In May of 2011, I wrote an article called B12 Deficiency: A Silent Epidemic With Serious Consequences. I argued that B12 deficiency is much more common than statistics indicate, with potentially devastating consequences. B12 deficiency can cause or is associated with:
- Premature aging
- Neurological disorders similar in presentation to multiple sclerosis
- Brain fog, memory problems and cognitive decline
- Stroke, heart disease and other vascular problems (due to elevated homocysteine)
- Developmental or learning disabilities in children
- Impaired immune function, autoimmune disease and cancer
- Male and female infertility
- Numerous other symptoms…
One of the biggest problems with diagnosing B12 deficiency is that the conventional serum B12 test that most doctors run only picks up a small fraction of people who are actually B12 deficient. This test measures the total amount of B12 in the blood, and does not rule out functional B12 deficiency. (1) More sensitive markers for B12 deficiency are now available, including methylmalonic acid (MMA) and holotranscobalamin II (holo-TC). MMA is converted to succinic acid via an active-B12 dependent enzyme, so if MMA levels are high, it suggests that active B12 is lacking. Holotranscobalamin II is composed of vitamin B12 attached to transcobalamin, and it represents the biologically active part of B12 that can actually be delivered to the cells and perform all of the functions of B12. Studies using these newer methods report much higher levels of deficiency than studies using only serum B12.
For example, a one review using serum B12 indicated that 52% of vegans and 7% of vegetarians are B12 deficient. (2) But a study using the more sensitive techniques found much higher rates of deficiency: 68% for vegetarians and 83% of vegans, compared to just 5% of omnivores. (3) That’s a huge, game-changing difference. It means that conventional testing is missing 61% of vegetarians and 31% of vegans that are B12 deficient. This is especially important because B-12 depletion can take years to become clinically evident (i.e. deficiency sets in long before obvious symptoms appear), and some of the more serious effects of B12 deficiency (such as nerve damage) are irreversible.
The effects of B12 deficiency can be irreversible—but most who are deficient don’t know it.
Although rates of B12 deficiency are much higher in vegetarians and vegans than in omnivores, that doesn’t mean it’s rare in omnivores. According to the study above, approximately 1 in 20 omnivores are B12 deficient. In my practice I’d estimate the rate at closer to 1 in 15, possibly because I see a lot of people with gut problems and that is one of the risk factors for B12 deficiency. Other risk factors include age (people 60 or older), present or past use of acid-suppressing drugs or other medications like metformin and women with a history of miscarriage and infertility.
Frankly, I’m amazed that this very serious problem doesn’t get more attention in the media. As Sally Pacholok and Jeffrey Stuart point out in their book Could It Be B12: An Epidemic of Misdiagnoses:
Over-diagnosis of B12 deficiency is essentially innocuous [because B12 is so safe to supplement with]; but…’missed diagnosis is quite clearly a matter of great gravity, particularly since the risk of formidable devastation from neurologic damage that results from uncorrected cobalamin deficiency is preventable.’
The importance of early diagnosis
Researchers now recognize four categories of B12 deficiency:
- Stage I & II: plasma and cell stores of B12 become depleted and the concentration of holotranscobalamin II is reduced.
- Stage III: functional B12 imbalance characterized by elevated homocysteine and urinary MMA concentrations in the blood.
- Stage IV: clinical signs of B12 deficiency become evident. (3)
As you can see, signs like macrocytic anemia and symptoms like peripheral neuropathy or brain fog do not appear until the final stage of B12 deficiency. By then, in the case of the neurological symptoms, it may be too late to reverse them. This makes early diagnosis crucial.
Of all of the available markers I mentioned above, holo-TC is considered to be the most sensitive. It can detect B12 deficiency in Stages I & II, whereas urinary MMA and homocysteine typically don’t become elevated until Stage III. Unfortunately, holo-TC is not yet widely available. Quest Diagnostics has recently begun to offer it, though, and it is one of the largest national laboratories so your doctor should be able to order it if you ask. [Update: although Quest lists it on their website, they apparently do not offer it at any Quest location in US as of 1-18-13.]
There are two ways to have MMA measured: in the serum, and in the urine. (4) Each has advantages and disadvantages. Some experts believe that urinary MMA is superior to serum MMA as a marker — possibly because it is more concentrated in the urine than the blood. However, elevations in urinary MMA can also be caused by kidney dysfunction. (5, 6) On the other hand, serum MMA can be elevated in the presence of intestinal bacterial overgrowth. (7). Therefore, which test you choose should depend on your health status. If there’s any question of impaired kidney function, serum MMA would be a better choice. If you have or think you may have SIBO or gut dysbiosis, urinary MMA would be the better choice. Quest, Labcorp and many other labs offer both serum or urniary MMA, so you shouldn’t have any problem getting it provided your doctor will order it. Note that you need to be fasting for the urinary MMA to get an accurate result.
If you can’t get either of these tests, you can order the standard serum B12 test yourself from DirectLabs.com or through your doctor. However, in that case you need to use a different range than what the lab provides. Although most labs define deficiency at <200 pg/mL, it is well documented that many people experience signs and symptoms of B12 deficiency at levels between 200 pg/mL and 350 pg/mL. (8) Also, be aware that a high serum B12 does not necessarily rule out functional/active B12 deficiency. In fact, I have come to view a high serum B12 in the absence of supplementation as a potential red flag for active B12 deficiency.
If you suspect you have B12 deficiency
The first step is to get a holo-TC and/or urinary MMA test. If either of them are abnormal, you should immediately take steps to increase your B12 levels. There are two ways to do this:
- Eat B12-rich foods.
- Supplement.
B12 in the diet
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. B12 is found exclusively in animal foods, such as liver, clams, oysters, mussels, fish eggs, octopus, fish, crab and lobster, beef, lamb, cheese and eggs.
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. (9) My intention here is not to bash vegetarian and vegan diets (I was a macrobiotic vegan myself at one point, for crying out loud!). 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 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. This is especially important for vegetarian or vegan children or pregnant women, whose need for B12 is even greater than adults. In addition, omnivores that are low in B12 despite eating a diet rich in animal foods that contain B12 should also supplement.
Supplementing with B12
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. (9, 10 p. 225) This is probably because methylcobalamin bypasses several problems in the B12 absorption cycle and doesn’t need to be decyanated or reduced to the (+1) state (the only state that can cross the blood-brain barrier). On top of that, methylcobalamin provides the body with methyl groups that play a role in various biological processes important to overall health.
A general approach to B12 supplementation might include 1,000 mcg (1 mg) of sublingual methylcobalamin — Jarrow Formulas Methyl-B12 is a good choice — along with co-factors like folate (Solgar Folate 800 Mcg 1x/d), potassium (Natures Way Potassium 99mg 3x/d) and trimethylglycine/TMG (Jarrow 500mg 1x/d).
Note: I earn a small commission if you use the links in this article to purchase the products I mentioned. I only recommend products I would use myself or that I use with patients in my practice. Your purchase helps support this site and my ongoing research.
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{ 157 comments… read them below or add one }
Hi Chris,
Interesting stuff. Have you found that people with a functional deficiency sometimes show elevations in serum B12?
Thanks.
Thanks for bringing that up! Yes, I have. I’m going to add a bit on that to the article.
Great! I look forward to your take. I have developed numbness and tingling in the past 6 months. My reg doctor tested my B12 which came in at 1257 pg/ml, but I wasn’t supplementing. She just brushed it off. It took a functional doc to connect the dots between my gastro issues and my likely malabsorption of B12 despite my high intake of animal foods. I was a vegetarian/vegan for 13 years.. that should have clued my reg doc in! Ah well. I have been supplementing 1000 mcg liquid methyl for 6 days. There is a noticeable difference, but I still have tingling. Hopefully the damage isn’t permanent. Fingers crossed!
If you were not absorbing why is your blood level for B12 in normal range?
What is your normal course of action when you see elevated serum B12 and a functional deficiency? I know that you said you were reserving judgment on Spectracell, but my daughter showed a functional deficiency with their micronutrient analysis and an elevated serum B12 with a standard blood test. Observationally, my daughter had the tingling in her extremities and mood changes that could be explained by B12 deficiency. I have just started here on 1000 ug/day sublingual B12. What is your rationale for these seemingly opposing lab results?
I wonder if the high serum B12 reflects a high analog level and that would be why the individual is deficient. I guess if a true ‘active B12′ level was done, the person would be found to be deficient in the genuine B12. Interested in this especially as one of my colleague’s husband has a very high B12 level (around 1200 pmol/L, I think).
Hi Chris,
What do you think about B12 injections? Is there any benefit compared to oral supplementation?
Some physicians feel they are superior in the case of neurological problems, but other experts believe the opposite: that high-dose sublingual is a better choice in all cases.
Hi Chris – The links in your last paragraph are all dead. Thanks for the great post on B12. I was recently told that I had a B12 deficiency and I would like to purchase the Jarrow Methyl B12. I’ll wait for your links to work so that you get your commission for my purchase.
Thanks. Someone will fix that soon!
My wife and I were vegetarian for 15 years. She has MS (20yrs). We changed our diet to Paleo Feb ’12 as we didn’t feel either of us was getting the proper nutrition. I must say I feel much better/energized, and my wife’s state is much improved. However, we have implemented other therapies so it’s hard to say the exact effect our diet had to do with her improvement.
May I ask what other therapy s she has implemented? I was diag ms feb 2012 at 51 yrs of age
If you haven’t already, you might want to check out the book “Minding My Mitochondria” by Terry Wahls; or Terry Wahls in general.
Ooops. Looks like the links to the suggested supplements are broken. Looks like you got a little CSS in your HREF, if you know what I mean…
It’s interesting that vegetarians and vegans (like you, I used to follow these diets myself) think that they’re lowering their risks of heart disease when their deficiencies are actually elevating these risks. It’s surprising (or not surprising?) that in spite of the number of studies that demonstrate the devastating results of a B12 deficient diet, you rarely read or hear about it.
Do you think that taking a sublingual methylcobalamin supplement is as effective as regularly consuming animal products (all other things being equal, like absorption)? I haven’t found any clear information on this issue.
Liz: I’m not sure who you’re addressing here? I am not a vegetarian now, though I was for a short time. At the time, I was experimenting with it for both ethical and health reasons, but I wasn’t doing it to lower my risk for heart disease.
Sublingual methyl B12 may be equivalent in terms of B12 absorption, but of course it doesn’t have the many other benefits of consuming animal products.
Sorry, Chris! I know you’re not a vegetarian today. I should have been more clear: one of the main reasons for following a plant-based diet is for health reasons, when actually there are risks due to deficiencies. We rarely see this issue discussed. Thanks!
Right. I agree 100%.
Assume you are aware of Biermers disease where you simply cannot absorb B12 and need regular IV injections….
Pernicious anemia is another disease that causes B12 deficiency. But many docs now believe that high-dose, sublingual methyl B12 is equivalent or superior to injections in these cases.
I have pernicious anemia, and have been injecting myself for the past four years. As I am only 35 and was told that I will have to do monthly injections for the rest of my life, sublingual b12 sounds like a much better way to go!
How can the high-dose, sublingual b12 be absorbed by my body if I don’t have the intrinsic factor? Is the b12 absorbed into the bloodstream in the mouth somehow?
Thanks for your time!
Sublingual preparations bypass the stomach so wouldn’t be absorbed via the digestive pathway that requires intrinsic factor. You’ll have to ask your doctor whether sublingual B12 can substitute for injections, but many physicians I work with use it for pernicious anemia cases (and I have also had good success with it).
A fixed proportion (1.2%) of ingested B12 is always absorbed by passive diffusion which doesn’t rely on IF. This is insignificant at doses obtained from food but highly significant in case of high dose supplements. I take one 5000 mcg sublingual methylcobalamine lozenge per week which should give me about 60 mcg of B12 per week.
I have celiacs and have been told that b12 is a common dificiency as well, i see no mention if celiacs herein?
Hi Chris,
I know that energy shots, like 5-hr energy and others, are not Paleo but they have been the one vice I can’t seem to shake. They contain a similar amount of caffeine as a large cup of coffee and contain mega-doses of B vitamins (B6, B12, B3, B9). I was just curious on what your thoughts were for these types of drinks from a health perspective for someone in maintenance mode (not trying to lose weight).
Any input would be greatly appreciated.
You might not like my answer. The vitamins in these products are usually the lowest possible quality. Caffeine is individual; if you have adrenal/brain issues, it’s not a good idea. If not, there’s nothing wrong with it.
No Adrenal/Brain issues here, but I guess it is time to cut back….
Thanks for the quick response!
Hi Chris- I am interested to find out what you know about Vit B sensitivity and overdose. I have symptoms of Vit B deficiency most of the time but whenever I encounter large amounts of B from a multi-vitamin, vitamin water type source, or B Complex supplement, after one or two doses, I begin getting overdose symptoms (major fatigue). I am also very sensitive to the natural sweetener stevia (flu like symptoms, feels like body is shutting down). I have had my liver enzymes checked and they are functioning fine. I have always been very sensitive to pharmaceuticals also (half life lasts much longer for me). Background: I am a fairly fit female in my 30s- 5’5″, 118 lbs. My body type seems to be a little more naturally acidic and my LDL cholesterol level trends a bit higher. I would love to hear your thoughts…. Thanks!
Your reaction to B vitamins is so similar to mine. I’m convinced I’m deficient ( I have ongoing gut issues I’m working on, and I think it’s effected absorption), but even with a natural food based B vitamin I had extreme fatigue and flu symptoms, reacting even after a single dose. When I take the Vit B complex it feels like overdose and herxheimers reaction rather than an allergic reaction–but I can’t be sure? I tried sticking it out for a couple weeks and kept taking it, but finally gave up til I can understand this better. I would love to see Chris respond to this!
SB above and Amber below,
What you mention sounds like what has recently happened to me.
Before I had come across Chris’ 2 blog postings about B12 or the other specialist websites that go in-depth about B12 replenishment (and thus I didn’t yet know that there are several supplements that should be taken ALONG WITH full-strength methylcobalamin), I had been taking a 1000 mcg tablet of methylcobalamin daily for 2 weeks with no problem, and the first steps of healing were really seeming to take place (in terms of my particular deficiency symptoms), but then I suddenly had a “potassium crash” that put me out of commission for about 36 hours (constant heart palpitations, lasting muscular cramps in my back and neck, feeling totally drained).
I tried to find out what was happening to me and discovered that this kind of crash was common with methylcobalamin (this potential potassium imbalance, called hypokalemia, is even mentioned on the Wikipedia page for B12 deficiency, which I had actually read before I started taking the B12 supplement, but I had just not paid enough attention to that part). I rested, ate as many foods as I could find in the house that are high in potassium, and stopped taking the B12 until I could obtain the other 3 supplements that are meant to balance everything out.
A follow-up to the last question. How does one know if they have adrenal/brain issues?
Thank-you!
christine — this is a good question! flipped around is this. . . “adrenal/brain” concept. I think I have it!
Hi Chris,
The B12 you link to is 5 times the daily dose you are recommending (1000mcg vrs. 5000mcg)
Oops, will change that right away. Some people do require the higher dose, but I recommend the 1,000 mcg for general/mild deficiency or maintenance.
Oh, crikey – I had already ordered via the link before I saw this. So now I have 5000mgc lozenges. Should I take one per week as the commenter above does? Thanks!
Pill splitter?
The last supplement you mention, TMG (trimethylglycine) – is that found naturally as part of the glycine component of bone broth and therefore less important for the bone broth addicts out here? Thanks!
Yes. Always best to get it from food when possible. But for therapeutic cases, some may need to supplement.
Very interesting article. About 13 years ago I was originally diagnosed with a blood disorder that required a bone marrow transplant and i was getting blood transfusions bi-weekly. I then decided to seek a second opinion, the second oncologist diagnosed me with anemia and started me on B-12 injections and folio acid. Within a month, my counts were almost perfect. The doctor had no explanation of why I was anemic. To this day, I still take monthly B-12 injections and supplement with folate. It was all very scary. I am thinking of starting sublingual to avoid the shots and having to get a prescription. What’s your thoughts?
Discuss it with your doc, but it’s probably worth a try.
I think you may have overlooked my query.
Hi, I am currently battling with my Dr for further b12 tests after my bloods came back normal. Many members of my family (ibs sufferers) receive the injection. I have recently realised that my symptoms, ie very listless, snappy, very sore lips, NO memory, tingling hands, are more than likely due to this deficiency. I shall probably direct my Dr to this article in the hope of moving things on a little quicker! I am in 38 yr old omnivor with serious cheese cravings if relevant!
Why not just go ahead a get a sublingual methyl B12 bottle and see how you feel after 2-4 wks? My serum B12 was 90 (extreme fatigue, ataxia, neuropathy, etc.) and she only wanted to give me one injection. I had pretty severe neuropathy in the left leg and foot (and mildly in the left arm and hand) and when I went from taking nothing to taking the sublingal cyano B12, it got a bit better over a few months. Then I read Dr. Kresser’s original blog article and switched to methyl B12. Within weeks almost all my neuropathy was gone (except when I accidentally ate gluten it came back; or if I eat too high a carb load or too many nuts). Why wait for your doc to address it if you’re feeling crappy. It’s very hard to overdose.
Hi Chris,
Being someone on SCD with gut issues and and a few gut-resections, I cannot take sublingual due to the illegal flavorings. I have recently tried a B12 patch – I’m not sure if these are bogus? if so, what would you recommend?
thanks, Jenn
I can’t tell from the B12 patch website, but I recall they use cyanocobalamin, which is an inferior (inactive) form that must be converted to active forms in the body.
Jenn, I don’t know what you are restricted from using sublingually, but I have a bottle of Natural Factors B12 methylcobalamin sublingual 1000 mcg that has no flavors, colors, citric acid, artificial sweeteners, etc.
The ingredients are:
methylcobalamin
lactose (from milk)
cellulose
croscarmelose sodium
magnesium stearate (vegetable grade)
Note: I think that this brand might also have B12 sublinguals of the same dosages, 1000 and 5000 mcg, that DO have that extra stuff in them, so read the labels carefully if you are thinking of purchasing these.
I am pleased with it so far, but it’s the only methylcobalamin I’ve ever used and I’ve only just begun to take it, so I have no basis for comparison. I have gotten the feeling from reading various discussions in various forums about B12 deficiency that the Natural Factors methylcobalamin is not very highly regarded (in terms of its perceived potency) by experienced users of B12 supplements (such as Freddd and folks who swear by his B12 replenishment protocol). But it seems to be doing something for me, and I try to avoid all the unnecessary flavors/colors/sweeteners that I can.
my rudimentary observations have shown me that vegan/vegetarian women who reproduce are ending up with babies who store extreme amounts of fat and end up on the autism spectrum. could this be due to B12 deficiency? this observation based on at least 10 different women in my community…
The Jarrow Methyl B12 appears to not be corn-free.
I’ve learned the hard way that I need corn-free. And, I prefer to not have the sugar alcohols, either, since I don’t do well with them. I see that it is free of wheat, gluten, soybeans, dairy, egg, fish/shellfish, peanuts/tree nuts, which covers a bit more than I need, except for the corn issue.
Any thoughts for someone needing corn-free?
I bought B12 Infusion by Enzymatic Therapy, which is corn-free, but I have not tried it, yet. It contains a sugar alcohol, so I don’t want to try it until my stuffy head clears up.
Can you handle a very small amount of lactose? Superior Source makes super tiny instant dissolving sublinguals that are methylcobalamin in a base of lactose and acacia gum (no sweeteners).
Natural Factors methylcobalamin sublinguals are also corn/gluten/soy/starch free (lactose base/sweetener free)
It seems strange, but I cannot even handle a small bit of lactose. It gives me sinus problems, which I battle with constantly. And, I don’t do well with gums. I looked at the Natural Factors and it does have lactose. Thanks for the suggestions, though!
Hey Chris,
It’s a little bit out of subject, but I’ve heard that yeast contains B vitamins, and so I was wondering if unfiltered beer (or beer on the lees, which contains yeast sediment) has some amount of B vitamins as well ?
Thanks !
Fleur de Lys
No, as it said above in the article, actual B12 is only created in the stomach of animals.
Do you just follow the lab range for urinary MMA?
Yes, though I’d pay attention if it were toward the high end of normal, since MMA doesn’t become elevated until Stage III deficiency.
Thanks for all of this information. Do you know why so many makers of B-12 supplements (in all its forms) state that the supplements are vegan or “suitable for vegetarians”? Even the Jarrow Methyl-12 bottle says this. I just want to make sure I’m getting the right stuff. Thanks!!
Because they don’t contain any animal products.
In the post you mentioned the only way to get B12 was from animals, but then this supplement is animal parts free. This doesn’t seem possible based on what I read?
The only way to get B12 in the diet is from animal products. The second way to get it is by supplementing.
Is it dangerous to have a really high B12 levels (after following Paleo for a while, like I am)… Mine are almost 1000?
No, it’s not. B12 is non-toxic even at relatively high levels/doses.
Over-methylation is a concern for those supplementing with very high doses of B12 over a long period. That should be done under supervision.
But I don’t take any supplements… I get all my B12 from the meats/seafood only. Does this mean I’m overmethylated and change my diet a bit?
As with Beth, my last B12 serum test was 1039. It’s been over 1000 for a few years now, but docs never blink. I was worried as I read scary things about elevated B12 (leukemia, liver disease?).
I also eat plenty of red meat (grassa fed, of course), pastured eggs, etc. I don’t pop B12 sublinguals too often. I decided to stop taking them when I noticed these high B12 levels.
My other blood tests don’t really suggest anemia. Any thoughts?
i was diagnosed w/ severe iron anemia a year ago. took 2 months of liver (2 oz) every day to become low normal. come to think about it ; i may have been in & out of anemia all my life.
the interesting thing was my B12 was also high.
my diet is between of PHD & WAP; i also dont’ take B12 supplements.
Thanks for yet another fantastic article Chris!! I found this out for myself through trial and error. My multivitamin company changed their formula and I immediately had some constipation issues. I figured I just needed to adjust so give it a month. As the month progressed my brain fog got really bad and my PN returned to the point it was bothering me. I decided to find a different multi. The lady at the health food store suggested I find one with methylcobolamin so I did. After just one dose I noticed a huge difference!! Went from standing at the stove trying to figure out how to work it one day to feeling sharp as a tack again the next. My ND wants to do some kind of special blood work for B12 and other vitamins, because of my response to the vitamins. Can’t wait to get the results (although do to finances, it will be a month or so before I go). Oh, and I’m a big meat eater. Always have been.
I would like to supplement with B12 as I have been told by my doctor am I in the borderline low range (from more standard serum tests). I was given Superior Source – No Shot B12 Methylcobalamin Instant Dissolve 10000 mcg to take which includes Vitamin B6 (as pyridoxine HCl), Folic Acid, B12 as Methycobalamin and stevia extract. After a week or so of taking the supplement, I begin experiencing extreme agitation and worsening mood. The symptoms were pronounced and severe. Once I discontinued taking the supplement these symptoms resolved. Has anyone heard of this kind of adverse reaction while supplementing with B12?
I would avoid supplements with folic acid, it’s probably what you’re reacting to. Superior Source makes a B12 without the additional stuff…maybe you can try that?
Ali,
What you mention might be due to the same thing that recently happened to me -
Before I had come across Chris’ 2 blog postings about B12 or the other specialist websites that go in-depth about B12 replenishment (and thus I didn’t yet know that there are several supplements that should be taken ALONG WITH full-strength methylcobalamin), I had been taking a 1000 mcg tablet of methylcobalamin daily for 2 weeks with no problem, and the first steps of healing were really seeming to take place (in terms of my particular deficiency symptoms), but then I suddenly had a “potassium crash” that put me out of commission for about 36 hours (constant heart palpitations, lasting muscular cramps in my back and neck, feeling totally drained).
I tried to find out what was happening to me and discovered that this kind of crash was common with methylcobalamin (this potential potassium imbalance, called hypokalemia, is even mentioned on the Wikipedia page for B12 deficiency, which I had actually read before I started taking the B12 supplement, but I had just not paid enough attention to that part). I rested, ate as many foods as I could find in the house that are high in potassium, and stopped taking the B12 until I could obtain the other 3 supplements that are meant to balance everything out.
For those looking for a corn-free sublingual methyl b12 supplement, this is what our family uses: http://www.drugstore.com/superior-source-no-shot-methylcobalamin-b12-1000mcg-disolve-tablets/qxp383321?catid=183199
Thanks for the lead. That one is not dairy-free. I have to have one free of gluten, corn, dairy, soy and yeast.
Hi everyone,
I just found out that Quest is not, in fact, offering the holo-TC test yet. It’s listed on their website, which is what led me to believe it’s available. However, they aren’t offering it at any of their Quest blood draw locations, which effectively means it’s not. Hopefully someone will get on this soon!
Chris, any experience with liposomal methyl-B12 like that made by Empirical Labs? (http://www.empirical-labs.com/product_p/liposomalmethyl.htm). A few people have trouble even with the sublingual lozenges, and I wonder if this might be a better option for those with very difficult absorption problems.
For those interested in testing their B12 levels, it’s one of the tests offered in Talking20′s “vitamin pack.”
http://www.indiegogo.com/talking20/x/2103506
I can’t vouch for the type of B12 test they offer, as I have no affiliation with them. It just seems like a great option for us health-conscious people to stay on top of what’s going on in our bodies without inconvenient and sometimes very pricey doctor visits.
The campaign is over at the end of Sunday, Jan 20, so not much time left.
Folks: just added some important information to the testing section:
There are two ways to have MMA measured: in the serum, and in the urine. (4) Each has advantages and disadvantages. Some experts believe that urinary MMA is superior to serum MMA as a marker — possibly because it is more concentrated in the urine than the blood. However, elevations in urinary MMA can also be caused by kidney dysfunction. (5, 6) On the other hand, serum MMA can be elevated in the presence of intestinal bacterial overgrowth. (7). Therefore, which test you choose should depend on your health status. If there’s any question of impaired kidney function, serum MMA would be a better choice. If you have or think you may have SIBO or gut dysbiosis, urinary MMA would be the better choice. Quest, Labcorp and many other labs offer both serum or urniary MMA, so you shouldn’t have any problem getting it provided your doctor will order it. Note that you need to be fasting for the urinary MMA to get an accurate result.
Chris are the supplements you refer to safe and beneficial during pregnancy (obviously I’m already taking solgar folate as part of your healthy baby code)?
They may be, but they’re not necessary unless you you are B12 deficient.
Can people get start up effects when they commence taking activated B vitamins. By start up effects I don’t mean over-methylation, but feeling unwell due to the long dormant biological processes coming back on line and perhaps causing the shift of toxins.
Also, do you think that adenosylcobalamin is worth taking as a supplement?
Yes to your first question. And yes, some have better results with adenosyl. Those with methylation defects may need both methyl and adenosyl.
Chris, do you have any thoughts on the work of Dr Amy Yasko regarding methylation and B12 supplementation? She might be an interesting podcast guest. She has some interesting theories associating certain SNPs with over/under methylation, MTHFR, autism issues etc.
To those feeling fatigued by taking B-complex vitamins. I used to feel low energy after a couple of days of taking methylated b vitamins, and after reading her work and looking at my SNPs, I switched over to hydroxocobalamin and there was no fatigue despite daily supplementation. Yasko associates some COMT SNPs with tolerance of methyl donor supplementation.
ks
I’m aware of Dr. Yasko’s work, and I agree she’d be a great podcast guest. I’ll ask my producer to look into it!
Hi Kris. I’m from New Zealand so sometimes translating American stuff to what is available to us is tricky. I’m hoping I can find someone here who understands about B12. I’ve had Bells Palsy for 11 months. My nutrition is generally good and I supplement with vitamin B complex with extra B5. I take a Nordic cod liver oil and eat grass fed beef etc. My B12 showed normal to high on blood tests but I understand B12 might help heal the nerve sheath or myelin. I still have active Herpes Virus but my doctor seems totally unconcerned.
I am thinking about going to a natural health doctor but feeling cautious as this will be costly.
Any ideas.
MargieAnne: I have read that benfotiamine, which is a lipid-soluble form of B1, can cause regeneration of myelin. See benfotiamine.org.
Thanks for this. I am searching through and will probably purchase a supplement with benfotiamine. Nothing like experimenting on myself but at least it seems exceedingly safe.
Blessings
Hey Chris what would you recommend for vegetarian children? I have an 8, almost 9 year old, who has never eaten any animal products except milk and cheese. He absolutely refuses. Gags, even as a toddler. I have given him iron supplements but his bloodwork always comes back on the low side.
Methyl-B12. I’d say maybe 200-300 mcg, but check with your doctor. The co-factors will also be important for him.
Hi Chris,
Can you please tell me if the B vitamins from kombucha are absorbable? I’m guessing they may be similar to what is found in brewers yeast. I have always considered kombucha to be a valid source of b12, I’d really love to know if that’s not the case.
Thanks!
Hi Chris,
A quick question about B12 testing and the standard complete blood count test. I frequently test as having mildly elevated MCV (around 98) and mildly elevated MCH (33.6 was the highest). These are usually just barely out of the reference range, and my doctor is not at all concerned. I’ve read, though, that much higher readings could be indicative of deficiencies in various B vitamins. In general, do you think such mild elevations are indicative of deficiencies?
Thanks for all you do! You have been so very helpful to me in my quest for better health.
Yes, elevated MCV is often a sign of macrocytic anemia. Red blood cells actually start out large, and as they mature they become smaller. That maturation process requires B12 and folate. The mean corpuscular volume (MCV) measures the average size of the red blood cells; if it’s high, it suggests the red blood cells aren’t maturing (getting smaller), which is usually caused by folate or B12 deficiency (more commonly B12).
That said, a few other conditions like hypothyroidism can also cause elevations in MCV. I would definitely get your MMA checked, along with serum B12.
Megan, I too had mildly elevated levels of MCV and MCH and was diagnosed with pernicious anemia a couple years ago, so I agree with Chris about the testing if you haven’t done it yet. I just did follow up tests last week and will be meeting with my practitioner this week — and I’ve been on B12 injections for two years, too. It’s like night and day for me energy wise, so I am so thankful my practitioner discovered this and this website is here for further information!
Our lab won’t test B12 without also testing folate levels as a reduced Vitamin B12 level can be masked by folate deficiency.
Great article Chris!
I actually did the blood test you mentioned above and my B-12, along with my Pantho (B-5, I think?) was low as well. I am working to improve my diet to amend this deficiency, but I also started a supplement today, taken after breakfast and lunch. I really did feel better and more energetic today, but I noticed my urine was bright yellow, even though just starting this morning. This makes me think I’m not absorbing the vitamin, yet I feel as if it has given me a lot of energy. So should I be worried about the bright urine color?
Thanks!
Check your supplement for riboflavin (vitamin B2). This is the B vitamin that causes bright yellow urine, and it’s totally normal.
It does have Riboflavin–thanks David!
Chris -
If you link to Quest’s site, and go to their lab locations page, you will find that the lab in Indianapolis lists the VitB12 HOLOTC test, which assay is actually performed in Valencia, CA, if I read it right. Seems to me that if they have the wherewithal to do the analysis there, should be easy enough to send the sample from any of their draw locations – yes/no?
I believe it would be. Our lab’s active Vit B12 test requires the plasma or serum to be spun off, then kept at 4 degrees Celcius (about the same as a fridge) then it is considered stable up to 7 days after this.
I’ve heard taking methylcobalamin can cause problems with people with MTHFR mutations. I have a double mutation so im A1298CC, but when I took methylcobalamin it made me feel even spacier, it was 5,000 mg which is a lot though. I’ve been taking hydroxycobalamin sublingually, about 1,000 mg and it seems to help some but think maybe taking shots or lower dosages over time might help. Im waiting until I get results from my 23andme test to see what SNPs I have besides MTHFR, since that can determine what form would be better to supplement with.
Hi, Really interesting article. I have been diagnosed with Hypermobility Syndrome, Fibromyalgia, severe IBS & also am Hypothyroid. I had a blood test Sep 2012 that should very low B12, doc wanted to give me injections but I really did not want to go down that route every 3 months! so I started on Jarrow Methyl B12 sublingual tabs and noticed a difference after a couple of weeks. Recent blood test showed B12 now back to acceptable levels (whatever that means lol) I still take them daily with my thyroxine and a multi vitimin tablet for the over 50′s..While I cant claim they are a cure all. They can’t for example address pain and mobility problems, but I feel much more alert mentally than before. so will continue to take them.
Incidently my Mother also had years of neauralogical problems before being diagnosed with MS at 50 with no remissions, and sadly died at 60. I wonder if B12 could have helped her as she also had Dimentia linked to the MS, and I have heard that a lot of elderly people with Dimentia are Vit B12 deficient?
Hi Chris,
Thank you for the article. Is there any harm in supplementing with B12 at your recommended maintenance dose for a ‘trial’ without lab confirmation of deficiency? I am paleo (PHD-esque) 1+years but was a veggie for a couple of years prior…
I had suffered from depression and anxiety since I became a vegetarian, and then being paleo only helped my symptoms slightly. I started supplementing with Nutri-Dyn’s Phytomulti multivitamin, which contains a high dose of methylcobalamin and this has made a huge difference. A chiropractor had previously had me supplementing with cyanocobalamin and this caused my serum levels of B12 to skyrocket to way above the desirable range, but my symptoms didn’t improve, potentially because I have methylation issues and was not absorbing any of that type of B12. The methyl- type definitely helps some of us while the cyano- version does not.
Hi Chris,
Do you ever see recovery of patients with peripheral neuropathy due to low vitamin b12? Is there anything else one can do besides normalize b12 levels to try to recover? Thanks
Hi Jens: yes, I have in quite a few patients. It’s definitely worth a try. You may want to read up on methylation defects and check into either Rich Van Konyenberg’s or Fredd’s protocols. Google them; they’ll come up.
Just a note to say that Rich and Freddd’s protocols changed over the years, and several versions of them are still on the internet, in discussion threads that can be very long, with people still contributing to them years after they were started (and it’s all so complicated anyway, at least when you are new to this subject like I am!)
Therefore, be careful when looking Freddd and Rich’s recommendations up on internet search engines — try to find the most recent version of their protocols.
I may be wrong, but as far as I have discovered, these are the most recent versions:
Rich’s: http://forums.phoenixrising.me/index.php?threads/revised-simplified-methylation-protocol-august-25-2012-revision.19050/
[Note: Sadly, it seems that Dr. Van Konyenberg passed away a few months ago, so this is the last version of his protocol.]
Freddd’s: http://forums.phoenixrising.me/index.php?threads/the-stages-of-methylation-and-healing.21725/
(note: That specific thread by Freddd is quite complex and technical, and I do think there are shorter descriptions around of his current B12 thinking – I’m not able to find a concise one right now though. Do make sure to look for posts by him that are from the last couple of months, because he has changed some of his hypotheses and some of his product recommendations relatively recently.)
I have the MTHFR variant. I know because in Sept 1999 I developed a blood clot. I was 35 at the time and had not been married a year yet.
I was on coumadin for 2 1/2 yrs and hemorrhaged.
I have been doing the supplementation ever since with B complex and extra folic acid, B12, B6 , E, Magnesium, Fish oil, zinc .
Chris first and foremost thank you for the info you provide. How do we keep the more natural approach to medicine and raise the standards of the current Doctors.
Chris, My family eats a mostly vegetarian diet, except we eat alot of pastured eggs. I want to make sure we are getting the vitamins and minerals we need. What kind of supplements do your recommend for people like us, and where’s a good source that we can trust to tell us exactly what nutrients a body needs–children as well as adults?
B12, iron, zinc, retinol (active vitamin A) and EPA/DHA are the most common nutrients vegetarians are deficient in.
Hi Chris, a friend pointed me to your site. A few years ago I had a near-fatal brain trauma (“died” and later “came back”) and have not recovered. At the time my neurologist said there was nothing nutritionally that would help. I have not recovered and have some level of brain damage, as well as quickly degenerating nervous, endocrine, immune, and musculoskeletal function, as well as have body-wasting. Probably more issues, these are just most obvious. Have seen nearly 100 specialists/doctors/nutritionists/alternative practioners/therapists and after they take the “well-intended” stab at diagnosis and treatment, they have all ultimately just called me humpty-dumpty. Starting in 2009 I followed the Clean Program religiously for a few years, did the fresh juicing, smoothies, proper calorie management, and supplemented to the very best I could, given advice and impairments. And it ended up have no beneficial effect. My body does not seem to tolerate or digest anything anymore. At some point, do you advise we just throw a hail-mary and hope for the best? best.
Mary,
Check this out: http://www.ncbi.nlm.nih.gov/pubmed/23100196
Not nutritional therapy, but appears to be acting as a “good” drug in this case because it is improving symptoms by improving function. Google a bit more about this. In some cases, long-lasting results (years) are achieved in as little as a single injection, even in cases of up to 10-year old brain trauma. Worth considering.
David, appreciated. Good to see trials underway and will discuss next time visiting doctor. As far as B12, was taking before and ordered some to try again, then will see. Maybe it will help some. Best to you.
Hope all goes well. If you’re able to try the drug therapy, I would be extremely interested to hear of how it works out for you. If you’re so inclined, you can get in touch with me through my website: http://www.reforminghealth.com. -David
Dr Chris,
I am 61 and not taking any meds and supplement with methlylcobalimin, TMG, and folate, among other things. I eat eggs and/or meat every day. Yet my homocysteine levels are elevated at 13 umol/L. My weight is normal and I also exercise. Any suggestions on how to reduce homocysteine?
Thanks, Michael
Vit B6 (pyridoxine) disposes of homocysteine, B12 and folate just cycle it back to methione from which it is formed.
You suggest egg but most studies show that the B-12 in eggs is not very bio available ?
Dr. Chris, Do you have any articles on the types of meat that are best for b12 and how often to eat, of course it would be a generalization. It would be nice to have a basic understanding of what is average to compare and contrast with my current diet.
Thanks
Clams, mussels, oysters and liver are the highest sources; then lamb, beef and venison.
I’m a 31M and just started having peripheral neuropathy and quad weakness for the last two months. I also deal with lots of anxiety and heart palpitations. Since my symptoms started, I’ve tried acupuncture, liver cleanses, juicing, more raw foods, removing a newly purchased memory foam topper, and and started supplementing with multi-vitamin, Nordic Naturals Ultimate Omega, 5-7 k IU of Vit D3, and magnesium. I *just* started 200 mg of Doctor’s Best stabilized R-Lipoic acid.
I even bought a glucometer to test my after meal blood sugars (my fasting blood sugar had been 90 twice, was 83 recently and my hemoglobin a1c was 5.4.) After meal blood sugars never went over 140 over a week of testing so it doesn’t sound like high blood sugars.
My Vitamin B12 level was 679 PG/ml, my folate, RBC is 364 mg/nl and my Vitamin D was 24 ng/ml. Been tested for Lyme, sjogren’s, lupus, gluten intolerance, etc and all came back negative.
Could it be a b12 and or folate deficiency all along?
Any suggestions Chris? Love the blog!
Heya Chris,
I don’t eat meat, but would prefer as much as possible to get all my vitamins and minerals naturally – what would be the most effective way of getting sufficient B12 while eating as little meat as possible?
I have been considering eating wild game, in the form of Biltong once in a while. I tried this a couple of years ago and was very ill – it had been quite some time since I ate it, but maybe less for the first time next time! How much do you think I would have to eat each month to give me the required amount of B12?
Thanks!!
Jose
Jose: clams, oysters, mussels and liver are the most concentrated sources of B12. 3 ounces of clams is equal to 1,401% of the daily value (DV) and 3 ounces of liver is equal to about 1,214% of the DV. So in theory one 3-ounce serving per week of either of those would be sufficient. (However, that’s assuming optimal absorption, assimilation, co-factors, etc. — which is often not a safe assumption.)
About a year ago I was eating a mostly vegan diet after being a vegetarian for a year. As soon as I learned vitamin B12 was only found in animal products, I sought out a supplement. While I eat pastured meat every 2 weeks and consume eggs almost daily now, I still like to take my supplement because I am sure I have some catching up to do, if you will. I take a SISU 1000 mcg methylcobalamin tablet daily, normally with a meal. However, I am wondering if I should be taking this pill on an empty stomach? I have had some low stomach acid lately (not new to me), which I am working on (this is actually how I came across your site), and was worried that if stomach acidity is important for B12 supplement absorption, that I may not be absorbing any of the supplement. Does it matter if I take it with food or not? and is stomach acidity important?
Hello Chris,
I’m very glad to hear that sublingual B12 is better than injections. I used to get injections and then developed reactions to them. I would break out in cystic acne about a half hour after and I now think this might be do to with my histamine intolerance. As I understand it, B12 can raise histamine levels. If this is the case, would sublingual be better for me since it is not as concentrated?
Thank you
Amy,
My sense of what Chris said was that sublinguals work better for some people than injections — I’m not yet convinced that they are 100% better for everyone based on my own experience, what I’ve learned from practitioners, and what people are saying here. For one thing, some people react to the other ingredients in sublinguals and some do well with injections while others do not, does that make sense? My sense is that it is a highly individual situation, but it is well worth being open-minded to all the options.
I am 8 weeks pregnant with my second child and keep waking up with tingling and numbness in my hands. I had this problem while nursing my first as well. I was vegetarian/vegan for 15 years. My B12 tests have always been on the lowest end of “normal”, so I guess I’ve been deficient for a long time. Are there any special supplementation considerations I should make while pregnant? Or will the recommendation above work for me?
Hi Chris,
I have MS but I inject B12 every 3 days because if I don’t I crash – numbness in hands, fatigue, worsening of spasticity and gait issues. Serum level at 1400 and doc thinks I’m crazy. MMA came back negative but clearly I have a B12 problem as I experience big improvements in numbness, spasticity, balance etc. Help!
Thanks in advance, P
Chris,
After years of b12 deficiency, I have a new doctor that tested me for the mthfr mutation. I tested positive for a compound heterozygous mutation. I’m learning info as I go. I’m now on methylfolate and methylb12. Can you give any nutritional advice? Also I’ve read a lot on epigenetics…is thissomething I can “turn off” after proper methylation supplements?
I’m having trouble with the Jarrow subling b12 5k. That area under my tounge feels very raw and almost burned. Any suggestions for different brand? Has this happened to anyone else?
Deborah, I have read on another forum that this supplement and ones that are similar can do this to people’s mouth tissue, and they also can erode nearby tooth enamel, because of citric acid and other non-active ingredients these lozenges are made with (in order to make the taste more palatable, I guess).
I have a bottle of Natural Factors B12 methylcobalamin sublingual that has no flavors, colors, citric acid, artificial sweeteners, etc. (I think that brand might also have B12 sublinguals of the same dosages, 1000 and 5000 mcg, that do have that extra stuff in them, so read the labels carefully if you are thinking of purchasing these). I am very pleased with it, in terms of not affecting my mouth tissues or my teeth, but I have gotten the feeling from reading various discussions in various forums about B12 deficiency that the Natural Factors methylcobalamin is not very highly regarded (in terms of its perceived potency) by experienced users of B12 supplements (such as Freddd and folks who swear by his B12 replenishment protocol).
Before I had come across Chris Kresser’s 2 blog postings about B12 or the other specialist websites that go in-depth about B12 replenishment (and thus I didn’t yet know that there are several supplements that should be taken ALONG WITH full-strength methylcobalamin), I had been taking a 1000 mcg tablet of the Natural Factors methylcobalamin daily for 2 weeks with no problem, and the first steps of healing were really seeming to take place (in terms of my particular deficiency symptoms), but then I suddenly had a “potassium crash” that put me out of commission for about 36 hours (constant heart palpitations, lasting muscular cramps in my back and neck, feeling totally drained), which I guess meant that the methylcobalamin in the Natural Factors must have been doing *something* powerful in my body!
I tried to find out what was happening to me and discovered that this kind of crash was common with methylcobalamin (this potential potassium imbalance, called hypokalemia, is even mentioned on the Wikipedia page for B12 deficiency, which I had actually read before I started taking the B12 supplement, but I had just not paid enough attention to that part). I rested, ate as many foods as I could find in the house that are high in potassium, and stopped taking the B12 until I could get some potassium tablets locally. (I’ll have to order the other two supplements online because they are not available where I live).
Hi Chris,
Just a few suggestions in terms of helping readers find this second, more-recent blog post on B12:
I first visited your site about two weeks ago for a short while, and at that time I skimmed through a number of your article titles, noting that you’d written two B12 posts (the one from last year, the one from this year).
Today, I tried to find the two B12 posts again by using an internet search engine to search for “Kresser” and “B12″, and only the earlier post came up. So I went to that post and clicked on your internal topic classification tag of “B12″, thinking that your second post would also have been assigned that tag, but under your classification tag of “B12″, only your first post is listed on your site. I then went to your site’s search box and typed in B12, but I don’t think that it came up that way, either. I was starting to wonder if my brain fog was tricking me into thinking that you’d written two posts on this topic, though you hadn’t! I think that, in the end, what I had to do was go back out to a generic search engine and find a link to this post via a mention on someone else’s paleo blog about your views on B12!
Because I believe that this 2013 follow-up post adds a lot of value and is good to read in conjunction with the original 2012 B12 post (which is one of your most popular posts, I note), I would encourage your web team to associate additional, relevant tags (like “B12″) with this post, to directly mention the existence of this follow-up post at the end of your first B12 post (and include the hyperlink there), etc.
Not only is it helpful to the reader to learn the contents of both posts, but I think you only mention your 4-supplement protocol in the second post (which is the information that I was trying so diligently to re-locate today!), and you may want to put an addendum paragraph in the first B12 post to give your 4-supplement recommendations — and to supply your Amazon links — directly on that page, since it’s a more highly-trafficked article.
FYI –
First one is tagged as: b12, cobalamin, deficiency, epidemic, vegan, vegetarian
Second one doesn’t seem to have any tags (?)
By the way, I’m not sure why (maybe it’s the nearly-1000 comments), but that first B12 post takes a long time to load on my computer (although I have a fast internet connection) and it sometimes freezes my Internet Explorer (whilst no other page on your site seems to do that). Either that happens, or I get a warning window saying that a script on the page is taking too long to run and do I want to cancel it. This will also unwittingly detour readers away from that page. Maybe it’s something easy to fix by the technical folks?
Thank you for your generous sharing of information and your extending of caring help to people, not only on this site, but also in the wider world.
Thanks for the insight. I added the tags, let me know if that changes anything!
Hi Laura,
Thank you for responding!
Unfortunately, the tags do not seem to be here on this post.
Even though I still can’t see any tags here, I thought that maybe they were associated with this post but just “silent”, or maybe they were really on this page and I was simply overlooking them (which is definitely possible!), so I went over to your first post on B12 (which earlier I had said was published in 2012, but now I see that actually it was published May 6, 2011) and clicked on the “b12″ tag that appears at the end of that post (it’s in this line “Tagged as: b12, cobalamin, deficiency, epidemic, vegan, vegetarian”) and unfortunately, what comes up under the B12 tag is only that 2011 post. So there seems to be a technical issue with the tagging.
I don’t mean to harass you about this – it’s not for my sake, as I have the posts saved in my Internet Favorites. I am only letting you folks know this because many casual visitors to the site who read the first B12 post will have no way of knowing that Chris wrote a second, updated, advanced post about B12 twenty months after he wrote the first one, and that he provided in the second one a suggested set of supplements to take, which he did NOT do in the first post.
The comments section of that first B12 post is still going strong (even this week there have been several new comments there), but the majority of the people who participate in those comments probably do NOT know about this second post which provides Chris’ updated thoughts on B12 and provides, for the first time, Chris’ suggested B12 supplementation routine. And even if readers of that post search Chris’ blog to see if there are other posts on B12, this second post is not listed in those search results.
Also, just for the sake of the site’s earning potential, it would seem beneficial for you to allow site visitors to learn about your suggested 4 supplements for B12 replenishment and to have access to your Amazon hyperlinks to them, so the visitors, if they so choose, can use those links to buy the supplements, giving your site a small cut from the retailer in the process.
Hi Lily,
Thank U so much for your generous and valuable input to these posts.
Like many others I was completely unaware of this 2nd post and did in fact recently post on the previous one- seeking for help in fine tuning my supplement regime.
Thank U for posting on the 1st article + over here to alert us all- U R a star!
Would highly recommend that Chris himself writes a comment on the 1st post to let everyone know that he has a second article & one that states some of the other supplements to be taken together with Methyl Cobalamin B12 sublinguals.
On another note- its the 1st time Im reading that we need Trimethylglycine!?!
Last week I started taking B12 Enzymatic Therapy 1/4 tablets (ie 250mcg) + Solgar Folate 1/2 tablet (ie 200 mcg) in addition to a Multi Vitamin & 2 Bananas daily- but after just 4 days I felt drained from the lack of good sleep! Im B12 & D Deficient & my recent Bone Mineral Density DEXA report indicates I have Osteoporosis at 41 years old despite a very active exercise & balanced diet regime!
TKS & God Bless U,
Mark
Yes, so thankful Lily pointed out this second post, and I second all of her suggestions above to get this one in the radar of readers. I have read every comment on both posts and it’s clear there are many, many people out here who have this issue and can use this very valuable information. It has helped me in so many ways, I can’t thank you enough — both the information itself, the suggestions that were applicable to me, and the connection to others who have a lot of experience with this issue. Thanks!
Mark – are you celiac? Celiacs are commonly deficient in B12 and of course, prone to osteporosis (many of whom dont know they are celuacs until they are diagnosed with osteo).
Mark and Felicia,
I’m so glad that my notice on the other thread helped you to find Chris’ updated B12 recommendations (and the further reader discussions) on this page!
===
Mark,
This is just a conjecture, but it sounds as if you may need more potassium than what 2 extra bananas can provide. That feeling of fatigue/needing to sleep a lot might mean that your potassium has been all used up by the methylation. Potassium is available in many stores in 99 mg tablets, and you can also order tablets of larger milligram quantities online (for example, from amazon, swansonvitamins.com, etc.)
About the TMG/betaine component of Chris’ 4-supplement recommendation, please see my comment further down this page quoting a BBC article from 7 April suggesting that standalone betaine supplements may cause health problems. I am hoping that Chris will address this claim, either in the reader comments here, or in the reader comments under his “eating red meat” article/blogpost that he published a few days ago.
Hi chris, I was diagnosed with b12 deff a year and half ago, this was after approx 10 – 12 years or more of going to and thro to GP with many symptoms, mainly to be told its all in my head or look at me as though I was mental and making it up. Finally my b12 was tested and was 133 and low folate (don’t recal the results) I had b12 jabs once a week for 10 weeks the first 5 was cynocolbamin and the next 5 was hydrocolbamin (sorry if not spelling these right but think u will all know wat I mean) then week after my last jab my bloods was taken and test results for b12 was 886. GP then stayed I only needed jabs 3 monthly as my b12 levels was now very high, just to add that after about the 6 week of having my initial 10 jabs I was starting to heal and this continued as by the 10th week I was so much better not perfect but a lot of symptoms had eased a lot. Part way through week 2 of not having a b12 jab I was starting to get symptoms back to the point that end of week 2 symptoms seemed worse than before I started jabs. Went back to GP and although I got him to agree to give me another jab and also agree to give me them monthly he did not agree that my symptoms could be b12 related. I had 1a month for 3 months then bloods tested yet again this time b12 at 931 so again GP wanted to give 3 monthly even though I stated that I was just about dealing with the monthly jab as week 2 symptoms all back with force. Agreed on 2 monthly but also sent me to see rheumatologist and neurologist. Rheuma said possible fibromyalgia but only once all other avenues had been exhausted and neuro though it to be hnnp but shock tests stated different. Neuro said in end he thinks symptoms vitamin related. I hav had tests twice for PA but negative. I possibly have nearly every b12 symptom listed and same with fibro as they are very similar. GP have now diagnosed me with fibro just over 5 weeks ago. She one of the younger GP today as meds for fibro not working he is in the same mind as me as is it fibro or b12 he seemed bit sceptical it being fibro. I just wish I get a firm diagnosis so I can at least hav a name for wat I got. I hav asked over and over for active b12 test and but they ignore me. I would like to know if anyone knows if the MTHFR mutation test is available in the uk as I hav been told on sites that should test for this and also if MMA test is available in uk as I do not want to ask GP for these and for them to think I hav gone mad. Just to add my sister b12 is 33, and several other members of family hav low b12, my mums is 220. My 3 older children are showing symptoms but not tested and my 6 year old daughter is showing a lot of symptoms but they refrain from testing her and say its calcium and to give her more but I’m so certain it’s b12 and would like to jump on it ASAP if she has. Look forward to hearing from anyone x.
Jacqueline,
Your story sounds very similar to mine! I am sorry you are having to go through all of this! Have you asked your doc for the MTHFR test? I didn’t even know the mutation existed until my Internist asked if she could test for it after years of low b12 and other symptoms. I have since learned of the 23andme testing, but I got mine through a regular medical lab and ended up not paying a dime after insurance.
Jacqueline, I believe that people in the UK can order 23andme tests. I think I saw information about placing international orders on their website (23andme.com). The price (before shipping & handling is added in) is 99 US dollars (around 60 British pounds or so). If you wish to order a test on one or more of your family members at the same time as you order your personal test, they give a discounted rate.
There is a video on youtube.com of a BBC regional news program about an NHS doctor who was diagnosing some of his patients with low B12 and giving them frequent injections, and he was investigated by the General Medical Council (or some such body) and stopped from practicing for a time. He had to jump through all kinds of hoops to prove he was not doing any harm and that he was doing something medically valid.
@jaqueline I used 23andMe for MTHFR. I’m from Canada and I don’t know if you can access from the UK.
FYI I’m using a naturopath now who is B12 savvy. GPs and specialists are generally out to lunch in this regard. He has created a “cocktail” injectable containing B1/6/12 5-MTHF + some other stuff.
Best of Luck!!!
I believe that people in the UK can order 23andme tests. I think I saw information about placing international orders on their website (23andme.com).
I am thinking about ordering a test. The price is now permanently $99, much lower than it was a few years ago.
@Points,
Where on the 23andme test is the MTHFR listed? I can’t seem to find it.. but if you do any reading on Phoenix Rising or anything people seem to be seeing a lot of stuff on their 23andMe that I am not seeing. Any advice?
Thanks,
Lindsay
Hi Lindsay,
I tried to post for you 5 internet links to explanations that I’ve saved about MTHFR and how to figure it out with the 23andme test, but this site didn’t let that go through. Maybe they have a policy about hyperlinks to other sites. I’ll try to type it out in words, so you can find them online.
a. look for the “genetic testing and snps” forum on phoenix rising
b. look for the 23andme forum on the mthfr -period- net site
c. look at the site called snpedia
d. look at the US goverment site on genetic testing at
ghr -period- nlm -period- nih -period- gov -backslash- gene -backslash- MTHFR
e. look at the mthrfsupport website under the nov 2012 article about 23andme
Hi Lily!
Thanks so much for your efforts and reply. I finally figured it out yesterday and low and behold I am compound hetero for both of the MTHFRs that matter. I feel at once relieved that it is not all in my head and discouraged after reading so many horror stories with how those mutations relate to failed pregnancies. Oh well.. I will keep on keeping on and will be certain to not just randomly stop taking the B12 and folate supps like I had in the past!
Thanks again,
Lindsay
Chris, can you advise me please?
My husband is 57 and suffers from lots of symptoms – all treated individually by different specialists for past 10 years. He has Ankylosing Spondylitis (an autoimmune disease), peripheral neuropathy in both feet (numb and tingly), a standing tremor, wide gait, osteoporosis, irritable bowel, depression and memory loss. His serum B12 was about 1900 and his MMA falls within normal levels. I am hoping to persuade my GP to refer him for an Active B12 test and Homocysteine – do you think it is worth it? Could he still have those results and not be processing B12 properly or am I barking up the wrong tree here?
Hi Lucy, Is he taking any Magnesium? I know low magnesium can cause systemic and wide ranging problems. And it’s an easy mineral to become deficient in due depleted soils, etc.
Hi Chris (or anyone that knows),
I am wondering about the MMA test. I have previously only taken the serum B12 test which showed elevated B12 which along with symptoms caused me to suspect a functional deficiency. Although I have been supplementing for a few months I would like to take the MMA test just to be sure I am barking up the right tree. Do I need to cease B12 supps for a certain period of time before taking the test? Thanks!
Lindsay
A BBC article about the new study on red meat/carnitine that has attracted a lot of media attention (published April 7, 2013) gives the following warning, and I’m wondering what to do with this information:
“….I would strongly recommend that unless you’re a vegetarian or vegan, there is a potential risk from taking L-carnitine, lecithin, choline or **betaine** supplements in an attempt to ward off cognitive decline or improve fat metabolism. If the evidence is confirmed, these supplements would do more to damage arteries than provide health benefits.”
from: the BBC, 7 April 2013, Red meat chemical ‘damages heart’, say US scientists http://www.bbc.co.uk/news/health-22042995
I was just about to order a betaine/TMG supplement today, as per Chris’ low-B12 advice (taking 4 supplements: methylcobalamin + folate + TMG/betaine + potassium), when I saw this BBC article warning against taking betaine. I don’t know if I should just take the other 3 and skip the betaine?
Hello,
I am interested in B12. But I also read that really high doses are not proven to be safe.
Can you overdose on B12? Can you take 1000mcg daily forever or only for a while?
I also wonder if B vitamins are water soluble then does this not mean that taking high doses
will simply be excreted by the body?
Sam
hi
most of what I’ve read is about b12 deficiency. My two year old girl who has been clinically diagnosed with autism has been found to have a spike in her b12 when her bloods have been taken twice in the last year. Nobody can give a straight answer for this every talks about the deficiency side but never the opposite. when her bloods came back today for her age etc, her b12 count in her blood was 1165 when in should of been between 700 -750 . they don’t know why as she doesn’t eat very much and its hard to get anything down an autistic child who doesn’t like what you’ve made she sooner go hungry or graze through the day. Please can somebody explain why this how it is?
Have you ever heard of sudden onset of B12 deficiency/symptoms? For some time before these “episodes” i have fatigue, significant muscle weakness, menstrual changes, mood swings, emotional changes, etc. 5 years ago, with those symptoms having been present for some time, i suddenly – in the span of 24 hours – experienced significant joint stiffness, pins and needles in my extremities, fatigue, and when i try to sleep, i experience sudden and severe pins and needles increasing to severe burning, throbbing intolerable pain in my feet and hands. This happened repeatedly over two weeks with no answer. I was incapacitated by resulting severe heat sensitivity in hands and feet, joint pain and what felt like bruised, battered and broken feet. No swelling, no redness, anti-inflammatories have no effect. After these “foot attacks” i am crippled.
Eventually a neurologist agreed to see me but sinve i would be coming from an isolated community and with a history of celiacs, they requested that i be given b 12 first. Note i had just startes taking seeious nerve pain killers. The b 12 seemed to help and i stopped the nerve pain killers, within days i no longer had foot attacks though i took a long time to recover from the stifnesa and bruised feeling. I stayes on b12 supplements and was suddenly more energized, improve menstrual (marked change). Etc. ive been on b12 shots, 1 every 3 weeks since. I can tell when one is due before the reminder – the muscle weakness ans fatigue increase.
I’ve ben under a lot of stres lately, as i was before that attack 5 years ago. Nearing my three week mark for b12 i was experiencing the muacle weakness etc but wed of last week, i began to feel significant stiffness in my neck and shoulders. I chalked it up to stress and took toredol. Sat/ sun i began to have noticeable stiffness in my kneea and by sunday night-noticeable stiffnesa in hands and elbows. Within hours – noticeable pins and needles and joint pain in hands. I woke up at midnight with increased foot and hand pain and heat sensitivity and gave myself a shot. Another shot at 7 am mon. Throughout mon/tues i would have rotating pain throughtout joints, shooting pain deom elbow to hands, barely lift my arms due to significant joint stiffnes, and burning pins and needles and shooting pain in hands and feet which increases with heat and lying down ( which may be bduw to the heat-warm bed?). Tues i had my diest significant foot attack. Unbearable pain for 30 min. It repeates hours later. On a friends requet, i tried ice cold water- it seemed to shock the nerves ans the pain halte after 20 seconds. Oddly, after the initial cold shock, my feet felt warm-like the bottom of the bucket was heates? Anyhow. Could walk!!! It lasted 45 minutes before it came back with a vengeance! By then i was at the beach and walked in the surf! Relief!
Unfortunately, again, another attack on both feet and while cold water helped somewhat, it couldnt take away the lingering joint pain and bruised feeling. Feeling a pending attack wed night, i went to ER where it progresses to intolerable pins and needles burning pain, joint pain in hands and feet (everywhere else still hurts – knees, shouldrs, etc). Anti-inflammatory IV-no effect until they just doped me with morphine. The after-effect if these attacks and progressively worse pins and needles in my thighs, buttocks, feet, hands. Etc leave my feet feeling bruised and broken, thighs feel bruised, knees are cripplingly sore. Still heat sensitive but finally manages to sleep through (mostly) the night thurs with no attacks. I can still barely walk and have the stiffness and bruising. The heat sensitivity is a bit decreases. They just started me on Lyrica. I had one dose late last night and one this am.
So -does this sound like it could be b12 still or related but in fact precipitates by something else? My b12 was normal the first time and of course, i had given myself shots before the first round of b12 so it was high in that and subsequent tests.
No inflammation markers though they did not test sed rate. All other routine bloodwork normal. Not lupus. ??? I’ve never read of anyone with b12 having these sudden acute episodes? Has anyone experienced this? Perhaps exercise/stress and some other compounding factors (celiac related) cause an acute reaction below a certain tipping point? Or that tipping point causing some other reaction to precipitate? Have you ever heard of this??? There are a battery of new blood teats including MMA i think, being done now…,
Thank you for all the good information. Since I didn’t read every reply, I apologize if my comments are repetitious. Post gastric bypass patients are also in need of better B12 testing. I am a successful 10 year post-op who has developed issues following a hysterectomy. Hypothyroid, adrenal, hyperaldosteronism, edema, diostilic hypertension and SIBO. I just ordered some of the sublingual methyl B-12 and hope it helps. In the past I used a sublingual cyan B-12 and got high serum B-12 results. When doc does my next labwork I’ll definitely ask for urine MMA too!
Hibi got diagnosed with B12 deficiency October last year I had injections every other day for 2 weeks then 12 weekly now 8 weekly, before I was breathless I had chest pains couldn’t think straight got confused couldn’t retain information and forgetful was an understatement, I had numb tingly site patches all over my body my eyes foggy, muscle aches I slept for 16 hours solid and got up and still felt like I hadn’t slept and was back in bed within 2 -3 hours, I couldn’t function, I also got shingles don’t know why or how I’d had chicken pox, it was after that I was tested and my levels were at 90, now I feel great only sleeping for 8 hours, looking at how I feel now and then I must have been deficient for at least 4 to 5 years, my doctor said he hadn’t come across a B12 case where it had effected someone neurally, but still get the numb tingly sore patches but not as often, I honestly was that bad September last year I thought I was dying x
I suspected b12 deficiency a few months ago and decided to take an active b12 test plus homocysteine test. The results came back more than ok. I’ve not been eating meat except maybe 3 or 4 times a month, for 4 years. I have GI problems, leaky gut probably too, I don’t absorb food very well. You would think these two facts combined would inevitably lead to b12 deficiency… If someone knows more about this, you can always leave a comment. Thank you.
Hi. I started having horrible anxiety almost 2wks ago. In the past I took a raw Bcomplex and it seemed to help so I again started taking the same BComplex. My doctor just ran a bunch of labs, including a serum B12. All my other labs were fine except the B12, which is 1700. My dr didn’t even say anything about it, just said my labs were perfect. I of course started looking it up and read about all these serious diseases that cause it. Is it possible I am oversupplementing and don’t need the Bcomplex? I know my father lacked intrinsic factor. Can high serum bcomplex be a sign of that? I’m very worried:/
I have SLE, anemia, high blood pressure,one bi-pass and 4 stents. I (by accident) of one of my doctor’s noticed a huge B12 deficiency and suggested 3 B12 shots a year. I did some research and found Superior Source sublingual b-12. Doing more research I felt better knowing that like Vitamin C you really cant OD on it. Subsequently I had just been taking 500 mcg b-12 in tablet form, which this particular doctor told in my case was useless. I have now been taking 10,000 mcg and some day take 20,000 and have seriously never felt better. When I bruise from my anemia or SLE they heal much quicker and overall my energy level, combine with a couple of Ensure Plus a day has truly been a life saver for me.
Wishing everyone on this post the best.
Hi! I am 17 year old female. I just turned Vegan and I have started taking 1000 mcg of B12 / day. Is that alright? I also take flaxseed oil in a fruit smoothie, will that affect the absorption of the B12? I am also going to go on a multivitamin and a probiotic. (when my dad gets paid) I was considering going on chlorella too, would that be a good idea? Will any of this affect each others absorption? Thanks!
Is it fine to boost glutathione (via undenatured whey) while doing a b12 protocol? I saw something of Fredd’s that suggested glutathione would covert methylb12 to glutathionylb12 and excrete it, though I can’t find these mentioned anywhere else. And it would seem, other sources mention glutathione as being protective of b12. Thanks!
Im 42 year old female started having GI problems 4 years ago GI DR diagnosed acid reflux,no ulcer,no celiac,High B12 and High Iron he said was not normal but wasn’t worried about it since it wasn’t dangerously high I advised him I do not take supplements but he still said nothing to worry about.Well here it is 4 years later and im real sick again this time with LOTS of issues …Gi issues,dizziness,brain fog,tingling limbs,blurred vision I worried myself into panic attacks and anxiey all my blood work comes back ok but again High B12 !! My dr thinks no connection no big deal I need help…now I read on your web site this may mean im deficient ???? how to I find out??Pease help ive had no life for the past 4 months!!!
Hi chris i suffer from pancreatitis would you recommend i go and get my B12 levels checked
So, sorry if I missed it but, what is the supplementation dosage for vegans? I have 500 ug Methycobal injections… How often them?
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