to find out why. That is not a normal colitis. Part of your bowel dies for a reason: clotting disorder, obstruction to the bowel, drug use, etc. I do not use drugs, so we needed to find out. Everyone was like, oh who knows. Ischemic Colitis can be a so so thing or serious. I was in the hospital for ten days, passing nothing but blood for at least two, and 9 inches of my bowel was not rejuvenating. It finally did or I would have had to have it removed. I could have died. I had a serious case of it. This is all tied together. I have been on Prevacid for years, is this why I have B12 def? I have been giving myself injections of betaseron for four years. What has that done? I am just sick over all of this.

    • gregory barton says

      No. Your life is not over at 59. But you need to find a doctor, or some caregiver, who can explain what’s going on clearly and whom you can trust. Keep shopping around till you find one.

    • Chris Kresser says

      Jan: at 151 you really need B12 injections. Preferably with methylcobalamin if you can convince your doctor to use that (tell him/her studies have shown it is the best absorbed form with the lowest toxicity). Yes, 151 is low and you need to take action to bring the level back up. Another option is sublingual methylcobalamin – but I would highly recommend you do this under a health care practitoner’s care. You need to find out WHY your B12 levels are so low. If you have an absorption problem like pernicious anemia, which is not uncommon in the presence of other autoimmune diseases like MS, you will have to be on injections or at the very least high dose sublingual B12 indefinitely. I’d say go visit whichever of the docs you listed that you have the best relationship.

      • Jan says

        Chris, I got back the results of the lumbar punch today from my new neurologist and I do not show that I have MS, as the Dr. she replaced had diagnosed said. To complicate this even more, I was shown on MRI in 2006 to have a lesion on my midbrain that had grown from a previous MRI done in 2004. This is what started the ball rolling. When I had breast cancer in 04 I owned a small investment company. I had to close it but I had felt that I was not on top of my game for some time. To reenter the corp work environment at 51 was daunting to say the least so I had a full neurological work up. There was a problem in the brain stem at that time but they did not report it to me. After working for two years and struggling both mentally and emotionally, a Dr, ordered a MRI and the place had grown a bit and that was when I found out it was even there. It sent me to a brain surgeon at the hosp. where I ended up with this MS clinic that I am still seeing. He felt it had not grown but rather the MRI was slicing thinner. And that it was just showing larger. He saw spots on my brain, sent me to the MS doc. He diagnosed MS with the 261 B12 level in front of him and told me that the brain stem issue was totally gone every year since. Had disappeared altogether.

        Well, it has not. The neurosurgeon thought it was a hamartoma, something that is a malformation from birth, and not a glioma. However, my spinal fluid was full of protein so now he says it is due to this brain stem “glioma”. So, seems like I have a tumor on my brain stem,, worst place ever, and a B12 deficiency. I am seeing my PCP today at 3. What am I? When this started, my tongue would get thick, I could not speak correctly, like I was on drugs, could not spell, word find, emotionally I was broken totally. Could not train for new things and retain them. Yesterday I collapsed totally, and I can hardly walk. I am in intense pain in my legs at night and my entire body hurts. Am I doomed to this thr rest of my life because I was not treated in time? What stage would you think I am in? My red cells seem ok, there has been a problem or two along the way. After my breast cancer surgery, they were way out of whack and taking iron for 6 mos corrected that. They said I lost too much blood. I am giving myself injections. But with the other B12, the least desired one. I am going to take your recommendations to the dr. today. I also feel that there is some liability on behalf of the first Dr. who ignored the B12, and there are other issues with him. There is a reason he is no longer at the clinic. The new dr. recommended that I may want to go to the Mayo Clinic also.

        • Jan says

          One other question, if you are taking/giving yourself injections of B12, whichever kind, daily for a week, then have done it weekly for two weeks and have your blood drawn, knowing that it was 151 or lower when you started (the 151 was in Dec. I started the injections in April) I think that the doctor told me that she would expect to see it abnormally high, like in the thousands, initially instead of 457. Is that correct?

          • Kelly says

            Jan, it’s my understanding that different folks respond to b12 injections in different ways — and Chris is right — you need the methylcobalamin, preferrably without preservatives. You can get this at compounding pharmacies, but need a prescription from a doctor.

            I just read a study where a 67 year old woman with ‘white matter’ showing up on her MRI’s had complete resolution of her symptoms with high-dose b12.

            Google “B12 deficiency is commonly misdiagnosed” and you’ll pull up lots of information and hope.

            Best regards,


            • Kelly says

              I would also try to get a second or third or fourth opinion. Clearly the injections aren’t given frequently enough, and again, aren’t the right form of b12.

              • Jan says

                Hi all,

                Well, there have been developments since I last posted. My Methyl whatever is fine, I have been tested for everything that has been discussed on here. I have not taken too many or much prevacid, I had an endoscopic and colonoscopic exam with biopsies, no celiac, chrons, cancer etc. We are leaving no stones unturned. My lumbar punch came back with a protein level of 123. I have not had my B12 checked again, I am doing that again tomorrow, and I am on once a week again, plus I am going to do a 24 hour check for heavy metal poisoning. I am not as concerned about the form of B12, I am concerned with my levels getting at least to 500 and not stopping progression. So, herein lies the new information.

                The brain surgeon that I saw in 2006 and who did not seem concerned with the brain stem tumor, but preferred to consider it a hammertoma, a thing more like a collection of surrounding matter and not a growing entity, had to step back with the high protein and is now sayng it is a pilotic astrocytoma. However, this is a pediatric tumor and rarely in younger adults and is cured by removal. It is slow growing but gets large. Mine, being in the stem, mid brain area, would not be a great candidate for removal, but should have been watched more carefully if it is what he is now saying and I have been lucky. I am going to Duke for a second opinion. He said he would see me every 18 mos.

                Tomorrow I see a new Dr.,, a neuropathic Dr. to be assessed for CIDP. The high protein in my punch, along with the advancing numbness and neuropathy, it is halfway up my calves, and my hands that have been more like tuning forks are now becoming numb, I am getting scared. Yes, I have a B12 issue but I have much more. It makes sense. The high dose of prednisone helped me last fall, and that would be correct for CIDP. But., this disease is an autoimmine disease, a much worse case of Guillene Barr, incurable, not likely to cause death but unchecked or treated it can. It causes paralysis so my goal at this moment in time is stop this now. IVIG is the treatment thatI am assuming that they will try??? and then blood change out? I have told all of them, no more dye of any sort will go into my body and this can be brought on by vacinations. I was told by the MS doc to get each and every one that you can think of, all flu, shingles, any thing you can think of.

                Scared??? hell yes. The whole game has changed. When my b12 is checked tomorrow I will post what it is.


                • Dr. X says

                  Jan – your story is heartbreaking, though I did not read every entry. I’ve been in a similar situation… lost everything… figured out my own problem after no help from 30 doctors in 5 years. The thing you have to stop doing is seeing mainstream, Western, allopathic doctors. I don’t care how “expert” or famous they are… the more elite, sometime is not a good thing. You want to look for a good integrative medicine doctor, or environmental medicine doctor http://www.aaem.com, or even a naturopath. A holilstic approach is the only way to thrive with or overcome these chronic illnesses… not looking at it like a disease, as a singular deficiency (there’s more to MS than just B12 for sure), and especially as a drug deficiency. My neurologist thought I had CIDP and didn’t offer me any hope. I probably did have it, but a label didn’t tell me WHY I had it or how to get rid of it. Prednisone would have been horrible for me (as it is for most people and only covers up symptoms at best), as I found I was suffering from toxic mold poisoning, which does demyelinate (and yes does cause MS and CIDP and numerous other things). Keep looking for a deeper cause, but find a GOOD doctor from recommendations… be willing to travel. I was driven 11 hours to the doc I found online, when I was too weak and neurologically impaired to drive, or to even stay awake during the drive. And you are right… do NOT get any more vaccines! And keep your spirits high, as that can be more healing than any drug and sometimes nutrients (sounds nuts to some, but there are biological reasons behind how our thoughts cause illness and how our mental state can help to cure disease). Remember our bodies want to heal… we have to remove the barriers, not add more barriers (like vaccines, drugs, negative thoughts, stress). Best of luck to you!

      • Jan says

        I know that we get a lot of folks here with a lot of varying issues and complications, each different in it’s way. I get confused by recommendations and know that I need the guidance of my neurologist and I feel fortunate to have one that is on board. I do not have pernacious anemia, all the concerns with different blood issues that would affect my abilty to absorb B12 have been assessed from taking prevacid too long to my small intestine issues (had colonoscopy and endoscopy with biospsies). I was tested for the issues for MTHR, I mean she has left no stone unturned. But, when administered B12 shots and my levels reached 1513 and it was not stopping the progression of the symptoms, I did not expect it to correct them right off, she knew more was at play. I have no reflexes, ringing in my ears, blurry vision, exceptionally bad ataxia, just so many nasty symptoms. I do not have MS, my spins is free from any sclerosis, but my nerve conduction, and muscle conduction indicate an issue. If there were no brain tumor when they did the lumbar punch and found the high protein, I would be being treated for CIDP, I feel certain. The brain stem tumor in my mid brain has just complicated everything and truthfully I am so sick, I just feel like giving up. Sitting around waiting for the special blood work that the neuropathic doctor is doing I am so disheartened. I hope so much for the B12 to be it. As to why I am not uptaking B12? I wonder if anyone will care. Sometimes I feel like I am just sitting around waiting to die. I did make an appt fir a second opin on the brain tumor. But I do not want the records from the first dr. reviewed. How is that an impartial disgnosis? I just want to start treatment and get better or just have them all leave me alone and let me succumb. I am pretty depressed.

          • Rose says


            I would strongly recommend you get tested for gluten intolerance. This is an insidious condition which masquerades as over 300 symptoms and medical conditions. Google it, because there’s far more to it than I can say here. I have to say though, that gluten intolerance tests are notoriously unreliable. A small intestinal biospy might show a negative result, but if the damage in your gut is patchy, it could easily be missed. Gluten is making us all sick but sadly it will take decades before enough people recognise it. I noly discovered that I am gluten intolerant in my late 50s and have a stack of medical conditions I need never have had to suffer from if only I’d known about GI. I’m not sure if links are allowed in here, but hopefully the ones I’m putting in will be.



            Very best wishes

      • Ernie says

        Dr. Kresser;

        I was told about 4 months ago I had a severe B12 deficiency and was give a prescription to start B12 injections right away. My diagnosis so far is thrombocytopenia and will get retested in a few weeks and results soon to follow. What do they mean by nerological and mental problems due to the B12 deficiency? Also, I have been having pain in my right leg just below the knee and it feels like bone pain and my veins are popping more frequently… can this be related to thrombocytopenia?

        • Chris Kresser says

          B12/folate deficiency is a potential cause of thrombocytopenia, but also of neurological and cognitive problems because of the role B12 plays in the central nervous system. Yes, your leg symptoms sound like they may be related.

  33. Larry says

    Conventional Wisdom says that if you’re over 50…you’re probably B 12 deficient.
    So….I’ve taken a 1,000 mcg lozenge, 4-5X a week for a couple of years now.

    I had a recent blood test and my B 12 level was a bit high.
    It came in at 1165, which is a bit over the upper level of 1000.
    No health issues here other than some reflux issues.
    I’ll be going for another B 12 test in June.
    That’ll also include a complete blood test.
    Until then I’ve stopped taking any more additional B 12.
    Other than what’s in a multi.

    It’s interesting how everyone I speak to on this, hasn’t seen this before.
    High levels can be a sign of serious matters I’m told…but…how high ?
    Can the high level here be due to a daily B 12 supplement ?
    I’m the oddball on this one.
    As “CW” says you can’t take too much B 12.
    Maybe I’m the 1% who can.
    I’ll know more next month I guess.

  34. gregory barton says

    What to do in a borderline case? I just got the result: 465 pg/ml, which is above the 450 minimum of Pacholok and Stewart (cited above), but below the 500 minimum that you referred to in the case of Europe and Japan.
    What is the best option:
    i. eat more liver?
    ii. take a B12 supplement?
    iii. do nothing and test again in a year?


    • gregory barton says

      This website claims that optimal is above 800:
      “B-12 lab test: Measures an essential vitamin, B12, which can be low in hypothyroid patients due to low stomach acid. You are looking for an optimal B12 lab result at the top of the range. It is NOT optimal to simply be “in range”. If your range is similar to 180-900, a healthy level is 800 or higher. In the 500-800 range, you can benefit from taking B12 lozenges, specifically Methylcobalamin. It has been shown in studies that patients with labs under 350 are likely to have symptoms, which means the deficiency is very serious and has gone on for a few years undetected. Lab ranges are much too low for B12…in Japan the bottom of the range is 500.”

      • Chris Kresser says

        There’s really no support for that number in the scientific literature. That said, there’s little risk of toxicity with B12 and little harm that can be done by supplementing with methylcobalamin even if you have normal levels. And in fact, I have some patients that do have levels of 800 or even higher that still benefit from supplementing. Placebo? I’m not sure, but since there’s not much risk I’m not concerned.

  35. Jan says

    I saw my PCP yesterday. He did not seem very concerned with the deficiency. He said that I could do injections or subingual. He had the same results with both. I think that my biggest concern is my advanced neurological symptoms. Perhaps he is not figuring that into the equation. He is an excellent Dr. and said he had some research to do. I have always trusted him without qualms. But he did not really seem to see the need for the B12 type that I was pushing for. I feel that with my level on up to 457 after giving myself injections every day for a week and having done it once a week for two weeks before that level was attained says something about my body still not taking the B12 up properly.

    Bottom line, how long before I would just die if no one took this seriously, or became paralyzed or fell into dementia? I am just worn out with it all. I am tired of dealing with it. I am ready to lay down.

    • Elisabeth says

      Jan, please, take a high-dosage of vitamin-D3. As soon as posible. Even if B12 and folic acid and B6 are important to you, so is vitamin D.

    • gregory barton says

      Mooney’s website is remarkable. No doubt, he is a director of a supplement company and recommends his own products. But his depth of research is compelling.

  36. mary ann says


    Have you been tested for MTHFR? You might be deficient in other B vitamins such as folate. There are prescription forms of methylfolate (the activated form) such as deplin, metanx, and cerefolin. Taking methylfolate in conjuction with the b12 might help your neurological symptoms. You might try googling “MTHFR treatment”, or if you are in the WA state area there is a fantastic doctor named Neil Rawlins that treats B vitamin deficiency and MTHFR. You can even do a google search and find his MTHFR protocol online…

    • Kelly says

      I agree with everything Mary Ann says, except for one thing — Rawlins is not a doctor…he’s a patient who went through similar issues related to b12 and methylfolate and MTHFR problems. I’m looking into that myself…after 13 years of worsening CFS.

  37. Jan says

    I am in NC. I need to dig out the recent blood tests. I am not sure if folate was part of it. I know that the doctor checked my potassium because my legs and arms hurt so badly, especially at night. She was concerned that I was having a side affect to the B12 injections. But it was fine. I need to see what was looked at on the blood panel that was ran.

    • Freddd says

      Jan, I’ll lay it out for you. I have terrible spasms and a whole lot else from low potassium starfting at 4.3, which on the scale from 3.5-5.0 is mid-scale. On the scale from 4.0-5.0 it isn’t low either. Lot’s of people start at 4.2-4.3. Further pain, not pain from spasms, can be casue d by folatye insufficiency or paradoxical folate deficiency. Start titrating methylfolate until the pain is relieved. Thsi would be a far more general and inflammatory pain than potassium. Also, IBS, cracking skin around the fingertips, sores at the corners of the mouth, allergies, asthma, MCS, nausea, and so on might flair with low folate. Most need betrween 1600 and 15,000mcg to get rid of all folate deficiency symptoms depending upon how they react to folic acid and veggetable folate. The only kind of b12 likely to do you well is methylb12 and adenosylb12. There are 3 brands of Dibencozide (adensoylb12), one with folic acid. There are two 5 star brands of methylb12, Jarrow and Enzymatoic Therapythat produce more reliable results than injections. These will make potassium drop rapidly most likely becasue healing starts immeditatly and potassium drops by the 3rd day whern that happens.

  38. Susinn says

    I have a parietal cell antibody which has in the past resulted in macrocytic anemia from vitB12 deficiency. Do you know if parietal cell antibody is associated with other gut issues such as leaky gut or gut/brain axis issues? Do you have suggestions how to approach this other than sublingual B12 and folic acid?

    • Chris Kresser says

      First, don’t take folic acid – take tetrahydrofolate (natural folate). They have a different effect on the body, and some studies show increased cancer risk with folic acid. Second, you have to address the immune dysregulation, which is the underlying problem. That’s an involved process.

  39. Julee Ellison says

    Hi Chris,

    Both my Mom and Grandma took B-12 shots for years. After being sick a year+ ago, I recently was telling my vitamin guy about how I still have such muscle fatigue. He recommended that I add NOW B-12 (as Cyanocobalamin 10,000 mcg) to my regiment. He said to drink one tube a day for 3 days, and then one tube every other day after that.

    This seems like a high amount of mcg’s to me … or am I to take that much because such a small percentage is actually absorbed by the body?

    Thanks bunches!

            • Julee Ellison says

              I’m just curious … I bought the 1mg, but my vitamin guy said I should be taking the 5mg. Any thoughts on this?

              • Freddd says

                Source Naturals methylb12 was the absolutely worst methylb12 and had zero activity. It was tye only zero star brand we found. The two 5 star brands are Jarrow and Enzymatic therapy. 1mg and 5mg will all be at least 1000 tiomes better than any size Source Naturals.

                • Lynn_M says

                  At Phoenix Rising, I believe you said the “red dot” methylB12 was a zero star brand. The manufacturer of the “red dot”, “No Shot” microlingual brand of methylB12 is Superior Source. Is there any possibility you are confusing the name Superior Source with Source Naturals? If not, then is it possible you found 2 zero star brands?

  40. Jan says

    Hi Chris

    Ok, background again, was dx in 07 with MS, but was not told I had a B12 of 362. It continued to drop. 08 it was 331, was not recorded in 09, and in 10 in was 151. Dr. was released from duty at the clinic, new dr. found the issue and began reasessing MS. Has all but ruled it out. Has me on B12 shots, they are the cyancocbalamin, 1ml, did 1 a day for a wk, then 1 a wk for a mo, just finished, and will go to monthly depending on my count next week. My count after the daily and one of the weekly was 475. I am ok for all the other areas you recommended. All of them. I had them checked. I won’t try to type them all, my hands are numb. They are worse than when I started. My feet are numb and worse as well. The numbness in my hands is simillar to tuning forks, a reverberating feeling. I fall down, have no reflexes left when they are tested, none in my knees, elbows etc, no reaction when the bottom of my foot is scraped. I cannot heel toe, etc. Blurry vision, crossed eyes to the far left or right, nystamus in left eye and eye muscle twitching when tired. Both of my eyelids had to be done to control drooping last year. Also, I do have a midbrain tumor, a glioma, which is very slow growing, near the aquaduct, that the first Dr. told me had disappeared. It has not. Needless to say, I am very upset. I have constant ringing in my ears. For the past five or six years. The lumbar punch was full of protein. The nerve conduction test, evoked potential, showed very little abnormality. I am having panic attacks. I see the Dr. next week, the neurologist. I was going to turn this over to my family dr., but I have decided to keep with the neurologist since this started there, I have the tumor to contend with and the brain surgeon is on the same floor and they confer and my family doctor has so much to catch up on and this is so complicated.

    With all this info, and all my other numbers are in line, and also, I have a colonoscopy and endoscopy scheduled for next week, (I have taken prevacid for years, I have bad gastro issues), to see if there are any problems there that may have caused this B12 thing to begin with. I have spent two hosp. stays of ten days each passing only blood, once was ischemic colitis, and the other undertimed.

    So, is there anything else that I should be doing? Folate, all of that is good. All the things that you say to check were, it made me feel very good that my dr. had checked them, she is on top of this.

    • Elisabeth says

      Please Jan, did you ever check your vitamin D3…if you did not, you must. It is really essential

      • Jan says


        I will ask her to add it to the panel she is running next week if she has not tested for it but before I do, if she has not already tested for it, what is the importance of this in conjunction to my issue?

  41. Jan says

    Oh, and I forgot to add that she is adding copper and some other metals to my tests to see if there are issues with that trying to pinpoint my numbness.

  42. Jan says

    Ok, I went to the doc today. After doing IM shots of B12, once a day for a week, then just finishing weekly for four weeks, (half way through the weekly my level was 475, up from 151 at start), and today my level was 418. All my numbers are normal, my intrinsic value is fine, folate, liver, the Methyl thing, all the numbers for all the things you have said to check are great. My CBC is perfect except for a slightly elevated chloride. My neurologist has never had this happen. She is sending me to a hematologist. Please, any comments. I think that some of the feeling is returning to my feet and hands, it could be wishful thinking, but I think so. She said one thing that was very upsetting to me, that because I had psychiatric issues, depression and upset from a cheating spouse, I may be making things worse in my head. I told her that I was offended and rejected that. Who would not be affected by a life trauma, but I am not exaggerating that I have NO reflexes anywhere in my body, have vertigo, fall down, have a terrible gait, blurry vision and a brain tumor in my midbrain. What would you recommend now please. I just want to vomit, which by the way I do quite often. I am having a colonoscopy and endocopic procedure at the same time next week as I do have a history of gastric issues, ischemic and regular colits, and due to the vomiting they are doing the endoscopy. What else? I am lost. Please respond. I know that you are busy. But I do not know where to turn. I am doing everthng that I know. The test for copper has not come back yet. lumbar punch was very high for protein, like 200 maybe? brain tumor.

    • Freddd says

      Jan, I can tell you the most effective therapy for such numbeness I know of. You tan test the effectiveness of a 5 star mb12 in the correct qunatity by taking 50mg of Jarrow and 10mg of Enzymatic Therapy. This is 20 tablets, 10 of them larger than the others. You can likely place 6 of them at a time around the upper dental arch and every 30 minutes add 4 more. As these can be made to last 4 hours and this will be equivalent to an 10-18mg methylb12 injection you may very well feel it quickly. This will tell you what 3x10mg 5 star injectable mb12 can do for you. If you get acne then the mb12 was exposed to light and broke down to hydroxycbl and is ineffective. Further if you take 7.5mg of methylfolate 30 minuites before you take the mb12, absorbtion, utilization and retention will be improved. There are a buch of other cofactors that could be critical to healing but these will tell you how much is possible.

  43. Jean says

    Any suggestions or recommendations for those who don’t seem to tolerate supplemental B12 even when there is a known deficiency? I am very deficient in B12, but any attempts at supplementing (methyl and hydroxycobalamin) have caused extreme fatigue.

      • says

        my troubles started 2 years ago i was first dx with PA then vit d deficient then told i had a stroke,then cfs/fibro i feel worse and worse but im convinced its developed into MS but since having the PA and fibro dx thats all the gps blame it on and wont do any more for me the only thing that helps me get out of bed in the mornings is hydroxo, i get it from here http://www.b12-hydroxo.co.uk/
        Gp will only give it me every 3 mths so i use it weekly, do you know or think an infusion would help me?

    • Freddd says

      Jean, That is a potassium response indicating healing most likely. The usual necessary dose for healing related potassium is 2000-3000mg per day in 3-5 divided doses. The other possibility is a folate deficiency. Usually somewhere between 2.4mg and 15 mg of Metafolin (Deplin) is needd to support the healing induced by b12. If it is the folate then next it will be the potassium. If it is potassium, then next it will be folate.

  44. Elaine Garcia says

    I just received my first b12 injection yesterday. I have been suffering from symptoms of b12 deficiency for about 10 years, going to the Doctor (s) and coming out never feeling better with any treatment they provide. I read the book “Could It Be b12, an epidemic of Misdiagnoses” and so many lights went off in my head. At this point I had severe breathing problems (that is how I found out about b12 deficiency, by doing a search for “difficulty breathing.” I ordered the book online and read it cover to cover the day it came. The book mentioned that radiation treatment for cancer could cause b12 deficiency. I had cancer in 1989 and have 4 months of daily radiation treatment.Blood work was done weekly. After I was finished my GP had me coming in for b12 shots, eventually they were monthly. He didn’t call them b12 shots so I didn’t know what they were. I never asked, I trusted this old country type of doctor with all my heart. It devestated me when he had a stroke and had to retire quickly from his practice. He sent to me a doctor that he really liked, but, sadly, he wasn’t on my Insurance plan. I felt great and figured whatever that shot was, I felt so good I didn’t need it. After being away from the b12 shots my health went rapidly down the tubes. When my doctor would see me they had that look, “oh, not her again, I really don’t know what to do anymore, look on his face. After reading about b12 I asked him about b12 injections and he said i watch too much TV. I still didn’t have any connection between the shots I received after Radiation treatment and the b12 shot I thought I might need now. Memory was one big issure with me and kept getting worse. About a week later I sat straight up in bed and said to myself, “What was that shot Dr. C was giving me…one time he charged me only for the shot because the insurance was getting fussy. That shot only cost 5.00 in 1995. I knew it was b12. I looked on the internet and found his number (it had been 15 years since I spoke with him. We talked for over an hour, what a great Doctor. He was so shocked and upset that I hadn’t been getting the shot and that not one doctor I ever saw (especially with the Cancer and Radiaiton history) never, ever thought to give me a very inexpensive b12 test. He wanted me to have my Doctor call him that instant and get me back on b12 right away! My doctor was out of town for 2 weeks. The longest two weeks of my life. When she arrived back I say her right away and I was a nervous wreck, what is she, like the other doctor, just ignored the b12 issue. Well, she didn’t. She gave me a blood test and that very same day a shot of b12. That was yesterday 6/20/11. She is going to the doctor that gave me the b12 injections and converse wtih him. I couldnt’ believe it, the nightmare was over. 10 years of suffering very poor health to the point where I would go to bed and wish I would not wake up. Yes, a simple blood test would have given an insight into what was really wrong. I do recall that in the book, Could It Be b12, the author suggests that when a Doctor sees a patient with mulptiply symptoms that can’t be resolved they should check right away for b12 deficiency. I suggest, when not check a new patient right away and check routinely after that. So much suffering could be avoided. This is day 1 and I know it will take time (10 years is a long time) but I now have hope, hope I would like to pass on to others. I wouldn’t even want my worst enemy to suffer what I have suffered these past 10 years. I will never get those years back again.

  45. Jan says

    Hello all,

    My B12 is up to 1513! And I have CIDP, they are running some extra blood work and I will be starting IVIG treatments when it all comes back torule out lupus, etc. I am looking forward to getting the use of my arms and legs back. I have been through EMG testing and my nerves and muscles are attacked but the myelin only is affected at this stage. I am so excited to get the treatments and get better. I will take my B12 shots monthly and keep checking it.


  46. Elaine Garcia says

    Chris Kresser May 16, 2011 at 5:39 pm

    I prefer sublingual methylcobalamin.
    Chris, I am the person above that was so thrilled to find out that b12 deficiency was my problem. I had so many symptoms and I could not resolve. I was taking sublingaul b12, methylcobalamin for about 2-3 weeks before I got my first injection of b12. I went home, fell asleep, actually I more like went into a nod.
    Then I would fall asleep sitting up talking to my daughter. In the middle of typing an email. This happened 2x and lasted for a few days. This was the shot of cyanocobalamin. I felt so much better taking the b12 methyclobalamin sublingual. I am taking those again, but I would like to know if you would know why that happened with the cyanocobalamin? I read on message boards that this happened to other people.


  47. Janet says

    Hi! I was just diagnosed as having a B12 deficiency and looked around online and saw that one of the symptoms is “breathing difficutly”. I have had breathing trouble since the 1st of July and it is now the 21st of July. Doctors have found nothing wrong with my lungs and im getting 100% oxygen, my heart rate is normal, and my blood pressure is perfect. I just have this feeling of not being able to get enough oxygen. Its almost like someone is holding a thick blanket over my mouth and im struggling to breathe in hot humid air at all times, and on top of it, i have a permanent lump in my throat. So what my question is, would these type of breathing problems be included into the B12 deficiency symptoms?

  48. amy says

    I just came accross your article and I have 2 quesitons:
    I have recently gone through 2 miscarriages and they were my first pregnancies. Could this be a cause? I’m struggling to find a cause so I can go on to have a full term, healthy pregnancy. I’m not real careful about getting enough meat in my diet, more careful about getting fruits and vegetables but I am a meat eater.

    Also, my husband suffers from what he was diagnosed with as Diverticulosis . He’s had it for years, suffers about every other month from an attack, can only eat certain things to keep it from agravating, and he’s ready to finally take care of this, but doctors don’t have any solutiosn for him. Could this be a problem? He takes a lot of over the counter heart burn medications: tums mostly. He’s wants to have major surgery to remove the part of his colon that has this Diverticulosis but he could end up on a colostomy for the rest of his life and he’s only 37.
    I will also talk to my doctor about my issue but wondered if this is a correlation….

  49. Jinny says

    First of all this is not just a vegetarian/vegan diet issue….meat eaters are just as deficient!! Could be an environmentally issue on the body.. I am vegan and years ago had all theses symptoms and found it is not true that B12 only grows in the gut bacteria of animals. It grows in bacteria that does not have to be in an animal. I take a vegan form of B12 in methylcobalamin form made by Pure Advantage as a sublingual for the best absorption. The last time I was tested my levels were above 650. I can tell when I need to up my B12 because my hands fall asleep when I am sleeping…here is where I get mine http://www.vitacost.com/Pure-Advantage-B-12 Also I feel better now at age 46 than I have ever felt in my 20′s and 30′s as a “meat eater”!!!!!!!!!!!!!

    • Chris Kresser says

      I’m glad you found an approach that works for you Jinny. However, it’s simply not true that meat eaters are just as deficient as vegetarians and vegans. Countless studies prove otherwise.

      • Jinny says

        As always we have to be aware of who funds these studies…and who funds doctors and websites on the information they are providing…. The meat and dairy industry are Billions of dollar businesses a year!!

        “Many people have heard that vegans are low in B-12. That’s absolutely true. Meat-eaters are deficient, too. There is a minimum level of B-12 you need to survive and a maximum level that is optimal for long-term health. At the minimum level, (180-200 nano-grams of B-12), 80% of vegans are deficient, but 40% of meat eaters are deficient at these levels as well. When you look at optimal intake of B-12, (400 units in your blood), meat eaters are equally deficient. It is likely that 90% of meat eaters and vegans are deficient at optimal levels. The best thing for everyone is to take a B-12 supplement. When I was at Columbia Medical School in the 1960’s, they did a study that found that 30% of people judged to have adequate B-12 levels (mostly meat-eaters), had dramatically positive responses to getting B-12 shots. Depression went away, and sense of wellbeing was reported in many study participants. Even in 1960’s they knew that on average people are low in B-12. I just want to emphasize the point that everybody is low in B-12. It is a big problem.

        Why is this a big deal? People who are B-12 deficient have more brain shrinkage. With age, your brain begins to shrink. We can protect against a lot of shrinkage through simple B-12 supplementation.”

        • Jan says

          Hey all,

          I posted some time back, had been misdx with MS, new doc felt it was my deficient B12 (125 or something). She was thorough, as much as I know, testing M. Acid, intrinsic factor, all the ones that you guys have talked about. After two weeks of weekly, if I remember correctly, and then a month of weekly, I was only up to 500. It took amother month of weekly to get to 1500, which was not great for the amount I was getting (by IM shot). So, I was then dropped back t monthly, but the first month my level fell to 400, the to right at 500, where it has remained. My thing is, I am, seemingly, at the optimum minimal level for someone in my situation. The B12 shots helped my depression immensely. An issue I had fought most of my life, I am 59. But it did not stop the progression of the neuro symptoms that brought me to a dx of MS, then B12 def, ie: numbnes, tingling, falling down, unable to lift my feet to climb stairs, no grip with hands and all reflexes gone. They now have dx me with CIDP, a chronic form of neuropathy that is an auto-immune disease, similar to Guillain-Barre syndrome, but chronic and slower acting with the same results. CIDP will eventually paralyze you if not brought into check, is incurable but great strides have been made for treatment options and this rarely happens. I am a hot mess. Whatever should be the bad thing, is me.

          I did have a endoscopy and colonoscopy with biopsies, all clear. No other blood count issues until I was given treatments with IVIG, wherein they put other ppls antibodies from their blood into my system. My blood work then went whacky, white cells are too low, red ones jumped around for a minute. I also developed aseptic meningitis from the treatment, which happens to some ppl, and usually if IVIG works, it becomes your treatment method going forward at the time intervals you need, but if you get AM, you will continue to get it with each treatment. It may lessen, but you will get it.

          I have had good results and and bad from the treatments, and the Dr. may not allow more due to the side effects, but my B12 is hanging at around 400. This Dr. at first glance just looked at the US standards of 200-900 and said, you are fine, and I said, no I am not, ,please look into this. He did and is on board now.

          I feel lost. I also have a midbrain tumor in my stem. My protein in my lumbar punch was like 126, but a brain tumor elevates that also. Elevated protein is a marker for CIDP.

    • Julee Ellison says

      Wow! Thank you so much for that link!! I have been doing the sublingual tablets and I hate them ,,, they take forever to dissolve! I love that you just do one spray a day!! Thanks bunches!!

  50. cecilia says

    Hi Chris,

    My sister is trying to become a vegan, and I am trying to explain to her she may be B12 deficient. She gave me this article to “prove me wrong” http://www.naturalnews.com/029531_vitamin_B12_vegan.html although I know this article doesn’t seem very reputable, do you have any thoughts on what has been said in it?

    “According to Dr. Vivian V. Vetrano, vitamin B12 actually comes from coenzymes, which are already present in bacteria found on the human body (in and around the mouth, for example)”



  51. Julee Ellison says

    I have been taking the LifeExtension Methylcobalamin 5mg sublingual tablets, but do not like how long it takes for them to dissolve. So, when I read about someone on here that uses the Pure Advantage B-12 spray, I was so happy! I’d much rather do a spray.

    However, I just got it, and realized that it is only 500 mcg (0.5 mg). So, the question is, even though the directions say to do one spray per day … should I do 10 sprays per day to get the 5mg’s in?

    Thanks for any help you can offer!! Warmly, Julee

  52. Rose says

    I am so thankful that I found this website and the information I read about how a serum B12 test could be 90% out because it doesn’t differentiate between active and inactive B12. If I hadn’t read that I would still be thinking I was fine as my levels are very high. However, my RBC count has dropped over the last 3 years to the lowest level of normal. I fit more than one of the risk groups, being over 60, have low stomach acid and malabsorption due to a damaged small intestine from undiagnosed gluten intolerance.

    About 9 days ago I started supplementing with sublingual methylcobalamin, 1000mcg daily. I had blood tests done 2 days ago and my RBC count is on the rise! It has risen by .2 and I hope it goes up a bit more yet. I’m not sure if it will on the same dose or if I should increase it, but at least it is finally heading in the right direction.

    Again, thanks so much for the information on this site.

  53. Rose says

    Just a follow up to my story. I saw a doctor last week and requested an active B12 test. I was refused outright. Thank goodness I can buy B12 and self-administer. I dread to think where I might be otherwise.

      • Rose says

        Doctor said that my serum B12 test was so high, there’s no way I could be B12 deficient. I disagree, but doctor knows best, right? I am seeing a different doctor soon and will request it again.

  54. kt mcloughlin says

    Hi there, I was diagnosed with b12 deficiency 4 years ago at 23. My level was 96. I got injections over a period of months and my level went right up. I was then told I could stop injections as I was testing negative for pernicious anemia. I recently returned to my doc feeling so down and my level was tested and had plumeted again. I once again tested negative for pernicious anemia. i have recently had an endoscope too which showed nothing strange, thank god, and the specialist there said as my diet is balanced and no obvious underlining condition I can presume i have anemia and said that the test is not always right. Is this true? Can i still have pernicious anemia but not test positive for it? It’s really starting to effect me with memory loss, lack of concentrating and my face looks so tired all the time. I have received nearly 6 injections in the last 4 months andy level has only increased to 210. Feel quite alone as feel like its only a vitimin and shouldnt be affecting my life this much. Would love to hear from you, thanks

    • Chris Kresser says

      B12 levels between 200-400 have been associated with neurological damage in the scientific literature. I strongly suggest picking up a copy of the book I referenced in this article, “Could it Be B12″, reading it, and taking it in to your doctor. Many doctors are under-educated about B12 and the devastating effects of ongoing deficiency.

  55. kt mcloughlin says

    Thank you for such a promt response. I will order that book. I rang my doctor yesterday and as my level is 210 she said it is at the low end of normal and will only recommend injections every 3 months. I said i would like them more frequently to begin with to get my level up and she got really defensive. I said i knew my own body and the difference I felt before when I got my level up high was incredible ( different doc then who has emigrated since) but she just said no my level is in normal range now! my friend I live with is a nurse and she gives me the injections but doc is refusing to renew my prescription for any more then every three months. I am furious and i just think doctors in Ireland are so under educated on this condition. I am obviously going to look at changing doctors

    • coral says

      Hey, it’s not just Ireland they’re uneducated, it’s everywhere. Apart from Dr Chandy in England (perhaps Newcastle?) who has been giving patients B12 shots and basically changing their lives. he was nearly struck off for this though. I mean, perish the thought-a GP actually helping people and making them well! You can look him up on You Tube. The medical profession make me soooo mad! Do they want to help people or not?? Grrrr…

  56. Angelica says

    Hey all!!
    I stopped eating both read meat and pork about 11 years ago now. WOW, just did the math and didn’t realize it was so long ago. I am currently 23 years old. About 4 years after I had stopped eating red meat, my mother began to notice that I had been forming dark circles under my eyes. I had assumed it was due to a lack of rest because I was always on the go. I slowed down on my activities, and they darkness went no where. When I began Undergrad, it was very often that I would feel tired. Not only was I tired, but when it would come down to studying, I would be in the library for hours trying to retain information. In highschool, I was an honor-roll student, and I loved to learn, but this made me feel dumb. On my internship I would feel veryyyy tired, and would occasionally doze off. It wouldn’t matter how much coffee, or how many energy drinks I would consume, nothing really worked. I became extremely embarrassed, and this is when I began to feel as though something may be wrong with me. My mother encouraged me to take multivitamins and doing so made me feel a little better, but I began to neglect those. Since I graduated from Undergrad in 2009 I’ve had a hard time holding a job because of my dyer need to rest (falling asleep on the job). I started to think I has some sort of sleeping disorder or something. I had to get a physical for a job, and 3 weeks after the physical, I received a letter from the physician stating that were defenciencies found in my blood test. I ignored the letter because I was scared to find out what the issue was. My present job asked me not to go back into work until I was tested for narcolepsy due to falling asleep on duty (again). It was at this point that I that it was crucial for me to find out the results of my blood test in hopes that it will give me an answer to my weak, fatigued, cloud-minded body. Come to find out….my B12 is extremely low (says my physician). The first thing she asked me was if I ate red meat. She told me to go to the pharmacy and get the B12 vitamins. The thing that tripped me out is that something so simple had such a bigggg effect on my life!! I’ve been taking the B12 and seriously…this is no placebo or anything. I know my body and how it felt before and omgggg!!! What a difference!! No naps needed throughout the day, I feel sooo much better!!!! WOW!! Ok sorry for the novel but I just wanted to share that with you all!!! *be blessed*

  57. Angelica says

    Please excuse all of my typos. I was just so excited to read the other testimonials, that I was so much in a rush to give mine. Woopsie!! :)

  58. Crystal says

    I found that I have a b12 deficiency and I began supplementing with methylcobalamin. Even 1mg sublingual seems to upset my stomach and I feel pretty spacey and weird. I have trouble sleeping as well and I always take the b12 in the morning. Any advice?

  59. June says

    Hi Chris,

    I’m June all the way from St Andrews in Scotland…across the pond so to speak. Very interesting info’ you have there and thanks so much for sharing. I could spend all day reading the stuff, ( but I got lost after the 22nd posting and require laymen terms PLEASE!) I want to know what type of B12 do you recommend I buy, what brand and where can I purchase it whilst on a tight budget. As you know we ain’t doing so good, at the moment, on the financial front in the UK.
    Very hard to get a GP who will test you for vitamin and mineral deficiencies, still a bit of the old school stiff upper lip attitude over here regards new ways of thinking, but that is changing.

    Thanks so much and hope to hear from you soon
    Kind regards

    • Rose says

      It’s the same here in NZ, June. Can’t get vitamin and/or mineral tests at all. As far as B12 supplementation goes, as far as I understand it, sublingual B12 is the best. Solgar puts one out, 1000mcg tablet. I am using methylcobalamin (B12) drops. They’re only 50mcg but I take as much as I want of them each day.

  60. says

    Chris –

    Great post.

    I’d like to add the fact that B12 deficiency, while a huge issue, is not the largest problem.

    There is a genetic defect in the MTHFR gene which causes serious implications – similar to the B12 deficiency but escalate the effects more broadly and more seriously.

    Given that more than 50% to 70% of the population has one of more mutations in their MTHFR gene, it is an important one to evaluate in people.

    If someone has the MTHFR mutation, and they supplement with inferior forms of B12 such as cyanocobalamin, they are not able to transform it into the active form of methylcobalamin.

    The doctor will test their ‘serum cobalamin’ levels and say they are ‘fine.’ The issue is the serum cobalamin is a measure for the inactive B12 form – not the active form. That said, it is crucial to test for methylmalonic acid (MMA) to truly identify a vitamin B12 deficiency.

    What does this have to do with MTHFR mutations?

    People with MTHFR mutations cannot methylate B12!

    I am making this one of my specialties as people are not getting the information they need on it nor are they getting doctors knowledgeable in it.

    To understand the conditions which MTHFR may play a role in, I’ve written an article here:

    I hope you and I can do a podcast on this very important subject soon.

    In health,
    Dr Ben

  61. Margaret says

    Hum, I was just going to add the same thing — I had read an article recently stating that the “methylmalonic acid concentrations (either serum or urine) are a much more reliable metabolic measure of vitamin B12 metabolism”. Article can be found here:


    It is also mentioned in this article that produce grown in cow dung may contain more B12 than commercially grown produce. The author does not go into detail about this, but I wonder if one can conclude from this comment that healthy cows eating grass (and not fed antibiotics) would produce in their gut healthy bacteria that produce B12 and when their dung is used for fertilizer on human crops (assume no pesticides), the beneficial bacteria and their B12 producing capability is passed on to humans.

    To me, the ramifications of this is staggering — the pesticides and artificial fertilizers used in food production not only destroy the life in the soil, they deprive our bodies of the beneficial bacteria we need to produce B12. Add to that formula our medical system that uses antibiotics, vaccines and pharmaceutical drugs that all destroy beneficial flora in the gut and you have a recipe for disaster! I firmly believe that we have unprecedented levels of mental illness in this country due to lack of B vitamins, particularly B12, due to the destruction of beneficial B producing bacteria by the above methods.

    Dr. Campbell-McBride has written “Gut and Psychology Syndrome” and describes how the destruction of beneficial bacteria in the gut leads to damage of the gut which can produce a host of symptoms and illness — from dsylexia, ADD and autism to bipolar and schizophrenia. I would add to that list Alzheimer’s. She uses diet including bone broth, fermented foods and probiotics to heal the gut. There is a yahoo group for families following Dr. Campbell-McBride’s protocol for support and sharing of ideas. There are many inspiring stories of autistic children speaking for the first time after following Dr. Campbell-McBride’s protocol.

    I have suffered from B12 deficiency for a long time. I believe my B12 deficiency stems from 8 mercury fillings at age 12 as my health declined after that point. Now I also have a hernia and stomach ulcer which further contributes to my digestive issues and inability to absorb B12. I used sublingual B12 for years with okay results. I did not want to do injections myself and I do not have health insurance.

    However, the best results I have found for getting B12 have been to take a probiotic recommended by Dr. Campbell-McBride. The probiotic is Bio-Kult, it’s made in the UK and it contains a soil bacteria which Dr. Campbell finds the most helpful in treating autism. When I compare the results with this probiotic and taking sublingual B12, I feel 100 times better on the probiotic. My sleep, mental state and ability to think have improved dramatically. I seriously wonder if those with a high IQ might just have more B producing bacteria in their gut.

    One last comment — a friend recently returned from France and she told me she was denied a B12 shot. The physician told her that they have found a connection between B12 injections and cancer so they are limiting B12 injections to 4/year. This cannot be good for those of us with severe B12 deficiencies.

    Thank you for the article and I appreciate all the thoughtful comments.

    • Chris Kresser says

      Serum MMA is notoriously inaccurate and is not a good measure of B12 deficiency. Urinary MMA is accurate, and can be used along with homocysteine to determine B12 deficiency in cases where patients may have a falsely elevated serum B12 level (i.e. alcoholism, liver disease, intestinal bacterial overgrowth, lymphoma, etc.)

  62. Mona says

    In Dec. ’09 I was diagnosed with a B12 deficiency. My level was 85. I started with 1000 mcg injections of cyanocobalamin daily for 5 days. Then progressed to weekly until May of ’10 and since then have been getting injections every 3 weeks. My last level reading in July ’11 was 279.
    In Nov. ’10 I was diagnosed with Subacute Combined Degeneration of the Spinal Cord. I use a cane to walk due to my balance issues. I have next to nothing for vibration sense though my reflexes are increased. In the dark or when I close my eyes my balance is severely compromised. Tingling and numbness are present in my hands and especially my feet. My short term memory and concentration have been affected.
    It is confusing to me that none of the physicians I have seen are very concerned as to why, in the first place, I developed the deficiency. I am not a vegetarian, I do not drink, have not had stomach surgery of any kind. I did get tested for parietal cell antibodies ….. positive …. and for intrinsic factor antibodies …… negative. Not really sure what that means if it means anything.
    Also confusing is to why some of the doctors I have seen are saying that my symptoms would appear to possibly be non-organic?? One says one thing, one says another. According to them my levels are “normal” and I should be better by now. If I think back, I have been dealing with odd symptoms and had 2 emergency room visits before my diagnosis in Dec. ’09. Quite possibly if someone had checked my levels then it would have shown and I wouldn’t be dealing with this 22+ months later??
    If anyone has any ideas or more questions I should be asking, thank you in advance!

    • Chris Kresser says

      Mona: were you tested for pernicious anemia? That’s the autoimmune disease that causes severe B12 deficiency. Anytime I see levels as low as yours I immediately suspect that. Ask your doctor to test your anti-parietal cell antibodies. 90% of people with pernicious anemia will test positive for them.

      • Linda Kapin says

        Hi Chris
        I have really enjoyed reading your postings! Just recently I have been diagnoised with B12 deficiency. I am a 65 year old female. Oct./Nov., 2010 I was hospitalized for 22 days for breathing difficulty, severe swelling of body, especially feet and legs. Upon hospitalization my RBC was at 4. I was immediately given an !PO injection to stimulate my red cell count. However, my count did drop to 2. It would then rise a point or two, then drop a point. This happened for over a week. I do understand that I had double Phneumonia which would account, along with the extremely low RBC, my difficulty with breathing. Also, 2 liters of fluid was drawn from behind my rt. lung. Gradually my RBC did raise, and I was released from hospital when it was at 8. Dr’s. never did find a cause for my low RBC, nor for the unusual color of the fluid drawn from behind lung. After 22 days of test after test, no cause was found for my LOW RBC, nor for why it took so long for the count to rise. However since then, I am doing much better. At my last Dr. appt. Dr. said B12 low, gave me an injection and prescribed me Cyanocobalamin 1000MCG/ML. I forgot to mention that I also have acid reflux and IBS which keeps me house-bound often. Since my hospital stay I have gained a little over 25 lbs. and do retain a lot of fluid. My weight gain is NOT due to over-eating as most Dr’s. would want me to believe. Is there anything you might recommend me? ANYTHING would be appreciated!


        • Moongirl says

          My IBS went away when I treated my B12 and Vitamin D deficiency, which includes stopping my PPI (Acid reflux medication). Get the book Your Inside Tract by Gerard Mullin and Could it Be B12. I lost 31 pounds so far ONLY by stopping acid reflux medication and starting B12 and D3. Find a naturopath or an integrative medicine doc to help you get your acid reflux under control using natural means. I take HCL tablets before meals. I rarely have bad reflux anymore. I am 41 and was on PPIs daily for almost 20 years. I had IBS 15 out of 30 days in Jan, Feb and March. As soon as I started treating my B12 and D deficiencies it was GONE.

          • Donna says

            I’m not sure where to create a post so I am just responding here. I am a vegetarian and I can say emphatically that you CAN get B12 from nutritional yeast – NOT brewer’s yeast and NOT yeast that we all cook with. I put a tablespoon in my oatmeal every day. My folate, serum is 21.2 and my Vitamin B12 serum is 1044. I’m not hawking any particular product; I order mine from amazon, but your local health supply store may carry it. It has somewhat of a nutty flavor. So before doing anything else, I’d at least give the nutritional yeast a try. My GP asked ME how I have such good numbers.

            • Molly Malone says

              Nutritional yeast only contains B12 because it has been added to it = fortified. It is NOT naturally occurring, lest someone be deceived.

              Eating this yeast may well be a good choice, but make sure it is indeed fortified as not all are and therefore not all have B12.

              “It is a source of protein and vitamins, especially the B-complex vitamins, and is a complete protein. It is also naturally low in fat and sodium and is free of sugar, dairy, and gluten. Sometimes nutritional yeast is fortified with vitamin B12.” [http://en.wikipedia.org/wiki/Nutritional_yeast]

              “Nutritional yeast is grown on enriched purified cane and beet molasses under carefully controlled conditions. T6635, with the addition of vitamin B12, is an ideal vegetarian support formula and has an appealing cheese flavor. It can be sprinkled over popcorn or salads, added to juice, cereal, smoothies, gravies, soups or casseroles, or used to make sandwich spreads.” [http://www.bobsredmill.com/nutritional-yeast.html]

              “The vitamin B12 component in B12 supplements and fortified foods is made by bacteria and sourced from bacteria cultures; it is not taken from animal products. However, some companies might put gelatin in their B12 supplements, though this appears to be less and less common. It is easy to find vegan B12 supplements on the Internet or in grocery stores in developed countries.”
              “There are many vegan foods fortified with B12. They include non-dairy milks, meat substitutes, breakfast cereals, and one type of nutritional yeast.”
              “Brewer’s and nutritional yeasts do not contain B12 unless they are fortified with it. There is at least one vegan, B12-fortified yeast currently on the market: Red Star Vegetarian Support Formula. (Twinlab’s SuperRich Yeast Plus contains whey).”[http://www.veganhealth.org/b12/vegansources]

              “itamin B12 is only produced in bacteria. No plant or animal is known to produce vitamin B12. This is why we require dietary sources of this vitamin to meet our nutritional needs. Many animals, however, are able to concentrate and save vitamin B12 produced in bacteria. As such, animal foods end up being important sources of this vitamin. Plants do not concentrate or utilize vitamin B12 in the same way as animals, so plant foods do not provide this vitamin.

              Seafoods, in particular, concentrate vitamin B12 well. All eight of our listed excellent sources of vitamin B12 are seafoods. A single serving per day of many types of seafood will meet or exceed your daily intake requirement. Older sources may claim that some plant foods—tempeh or spirulina, for instance—can be good sources of vitamin B12. This is because the laboratory assessments we use to find the small amounts of this vitamin in foods can pick up the presence of related (but different) compounds. The only usable vitamin B12 you’ll find in plant foods is residual from manure or bacterial contamination.

              Nutritionists currently recommend strict vegetarians or vegans use fortified foods or supplements to ensure proper vitamin B12 intake. For our readers that follow this dietary pattern, we agree with this public health recommendation.

              Nutritional yeast grown on a molasses medium is an example of a food-based quasi-supplement approach that would provide a vegan source of vitamin B12. One widely available brand has more than twice the Recommended Dietary Allowance (RDA) for B12 in one and one-half tablespoons of yeast. Note that not all nutritional yeasts are rich in vitamin B12, and that you’ll need to check labels for details.” [http://www.whfoods.com/genpage.php?tname=nutrient&dbid=107]

  63. Mona says

    Thanks Chris for your quick response!
    Yes I did get the anti-parietal cell antibody test done in March ’10. It came back positive whereas my intrinsic factor came back negative. My understanding was if those were the readings I did not have pernicious anemia???
    On a side note, at that time, my Ferritin level was 9 ug/L. Also my Folate was >45.0 nmol/L. As of July ’11 my Ferritin is 12 and Folate is >40.0

  64. SuzieD says

    Hi Chris,
    I am just wondering if there is a link between low b12 levels and osteoporosis. I’m in my late 30′s and was diagnosed with osteopororis a couple of years ago (at the time it was thought it was brought on by use of steroids as I am an asthmatic, but the medics never got to the bottom of it). I am on Calcium & Vit D supplements but nothing else due to being of child bearing age. I had low B12 levels a number of years ago and received a course of injections at that time, but it was something that was never really checked after that until last year when I started to have scary neurological issues with muscle twitching, muscle cramps particularly in my lets, feet etc. The muscle twitching was scary experience happening over my whole body for weeks on end. My Gp ran some more tests and came back with low B12 and high platlets. My blood pressure has been on the high side on occasions over the last year. While a course of weekly B12 shots helped with the neurological issues, it was decided I would have 3 monthly shots. What was recently noticed by the GP is that while my B12 increases after shots, it falls dramatically after 3 months and thus GP has agreed to give me monthly shots just recently. I also suffer alot with colds and flu’s which I am beginning to think is linked to perhaps a low immune system as a result of the low b12 – could this be right? I’m an asthmatic so the cold/ flu experience is always that bit worse when I get it.
    I am just wondering what your advice is on the links. Pernicious anaemia was something my GP has never mentioned – should I look into this also? How is this diagnosed? I don’t think my FBC/ CBC has ever come back stating I’m low in iron so maybe this is not an issue. Maybe now that the GP has agreed to monthly shots, that is all I need to do. Any advice at all would be much appreciated. I am also interested if you have any advice on the low b12 / osteoporosis link. I am delighted I came across your site – I don’t think often this issue is taken seriously enough. Many thanks, SuzieD

  65. lilly says

    Hi Chris,

    I have some terrible symptoms and I am not sure if they are related to b12 difficiency or maybe some cortisol problem( i have pcos and insulin resistance)?

    The symptoms are: numbness and tingles troughout the body and face, severe heat and tingles in the faceand head(sensation like fever) , bloodshot eyes, sudden weakness and deconcentration and memory loss. These symptoms are the worst just after a meal! ( I eat low carb Paleo).

    What do you think it could be?Thanks!

  66. Sindee Edwards says

    51 years of age and working a 3 way police shift pattern full time. Underactive thyroide diagnosed 18 years ago, B12 deficiency diagnosed 5 years ago. I was anemic last year.

    I have been to the doctor for test 3 times now with complete exhaustion, aching legs, arms, neck and bad headaches. Tests show now my folic level is low. On 3 monthly b12 injection. I need my brain for work, but body and concentration is letting me down.

    The question are:- Does anyone have flue like symtoms after their b12 injections and is there anything else I can do to help my conditions.

    • Rose says

      Have you considered being tested for gluten intolerance? I was 59 when I finally realized that gluten was wreaking havoc in my body. Since going gluten free, my chronic fatugie has vanished. Also, B12 is hard to absorb from the small intestine if it has become damaged by gluten. My personal opinion is that gluten should be banned, period. Google gluten intolerance and the diseases it causes. You’ll be shocked.

  67. yasmin says

    Hello I came across your website and I just wanted to ask you some questions regarding b12 deficiency. I have many symptoms of the deficiency like anxiety. Panic attacks, loss of balance, foggy mind. They tested my b12 level and it was at 372. Which to some is believed to be within the normal range which is confusing to me as to why I have the above symptoms. Anyhow I take 1000mcg of b12 time released a day but I just started 3 days ago. I was wondering if 372 is in fact low enough to have symptoms as well as cause alzheimers and irreversible damage? Also how much b12 should I take daily? And this might sound ironic but when I take the b12 I feel a little anxious and have a little trouble sleeping, could that be from the b12 pill? I eat plenty of meat, chicken and all kinds of food so I am not sure how I got this low. Also is it better to take sublinual vs oral capsules? I just want some solid good answers from an expert. I appreciate your help thank you so much,

  68. B Johnston says

    Thanks for the informative post; what brand and dose of B-12 do you recommend? Not sure if you want to endorse but couldn’t find any recommendations as I tried to slog thru the long thread. Thanks in advance!

  69. Clare williams says

    Hi I’ve been reading these posts with a lot of interest. I was diagnoised with b12 deficiency four years ago and given oral b12 my levels increased and tingling and vibratingfeelings got much better my levels were 158. My gp took me off b12 twice as my levels were high but my symptoms cane back. Object changed my gp and my levels were 258 the gp told me they were normal and refused to treat me. I told him that my levels were158 at one point so he gave me an injection this helped the symptoms but they did not go like they had previously so I asked for more frequently injections so I’m on one every two months. The go told me the symptoms were not due to by b12 level ad they were normal at 377 I still have symptoms the gp referred me for verve conductive tests which were 100 per cent normal and now I’m referred to a neurologist and I’m worried it’s ms but my symptoms were ok when I was on 50 mcg tablet per day. Are theses symptoms of ms?

  70. angola says

    I have not been eating meat and have had neuro problems. I will resume meat. How much do I need? Is a couple of buffalo or hamburgers a week enough? I will ask my neuro to give me rx for b12 injection. I have had inner tremors and one episode of violent shivers along with nerve pain and swollen tongue, mouth and tongue sores. Also diagnosed with eosinophilic esophagitis. Any connection between that and B12 absorption problems?

  71. Angela B says

    Hi. Very Interesting information. I had a B deficiency test done a month ago. Dr. Sent it off to Mayo Clinic. A week later I had a notice of Urgent and a phone call. Dr. ordered me to take 50 mg of B6. I went and bought a liquid b complex that has 50mg of b6 in it. I take medication due to anxiety, and antidepressant zoloft. I have been on zoloft for 14 yrs. I have been taking the B complex for two weeks now and I am getting these “zaps” all over. This I was told was from a neurological problem …this happens every time I stop my zoloft for 2 days, however since I have been taking the B complex, and the zoloft…the zaps are here, I feel weird and am really confused feeling…what is going on? This is really scary to me because it appears the zoloft does something to the neurological system and this b complex is battling that. The reason I asked Dr. for B test, is I was having very bad symptoms for along time…including swelling of lymphatic system…throat, neck…different area’s of internal areas of body, very bad digestive problems, anxiety, pmdd, or a form of mild depression, I am certain there is some link to this with my medications and B …..and my son…he is high functioning autistic…could this be a problem as well. My Dr. had said that B deficiency (not just B12) is very rare. Why did he order B6? I really am praying for some ideas or tests to ask for or what kind of dr. I should see because my family Dr. seems to not know a whole lot about this. Your advice would be very appreciative. :)

  72. Kim says

    I started with sensory problems and pain in my joints when I was about 21, shortly after the birth of my son. Long story short, after seeing several doctors and having some investigations they decided I had fibromyalgia. I wasn’t so convinced by the diagnosis as although I exhibited many of the symptoms I had many other symptoms that were not covered by the fibromyalgia umbrella however, feeling like the Dr’s were seeing me as some crazy hypochondriac I had to accept their decision and just get on with things, albeit with the assistance of crutches as I could no longer walk unaided.

    Fast forward 5 or so years during which time I had many symptoms such as intermittent burning feet, with intense pins and needles which I casually mentioned to my haematologist (I have an auto immune disease chronic idiopathic thrombocytopenia) who said it had nothing to do with my blood problem and did not investigate further. Then I noticed that my fingernails had developed ridges in them and decided to see if I perhaps needed a vitamin supplement as i have been vegetarian for 20 years. After a search online I was shocked to see the signs and symptoms of b12 deficiency, many of which I clearly had, I went completely grey by the time I was 25 and no one seemed to see this as an indication of anything being wrong.

    Next time I went to my haematologist I asked him to test my b12 levels at my next routine 3 monthly blood test, he agreed but said it would be unlikely to be low. However, they were at 192 and when I went to get these results I actually saw a different doctor due to mine being busy with new patients and I had to ask if the results had come back … kind of expecting them to be normal and she looked and said … hmm, yes they are low …. and your iron has been low …. forever. She put me in for more tests for the intrinsic factor, celiacs and thyroid test and for a repeat b12 test in 3 months with no supplements in the meantime. When I went to get the results, the intrinsic/thyroid and celiacs test results were not back but my b12 had dropped further to 183 and my iron levels had also dropped.

    My consultant has put me on monthly b12 injections and is seeing me again in three months. Had my first jab today so of course have not felt any benefit yet but I hope to perhaps in the future, although I would imagine that much of the nerve damage I am exhibiting is now irreversible.

    One other thing i would like to mention is that from time to time I have been treated with short term, very high doses of steroids and long term lower doses of steroids for my thrombocytopenia when my platelets have been very low, during these times I felt a great deal better in myself as a whole, I read something yesterday about steroids actually helping the absorption of b12 or something along those lines and wonder if this is why I always felt so well on steroids and so dreadful when not.

    Doctors really need to be on the ball with this, luckily even though I have to walk with elbow crutches and am in a lot of pain on a daily bases I have managed to stay in work and still contribute to society but this has only been due to my own determination and I am sure there must be a lot of people out there on welfare etc when a simple b12 shot could allow them to lead full and healthy lives. I have written to the BBC today about my case and am hoping that some media exposure could really get this discussion going especially with regards to the so called ‘normal levels’ decided by the NHS, which are clearly too low.

    Sorry for the long post and I understand if anyone says tldr … but I felt it important to give the whole picture

  73. Kristin says

    O.k. so here’s my question… my B12 has been falling steadily for about a year despite taking 1000 units of B12 a day… first 186, then 170, fell to 156, was 130, and so my GI specialist tested me for pernicious anemia ( I should mention I’ve also been dx’d with Fibromyalgia last March). I’m still waiting for the results and it’s been over a week since the test (tested the B12 level too… I suspect it is lower given my level of fatigue, brain fog, and hand foot involvement). I’ve recently had a plethra of other issues, including sternum pain, rib pain, chest pain that radiates to my back in and around my left shoulder blade, and hip pain. All of this feels unlike my Fibo symtoms, and more like bone pain. So let me get back to my question… If this pernicious anemia test is negative… should I be worried? Could there be another serious underlying problem?
    Thanks for your time and assistance.

    • Beth says

      Hi Kristin,

      I am not a doctor but your description reminds me of an autoimmune condition I was diagnosed with. The rib, sternum and back pain get worse when laying down and are somewhat relieved by movement. Google reactive arthritis or ankylosing spondylitis.

      I’ve also had a lot of neuro symptoms similar to what have been described in this thread. My doctor has me on B 12 and at times I have been anemic in the past.

      Anyhow, good luck!

  74. Carole says

    I recently moved from Scotland down to England ….. I was diagnosed with PA over 20 years ago and have been having injections of B12 6 weekly for the past 10 years ( prior to that I started for a few years 12 weekly then went to 8 weekly ) When I registered at my new GP he refused to give me by injection ( which was due ) until I had a blood test. The test came back with B12 levels of 1152 …… and he is now refusing to give me my injection until results of a further fasting blood test are back.
    I am beginning to panic now …… not only ( because my injection is nearly a week overdue ) do I feel lethargic, headachy, woolly headed and generally unwell, but I am not sleeping at all because I am so worried this GP will refuse to give me B12 jabs at all. Within 36 hours of having my injections I always feel ‘ back to normal ‘ bright, alert and my headache disappears …… I feel my life ( and that of my family ) will be ruined if I don’t have my regular injections. What I can’t understand is why …. after 20 years of my B12 injections alleviating all the awful symptoms I get, this GP can think for one minute I don’t need them ?? I know my levels were high in the blood test but surely the remarkable change in how I feel after having my jabs speaks for itself ??

  75. Lucia says

    Thank you for the great post and information Dr. Kresser!

    To those in doubt about the seriousness of B12 deficiency, I can tell you finding out the HARD WAY that you are deficient is horrible. In May 2007 when I was 30 I ended up in the hospital with a severe case a ataxia and nystagmus. I was in the hospital for 8 days, where I was initially diagnosed with MS. After almost every possible test available was performed on me (3 MRI’s, Cat Scan, Spinal Tap, blood tests every day, to name a few), they only thing that was wrong with me was a B12 level of 110, with sclerosis of the brain caused by the deficiency. Since then I’ve taken B12 shots every month, and have been much better. There was a period when I doctors were trying to wean me off of B12, but that caused me a severe metabolic imbalance, so I was back to B12 shots again.

    Right now, after new B12 tests, it was discovered that even though with the monthly shots I take, my B12 level is still low (475), which dropped to (261) after 7 weeks with no B12 injection. So, in addition to being back to B12 shots (of the Cyanocobalamin kind), I’m also supplementing myself with sublingual Methylcobalamin. Hopefully this will increase my B12 levels back to normal (I hope at least to 600), while my doctors try to figure out again where in the process I seem to not be assimilating B12 (I’m a meat-eatrian, with no reason WHATSOEVER to be deficient).

    Word of advice: The only reason why ((it seams)) I was not diagnosed with a B12 deficiency before, was because doctors had me labeled as having depression and anxiety, which was causing me to have low body weight -all bullshit!. They had me on medication which improved my mood, but physically I was still deteriorating. I had to end-up in the hospital for anyone to realize my B12 deficiency.

    Anyhow, wish me luck!
    But seriously, if you’re vegetarian or vegan, or if you find yourself tired and achy all the time and unable to keep a decent weight, have your b12 level check -it is worth it!

    Dr. Kesser: Are there any other tests I should demand from my Doctors? The only one I know they did, was Intrinsic Factor, and supposedly that one came negative. Any help would be appreciated!

  76. Jinny says

    I highly recommend the book “Could It Be B12″ for all of you that have questions….it is a wealth of information. The author’s website is b12awareness dot o r g

  77. anonymous for now says

    Hello All,

    As it turns out, after being dx with MS for 4 years, injecting betaseron, having no tests that confirmed the dx, and my MRI, while consistent with MS, was also consistent with normal aging, I also had a brain stem tumor in the mid brain. That was batted around for a bit. Symptoms had been, poor gait, when I bent over, I fell down, vertigo when I would lay down, sensation of tongue becoming thick and causing difficulty in speaking, rare nystamus, hypersensitivity body wide, including sexually and sometimes feeling out of it with the sensations, in a fog. My evoked potentials, normal and he ran no other tests. The brain surgeon dismissed the tumor as probably a hamartoma, which is a growth from birth, non growing by itself and of no consequence. He sent me to his MS colleague for some lesions he saw and said “everyone I send to him has MS”. The MS clinic Dr., who made the MS dx, made it based on the above, started the shots, and while I got better, chances are I would have anyway, had been on topomax for some time and had already gotten better but relayed the symptoms previously had to him. My B12, which he drew but did not tell me about, was 261 dropping to 231, then he skipped a year, then it was down and finally it hit 151, my point being it was too low and it was dropping with no notice by him, a neurologist who knew enough to order the test outside of normal blood work but obviously either did not care or did not read the tests. I could go either way with this as he also was telling me each year the brain tumor was gone, when indeed I have had the displeasure to learn it was not, and also that it is not a hamartoma, or so the surgeon has back pedaled on. I, personally, have no idea what it is, but it is not growing.

    To add to this mess, my symptoms were better by the time I came to him as I was already on topomax, that helped me with most of the bodily things. My personal life took a nose dive with a spouse who confessed to living a double life for the past 37 yrs in 2008, lost both breasts to cancer in 2004, father died in 2007, the women my spouse choose were all my friends, etc. I have been emotionally decimated over a short time period. I also closed a thriving investment company, was forced back into corporate America at age 51, with severe cognitive issues, so with all of this I was off kilter.

    I am saying all this to say that after I followed Dr. MS to his private practice in 11/10, bells rang and I went back to the clinic where the replacing Dr. told me she doubted very seriouly my dx and went about determining if I had MS, and disproved it. Her philosphy is, you dx MS when you rule everything else out, which he did not. The cognitive issues were correct/helped greatly with B12 injections, (I have had all the required tests for everything discussed here before we go over that, no pern. anemia, gut issues, etc., all levels of the things you check, were checked) I am having a hard time getting my B12 above 400 and will deal with that as I can, I am struggling with so much.

    I have been dx with CIDP and have a peripheral neuropathy with absolutely no doubt. I have demylation of my nerves in my legs, thus the numbness in my feet and hands are due to this. And, it is local nerves proven with EMG, not brain as would be the case with MS. My protein count with a lumbar was 123. I have had IVIG, with serious side effects and cannot take them again, and most recently medusol (prednisone), 1000 mgs infused over three days, so that I had 3000 mgs in three days (any of you who have had prednisone, taken the normal 80 mg, dropping down over 10 days, how do you think 1000 mgs, infused over 1 hour, three days in a row made me feel?), and it made me absolutely insane. It has been four weeks tomorrow since my last treatment and I cannot see a benefit from the steroid, but can still taste it in my mouth, so I am reluctant to do that again. I did get a benefit from the IVIG, I had reached the point that I could no longer lift my feet and as a result of IVIG, I can do that now.

    The hospital that hired Dr. MS, and forced him to leave due to conflicts in his behavior and protocol, has been deliberating my case as well as several others, to determine damages. They sent my case to four esteemed Dr.s across the country for their opinions, did Dr. MS make a valid dx based on the information gathered or not? Ones opinion comes in tomorrow, two say yes, although my Dr. says that one of those two says he will not say, and one says no, he did not do due diligence. The risk mgmt ppl say, “your numbers were within normal ranges, those being 200-900, while he was here and only dropped below when he left”. Never mind that they were below 300 from the start and dropping and he ignored them. Never mind that I am properly dx with CIDP (chronic inflamatory demyeliating polyneuropathy). CIDP is considered by some to be the chronic form of Guillain Barre if any of you know of that disease, while others say that it has the same effects but is not actually the same disease. However, the end results would be the same were it not treatable or brought under control. I, so far, have not found a treatment that will work for me for the long term and due to the fact that I was not properly dx and treated from the get go, or even when my feet felt like I was wearing socks all the time OCT of 2010, and I reported this to Dr. MS, it goes to another level. I am seemingly progressive with little to no remission. Dr. MS wanted me on Tysabri, and to those who are aware of this medication, it is a wonderful med that is to be used when you have exhausted all other means, it has a fatal side effect and I was not going to do that. All the ppl in his outter office as I waited to see him in private practice were on Tysabri. You make your conclusions. He told me that he could tell I had MS lesions all the way down my spine by looking at a cervical mri, neck only. He told me that a place that he showed me on my MRI that was bright, had a lot of uptate of dye, was MS. It was NOT MS. He was using scare tactics to get me onto tysabri, imo. He was pushing a medication that he told those of us who attended many seminars he gave where he said tysabri was a drug only used as a last resort when all else failed. Yes, there is a test to see if you carry an antibody, and if you do not you cannot get the fatal side effect. You can walk out of the office and be exposed. There is not a shot to keep you from being exposed. It is all BS.

    I need to prove to the risk mgmt dept with clear cut, concise material from a source that they will accept that the numbers we use in America are low, that we, in America, are reassessing this number. I need a place to go, a clinicians review area, where they make these rules or whatever you call them, that I can present to this unlearned man in risk mgmt. But, it will have to be something he cannot shoot down. I have the charts from the CDC from 2009 showing the difference they use for age ranges, that helps, but is there a place to go and download some assessment from a group like the CDC or a medical association?

    I lost my career, my pension, my retirement stability. I do draw disability from my job, which is decent but I lost my stock options, my life. I worked hard all my life and have little to nothing to show for it, I had to use all that I had, retirement funds, etc, to stay afloat after breast cancer in 2004, until I could go to work when I closed my business. I was working on replenishing my stores and life, and with the improper dx, I lost my hard gained licensure, status and potential. At that time I was 55, you do not keep starting over. If they had properly dx me, treated the B12, I could have continued to work and I would have moved up. Not down. Or out. Now, I cannot augment my income or life, and all so someone could build a clinic. I have no idea if the medication I gave myself will have any effect. I just need help.

    Sorry to be so long, I have had permanent damage and there are probably ten or more of us who were improperly treated and dx by this man, and not really knowing the number, it could be many more. The person who called this out to the hospital was the doctor who replaced him, not any of us. She was appalled at the number of patients who were misdx as well as the number of ppl who followed him to private practice and returned saying he was scaring them into tsyrabi. Of course I am not done with this.

  78. says

    I feel strongly that many people are deficient in B vitamins. Factors in our current diets contribute to rob our bodies of B’s. I think that most people would benefit from supplementing. However, believe that it’s best to take a B-Complex supplement – to get the B vitamins closer to the way you would find them in nature – or food. You don’t find isolated vitamins in nature, and reminds me too much of drugs.

  79. Vivek Mittal says

    Thanks Doc. That was very informative and am sure will change my life for good.
    I am a 48yr young vegetarian male in India just diagnosed with B12 & D3 deficiency by my doctor here. My B12 level is 104. He has put me on methylcobalamin both injections for 4 weeks (twice a week) and orally 1 tab daily. I never thought it is so serious. I would have taken it lightly if I hadn’t read this article of yours. Would appreciate some further clarifications.

    1. How long do I have to stay on this medication?
    2. Can this be treated by one course of medication or will I have to be on this throughout life?
    3. The symptom that worries me most is forgetfulness. In fact I won’t be wrong if I could say it seems like the early stages of Dementia. I have trouble recollecting thoughts and find very hard to concentrate on 1 thing. My mind keeps wondering. I understand this B12 deficiency could be the cause. If yes then will be restored once my B12 levels go up or will it remain same but not deteriorate maybe??
    4. Is there any vegetarian product which has B12?? I eat eggs and other dairy products.

    Would highly appreciate your advise.

  80. Tiffany says

    I was diagnosed 2 days ago with a B12 deficiency. My level is at 63. I am 29 years old, have been eating paleo for several years now, and have been struggling with many symptoms for quite some time. Anxiety, panic, digestive issues, and fatigue to name a few. I am going to have the doctor test me for IF antibodies and anti-parietal cell antibodies to rule out pernicious anemia, but the doctor said she didn’t think I had an autoimmune condition based on the other lab results. My question is…why else would my B12 levels be SO low? Anything else I should look into? Thank you!

    • Chris Kresser says

      It’s almost certain to be pernicious anemia if it’s that low. Other possibilities could be atrophic gastritis or another functional/inflammatory gut condition.

    • Freddd says

      Hi Tiffany, It’s difficult for the b12 level to get that drastically low without something essentially totally blocking it. However, as the solution is the same, get b12 into yourself and needed cofactors for healing. If you take Enzymatic Therapy B12 infusion, Anabol Dibencoplex (AdoCbl, the mitochondria b12) and L-methylfolate, you will need to taqke potassium as well as your levels will plunge on the third day as cell formation goes into high gear.

  81. Jen says

    I’ve rang my doctor (today) for my blood results and was told that i have boarderline B-12 deficiency. and got to see my doctor tuesday to find out more. I’m only 25 and got diganosed with Iron-deficiency anemia 2 months ago and now this, does anyone know if the 2 are related at all? I don’t have many of the symptoms of B-12 only the usual tiredness, headaches (which i asummed was down to the iron-deficiency…. I went to doctor to have a blood test for Coelics as i had symptoms for this and the B-12 showed up. Can mouth ulcers and loss of hair be a sign of B-12 then?

  82. Sanda says

    My mom’s B12 level is measuring the exact same number for two years in a row, 1107 pmol / l. I checked her results and they were done on different dates, not a mistake. She has PA; received monthly injections for a year, and then received four injections in one week in aug 2010.
    My question: What does this indicate? Is it suspicious that the number didn’t change at all? Her GP doesn’t know what to make of it. Also, should she resume injections or supplements (she has various symptoms mentioned here)?
    Thanks for the info, great site. Appreciate it,

  83. Corvus says

    Hmmm, I looked at the vegetarians b12 studies you posted and they said they had lower levels but not that they were deficient. The vegan one did not have an abstract to read so I couldn’t read the results of that one. I am skeptical in your intention in writing this. Bacteria like nutritional yeast have alot of b12. Why did you leave that out of your article?

    Before I was vegan, my iron levels were really low and all other nutrients were messed up. I have been vegan for 5 years and have never had a b12 deficiency. My tests have always been in fine range as have other vegans I know who have gotten b12 tests.

    I do take a vegan multivitamin to be safe but I also did that before I was vegan. My b12 sources are all plant or bacterial and my levels are fine as are other people I know who have been tested, and their vegan kids. The vegan kids are all healthy, smart, cognitively functioning well, and growing great. I hear a lot from people that vegans are this or that but I never actually see it in real life. I do see a lot of illness from meat eating in real life quite often. And, from my research of studies published, I have found a lot more evidence that eating animals makes people sick than veganism. In fact, it is really hard to find studies that say veganism is bad for you, but very easy to find studies showing that eating animals is bad for you.

    I’ve also read studies that say that vegans may be deficient in b12 or whatever, but when compared with animal eaters, the animal eaters are always deficient in a bunch of nutrients, not just one or two. So, rather than conveniently focusing on one nutrient (which may make it look like veganism is unhealthy), why not look at the whole system? Why not focus on a culture and system that subsidizes animal farming but not plant farming, therefore making eating animals an easier way to get some nutrition for some people, even if it does clog their arteries in the long run? Why not focus on the fact that a balanced vegan diet is good for you and food politics and accessibility in an animal corpse eating society probably play a huge role in any deficiency?

    • Chris Kresser says

      Not a single credible study listed on that page. I’ve posted several, and just take a moment and search Pubmed and you’ll find that B12 deficiency is very common amongst vegans.

      For example, this study showed that 50% of vegans are B12 deficient and would be expected to have a higher risk of developing clinical problems due to B12 deficiency. http://www.ncbi.nlm.nih.gov/pubmed/20648045

      • Corvus says

        The latest data on the dietary intakes of vegans was just published last month.[1] The diets of about 100 vegans were recorded for a week and were found deficient in calcium, iodine and vitamin B12. Using the same standards, though, the standard American diet are deficient in 7 nutrients! The diet of your average American is not only also deficient in calcium and iodine, it’s deficient in vitamin C, vitamin E, fiber, folate, and magnesium as well.[2]

        Not only does the American public have over twice as many nutritional deficiencies in their diets, vegans were shown to have higher intakes of 16 out of the 19 nutrients studied, includeing calcium. The vegans were getting more than enough protein on average and three times more vitamin C, three times more vitamin E, three times more fiber. Vegans got twice the folate, twice the magnesium, twice the copper, twice the manganese.

        And of course the vegans had twice the fruit and vegetable intake and half the saturated fat intake, meeting the new 2003 World Health Organization guidelines for fat intake and weight control.[3] Almost 2/3 of Americans are overweight.[4] In contrast, only 11% of the vegans were overweight. Almost one in three Americans are obese.[4] Zero of the 98 vegans in this study were obese.

        So when a meateater asks you “Where you get your B12?” You can counter with “Where do you get your vitamin C, vitamin E, fiber, folate, and magnesium? And while you’re at it, you can ask them how they keep their sodium, saturated fat, total fat and cholesterol intake under control (not to mention their weight).[5]


        [1] Results from the German Vegan Study. European Journal of Clinical Nutrition 57(August 2003):947.
        [2] USDA. Food and Nutrient Intakes by Individuals in the United States, by Region, 1994-96.
        [3] World Health Organization Technical Report Series 916. Diet, Nutrition and the Prevention of Chronic Diseases. 2003.
        [4] Centers for Disease Control.
        [5] Then you can finally answer their question and proudly say B12 fortified foods or B12 supplements Of course the fact that we’re seriously deficient in B12 should not be taken lightly. Evidence suggests that our low B12 intakes make be shaving literally years off of the lives of vegetarians and vegans, so make sure you get your B12!–I recommend ” Vitamin B12: Are You Getting It? ”

        Source: http://www.veganmd.org/september2003.html

        • Jan says


          I don’t feel like I should apologize for eating meat. And, not all meat eaters are gulping down trans fats and junk, ok? Not all of us are calcium deficient, etc. But, B12 does not exist in vegetables, It is only available to humans who decide to eat a strictly vegan diet as a supplement. So, it is a fair question for someone to ask a vegan, but not for a vegan to ask a meat eater.

          I am not sure why it feels that your posts are angry, or attacking, do you feel that you are being criticized for not eating meat? I hope not. That is a personal choice and I support your choice. I just don’t like to feel attacked for mine. Sorry. I am not B12 deficient because of my diet. I am not deficient in any other area, or for any other element or vitamin.


          • Corvus says

            I was just dispelling the myth that all vegans are nutrient deficient and that eating animals is the superior diet. Both diets require supplementation. The meat eating diet just requires a lot more. I think it is you who are feeling attacked by my post.

            • Jan says

              Your posts are almost hostile toward meat eaters, and not all meat eaters need supplementation. I am curious about your stating that you get your B12 from plant or bacteria? Really, I have never known of any source for B12 outside of animal sources, or supplementation. What bacteria or plant do you use to provide B12 to yourself? My vitamin and blood panels are great, I only have an issue with B12. And, I am sick with a brain tumor and a disease called CIDP. I have reached a point where I just do not enjoy eating. End of story.

              I do not feel attacked but I feel hostility from you, and it becomes uneasy after a bit. You seem to be challenging everything that Chris says, and personally, I trust his sources as well as some other solid sites offered. I am not into random sites that just come up with data.

              I do not believe that meat eaters require a “lot more” supplements than vegans. Sorry. You are biased. And I do not think that all diets have to be supplemented. Sorry. I am not with you on that either. Many ppl do not require additional pills to be healthy.

              I do not think that all vegans are nutrient deficient, but B12 is an issue for reasons cited.

              • Corvus says

                If my post was hostile toward anyone it was the man using tiny bits of science and leaving out the rest to sell his paleo diet ideas and try to get people to believe that consuming animal corpses is good for you, while simultaneously trying to make it look like veganism is bad for you. Neither is true.

                Many vegans don’t need supplementation either. As I said above, b12 comes from a bacteria, not from animal flesh. This bacteria can be found in nutritional yeast and other vegan foods. Taking a b12 supplement is just good for everyone regardless of diet. That is why you will see most people on this thread who have been b12 deficient saying they aren’t vegan.

                Corpse eaters get so defensive when the dominant paradigm of eating tortured animals is questioned, when in fact, that questioning should be welcomed since most of the food grow and water depleted is due to feeding livestock, that animal agriculture is the number one cause of climate change (ahead of cars), and that animals suffer and die so people can eat their flesh. If we wanna talk about health, and what’s good for us, let’s talk about the big picture, not pick one random nutrient that people who don’t eat meat are sometimes conveniently deficient in.

                I bet if this post was about meat eaters being deficient in nutrients and how they should stop eating animals, people would go nuts.

                • Rose says

                  People need to realise that it is gluten damage to the small intestine that causes malabsorption of B12. 80% of the immune system is in the small intestine so people who are gluten intolerant or have celiac disease are often ill with other diseases also and still don’t know in many cases that it is gluten that is underlying their problems. In our grandmother’s day, flour contained only 2% gluten. It now contains 55% gluten and most are eating way more bread, hamburgers, pastries etc than they ever have done before. There are millions of people who are gluten intolerant yet don’t have the slightest idea that they are. I can speak from experience here as I was 59 before it finally dawned on me that gluten was killing me. By then it had done so much damage to my small intestine that I have lactose intolerance, fructose malabsorption, histamine intolerance and salicylate sensitivity. My diet is extremely limited and however much I would like not to eat meat it is impossible as it is the only source of protein I can digest. Since learning that I am gluten intolerant I have researched it thoroughly. Anybody reading this who is genuinely concerned about good health should Google gluten intolerance and the diseases it causes. From the Celiac Disease centre of the University of Chicago comes the information that there are over 300 different diseases and symptoms caused by gluten. B12 malabsorption is just one of them. Gluten also attacks the brain causing any number of mental health problems, including depression, bipolar disease, ADHD………..the list is endless. It still blows me away to realise that billions of people are not even aware that it is gluten that causes the majority of illnesses.

              • Margaret says

                I am a bit late responding to this, but I use a probiotic to provide my B12 and have excellent results — much better than using a sublingual B12. For years I supplemented with a nutritional yeast based B complex, but after reacting to a homeopathic remedy, my body could not longer absorb B12 from the supplement. Then I was on sublingual B12 with poor results, but it still kept me from totally losing it. If you do a little research, you will find that beneficial bacteria in the gut do produce B vitamins including B12.

                • says

                  Hi Margaret, do you mind sharing with me which probiotic you are taking, thank you.
                  AS for the animal vs plant debate. I would not be eating meat(for the sole reason of the treatment of animals) if I could digest anything else. Presently meat is the only food I am able to somewhat digest. I’m sick and tired of eating meat, and it breaks my heart how these animals are treated. I opt for cruelty free meat which is very expensive(unfortunately) . I’m not able to work because of my health…so I limit my meals to once a day. I tried a plant based diet and it almost killed me. :( … If we choose to eat meat(for health reasons) then we need to make a conscience choice of going cruelty free. Many local farmers provide and treat their animals humanely. Or so is the case with the farmers I buy from. … if we all make this choice, factory farming will end!!! … ..anyhow. I do wish good health to everyone here.

        • says

          You are comparing nutritional deficiencies in vegans versus the Standard American Diet. The standard american diet does not take into account the quality of the food being eaten. It is too broad, and I’m sure there’s a big difference between meat eaters who get their meat from McDonalds (loaded with all kinds of who-knows-what by-products and chemicals) versus those who seek out pasture-raised cows and whole foods.
          There’s also a difference between those who care about their nutrition, and those who load up on empty calories and sugar-laden junk. People who follow the Standard American Diet can be nutritionally deficient because of the empty calories in the form of junk food they consume. You cannot conclude from that study that meat causes deficiencies unless you test different kinds of meat eaters and find the same deficiency patterns. I would like to see a study done on the vitamin levels on SAD versus a clean Paleo diet that does not permit junk food/empty calories.

  84. Jan says

    I do not know why I allow you to draw me in but I have to respond to this.

    Corvus, this blog/site is sponsored by Chris Kesser to educate ppl who areB12 deficient and share the in depth study that he has conducted. It is not to necessarily bring ten year old study info done on ten vegans as fact to fight. No one is accusing vegans of being inferior humans. B12 does not exist in plant life, period. As for your assertion it does in bacteria, uh no thanks. We were born with teeth to tear meat and that is a fact. The balance in nature, were mankind to completely stop eating meat, would impact the world environment horrifically. Deer, if not hunted, cannot find enough food. There is a cycle of life. YOU do not have to eat meat but back off. This site is not dedicated to the belittlement of vegans or vegetarians, but neither is it a forum for them to rant.

    Chris uses material that is current from reliable sources. As a person who enjoys this site would you please stop. Please share your experiences and defending your choices and culture. That is not what this site is for. You are not bringing any help or positive energy to us and it is upsetting.

    As for celiac disease, can it not be detected fairly easily from the area at the beginning of the intestinal tract? One thing is for certain, one size does not fit all. I am learning that. Also, I am using an iPad so overlook spelling and grammar. It changes things randomly and I cannot review them properly.

    • Corvus says

      Actually, we are born with the teeth of omnivores, closer to the herbivore side of things. All herbivores have canine teeth you speak of anyways as well. Ever look at the teeth of the gorilla? http://www.ereads.com/uploaded_images/gorilla.jpg They eat all plants. And our teeth are very flat compared to theirs. I don’t blame you for bringing up that point as it is one of the most popular points that people are taught in school, the days of the “4 food groups” and all that- one of them being cow milk. What if it was breast milk? Wouldn’t that be weird? Our culture consumes baby cow food in drones and acts like it is natural. It’s killing us and the planet. And other natural arguments I am sure you know, don’t fit much into this http://www.willowcreekfoods.com/images/Factory%20Cow%20Herd.jpg which is what about 99% of farms look like (that have cows). Ever see a pig outside when you’re driving through a rural area? That’s because they’re all inside in gestation crates and such. Every time you hear about a contaminated plant with e coli, that’s livestock runoff (ie shite) running into the plant and water systems. And animal farming, like I said previously, uses almost all of the food and water in the world and is the top cause of climate change.

      So, do you really think stopping eating animals would HURT the environement? You still have not explained how….

      As for deer, google deer farming. Deer are over populated in part because of HUMANS over urbanizing into their habitats, building new roads before the deer can find new habitats from the last time humans mowed down their forest homes. And there is big money in deer breeding to keep those populations up, to continue to justify killing animals for sport first and food second. Natural predators being hunted out of existence by hunters and animal farmers is also responsible for animal overpopulation, so again, if humans stopped eating animals, the whole environment would benefit.

      Meat is a corpse. What do you think it is? Flesh that grows on a tree? Our culture has referred to dead animals as “meat” so people can have an easier time torturing and killing them without guilt. Do you like cats? Doggies? Same as pigs and cows and chickens. Only some species are labeled meat so people can kill them. What if this article said you needed to eat dogs to keep your b12 up? Would you? QUESTION THINGS. I just call eating animal corpses what it is- eating the flesh of animals who were killed by humans. Dead animals. Corpses. I’m just being realistic and not living in a fantasy world where corpses are reduced to “meat”.

      But that wasn’t why I am here. I was here to address the passive shots at veganism by the author, whether you see them or not, and his convenient use of 1% of the information about diet to make his claims. As much as you seem to be annoyed with me bringing “negative” energy (eg more truth to the story) I was glad to have this exchange with you. Thank you for giving me the opportunity to share this information, for our sake, for the animals’ sake, for the planet’s sake.

      • Lucia says

        Yow know? While you might have some decent points in your matter-of-fact arguments, your demeanor and closing self-righteous sentence: “…..Thank you for giving me the opportunity to share this information, for our sake, for the animals’ sake, for the planet’s sake….” just makes all your entire spill bullshit.

        Upon re-reading the original post by the author of this blog (Chris), I don’t know where you see that he was taking shots at vegetarians/vegans with this article. Rather, he stated true-facts that: YES, if you are a vegetarian or vegan, you are AT RISK of low b12 levels. And the true-fact that YES the ***most direct-efficient ways to maintain healthy b12 levels*** are by not being vegetarian/vegan (and consuming animal products), OR by taking supplemental b12 in your diet. SIMPLE AS THAT. Nowhere it tells you that being vegetarian/vegan is a bad thing, only that you should do it responsibly towards your own health.

        While I’m omnivore, I’m someone who has been suffering b12-deficiency for over a decade now due to health/genetical issues, and can tell you by-experience that low b12 really f’s you up if not known and controlled. From depression, chemical imbalances, neurological damage, low energy, spending a week in the freaking hospital trying to figure out what is wrong with you, plus multiple doctors appointments after that, monthly b12 injections, etc…. it IS NOT a fun time to be b12 deficient, and something that I do not wish even to my worst enemy.

        After all that happened to me, I’ve shared my experience to my friends/family as a word-of-caution. And yes, I’ve shared my experience specially to my friends/acquaintances who are vegetarian/vegan, knowing that they are at risk, all in the hope that they will not have to go through what I went to.

        So, in short, THAT is in-itself the purpose of this article and subsequent comments: B12 deficiency is indeed a silent ailment/epidemic out there affecting many people. And so, take care of your health and your diet -whichever diet you chose to follow. And that YES, if you are vegetarian/vegan, make sure you are informed about b12 deficiency, and that you are at-risk of it -that is all.

  85. Jan says

    One other thing. While I am not sure taking B12 is good for every one, it will not harm anyone. That is key. And to phrase meat as corpses, come on. You are making vegans appear less on this site Corvus, not making a good impression. I have seen more ppl die from eating improperly grown vegetables than meat, and that is a fact. If you want to march on Hormel or wherever, fine. That is not here. We are ppl who came here to find out what Chris had to say. If we don’t like it we leave. It is his site. Simple. We can share experience, other ideas, but you are not doing that.

    • says


      Cool u know so much and have opinions. I’m not evaluating them nor following the thread all that much. But have you looked at the recent NYT article re: B12? I’ve not read comments there; perhaps you could influence more folks on the national if not international audience over there. That way you can leave chriskresser.com for those who seek Chris’ wisdom and carry on elsewhere.

      • Corvus says

        Sorry, I didn’t know this was an exclusive club of people who believe everything without questions or double checking any of the information. I actually got to his site via something on chemical imbalances that I agreed with a lot. Then I saw this stuff and he lost a lot of credibility, because I, you know, questioned him instead of automatically believing it. Perhaps you’re right, this isn’t the place for someone like me. See you all.

        • says

          Only if you think it exclusive. I think you’ve done more than “question”. And that’s great. Good luck and I hope you get the help you are seeking. You seem like a great person; energetic and selfless.

          • Jan says

            Agreed. This is not a site for activism. That is the point. We are here sharing what we are doing not bashing vegans, or meat eaters or any other thing. It is getting old. Please find another place to rant and allow us to get what we need. I will move forward with my delicious steak corpse and be done with it. You can have your soy burger. Personally, I do not care what you eat, why do you insist on caring what I eat? Leave it Corvus and move it. Please. This is not a rant site.

        • Elisabeth says

          Corvus, are your sure about your theory of man being a non-meat-eater?

          We don´t have the GI-tract like the animals we eat, eg, our guts are not shaoed for all that granis and cellulosa.

          By the way, ever looked att our eyes? sitting in the front, looking stright forward…
          That´s the eyes of a hunter, not of the game.

  86. Jan says

    Thank you for reminding me about the eyes straight forward. Animals of prey do have eyes like that while animals preyed upon have them on the side. The things provided are old, 2003, and back in the 90′s and thank you for helping put this into perspective. Chris has provided this forum for us to share, learn and grow. Not fight, confuse, rant and bring speculative info. I have never gotten the answer to what plant B12 is derived from as there is none. I do not believe that there is a safe way to get it from bacteria. Meat does not provide us B12 by giving us bacteria, as was said. I am comfortable with Chris’ sources and not with the others.

    So, moving on, I am still giving myself injections and I too, have neurological issues and frustration with getting my CIDP under control. I have a fear that I will just slowing lose all feeling in my extremities.

    Does anyone on here have a diagnosis of CIDP as well as B12 issues?

  87. Lorraine says

    Hi Chris,
    I get injected with B12 due to pernicious anemia and I read on here that they say in France that that can give higher odds of cancer. What is your understanding of these findings?
    Also what is the relationship with B12 deficiency and carcinoid tumors?
    I read they can sit for up to nine years undetected in three different sites in the gut and are deadly! I also saw something about 5-htp which people take as a natural anti-depressant being present in some of these tumors. Please let us know more on our risks and what to do to check!!!

  88. ariel says

    I took the blood test 3 weeks ago and I have 250 of vitamin B. Doctor gave me vitamin B12 and another vitamin b complex. I took both and I started to have a terrible headache, I had in somnia and very sensitive to the light, also a bright yellow pi. In this case that vitamin b makes me feel so bad how can I do??? is there any o ther way to absor vitamin B without those symptoms??? Thank you!!!!!

  89. CFS says

    Ok I first got ill fatigue and dizzyiness about aged 14 I was also getting a lot of acid reflux and was treated for helicobacter pylori. Few years on I got a lot worse would be so tired I felt drugged, achy, sensitive eyes and mouth ulcers. I got worse after first child at 22 (just walking in park left be breathless) and worse again after second child a few years later. I breastfed too and felt slightly better whilst breastfeeding but very bad when stopped.

    I was diagnosed with CFS. If I walk up stairs I am breathless and legs cramp and ache. I always feel tired. I am dizzy and if I swing on child’s swing even just for 20 seconds I feel disoreinatated, sometimes turning round quickly does this too. I can’t strighten fingers on right hand and get itchy tongue and red patches on roof of mouth. My eyes are v sensitive, flashing lights can bring on visual migraines. My nails have had deep ridges vertical and split along these ridges since age 15. I have no nail moons and pale yellowlish skin.

    I finally got Dr to check my b12, it came back at 160. I was told this is satisfactory. My full blood count is within normal limits. Dr just said I need to try anti depressants. I am reluctant to.

    I work part time and always without fail exercise slowly each day. No matter how much I do I do not improve. If I try to exercise properly say dancing I get dizzy and my vision starts to blur. I used to get sinus infections but have a daily sinus pain in left cheek. Had CT of sinus and they said it shouldn’t hurt that much. I also have irratable bladder and get cold easily. I’m 29 now and feel like an old woman.

    • Chris Kresser says

      A B12 of 160 is absolutely not “satisfactory”. It’s well below the low end of the lab range, which is 211, and it is documented clearly in the scientific literature that even levels between 211-450 are associated with neurological damage. I’d strongly advise you to find another doctor as soon as possible and begin treatment for B12 deficiency. Your doctor is either grossly misinformed or negligent.

  90. CFS says

    Thank you for swift reply. Ive been told by way of letter today they need to repeat b12 test in one mths time so hopefully they arent going to completely dismiss it.

  91. Clare says

    Hi I’ve been reading these posts with a lot of interest. I was diagnoised with b12 deficiency four years ago and given oral b12 my levels increased and tingling and vibratingfeelings got much better my levels were 158. My gp took me off b12 twice as my levels were high but my symptoms came back. I then relocated and changed my gp and my levels were 258 the gp told me they were normal and refused to treat me. I told him that my levels were158 at one point so he gave me an injection this helped the symptoms but they did not go like they had previously so I asked for more frequently injections so I’m on one every two months. The go told me the symptoms were not due to by b12 level ad they were normal at 377 I still have symptoms the gp referred me for verve conductive tests which were 100 per cent normal and now I’m referred to a neurologist and I’m worried it’s ms but my symptoms were ok when I was on 50 mcg tablet per day. The GP states at a level of 258/377 tingling would not be caused by lack of b12 i would like your opinion Chris.

  92. Helene says

    I have pernicous anemia due to problems with absorption of my B12. I now take B12 injections and 5-methyl folic acid. I have been told by my doctor that my B12 problems are due to methylation problems. You can read about it on Dr. Amy Yasko’s site. Dr. Yasko is a researcher and much of what she talks about is directed for children but also applies to adults.

  93. TDS says

    I’ve been reading this entire thread with interest as I figure out what step I need to take. I’m 44 and a year ago, I was feeling miserable (very fatigued, short term memory loss,weigh gain (I’m active and thin), cold, etc.). All the Dr’s were brushing me off and basically my Primary Dr referred me to a Biomedical kind of throwing her arms up not sure what to do with me. Frustrated I went to this Dr. even though I had to pay out of pocket because I was so desperate.

    I did receive some useful information, my B12 was at 224, D3 was at 30, thyroid was just above acceptable for hypo. To me this Dr was a quack so took my results back to my Dr. I was put on B12 shots, but had a reaction and had to stop after about 6 of them. My levels were tested and were at about 574 Dr said all was good. I’ve had them tested about every three months recently because even on thyroid meds, I’m still unusually fatigued. Most recent one was 342 (it seems to be falling about 100 every 3-6 months). Thyroid Dr said that number was fine, but it is NOT fine for me. I’m back to the unusual fatigue and the short term memory loss (I know what I want to say, but can’t think of the word).

    Who do I see that will take me seriously and figure out why I do not absorb B12? I’m not a vegan, I’m in great health otherwise, don’t take acid meds. I’m too young to feel so tired, that it exhausts me just to think about what I need to do.

  94. Julee Ellison says

    Chris, can you help me understand something please. I just had a full blood panel, including B12, VAP, metabolic panel, CBC, etc. From the paperwork —> Vitamin B12: 954 (200-1100 pg/mL). So, if my number is 954, that might sound high compared to a lot of other people here. However, based on other numbers in my test results, my doc said I need to up my intake of B12. Do you know why this would be? The only numbers I see that are out of line (and I don’t know what they mean) are: Creatinine: 0.55 low, Hematocrit: 45.2 high, MCV: 101.9 high, MCH: 34.3 high. Do these numbers mean anything in connection to needing to increase my B12?

    Just like the previous poster, I am so tired of being tired, with no help from my PCP … even though he is a good doc. The muscle fatigue is making me crazy. Thanks for any help you can offer. Jules

    • Chris Kresser says

      He’s referring to the elevated MCV and MCH, which is often indicative of B12 deficiency. But it can also suggest folate or B6 deficiency, hypothyroidism and a number of other conditions. Another possibility is that you have a genetic mutation called MTHFR, which decreases the ability of your body to properly convert the inactive form of B12 to the active form. A number of possibilities here…

  95. MLS says

    I am a 62-year-old woman who some months ago started having symptoms that I could not understand. I would start talking and the words coming out of my mouth were not words at all. This happened on two occasions with no other symptoms at that time. In the meantime, I started having word finding difficulty, depression, lightheadedness and nausea. My PCP sent me to a neurologist who put me through some testing and diagnosed me as having had some strokes. They did not feel that the other symptoms were caused from the strokes as these were mini strokes. The did find that my B12 was 234 with a range of 200 to 900. The doctor ordered another test to see if I have an absorption problem, which according to my PCP came back within the normal range. It came back at 117, ranges I do not know. Also the B12 that my doctor ran two weeks after the original B12 by the neurologist came back at 186. My PCP’s office informed me that on their ranges this was normal because it was not under 180. What are the ranges? Being as the PCP will not give me injections as my levels are in the “normal range”, how much over-the-counter B12 should I take as I do not want to have permanent neurological damage from all this. I am really getting worried as I have a hard time carrying on conversations as the words are locked in my brain. Thanks for any help that you may be able to give me.

    • Julee Ellison says

      MLS … if you read everything here, you’ll find there is no evidence that taking B12 can cause any problems. I take the LifeExtension Methyl-Cobalamin 5mg once each morning. The words locked in your brain sound totally related to the mini strokes, for sure.

  96. Jacko says

    I’d like to point something out, i’m sure you didn’t mean to say it that way, but its incorrect.

    All forms of B12 are analogues of which there are two types, active B12 and inactive B12. Inactive B12 analogue is refered to as pseudo B12 which is not biologically active but chemically looks like B12. Vitamin B12 is composed of “vitamers”. A vitamer of a vitamin is a chemical substance that shows vitamin activity.

    All B12 is a cobamide, or more accurately a cobalamin. The term ‘B12′ refers to a group of vitamin compounds known as cobalamins. The B12 group of cobalamins are a member of a group of corrinoids which are a group of compounds based on the skeleton of corrin, thus B12 is sometimes refered to as a Corrinoid. The cobalamins are the best known members of the corrinoids group, thus B12 is also refered to as cobalamin. A cobalamin is a cobalt-containing complex common to all members of the B12 group. The term ‘Vitamin B12′ ,one of eight B vitamins, actually correctly refers to an entire class of water soluble coenzyme chemicals with B12 biological activity, and not specific B12 chemicals for which it is often applied incorrectly. When we say ‘cobamide’ its the singular form in reference to a specific chemical, when we say cobalamin its also singular but in reference to the group.

    Both active and inactive analogues look chemically similar to each other, the difference is that active analogues are biologically active and inactive analogues aren’t.

    Spirulina is said to contain Cyanocobalamin. This is frequently taken as a sign that Vitamin B12 is present, and indeed Cyanocobalamin is often called vitamin B12. However, when it comes to spirulina, these companies have played a little trick. Normally in industry Cyanocobalamin is used in fortified foods and vitamin supplements so its become common term usage to relate Cyanocobalamin to Vitamin B12 in a broad sense because its the most common analogue used for vitamin supplements so no one ever paid attention that there can also be a Cyanocobalamin that really isn’t Cyanocobalamin but rather an inactive analogue, a counterpart if you will, that will show up in tests because its chemically similar. It really doesn’t show up as Cyanocobalamin directly, actually the spirulina companies have done a little creative science – they have guessed. What happens is they have tested spirulina, the inactive analogue shows up as B12 because its chemically similar, and because they can’t find another analogue indication in the spirulina, by process of elimination they claim it to be Cyanocobalamin. In reality, Cyanocobalamin is only produced in the presence of cyanide and another B12 analogue called Hydroxocobalamin of which there is none in spirulina and the amounts of trace cyanide in any spirulina growth medium is so low that even if there was Hydroxocobalamin in the spirulina the amount of Cyanocobalamin produced would quickly be overwhelmed by its inactive counterpart. There is no way to add enough cyanide to algae growth medium even if Hydroxocobalamin were present, without actually poisioning the entire algae and thus producing poison products so no one wants to do that. If Hydroxocobalamin is not present the only “Cyanocobalamin” that can be produce is an inactive analogue. So, all this together conpires to produce only an inactive analogue that is refered to as ‘pseudovitamin B12′. A pseudovitamin is one that looks chemically like a vitamin but lacks capability (efficacy) to be bioavailable in the human body because its biologically inactive. The pseudovitamin B12 in spirulina does nothing useful in the human body.

    As a side note: Its often claimed that (real) Cyanocobalamin is somehow bad. Its not actually bad. Its true that real Cyanocobalamin is not directly biologically active. Cyanocobalamin is not useful by its self in the human body (or that of any animal) and must be converted in the body to Methylcobalamin and Adenosylcobalamin active forms. The role that real Cyanocobalamin fills is that its quickly produced, can be stabalized more readily and cheaply, and can be made in large quanity more cheaply then the other forms, and thats why its used in fortified foods and supplements. Its not really less effective for general health substance delivery, its just a little more less efficient. However, its still a form of B12 analogue.

    • Freddd says


      Cyanocobalmin is the worst possible form of cobalamin that has any activity. It is the offficial “B12″ only becasue of a lab mistake in 1947-48 in identifying liver extract (55% adb12, 40% mb12, 5% misc). Most cyanob12 is excreted by the kidneys and is ther bodies preferred excretion form made from neutralizing cyanide from any source with hydroxcbl, mb12 and/or adb12. Hydroxcbl is several times more effective than cyanob12. Mb12/adb12 is 100-10,000 times more effective than cyanocblhydroxcbl. People can develope fatal deficiencies of b12 wile taking cyanocbl and/or hydroxcbl. They are both largely inactive and terrible.

  97. jillian says

    hi there

    i was diagnosed with a vit b12 deficiency in september 2011. i am 29 and felt so unwell. fortunately i was started weekly injections then went onto monthly and have my last monthly one in 2 weeks then go onto the 3 montly injections. i am feeling so much better but think i will always have some lasting effects from it. i blame myself for the condition as i have had bulemia for over 10 years. i haven’t made myself sick since i found out so i suppose every cloud.

    My question is that me and my husband want to start trying for another baby. should i wait a certain time and is there anything specific that i should be doing? scared of neural tube defects etc



  98. Lisa says

    Love your blogs. I guess I need to appreciate my health provider better as I was diagnosed B12 deficient without any push on my part and given a prescription for 1000 mcg methylcobalamin B12 sublingual daily. Trouble is life got busy and I got lazy about taking it. You have all reminded me of the importance of this as I have many health issues.

  99. MLS says


    Although locked in brain sounds like my strokes it appears that is not the case according to my neurologist. This is why I am searching for all other options. My neurologist is the one that has said that it is a very distinct possibility that the neurological problems could come from B12 deficiency even though my number was 234. He said that some people can have neurological problems if their number gets below 400. Upon reading more from Dr. Kresser, I realize that maybe something beside an absorption problem is causing this. I also take acid suppressants on a daily basis and have taken Metformin in the past. I am on my way to the doctor with more information and hopefully we can work something out. My question is if in fact the acid suppressants are the culprits would it hurt to get the injections to get me back to normal?

  100. Lucia says

    So, an update… and Chris – a question – PLEASE ADVICE!!!

    Talked to my PCP and he changed his mind about me having a deficiency :/

    Even though back in 2007 I ended up in the hospital having an attack of nystagmus & ataxia due to low B12 level of 110, and was then put on monthly B12 injections for awhile. Even though I had a metabolic imbalance 2 years ago when my PCP tried to wane me out-of B12 injections. And even though back in October-November 2011 they did new blood tests and my B12 dropped from 475 to 261 within 7-weeks of me not taking a monthly B12 shot, my PCP called me yesterday and told me that those numbers *475-261* are still within “normal” B12 range, and that I was not allowed to get more B12 monthly injections until maybe March (or 3 1/2 months later from my last shot). When I told him that in-the past I had not done well without my shots and was concerned about the over-200 drop the previous month, he said that he had a hematologist look into all my recent blood-tests, and that they did-not think that I had a deficiency. That I should just make an appointment for March 2012 and they would do a blood test and check my B12 then and see if I needed a shot then or not.

    I am utterly confused, and don’t know what to do.
    I can supplement myself by taking over-the-counter Metholcobalamin as I’ve been doing lately, but I’m disturbed by this development -I mean, really?!? With the last blood-test and a B12 of 261, I am now as my PCP says within “normal range” even though my B12 dropped over 200 units without a monthly shot within weeks? Do I stop taking the sublingual B12 and see really “what happens” if I just rely on my general protein/B12 intake?

    I am confused, and don’t know if I should trust my PCP, or if I should change doctors. I DO NOT want to go through another metabolic imbalance or nystagmus/ataxia attack.

    Is there any logic into what my PCP thinks now? Or a potential logic behind it that I do-not know? Should I play along and see what happens?

    Please advice!!!

  101. cfs says

    Hi Chris my b12 level 160. It is being rechecked in a couple of Weeks. Last week I developed a dvt out of the blue. Im 29 no real risk factors. Does low b12 cause increased risk? Im on warfarin for six mths now and had Weeks worth of Celexane.

  102. CFS says

    I did post yesterday but can’t see my comment. I wanted to know if having low b12 is a risk factor for deep vein thrombosis. I currently have a DVT completely out of the blue despite not having risk factors for it. My b12 is 160 and I have my repeat blood test to check this level tomorrow. I can’t see any reason for this blood clot to have former and I also can’t see any logic behind my b12 being low (take no meds other than the pill – now switched to mini pill), eat a varied diet with plenty of meat and animal products in. I’m 29 years old, had fatigue for 15 years.

  103. Jen says

    I have been ill for last 6 years with undiagnosed neurological problems. I have epilepsy and had surgery for that in 1996. I had a temporal lobectomy and had part hippocampus removed. I have been on epilepsy drugs for 27 years and am currently taking tegretol and keppra. I have had nerve pain for about 10 years but it was only about 5 years ago I felt remainder of left hippocampus swelling and then shrinking when I was given steroids for asthma. Took me about 8 months after before I got taken seriously and had 1st mri which showed sclerosis of remainder of left hippocampus. I have had 2nd mri scan about 2 years later, then nerve conduction somatosensory evoked potentials and emg test last year which came back normal. I have nerve pain all over which varies from day to day and can be anything from tingling to stabbing pains I have been prescribed lyrica for this. When this started I had megaloblastic anaemia I had already been taking 5mg of folic for about 18 months as I was planning on becoming pregnant because of epilepsy drugs. I have recently had blood tests which showed elevated mcv and mch which was ignored as follow up test showed normal. 6 weeks ago I saw a different gp who said my folic acid leves where low but I refused to take it as my b12 was 252. I asked my GP for a letter to have an active b12 test from St Thomas’ Hospital in London which he agreed to. This has just shown my b12 levels are borderline and he has prescribed me cyanocobalamin 50mcg 1 twice a day and folic acid. A text book I have for epilepsy says hippocampal sclerosis can be caused by a b12 difficiancy. Is this the best drug to take or should I try to get something different. Is it more likely epilepsy or a different neuro condition like MS as last time I saw my consultant he said there got to be something causing it it a symptom not a diagnosis.

  104. Helene says


    I have pernicious anemia and do not absorb cyanocobalamin or plain folic acid. I need a form of both that are already broken down and my body can absorb it. I take Folapro and methylcobalamin. My levels of B12 always showed normal but my body did not use it properly. Found out too late and have many problems now. But the methylcobalamin and folapro made a different, you might want to check this with your doctor.

    • Jen says


      thanks for your reply, I do not see my neurologist now until June will see what he says then. What makes me laugh is that I am under Neurology hospital in London and have had to do research into this myself to get anywhere. I know that my epilepsy drugs deplete my b12 and folate levels but will look into the information you suggested. I have read the book could it be a b12 and suggested to my gp to have a look at it, he was very interested but admitted that he didnt know much about b12 and that my hospital should know more about it. If you near London go to St Thomas Hospital in London for active b12 test, before I had this my gp was not interested in my results said they were normal. Will do a bit more research into your suggestions thank you.

      • Cate says

        Hi Jen,

        I am in London and am going to ask for my GP to refer me to Tommy’s for the active B12 test. Have been dx with fibromyalgia and other things. Have only recently started reading up on B12 deficiency. This is a great site.

        • Jen says


          The test is worth getting done it may cost 15 or 20 pound but no one asked me for payment was told bill would be sent to me, but when I saw my gp he said that because I had a letter from my gp giving permission for the test that it was unlikely that I would be billed and the nhs would pay for it. My gp was very suprised with the results my normal test showed 252 and active showed borderline. I am just taking tablets at moment as my gp said he didnt want to just flood my body with injections. Good luck with test it may finaly get you some proper results.

          • Cate says

            Hi Jen,

            Did you just take a letter from your GP to the phlebotomy dept. at Tommy’s or did you have to make an appointment? Were you tested for anything else there at the same time?

            • Jen says

              Hi Cate

              I phoned up the hospital to let them know I was coming in for the test, click on the link I have added think it Robert you need to speak to let them know day you coming in for test. You go to get blood test done then have to go to the lab dept with the blood sample. Just handed in letter of permission from my gp for the test with sample. Robert wasnt there when I turned up so person I spoke to first said we dont do this test so I showed them the web page from my iphone and they took sample. My gp got results back within 7-10 days which was borderline hope this link helps. Also look on pernicious anaemia website which shows few other people who have gone for the test.


  105. Jan says

    Hi Guys

    I need input, again. I will try not to be long so as not to be ignored. I know it is laborous to read.

    I had low B12, neuro ignored it, misdxed me w MS, watched it drop for four years. At 150, he left clinic, new Dr. caught it, began treatment, but she checked all the things we discuss here, the methyl things, But, even after a struggle to get it up to 1500, and it took a lot of muscle shots, had to stay at bi monthly for a long time, when I am ready for a new shot, at the two week mark, I am back down to 400, from 1500.

    Any comments on this? I am injuecting 1ml IM every two weeks. I have CIDP, have to take treatments of IVIG infusions every two weeks now also, HATE THEM, or I cannot walk. These should not affect my B12. CHRIS, any comments>


    • Chris Kresser says

      Have you had your anti-parietal cell antibodies tested? If you have pernicious anemia, addressing the immune dysregulation is key.

  106. Jan says

    Chris, yes, thank you for responding. My neuro, fortunately, was very up to date on B12 and left no stone unturned. I went through your article and this site with a fine toothed comb and made sure I was checked for everything, and as to the numbness and tingling, had them rule out all metals and toxins as well. Unfortunately, that neuro was my MS Dr. and when that DX was disproved, and CIDP was found, I was sent to a different clinic at Wake Forest where this neuro specializes in neuropathy. His answer to this drop was to augment with under the tongue B12. Fine. Maybe that will keep me more steady but my thing is why. Why is it so low and why am I having so much trouble. What Dr. would specialize in this? Would it be a hematologist? or something else. I have horrible bowel issues, being told that it is most likely permanent nerve damage from the CIDP and misdx. My lumbar punch was 123 for protien. To further complicate this, I have a brain tumor in the mid brain, what is believed to be a pilocytic astrocytoma.

    • Chris Kresser says

      Yes, a hematologist – but find a good one. 10% of people with pernicious anemia don’t test positive for the antibodies. It’s entirely possible that B12 deficiency is not the main issue here, although it seems primary.

      • Jan says

        Okay, I will. Before I do, understanding that I truly have had every single thing you recommend tested and all is ok, I have lost most of the feeling in my rt foot, a lot of it in my left. Hands are going numb and tingle but are much worse after IVIG treatment, neuro says it is most likely due to nerve sheath stimulation (even though they were not so before last treatment, nor before any treatments, the tingling in hands; IVIG seems to cause it). I have insane gastro pain and issues up to passing blood only w 2 10 day hosp stays, one ischemic colitis. No one cares to find out why, ischemic does not happen for no reason. So with pernacious, would my b12 not have gone much lower than 150? My concern is why will it not stay at a decent level? No Dr. seems to share this, it is almost like, “get over it, you are over 200, take your shot and move on”. I do not share that feeling, I am more like “If I stop the shot, I feel certain I would drop like a stone down to nothing if with them I am dropping in two weeks from 1500 to 497.” Is it unreasonable to be concerned? Am I making a mountain out of a mole hill? Some things, like the brain tumor, I cannot change, and the CIDP, as the EMG tests have proved out to be absolute, as well. But, how much of my symptomology are due to CIDP, B12 and is it possible I do still have MS? I am truly in need of Dr. House.

        • Jan says


          One other thing, the risk mgmt team at the clinic, as this appears to be a misdx, were informed by the MS dr. who replaced the one who left and found the B12 prob, that the former dr. had monitored it and ignored it, and she felt it was possibly the root of all the problems, they are not recognizing this issue. They are maintaining that at 200, I was fine. I am so over our guidelines affecting us in America and allowing Dr.s to actually commit malpractice if they so choose. I lost my career etc over all this. Would I have not done so if he had treated me? I will never know. I have permanent damage now. From what? I do not know and the complications in my case are staggering. I just wish that I knew where to turn.

  107. Eric says


    I’ve been diagnosed with b12 deffiency since im 14, now 23. My doctor always recomended injection of once a month 1000mcg.

    I see now this is most likelly not enough. Im now currently in Thailand for 1 year and all they have is the cyanocobalamin version(which also was prescribed in canada), I don’t have access to the other. Will this type suffice for now? I see that it is less effective, but would a higher dose work or am I out of luck this I get back to canada?

  108. Veronica says

    I have never been officially diagnosed by a doctor with b12 deficiency, but I diagnosed myself when I made the best of not having a family doctor and being able to look over my blood tests themselves since they let me have them for my own records until I could find one. 220 (units) was the measure. The acceptable range on the sheets was ~170-800. I didn’t get that, along with a battery of other things tested for, to find out nothing was wrong with me; obviously something was, even if what was tested didn’t show! So I looked up every test result online, trying to find anything. Lo and behold, in north america, according to wikipedia article then, like the lab said, my b12 was fine. But if I lived in Japan, I’d be getting shots for it at anything under 400units!
    I eventually settled on taking 1000mcg/day orally of cyanocobalamin for awhile. It helped some of my issues, and my b12 levels are up in the 500 area now. (But again, no doctor told me about this, I had to see the results for myself.)

    Eric, seeing as you have no choice but to take cyanocobalamin orally, you should take large oral doses of it you still think you are b12 deficient. I have also *just* been diagnosed as a celiac, which means I definitely had digestion issues when I was orally supplementing with cyanocobalamin, and it was still absorbed passively through my damaged intestines, just like I thought it would. Yes, taking a larger dose is necessary when using something that has reduced absorption.

    • Jan says

      Wow….Sometimes, shots are just the best choice if you can get them, they do not have to go into the digestive tract. I have been at this almost a year and still struggling. It is tough. I wish that I could just find a Dr. who coud help. My family dr., who I really trust, said “I had an 80 yr old guy whose B12 was 80 and we got it up to blah blah and it was ok, etc and so on” and I was just floored. I have always trusted him in every way and this was the first time that I saw something that had a really big issue. An elderly person, who had NO symptoms, according to him, and myself, ne not feeling my feet, unable to fill out a flipping expense report (I had been HIS stock broker for years), there was a distinct difference. I had so much to learn. And, I still am not up to steam.

  109. patineuse says

    had blood test for b12 in September having been off work for a year with “depression”- fatigue, dizzziness, breathlessness, throbbing feet and digestive problems. Blood test was 160 on 190- 900 lab range . Doctor told me to add back fish to my vege diet and have fortified breakfast cereal. I saw a dietican privately and she thinks its not the vege diet as I have so much cheese and milk ;she thinks it more than likely malabsorption. 3 months later blood test now 199. Doctors say Ok now. However I am still easily fatigued and soles of feet still throbbing. Im seriously thinking of supplementing even though the doctor and dietician seem against it

    • Jan says


      I think that you may want to educate yourself a tad on B12, where it is derived, etc. It is not available in nature but from red meat. So, you are not going to be able to change your diet as you are and fix this. But, you can supplement with B12 sublimigal and do it or shots. You don’t have to compromise your Vegitarian or Vegan lifestyle. However, you will have to supplement. Also, you may need other tests, the article that is associated with this blog is a great source of info. The fact that your symptoms are not better is your first red flag. The zone of ok, 190-900, is so off base, and if someone is exhibiting symptoms, a good Dr. would look at that as way low. Our own CDC has higher expectations according to age, I am turning 60 this month. So, our local lab standards of 200-900 are too low for me and in other countries, they expect in the area of 500 as a low. WIth all that said, I think another Dr.s opinion is in order maybe, but your own fatique and how bad you feel is a great yard stick.

  110. Jan says

    I have one more question. My methyl. acid is ok, no problems there. Is it ok for my shots to be the C ones, cannot spell that, instead of the M ones? I put that I did 1000 ml, but of course, it is whatever that is, mcg, or whatever. And, I will get the subling. Methy. B!2, but unfortunately as well, I am struggling to even get B12 for shots here for some reason. My pharmacist cannot get it, says that there is a shortage countrywide. Sounds like a CVS issue to me, but whatever, anyone else have this issue? I am lucky to GET any, according to him.

  111. Jan says

    TO Jacque: I am so sorry, it is probably my browser but for some reason, I cannot get to your question and or response wuthout a big search so I am going to respond at the bottom, I hope that you see this.

    I think that the most frustrating thing about all this are the Doctors. IMO, your B12 was not very high at all for having taken weekly injections for ten weeks. Most would have been over a thousand and you cannot overdose. Your symptoms going away was the key as well. You know, maybe another Dr. is in order. At first I wanted to say take a supplement on your own, and that is good but, you need to find out why, like me, your B12 is so low and your body is not holding onto it, processing it properly. I am very frustrated, just like you. I have a platter full of illnesses right now and it is a matter of picking which one I would like to take care of. Hmmmm, brain tumor, CIDP, B12,,,Hmmm…But then again, could some of my symptoms be worse due to my B12? This is a puzzling stew and I just wish that I had a doctor who was on board with it all. My great doctor who started this rolling for me, found the ignored issue, returned to Lebanon to take care of her mother, who has MS.

  112. Helene says

    Please consider a problem with the MTHFR genes. I have problems with the B12 also, have pernicous anemia. My big problem is methylation which can cause all sorts of problems, including B12 problems and pernicious anemia, ammonia in the brain which causes foggy thinking, Trying to avoid food with sulfur. There are doctors who specialize in methylation treatments. You can get tested for these problems.

  113. Mona says

    I have read information on the internet in regards to Subacute Combined Degeneration of the Spinal Cord, which I was diagnosed with in Nov/10. Have posted here before but always searching for info regarding B12 deficiency and SCD since B12 def. diagnosis in Dec/09.

    I would like to know if Chris or anyone has any info to share on SCD.

  114. Elizabeth Skaggs says

    I was tested about 5 years ago and my B12 level was in the 200′s. I was recently retested and it is not at 388. I has gone up, but I still have many of the symptoms and I also have several family members who are being treated with the deficiency. However, my doctor won’t give me the shots because she said my levels are within the normal range. I am very frustrated, and sick and tired of being sick and tired. What should I do?

  115. Leann Warford says

    I had bloodwork with B12 deficiency 2 months ago but doctor didn’t give recommendation. I take a B12 daily. 2 days ago went and had bloodwork. My B12 level is 21. Haven’t spoken with this doctor yet just got blood levels back from office. Got me pretty worried. Just checking around different websites over the weekend so I can get all worked up!!!!

  116. Annie says

    Hi, I was found to have a b12 of 160. I have major fatigue issues, dizziness, migraines and sensitive eyes dating back many years. I had test dose of hydroxy – b12 plus 5 full shots every two to three days. I was so hoping to feel a lot better but actually a lot of things got worse. I had numbness and tingling most of night after first full shot, plus constant thrist and weeing which settled. I had had an eye twitch in one eye the whole time I have been getting the shots and initially was even tireder. After 3rd shot I found I am now more alert, when I wake in morning I feel awake within 5 mins rather than 45 and I have stayed up later without nodding off. But still have symptoms.

    Is this normal? Would I be best trying methylcobalamin? Friend of mine had that and said big improvement quickly . Are 3 monthly injections ok from now?

  117. Veronica says

    Is it true that if one has a vitamin B12 deficiency that the half white moons above the cuticles of their fingernails are missing? A nutritionist with whom I spoke said that this was indicative of a vitamin B12 deficiency. If so, does this indicate a major deficiency? I can’t afford to get vitamin B12 shots, but strongly suspect, given some of the other symptoms I have (depression, compromised cognitive fuctioning, lethary, shortness of breath, and overall not feeling well) that I have it. Not the case currently, a former doctor wanted me to have regular monthly, bi-monthly, or weekly vitamin B12 shots a few years back. (I had maybe two, but felt no relief whatsoever after both injections). If you think I have a B12 deficiency, would you recommend that I supplement sublingually with methylcobalamin. If so, with how much, and, do you recommend any particular brands? And, being a water soluble vitamin, is it possible to get too much vitamin B12?

      • Veronica says

        Thank you Chris for getting back to me about this.

        Do you know of any laboratory company I could order such tests from? Due to financial reasons, I’m not currently under the care of a doctor.

        Also, can a vitamin B12 deficiency cause hypothyroidism and gluten intolerance? It was thought at one time that I was hypothyroid (really, its just reverse T3 dominance and adrenal fatigue syndrome) as well as anemic. However, I am gluten-sensitive.


        • Chris Kresser says

          You can check directlabs.com and privatemdlabs.com. You can order blood tests directly from them.

  118. Elizabeth says

    Hi, I was just diagnosed with Lyme Disease 2 years ago. My b-12 levels have been high this long. I only take a b-complex daily. my hemoglobin, Hematocrit, MCV, and MCH are always about 2-3 point higher than normal. I’d like to know why my B-12 levels are so high. I suffer from extreme fatigue, weakness, severe anxiety I suffered for 7 years, and still present. Burning in my legs and tingling feelings at times. If I go to my primary DR what would he test for to see if I have a deficiency. Apparently, my Dr has not been so concerned that the level has been that high. Any suggestions?

    • Chris Kresser says

      There’s a strong correlation between Lyme and ME/CFS, which is in turn correlated with glutathione deficiency and a methylation block. Check out the Phoenix Rising forums for more on this. Anecdotal evidence suggests that treating the glutathione/methylation issue can help clear Lyme.

      • Sandra Brigham says

        Will definitely be looking into this. I was dx with Lyme a few years back. While I caught it within 48 hrs and was put on an aggressive course of doxy, I never felt right after. Eventually I asked for B12 testing and got a serum value of 90. By then, I’d been dealing with CF for a couple of years. While they didn’t dx me with clinical CFS, I was sleeping 10-11 hrs at night and falling asleep at the law firm during the day. My lunches were a 5 minute drive to a local trail where I parked the car and slept for an hour. I’d set a timer to wake me up to return to work. When the med estblishment referred me to Pysch for my fatigue, I found Paleo, It has given me back most of my energy. I sleep 9 hrs every night now but actually wake feeling refreshed. Naps are a thing of the past. I can hike without fatigure but can’t do HIT or work my muscles to fatigue or else I’ll crash for days. ? adrenal fatigue? Your suggestion of changing cyano B12 to methyl B12 also took care of my leg neuropthay. So thanks for sharing so new info that may, or may not, apply to me.

  119. says

    Chris – this is an excellent article. I could be your poster child on this issue. I am a former vegan slowly embracing the Paleo diet. It hasn’t been a perfect transition, but neither was being vegan. As a fitness instructor, lawyer and mom of 2 young kids, I thought that my exhaustion was due to my schedule (it is part of the problem…but there was an even bigger problem). As a “seemingly healthy” role model of health and fitness, after months of testing the truth came out early last year – severe b12 deficiency requiring injections 2x per week. I am not a fan of needles, but all of a sudden I had to become very comfortable with giving myself injections. I was a prime candidate and on a path for cancer…yep – what a rude awakening. It has been a very long and challenging road. I don’t like meat and the smell of certain meats and all seafood make me want to vomit. I have serious food sensitivities that make it challenging with some of the Paleo staples and I have had digestive issues with all the “trial and error”, but I continue to move forward and embrace the changes. I started blogging about my experiences (when time permits), but am really glad that I found your site.

  120. Kris says

    Chris – I have high LDL (just the LDL) from a year and half..I recently luckily checked my B12 and Vitamin D – they are very low. B12 155, Vitamin D 17.
    Do you see any correlation between lowB12,VitaminD and HIGH LDL? Do you think getting them to normal range with get LDL back normal?? Please help, i am currently on Statin,B12 shot and vitamin dose.

    • Mark B says


      I’ve had exactly the same…high LDL and virtually the same numbers for B12 and D3.

      Interesting info here:


      Covers sleep disorders related to both deficiency’s and also the high LDL level (in the lectures section – the slideshow in the top left)

      I’m waiting for some D3 supplements to arrive but having been on 6 spray’s a day of the Pure Advantage B12 spray for a week now and I’m noticing positive changes and improvements day after day.

      • kris says

        Mark – Did your LDL come down on supplementing with B12 AND Vitamin D..i too have the pins and needles..please help me Mark.

    • Mark says

      Hi Kris

      I’m in exactly the same boat as you with regards to the levels of D3 / B12 and also high LDL. From all the research I’ve done I think that yes, the high LDL is a symptom of the two deficiency’s.

      Interesting info here:


      Also check out the top left hand presentation in the lecture section on her site.

      I think that of the two, the D3 deficiency is actually more serious.

      I’m waiting for the D3 supplement but have been taking 6 sprays a day of the Pure Advantage B12 spray and the difference in a week is amazing – I’m sleeping again and the pins and needs have gone !

      • Julee Ellison says

        Mark, I cannot find the post, but are you the one that wrote: “I found that by addressing the cause (restoring my digestive ph) by supplementing with “Betaine HCL” within 3 weeks my energy returned and within a month ALL my symptoms resolved. I would suggest looking into restoring gastric ph, since not only might it help increase B12 levels, it will most likelyimprove absorption of all the other minerals dependent on gastric acid and intrinsic factor!”

        Was this you? If so, can you tell me what brand of “Betaine HCL” you take, and how much?

      • Kris says


        You said you are taking b12 spray 6 times a day that is 3000 mcg a day. is it ok to take that high dose?
        Please suggest me..also how long should you take that high dose of spray?

        Pleas help

        • Mark says

          Hi Kris
          I’m currently taking 4-5000 mg per day via a combination of the Pure Advantage B12 Spray and Now Foods 1000mg Methyl Lozengers – I’ve also got some of the Jarrow 5000mg lozengers on the way as well.

          It’s impossible as far as I can tell to ‘overdose’ on B12 so the high level’s i’m taking daily don’t bother me at all, all I’m interested in is getting rid of the symptoms. The central sleep apnea / shudders when going to sleep have totally gone, the pins and needles are going and getting better most days and pretty much everything else has cleared up after 4 weeks of supplementing, apart from v.mild tinnitus that has appeared in the past few days (but I have noticed that symptoms mutate and change week by week – last week I kept nearly falling sleep if I touched the backside of my upper teeth with the tip of my tongue for example and this week that has totally gone). I’m also having a few concentration issues as well, BUT (and its a big but, if I look at the improvement over the past 4 weeks since I started the spray, it’s amazing, so I realise the importance of patience as well !

          I’m also eating 2 egg yolks a day, so I’m not bothered about my LDL at the moment – I just want to get my B12 levels up / get rid of the symptoms. I’m also taking 15000IU of D3 a day for the next 3 weeks and then I’ll get another D3 test (because 14.9 D3 level is dangerously low !)


  121. Deb says

    This is so true, I am “The Winner of Life” From a Vitamin B12 Deficiency. Please watch video below.


    This is My Ulcertive Colitis Success Story. (2009) due to a Vitamin B12 Deficiency.
    My wonderful son Bobby helped me wrap up my personal battle with Ulcerative Colitis in a Video. This story I hope can help one or perhaps many. I struggled for 7 years and thank my family for helping through these very hard times. We entered a contest for UC success stories and WON! My main goal is to help others if I can by sharing my story.
    I want the world to know what my life was like, why I live each day to the fullest, and count my blessings everyday!

    I also suffered during this time of 7 years with Chronic Fatigue, a Sleep Disorder, Fibromyalgia, Nerve Damage, Hair Loss, Bleeding Gums, Unexplainable Uterine Bleed, Chronic Inflation of the Bladder, High blood pressure, nerve damage and was in the process of being tested for MS.

    All symptoms have reversed. Complete remission and reversal of the nerve damage.

    It has been four years, no medications, just B12 injections. Much different than 27 pills a day, all forms of rectal medications and $7000 Remicade every six weeks.

    Thanks to a very special nurse “My Angel”.

    B12 injections $5 a month, PRICELESS…

  122. Deb says

    This is so true, I am “The Winner of Life” From a Vitamin B12 Deficiency. Please watch video below.


    This is My Ulcertive Colitis Success Story. (2009) due to a Vitamin B12 Deficiency.
    My wonderful son Bobby helped me wrap up my personal battle with Ulcerative Colitis in a Video. This story I hope can help one or perhaps many. I struggled for 7 years and thank my family for helping through these very hard times. We entered a contest for UC success stories and WON! My main goal is to help others if I can by sharing my story.
    I want the world to know what my life was like, why I live each day to the fullest, and count my blessings everyday!

    I also suffered during this time of 7 years with Chronic Fatigue, a Sleep Disorder, Fibromyalgia, Nerve Damage, Hair Loss, Bleeding Gums, Unexplainable Uterine Bleed, Chronic Inflation of the Bladder, High blood pressure, nerve damage and was in the process of being tested for MS.

    All symptoms have reversed. Complete remission and reversal of the nerve damage.

    It has been four years, no medications, just B12 injections. Much different than 27 pills a day, all forms of rectal medications and $7000 Remicade every six weeks.

    Thanks to a very special nurse “My Angel”.

    B12 injections $5 a month, PRICELESS…

    Edited with correct link-Thanks

    • Deb says

      The bottom line is, it is our U.S. so called “FDA NORMAL B12 LEVELS”.
      Normal values are 200 – 900 pg/mL (picograms per milliliter).

      As for China and other European Countries.
      Normal values are 500 – 1500 pg/mL (picograms per milliliter).
      They also far have less GI, Alzheimer’s, over all heath issues than Americans.

      Perfect Book-Could It Be B12?: An Epidemic of Misdiagnoses.
      Sally M. Pacholok RN (Author), Jeffrey J. Stuart DO (Author).

      In my case, once when the deficiency was discovered my blood serum B12 test was in the 180 range. At the time, I acquired a primary care doctor who started me on a 1mg injection once a week for a month, they called it a “MEGA DOSE”. After the completion I was retested. the test result was 2400, WOW RIGHT? Now you can get a 1mg injection once a month and you will be good. GREAT RIGHT? Not so fast, in the first month I could feel improvement in all the health issues I was diagnosed with. I was ill for well over ten years, with many different conditions.

      THIS WAS VERY WRONG, after 2 weeks of the super high 2400 test result, all symptoms were starting to return. I knew it would take time to get better, unfortunately I felt like I was getting worse again. So I called my PCD asking to be retested. She said NO! You just had a test result of 2400. This is when I panicked; I didn’t want to get any worse!

      I decided to call my Pulmonary Dr. who I was able to explain how my Catathrenia (Sleep disorder to this date with no know cure, B12?) sleep disorder had completely stopped for the first time in well over ten years with the B12 injections. Now it was coming back too! I asked him to check my B12 level or I was going to the emergency room for a B12 test. He checked it and results showed it had fallen in this short period of time (about 2 weeks) from 2400 down to 400. He told me we know now you need to maintain higher range for me, than the average FDA normal range. We knew more than 400 for sure. So he prescribed the injections 1mg once a week. While checking my range (that has been as low as 500 to as high as 1200 over many years) we discovered my body doesn’t maintain B12!

      So this told my Pulmonary Dr. that he needed to treat me according to my symptoms. The current FDA range is far too low and far too broad. How can we change that?

      My children age 18 (300 B12 range) and age 22 (400 B12 range) are very low in their B12 range and we CANNOT find a Doctor to help us, as my Doctor has retired. My children are not as sick as I ended up being, YET!

      I’m good, great, better than I ever dreamed. I have my life back and more!
      “I truly believe it was for a reason!”


      Why don’t Doctors and the FDA listen?

      My video has been viewed within a couple of weeks in; 49 states and 36 different countries.

      Video Link PLEASE WATCH! http://youtu.be/CH-N3ktF25g

      Second video: http://www.youtube.com/watch?v=3EiUWPwz6Co.

      • Junto says

        Thanks for sharing your experience. I too have catathrenia so I’ll be getting my b12 checked for sure! My other symptoms include restless leg syndrome (something I don’t here discussed often in teh paleo-sphere), cold feet and hands and fatigue (as well as fatigues ugly twin..depression). I’ts my understanding that b12 and iron deficiencies often occur together, perhaps both levels need to be checked. Thanks again for sharing your experience.


    • Chris Kresser says