Vitamin B12 Deficiency: What It Is, Symptoms, & How to Treat It | Chris Kresser

A Silent Epidemic with Serious Consequences—What You Need to Know about B12 Deficiency

by Chris Kresser

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This tired man rubbing his eyes may be experiencing B12 deficiency.
Fatigue is a common symptom of B12 deficiency.

What do all of these chronic 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 illnesses like depression, anxiety, bipolar disorder, and 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 a vitamin 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, the condition is far more common than most healthcare practitioners and the general public realize. Data from a Tufts University study suggests 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. Nine percent had an outright nutrient 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. (1)

That said, this type of deficiency has been estimated to affect about 40 percent 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, and decreased mobility—are at least in part caused by a deficiency.

Why Is It Underdiagnosed?

B12 deficiency is significantly underdiagnosed 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 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 vitamin deficiency symptoms. (2) Experts who specialize in the diagnosis and treatment of a deficiency, like Sally Pacholok, R.N., and Jeffrey Stuart, D.O., suggest treating all patients that are symptomatic and have B12 levels less than 450 pg/mL. (3) They also recommend treating patients who show normal B12 levels but also have elevated urinary methylmalonic acid (MMA), homocysteine, or holotranscobalamin, which are other markers of a deficiency in vitamin B12.

B12 deficiency can mimic the signs of Alzheimer’s, dementia, multiple sclerosis, and several mental illnesses. Find out what this vitamin does and learn how to treat a deficiency.

In Japan and Europe, the lower limit for B12 is between 500 and 550 pg/mL. Those levels are associated with psychological and behavioral symptoms, such as:

  • Cognitive decline
  • Dementia
  • Memory loss (4)

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 the vitamin) 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 a deficiency. Long before anemia sets in, deficient patients will experience several other problems, including fatigue, lethargy, weakness, memory loss, and neurological and psychiatric problems.

The Stages of a Deficiency

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). (5)

Common B12 Deficiency Symptoms

The signs can look like the symptoms of several other serious disorders, and the neurological effects of low B12 can be especially troubling.

Here are some of the most common vitamin B12 deficiency symptoms:

  • Tingling or numbness in the hands and feet
  • Brain fog, confusion, and memory problems
  • Depression
  • Premature aging
  • Cognitive decline
  • Anemia
  • Weakness
  • Fatigue
  • Reduced appetite and weight loss
  • Constipation
  • Trouble balancing (6)

Children can also show symptoms, including developmental issues and learning disabilities, if their B12 levels are too low.

Why Is It So Common?

The absorption of B12 is complex and involves several steps—any of which can go wrong. Any of the following can cause B12 malabsorption:

  • Intestinal dysbiosis
  • Leaky gut and gut inflammation
  • Atrophic gastritis or hypochlorhydria, or low stomach acid
  • Pernicious anemia
  • Medications, especially proton pump inhibitors (PPIs) and other acid-suppressing drugs
  • Alcohol
  • Exposure to nitrous oxide, during either surgery or recreational use

This explains why a 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 two or three times daily.

Who Is at Risk for a Deficiency?

In general, the following groups are at greatest risk for a 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

You cannot get B12 from plant-based sources. This vitamin is only found in animal products. That’s why vegetarians and vegans need to know the signs of deficiency—and the steps necessary to fix the problem.

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 among vegetarians and vegans is that it’s possible to get B12 from plant sources like:

  • Seaweed
  • Fermented soy
  • Spirulina
  • Brewers yeast

However, plant foods said to contain B12 actually contain B12 analogs called cobamides that block the intake of and increase the need for true B12. (7) That explains why studies consistently demonstrate that up to 50 percent of long-term vegetarians and 80 percent of vegans are deficient in B12. (8, 9)

The Impact of a Deficiency on Children

The effects of B12 deficiency on kids are especially alarming. Studies have shown that kids raised until age six 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 an association between a child’s B12 status and their performance on testing measuring:

  • Spatial ability
  • Fluid intelligence
  • Short-term memory

Researchers found that formerly vegan children scored lower than their omnivorous counterparts in each area. (10)

The deficit in fluid intelligence is particularly troubling, the researchers said, because this area impacts a child’s ability to reason, work through complex problems, learn, and engage in abstract thinking. Defects in any of these areas could have long-term consequences for kids.

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. If you’re not willing to take a dietary supplement, it may be time to think twice about your vegetarian or vegan diet.

How to Treat a Deficiency

One of the greatest tragedies of the B12 epidemic is that diagnosis and treatment are relatively easy and cheap—especially when compared to the treatment patients will need if they’re in a late stage of deficiency. A B12 test can be performed by any laboratory, and it should be covered by insurance. If you don’t have insurance, you can order it yourself from a lab like

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 a severe deficiency that’s 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. (11) However, most B12 experts still recommend injections for people with pernicious anemia and an advanced deficiency involving neurological symptoms.

Try Supplementing

Cyanocobalamin is the most frequently used form of B12 supplementation in the U.S. But recent evidence suggests that hydroxocobalamin (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 neurological symptoms and that it may be better absorbed because it bypasses several potential problems in the B12 absorption cycle. (12, 13) On top of that, methylcobalamin provides the body with methyl groups that play a role in various biological processes important to overall health.

Change Your Diet

Nourishing your body through whole food is the best way to get the vitamins and nutrients you need. If you’re low on B12, try eating some vitamin-rich foods like:

Eating other kinds of seafood, like octopus, fish eggs, lobster, and crab, can also help you attain normal B12 levels. If you’re seafood-averse, you can also get this vitamin from:

  • Lamb
  • Beef
  • Eggs
  • Cheese

It’s important to note, though, that the amount of B12 in these foods is nowhere near as high as the levels in shellfish and organ meats.

What to Do if You’re Experiencing Vitamin B12 Deficiency Symptoms

If you suspect you have a 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. You’ll probably need help from a medical practitioner for this part. 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.

Now, I’d like you to share your experience. Have you experienced any of the symptoms associated with low B12? How do you make sure you get enough of this vitamin to stay healthy? Tell me in the comments below.


Join the conversation

  1. I discovered that i am b12 deficient in 2014. Along with that i had low ferritin. As doctors prescribed taking b12 shots, i started taking them but i was looking for the reason behind this deficiency. My brother has wheat allergy(celiac) so one of the doctors asked me also to get tested.But it was negative. My digestion was never good. I had bloating, gas, vomitings, headaches and hair fall. Recently i thought to quit milk and results are amazing, no more gas bloating and headaches. Its been only a month.
    I am confused whether i am having wheat allergy or not(I am on a strict non celiac diet from the past 1 year), coz i have read that for some people it doesn’t show in their test and celiac runs in the family(my brother has it).
    second question is can lactose intolerance leads to low b12 and ferritin? Please somebody help.

  2. I’m wondering if some of the people here who still have really low levels of B12 despite injections, etc. might not have liver problems. Maybe too, some kind of cancer? Cancer can cause all kinds of weird symptoms even when it’s still small. I don’t know how you can test for it, though, if you don’t know what type you are looking for. You can have tests for liver function done, though, along with a sonogram. You might want to have your kidneys checked while you are at it.

    • I had B12 and D deficiency but after some time on supliments, my blood work is normal with the exception of a low reading of 11 for Gamma Glutamyl Transferase ( range is 14 – 62 U/L) . My Glomerular Filtration rate was 79 (An eGFR from 60 – 89 ml/min/1.73 m2 is consistent with mildly decreasing kidney function) . I could never find anything out about the low Gamma Glutamyl Transferase and all my doctors tells me is that low is better than high without providing any details.

  3. My my what a big long thread of comments

    Hello Chris

    At the top of the page you forgot to mention *Cholesterol (&or Statin provoked medical conditions).

    A few years ago I am thinking “I am doing everything right but can not get my cholesterol test right”
    The best I could get out of the cholesterol group was the triglyceride down to almost half 1.1 mmol/L where the pass is <2 by saying a absolutely NO to any food I thought had “toxic” sugar in it.
    The breakthrough came when I was reading “Your Blood Never Lies” it was suggested by the author James LaValle RPh, CCN to look at Homocysteine. So next time I had a cholesterol test I added it in as a extra private test. After the results came I made a visit to my naturopath (who in fact teaches doctors how to read blood test) the Homocysteine was over the limit at 19.8 when the limit was 5-15umol/L.
    It was suggested next time I get a blood test to go for a vitamin B-12 test, I wish now I had of gone back just to test B-12 because 3 months later the Homocysteine had gone worse from 19.8 to 22.1 umol/L and Vitamin-B12 was 161 pmol/L the high end of the borderline 110-170 the pass is 170-600 pmol/L. But despite that the over all cholesterol had dropped a bit better and closer to the border line fail apart from the HDL cholesterol, so I think my diet & lifestyle must be right for good cholesterol apart from the B-12 deficiencies.

    My naturopath added it is the B12 deficiencies that makes the homocysteine to go up, then that in turn makes your cholesterol go up, and added high homocysteine does far more damage than high cholesterol. I wish I could pass this information onto James LaValle as it is missing from his book and could be worthwhile added in to his next edition, if it turns out my naturopath is correct, the next cholesterol test is lookinggood. On page 208 there is a list of food for Iron, Folate & Vitamin-B12, as I have a high end pass for iron I can see some foods on the list I have in my diet, the same for folate (I get a mid range pass) but can not see many foods I get out for the B12 apart from the odd smoked salmon I get from time to time. Interesting enough in the book it says for high than normal calcium could be “Control your homocysteine ……” & you guessed I have high end normal for calcium on a OligoScan mineral hand scan use internet to learn more on OligoScan reports.

  4. Hi, i’m 32 years old and already 6 years suffering from depression. i’m getting treat by antidepressant drugs “ssri” everyday and b12 injection one a month.
    every half a year my b12 decreased to 180 and i’m feeling extreme depression. so, usually i’m doing series of injection (about 6 at 2 weeks) and i’m feeling excellent, and so forth.

    month ago i did the same series of injections and felt better. but this time only after a month its came back: sadness, depression, no energy. i did blood test and its shows 180 again . how could it be after a series of 6 injection month ago.

    something got wrong, what/how its could be? my blood not absorbing b12? or maybe ther are any influence/ correlation between the antidepressant to b12? im feeling very bad, what can i do?

    i would appreciate any kind of advise and treatment.
    thank you 🙂

    • Luba, what form was being injected? I read that the most common type used for injecting was cyanobalamin, the least useful type to our bodies. Maybe you’re not converting it to the active form.

      I’ve just been reading a ton of useful information here:

  5. what type of test will show me my TRUE/REAL b12 status…

    there are many tests recommended like total B12, active B12, homocysteine, serum folate, RBC folate etc…?

  6. Eleven years ago I found out I have a severe B12 defiency. My level was 41. I’ve been using the B12 oils (methylcibalamin) you can order online for years now. My level has been very good. But my symptoms really haven’t gotten better. My gait is still bad, short-term memory problems, weak very stiff muscles and more. My doctor doesn’t really know what else to do. I use a cane for short distances and a rollater for long distance. I’ve learned to live with this but it does get me down a lot.

    • Hi, Judy – perhaps you try and read about the Wahl’s Protocol, you can find an article even here, in the section Immunity & Autoimmune Disease. It looks from your description like you may benefit from her diet, even if you are not diagnosed with any of autoimmune problems. Her diet increases energy levels providing all essential nutrients needed to produce more energy on a cellular level. She has her website and there are books / ebooks on Amazon as well if you are interested to become familiar with her works.

  7. I went to the doctor for really bad signs of demetia or alzhiemers, muscle wasting, weakness,depression,hand and head tremors and back pain. They sent me to mental health and the did blood work. I was sent to a neurologist and she did tests and prescribed me B12 1000 mcg. My level is 350. She never told me I was B12 deficient or anything. I am also taking vitamin D3 5000 once a week. I was doing really good and I didn’t take any B12 for about 8 days and everything came back like everything !! I started my pills again and ordered the methyl type online. I’ve been in the dark all this time. Thank God for articles like this. I super depressed right now. They are starting neurological behavior testing.

      • Instead of doing this outside the box testing why not just supplement along with increasing meats (i.e. B12 rich foods) if symptoms are present.

        The B12 lozenges are super cheap. it can’t hurt even if you don’t need it. End of discussion.

    • “vitamin D3 5000 once a week” This is way, way low. Recently revised recommended daily levels are for 8,000 iu a day of D3. Take with preformed Vitamin A as well, to keep them in balance, or simply eat a lot of liver or other organ meats.

      • I was found to be B12 deficient with many of the symptoms discussed on this form. I was also found to be vitamin D deficient. Not sure if the 2 are some how related. I started taking over the counter b12 suplements and a lot of the symptoms got considerably better but not all. When I finally started taking vitamin D suplements, that is when the symptoms finally disapeared. Testing for Vitamin D is expensive and so a lot of doctors do not want to do it and in Canada some government plans do not cover the testing unless you have a defficiency. Not that my doctor put me on 1000 per day which proved to not be enouogh and I am now on 3000 per day which is proving to be adequate in my case. The specialist sent me for the initial D testing ( it was covered if a specialist sent you but not if a GP sent you) and now that I have been shown deficient, I am covered regardless of who sends me.
        Good Luck

        • Note – I was also taking magnesium and I am no longer taking Magnesium as my levels are fine – A lot of the food I eat is high in magnesium and that seems to be adequate to maintain my levels.

  8. B12 and magnesium . Long story short – last summer, I was having issues such as tingling arms and tingling legs, off balance and head pressure. blood tests showed that my B12 was low (77) and so I went on over the counter B12 (1200mcg) . This over a period of months cleared up all the symptoms . In mid February of this year, my blood tests showed a high B12 level (703 – range is from 138 – 652) . Everything else showed within limits . When i went to a neurologist (mid April) , he told me to start taking Magnesium (250 mg per day) he ordered additional blood work which showed a b12 level of 546 (I had backed off on the b12 supplements due to high reading), a low vitamin D level of 47 (75 – 250) is the range, a low reading of 11 for Gamma Glutamyl Transferase ( range is 14 – 62 U/L) . My Glomerular Filtration rate was 79 (An eGFR from 60 – 89 ml/min/1.73 m2 is consistent with mildly decreasing kidney function) .

    Everything else tested was in range .

    The last blood test taken in early may (ordered by my family doctor showed a b12 reading of 676 (Hi), a magnesium level of 0.98 (range is 0.7 – 1.0 mmol/L) and confirmed the other readings from the previous blood work.
    In early May I stared taking a vitamin D supplement (1000 IU 25mcg) as well as the B12, Complex B100, a one a day vitamin and 250 mg Magnesium I was already taking.

    shortly after starting to take the magnesium Symptoms (tingling in arms and legs and head , off balance feeling, pleasure in ears and head) came back.

    Has anyone had any issues, similar issues as a result of to much/ hi b12 / magnesium or a combination of? Also, I could find little on what Low Gamma Glutamyl Transferase means as most problems are related to high readings and so any insight on that or anything else I have written above would be appreciated.

    Thanks Marpy

    • note that after the last blood test showing high b12, I continued taking my B12 as the doctor did not say to stop and as such, my level could have gone considerably higher. I stopped taking the B12 yesterday after reading that to much could cause side effects – some similar to what I am experiencing. My B100 Complex contain 100 mcg of B12 which I figure should with my change in diet to eat more foods fortified with and containing B12 maintain a healthy level for me.

    • It isn’t possible to have B12 levels that are too high. B12 overdose is impossible, as the vitamin is water soluble, and any excess is excreted-this has been proven in studies where patients were given extremely high doses of b12 over a period of time with absolutely no ill effects. Of the B vitamins, only B6 is toxic in high doses.

      It should be noted that a high reading of serum B12 does not mean you’re “cured”. If you are still having deficiency symptoms, you still have a deficiency. The only way to know how much b12 in your blood is actually being used by your body is an Active B12 test, which are hard to get and usually expensive.

      If you’re supplementing with B12, you need to supplement with Magnesium and Folate or Folic Acid (whichever works better for you) as B12 methylization requires Folate and depletes magnesium, as well as potassium, which should be supplemented by high potassium foods only if your levels are low. Too much potassium is dangerous and can cause heart issues and stroke. You should have your ferritin (blood iron stores levels) tested, as people with b12 def often have low iron as well.

      • Hi Tracy – Thanks for the reply. My Magnesium and potassium levels were checked and were on the high side of acceptable limits. My B6 was not checked. What I am taking B6 wise is a multivitamin (2.5 mg) and B100 complex (100 mg) . My understanding based on an internet check is that the maximum recommended daily intake for B6 is 100 mg and the daily recommended intake is less than 2 mg. As such between diet and supplements, I am somewhat over the maximum daily and way over the recommended daily . As such I will stop taking the B100 complex. This is considering that my levels for everything vitamin wise checked during my last blood test was good with the exception of Vitamin D. I will stay on the vitamin D and the one a day vitamin and see what that does.
        Thanks for the information – Marpy

        • I have be off the B100 complex (which contains 100 mg of B6) for 3 days now and my symptoms have improved considerably. I was wandering if anyone has any idea of how long it takes for the B6 in a persons system to get down to normal levels? The tingling feeling in arms and legs is much better but still experiencing off balance ringing ears and light headednes although not as bad. Thank you

          • usually the protocol with b6 is 4 months on 2 months off. I would have your b6 levels checked. If you feel you need to supplement other b vitamins, find a b that contains no b6

            • Thanks Tracy. I was only on the B100 and magnesium for 3 weeks and began feeling the symptoms (off balance, tingly arms and legs, shaky feeling, ear pressure) within days of starting to take them. These symptoms seemed to be slowly improving even while I was taking the Magnesium and B6 but really got much better within days of when I stopped taking magnesium and B6. I have for 15 years or more some twitching in my right eye lid and left cheek that comes ant goes as well. This as well got worse and then got better when I went off the B6 and Magnesium. I was wandering if B6 in the amount I was taking over a short period of time can cause this ?
              Next time I am in to see the doctor, I will ask for a B6 test as it has never been tested for in the blood tests that they sent me for to date.

              Thanks Marpy

                • Thanks Tracey – I will visit the FB site. Base don last blood test, my B12 levels were up around 700. My symptoms were almost completely gone till I started taking the Magnesium and The B100’S . I was never tested for B6 but will ask the next time I am at the doctors (3 weeks). I had read that some people will have symptoms when they go on B100’S as their body has to adjust. Lots of information out there but some is conflicting and so I am trying to get a better understanding. Especially with respect to the B6.
                  Thank You

    • Yes, organ meats can easily supply B12, and other nutrients like choline; nutrients that are hard to find in other natural foods. Liver and other organ meats are not liked or consumed by many westerners. And anyway, doctors still are recommending limiting the consumption of cholesterol. So nutrients like B12 and choline are not consumed in adequate amounts via natural foods. Doctors and other health professionals also recommend limiting sun exposure and to always wear sunscreen, which helps contribute to vitamin D deficiency. Are doctors working with us or against us. Doctors need to get their acts together. Bad communication, and bad information plagues us.

      • Doctors are still following the outdated and debunked Ancil Keys study about fats and cholesterol. And, let’s not forget, statins (cholesterol meds) are one of the most prescribed (and most profitable) medications. Doctors are barely trained in nutrition and vitamin deficiency, and are still trained in theories that are no longer useful. It is up to us to take charge of our own health.

        • Both myself and my father have suffered from fatty liver at one time. In doing about 10 minutes of research on the internet, I found that low choline can be a cause of this condition. I started eating more eggs, and also (on days I didn’t eat eggs) started using a supplement. Fatty liver gone; liver enzymes back to normal. My doctor knew nothing about this. Doctors really don’t know that much about nutrition (as you said).

          • We are the ones that are responsible for our health… no else… just us.

            People are so busy trying to get their kids into the best schools… so busy being good consumers… so busy that they don’t bother with health related learnings… until it’s too late. Actually, even then, most people don’t bother to learn… they’d rather pay for advice and pay for some pills. After all, that’s what good consumers do.

            A return to true ancestral living is the paradigm shift.

  9. A couple of years ago I had the same thing. Numbs legs all the way to my hips. I also had a very red throat that didn’t allow me to eat hardly anything. Finally I was diagnosed with a B12 deficiency, my level was 75. Not good. Hospitalized for 4 days, received shots every day, then weekly and then monthly. I finally gained all feeling back in my feet and legs. Took many months, so hang in there! I have since been diagonosed with pernicious anemia and am not able to absorb B12 through food, just shots. So now I give myself shots every 2 weeks. Monthly was not enough for me. B12 does not stay in my system very long. I’m told everyone is different. So just listen to your body and don’t let anyone tell you that your amounts of B12 are high enough. Also read the book “Could it be B12”? I found it has some good information even though I knew I had a deficiency.

    • So crazy how doctors always have people shoot once a month or once per three months even. This is never enough. If you check blood test on the internet for example for b6 or so, they say that if you take b12 injections, one should stop for a week before the test cause it may influence the test. This kind of tells me that the b12 shorts stay in your body for about a week. I inject myself every week instead of what my doctor told me to do it once per 3 months. I found out about my b12 absorbtion problem because I had many, many miscarriages for years. My serum b12 level was 241 and in the Netherlands this means there is no problem but some grey area. I insisted on injections and right after my first shot when I got pregnant again (I got pregnant every month) IT STAYD and I did not have a miscarriage. I also noted my egg came on day 12 when on b12 injections while before it was always day 4 to 9. Now, if I stop injecting for just 1 month, I have my ovulation on day 4, for me this is prove that I need to shoot more frequently so I shoot every week. I also noticed I got back to being tired and depressed again, so I will now take folate with it, I think this should help. I already take magnesium so my hopes are on folate 5-MTHF (don’t take folic acid cause that chemical fake stuff that can cause problems).

  10. About a year ago I was finally tested and found to be B12 deficient. 138 My numbness was all the way up my legs past my hips. I was afraid I was headed for a wheelchair. I started taking the shots and my numbers responded quickly. I still have numbness in my feet. I am wondering if this will ever go away. Is there a therapy or exercise? another vitamin supplement?

    • I have read about b12 patches you can get online. That’s my next try. I’m getting injections every week for the last 6 months or better and I’ve barely creeped up to 300. I still feel like garbage but better than before.

  11. Hi
    I was diagnosed with b12 deficiency 2 years back(with level = 130 )and was treated the normal way (B12 shots every day for a week, then weekly and then monthly for 3-4 months). I got my levels checked, they were around 700. Almost all of my symptoms were gone. But now since 3-4 months, I started feeling the symptoms were coming back. I started taking b12 shots 1000 mcg monthly and I feel better. Anyone out there felt the same? or anyone taking B12 shots since many years?

    • Try jarrow b12 lozenges from Amazon. I heard some users getting limits of 1999 because she took too much, like 3 a day which is way to high. Recommended dose is 1 per day you can chew. I took one today for the first time and man I felt great. Pure clarity and calm.

    • have you been tested for Intrinsic Factor antibodies? It sounds like you might have an absorption problem which could indicate Pernicious Anemia. Have you had other blood tests? MMA and Homocysteine? Elevated levels are also indicative of PA. It would explain your recurrence of symptoms and the lowering of your b12.

    • B patches have been proven ineffective because the B molecules are too large to be absorbed trans dermally.
      Nice idea but does not work.

  12. My daughter was diagnose with a seveve vitamin B12 deficiency . She has had one B12 injection.She has a severe case of under the skin swelling, itching and peeling on her face, ears and moving onto her neck. Her face is red with leather like spots. Could this be as a result of her b12 deficiency? She has had it for 6 months and doctors say it is eycema and will have to live with it. The only treatment of the symptoms that helps is acupuncture but they isn’t treating the cause! Her skin is back to normal after a treatment but lasts only about 3 days. What are your thoughts and/or suggestions? HELP!!!

  13. Dr. Kresser, I didn’t see MTHFR mutations as a cause of B12 deficiency. Is MTHFR homo- or hetero- zygous mutations not a cause of a deficiency?

    • I had been having trouble for 3 years with tingling in hands and feet. Thought it was topamax i was taking for migraines. Past year i almost fall asleep while driving heart palaptations in last 2 months had gotten so bad I thought i was having a heart attack. Leg cramps were waking me up at night, started drinking coconut water with potassium which helped a lot with those. But chalked it all up to thyroid. Went to dr and she tested my b12…im at 182 deficient. I have started shots. 2 shots, one a week so far. 2 more in 2 weeks. Then once a month for 3 months. My heart palaptations have stopped….one now and then. Leg cramps so so. Tingling is a little less. I now itch like crazy no hives. And mild headaches are slowing that were getting bad. I hope this works.

      • Leg cramping is due to Magnesium deficiency most likely since calcium is a muscle control tractor(and we get more then enough in our diets) magnesium is a muscle relaxer! I love it and take powder form of magnesium twice a day in warm water (the blue bottle brand Calm found at whole foods! Cheers!

  14. Hi. I read some of the comments and replies on this conversation. I am too a B12 deficiency for almost 2 years now. At first, I tried the over the counter tablet but it made me so constipated!. Then, I talked to my doctor that I don’t want over the counter B12 vitamin and she suggested the B12 injections. Right now, I have been doing the injections. When my lab work results came out, it was low 152 and I have 4x a month B12 injection until it went down to once a month injections. From time to time, it will be almost normal B12 range then it will go down again. But one thing that really help me is eating liver! My mom will cook for liver and I will eat it for a week then my symptoms will be gone..

    • Azolla an aquatic fern and algae spirulina and chlorella are the best and naturally source of Vitamin B12. The Good thing about this is that they are tasteless so you can add flavour to it. Try these, after that, your Vitamin B12 deficiency is controlled.

        • I wish folk would get it right:

          Many people say that the only foods which contain vitamin B12 are animal-derived foods. This is untrue. No foods naturally contain vitamin B12 – neither animal or plant foods. Vitamin B12 is a microbe – a bacteria – it is produced by microorganisms

        • That part sounds like a joke. According to this article, logically all vegetarians should have neuropathy and severe symptoms. My whole family and forefathers have been vegetarians for thousands of years, one of most healthy and happy people on earth. i personally don’t recommend being veg or no veg, but this article is surely misleading.

          • Vitamin B12 CANNOT BE FOUND IN PLANTS. Period. The only edible source of vitamin B12 is through meat. I’m sorry if this violates your sensibilities, but numerous scientific studies have proven that cobalamin is only found in meat and the B12 found i plants and micro organisms is an analog. Until the analog is consumed and digested and absorbed into the animal’s body, it is useless to humans. If you object to eating meat, use a b12 supplement.

      • There are no natural plant substitutes for a true B12 plants carry a sub catagory which is of no use to human use and can actually make uptake of genuine B 12 less effective Many vegetarians / vegans are under this false illusion and are making themselves sick.

  15. Thanks Chris. Really love your work. I just wanted to share my experience with b12 and spirulina. I was vegetarian for 8 years and took spirulina consistently in high dosages for months. I then went to the doctor to test my nutrient levels and she was surprised to see how high my b12 was i.e over 1,000. The only thing we could put it down to was the spirulina. The spirulina I use is 450% RDA in b12. So perhaps there is some spirulina that works to build b12? I’m no longer vegetarian and prefer to eat the Paleo way, however still take small doses to keep my nutrient levels up.

    • Hey spirulina has the inactive form of vitamin B12 which your body can’t use and it may block your body from absorbing active vitamin b12 found only in animal products. It will also appear as b12 in your serum B12 blood test (the serum blood test does not differentiate between the active and inactive forms of b12 but measures all cobalamins). To check whether you actually may have a deficiency get the blood test called Active B12 from your Dr. If you have any of the symptoms please get it checked as it can cause permanent brain and spinal cord damage if left too long.

    • you can have high serum B12 levels and still be deficient. An Active B12 test is the only way of knowing if the B12 in your blood is actively being used by your cells. Usually about 80% of serum B12 is inactive and useless.

  16. Hi Chris, thanks for writing the article. I live in Canada and have had digestive issues since my teens, so yes I take prescription and non prescription ant acids. I’m 44 now. I have also been diagnosed bi-polar with anxiety since 18 and degenerative disc disease since 30..I could go on. Anyway I have been having worsening symptoms and went to my doctor. He ran many tests and said he would call if something came up. no call came, not shocking. Lucky for me I was able to get my results on line. My B12 is 188 no MMA was done but it did show High RDW 15.2 looking that up said possible PV, but explained it was unusual blood cells. I think I’m B12 deficient how do I get my doctor to help me if test as far as they are concerned are fine?

    • imo – Your doctor may have missed picking up the low reading in the results. Discussing it with him may be an idea. As well, you can pick up B12 supplements at places like Bulk Barn and Shoppers Drug Mart. I had an initial B12 reading slightly lower than yours and I took B12 vitamins I purchased at Bulk Barn. It took a couple of months before most of my symptoms were gone but it did work in my case.

  17. Ugh I wish you would do more research and rewrite this article. Up to 60% of people have a methylation issue and can not process the synthetic cyanocobalamin that food is fortified with. It actually causes more problems.
    Also advise to people to get a blood test results in a false negative with this part of the population. I test that I have too much which perplexes the doctors as I’m vegan. My first test was prior to me eating vegan. My mother eats meat and lots of eggs and her test results are the same too. This is because this fake vitamin cyanocobalamin is floating around unused in our blood stream.
    There is study I guess you missed that supplementation with nutritional yeast corrected the b12 deficiency in a group of raw foodest.
    There is more updated news in these comments than in your article. This is a horrible and eventually fatal imo so people need the truth.

  18. So i was diagnosed with a b12 deficiency of 90, i had tingling, numbness in my leg & hand, heart palpitattions. I have had 5 i injections yet in 2 weeks. I dont think I am getting better. How much time does it take? Also, since i have been taking my mecobalamine shots my heart palpitations have increased and i cant sleep properly. Please tell if it will get better!

    • B12 uses up minerals, perhaps potassium, magnesium, and possibly calcium are needed? I take 2,000mg potassium daily in 4 doses and all heart issues stopped. Occasionally I need more. If you choose to try minerals, start low like with 300mg in the morning and evening. See if it helps.

      Magnesium may also help, I take it as well. Start with a low dose like 100-200mg in morning and evening and see if it helps. You can take more as needed. I do not take calcium because I eat a lot of raw cheese which has a lot of bioavailable calcium in it.
      Best Wishes.

      • Molly, I am sincerely worried for your health. (I don’t know where you have been receiving your information.)
        1. Unlike sodium, magnesium is a scientifically PROVEN cause of hypertension, and a very, very, very minuscule number of people in the world would need to take magnesium supplements. Most (if not all) of these people would need to NOT use the supplements for an extended amount of time. … The popular belief that salt causes hypertension is based on a correlation, NOT a causation.
        2. The 2,000 milligrams of potassium is an enormous amount to be taking daily.
        3. From the numerous medical journals I have read, (unless a person has an EXTREMELY rare contrition or are severely anorexic/bulimic), the only supplements that can be taken daily without severe side effects are B- vitamins (and B-12 can safely be taken in extremely high doses). Also (from what I have read so far), the only mineral supplement that people may need to take OCCASIONALLY is zinc.

        • *I meant the only supplements that are safe and may be necessary for optimal health (caused by our diets, the industrial production of food, and the long list of unnatural pollutants, etc.) …
          Also, I forgot to include the fact that sodium bicarbonate is helpful for maintaining kidney function, and Vitamin D (cholecalciferol) is also safe to take on an as-needed basis.
          Vitamins A, C, E, and K -as well as potassium- are UNNEEDED if you eat anything that’s naturally green or orange, even if it’s only in a pie formation or a juice.

          • Your comments are so full of misinformation, I don’t know where to start. Here’s one: Vitamin A is not found in “anything that’s naturally green or orange.” You’re apparently thinking of Beta-carotene, which MAY or MAY NOT be converted in the body to true Vitamin A, which is only found in animal foods. Many factors make the conversion difficult-to-impossible for a large percentage of the population.

        • Sources: Dr Linus Pauling, PhD; Dr Abram Hoffer, MD, PhD; Dr Andrew Saul, PhD; Dr. Carolyn Dean, MD, ND; and 2 bookcases of books, including text books, and sites like this one – many of them. And quite a few videos.

          You are kind to be concerned, but please don’t worry. I know my history, you don’t. What I will tell you is that I’ve been able to fully reverse neuropathy in both feet and eliminate heart issues such as palpitations, pounding and skipped beats. All in all, a nice improvement. Ever onward!

          • The problem with receiving medical information (aside from definitions that have not been revised over time) from books is that literally any person can write (or dictate), publish, and sell a book. Also, many health/nutrition books are written using epidemiological and sometimes entomological studies as their supporting medical evidence. (It is scientific evidence, but it’s not solid medical evidence because it does not provide causation.) Reading numerous peer-reviewed scholarly articles published in different medical journals on each subject is the best way to justify any nutritional practice.

            • Peer-reviewed scholarly articles are rampant with fraud, even the NY Times has had articles about this, along with the Washington Post and others; it’s big news. I read actual studies, also often fraudulent, but when thoroughly read such fraud can often be discerned.

              You said:

              1 – “magnesium is a scientifically PROVEN cause of hypertension.”

              No, the lack of Mg is a proven cause of hypertension. It is used in cases of heart attack in hospitals to save lives, and it does. Research has proven that proper levels of magnesium will lower insulin resistance, lower blood sugar, and aid in the prevention and treatment of complication of neuropathy and retinopathy. Magnesium enhances blood flow through damaged vessels, and prevents or delays the onset of type II diabetes. Without enough magnesium, the heart muscle can develop a spasm or cramp and can stop beating. Ever wonder why heart disease is rampant today? Could be partly due to magnesium deficiency.

              2 – “The popular belief that salt causes hypertension is based on a correlation, NOT a causation.”

              Maybe. If by salt you mean pure sodium chloride, NaCl, you are dead wrong, it does indeed lead to hypertension and the mechanism is well known. If by salt you mean the genuine article such as any good sea salt, then yes, it does not cause hypertension, it reverses it because not only does it supply all the vital minerals the body needs, it provides potassium which is stripped out of table salt, NaCl.

              3 – “The 2,000 milligrams of potassium is an enormous amount to be taking daily.”

              It all depends upon the health issues of the person taking it. Doses of 1g up to 11g are very helpful for certain conditions and under certain circumstances.

              4 – “…the only supplements that can be taken daily without severe side effects are B- vitamins (and B-12 can safely be taken in extremely high doses).”

              This is untrue. Depending upon the forms and the amounts, B vitamins can have very severe side effects; it’s always best to use the correct form to minimize or eliminate those effects. B12 used incorrectly and without folate, magnesium and potassium can cause all sorts of trouble, including severe migraine. The safest vitamin is vitamin C, taken to bowel tolerance.

              5 – “Also (from what I have read so far), the only mineral supplement that people may need to take OCCASIONALLY is zinc.”

              Also untrue, most of America is deficient in magnesium, as well as zinc, and in sulfur. Many are deficient in potassium. Certain health issues may require minerals not even stated here, many with chronic fatigue need copper, which needs to be taken with zinc…

              6 – “I meant the only supplements that are safe and may be necessary for optimal health (caused by our diets, the industrial production of food, and the long list of unnatural pollutants, etc.)”

              You are possibly ignoring the effects of poisoning of the cell via various means, and the fact that even some who eat only organic or better, and no processed food whatsoever, are still ill. Any supplement is safe if it is the correct, orthomolecular form, and if your health issues dictate that you need it.

              7 – “Also, I forgot to include the fact that sodium bicarbonate is helpful for maintaining kidney function,”

              Even sodium bicarbonate can cause trouble such as headache, nausea, and even kidney failure under certain conditions. A person needs to know why they need it and how much to take, and when.

              8 – “and Vitamin D (cholecalciferol) is also safe to take on an as-needed basis.”

              If by “as needed” you mean people who have either been tested and found deficient, or who have most of the symptoms of vitamin D3 deficiency, I agree: they need it. If, on the other hand, you mean occasional use just for good measure, I respectfully disagree.

              9 – ““Vitamins A, C, E, and K -as well as potassium- are UNNEEDED if you eat anything that’s naturally green or orange, even if it’s only in a pie formation or a juice.”

              You could not possibly be more wrong.
              There was a study done at the University of Washington in Seattle comparing oranges that were grown organically to those grown conventionally. You probably presume that all oranges have around 60mg of vitamin C, like most people think. What they found was that conventional oranges have no vitamin C whatsoever, and those grown organically vary between 10mg and 60mg.

              Furthermore, vitamin C is NOT heat stable, so in a pie at least 50% will be lost. In any store bought juice, unless it is unpasteurized, again 50% or more of the vitamin C will be destroyed by the heat. Store bought juices are nothing more than colored sugar water, so for good nutrition you must have a good masticating juicer and juice your own. It’s a great idea, I have one, but it’s not cheap and it’s not easy.

              As for vitamin A, the analog is found in fruits and vegetables in the form of beta-carotene. Genuine vitamin A, the group of retinoids that includes retinol, retinal, and retinoic acid, is only found in animal foods such as liver, butter, seafood and egg yolks and cod liver oil. The ability to convert beta-carotene to vitamin A is highly individual, not all are efficient at it, some cannot do it at all, and the ability to convert declines with age starting around 20yrs old. Beta carotene is not an adequate substitute for retinol, true vitamin A. All the fruits and vegetables in the world will not adequately substitute for the real deal.

              Most people need more vitamin E than they can possibly get today since the germ is stripped out of refined flour and our current society is fat-phobic (vit E is a fat soluble vitamin, found in wheat germ oil, almonds, sunflower seeds, avocados).

              As for vitamin K, it is found in more than just colored vegetables or leafy greens. It can be found in dark chicken meat, pork sausage, baby back ribs, goose liver, hard cheeses such as Emmental, Jarlsberg, cheddar, bleu and Edam; eggs (yolks), butter, and natto. In fact, only K1 is found in leafy greens, K2 (MK-4) is found in animal foods, and MK-7, MK-8, and MK-9 are found in fermented foods such as cheeses and natto.

              Finally, since there really is no one-size-fits-all-protocol for health, everyone should read and carefully consider for themselves. That is the beauty of a site like this one, with conversations back and forth that help others as well as ourselves.

              • Brilliant! May I add a few things? Vitamin B6 should be taken carefully, as high amounts can be toxic. If supplementing with B vitamin complexes containing B6, it is best to follow a 4 month on 2 month off regimen to avoid toxic build up. Potassium should ONLY be supplemented if you are tested to be low. High levels of potassium can cause hyperkalemia, a dangerous condition that can affect the heart and lead to stroke and other heart issues. It is best to supplement with potassium rich foods instead of synthetics. Vitamin B12 needs folate (folic acid) to properly metabolize. It’s important to a) have folate levels checked, and b) if on injections especially, supplement with folate or folic acid (depending on which your body tolerates better) at injection time to make sure you are getting the benefits of the injection. Finally, if severely deficient, cut out alcohol (if you drink), and, I swear to god, foods like Redi Whip, which use a nitrous oxide propellant. Also, smoking can make a difference as to which form of B12 will be effective.

                Pernicious Anemia (the form I have) is difficult to diagnose, as current testing is not always accurate. IF antibodies test is the current model for testing for PA, and is only accurate about 60% of the time. Supplementing with b12 before testing for deficiency can also skew results, and you should be off supplements at least 4 weeks (longer, if possible) for a more accurate reading. Once you start treatment (especially injections) further testing of B12 is useless, as it will always skew high. Elevated serum b12 levels after treatment only indicate how much b12 is in your blood-NOT how much is being used by your cells. An Active B12 test is the only indicator of how much vitamin is actually being utilized, which is usually about 20%

                • Agreed! And thank you. In my case, potassium reversed all heart issues I had – because they were a result of potassium deficiency and not magnesium or calcium deficiency.
                  No processed food in this house, either; all organic or better.

              • Molly – you have an outdated understanding of nutrition one, and two – you really need to back away from nutrient supplements – all of them. Of all things science knows the least about in minerals and what we do know is the damage they can cause when taken as supplements. Just east some normal raw foods along with your burger and you’ll be a lot better off.
                You are on the most slippery of slopes with all your supplement taking and you will never right your ship – and it will get worse for you.

                ===What we do know is that many elements can negatively impact other elements. For example, many minerals do not ‘get along’ with other minerals – they can cancel each other out; long-term, doses of zinc can cause copper deficiency; Calcium will compete with other minerals to reduce their absorption, as well as Magnesium;

                In short, so many vitamins and minerals, especially in the concentrated form that are supplements, can have an adverse chemical reaction when they meet up with other chemicals and chemical processes in your body – including the depletion of many vitamins and minerals – the ones you naturally make and use.

                This is especially so with minerals which in large part act as catalysts, chemical elements that trigger many of the natural chemical reactions in our body. Minerals are co-factors for most biological reactions. Without minerals, vitamins have little or no effect. Minerals, each and every one, play an uber key role in how each and every vitamin works in the body. Minerals are basically the spark plugs of life, or keystones to our health. Minerals are the catalysts that keep our ‘battery‘ going and hold it’s ‘charge’, and have so much to do with how our body creates and uses our vitamins. Minerals are co-factors – triggers for thousands of essential enzyme reactions in the body. No trigger – no reaction – no vitamin effect.
                Stop taking mineral supplements.

        • EM! Pls do t be telling someone not to take Magnesium. So many people are deficient in it and being in healthcare. I can tell you. It is a muscle relaxer and gets rid of palpitations and cramping most athletes take it after a good sweat. In fact I take it twice a day and so does my mom who 5 years ago at 80 she diagnosed with chronic heart failure! (Likely due to excess calcium that some idiot told her to take. Magnesium glycinate (powder form for quick absorption) and K 2(Japanese natto) has totally reversed her CHF !!! Doctor was pleasantly surprised. And called it a miracle. I call it a deficiency. No one person eats the same so we don’t all need the same supplements however that one is a bigge. Studies have shown that men qith prostrate xmxer all had a Mag deficiency! So do t l ow here u got your info from!!! And last n bits are awesome and yes cows eat greens and greens have B12 gee ppl!

    • Also, cobalamin should not be taken in the evening, it will keep you awake. I don’t take it after 2pm.

      Magnesium relaxes muscles and helps with sleep, take it 30 min. or so before bed and see if it helps.

      • Hi Molley

        I have heart palps and other symptoms for over one year, been supplementing magnesium, but no help, I have been thinking of potassium link, would you mind sharing how you decided to supplement with potassium? Mine blood levels are normal, but there might be some other test i can look?

        • Same here, I was already taking magnesium and using Celtic sea salt, but got heart palpitations anyway. I read about potassium and thought about it and decided to try it. My blood work was extremely good – but I was not well so the bloodwork was useless. If a test says you are fine and you are absolutely not fine, the test is useless, please don’t rely solely on blood tests! They are supposed to aid in diagnosis, they are not the final word. Symptoms are much more useful in determining your health issues simply because you know how you feel. [Blood work only shows what is in the blood at the precise moment in time when that blood is drawn. It does not show what is in the cells, it does not show what is in the blood before or after the blood is drawn.]

          In general, people need to eat an average of 4,000mg of potassium per day. I started with 3x99mg capsules for 3 days and increased that by 2 more until it worked; holding each increase for 3 days to give it a little time.

          If you read allopathic mainstream medical sites they are panick-stricken by the idea of overdose, but if you read alternative sites and orthomolecular ones in particular which have actual data, you will find that it’s not all that easy to do – especially if you need potassium. It is water soluble and does not stick around so the danger is low. The form also matters, potassium citrate and potassium gluconate are good, I use them both. In a pinch I have used potassium chloride (potassium salt!).

          I take potassium with each meal and before bed. My husband only needs to take potassium once per day – we are all unique so you will have to figure this out for yourself by doing it. You will find your dose amount and you will find the times to take it by trying it out.

          For me, potassium takes 15 minutes to work – it’s very fast.
          Best Wishes for your health!

      • In my case, I only used supplements (no injections) and it took between 2 and 3 weeks before I noticed some improvements. My understanding is that it takes some time for the bodies systems to utilize the b12 and fix what is going on with the nerves and other affected area’s. I also had H Pylori which was causing b12 absorption issues. I think Stephan brings up a good point and there may be something else going on as well that needs to be investigated. From my own experience, it can take a while to get it all sorted out.

        • I also started taking a multi vitamin at the same time as I started taking b12. My thinking (never substantiated) was that I might be low on other vitamins as well.

          • I think you are probably correct, it would be amazing if B12 was your only deficiency. A multi that incorporates mB12, methylfolate, P5P, other B vitamins, A,C,D,E, and bio-available minerals may be a good idea. And as you’ve found out, rarely are adequate amounts of magnesium, calcium, or Vit D included in these (you probably need to add them separately). And I agree with other posters, it will take time. Regarding B12, the Swedes have found that oral methylcobalamin can be used even in people that have absorption problems because some will be absorbed through diffusion in your gut. They recommended 2mg mB12 two times per day. You may be able to find this research online. PS, don’t forget sodium and potassium as well.

            • oral b12 is not useful in all absorption issues. It is important to remember that if you have PA, there is no way to absorb b12 through the digestive tract because the body no longer has any of the protein (Intrinsic Factor) necessary to absorb b12. I that case, injections are the ONLY effective treatment. It should also be noted that, when supplementing b vitamins, you should be careful with B6, as high amounts are toxic. It’s best to follow the 4 months on two months off regimen to keep b6 at a safe level.

    • alia, have you considered B1, thiamine deficiency as a cause of the tingling? Do you suffer burning sensation in the feet also? Lower down i have more of an explanation.

      Re-quote: Quote: Chronic exposure to nitrous oxide has been associated with subacute combined degeneration [15]. The mechanism by which nitrous oxide induces vitamin B12 deficiency is by inactivation of methyl-cobalamin thereby inhibiting the conversion of homocysteine to methionine and methyltetrahydrofolate (MTHF) and 5-methylene-tetrahydrofolate (THF), which are required for myelin sheath protein and DNA synthesis.

      Ref: Nutritional Neuropathies – NCBI – National Institutes of Health › NCBI › Literature › PubMed Central (PMC)
      by N Hammond – 2013 – Cited by 11 – Related articles
      Thiamine (vitamin B1) is a water-soluble vitamin present in most animal and plant tissues. Neuropathy due to thiamine deficiency, known as beriberi, was the first … features of thiamine deficiency begin with distal sensory loss, burning pain, …

      Hope this helps in joining some dots. In Canada we are limited to buying 100mg of thiamine. Larger doses are available in the US.

  19. I have a b12 deficiency (my last blood test showed 170 mcg) . My symptoms are – light headed, tingling in my face, mouth , hands and sometimes arms , Involuntary twitches (like when I was consuming to much coffee) sometimes feel depressed, although I have energy once I get going, I do not always want to get going and can feel clammy/ sweaty/ hot face after being active for a while (activity that normally would not result in feeling clammy and sweaty. Eating can make the symptoms worse or bring them on – especially breakfast. Symptoms began to develop slowly about 6 months ago and would be worse after some considerable physical activity . they are now present most of the day although they may alternate and I do get some periods when they are absent.
    I suspect that my B12 deficiency is quite likely diet related as my son is a vegetarian as such although I do consume some meat products, it has been less than I used to for a number of years now as we cook with his diet in mind a lot of the time.
    My doctor has told me to take over the counter B12 which I am (Webbers 1200 mcg) – cyanocobalamin). After reading this form, I am going to get the under the tongue type and look for methylcobalamin or hydroxycobalamin.
    2 questions for this form please.
    1) Are my symptoms typical of B12 deficiency (especially tingling in the mouth) ?
    2) How long after taking b12 supplements should I start to see a difference?

    Thank You

    • yes, the tingling in the mouth and your other symptoms are typical of B12 deficiency symtoms-absolutely.
      Glad you will be looking for the other forms of B12, -sublingual and methylcobalamin-you can find them on amazon 5,000 mcg-I took those five under tongue at a time on the hour for five hours, then noticed a difference-excessive, but it worked. I took high quanities for days, and slowly over time brought the dosage down I now take 7 of these tablets a day, which is comprable to one shot a month…Good luck…

      • Thank you for the reply. I will be seeing a neurologist team in a couple of days (my doctor booked me as a result of my symptoms. I am now taking 3600 mcg of the webbers b12 as well as a multivitamin that contains b12. My thinking is that I will wait till I here what the Neurologist team have to say and what testing they want to do and then get the better quality b12’s. For sure, I am b12 deficient but I am not sure what else may be going on.

        Again thank you

        • Just worth mentioning that the forms of B12 you actually need, which the body makes (out of hydroxy & cyano), are methyl & adenosyl, & if you can’t make them (efficiently), as some can’t, you need to supplement them.

          You can swallow a pill (1% uptake), suck a sublingual (5%) or use the new transdermal approach pioneered by – perhaps 80% uptake.

          After switching to this product (with which I have no affiliation) I could lower my doses.

          • YES – If the primary cause of the B12 deficiency was dietary in nature then there is no reason why a change in diet to include more meat and B12 reinforced foods should not be able to maintain a healthy B12 level once its back where it should be. Also once the problem causing/ making the deficiency worse is solved ( H-Pylori in my case) then diet would go a long way in keeping levels where they should be.

      • Thank you – looks like it is a possibility. I am taking a multi vitamin That contains 5.5 milli grams of magnesium sulfate (just started) . With b12 it can take a while to get over it and feel better – 3 months or more. Any idea of how long it takes to get over it with a magnesium deficiency? Does age have anything to do with it? i am 60.

        • 5.5 milli grams of magnesium sulfate (just started) is a small amount. Depending on sex and age us adults need somewhere around 400mg a day. I started this last night. For me it has helped to feel markedly less anxious, improved mood, significant reduction in restlessness, quieter mind (not racing thoughts). I also take Vitamin D due to deficiency and a natural testosterone booster (i’m male) due to deficiency.

    • i was also wandering – how many people that are b12 deficient get all the symptoms I do? I seem to have an awful lot going on. Are all these symptoms common for B12 deficiency?

      Some answers would be very helpful for me.

      Thank You

      • Oh , the symptoms for B 12 deficiency go on and on, and affect different people differently. And there are numerous ones. I recommend checking out the site…www.B12, there is a documentary on the left side-there are a couple, one is about an hour long. You can find it on you tube too. Well worth watching, you may end up even saving your own life, as I did mine. With levels as low as yours, yes all of your symptoms can be from B12 deficiency. Please do yourself and possibly others a favor and watch that documentary!

    • I have learned a lot from this form – thank you. i am early in my situation and will post as i learn more so that others may be able to learn something from my experience.

      I have also bought some Swiss natural ( 1000 mcg b12 – cyanocobalamin, 600 mcg folic acid, 25 mg b6) as well as my original (Webbers 1200 mcg) – cyanocobalamin). The Swiss natural are chew able and so I am suspecting that just like the under the tongue type you get better up take. I am now alternating between the 2 – taking one in the morning and the other at night with my multi vitamin. I will some times take another chew able mid day depending on how i feel. i have only been at this for about 2 weeks and I know my symptoms can be cyclical – the off balance feeling seems to be the one thing that is their most of the time and it was i believe my first symptom on and off 6 months ago. I have low stomach acidity levels as I do not get heart burn regardless of what I eat and my diet had a lot of the time minimal natural b12 products for years.
      My doctor told me to take 1 – 1200 b12 tablet once a day and I am at 2 – 3 times that. I understand that B12 is water soluble and overdosing on it is not an issue but I am wandering about the impact on organs/ body (liver, kidney bladder etc.) from dealing with large doses of B12. it has to go somewhere even if the end result is that it goes through you. Any insight on this would be appreciated.

      thank You

      • Went to one specialist for emc testing (where they fire impulses through your nerves and measure the response) Findings were minor to no problems but based on my symptoms, this specialist is sending in as request that I be sent to a neurologist for further testing. in the mean time, I continue to take my B12 supplements (3 tablets /day – a combination of Swiss natural chew-able ( 1000 mcg b12 – cyanocobalamin, 600 mcg folic acid, 25 mg b6) as well as my original (Webbers 1200 mcg) – cyanocobalamin). ) Symptoms are not as frequent and not as intense. I am noticing that certain foods that were never a problem before can bring on symptoms. I ate 4 or 5 of those Halloween chocolate treats last night and symptoms seemed to come on with a little more intensity after words. I am not sure if this is a coincidence though.. I am wandering about others experience with respect to certain foods. Any feed back would be appreciated.

        • Are you sure it’s cyanocobalamin you need, and not a bioactive form? Are you sure you need folic acid, and not methylfolate? You might be like many of us, and need methylcobalamin and methyl folate.

          • As I eat a lot of stuff with folates in it, I suspect that i do not need the folic acid. i figured that out after I bought the supplement. I am seeing my doctor Nov. 1st and will review with him. That may be hit and miss as I am not sure how much he knows about this stuff.

            • Probably not much if he’s an average doc.

              The other big issue IMO is uptake. With oral (swallowed) you get 1%; sublingual maybe 5%; transdermal (Australian brand) 80%. I noticed a big difference switching from the sublingual to the transdermal & was able to lower my dose.

              • Thanks for the reply . I am in Canada so am not sure where I can get the Australian brand. I did pick up a bottle of Swiss natural chew-able ( 1200 mcg b12 – Methylcobalamin sublingual tablets after learning on this form that they are better. cost was about the same as the cyano tablets. Methyl seems to be widely available in Canada but I have not seen any transdermal (Australian brand.

                • The Australian brand is at

                  (I don’t have any affiliation with it, tho I have got to know the scientist-owner via his remarkably generous question-answering.)

                  You have to be careful with the sublinguals. A poster named Freddd at the Phoenix Rising CFS forum has tested the brands extensively, & found the majority to be sub-par or duds.

                  I found that the sublinguals worked if you kept them in your mouth for 45+ minutes, but they rotted my teeth a lot; plus the ride was quite a bit rockier than with transdermal, which is very smooth & even due to the gradual (6-8-hour) uptake.

                • Thanks for the Info John M.. So far the combination I am taking seem to be working for me (symptoms heading in the right direction). So I will probably stick to what I am doing. I will definitely check out the Phoenix Rising CFS forum.

            • Hi Marpy! First, multivitamins/mineral supplements are unnecessary. The B-12 would be just fine. If you want a B-complex vitamin supplement, I would recommend you look for “Alive water enhancers” at the Vitamin Shoppe (.com) …or from a different website, if they don’t deliver to Canada.
              Second, you may want to consider consuming a small amount of sodium bicarbonate daily. It is proven to help maintain kidney function… and it sounds like your kidneys could use the help. (Baking soda may also help with IBS and cleans teeth well.) If you have trouble producing saliva (spit), you may want to mix with a little water. Arm&Hammer is a good brand. Always make sure there is a nutrition or drug facts label before purchasing.
              Lastly, you may be experiencing “heart palpitations” from having a bit too much magnesium (and/or copper) in your body at the time that you experience these “heart palpitations”. Magnesium and copper in excess have been proven to cause hypertension (high blood pressure). Very light arrhythmias or heart palpitations can also be early signs of hypertension. Coffee and cocoa powder are often the sources of an abnormal amount of magnesium, and coffee can also contain an unusually high amount of copper.

          • Thanks for the reply -= I am going to the doctor on Nov. 1 and am going to see if I can get injections. Based on the outcome of that visit – I will pursue the better forms of b12. if I keep taking the oral forms, I will switch from the cyano.

        • Yes – you are correct Bonnie. ;-).

          On the B12 subject – i got a call from my doctors office and he wants me to stick with supplements for another 2 months before he will consider injections. He has me scheduled for a blood test them. I can live with this as the supplements seem to be working well for me. Symptoms are almost all gone and I am almost done with the antibiotic treatment for the H. Pylori. H. Pylori seemed to be making my B12 problem worse than it otherwise would have been. which

      • I got my blood test results today and after 5 months of taking over the counter B12 supplements, switching to B12 fortified milk, and eating more meat, my B12 level is 703. My symptoms have been gone for some time. As i did not seem to have any other complications, in my case the above changes seem to have worked. For people in Canada and specifically in Ontario and BC, if you go to Life Labs for your testing, you can look at your results on line a few days later for no additional charge. The testing is free regardless of where you go as it is covered by government insurance but the other lab company I went to in the past charges for on line access to your results.

    • Please reconsider taking the under the tounge dissolvable tablets. I took them & what they do not tell you is the ingredient used to cause the tablet to dissolve also rots your teeth. My front bottom teeth started to turn black & I realized it was after using the tablets for about a month. I contacted my doctor & told them because she had recommended them. The nurse told me to discontinue & go to liquid drops or pills. After stopping & meticulous brushing & dentist cleaning my teeth are back to normal.

      • thanks for the info. I am talking to my doctor about injections and the sublingual B12 i am using dissolves rather quickly . i will monitor for any changes in my teeth though and hopefully will be getting injections. I have also been diagnosed with H. Pylori which is a stomach infection that can lead to absorption issues with B12. I am on a antibiotic treatment plan to get rid of the H. Pylori and so hopefully that will lead to improvements as well.

    • Marpy: Do you use cow dairy, because with you stating that : Eating can make the symptoms worse or bring them on – especially breakfast, and that your symptoms would be worse after some considerable physical activity, I suspect you are overproducing Lactic acid which exercise and/or diet can drive up.

      I suffered similar symptoms from inhaling methanol from Pulp Mill emissions (ref: comment to Paul). My conclusion is that the cellular Lactic acid we produce is first cousins to the Lactic acid in cow dairy. Also foods with aspartame which has a formaldehyde component metabolizes to lactic acid. First to Formic acid in the liver (which may cause the burning tingling mouth) then to Lactic acid in all our cells. There are also many sources of environmental formaldehyde which when inhaled build up through biochemistry and metabolism converting to formic acid then cellular lactic acid. Vehicle exhaust, carpeting, new waterproof drywall etc.

      Since every cell is an energy furnace (mitochondria) the ATP energy conversion can be impaired possibly onsetting fatigue. High lactate levels can also onset muscle burning and cramping. If the cells are impaired, high Carbohydrate intake can metabolize to lactic acid (anaerobic glycolosis) further complicating pain issues. The remedy to this is to eat smaller portions of high carbs or glucose which we still need for energy conversion, much like the practice of grazing, eating smaller portions 5 to 6 times per day, or whatever the body craves.

      Minnesota Poison Control’s paper on methanol toxicity shows the sequela with the conversion process of metabolism and biochemistry. Note folate (folic acid) is used by IV in the ICU Unit or ER. Ethanol is even used as an antidote. Quote: Formate inhibits mitochondrial respiration leading to tissue hypoxia and lactate formation. Formate production occurs in the retina and may lead to optic papillitis and retinal edema.

      • thanks – lactose intolerance is not an issue for me. I was consuming a lot less cow dairy when I was having a lot of issues than I am now. I am now drinking milk fortified with b12 and many other vitamins and my symptoms are much improved. i can see how for some people lactose would be an issue.

  20. Couple very important things I learned about B12, just this year. Eggs have very low absorption rates of B-12-only 9%, so don’t count on getting B-12 there. Also, farm production animals typically drink chlorinated water in the barn, just like people in their house, so their only source of B-12 is the dirt on the grass or in their feed which is supplemented with B-12. I am not sure how well regulated this B12 supplementation of feed is. Studies found that those with highest B-12 were not the big animal product eaters, but rather, those who were taking a supplement and/or eating fortified foods- think Cheerios, or plant milks (almond, nonGMO soy, oat…)that have 25% RDA in one glass.

  21. Hi ya’ll.

    Was lurking and happened to stumble upon this article while researching.
    I took a blood test before heading out the country regarding my neuropathy and some numbers I would like to point out: My glucose level is at 90 and my B12 is at 595. I ate a meal before testing(spam, eggs, and bread if I recall), so IDK how accurately these results are, but the glucose checks out, so most likely no diabetes. But I read that B12 levels @ 500-550 are considered to be on the lower end in Europe/Japan.

    I’ve seen the doctors on my vacation here in Taiwan and my neurologist prescribed me B12 pills(250 mcg, taken 3 times a day I think). I think they’ve helped a fair amount after taking them for 2 weeks. I’ve noticed less tingling/burning/aching of the nerves but just 2 days ago I ran out of them. Yesterday I opted for Super B Complex by Naturemade out of convenience but I notice it only contains 50 mcg of B12. I took it to start off yesterday morning and I felt pretty good throughout the day until right before I went to sleep when the pinching/tingling began again. Woke up today and was fine until 3ish when the tingling/pinching came back to my dismay. It was improving until that point so IDK if I should chalk to up to inconsistency or a REAL deficiency in B12. Maybe I needa switch back? Maybe I should just give it time and stick to the B complex? How much of a dosage of B12 should I take from now on?

    • Paul, Thiamine deficiency can be responsible for Neuropathy. Polished rice, wheat, barley have all the B vitamins removed to the point where babies can inherit a thiamine deficiency in the womb onsetting infantile apnea. Dr. Derek Lonsdale worked on this by giving babies mega doses of B1 to shock their bodies into assimilating this most important vitamin that is responsible for motivating our breathing function in our lower brainstem. The American Medical Association wanted to revoke his Medical License for doing Vitamin Therapy. This motivated the start of the Integrative Medicine Group, taking the best practices of Allopathic and Naturopathic modalities for treatment.

      I suffered thiamine deficiency from inhaling Aldehyde (hangover component of drinking ethanol) and Nitric oxide from working on an Air Emissions Project inhaling Pulp Mill emissions. People who may have been sedated often with Nitrous oxide anaesthesia or staff in OR and Dentistry inhaling vagabond gases may develop traits of B12 deficiency, plus a bonus of possible heart fibrillation issues.

      Quote: Chronic exposure to nitrous oxide has been associated with subacute combined degeneration [15]. The mechanism by which nitrous oxide induces vitamin B12 deficiency is by inactivation of methyl-cobalamin thereby inhibiting the conversion of homocysteine to methionine and methyltetrahydrofolate (MTHF) and 5-methylene-tetrahydrofolate (THF), which are required for myelin sheath protein and DNA synthesis.

      Ref: Nutritional Neuropathies – NCBI – National Institutes of Health › NCBI › Literature › PubMed Central (PMC)
      by N Hammond – 2013 – Cited by 11 – Related articles
      Thiamine (vitamin B1) is a water-soluble vitamin present in most animal and plant tissues. Neuropathy due to thiamine deficiency, known as beriberi, was the first … features of thiamine deficiency begin with distal sensory loss, burning pain, …

      Hope this helps in joining some dots.

    • Paul Chiu, I forgot to mention Chemically induced Neuropathy can be caused by medications, chemicals and air pollution.

      Quote: Management
      In addition to advising the patient to avoid the causative drug or occupational or environmental toxin, management of toxic neuropathy can include the following:

      Ref: Toxic Neuropathy: Practice Essentials, Background, Pathophysiology
      Feb 3, 2016 – Toxic neuropathy refers to neuropathy caused by drug ingestion, drug or chemical abuse, or industrial chemical exposure from the workplace …

      My work exposure was in NW Ontario at Dryden to Pulp Mill Emissions building an Air Emissions Project. My last day of work on August 2003 there were 59 men on oxygen at the hospital. Being the 13th worker to suffer cardiac issues (we were inhaling potassium from the Recovery Boiler stacks) I knew i had to avoid Pulp & Paper Mills.

      After doing a stress test i decided to work in Southern Ontario building a NOx Scrubber at a coal fired power facility to avoid pulp mill emissions. It may have been a perfect storm, but at Dryden my fellow tradesman were suffering burning feet. They would buy more comfortable work boots with no relief in symptoms. No physician ever clued us in that it was Chemically Induced Neuropathy.

      It was God’s grace that I survived that winter. We were inhaling a Chelation Agent to remove heavy metals from pulp fibre and my Nutritional Minerals were depleted except for potassium and manganese. I would suffer burning feet, full body cramping from head to toe with full body arching. Embarrassingly collapsing to the ground hoping no one witnessed the sudden fall. I finally went to ER in Southern Ontario in June 2004 because of sock to glove numbness on my right side (Sensory loss in a stocking-glove distribution).

      When we left the north shore of Lake Erie and spent a night in a motel at Blind River, I woke up with absolutely no burning feet. We slept another night in Wawa with the same result, no burning feet. I started joining the dots. Work exposure to more polluted air on the North Shore of Lake Erie. Move back up North to cleaner air and my neuropathy vanishes except for vehicle exhaust exposures and chemical off gassing in Big Box Retail Stores.

      Crazy as this is, a Canadian Geographic Magazine bought the fall winter of 2003-04 of which I had never read because we were working 6 days a week had an article on the Air Pollution from America’s Industrial Corridor, Indiana, Ohio’s air pollution blowing north over Detroit picking up more pollutants then swinging east over the north shore of Lake Erie over the Nantikoke Industrial Park where the largest Coal fired (8 boilers) facility in N.A. existed, now closed, along with Erie Steel and an Esso Refinery, then proceeding east over Hamilton’s steel mills blowing over Toronto towards Ottawa, Canada’s Capital.

      I later read a statement that there are high rates of neuropathy in Southern Ontario, these are my observations from the fish bowl I was swimming in. In the fall of 2004 vehicle exhaust started causing the same symptoms as the pulp mill x-p, which = no RTW. There is formaldehyde in vehicle exhaust which is a component of the methanol chemical chain. Ref; my link to MN Poison Control in an earlier comment.

      • If President elect, Donald Trump guts the EPA, and encourages more coal power generation and relaxes pollution abatement for other high polluting industry this is one result, chemically induced neuropathy. Respiratory illness will also follow.

        Lower limb and hand amputations can result from neuropathy. How convenient, Chemically Induced Neuropathy is in the same class as Diabetic Neuropathy. When i researched this in 2005 it listed 7 classes of neuropathy.

        Ref: Types of Peripheral Neuropathy – The Center for Peripheral Neuropathy
        There are many types of peripheral neuropathy, which can be brought on by diabetes, genetic predisposition (hereditary causes), exposure to toxic chemicals,  …

        B12 is listed as the only Nutritional deficiency in this extensive article.

  22. My mom as always been b12 deficiency. She took shots and now just over counter pills. She shakes inside all the time. Now they say she has.dementia. we are doing blood work. X-rays andore test. I wonder if her b12 could be the problem.

    • In autopsies, demented people have low concentrations of B12 in their brains.

      The form of B12 is important: firstly, the nervous system needs methyl & adenosyl – & if you can’t make those efficiently from your food or supps you’d be in trouble. So it’s best to take those forms direct.

      Secondly, tablets give you 1% uptake, and sublinguals 5%. So transdermal made by B12oils in Australia is IMO best: it has an 80% uptake.

      (I have no affiliation with them.)

  23. Good article – nicely covers the waterfront as usual.

    I take methyl & adenosyl (the two B12 forms made by the body from hydroxy), & have graduated over time from oral (-1% uptake) to sublingual (~5% uptake & lots of dental caries) to transdermal (80% uptake, so lower dosage, & a perceptible bang for your buck). Knocked over 90% of my chronic fatigue in a couple of months.

    I bought it from (with which I have no affiliation).

  24. Hello all, and thanks for the fantastic information. I am MTHFR compound heterozygous and just now finding out about all of this stuff after having a multitude of B12 and folate deficiency symptoms my whole life. I read here that some people have a transcobalamin deficiency and therefore cannot get the B12 into the cells, but there was no followup to that. How does one know if they have a transcobalamin deficiency, and what can be done about it if it exists? Assuming transcobalamin is adequate, if one still have low intracellular B12, what is the best way to increase it? One comment said lithium can help, but no further information about dosing or brand/form was given. Thanks in advance!

  25. Do you have any documentation on the levels from Europe/Japan being 500 is what they call a deficiencie? I have been told this is a myth

  26. I was diagnosed with slight B12 deficiency and started taking a B complex vitamin on a friend’s recommendation. I do feel calmer and more energetic, but I have become hungry all the time, I want to eat constantly. I am already overweight and don’t want to gain even more. Has anyone else experienced this? Will this level out over time and stop? I really don’t know what to do.

    • I eat a lot too and before a year ago I had a bad habit of consuming a lot of foods high in sugar such as pepsi/coke, icecreams, biscuits, chocolates. I’ve since cut them out and replaced them with natural fruits, 70% dark choc, 7g sugar content muesli bars, fruit yogurts. My weight has dropped, not to the optimal level but better than a year ago.

      • Eating a lot of nuts too. More than supposed to but I want to avoid high content sugary foods. I’m also on Lexapro 30mg so that could be increasing my apetite too.

    • Hi

      I have a really bad b12 deficiency (found out im March this year, although I had been taking b12 tablets for a long time). At first I just got 1 injection a week and it didn’t help – the results got worse! – and now I am getting 4 injections a week. I cannot say that since the injections I want to eat more.

      Wishing you all the peace of the night (it’s 20:30 in Germany and I am exhausted – you know why;))

  27. I am a 46 yr old Male, 5’10” 230lbs
    I just got this result back from a blood test, should I look to get my number higher?

    Component Standard Range Your Value
    Vitamin B12 200 – 1100 PG/ML 414 PG/ML

  28. I have been a vegetarian for about 3 and a half years now. Past month I have been having sudden chest pain, shaking, dizziness and symptoms that mimic a panic attack or anxiety. And there’s nothing I’m stressed about it just comes on for no reasons. Olus I’m always tired. I’m starting to think it’s because I’m not getting enough vitamins, and really no B12 at all.
    Will taking a multivitamin (something I don’t do) with an extra dose of B12 be enough?
    I’m 42 year old female.

    • Most multi’s contain the form of B12 called cyanocobalamin, this is a synthetic form, and your body needs to convert it to the methyl form in order to use it. Some people aren’t so good at converting this B12, so look for a multi or B-complex that contains the methyl forms of B12 and folate. Or you can also just purchase methyl B12 caplets, and if you are deficient, you may want about 5mg per day for a while to get your B12 stores topped up. B12 is stored in the liver, and this is why you may get away with a low B12 diet for several years before you have problems.

    • Have you considered mineral deficiencies? Particularly potassium, magnesium, and possibly zinc? I wouldn’t know about you in particular, but sometimes heart issues are related to these.
      Fatigue can be related to mineral deficiency as well, but often it’s B12 deficiency and can also be either too much iron (hemochromatosis) or not enough, or some combination of the above.

    • Go vegan not vegetarian because dairy and eggs are cruel af and horrible for you. Take a b12 supplement, exercise, hydrate, carb up on some whole plant foods

      • Ava, before refrigeration dairy cheeses, yogurts, kefir etc could be stored for long periods. In colder climates where a plant based diet can only be secured in warm months and harvested near the end of the season, meats and dairy sustained humanity for thousands of years before the recent creation of CAFO, Confined Animal Factory Operations.

        Hay is put up for winter months when animals cannot graze in their pastures. The Sunshine, Rainfall, Grassland Cycle is a renewable resource which has proven to be sustainable for centuries. Food Miles and Full Cycle Costs should be calculated in any food system.

        Sub-marginal land has nourished ruminants foraging grasses and weeds. Their by-products of fibre, dairy, meat and hides all cater to a value added commodity which is renewable. Substitutes for dairy have ingredients shipped from around the planet all adding to the excess of Co2. Ava, what is your opinion on field critter kill from mono cropping grains, seeds and beans for a vegan diet?

        • What is your opinion on the massive destruction of forests and wildlife habitat to grow soy in order to feed the billions of farm animals we mass-breed? What is your opinion on all that wasted water, energy, and land to sustain their sad lives, rather than the lives of our own people? Soon, there simply won’t be enough room and resources on earth for all these animals- humans, cows, and wildlife. Somebody is going to have to go. I vote the farm-animals. We have to stop breeding and eating them. It has become cruel and destructive for everyone.

    • Hi Mindy,
      I’ve been experiencing exactly the same symptoms for past week or so. Awaiting my test results. How’s your condition now? Did it get better?

  29. I’ve been diagnosed with Crohn’s disease a little over a year ago…I’ve had low vitamin b12 levels (115pmol/l) in december and anemia that wer treated with a shot and weekly usage of nasal spray and an iron infusion….the b12 levels went up to 183 in February…in April my doctor wanted to see if I could keep the levels up naturally and took me off the b12…I had a blood test last week and now the levels are at 99pmol/l…so she gave me an injection and put me back on the spray…
    Anyhow I’ve been reading about all the symptoms and how other people experience it and frankly I don’t think I have any at all…I mean I’m tired after work which is normal I guess (I’m in hotel industry and am on my feet all day) and do need a lot of sleep (9hours) but I do a lot of sports every day and don’t seem to be particular exhausted…
    I wonder if that’s normal (not that I’m complaining 🙂 ) I do have to say that when I went for a run this morning (usually about 5-7k) I did get a bit dizzy towards the end..but since that’s rarely ever happened I just figured it was the heat (lesson learned….no running after 9am in summer I guess)
    Does anyone else have the same kind of experience?

    • Do you mind sharing your age? I’m wondering if your symptoms will change as you age. I don’t know if I was deficient in Vitamin B12 and other Bs in my earlier years but I know many symptoms that I have when low have worsened/changed as I have gotten older. So now I do treat myself with a natural multiB supplement and an extra natural B12 most mornings.

      In Japan and some European countries the minimum level for B12 is around 500…

      • Not at all, I’m 31. I was thinking about it some more yesterday and I don’t think I’m just being ignorant to any symptoms, but I definitely don’t have anything…or at least nothing that would be obvious enough

    • This study is very misleading. The B12 found in these plants, is INORGANIC. It’s a yet different form, and it is toxic to our body. Nothing to do with the bioavailable meat B12 form.

  30. I have all the symptoms of b12 deficiency,I have been taking metformin for years and is known to cause b12 deficiency but every time because the levels are so low in this country I am told my bloods are normal and I know it wrong.I know how I feel and the symptoms,I am not paranoid,Drs wont listen,what can I do now to convince them,so many dont even realise their symptoms are a cause of this

    • In Japan apparently they lifted the minimum level in the reference range for B12 to around 500 pmol. You might want to consider taking matters into your own hands and treat yourself with the help of a physician.

      According to Australia’s reference range I’m within range, according to Japan I’m below. After treating myself with this product once or twice a day I have recovered so much cognitive function, memory, mood, assertiveness, confusion, anxiety, depression, concentration, busy (racing) mind, irritable, agitated, anger. It is just amazing this product. It has all the natural forms of vitamin B as some people cannot metabolise well or much at all the synthetic forms.

      Let us know how you progress in a few weeks. I noticed immediate benefits after first day! And I’m improving more and more each day. Its like I am gaining 20 years in some aspects of mental functioning. A renewed me.

      • Hi: I have been treating this issue “I believe” for many years. I had no idea I had a problem until recently. I would go to the Dr. barely able to move my body and complain I was beyond fatigued, or my hands were tingling or numb. I was soooo tired. I would have a blood test and it would show normal. THen the last one showed a B12 deficiency I had 97 instead of the not very effective 138 that is defined as the low.
        It bothers me greatly that I could have had help over the last 20 years if the blood test had requested a B12 level or if I had somehow known. My Mom died of cancer, but she also had a B12 deficiency. Is it genetic in my case. Should I be telling my kids to get tested. How does one know. I went to a naturopath and she also said that in most modern medicine the low acceptable is 500. That scared me even more. Have I done damage to myself over the years because I didnt know what I was dealing withÉ
        I just dont know what the average person should be doing.
        I think it should be checked better and more accurately.

        • Hi Ann, I understand your worry and concern. I think you can heal yourself by taking the appropriate steps now. We cannot right our wrong past mistakes, they are left in the past. But we can take action now that is beneficial for us. None of us make perfect decisions during our entire lives.

          I hope you draw some positiveness from this video where a Dr. treated herself with a healthy diet to cure herself, it is not about B12 per say but shows the importance of good nutrition.

          • Thanks Stephen: I have an exceptionally healthy diet, so I knew that was not the issue. I have a naturopath now that has been excellent in tracking the B12 issue and it is definitely the culprit.

            • I have suffered from mysterious fatigue for 20 years as well. About a year ago, I went mostly vegan, and this summer my fatigue started to get really bad. I’m always tired, that’s nothing new, but I started getting anxiety/palpitations, and waking up with my arms numb and tingly. Very concerned…

              I was aware of the B12 vegan problem, so I started taking methyl B12, and my symptoms greatly diminished in about 1-2wks. Also, no more deep afternoon naps, nor waking in the morning feeling like I’ve been drugged.

              I did strict paleo for several years, eating supposedly high B12 animal products for every meal, but I never got rid of my fatigue.

              I’m hoping B12 is at least a piece of this 20 year puzzle I’ve been hopeless to solve.

    • I am a type 2 diabetic who has just been diagnosed with a B12 deficiency. He has suggested I take a B12 supplement daily for 1 month to be followed by a blood test. My advice to you is to change your doctor, and in the meantime go to your health store and buy a supply of supplements. Take one a day for a month and see if your symptoms change. But do seek out a doctor who will listen to their patients. Don’t leave it to chance!

    • I was told the same thing as you, that my B12 was fine. I found out though that taking methyl B12 helps my energy level significantly. I started taking 5mg per day, and later switched to a B-complex containing the methyl forms of both B12 and folate, and feel even better.

    • Sonia, metaformin use can also onset metabolic acidosis or lactic acidosis. A food conflict by drinking/eating cow dairy products can/may be alleviated by switching to goat or sheep dairy products. A personal joke is to do a cow dairy exorcism for about six weeks and note if any symptoms vanish.

      I did and was off my puffers within weeks (the lactic acid may inflame the delicate air sacs in the lungs) and Fibromyalgia free. I did not eat/drink any dairy for 1.5 years, than at the suggestion of my Naturopath tried goat and sheep dairy products with no noticeable adverse effects.

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  32. Has anyone had Joint pain taking the B-12?..
    I know it is supposed to help with joint pain, but I have started having severe pain in my wrist and shoulders since starting the B-12 shots…

    • Yes, Vicki I had my first injection yesterday morning. I went to work but by the time I got home I had abdominal pain and severe joint pain. I have been trying to find out how long this will last and if this will always be the reaction I get.

      • I had my first injection this week and my arms ,shoulders and legs have been in pain . I am having 6 injections over this next two weeks and i cant wait to have more energy . I have to keep lying down as i feel so lathargic . Do u know when i will feel the benefit ?

        • Let me start out by saying that I am not a doctor. You should feel positive effects from a B12 injection almost immediately (within minutes). And I’ve just got to wonder why doctors prescribe B12 injections; oral B12 (preferably in methyl form if you can tolerate it) works just fine and costs much less than injections. Someone is paying after all (even if it isn’t you).

  33. interesting article … I was diagnosed with a low b12 level of 22 about a year ago … I got pretty sick like most folks who suffer from low levels, couldn’t stand, couldn’t walk, numb legs/feet, numb arms/hands, couldn’t eat and lost weight, lethargic and generally tired, really bad brain fogs, actually forgot which toothbrush was mine and also forgot my name … doctor was pretty shocked at the results … have monthly b12 shots [methyl] and have improved immensely … still have the odd down day, but largely feeling pretty good now … i’m a fairly active 55yo male
    I found using oral sprays and sub-lingual tablets actually seemed to make the brain fogs worse during the early days when I tried to supplement the injections … would this be because of the different type of b12 or just the timing was wrong?

  34. My sister is a gastric bypass patient (15 years) and is now suffering from severe peripheral neuropathy. She can hardly walk and is pretty much disabled. I keep telling the doctors she needs B12 as her body doesn’t absorb it. Finally after 9 months and 5 doctors, one of them finally diagnosed her with pernicious anemia. He says she should take B12 but didn’t order the injectable! How much should she take and for how long? I pray someone out there knows.

    • I started taking 2000mcg per day (1000mcg after waking and 1000mcd near bedtime) maybe 3 weeks ago and noticed cognitive improvements, improved energy, reduced anxiety and depression, improved mental focus, reduced irritability and anger. I read several articles saying to take somewhere around 1000-2000mcg per day so I decided on 2000mcg since my symptoms were severe and impacting my emotional and cognitive state that it was impacting my personal life and work.

    • I take all of my B12 after breakfast. I take 400mcg of folate and 4000mcg of methylcobalamin and 4000mcg of adenosylcobalamin. The folate I just swallow, the 2 forms of B12 I take as sublingual tablets; I place them along my gum line on both sides of my lower jaw between my gums and cheek, and let them dissolve until they are gone, it takes a little over an hour. This works for me. The methylB12 I use is Enzymatic Therapy B12 Infusion off Amazon.

      • Molly could you explain to me why you take two types of B-12. And what does the folate do?
        I take methylcobalmin lozenges and Methy B-12 shots, But if I can improve on that I would like too

        • I use Dibencozide, by Source Naturals. I read that adenosylcobalamin is preferred by the mitochondria, so I use both forms. I use half a tablet per day because the dose is nice and high at 8.6mg.

          Just so you know, I am still working on my low B12 issues, they are not fully resolved. I hope they will be, but I don’t know; they are at least improved so it’s possible that I need more than I am taking.

        • Ack, I forgot to add this, it’s from another commenter here, John Macgregor:
          “…methyl & adenosyl B12 are crucial to the methylation system, but often can’t work well without cofactors such as each other, & methylfolate & carnitine (which crank up ATP).”
          Adenosylcobalamin Catalyzes Nitrous Oxide

          Another good reason to use adoB12 with (simultaneously) methylB12.
          Best wishes to all in their healing journey.

  35. Great article! As I was reading, a pop-up displayed offering a free eBook on Vitamin B12 deficiency. I clicked on it, but got the message the page wouldn’t display. I’ve tried several times, even shutting down my computer and starting it again, and I get the same thing. Is the link broken?

  36. Hello Team,.

    I have bee facing extreme fatigue and great pain in my legs and thigh since three months but this problem was started 2 years back and I didn’t realize this would be very dangerous.

    A month back I went to the doctor and after doing whole blood check we found B12 (104) and D3 (19) deficiency . I am taking methylcobalamin 1500mcg with mulivitamins since one month but getting no benefits.

    I have few questions from the experts:
    -Should I take injection instead of tablet as I am having IBS that may be causing medicine to not go in to the blood strem ?
    -How much time would it take to recover extreme pain from legs and thigh ?
    -Is there any nerve damage in my case as I am afraid after reading information about b12 deficency ?

    Asif Khan

    • 1500 mcg is nothing when you are deficient. If unable to get shots you should try megadosing with 5,000 mcg SUBLINGUAL tablets. When I first started self treating, I started at 60 tablets a day which matches two shots a week-loading doses are necessary to start out. After a month or so, I brought that dosage down to 30 a day, after another month or so down to 15, and I am now taking 6-7 per day which if you put it on a conversion chart, matches a shot a month. I went from extreme fatigue, brain fog/dementia/ neuropathy etc, etc. to being extremely healthy and feeling fantastic. The difference is incredible. The first day that I figured out what to do, after getting no help from doctors, I dissolved 5 sublingual (under the tongue) tablets at 5,000 mcg every hour, and the fifth hour (25 tablets later) I stood straight up, woke up, felt normal-no brain fog, pain or headaches-for the first time in months, I felt like me again…Hope this helps you…

      • Hi Kymm,

        I have 10,000 mcg methyl b12 coming in today to start taking, I am beyond excited, hoping that I will have the same results as many of you. I am not sure how many tablets to take in the beginning though…were you taking 60 of the 5,000 mcg?

        • Hi, yes I was taking 60 at 5,000 mcg, sublingually: 5 under my tongue every hour for 12 hours a day. You may want to start lower at first and increase as needed. I was pretty bad off at the time, I’m not sure what your symptoms are/how deficient you are. I could barely stand, stay awake, etc., etc. Maybe try 2 or 3 per hour at first and see how you feel by end of day. You have to play with the dosage to see what works for you. Keep me posted if you will. I sure hope this helps. If you are deficient, it certainly should!

          • PLEASE PLEASE PLEASE DO NOT ‘MEGADOSE’ on vitamin B12. If you have a balanced diet you will be sufficient for vitamin b12 unless you have a malabsoprtion disease such as ceoliacs.

            You can overdose on vitamin B12. Also keep in mind you have stores of B12 that will last you three years as it is essential for life…you wouldn’t last very long if you were completely deficient as your blood cells REQUIRE it to form and survive properly.


            FYI: For older children and adults, the ideal vitamin B12 dosage should be 2.4 mcg DAILY.

            • The vitamin B12 is water soluble. Excess is excreted in urine. This article is accurate. Biochemist Clinical is not accurate.

                • B12 is also stored in the liver, and if you are not replete, most of the B12 will be stored there. A bit different than most B vitamins.

              • Biochemist Clinical, why are you ignoring the fact that Nitrous oxide anaesthesia can impair cellular absorption of b12? Staff in OR and Dentistry inhaling vagabond nitrous can/may suffer from impaired cellular absorption. Patients who have had multiple surgeries, births, dental work OR recreational users may/can suffer impairment.

    • I found I was deficient for B12, and I started taking 5mg twice per day for a month, and now I take 1mg. I also started taking D3 since I was deficient for that vitamin as well; I take 5,000iu per day. Both levels are now OK (though it took a while for D to get to a good level).

    • Magnesium helps me significantly with my joint pain. When I don’t take it, I can really tell. Magnesium Citrate is most easily absorbed, but be care with your IBS as it can have laxative effects.

      • If you take the Magnesium L-Threonate, it is the most absorbable and does not affect the IBS at all. carries it.

      • Andrea: B12 helped alleviate my hip and shoulder pain. Apparently the Bursa sacs are dependant on good b12 levels. I thought I was headed for hip replacement and am now pain free. It was even hard to turn in bed or get out of bed because of the hip and opposite shoulder acting up.
        I carry magnesium to relieve leg cramping and chest pain which was used in ER pre the introduction of Nitro. It is also used by IV for severe asthma attacks. It is a muscle relaxant. My leg cramping has diminished greatly since i started supplementing with Ribose recently.

    • I have been told i must take an oral spray under the tongue as I’m not absorbing b12 with diet so taking a vitamin tablet is a waste and i found some good oral b12 sprays on iherb and am waiting for my order.

      • B12 is a large molecule, and I doubt it’s possible to absorb it sublingually. You probably end up just absorbing it through the digestive tract. With high dose oral forms, enough B12 gets absorbed through your digestive tract via diffusion even if your stomach doesn’t produce enough acid or intrinsic factor. For this to work though, you need to use the methyl form (disclaimer: I am not a doctor).

        • Yes, it is a large molecule, but the people on the Phoenixrising site would heartily disagree with you. Take a look, not all sublingual supplements work, but Freddd in particular has tested many out and found some that work very well.

  37. Why are doctors reluctant to treat vitamin b12 deficiency? I have celiac disease and even though I follow a strict GF diet I have had consistently low vitamin b12, D and iron levels. My b12 was recently at 70 and vitamin d was at 48 I was getting heart palpitations and felt awful. When I asked the doctor if it could be my low vitamin levels he said no and told me I just must be stressed. I said I did. It feel a great deal of stress. He sent me for an EKG, stress test, and several other tests but was so dismissive of something that is simple and inexpensive to treat. B12 has also been something that I have responded well to in the past. I then was able to get a few B12 injections and things have improved significantly. I just don’t understand why they don’t treat something so simple.

    • Jill, the American Medical Association (in the past, not sure if the teaching has changed) labelled Vitamin Therapy as Medical Heresy. Dr. Russel Blaylock who treated babies suffering Infantile Apnea (often resulting in crib death) with mega doses of B1 was threatened to have his medical license revoked. That motivated the beginning of the Integrative Medicine Group.

      Ref: [PDF]
      Is There a Conspiracy? –
      by A Hoffer – Related articles
      root out these heretics because they and their principles have … activity of the American Medical Association in trying to destroy … critiques of vitamin therapy appeared. They were ….. They were incensed by a report I had published called.

      Blaylock has called the American medical system ‘collectivist’ and has …. naturopathy, vitamin therapy, alternative cancer and arthritis treatments and even books … Beasley’s Betrayal of Health, Mendelsohn’s Confessions of a Medical Heretic, …

      Diseases caused by medical treatment are called iatrogenic diseases. …. Dr Weston Price (19), a former Director of Research for the American Dental Association, observed that …. by greatly increasing our levels of vitamin D with suitable foods, supplements, and …. (2) Mendelsohn, R.S. Confessions of a Medical Heretic.

  38. I suffered terrible dysphagia (difficulty swallowing) for two years and also bursitis (inflammation of my hip) for seven years, after stumbling on an old B12 protocol devised by a doctor in the 1950’s I eventually managed to convince my doctor to give me an injection. The next day I could swallow normally for the first time in two years and my hip got a little better, I was not able to convince my doctor to give me more than a second shot, so I had to come up with a new plan. The information I found here on Chris’ site was phenomenal and as a result of the complete resolution of both of these health issues I started blogging in the hope that others with dysphagia and/or bursitis could find this awesome information and heal themselves too. Chris is right sublingual methylated B12 is the way forward and much better than the injections anyway, if anyone had told me before that a simple deficiency like B12 could have the impact it had on my life and that I could completely get my life back through just adding this mighty supplement, I would have thought them mad. But its true! All the best to others on this journey who have found Chris and his awesome information.

    • Di, Thank you for mentioning the difficulty swallowing. That was happening to me lately which was worrisome as i was exposed to Neurotoxins. I also thought i was headed for a hip replacement with shoulder symptoms also. My brother suggested i increase my b12 intake as the Bursa sacs are dependant on b12, and all the pains issues vanished in my hip and shoulder. Will monitor for the swallowing issue.

  39. I was diagnosed with paranoid delusion , depression ocd and was on antiphyscotic. Seeing this my doctor suggested for b12 and d Vitamin test serum. Which turned out to be 105 and 10 respectively. It took nearly 20 years for me to figure out the problem. In the year 2014 I started taking b12 and d supplements which almost success rate of 99%. Now my b12. Level is 1850 and d is sufficient. This makes me very happy and I am pink in my health.

    • Hi, my husband has the same as May described, but he has them every two weeks. He had bariatric surgery long time ago, but discontinued to take big vitamins, prescribed for that. He has B12 injection every month. So is that a possibility, that he is normal two weeks after the injection, and kind of confused, euphoric, irritable, the other two weeks, when B12 is less in his blood. Please, what do you think? We are going through such circles for two years. I was thinking that it was Gabapentin, he had for pain in the back, he discontinued, but his symptom returned in two weeks, I thought adverse effect of Oxycodone, also I made him stop it, but it did not work. Today I found this discussion and I think maybe my husband needs more B12, since he can absorb it? His symptoms are euphoric, too full of energy, sometimes angry, paranoid, psychotic, annoying, he has red eyes, scratch himself all the time, can’t sleep in the night, cough a lot only on these days, eats too much, but in three days he will fall asleep and almost will not eat . I don’t know what to do, please help me!

      • I feel for your husband Angela. He is struggling big time and it is also very difficult for you too. I have read about difficulties for people after the surgery to absorb nutrition so his issue may not be just B12. Here is a medical article concerning B12 deficiency after bariatric surgery

        I wonder though he may be deficient in other nutrients too. I think a physician that can take a holistic view of his health is advisable. Depending on his age maybe but I’m no expert he might need many nutrients such as

        I like Thorne’s products because they typically use natural forms of nutrients rather than synthetic which may be better for absorption and more gentle on his body.

      • If he wanted to get a constant dosing of B12, with a steadier delivery, and near-maximum uptake, he could try the transdermal B12 oils developed in Australia:

        (I am a customer, but have no financial interest in the company.)

        Sublingual tablets yield about 5% uptake, oral (swallowed) 1% – but the transdermal oils yield about 80%.

  40. Hi,

    I am 28 years old and I’ve been a vegetarian since the past 22 years.
    The symptoms are pretty much similar to what is covered in the above article.
    My current d3 level is 4.83 ng/mL and b12 level is 134 pg/m
    The physician has prescribed 3 injections of D3 and B12 every 10 days for a month. I have taken 2 already but dont see much improvement.
    I am ok turning into a non-veg and plan to start with Tuna fish which has 2.5μg of B12 normal daily intake being 2.4μg
    I am keen to know how much time would it take for recovery with the activation of Tuna in my daily diet?

    • Diet has little to do with it, even though he said vegetarians are most at risk. If less than 1% of the population follow a vegan diet, then why are 40% are sub-optimal levels? Again, best way to get your b12 is through supplementation or b12 shots. I found Jarrow methyl b12, 1000 mcg online for very cheap.

      Same is true for vitamin D, unless you live in a warm, sunny climate. Still, how well your body absorbs it is another issue. Always test annually for these and supplement if needed.

    • A suggestion- find out if the injection of B12 you are getting is the methylcoblin form, rather than the cheaper, synthetic cyanocobalamin form. Your body has to covert cyano into the methyl form. Some people, like me can’t metabolize the cyanocobalamin form. If your doctor is using cyan, ask if he will switch to the methylcobalamin form…

        • You ask your Dr. to switch you and see if there are almost immediate noticeable improvements. That’s the easy, quick way. Apparently thete are also tests to check, but I forgot what they are, and good luck talking doctors into doing specific tests anyway, at least that’s an issue where I live!

      • I finally convinced my dads doctor to give him some B12 jabs, 5 injections over 2 weeks then once every three months.
        I asked dad to check which B12 they were using in the injection, the nurse had no idea!!! She apparently looked on her screen and couldn’t tell which one it was!! Is this possible!??
        He has had no improvement after the first 3 injections yet, suffering with deep depression, anxiety, insomnia and panic so having to do everything immediately to get it done and out of the way (even eating a meal in a pub!)
        Should he have seen any improvement yet with a blood result of 400 before the injections were started or should I try to get another B12 type injected instead to try to help

    • I have been taking 5000mcg per day, and firemen exposed to toxic smoke take this amount twice in a 20 minute period with no ill effects. There are no reported cases of over dose of B12.

  41. Sometime, last year, I think, I asked for help because I had mucous that would trap food. Someone said his wife suffered from this, and was helped by apple cider vinegar. It did help, but I could not stick with it. I then had a very embarrassing episode at a family function, after which, I mentioned the food getting stuck to another doctor, and he tested me for thyroid problems. I was HYPERTHYROID! Since taking my thyroid meds, I am not nearly as mucousy, and food doesn’t fight with me because I want it to stay in, but it wants out!

    I couldn’t find the original entry here, but I wanted to give that guy and his wife, and anyone else with that problem a heads up — have your thyroid checked.

    • Hi there,

      I have been having this mucous issue for almost 2 years. My TSH has been around .4 but my doctors say it is fine because it’s at low end of range, even though I have all hyperthyroid symptoms. What was your TSH? Can you tell me which medication you are taking for this so that I can push the issue with them or a new doctor and hopefully get some relief? Any other advice would be appreciated. Thank you!!

      • Hi, this sounds crazy but I have been on synthroid since having my thyroid removed. I have felt terrible for years and told my doctor the meds must not be working but like you I was told the test showed my levels were good!
        My condition declined to the point that I couldn’t walk, had trouble breathing and didn’t have the energy to get out of bed and my memory was pathetic. I was so worn down and weak that I ended up in bed for at least 18 hours a day.
        Finally a new doctor checked my B12 because I had symptoms of Rheumatoid Arthritis, heart problems and nerve damage.
        B12 anemia was the cause of everything! Get your levels checked……feel better!

  42. Hi!

    Does it actually work if you take ONLY Methylcobalamin to treat b12 deficiency or do you also need other forms like adenosylcobalamin (or can Methylcobalamin get converted into adenosylcobalamin)?
    And if you corrected high MMA and homocystein via Methylcobalamin is then a potential adenosylcobalamin deficiency ruled out?

    thank you

  43. Hi Chris,
    I was identified with GERD (Grade A) in August 2015. My Gastro prescribed PPI for 8 weeks but I didn’t take the same. Thanks to your articles !!

    Been on Ayurvedic medication since then. The heartburn has been under control but I lost almost 14 kg in last 8 months. in fact last 6 weeks I am experiencing high levels of fatigue. I checked out the Vitamin D and B12. My results shows Vitamin D levels as 19 and B12 as 268. The endocrinologist who checked my results told me to take B12 shots and Vitamin D3 (60000 IU every week). I heard Vitamin D can aggravate the heart burn. Please advise if I can take B12 and vitamin D shots same week? will it aggravate the reflux.

    Thanks for your time.

      • Hi Ann,
        Thanks for the reply.
        In fact my gastroenterologist has done a Serum TSH (ECLIA) to figure out symptoms of a thyroid disorder. The result was normal (1.580 micIU/mLa).
        In fact later my endocrinologist has done a Plasma Cortisol, which looks like within normal range (442 nmo1/L).

    • Also, was Heartburn your GERD complaint to begin with, or was it something else? For example, I had a cough, and without testing anything, the doctor prescribed 2 kinds of acid reducers. In a way it was good, because it led me to discover my pre-existing B12 deficiency, but the lack of testing was ridiculous, and the reason for my cough was the Amlodipine I was taking for my high blood pressure. I am very suspicious of all these GERD pills they hand out like candy now.

      FYI, if I can, any pills that gives me heartburn, I take with milk. D3 used to make me feel terrible until I started taking Vitafusion gummies. My practically negative D level is now excellent.

    • Hello Faizel,
      I take daily: 10,000IU vitamin D3 along with 6mg (that’s 6,000mcg) B12 tablets dissolved over an hour along the gum line – no problems at all for me, but I don’t have any heartburn issues.
      Sometimes the best we can do is experiment and find out what works for us after learning all that we can about our issue(s). Best of luck.

          • Thanks Daniel, I didn’t see this until just now.

            Erika, here’s the math:
            1mg = 1,000mcg = 1,000µg(for physicists and chemists)
            Therefore, 6mg = 6,000mcg.

            It is correct, but I’m glad you checked it for me, even scientists and mathematicians make mistakes, especially with brain fog!

  44. Yes, vegetarians suffer from decreased cognitive ability. Albert Einstein, Nikola Tesla, Leonardo Da Vinci, Socrates were obviously all suffering from decreased mental capacity. This article is anti-vegetarian propaganda. Granted we need B-12 more than average, there are many other sources it can be obtained from. I feel sorry for anyone who allows themselves to become fearful based on this mis-information.

    • First of all, vegetarianism is hardly the focus of this article. “anti-vegetarian propaganda”???

      Secondly, if you are so sensitive, why are you on Chris Kresser’s website?

    • The author actually never mentions in his article that one should not be vegetarian. All he says is that if you are, then you should supplement with B12. They only thing he refuted is the myth that you can get it from plant foods. So if you have any concern get tested, as he recommends, and see if you are deficient. If you’re vegetarian and you’re not deficient then fine but if you are then supplement. How is this anti-vegetarian?

    • I have been vegan for the last three years. Seemingly, very healthy and eating all the right things. However, I have managed to become severely deficient in B12. Although veganism is not the only cause by a long shot – I know it has not helped my condition and made it much worse. I have unknowingly become more tired, weak and worn out over the last few years. I thought I had ME. Been to doctor a few times and they tested me but all came back normal and they kept telling me to take antidressants as they thought it was all symptoms of depression. I knew it wasn’t, but finally took action to get some private bloodwork done to find that my B12 level was 140! No wonder I have felt so rubbish over the last few years. Wish I had found out sooner as I thought I was going to be like this for the rest of my life. My GP for some reason decides not to test for this. I am now waiting to see how my body responds to the high dose B12 I am now taking.

      • Hi Joseph,

        What’s the dose of B12 you are now taking? What form is it in. There are guidelines for supplementation doctors are now supposed to follow in the US and the UK if a patient even just shows signs of B12 deficiency; however, most of them never even heard of B12, kit seems. The Pernicious Anemia Society probably have links. You could then print them out to show your doctor.

    • Ian,

      Everyone needs more B12 than average. Though there are B12 vitamins that are made from non-animal sources, there are hardly many sources of B12. If you are privy to such sources, how about being specific.

      Eat meat or don’t, but don’t make vague statements. Being B12 deficient has really taken a toll on me. I did not know I was deficient until everything started going…I could not think, remember anything, walk without sever pain, or see straight. I could not walk without bumping into walls and felt dizzy all the time. Now I have uncontrolled blood pressure, asthma and a hyperactive thyroid, and I wonder if it is because of being low on B12 for years. It’s real, not propaganda.

  45. I notice from my recent testing that B12 is now being measured in total and ACTIVE form. If my TOTAL B12 is very low but ACTIVe B12c is low-normal, what is that telling me? I’m totally confused but I definitely am suffering from several symptoms of deficiency.

  46. Red Star nutritional yeast T-6635 is a Vegan source of B12, 1 Tablespoon supplies the adult RDA. I have been Vegan for 11 years, and DO NOT have a deficiency. This makes me wonder about the data presented.

    • It’s great that the nutritional yeast works for you. That may be an excellent choice, and much less expensive, I might add. Yeast, however, can be allergenic for people with mold sensitivities. Also, some people with gut problems are quite sensitive to yeast products. My allergies to mold and yeast came well before the low b12. As healthy as yeast products are for many people, I wouldn’t take a chance. The methyl B12 shots work for me.

    • Hm, I have to agree with you here. I was intrigued by the info until I read that, which I happen to know is not true. Is it that I am learning new things from this article, or learning fake things?

      Please, not trying to be a hard time and correct me if I am wrong, but I believe that the reason animal products have B12, is because they eat grass and soil contaminated with the micro organisms.. So vegans can also get from the same sources, but not already digested once over…

    • Stephen,

      The USRDA for B12 would not keep a flea alive. If vegan and yeast work for you, that’s great, but I also find stories all over the place of vegans that had to return to meat for health reasons. For me, I have to take 15,000 mcg just to keep most of my symptoms at bay. The FDA recommends 2.5 mcg.

      There are a few B12 supplements, though, that say that they are good for vegans (because of not using animal sources, not just because vegans should supplement B12), so vegans should look around.

  47. I am in early 30’s & having B12 deficiency, lots of relief after started taking needles or methylcobalamin supplements. It took 7 years for me to figure out the root cause for daily suffering. From few years I am pushing hardly to fullfil daily activities.The symptoms are crystal clear, pains all over body, fatigue, needles pains, sometimes headaches, mucus filled throat, gut problems. when you woke up & get ready to go work you feel very tired & will push yourself. slowly the day will be better & again feel fatigue from evenings. I feel light headed ,no more body pains feeling lot better now. Symptoms mimic lots of other dangerous diseases which you feel like you have all of them when you google them & ask doctor to do all those tests. All results will get normal as usual at this young age. but still suffering will be there. It seems like a growing problem.

    • Hi you sound like me I to have suffered from b12 deficiency all my life and had injections in the past but I would like to know what the count should be as I have just been to my doctor and she wouldn’t do the blood test as the last time I had a test was last year sometime so I am going to ask her for a print out so I will know if it’s low or not and if it’s only a little bit down it still makes a big difference on how you feel they don’t seem to understand this so please can you help me thank you

  48. My 2 year old boy has about 1500 b12 and 56 vit d…I am really worried.Should he eat less meat and more greens?Is too much meat elevating b12 levels?

  49. I was diagnosed with low b12. I started to have vold sensations in my legs, i had nentioned to my gp pteviously that i could become very tired. I have been diagnosed with IBS msny years ago and had two premature borths. Any way i came down with a cold and had balance problems, flushes, sinus, blinding headaches. My b12 was low so im having 2weeks of injections but further tests have indicated that the intrinsic tests have come back normal. My level for b12 is 161 which apparentlyis to low. Im struggling tp go to work, concentrate, im feeling extremely tired, emotional. Really fed up as whatever it is its effecting me and i just dont feel normal. Im worried now that further tests are normal they will not treat the b12. Any advice would be great.

  50. I was diagnosed with B12 deficiency in June when I was feeling dizzy and had the tremors. I have come to realise I have a lot of neurological symptoms that can be due to B12 def. I tested negative for the antibodies that affect intrinsic factor so the GP said not classic PA. I was put on the loading doses for 2 weeks then told I will get a blood test at Christmas. I went back as my neuro symptoms were getting worse. I was then offered 2 monthly injections after a further 3 weeks of loading doses. The haematologist told the GP that any symptoms remaining at the end of 3 weeks were not due to PA. My symptoms are still bad and worsen each day but the GP will not give me any frequently than every 2 months. I wrote to the practice manager stating my treatment needed changing and the GP then referred me to the haematologist (still waiting for that appointment). Seen the gastro today and he said my vit D levels were good despite the GP saying they were very low and I need vit D tablets for life. He said my b12 levels (133) were not low enough to produce symptoms. He said my def could be due to Crohns but did not want to do a colonoscopy. I told him to do the calprotectin stool tests and he did agree to that. I also asked for the breath test to check for H pylori but he said there is no link to B12 deficiency. I am worried that I will not be able to do the career I am training for in the future (midwife). I am being fobbed off by every medical professional I see. The lack of knowledge and the refusal to provide adequate treatment scares me. I do not know how to get the right treatment. Occupational health wanted 6 weekly blood tests to keep an eye on my levels and see if working near entonox affects my levels but the GP has refused to do it (despite agreeing at first). I feel if it is left to the heath professionals I could end up disabled.

    • My podiatrist tested my feet when I visited for a routine check on my plantar fasciitis. She was horrified the GP has not referred me for a spinal check. She said I am unable to detect temperature change on my feet. If it gets worse I am to go back to her as an emergency and she will carry out the tests again and write to my GP.

    • SLEEPYPUSS – Read Could It Be B12 by Sally Pachlok (excerpts on Amazon). Sally also features with her husband in a fantastic You Tube video – Diagnosing and Treating Vitamin B12 Deficiency which will set you on the right path straight away.

  51. I’ve struggled with undiagnosed b12 deficiency in the past. I had severe nerve conduction problem for about a year that got progressively worse several years ago. All the doctors I went to couldn’t figure it out despite me telling them I had a history of nerve problems, didn’t eat red meat and was into endurance exercise… all that sweating of course washing out my already meager stores of water soluble B vitamins.

    Finally I woke up one day without a voice! My vocal cord had become paralyzed! I’d read that its roughly the same nerve branch that gets affected in Bell’s Palsy. Some studies show that B12 injections speed recovery of Bell’s. The ear, nose and thoat guy who was treating me for Idiopathic paralysis of the vocal cord refused to give me B12 so I found a doctor who gave me a bottle of Methylcobalamin and some needles. I was injecting myself once a week during the vocal therapy I was prescribed. Suddenly the vocal cord started to wake up. According to the first doctor I was the speediest recovery of paralysis he’d ever had. It still was 8 weeks with no voice!

    The profound B12 deficiency was not only caused by the fact I ate no red meat but that I also have the gene variations that make it difficult to absorb B12 it turns out. The final key to this sudden B12 crisis was a stool test showing that I was creating anti-bodies to gluten and that I had stomach inflammation that had progressed to leaky gut. I was deficient in B vitamins and magnesium… both are common deficiencies when food allergies are involved.

    I now take the stool test every couple of years to check on the condition of my stomach and bacterial ecology. I need to eat gluten for a few days before the test to get the antibodies on alert. I started eating gluten last week because I’m going to test soon but I actually extended my gluten eating for for over a week because I miss all these foods so much. Key lime pie and bread at Joe’s Stone crab in Miami! I’ve paid for it though! I immediately started to get lots of mucus and a need to clear my throat often… no big deal. Then I started to get a mouth full of canker sores. Very small but irritating sores that I think probably extended down my digestive tract in response to being exposed to gluten. I choked on and spit out water while taking a drink twice because of my vocal cords allowing water into my lungs. Then I started to get hoarse and could tell that I’d lost part of my upper vocal range! I’d been though this before so I know what’s happening to me.

    That scared me enough to run and get a B12 injection at the doctor since I no longer inject myself. As I was paying the $15 and thinking about traffic on the way home I suddenly got a cramp in my vocal cords and as I stood there the pain moved down my esophagus to my sternum. I almost stayed there at the doctor to see how bad the pain would get but I felt a release of the cramped muscles after about 15 minutes or so. Within a hour my vocal range started to come back too. A few hours later I felt a burning in the muscle in my back that is still mildly atrophied from previous nerve conduction problems I experienced. So there it is… I must have been heading into another deficiency crisis brought on by introducing gluten back into my diet and not keeping up with the B12 supplementation.

    I’m just posting this because I didn’t find a lot of help with my vocal paralysis issues on the internet. I just want to say that my vocal paralysis is absolutely the result of B12 deficiency and MY vocal cords and the nerves that control them are very, very sensitive to B12 levels. I do not believe that it is a rare as the study below would have you believe. If you have a weak voice with excessive need to clear your throat then I suggest methylcobalamin B12 injections or 5000mcg sub-linguals. The results for me are almost immediate in the strength of my vocal cords.

    Vitamin B₁₂ deficiency: an unusual cause of vocal fold palsy

    To our knowledge, this is the first reported case of unilateral vocal fold palsy secondary to vitamin B12 deficiency. Central and peripheral neuropathies have been described; however, other than the optic nerve, the cranial nerves are very rarely affected. It is important to consider vitamin B12 deficiency as a cause, as speedy identification and treatment can help prevent permanent neurological damage.

    • Thank you for this, I do have a weak voice, and I clear it all the time just in order to speak, and yes, I am B12 deficient but it is not as simple a fix as I would like, I suffer from chronic fatigue as well – likely a methylation issue.
      I take B12 sublingually as 2000mcg methylcobalamin and 2500mcg adenosylcobalamin, along with a b-complex that contains 800mcg folate. It helps, but it is not a cure, I have slowed the degenerative spiral downward, but have neither stopped nor reversed it. I am still working on it.
      Thank you for this invaluable comment, I had no idea voice could be another symptom! I too have lost my voice, due to stress, for 3-4 days each time, but it returned on its own. Good thing because I knew nothing about this.
      Thank you, thank you, thank you!

    • I haven’t heard that, but I try my best to avoid artificial sweeteners. As far as I am concerned, they are poison. Check out “A Poisoned World” for the story of aspartame. I streamed it on Netflix, but I don’t know if it still available there. I personally had problems with sucralose. I used to eat these liquid filled mints — I haven’t seen them in years now — and I noticed that I was jittery and paranoid. I stopped eating them, and I was o.k.. I started to eat them again, jittery and paranoid.

      The problem is that they sneek artificial sweeteners into EVERYTHING now.

    • Methyl folate and some form of B12 other than cyanocobalamin. And make sure you are supporting all of the other b-vitamins. And be careful with dosages of methyl folate and methyl b12; some people are very sensitive.

  52. I was wondering if someone could help me. I was affected by B12-deficiency when i was a teenager. Due to age prejudice doctors didn’t diagnose this until I was 18. By that time I was always tired and didn’t do anything except sleep and torturing myself to go to school. I had problems communicating myself because I couldn’t remember the right words and my longterm and shortterm memory was a mess. Before that I was an excellent student and I always loved studying and i am very ambitious. I’m 23 now and i have gotten shots regularly since then and yet my memory and ability to communicate myself hasn’t gotten to the level that is was before the symptoms begun. Now I am very aware that I am a very slow learner and it doesnt matter how much i concentrate or try my memory is very bad and I still mess up words when i’m speaking. It makes me really sad because i wanted to go to university and i had it all planned but I know that I am not capable of what they expect from us. I suspect some sort of neurodamage due to the b12 deficiency but the doctors say its unlikely. I ask, is it really that unlikely and what can I do ? Is it possible to find it out if there is damage ? I just want them to aknowledge their mistake if that is the case.

    • Have you been tested for heavy metal toxicity? I urge you to find a practitioner whose niche/speciality is heavy metals and chelation. You would be surprised how many of your symptoms are because of heavy metals. Heavy metals also displace minerals in the body and can contribute to health issues that way as well.

    • I am a 52 year old women with Pernicious anemia and have been taking B-12 shots since I was 40 years old I got admitted to the hospital This is when I found out I had no B-12 at all I have been taking the shot every 3 weeks since. I have trouble saying things sometimes like for instance Go get the pan off the table when I mean stove I turn my my words around an I realize I have said what I say after I do it but sometimes it just comes out wrong I to find it hard sometimes to talk to people because you just don’t know when im going to twist my words It doesn’t happen a lot but enough to notice I find it happens more when my B- 12 is low I get sleepy a lot even with the shot and get mood swings Now about your education Go part time and take extra time to study lots of schools have tutors

      • Teresa, you are the first person I have come across that does the EXACT same thing as I do with my words!!! I am a 47 year old woman and have been dealing with this for more than 4 years now. I just had a metobolic panel done including B12. This is the first time my Dr. has ever checked my B12 levels. They came back at 133, which according to the chart shows very low. She recommended I take 1000mg of B12. Can you tell me whether taking the B12 shots have helped your word finding/ saying the wrong thing (as I call it)?

        • I did the same word mix-up routine. I had never ever had problems like that before. Sometimes I couldn’t come up with the right word so I would describe the missing word….and that can sound really weird! At my age I worried people would think my brain was declining. The methyl B12 shots have helped me and I think I can feel it when they wear off. Right now I get one shot a week. The word mix-ups are about 90% gone now. I hope this helps. One more thing. I see a Functional Medicine nurse practitioner and she is very knowledgeable about B12 and other supplements.

    • Vigdis, please do not make the truly fatal error of assuming that you have been damaged for life because if you do you may make it a self fulfilling prophecy. Learn as much as you can about optimising your methylation and consider going on a very healthy nutritional ketogenic diet. If you enter into a healthy state of ketosis I expect that you will discover that your brain is quite fine. The best way to do this will be to get some guidance from a doctor who fully understands the principals of a ketogenic diet. You can try do it alone but you then run the risk of assuming that you are permanently damaged if you do not get it right. (I hope you get your life back very soon!)

    • Hi Vigdis,

      The idea of checking for heavy metals is a good one. If you have fillings that contain mercury, that could be it.

      What kind of B12 is in the shot? Does it contain preservatives? People here have talked about the different kinds of B12, so read all the posts.

      Take Magnesium, D3 and B2.

      Have your thyroid checked. Thyroid can affect memory, and it is a problem with people with B12 deficiency.

      You’ll find that once you have B12 deficiency, your body is kind of like an old house — you fix the roof, and the plumbing goes, you fix the plumbing, and the plaster starts crumbling. So don’t be surprised if you have years of doctor visits ahead of you. You will eventually reach a point where you say to yourself, “You know, I still feel rotton, and yet I’m feeling pretty good.”

      Good luck, and let us know what happens.

      • I a going through everything that you stated, and although I am 63, I have had iron deficiency and low B 12 since I was young. I never took it as anything ore than, ( oh I just need to ear a few more vegetables) it is not serious,but I am dilibated this time, with not being able to stay awKe, or even and sturdy o y feet.. I have gained weight and I feel worse Thani have come during much more seriousilless’ ..please aside from the pills twice daily , is there anything else I can do to speed up the healing. Devastatingly tired out?

        • Hi Brenda,

          I don’t know if you will be reading this…

          but I was recently introduced to a new supplement unlike any other on the planet. It is called, ASEA. It is said to increase “redox signaling” in our bodies(a much needed function for every function in our bodies). It also is said to increase our glutathione by up to 500%. Glutathione is so very important. It is a major antioxidant and there are many studies that support it as a detoxifier and healer in our bodies.

          If you are interested in learning more, you can go to

          Since I have been taking it(about 6 oz per day), my energy is much better.. and I mean MUCH better.

          I also have started taking Stem Worx.. available on This product, too, has had remarkable results and I have only started taking it a week or so ago. It stimulates our own stem cells. That too has increased my energy.

          Before taking these 2 supplements, my energy was quite low and I was taking numerous other supplements. I am pretty good at research and believe that the supplements I was taking prior to the 2 mentioned above, were pretty good..quality-wise.

          Anyway, we are all different, however, we all have redox signaling molecules in our bodies. Every cell function requires them. However, they lessen by 10% every 10 years after age 30.

          “A balanced Redox potential in the tissues increases the efficiency at which oxygen, fuels and wastes can be transferred in and out of the cells and tissues, making the natural aerobic processes more efficient. If aerobic capacities are increased, then the natural length of time that aerobic activity can be sustained under high energy demands is also increased.” (Special Report: Redox Signaling Molecules” Optimizing Your Cells To Stay Healthier, Younger, Longer”)

          There is a lot of science behind the importance of well-functioning Redox Molecules. All I know is I feel a lot better.

          I have a doctor friend who was tested using dark field microscopy before and after taking ASEA. This is a post I wrote on youtube about her experience with ASEA:

          I have a friend who came over on May 6, 2016 to tell me his daughter’s (to whom I also know), along with her boyfriend’s, experience with Dark Field Microscopy and ASEA.

          She is a doctor of Chinese Medicine and Acupuncture. He told me that she was introduced to ASEA by a health professional contact of hers. At first, she had her doubts about the product.. and wanted to be certain that it would work for not only her patients, but also for herself.. due to Lyme Disease.

          So, she called a friend who is an MD who also does Dark Field Microscopy and made an appointment. She and her boyfriend intentionally did not try any ASEA beforehand. When she arrived to her MD friend’s she and her boyfriend’s saliva and blood were both tested. The results for the boyfriend showed numerous parasites.. including liver flukes. As it was told to me by her father.. “he was loaded”.

          For her, the test results showed up spirochetes and numerous co-infections (she has been very ill for the past 3 years). The test also showed she had no white blood cells.

          After they were tested, they each drank ASEA. Being that she is so ill, she only tried a quarter dose (1/2 ounce) of ASEA, whereas her boyfriend drank 2 ounces.

          They each were retested (20 minutes later). The results were astounding. Her boyfriend’s test showed him to be almost clear of the parasites and pathogens. For her, the results showed numerous white blood cells at work, whereas before taking ASEA it showed she had no white blood cells.

          All my best,

          All the above statements are not to be construed as a treatment nor cure for any disease condition or affliction.
          I am not a licensed medical health care provider.
          Always seek the advice of your physician or other qualified health care provider with any questions about your medical condition, especially before implementing any dietary changes or adding supplementation to your diet.
          Also, do not disregard professional medical advice or delay seeking advice or treatment based upon information gained above.
          All shared information are either from my own opinions, the opinions from others, from personal experience or experience by others and/or are based upon that which I have read from scientific studies, medical doctors, doctors of acupuncture, herbalists, nutritionists, homeopaths or other health care providers, and is provided to the best of my understanding, ability and recall.
          Any implementation or change in diet, exercise, supplementation, herbs, medications, medical care is done so at your sole risk and responsibility. These and any subsequent considerations in your health care should first be discussed with your medical doctor/provider.
          Consider all information gained here for educational purposes only.
          My licenses/degrees include:
          B.A. Fine Arts, English
          Masters in Education

          • Also, so what does this have to do with Vitamin B12?

            Before learning about ASEA & Stem Worx, I was studying Biomagnetismo(I highly recommend this healing modality). What I learned, from Dr. Goiz who developed this healing protocol, is that just about any disease you can think of is or can be caused by a pathogen(viruses, bacteria, fungus, parasites). I also learned that these pathogens can rob us of many vital nutrients, including B12… not to mention iron, manganese, magnesium, etc.

            To rid the pathogens is to rid many of our deficiencies as well.


            All the above statements are not to be construed as a treatment nor cure for any disease condition or affliction.
            I am not a licensed medical health care provider.
            Always seek the advice of your physician or other qualified health care provider with any questions about your medical condition, especially before implementing any dietary changes or adding supplementation to your diet.
            Also, do not disregard professional medical advice or delay seeking advice or treatment based upon information gained above.
            All shared information are either from my own opinions, the opinions from others, from personal experience or experience by others and/or are based upon that which I have read from scientific studies, medical doctors, doctors of acupuncture, herbalists, nutritionists, homeopaths or other health care providers, and is provided to the best of my understanding, ability and recall.
            Any implementation or change in diet, exercise, supplementation, herbs, medications, medical care is done so at your sole risk and responsibility. These and any subsequent considerations in your health care should first be discussed with your medical doctor/provider.
            Consider all information gained here for educational purposes only.

    • I am experiencing the same problem as V. I was already iron deficient but started experience b12 deficiency symptons at 20 ( 150) and was told its just bit on lower side.I couldn’t remember words, my short term memory was extremely bad and had balance problems. I used to have an extremely good memory and had a sharp brain. Now at age 26, have realized the severity. I got used to all the symptoms(tingling, forgetfulness) and couldn’t figure out what was wrong as my doctor said everything was fine.I can say that I feel very dumb and its taking toll on my life. I have been feeling emotionally numb for years and have no motivation to do anything( no hobbies and no desire to date). I just want to be how I used to be but I am afraid damage is permanent 🙁

      • Hi Menak

        I was also recently found with B12 deficiency (126). The constant fatigue, the memory loss, losing the words I want to speak out has also made me feel dumb and very emotional. I thought I was going crazy. I have since had to quit work as my performance and ability to deliver were affected. Even typing out this email is more challenging than before. Despite the injections my levels seem to be dropping to quickly once the injections stop. I dont know what else I can do to restore my life to normal. Your sharing does help though. You are not alone.

        • I could cry as all these symptoms are mine why are we ignored and if the doctor felt like we do sure would do something

        • Hi, what has worked for me for the last few months while trying to find a Dr./specialist who truly understands B12 deficiency is very high levels of sublingual METHYLcobalamin (5,000 mcg) tablets. I used to tske 60 a day, 5 under my tongue at a time every hour for 12 hours every day for a couple of months. I am now taking half that. I know it sounds excessive, but it has worked. I had to take matters into my own hands since doctors have not been helpful for me so far. Remember the shots are usually 1 ml. There are a million micrograms in a milileter. I checked in on a conversion chart in order to figure out how many to take. Expensive, obviously, but until a knowledgeable Dr. prescribes the shot, well desperate times call for desparate measures..I am back to myself again, and I had just about every symptom B12 deficiency comes with.

          • Kymm,

            Yikes! That is a lot! I know it’s sake and all, but don’t forget, your liver and kidneys have to deal with it, and they might not be too happy. Also, everything is really like a tangled bunch of strings in your body — you pull too much on one, ten more are pulled — so that amount might throw everything else out of whack.

            You don’t have to worry about converting all that tablet amount into shot amount. Remember, the shots go directly into your blood stream.

            • Oh, hi, Thanks for the reply. Yeah, the problem is getting a doctor to prescribe the shots, believe me I would prefer that! weight loss clinics do and I tried that, but I do not respond well to cyanocobalamin, which is what they use. My doctor okayed me taking 30 sublinguals a day, I asked her about shots, she said for now keep taking them and after more tests we’ll talk about it again…

    • Hello,
      Please research B1 and B2 deficiency, as these can be correlated to B12 deficiency. Also, nerves can take a long time to regenerate, so don’t give up and keep researching. (Phoenix Rising is a good site.)

  53. Hi There,
    Is there anyone who can help me out?
    I have a low b12level of 102 pmol/l. Normal range is between 130 and 700 pmol/l. I have been having symptoms for years (just never knew about b12, neither did my gp). So my levels must’ve been low during my pregnancy as well. My baby who is now 13 months old had a score of 240 on vit b12. I haven’t seen any symptoms yet which is a relief. Thankfully I only breastfed for a short period of time. But still I wonder what to do now. My gp doens’t know much about b12 she said and thinks this is a good score, because it lies in the normal range…So what would be best? I have read that it is good to supplement children but I don’t know what would be the best dose, because I read different things on that. Also, I read that even though you can’t have too much b12, it cán lead to an imbalance when it comes to other vitamins. I have read that potassium levels can drop once you take on high doses of vit b12. I want to be a good parent and give my child whatever is necessary, however I am afraid of consequences like these in the longterm. I also can’t find anyone who treats children. I hope you can help me! Thank you very much in advance.

    • Hi Stefanie,

      Sally Pacholok has a new book out called “What’s Wrong with My Child?: From Neurological and Developmental Disabilities to Autism…How to Protect Your Child from B12 Deficiency” which you should purchase, it’s available from Amazon. Disclaimer: I haven’t read it, but I do own “Could It Be B12? An Epidemic of Misdiagnosis” and it is a real eye opener. This is a serious problem that the medical community is misinformed and not doing enough about.

      Don’t believe the range your doctor uses. I don’t know why it is so low but there are many who get neurological damage within the so-called “normal” range. For adults, below 500 is considered too low, normal is 900 or higher. I believe children should have higher levels because they haven’t yet built up their stores. The liver stores 4 – 5 years worth of B12.

      Spend some time perusing the rest of the comments below. I’ve posted quite a few, search for my name (there are a few at the end that are from a different person with the same first name).

    • Diagnosing and Treating Vitamin B12 Deficiency
      YouTube video featuring Sally Pachlok is a must-watch for you and your baby. Given what you say about your baby it is essential to watch the whole thing right to the end. I echo Tracey’s advice wholeheartedly – good luck and God Bless.

  54. Hi,
    From past few years (around 5 to 6 years) I stopped eating Non vegetarian (except egg – taking one or two eggs per week). From that time on wards I gradually lost weight. I was around 65Kgs and now I became 50Kgs. I have no fatigue and any other problems. Daily I am doing Yoga, meditation etc. Yesterday I undergone blood test for B12 levels and came to know that I have only 133 reading. Doctor suggested to take me B12 supplementation which will make you observe the food what you take daily. Please let me know do I really lost the weight because of B12 deficiency. Do I have chance to regain at least 3 to 5 Kgs weight after taking B12 supplements. Waiting for reply.

    • Hi Ganesh,

      First, are you male or female? Also, what is your age and height? Did you Want to gain a little weight back, or are you afraid of gaining some weight back?

    • Hi Ganesh,

      First, are you male or female? Also, what is your age and height? Did you Want to gain a little weight back, or are you afraid of gaining some weight back?

      If you are B12 deficient, you can gain weight, like 1 dress size worth, here and there with no apparent reason. When you start taking B12, this stops happening, and losing weight becomes a little easier. I hope this answers your question.

      Since you are a vegetarian, you should take B12 methylcobalamin 1000mcg tablet under your tongue every day. You should also take a multivitamin, B-complex vitamin, B2, D3, magnesium, and eat a banana a day.

      • So many people don’t realize that there are different types of vitamin B-12, Methylcobalamin Vitamin B-12 1000 mcg being the best type. If you take B-12 orally then check the label’s ingredients to make sure you’re getting the best kind.

        • I should have also mentioned that not all B12s are for vegetarians. Find out which ones aren’t made from meat. There aren’t that many.

  55. Hi,

    I was recently diagnosed with b12 deficiency, my levels were just 71 (UK). I have lots of symptoms, the main ones being pain, burning skin, extreme fatigue, dizziness, breathlessness and confusion. I’ve had the initial six loading doses, and now have to wait three months for the next one, which is ridiculous. I’ve seen no improvement after the loading doses and asked to either continue them or be referred to a specialist, doctor declined both. I’m the last month I’ve caught both mumps and tonsilitis, which I feel must be connected as normally don’t get more than a bit of a cold. I’ve been reading everything I can, this seems to be a hidden disease which gps don’t know enough about.

    • If you are in the UK, the main forms of B12 for injection are hydroxyB12 or cyano-B12. I don’t know why because the EP has got methyl and adenosyl passed as food additives. If you are B2 deficient or have hypothyroidism (very common in women) you can have troubles converting the “Pro-vitamin” forms of B12 to the active forms. Your blood levels will go up, BUT these basically only measure what you have been injected/supplemented with, and don’t measure the active forms. The problem then is that the docs don’t know this and when they check your B12 levels they will say that they are find and therefore your problem can’t be B12. This message has been around for decades, yet the problem persists. There are other problems as well. Do you know which form you were injected with?

    • Hi Tess,

      I was watching “Living With the Fog” on YouTube, which is about trying to get shots for people in the U.K.that need it as OFTEN as they need it. To tell you the truth, if you usually don’t get sick that often, then the mumps and tonsilitis are probably just bad luck, or if they were within a month apart, one probably helped the other get a foothold.

      Ask your doctor if taking sublinguals or using the oils will interfere with being allowed to get more shots. If not, then I would definitely supplement.

  56. Hi, i have just had my blood tested by a locum doctor who has said i have symptoms of vit b12 deficiency. My results have come back as 170 but i have been told by my usual doctor that the level is normal? can anyone please tell me if 170 is classed as normal i am at a loss as to what to do. I have a follow up appointment to look at my symptoms with my normal gp as he wants to do more tests. I have been trying to get to the bottom of this for at least two years now and my symptoms are getting worse. I am suffering daily with not fatique but more like exhaustion, i have pins and needles in my hands and feet and when i do get myself up and try to get motivated my legs feel un co ordinated and like jelly if that makes sence. I often feel nauseous and poor appetite I fall asleep most of the time when sat down, cant focus on my work especially training days in a classroom. Iv started feeling a bit faint this week with dizziness and sometimes become breathless ( like im just not getting enough oxygen ) so have been signed off for a week. My vit d levels are 38 and been told they are slightly low so have brought some supplements. I have been taking omeprozole for approx 4 yrs. Would that have anything to do with it? Any advice people please.

    • kath,

      Yes long term use of omeprazole (Prilosec) very likely has a lot to do with your symptoms. It reduces stomach acid, which is needed along with the intrinsic factor created by your stomach to absorb B12 from your food. Since your liver stores 4 – 5 years’ worth, using omeprazole for the short term should be okay. But it’s EXTREMELY dangerous to take it for years as you won’t be replenishing your B12. There ought to be a strong warning on the box about the potential for B12 deficiency and permanent nerve damage if used long term.

      In the book “Could It Be B12? An Epidemic of Misdiagnosis” Sally Pacholok says 200 – 450 pg/mL is the gray area where neurological damage can occur and you are below that. I’m assuming the units for your B12 is pg/mL (or ng/L in the UK which is equivalent)*. The range used by most doctors is far too low. Usually 200 is the low cutoff, your B12 is way under that. Why is your regular doctor using such a very low cutoff that 170 is considered normal?

      * Some countries use nmol/L and the corresponding range is 147 – 332 nmol/L. Multiply your B12 number by 1.355 to convert to pg/mL.

      You have likely depleted your stores and need to get loading doses of B12 ASAP. Supplements probably won’t do it, you need shots. But – first you should get your MMA and homocysteine tested, which can confirm you are deficient. You should also be tested for pernicious anemia (intrinsic factor antibodies test and parietal cell antibodies test). These tests must all be done BEFORE you supplement B12 as it will skew the results.

      You really are going to need to get off the omeprazole which can be difficult. Do an internet search, others have suggestions. Most people who take it really had the opposite problem, too little stomach acid, which has similar symptoms. The drug companies have gotten it all wrong and have sold the public on a very dangerous cure for stomach problems. And what’s worse is that it is now available over the counter so there isn’t a doctor monitoring the use of this drug (not that they all even realize what can happen, nor are they aware of the symptoms of B12 deficiency).

      I’ve made other detailed comments in this thread, search for my name.

      • I have been on Omeprazole for years,and have Osteoporosis,discovered Omeprozole affects youe bones and now that ir affects your B12 levels,I now take Ranetidine which isnt as effective for my gastritis,asked Dr to check my B12 and they constantly say my B12 levels are fine because the levels in this country are too wide compared to other countries,but I have symptoms,what can I do

    • Hi There,
      Your levels are way, way low. Many studies have shown that even 400 is sub-clinically low, with brain shrinkage of 2% per annum occurring in one study. Homocysteine and MMA have been shown to increase at levels below 300, so your levels are way below that. Be careful with what you supplement with as some people have found that if they get cynanoB12, it can result in increased levels of homocysteine, presumably because this inactive form of the vitamin competes with the active forms of B12 and blocks their “good” activity.

  57. Hi there, just wanted to correct you on something.

    B12 is NOT only found in animal products. B12 is a bacteria, found in the dirt. The B12 in animal products comes from the dirt those animals ate. In fact, livestock no longer feed on grass and dirt on factory farms because pesticides KILL B12 producing bacteria. Plus, animal products high in B12 also heighten risk of cancer and heart disease… (try vegan!!!)

    B12 is also killed as soon as it is cooked, so whatever limited traces of B12 there might of been in the animals flesh is eliminated as soon as its cooked. Oh, and did you know that 90% of the worlds B12 supplements are fed to livestock?! That says A LOT.

    Grab a carrot and don’t wash it and there is bound to be an abundance of B12 on it. This generation is too clean, no wonder our immune systems are crap.
    For all vegans/vegetarians, B12 can be found in any fortified plant based milk and nutritional yeast.

    ANYONE can have a B12 deficiency, regardless of diet.

    • A minor point, but… B12 is NOT a bacteria, it is MADE by bacteria from cobalt and other nutrients.
      Pesticides and industrial fertilizers (rather than compost or fermented compost) are a modern day scourge, deadly to all living things, I agree with you.
      There is no hard evidence that I have seen or can find that claims that too much B12 can lead to heart disease. B12 is water soluble, and in the body too much will wash out and is excreted in urine. On the other hand, too little B12 can cause heart disease, among other issues, some of which mimic MS (Multiple Sclerosis).
      As far as cancer is concerned, information is conflicting. There is only one study that claims that high levels of both folate and B12 may increase the risk of prostate cancer. The authors also note that this is only one study. That the authors found what they think they found I have no doubt, but I would like to know what form of supplements may have been used, if any, and I would like to know all the details of the study. Without the details, we cannot really know much of anything, sadly. There are several studies that claim the opposite, that more B12 prevents or suppresses cancer.

      I agree about scrubbing carrots rather than peeling them, but this small amount of soil bacteria assumes several things that have not been shown to be true, and that have in fact been shown to not be true.
      The assumptions are:
      1 – Healthy soil fertilized by compost
      2 – And filled with healthy bacteria.
      3 – The presence of just the right bacteria that manufacture cobalamin(s) in said soil.
      4 – The correct other nutrients in the gut to enable these soil bacteria to manufacture cobalamin(s).
      5 – A large enough population of B12 producing soil bacteria on the food that is eaten to produce enough B12 in the gut to prevent deficiency.
      6 – And last but not least, the ability of the gut to absorb this B12 from the gut bacteria.
      These have been shown to be highly unlikely, and vegans often are deficient.
      “Preliminary results show that, unlike other B-vitamins, humans don’t get enough B12 just from bacteria in their gut, and need more of it through exogenous food sources.”

      B12 is not “killed” as soon as it is cooked, though its activity is reduced. Vitamin B12 is heat stable. The cobalamin molecule breaks down at 250˚ C. B12 is therefore destroyed on the surface of grilled meat, but not in the interior. Gentle braising or cooking steaks to rare or medium-rare best preserves B12 in meat.
      Though B12 (cobalamin) is heat stable, it is not stable in either acid or alkali environments. It slowly loses its activity when exposed to light, oxygen, and acid or alkali environments. Please keep in mind that the stomach is an acidic environment, which may be why sublingual drops or tablets seem to work so much better than pills that are swallowed. The B12 bound in food is another story altogether, the digestion of which is much more complicated than that of supplements.
      Vitamin B12 is present in liver, organ meat, muscle meat, shellfish, eggs, cheese, fish, and can be manufactured in the body only by gut bacteria. (Again, these gut bacteria are not enough all by themselves to prevent deficiency in humans. B12 is manufactured below the point of absorption, the ileum.)
      Vitamin B12 can not be manufactured by any plants, it is only found in animal products. The possibility that some B12 producing soil bacteria may adhere to fresh root vegetables still does not make the case for plants producing B12 – they do not, nor do they contain any B12.
      Vitamin B12 is produced commercially from bacterial fermentation.

      Your idea of drinking or eating fortified foods seems to be a sound one concerning B12, but it is not possible if one chooses to eat only whole foods. Vegans can make their own nut milks, I have done, but where is the B12? Missing, though I wonder if a crushed tablet or a drop of liquid B12 might just work. The dose would have to be carefully calculated, but it could be done. However, the milk would be exposed to light and air for a time, so I could not say what B12 activity would remain.

      Here is good news: “Several probiotic bacterial species such as Lactic-acid bacetria (LAB)- Lactobacillus spp.(species), Propionibacterium spp. or Bifidobacterium spp. can produce B12 and other B-vitamins. Two species that possess all the genes for B12 synthesis are Propionibacterium freudenreichii (A genetically-engineered strain of this bacteria is used to make B12 commercially) and Lactobacillus reuteri (naturally found in most human intestine).”
      So perhaps we should all take our probiotics and eat homemade yogurt regularly.

      Here’s a good article that complements Chris’s on how it all works:

      • Hey Molly, I think you’ve cleared up a mystery for me. Last year I had blood tests done by a GP who informed me that my folate and B12 were too high and to be sure not to supplement any further. This is the thing, he assumed I was supplementing because I consume mainly vegan foods. I was not taking any such supplements though. I was however taking lots of probiotics and experimenting with different ferments. So perhaps that is why my levels were high? Margaret

        • Hi Margaret,
          I just stumbled on this website and your post caught my eye. I, too, had high serum levels of B12 without supplements. I am not a vegetarian. I had also been on PPIs for many years. They were looking at B12 because I had a long history of fatigue and ‘brain fog’. My levels came back more than 25% above the upper limit. Dr said ‘we only worry if it is low’. It really bothered me, and awhile later I saw a nutritionist who recommended intracellular micronutrient testing. B12 levels were deficient intracellularly. I was found to be homozygous for the MTHFR a1298c polymorphism, which presumably affected my ability to get B12 out of my bloodstream and into my cells. I Have been supplementing daily with 1000 mcg of sublingual methylcobalamin and have seen noticeable improvement. So, even ‘high’ levels of B12 in your blood may be misleading. I have lots of things wrong with me – all stemming from a 20 history of RA and consequent treatment with steroids and other meds, but have found many approaches that have helped improve well-being and this was definitely one of them.

          • HI Maureen- my husband has been dealing with RA and gastrointestinal issues for years. we just had his b12 and folate tested and they were above normal. (i foolishly made him take a b complex vitamin the morning of his blood work) so that may have something to do with it as well. He has been on PPI’s for 2 years due to severe acid reflux. he also has low iron. we are currently on a waiting list for a functional medicine doctor but in the mean time i’m looking for insight because his RA, family and gastro doc offer us nothing in terms of a solution. only more medications. thank you! J

            • Hi Jen!
              Embarrassed because I seldom check the email I used for this post and never saw your comment until now. I am glad the info I shared about my experience was helpful to you and your husband! I am curious to know whether you were able to see the integrative medicine specialist and/or if your husband has found anything that helps.

              A few other commonalities we might share: I was originally on PPI because of presumed risk due to prednisone. However, I remained on them for years after I stopped prednisone b/c then I had reflux. I also used to get a lot (4/yr) of sinus infections & the otolaryngologist told me that many with chronic sinus problems are now believed to have GERD. in any event, I no longer have reflux and I believe that is because I eliminated gluten from my diet. I do not have celiac disease, but I notice that my body does not seem to like gluten:). I have had a small but noticeable improvement in joint pain also. Haven’t had a sinus infection in at least 4 years (knock on wood – don’t want to jinx myself.)

              Like other posters I have also been diagnosed with vit D deficiency and have had to supplement with as much as 100,000 units/week at times. DRAMATIC improvement from vitamin D3.

              Lastly, the micronutrient testing revealed low or borderline low results for about 15 vitamins and minerals. I have taken supplements for each seperately and have an overall improvement in well-being. I took each for a couple of weeks before introducing a new one so that I could identify any changes and tie to a specific supplement. I did not notice anything special except for the B12, D3 and also magnesium. Great effect from magnesium malate. Improved joint pain, greatly improved sleep, helped lower BP, felt calmer. I think the cumulative effect of supplements targeted to areas I was deficient in has been responsible for me being so much better. Hope this helps, too, and let me know how you are doing if you pick up the message.

  58. Hi,

    10 years ago I fell very ill and was in hospital for a week. The consultant said they did not know what was wrong but that my white blood cell count was ‘way too high’. I was exhausted, the glands in my neck were so enlarged that I had lumps the size of oranges leaving me looking deformed (they carried out an ultrasound to look for non-hodgkins / hodgkins in the lumps but this was clear), my tonsils were swollen too. I was ill for 2 years following this suffering with weight loss, hundreds of mouth ulcers, UTI’s etc. I had further blood tests but the results went missing for 6 months so I assumed all clear when I didn’t hear anything then my doctor called saying it showed that I was vitamin B12 deficient but as it was 6 months ago and the ulcers had gone he would ‘file his papers’.

    I’m 33 & have a healthy diet but it’s been a running joke that I catch every bug going around.

    Almost 2 years ago I caught Molluscum Contagiosum and have been unable to fight it off leaving me feeling very down.

    My doctor finally carried out a blood test a week ago and I got a call 1 day later saying I need to see the doctor asap as I have a vitamin B12 deficiency.

    I am seeing the doctor on Thursday but want to be more informed this time. Is it possible that I have been deficient all of this time? Could this explain why I seem to catch everything and not be able to fight it off like a normal healthy adult? I do have other symptoms (out of breath, palpitations & tiredness).

    Can this affect the immune system?

    Any advice would be appreciated seen as my previous doctor just ‘filed his papers’!!

    Thank you

    • Hi Lisa,
      My sons had Molloscum, and it took a very long time to go away. What really helped was Grandpa’s Pine Tar Soap in the bodywash form, and dabbing then with alcohol pads. Once they started washing and dabbing, the molloscum cleared up in two to four weeks.

      When you say healthy diet, what do you mean?

      Had you had some illness before you started getting sick all the time? About 20 years ago, this woman on the bus kept coughing right in my face. A few days later, I became ill for three weeks. My old family doctor, ” I don’t know what you got, but you got it good!” ( I miss my old doctor). After that, someone would have the sniffles, and I would get the flu.
      After I started taking my vitamins that I have listed elsewhere here, I did start having more resistance. I don’t exercise because of my asthma, but now that it’s cooler, I’ll start going for walks, and I am sure that that will help my resistance even more.

      So, my advice to you, is to take my list of vitamins, plus B2, and do calm exercise like walking, even in cold weather, and you should start seeing an improvement before you know it.

    • Get checked for the genetic mutation MTHFR. If you have any of the mutation SNPs, you will likely have issues with folate and Vitamin B12, maybe other methylation pathways. Can get it done yourself through 23 and Me for $99.

  59. There are four different types of B12 that I know of (the one you didn’t mention is adenosylcobalamin), and each has different functions & tends to live in a different part of the body.

    When you don’t respond to one type of B12 (this is a common problem with cyano & hydroxy) it’s advisable to trial what the others will do for you. Most responses seem to come from methyl.

    MethyB12 (methylcobalamin) is perhaps the most commonly deficient one – & still isn’t well-known.

    The Japanese may be resistant to neurological disease not because they eat more B12, but because the supplemented form there is methyl, unlike in the West.

    Finally, methyl & adenosyl B12 are crucial to the methylation system, but often can’t work well without cofactors such as each other, & methylfolate & carnitine (which crank up ATP). There is a protocol – named the Freddd Protocol – which addresses the whole picture.

    This rather radical paper by British oncologist Carmen Wheatley seems to have changed the landscape re adenosyl B12:

  60. I have been vegan for 1 year and just had my blood tests done just to make sure i was getting enough nutrition as a vegan.
    my b12 levels came back as (<125).
    I have lots of energy and had no symptoms that everyone else in the comment section had.
    I am now taking a spray under the tongue once per day.

    It's very strange that if you're levels are below 500 in japan then you are classed as deficient, but in the uk it's 180.

    • I believe something happened in Japan during the 1960s that caused them to raise their minimum level to 500. From what limited information I could find on the internet, there was an antibiotic that caused a B12 deficiency. Most likely a large number of people were severely affected, resulting in raising the low cutoff value. I have read that there are very few instances of Alzheimer’s in Japan, though their diet is quite different from the US diet so there may be other factors involved, and not just B12 levels.

      We do know there are many instances of people getting neurological damage due to the current low cutoff (myself included). It is a major undertaking to change this across the US in all medical organizations, change happens slowly in medicine. Some labs are now including notices in reports where measured B12 is in the gray area of 200 – 450 pg/mL.

      What units was your B12 measured in? If pg/mL (US) or the equivalent ng/L (UK), then your B12 was very low. If it was pmol/L then not quite as bad (cutoff of 200 pg/mL = 147 pmol/L). Was your MMA tested? An elevated MMA value can back up a B12 deficiency. Were you tested for pernicious anemia? If not, to get any of these tests you may have to stop taking B12 for a period of time which you may not want to do. Don’t bother getting your B12 tested again while supplementing as it will be high. Some doctors try to use this as evidence of being “cured” but if you have pernicious anemia your B12 levels will eventually fall again.

      Serum B12 is the total of active B12 available to cells plus inactive B12. Perhaps you have a larger percentage of active B12, so even the overall number is low your cells are still getting the active B12 they need. In the UK there is a test to measure active B12 but it is not available in the US from what I can tell.

      • Tracy – what tests should I be having to diagnose non-absorption of B12. My serum B12 was tested at 175 and I was given 7 loading doses over a period of just over two weeks just before Christmas 2015. I was then offered injections every three months. I believe I have peripheral neuropathy in my feet which seemed to improve after the first week, and so, following advice gained in my research on the internet to follow the clinical symptoms to prevent further nerve damage, I asked for injections every other day ‘until my symptoms improved (not stopped improving – as my doctor quoted me as requesting when she discontinued these after only three injections). I was given three more ‘every-other-day’ injections which were stopped after my doctor had consulted colleages. After insisting on the ‘proper treatment’ whilst waiting for a (now promised) referral to a neurologist I was given permission for a further course of injections but only managed to get one before they were again discontinued after my doctor had consulted a haematologist at the local hospital. Last week I spoke to another doctor in the practice and, after further lengthy discussion along the same lines, I have been offered another three injections as ‘an experiment’ – presumably to see if they ‘work’ again …. I did tell her that my doctor had told me that she was ‘at the limit of her expertise’, this after she had pointed out that my B12 now tested normal at 2,000 (UK) but had then agreed (eventually) with me that this was only to be expected after I had received so many B12 injections! My intrinsic factor was tested as was folate and iron, kidney and liver function plus a full blood count but only after the loading doses and at my request (I had been wildly scrabbling around for any information at that point as I was desperate but now I know that these should have been done prior to any treatment). All came back marked ‘no action required’. I have rheumatoid arthritis (10mg steroids daily plus Leflumonide), osteoarthritis, diabetes (Methotrexate), under-active thyroid, asthma and COPD, high blood pressure (is it any wonder???), and have been taking Lansoprazole for a number of years. I am presently being investigated for breathing problems. I have been tested for an impaired immune system with an initial reading of 2.8 and after testing of 4.6 which apparently is acceptable as being on the way up (to 6). Any advice warmly welcomed

  61. Chris,

    I just ordered B12 supplements because I just found out I am deficient. What I don’t understand is for how long I have to supplement. Is that forever or until my B12 is higher? What is the rule of thumb for stopping taking vitamins? Thank you

    • Mary,

      You need to find out the cause of your B12 deficiency. You should be tested for pernicious anemia before taking any B12. I’d be cautious about getting this tested after starting on B12 as it can interfere with the test results.

      Do you have any of these other B12 deficiency risks: vegetarian/vegan, used PPIs or H2 blockers, take Metformin, had nitrous oxide anesthesia for surgery or dental work, gastric surgery?

      If you have pernicious anemia you will need treatment for life.

    • How many micrograms are in the tablets and are they dissolved under your tongue?

      Rule of thumb is, you are on them for life. If you reach your mark and stop taking them, two things can happen, your levels will stay the same, as far as you know between doctor visits, and of course, it depends on what your doctor considers the right level, or, your levels can go down. Believe me, it’s far better to take b12 for life than to chance having the things happen to you that can happen to you when it’s too low. The pills are extremely safe. Don’ t chance it.

  62. hi
    I am having severe vitamin b12 deficiency.(167)
    my doctor prescribed me cyanocobalamin (vitcofol).
    but i would like to take methylcobalamin instead.
    Is it ok.
    also can you tell me how to self inject methylcobalamin by syringe.
    thanks in advance.

    • I did a little researcg on this before and this is what I understand: If you have a high concentration of mercury in your system, methylcobalamin isn’t advisable. This will react with mercury and produce methyl mercury, which is worse as it is more reactive biologically. Perhaps someone else can shed more light on this.

      • There are loads of sources of the methyl group, almost all of them in higher concentrations than you’ll get from MeCobalamin. 1000ug of MeCB will produce just 11ug of methyl radicals. That’s about one thousandth the amount of methyl in a glss of red wine.

    • You could try Hydroxocobalamin. It doesn’t add methyl groups but is, as i understand, easily converted into the active b12s methylcobalamin and adenosylcobalamin when and where it is needed. It is actually said to “eat up” exess methyl groups. I tried methylcobalamin and I had awful symptoms, OCD and anxiety went through the roof.

      • Hi Brandon,
        I have had issues of fast heart rate, insomnia, overwhelming energy since my first b12 shot, it’s been month and a half, did ur anxiety side effects go away ? How long? I had similar issues from supplement dunno why I let dr give me the shot. Thanks Melissa

  63. Hi, Chris – thanks for writing such an important article. I only wish I’d seen it in 2011 when you first published it! For the last 7 years or so, I struggled with many symptoms of an undiagnosed B12 deficiency. In fact, I may have been low in B12 most of my life.

    It reached a crisis level a month ago, and by sheer luck I was able to diagnose it, then confirm via an MMA test at my doctor showing a reading of 340. Details of my story are here:

    Neurological symptoms for me, unfortunately, are severe, and while I’ve recovered some, after 3 weeks of supplementation with oral methylcobalamin, 1 mg per day, heavy fatigue is still with me, and my doctor has very little advice for how to proceed.

    I would love it if you could write a follow-up article that focuses on the best approaches to recovery. It’s not clear if taking >1 mg methylcobalamin is necessary to heal long term neurological damage, MTHFR gene mutations add more layers of confusion for the newly initiated, and since this truly is an epidemic, that our doctors usually know very little about, we look to people like yourself to continue speaking out and taking the lead.

    Thanks again.


    • Hi Terry,

      Three weeks isn’t that long at all, so stick with it. If you are taking sublinguals, you have to seriously increase your dose. I take 10,000mcg, or 10mg a day. I also take Vitamin D, just added B2, iron, zinc, magnesium, a multi, and B complex.

      I knew there was something wrong in my 30s when everything seemed to be getting just to much and was always tired. Symptoms kept piling. The one day I went to the doctor for a cough, and he kind of knee-jerk diagnosed me with acid reflux and prescribed the heavy duty acid blockers an antacids. I didn’t think that was it, so I went online and looked up something like problems with taking antacids for a long time. One of the artcles that popped up was “Antacids Ruined My Life”, where tge author described her B12 deficiency, and there were ALL The symptoms I was experiencing right down to the sore tongue. Symptoms that I did tell my doctor about. She just dismissed them, seemed miffed that I had seen other doctors, and upped my prescription of Amlodipine for my admittedly VERY high blood pressure.

      Anyway, it took about a month for some of my symptoms to go away, but after three years, and adding the other vitamins, I still get very tired. I feel a lot better, but I still go from general to heavy duty fatigue.

      I think it would help if I exercised, but I now have asthma, brought on, I am pretty sure, by the Amlodipine I took for my HBP.

      I meant to explain more than complain. My advice, seriously up the B12 dosage and add the vitamins I wrote down.

      Good Luck

  64. I really appreciate this article, Chris. I’ve been struggling with the symptoms of B12 deficiency since the late 1990s, didn’t realize it – and was never tested by any doctor because they assumed a meat-eater wouldn’t require B12 supplementation.

    1 month ago my symptoms reached a crisis point, and I was luckily able to make my own diagnosis, then follow up tests with my doctor confirmed it: an MMA test of 340.

    Unfortunately my neurological problems became advanced enough in recent months that I may not fully recover. I’ve done 3 weeks of supplementation and while much has improved, heavy fatigue has not. More detail on my story can be found here:

    Diagnosis is only half the battle. I’d love it if you could do an update on your B12 article that focuses on approaches to recovery. The MTHFR gene mutation and other variables make deciphering and applying protocols really confusing, and since B12 deficiency really is an epidemic that most of our conventional doctors don’t include in their workups, we look to people like you, Chris, to lead the way.

    Thanks again!


  65. Hello chris
    I have been suffering from hair fall problem since7-8 years. 3 years ago i was diagnosed with iron deficiency. it was 0.7(too low). I started with medications and thought it is the end of the problem but last year (august 2014)along with hair fall a lot of problems such as fatigue,weight loss, improper digestion, farting,weakness engulfed me. It was b12 deficiency(130 pg/ml) i started getting b12 shots and december 2014 all my problems were solved. But from the past 2 months again weight loss, hair fall, weakness, digestive issues(i dont feel like eating anything), gas have started. in 2014 i also had endoscopy done it showed chronic gastritis. What should i do? please help

    • @Divya, Are you still on B12 shots? If you don’t address the reason why you became deficient in the first place, you will become deficient again without constant supplementation.

      The iron issue along with B12 may indicate some other problem such as low stomach acid (achlorhydria) or gut dysbiosis interfering with absorption of nutriets. Chris has a lot of info on this site about gut issues.

      • Yes I have the same symptoms again. Rather more this time. Gastro issues are there. I am not able to eat anything. If i eat anything i have gas, bloating and feeling like vomitting

        • Hi Divya,
          For the last one month, i started developing symptoms of little dizziness and unsteady gait. First i thought its related to Inner Ear and thats why i saw a ENT specialist, he told that it might be related to inner ear inflammation and asked me to wait and watch without prescribing any medicines.
          But the situation remained the same and fatigue also started groping me. I decided to see an experienced neurologist and did CT Scan as well, it came fine.
          The neurologist immediately asked me to get the thyroid and b12 levels checked. The thyroid came normal but my b12 level was 229 and according the neurologist, if the level is below 500, i should get started with b12 injections.
          I had my first injection yesterday evening and i am hoping my symptoms would go in the near future.
          The cause of b12 deficiency according to the doctor is the long term use of Proton Pump Inhibitors (nexpro,parit,acilog etc.) for my acute gastritis.
          Thought to share with you as you have very similar symptoms and please suggest anything that would help me get rid of these uneasy symptoms.

          • Hi Pankaj,

            My steadiness was off before the b12, and the b12 helped, but what really did the trick was also taking Magnesium and D3. Try adding these to your diet. Also, drink Bragg’s Unfiltered Apple Cider Vinegar, a teaspoon in a cup of warmish water with some raw honey in it.

            I would definitely go to see an Endocrinologist and have your Thyroid checked again.

            For several reasons, the main one being that I am lightheaded from trying to breathe because of asthma I have developed, I have started taking Meclizine, and it really helps. You can get a prescription for it, or buy Dramamine NON-DROWSY ( the only one with meclizine is the non-drowsy one). Despite what Dramamine says, it does make you very drowsy, so be careful. I haven’ t taken it every day, just one pill a day as needed. I have had an earache the last few days that goes down my neck and hurts my gums, jaw, and all the teeth on that side. Unable to eat too well, I became nauseous and dizzy. And you know how it is when you are nauseous because you haven’t eaten., the thought of eating makes it even worse. So, the other night, I took one before bed, and in the morning, I didn’t feel lightheaded, and I didn’t feel nauseous! I ran to eat whatever I could find — anything small and soft, that is.

            I hope some of these suggestions help.

            • Hi.. I had been finding myself V tired irritated and have been having mood swings. All the time I feel lightheaded and anxiety could take over me anytime. M drained off my energy. Since a few days I hv been having the same type of pain what u had lyk pain in gums jaw n ear.
              Hv my thyroid function tests done, reports r in normal range
              Pain is sharp, heavy,radiating and my teeth r xtremely sensitive on that side,no sinusitis no cavities
              I hv a long long history to go. There’s tingling in my fingers and toes tips, hv greying of hairs with hairfall, nails hv become brittle..oh god!! Never tried to jot down whatever I had been feeling
              There’s constant fatigue present..nauseous in morning, lack of coordination bit of.. And headaches too take over for no reason..
              Ny of u had such symptoms Pl tell n guide me through.. Suggestions r welcome

          • Hello Pankaj
            I have started taking apple cidar vinegar and that has given a lot of relief to my stomach. I have even started taking as much acid i can take in the form of lemon in ginger tea,pickles or tamarind. It has really helped. The only problem left is oily scalp, skin and hair fall. I am taking b12 shots after one month.lets see. I am waiting.

        • Hi Divya,

          Go to an endocrinologist. It could be your thyroid. I have to make an appointment myself. My pulmonologist did a test and it appears I have an overactive thyroid. I knew something was up because I lost 25 pounds in two months without trying. Before I started to lose the weight, though, I had a stomach virus for about a month. The symptoms are the same for virus and thyroid trouble, but I think, for me, it was the virus that caused the thyroid trouble, and not the thyroid trouble making me ill. Since they both have similar symptoms, and many people with low B12, particularly pernicious anemia, have some kind of thyroid trouble, I would definitely have it checked out.

          FYI. Vitamins can really upset your stomach, too — nausea, vomiting, gas, lightheadedness — if you take them at the wrong time of the day and on an empty stomach. Last month, I started taking ground clove capsules to settle my stomach. I have always felt queasy, and they stopped making the clove gum that used to help, so I tried the capsules. They gave me such gas that the odor kept waking me up! Now that’s some heavy duty gas! Just so you know, it could be something you are eating or taking.

          Also, try Bragg’s Apple Cider Vinegar, one teaspoon in a warmish cup of water with some raw honey. And stop taking those stomach pills if you still are taking them! Lower the dose week by week.

  66. Hi Chris
    I was having problem of hair loss since 8-9 years. I tried many things but nothing worked. Three years ago i was diagnosed with iron deficiency. My ferritin was 0.7(too low). Last year in august 2014 i was diagnosed with vitamin b12 deficiency(pg/ml), vitamin d was also less. I was on bed for almost 2 months with b12 shots. My digestive issues and hair fall got completely solved in december. I am again experiencing a lot off hair fall,weakness, weightloss, poor digestion, farting, burbs(i even dont feel like eating anything). I had endoscopy also done last year. It showed gastritis. i dont have wheat allergy. What should i do? please help

  67. This is kind of the opposite situation, but have not been able to find info on your webite for it. My B12 readings on my last blood workup was extremely high. I’ve been told that having B12 Elevated is just as bad as having a dificiency. What could be causing my B12 to be High, other than when I was taking B12 supplements, but I had stopped for almost 2 months before my last blood workup.

    Is there anything I can do to bring down the HIGH B12 in my blood? If so, can you share what that might be?

    thank you

    • Gabi,

      Vitamin B12 is stored in the body for some time – I’ve read as much as several years. However, because it is water-soluble and readily excreted, supplementation will not cause high B12 levels in the blood.

      According to the Mayo Medical Laboratories website, many conditions other than Vitamin B12 supplementation are known to cause an increase or decrease in the serum vitamin B12 concentration including:

      Increased Serum B12
      Decreased Serum B12
      Ingestion of vitamin C
      Ingestion of estrogens
      Ingestion of vitamin A
      Hepatocellular injury
      Myeloproliferative disorder
      Ethanol ingestion

      Also, see

      • I clicked enter too soon – this is the correct version:

        According to the Mayo Medical Laboratories website, many conditions other than Vitamin B12 supplementation are known to cause an increase in the serum vitamin B12 concentration including:

        Ingestion of vitamin C
        Ingestion of estrogens
        Ingestion of vitamin A
        Hepatocellular injury
        Myeloproliferative disorder
        Ethanol ingestion

    • Hi Gabi,
      I just stumbled on this website and your post caught my eye. I put the same response in to another person, but will attach it here as well for you. I, too, had high serum levels of B12 without supplements. I am not a vegetarian. I had also been on PPIs for many years. They were looking at B12 because I had a long history of fatigue and ‘brain fog’. My levels came back more than 25% above the upper limit. Dr said ‘we only worry if it is low’. It really bothered me, and awhile later I saw a nutritionist who recommended intracellular micronutrient testing. B12 levels were deficient intracellularly. I was found to be homozygous for the MTHFR a1298c polymorphism, which presumably affected my ability to get B12 out of my bloodstream and into my cells. I Have been supplementing daily with 1000 mcg of sublingual methylcobalamin and have seen noticeable improvement. So, even ‘high’ levels of B12 in your blood may be misleading. I have lots of things wrong with me – all stemming from a 20 history of RA and consequent treatment with steroids and other meds, but have found many approaches that have helped improve well-being and this was definitely one of them.

      • I too have high B12 with doctors that don’t think it’s a big deal. What type of nutritionist or practitioner did you see for the discovery of MTHFR? I have suspected this, but not sure who can help me figure this out. I have joint and muscle problems for the last 3 years, with no doctors able to figure it out.

        • Hi Babs, sorry for delay in responding. I went to a nutritionist who works in the Integrated Medicine Dept at a local hospital. I kept probing around why my B12 would be high. After a while she suggested a test of cellular micronutrients. (As opposed to serum/blood levels.) Their office used Spectracell Labs. It cost $190; insurance did not cover. I think it was the best money I ever spent. Results included MTHFR status as well as a number of micronutrients. The cellular B12 was “deficient” which was in contrast to serum levels, which were above normal. A couple of other micronutrients were also “deficient” and about a dozen were “borderline”. I have used the results to do targeted replacement. I feel the best I have in years. I have not yet had the test repeated, but plan to do so in the fall.

            • Stephen, I have not checked back on this site for quite awhile so just getting your question now. Hope it’s not too late to respond.

              The micronutrient testing is a blood test but they apparently use the white blood cells to look at micronutrients. The lab was Spectracell.

  68. I have been having issues with my stomach for years being told it is gastritis, then diverticulitis, then colitis had an expensive test done that said it was inclusive but indicated some form of inflammatory bowel disease however all the blood work and stool test and biopsies that were done during an endoscopy and colonoscopy all came back with nothing but i am in constant pain in my abdomen my stomach swells to where i look pregnant at times I can be 10 to 15 pounds heavier in the evenings then i was in the morning and another dr just happen to run test and said my b-12 was low 212 and vitamin d was low and testosterone was 101 for a 47 yr old man. Could the b-12 be causing my stomach issues the gastro dr is wanting to send me to another dr for a second opinion or more testing.

    • Michael, you didn’t mention whether you have been taking any meds for your stomach problems. If you have been taking PPIs or H2 blockers, they deplete B12 because they suppress the stomach acid that is part of the system used by your body to extract B12 from your food. If you are a vegetarian or vegan, unless you have been supplementing then you can have low B12.

      You need to find out the cause of your B12 deficiency. You should get tested for pernicious anemia, which results in little/no stomach acid. PA can run in families so let your doctor know if other members of your family have had it.

      The symptoms of insufficient stomach acid are similar to too much acid. Most people who are older don’t have enough (decreases with age). The drug companies have been misleading the public about this for years. With the availability of PPIs and H2 blockers over the counter, it’s too easy for people to find themselves in serious trouble after taking them long term. These drugs should only be taken for a few weeks.

      Traditional Western doctors are using a minimum B12 that is far too low, typically 200 pg/mL. According to Sally Pacholok in her book “Could It Be B12?” the gray area of 200 -450 pg/mL is where neurological symptoms are known to occur. When in this range, particularly if you are having symptoms, you need to get treatment.

      After you start treatment or supplementing, your serum B12 will greatly increase and any future B12 tests will be skewed. You must stop the B12 for 6 – 8 weeks before testing.

    • Michael ..
      People can have gastrointestinal symptoms with low B12 and low Vitamin D. Yes, it can affect your tummy. Low B12 can reduce the production of thyroid hormones. Your Thyroid also affects your whole body when low. When mine was low I had bad acid with acid reflux. I kept Tums in business. Now that all my levels are in the normal range those symptoms are gone. As we get older many people become milk intolerance and that can make your tummy hurt, swell, diarrhea and gas. So many things can cause your symptoms .. gallbladder conditions, food allergies, Vitamin deficiency, certain medications. When you get your levels back in order if the deficiency is the cause things will improve. During the mean time, I would see the other doctor for a second opinion and have more testing done. Have you been checked for a gallbladder condition or gallstones? That could be another reason your doctor wants you to be seen by another doctor. I’d rather be safe than sorry when it comes to my health. Rule out as much as you can. You didn’t state if your doctor was giving you B12 shots or … Make sure to take a B12 Sublingual not the tablet, if your taking B12 by mouth. Keep us posted how you’re doing.

  69. I just turned 60 and I am a very active woman. A couple of months ago I got a UTI and from that point on my health has gone down hill. Shortly after taking ciproflaxin for the UTI I started getting back pain that would start in lower back and then move to shoulder blades, neck. Then a few weeks ago, I starting getting pins and needles in fingers, legs and toes. I had heart palpitations and shortness of breath. Went back to doctor and wanted me to see a neurologist. I finally talked him into giving me blood tests and it came back that I wasVitamin B 12 deficient. He told me I would have to give myself injections everyday for a week, then once a week for a month and then once a month after that. He still wants me to see a neurologist because he is insistent that I have a nerve problem. I have just made an appt. with a neurologist but I am just wondering if it could be the Vitamin B 12 deficiency. The pain and the pins and needles has subsided somewhat but I still have pain. Has anybody else have the same symptoms.

    • Jean,

      Yes, B12 deficiency can cause nerve pain, particularly when is in an advanced stage. Last fall I had shooting pains up my legs. Felt like sciatica but not always constant like typical sciatica.

      Two years before that I had a disc bulge which caused terrible sciatic pain, and odd back pains that would come and go. Recovery took months, should have only been 6 or 8 weeks. I believe I was becoming B12 deficient then, which caused those symptoms.

      My pins and needles feeling has subsided. When my B12 gets low then it comes back again. I still have a lot of pain in my feet, because I had foot pain well over a year and foot surgery (misdiagnosed as a neuroma). It’s been a year since my surgery and I still have nerve problems in my feet.

      I sincerely hope your foot pain subsides. I’ve read in Sally Pacholok’s book “Could It Be B12?” that if you’ve had it 3 months or less there’s a good chance it will go away. I recommend that you buy the book, it’s available on Amazon.

      I suggest you continue treating your B12 deficiency and also keep your neurologist appointment. There are tests your neurologist can do to determine if you’ve had nerve damage.

      Good luck in your recovery!

    • Jean, Cipro has many side effects that sound like what you’re experiencing. It is in the fluoroquinolone class of antibiotics, along with Levaquin, Floxin and Avelox. Google “fluoroquinolone toxicity syndrome” to find out more. There is also a site, for help with getting better.

    • For seven years I was experiencing off and on, hands and feet tingling, burning, pain, difficulty walking, extreme fatigue and depression. It then started where I had extreme difficulty getting dressed, had trouble feeding myself, could not write or hold a pen. Bending my neck sent electric shocks thru my body. Went to the hospital for MS testing. MRI, spinal tap, brain scan. After more testing, one Dr. checked my B12 level, it was 80. I spent 10 days in the hospital and 10 days in rehab. They were not sure if I would recover. Left untreated, B12 deficiency can cause permanent brain damage. I was lucky, everything reversed. Maybe if B12 methylcobalamin supplements were given early on, we might be able to prevent MS and other brain and nerve related diseases.
      If that one Dr. didn’t check my B12 level,I would have been diagnosed with MS, because the symptoms are the same.
      B12 is vital for our health. It helps make DNA & RNA, your red blood cells.
      Helps with Depression,Dementia,Sleep Disorders.
      Protects &a rebuilds the Myelin sheath covering your nerve fibers.
      Slows brain shrinkage up to 80%.
      Lowers Homocysteine levels associated with heart disease.
      If low levels are left unchecked, brain damage will occur and can become permanent.
      Helps with age related macular degeneration.
      By supplementing with sublingual Methylcobalmin B12 around 40 or 50 years of age, we could help prevent problems before they start.

      • Hi Joyce
        Ten years ago I was like you experiencing health problems and my doctor tested me for MS and had a spinal tap, MRI’s, blood tests, etc. Luckily my doctor tested me for B12 and my level was 41. I was not in the hospital though, he started me on cyanocabalim injections.My level eventually went up but my symptoms didn’t improve a whole lot. Just a few years ago I found on a website about transdermal of B12 (methylcobalamin) oil. I’ve been using the oil and my MMA has improved. But I think since it took the doctors to find out what was wrong with me, I may have permanent nerve damage, especially in my legs and feet. I’ve done so much physical therapy and aquatic therapy but still my gait, numbness, spacticity, and severe stiffness is still there. I think it will take some time for my nerves to regenerate.

      • Hi Joyce,

        So glad everything reversed for you. Do you know the reason you were deficient? Were you tested for pernicious anemia? I’ve got permanent nerve damage as a result of my deficiency which was caused by pernicious anemia.

        Please tell everyone you know about the terrible consequences of being B12 deficient since you experienced them firsthand. Maybe if enough people pester their doctors to have their B12 tested annually, doctors will wake up to the fact that there is something serious going on and that they should automatically order this test for patients who complain of fatigue, brain fog, hair loss, and/or weird pains. As it is now, thousands of dollars are spent unnecessarily on expensive MRI and CT tests as well as doctor visits and drugs. Why the medical community hasn’t yet woken up to this problem just dumbfounds me. (Actually doctors knew more about it in the 1950s when B12 began being manufactured than they do now).

        • Hi Tracy,
          Amen to that! I totally agree with you about getting the word out about B12 deficiency. I also have permanent nerve damage. In the beginning, my doctors put me thru agonizing tests, costly, and after 2 years a simple blood test discovered my B12 level was 41. I still have specificity, severe stiffness and bad gait. I guess it could be worse.

    • Ciprofloxin is a fluorinated antibiotic. Do some research on prescription drugs containing fluoride and you will find tons of information about the dangerous side effects of these types of drugs. I will not take them. They can cause serious reactions and side effects. When asked about allergies, I list all fluorinated drugs.

  70. I was just tested and have what my doctor considers a ‘normal’ level of B12 at 228. I feel it is too low. Is it too low?? It was 167 two years ago (summer 2013) and I had several injections which brought it up to around 1000, so it’s dropped quite a bit since then.

    What can I do because my doctor won’t prescribe injections for me?

    Is there a way to get Methylcobalamin into my system without injecting it? And is it available to buy online somewhere?

    Thank you!

    • Taura, if you are in the US or UK then 228 is in the gray area of 200 – 450 pg/mL where neurological symptoms can appear. You probably won’t find a regular doctor that will treat you as they typically use a very low cutoff of 200 (some even use lower). A naturopathic doctor is likely to be more willing to treat you. Once you start supplementing then any future B12 tests will be skewed unless you stop taking B12 for 6 – 8 weeks beforehand.

      You can buy oral methylcobalamin on Amazon. If you have pernicious anemia your GI system won’t absorb it properly so get sublinguals. It goes under your tongue so it dissolves slowly into the blood vessels there. If you have a health food or health supplement store nearby, you should be able to get some there.

      Look carefully at the label to make sure you are getting methylcobalamin. You’ll also find cyanocobalamin and hydroxocobalamin. I’ve found the Jarrow brand to be of a reliable strength. Read the reviews if you are concerned about additives.

    • Your Doctor is full of crap. Your numbers are really low. My numbers were at 217 with neurological symptoms. My endocrinologist recommend injections for a few months, which I took. Then he changed me over to a B12 Sublingual 1000 mcg daily. A endocrinologist is the person to seek treatment for this deficiency. I use Nature’s Bounty B12 Sublingual 1000mcg and have been on it for three years now. I’ve tried other brands, but Nature’s Bounty I found to provide supplements of unsurpassed quality and value without the added junk or adverse reactions. The starting standard dose is Sublingual 1000 mcg daily, under your tongue. Take SUBLINGUAL ONLY! Takes up to 2 months to get your levels back into a normal range. Did your doctor test your Thyroid, Vitamin D, etc? Hope you feel better soon.

      • tnt3266

        I agree that they are too low. I’ve been experiencing memory issues and low energy lately. I’m only 37 years old so it’s concerning for me.

        I am currently being tested for high blood pressure (It’s sitting around 145/99) and the doc told me my Iron is low but I don’t know the number. I think I’m going to ask for all my numbers when I see him next.

        I have none of the usual risk factors, I’m not overweight, I don’t smoke, I’m very active, diet is ok etc. So they are trying to pin down the cause (BC pills, heredeitary, or stress), then deal with the iron issue.

        I do have a history of gastro issues like inflamed intestines. I think it’s all related somehow.

        For now I’ve found a sublingual B12 by SunForce – it’s methylcobalamine so I’m hoping it provides some results.

        Thanks for the advice 🙂

    • I highly recommend that you purchase the book “Could It Be B12? An Epidemic of Misdiagnosis” by Sally Pacholok and Jeffrey Stuart. They are two medical professionals who recognized this is a huge problem and are making it their mission to educate doctors and the public about B12 deficiency. It’s available on amazon.

      I came across it when searching for answers after my B12D diagnosis last fall. It is stunning how ignorant most doctors are about this very serious problem.

      Also there are online message boards you can join, such as the Facebook Pernicious Anemia/B12 Deficiency support group and the UK-based Pernicious Anemia Society.

    • Taura,

      A fairly new product that is even more effective than sublingual formulations is a transdermal B12 oil available from They have several B12 products, including methylcobalamin, adenosylcobalamin, and hydroxylcobalamin, as well as other formulations.

      The transdermal application looks like it is comparable to using subcutaneous B12 injections. I have used the adeno/methyl B12 oil for over two years now, and my MMA test shows I’m getting adequate B12.

      • Lynn_M

        Thanks for the tip! I found some sublingual B-12 methylcobalamin and I’ve been using that for a few days. I will definitely look into the trandermal oil though!

        I can buy injectable B12 form the drugstores but I am not comfortable giving myself a shot which is why I’m looking for alternative options.

    • Taura,

      A fairly new product that is even more effective than sublingual formulations is a transdermal B12 oil available from They have several B12 products, including methylcobalamin, adenosylcobalamin, and hydroxylcobalamin, as well as other formulations.

      The transdermal application looks like it is comparable in effectiveness to using subcutaneous B12 injections. I have used the adeno/methyl B12 oil for over two years now, and my MMA test shows I’m getting adequate B12.

  71. My Autoimmune Vitamin B12 Deficiency was diagnosed 2007, but inadequately treated for over a year, which had a disastrous impact on the quality of my life and I’m still dealing with some of the negative consequences. As a physician, I could easily access medical literature on the subject, and soon became frustrated and demoralized by medical care providers who were not as well informed and were not amenable to my bringing them up to speed. I was significantly incapacitated by my illness and had to work far too hard advocating for myself in order to finally receive adequate treatment. Currently, I am very concerned that standard dosing regimens are insufficient to achieve acceptable outcomes for these patients, and patients are still not adequately informed about the many potential comorbid medical issues that may be ignored, and thus hampering recovery. In my experience, providers are definitely not attending to quality of life indicators in order to measure the effectiveness of disease management. I am interested in connecting with advocacy groups and finding venues for better educating physicians and the public with the goal of addressing the importance of early detection and improving quality of care for this group patients at high risk for suffering permanent disability, as well as contributing significantly to rising costs of medical care and elder care in this country that is still under recognizing and poorly responding to the problem.

    • Jeanne, I am so happy to learn you are a physician willing to take an advocacy role in educating doctors and the public about this very serious public health problem. I am a member of some online groups that you may wish to join and monitor as there is much discussion there about late diagnosis and the woefully inadequate treatment of B12D.

      The two groups I’ve found to be most active are the UK-based Pernicious Anemia Society, and the Pernicious Anemia/B12 Deficiency Support Group on Facebook. There are members from all over the world who post on these groups.

    • Jeanne, have you read the book by Sally Pacholok and Jeffrey Stuart, “Could It Be B12? An Epidemic of Misdiagnosis”? They are health professionals (RN and DO), Sally discovered she had pernicious anemia quite by accident while in nursing school. Perhaps you could join forces with them as they have made it their mission to educate doctors and the public. You may be able to get in touch with them by contacting the publisher of the book, the info is in one of the inside cover pages.

      Early this year a movie was released about Sally’s life (titled “Sally Pacholok”, IMDb shows 4 stars for it), but I don’t think it is in wide distribution. If that movie got the level of attention that Erin Brockovich did, it would make a huge difference in the level of awareness of this devastating problem.

      • Tracy,

        No, I haven’t read the book, but will. I’m afraid I’ve gotten side-tracked by quite a few of those comorbid disorders I mentioned, after my B12D was finally diagnosed and treated. But I continue to feel very much alone with the management of my B12D. I’ve lived with the illness and studied my own course long enough to know that I function best with a serum B12 level in the high normal range. Only one of my care providers has had the experience and knowledge to understand why that is the case, while others have consistently sought to debate the issue with me. It’s quite tiresome. I also have Vitamin D Deficiency, and under-treatment was, again, an issue. I have Celiac Disease, and still have to be ever-vigilant with my oral medications in order to maintain the necessary strict gluten free diet. I’ve accumulated a number of entirely unexpected diagnoses over recent years. I have been fortunate, so far, in that all my medical problems are fairly easily managed. I have not been fortunate, in that signs and symptoms of each medical problem presented and worsened, just to be ignored until an acute event occurred. I trained under Preventive Medicine and Continuing Care models. Acute medical events are best avoided. Current standards encourage them.

        • Jeanne,

          Good to hear you are managing your medical problems, you are fortunate. I am disabled as a result of my very late B12D diagnosis. And I’m covered by the largest HMO in the western US, you’d think they’d know better! Just two years ago I was a very active and athletic 56 year old woman. Now I must use crutches or wheelchair outside the house and feel unwell all of the time. I have not been able to find or get a referral to a doctor within that HMO system who knows anything about B12D or PA. The doctors I’ve seen just want to hand out powerful scary drugs for my pain. Most meds I have been unable to tolerate as the PA has made my body hypersensitive. Why couldn’t they have figured out what was wrong before all this happened? I had a number of visits with several different doctors, I kept telling them something was wrong and my symptoms, but none of them figured it out. The state in which I live has such a low cap on medical malpractice awards it isn’t even worth pursuing a lawsuit, it’s even difficult to find lawyers who will touch it. A multi-million dollar lawsuit might have grabbed the HMO’s attention (and the headlines) and perhaps resulted in process improvements and more doctor awareness.

          I agree, current medical practice is to wait for something catastrophic to happen rather than being proactive and figure out what is starting to go wrong. I think doctors in the 1950s were much more aware of B12D than the doctors today. To top it off, there are drugs often prescribed or available OTC that cause depletion of B12 resulting in increasing numbers of people at risk for serious, permanent neurological damage. Meanwhile, doctors continue to hand out antidepressants like candy.

          Other issues with the current situation is B12 is not normally tested by traditional doctors, and the currently accepted normal cutoff is far too low. I think that a B12 test ought to become a standard part of the CBC test as we cannot rely on an elevated MCV to flag a potential deficiency (folic acid enrichment of flour masks this symptom). And as Sally mentions in her book, a B12 level of 200 – 450 pg/mL is the gray area where neurological damage is known to occur, so the lower cutoff needs to be raised to at least 400 pg/mL, at my HMO it is currently 200 pg/mL. When my B12 was finally tested it was 196, barely below the minimum, and I was in terrible shape neurologically by then. There does seem to be a wide variation in symptoms vs. B12 level among people so improvements in analytic test procedures as well as allowing physicians to treat by symptoms not just the numbers are also sorely needed.

          Hope to see you on the FB or the PAS message boards!

  72. Hello. I have been reading many posts here very recently and am amazed. It has been a revelation. I will keep my post as short and sweet as possible. I am 57 years old and have been in pretty good health all my life until recently. About a year and a half ago I started to notice pain in my feet after not being on them very long at all. Also noticed range of motion in my hands was decreasing and some loss of sensation in fingers which at the time I attributed to age related arthritis and long standing carpal tunnel. Approx. ten months ago severe neurological deficit started to manifest itself very insidiously. I now have severe paresthesia / hyperthesia in both hands with very restricted range of motion. Intermittent tingling involving various parts of my body especially my lower legs and feet. Periodic electrical zips/zaps. Itchiness.Cervical and lumbosacral spine pain. Myasthenia / myalgia / radiculopathy. Pain…. Pain… Pain… I am anemic and all my doctors never even mentioned the possibility of B12/Folate deficiency. Here are some of my labs:
    RBC – 4.13 M/uL
    MCV – 106 fL
    MCH – 34.1 pg
    B12 – 279 pg/ml
    Folate – 24.13 ng/ml

    I have been a long term user of both PPI’s and H-2 blockers. My paternal grand mother had P.A. which I informed my doctor of after being advised that I was anemic and not knowing at the time what P.A. even was. Still no mention of possible B12 connection. Well that’s my story so far. I dare not speculate on the next 1 1/2 yrs.
    I think I am in pretty bad shape. Any seasoned veterans out there? I don’t quite know what to do. The best way to describe what is happening to me is it feels like all my sensory nerves are short circuiting. Any advice/info regarding all this would be very much appreciated. Many, many thanks.

    • @paul – A B12 test result of 279 is very low. You have a B12 deficiency. If you want to work with your doctor, you should read Sally Pachalok’s book. Your best bet is to get shots (make sure you get methylcobalamin), because you’ll get more B12 into your system in less time.

      If you want to go it alone, you should search Google for the “active B12 protocol”. Take sub-lingual tablets of methylcobalamin and try to keep them under your tongue as long as possible. Longer time in the mouth leads to better absorption. Anything you swallow is absorbed at a very low rate (which is why you have a deficiency). Some people report good results with transdermal B12, but the sub-linguals are cheaper.

      You should get off the PPIs and H2 blockers, because they interfere with absorption of B12. This may not be easy. Many of those drugs leave you with terrible rebound reflux when you stop taking them. Good luck. There are dietary changes you can make to improve your situation. I don’t know details, but Google should help.

      The good news is that many of your symptoms should improve with B12 shots or supplements. It may take some time before all the damage is reversed, but the prognosis is good… if you can convince your doctor to keep you on the shots long enough.

    • Paul, your story sounds sort of similar to mine with the foot neuropathy. So glad you found this when you did. Please DO NOT handle treating your B12 deficiency all on your own, you need to be under the care of your doctor and have it in your medical records. As you get treatment you’ll need tests to follow along how things are going, and you’ll need your doctor’s help for that.

      Have you been tested for pernicious anemia yet? The tests aren’t always reliable but if the Intrinsic Factor Antibodies (IFAB) test is positive then you definitely have PA. The IFAB test can give a false negative, so the parietal cell antibody test is run. Your doctor should order both tests. Since PA runs in your family, it’s very important to get tested for PA as soon as possible BEFORE taking any B12. I have read that supplementing B12 can affect the antibodies tests and you want those results to be as accurate as possible. It is also a good idea to get MMA (methylmalonic acid) and Hcy (homocysteine) tests and these must be tested before B12 supplementation as they will drop back to normal levels very quickly after getting some B12. Elevated MMA is a marker for low B12 so it can back up your B12 deficiency. Elevated Hcy has several causes including low B12, and it is a cardiac and stroke risk (some researchers believe Hcy is more important than cholesterol levels for determining these risks). My doctor ran these tests on me two weeks after I started getting B12 shots and by then they were in normal range, so unfortunately I don’t know how bad my levels were but I bet my Hcy was sky high as I was in really bad shape. If your ferritin hasn’t been tested, you’ll need that checked too as you may need to supplement when you start getting B12.

      Your folate is high, mine was too. That really confused my doctor (many who are deficient in B12 are also deficient in folate), but I think that when B12 is very deficient then folate elevates. Both are needed together and there is an excess of folate when there isn’t enough B12, so it builds up. For the B12 test, the US and UK typically use 200 pg/mL as the low cutoff for deficiency, but it is known that symptoms can appear within the low normal range of 200-450 pg/mL. But your MCV is very high, usually the normal range is something like 80-100 (MCV= mean corpuscular volume, the average size of red blood cells). Yours are very large, meaning your blood cells are what doctors call macrocytic. That is a definite sign of B12 deficiency. Even though your B12 is not below what doctors use as the normal range, your high MCV means you are deficient and you need treatment ASAP. The serum B12 test is a measure of active plus inactive B12 and some people may have a smaller proportion of active B12 even though the total is within normal range.

      Mike S. is right, you need to get off of the PPIs and H-2 blockers but from what I have read it won’t be easy, work with your doctor on this. Search the internet and you’ll find stories from other people who have done this. I sincerely hope that you don’t have PA so that getting off of these drugs will restore your stomach. PA requires lifelong treatment and there are many other problems associated with it (higher stomach cancer risk, stomach and malabsorption problems, continuing fatigue, etc.). Sadly, doctors have been duped by Big Pharma into believing that stomach acid is a problem. The real problem is low stomach acid, which has similar symptoms. As people age, they typically produce less stomach acid, not more.

      Not many doctors seem to be aware of this so you may need to find one in your area that is more knowledgeable. Severe B12 deficiency may require longer and more aggressive treatment than the standard formula most doctors go by (in the US it is 1000 mcg B12 shots of cyanocobalamin, every other day for a week, then once a week for a month, and once a month after that). In Sally’s book she recommends methylcobalamin every other day until there is no more improvement (rather than just a week). I personally have found that once a month isn’t enough and I need to supplement on my own in between.

      There is a Facebook group for PA. You may benefit by joining the group as the members are very knowledgeable and supportive and it sounds like you need this right now. And you should get Sally Pacholok’s book “Could It Be B12? An Epidemic of Misdiagnosis”, it’s available on amazon, not very expensive (the price of most paperbacks).

  73. Hi, my name is Sandra and I am 28 years old. I have been living in Berlin for almost a year and started having what I thought were sciatica symptoms for about a month now. I went to 2 hospitals and they said I was fine after they ran blood test. Until, I decided to go to an orthopedic. I told him my I haven’t really been the healthiest and was definitely drinking excessively and am not really a full vegetarian . He told me I didn’t have sciatica and that I was vitamin b deficient. After I took the vitamin b complex for a week, I felt like my old self again with now pains and was able to run around.. I messed up because friends were in town and I thought I could handle “partying” with them drank and guilty of doing some drugs. It wasn’t a lot, but was enough to make me feel the same again and also spark up a sinus infection.
    I went back to my orthopedic doctor and I told him the truth and he made a vitamin b transfusion. It’s the second day and I still have tingling in my body especially my left leg and feel fatigued. I totally understand that I definitely messed up with my poor choices. And am super ready for a lifestyle change. I just would like to know if this permanent nerve damage, and if there is anything else I can take if I don’t get better. Or if the shot is better than the transfusion? i’m not sure yet how many milograms were put in me. But I am taking the vitamin b, magnesium, vitamin D and C, along with Calcium. I know I am a stupid kid, but in a way its a blessing in disguise showing me that I am not being good to myself by self destructive. Please help me. Thank you, God Bless.

  74. I am going through some attacks formore than 4/years now each each month my body goes through a debilitating attack. Can not get b12 to absorb. Doctor does know what is wrong, worst starts a week before period fatigue blurred vision confusion then worsens right before inflammation breathing labored. Other blood test high MCV, MCH and Absolute Eosinophils. SymptomsMy symptoms inflammation all over (tight feeling, painful in areas of body I use more often). Bluured vision with a pressure and delay in eye (right), crawling skin every once in a while, inflammation, pain, confusion, mood changes, circulation issues, palpation in heart with instead tight feeling around throat, cystics on face, low testosterone and I take a compound for also still low and progesterone even though I take a compound and estrogen very high. I feel like my body is under attack I am no use to myself or family. I can nearly move or talk and the my period starts I get a some relief. The attacked are getting more severe. I am afraid I am getting worse and no one is helping me. I am getting worse. My body is not absorbing any b12, progesterone, testosterone.

    • Sounds like you already know you are B12 deficient. Are you getting large doses of B12? You may need injections, typically these are 1000 mcg (micrograms). Normal RDA for B12 is 2.5 mcg so you can see injections are a large dose. The amount of B12 in a multivitamin is not enough.

      Since your eosinphils are high, get tested for parasites. Elevated eosinphils can be one of the signs. Parasites can rob your body of B12, so if you are getting lots then that could be where it is going.

  75. I am looking for a cause of the neuropathy in my feet. I am 50, have had the problem since 2012 and it is getting worse. In 2013 my homocystine level was 8. I have read that anything above 7 should be followed up with additional bloodwork. In 2014 my neurologist ordered bloodwork and my B12 level came back as 384. I didn’t know much about it and she just said it was fine. Even after I have been taking a multivitamin and B12 fairly religiously, my B12 level came back as 360 last month. I recall that my father had very bad neuropathy in his feet but he was not a diabetic. Also, my daughters B12 level came back as 304 and she is having nerve pain in her feet and hands as well as serious psychiatric symptoms. I have been reading a lot about people having problems with B12 levels under 400 and that the level should probably be above 500 to be safe. I think that I may have an inherited condition concerning how my body processes B12 that came from my father and was passed by me onto my daughter. I don’t think it is full blown pernicious anemia, but I don’t know. Any thoughts someone could share would be greatfully appreciated. If my neuropathy is from a B12 deficiency, any info as to whether or not and how long it might take the nerves to regenerate would also be helpful. Is the prognosis better since me and my daughter’s levels were above 300? Thanks!

    • Hi Joe, short answer to your question: get treatment ASAP as you are showing symptoms. You do need to get blood drawn for some tests before your first loading dose of B12, see below.

      The long story: My neuropathy started in fall of 2013, developed into pain that was diagnosed as a neuroma (swollen nerve). It got so bad I could not sleep with anything covering my feet and had to ice my feet every afternoon. The podiatrist insisted I had neuromas so I opted for surgery in late July 2014 to remove one in my right foot. Two weeks later I sensed something wasn’t right and I got progressively more and more ill. 3-1/2 months went by before I was finally diagnosed with a B12 deficiency, by then my B12 was 196 and I had severe neurological symptoms (shooting pains in my legs, palpitations, personality changes, insomnia, and more). I’ve now been getting treatment for 9 months; unfortunately my diagnosis was delayed too long and I still have the neuropathy as well as other nerve problems, and am disabled as a result. I keep hoping for a miracle, in the meantime I’ve started taking a drug to try to calm my nerves as they went on a rampage as a result.

      I highly recommend you buy the book by Sally Pacholok and Jeffrey Stuart, “Could It Be B12? An Epidemic of Misdiagnoses”, it’s available on amazon. In it they say the current low threshold for serum B12 of 200 pg/mL used in the US is way too low. The gray area is 200 – 450 and is where neurological symptoms are known to occur. You and your daughter are within that range and are clearly showing neurological symptoms so you need to find a doctor willing to start treatment. Traditional doctors are likely to balk as you are not below that low threshold, unless you find a really good one. Naturopathic doctors are typically more likely to start treatment.

      The amount of B12 in a multivitamin is not enough to make much difference when you are deficient. The RDA is something like 2.5 mcg (micrograms). Treatment usually consists of a series of high dose 1000 mcg injections. Initially they are quite frequent to load up your system.

      From what I’ve learned, the biggest impact on prognosis is how long you had symptoms before getting treatment. It’s generally felt that the damage is reversible if symptoms have occurred for 3 months or less. Nerves do heal, but they grow very slowly so it can take years.

      Be sure to get a blood draw for methylmalonic acid (MMA), homocysteine (Hcy), intrinsic factor antibody, parietal antibody, folate, and ferritin tests BEFORE you start B12 treatment. A urinary MMA (uMMA) test is best if you can get one. MMA will likely be high if you are B12 deficient and can be used to confirm deficiency (some doctors may know this and start B12 shots even though you are not below the minimum). Hcy will likely also be high, it is associated with cardiac disease and strokes though when high is not specific to a B12 deficiency. After you start B12 injections, your MMA and Hcy should quickly drop back to normal levels. You need the antibody tests to check for pernicious anemia and these should also be done before your first injection as B12 can interfere with the results. It is important to know your ferritin level as when you start getting B12 injections your body will kick into gear making new blood cells and ferritin is needed for that, you may need to take an iron supplement. Folate works hand in hand with B12, and may need to be supplemented as well if it is low.

      You may have MTHFR genetic mutations which can affect the processes in which B12 is involved. This is too complicated to go into right now other than to say you might want to get a genetic test as it takes a while to get the results. If you have a family history of Leber’s disease (affects the eyes) be sure to tell your doctor as the type of B12 traditional doctors use, cyanocobalamin, should not be given. There are other types of B12 available that should be used instead.

      Good luck and I hope you both get treatment promptly.

      • Thank you for the information Tracy. You were right about the MTHFR mutation. I am compound heterozygous for the two variants. As I understand it, MTHFR mutation can cause neuropathy in and of itself and the gene requires adequate B12 to function as well. With my B12 deficiency and MTHFR mutation, no wonder I have neuropathy.

    • Hi Joe,

      Your daughter should also be taking B12. You both should also be taking D3 and Magnesium.

      Have you been checked for Celiac? I believe that runs in families. Try to eat as organic as you can, and if you have the room, grow your own veggies. The more I read and hear, the more squeamish I am about our food supply. It doesn’t stop me from eating Taco Bell and then Peanut Chews, you understand, but at least I know that stuff is not supposed to be good for me.

      Good Luck.

    • Does anyone else have trouble posting here? Overtime I go to post something, I get an error message that the site’s server is down, so I click the button that says to try a live version, then I hit the back button, and there is my post.
      Today, when I add a post, and then try to add another, my first post is still in the comments section.
      Is it me, or the site? Either way, it’s frustrating, especially the times when my post does not appear.

      • Ann, yes that happens to me when I post to this page, I just ignore the error. I think it might be due to so many comments attached to this particular page. This has got to be one of the most highly commented on pages Chris Kesser has on his blog.

    • Joe, I don’t know if your still tracking this as there’s a 15 month spread since your question. Medications, chemical exposure and air pollution can cause neuropathy.


      Posted earlier today; Chemically induced Neuropathy can be caused by medications, chemicals and air pollution.

      Quote: Management
      In addition to advising the patient to avoid the causative drug or occupational or environmental toxin, management of toxic neuropathy can include the following:

      Ref: Toxic Neuropathy: Practice Essentials, Background, Pathophysiology
      Feb 3, 2016 – Toxic neuropathy refers to neuropathy caused by drug ingestion, drug or chemical abuse, or industrial chemical exposure from the workplace …

  76. My tongue became swollen 10 months ago and my RBC count is 3.8, has been for years. I was given one B12 injection a week for 4 weeks in January then one a month since January. My tongue is still swollen and in fact tingles from time to time. I also take 6 to 8 doses of transdermal B12 daily. Am finding it impossible to take folic acid as I lack enough stomach acid. Nothing has changed. Totally fed up, have already changed my doctor and can’t do it again.

    • I didn’t have a swollen tongue, but I did have really red Geographic Tongue, which still comes and goes, but not so often, and not so bad. It used to go up to the roof of my mouth, and onto my tonsils.

      Anyway, the b12 and the b complex, including folic acid did not help it that much. What helped was the D3 and the Magnesium.

      Can’t you get a shot , a patch, or an oil with folic acid. How about taking it with orange juice, or Apple Cider Vinegar with the mother still in it mixed with water and unpasteurized honey? I haven’t been taking Bragg’s ACV for awhile because, after a month or so, uch, but it really makes me feel good.

      I believe that you have to get the right combination of things in order for your body to work well. Many people tout honey and other bee products. Try adding some of them. I don’t remember the name of the Canadian company itself, but I subscribe to newsletter called “Bee Pollen Buzz”. If you Google it, it should pop up. Try getting something from there.

      For you, and everybody, non-vitamin things that I think are helpful:

      Soups and stews (even if you are vegan, use veggies)
      Unfiltered Apple Cider Vinegar with the mother still in it
      Cod Liver Oil — not just fish or Krill oil
      Exercise — even if you walk for 3 minutes a day, that’s somthin more than nothin
      Stretching — it helps unclog the Lymph system
      Unfiltered and unpasturized bee products
      If you are not vegan, Marrow — I am still up in the air about organ meats

      I read a lot online and listen (tv) a lot, and know what works for me, and I filter out the phonies, so I am confident that the above can really help.

  77. About 10yrs. ago I started having numbness and tingling in my feet, tiredness, mouth ulcers. I went to so many doctors and had numerous MRI’s, lumbar puncture and bloodwork done. Two yrs, went by until a doctor found out about my situation and asked me to make an appt. With doing more bloodwork and this time testing my B-12, I have a B12 deficiency. My level was severely low at 41. He started me on a regimen of cynocobalamin shots and my level went up over the next months. Later, I started using a B12 nasal spray instead of shots. Well as my levels was very good, I still had numbness and tingling and my gait is terrible. Then I started using Transdermoil (methycobalamin) and although I have nerve damage, theres a slow process of nerve regereration happening. It may take a long time for my nerves to regenerate fully but I feel better using methylcobalamin oil rather than cynocobalamin. Doctors here just are not familiar with the knowledge of B12 deficiency and thats why I started doing research on B12 on the internet.

    • may be u take to much nuts (family of seeds etc ground nut, peanut, walnut etc) may cause uric acid problem usually if u stop taking uric acid foods this problem may go away after 6 months

  78. I was diagnosed as low B-12 four years ago (using a MMA test) and started giving myself B-12 shots bi-weekly until I was in a good range and then monthly. My new PCP states that my B-12 level is normal (regular B-12 blood test) and has taken me off shots. I am starting to get the symptoms again of low B-12 (migraines, foggy feeling, fatigue, etc). Pernicious Anemia runs in my maternal family side. I understood I would have to take shots for life so I was surprised I was taken off the shots. Should I request my new PCP run an MMA test

    • Have you been tested for pernicious anemia? You should have been tested when you were diagnosed with a B12 deficiency, especially since it is known to run in your family. Get tested if you haven’t already.

      Other reasons your B12 level has dropped includes gut parasites and SIBO (small intestinal bacterial overgrowth) which can rob your body of B12.

  79. I went to the doctor complaining of dizziness, memory loss, stumbling, depression, numb feet and hands, and many of the other symptoms mentioned here. My B-12 was 115. I have been on B-12 shots for 4 months, every other week. I just had blood work again and it still only 249. She said that is very low considering I have been having shots for 4 months. She wants me to see a Gastroenterologist. What would case my levels to not increase. I could not tell a bit of difference from the shots. I feel exactly the same as when I started. I want to feel better. I have been like this for so long, I guess it just feels normal to me now. It is all I have known for so many years. Thank you for your input.

    • Dianna,
      The B-12 shots you’re getting are probably cyanocobalamin. People with certain genetic polymorphisms lack the enzymes necessary to effectively convert cyanocobalamin to methylcobalamin, the active form of B12. You could look into getting injectable methylcobalamin from a compounded pharmacy, as one solution.

      What I use is a methylcobalamin/adenosylcobalamin transdermal oil from It’s a red oil that comes in a pre-dosed pump. I apply it on my skin at least once a day and rub it in until the red disappears – takes maybe 15 seconds. You could use daily or even more frequent applications of the b12oil while continuing your injections.

      You need Vitamin B2 to metabolize Vitamin B12. You might check out whether you have any other nutrient deficiencies.

      The serum B12 test is not very accurate. A MMA test (methylmalonic acid) would give you a truer picture of your B12 status.

    • A couple years ago my doctor suspected mal-absorption issues, as my B12, Iron, and Vitamin D (possibly others, too) levels were all below HALF of the minimum recommended level. Colonoscopy revealed no evidence of Celiac Disease…my doctor didn’t pursue any other causes, and eventually I changed my doctor! However, I have heard him and other doctors say that a swollen tongue can be an indication of low Iron levels. If Iron, Ferratin, and B12 levels have not been tested, it’s a good place to start….also fairly easy to treat with prescriptions/injections.


    • Hi Lisa,
      I have a few thoughts for you:

      a) 5 months isn’t that long. It has taken me over 3 years of taking the sublinguals, and I still feel tired, but I do feel better. Many of my symptoms, like foot pain, got better right away, so if you have symptoms besides fatigue that don’t seem to be getting better, I would discuss other diseases — diseases which might have developed because of low B12 — with your doctor. Lupus is the first one that comes to mind.

      b) Take other vitamins — B complex, D3, Folic Acid, Iron, Zinc, C, and Probiotic.

      c) Go to a pulmonologist and have yourself checked for asthma. It kind of snuck up on me, but my first visit cleaned out my lungs so well, I had tremendous energy, and didn’t even need my 1x glasses to read! It only lasted for about 2 days, but it was great.

      d) Have your liver checked out. If there is something wrong, there are a lot of things they can do. The latest news is even if your liver is really bad, you can heal it by drinking 4-5 cups of black coffee a day.

      e) See about weekly B12 shots.

      It’s good that you have a B12 proactive physician, so I would discuss all my symptoms, even the smallest weird thing you notice lately, with him, and see if he has any ideas. Good luck!

      • Hi, mostly Vitamin B12 & D3 have similar symptoms except those related to neurological (and some which I may not know). I would suggest please check your Vitamin D3 levels and if found deficient or even insufficient get those shots too. Hope to hear to recovering soon.


  81. What many people don’t know is that you can have a high level of B12 but it’s not reaching the cells. My serum level of B12 is 1500 (I have taken methy B12 shots for years) but in spite of supplementation of it and folate, my homocysteine level was still high. My doctor ran a micronutrient test that showed in spite of all those shots, I’m deficient in B12 in the cells. I have a c677 methylation defect. So don’t assume your serum levels are accurate.

    • Collen- were you able to fix this? If so, I’m curious as to how. I’m starting b12 and methylfolate soon myself.

    • I had the same experience- I have very high b12 serum level when blood tested, but neurological b12 defiency symptoms and a nutrient test showed the defiency. I’m homozygous for c677t. I’ve been supplementing with a methyl compound and I’m still deficient according to that nutrient test and symptoms are bad as ever. Has anyone else in this situation found a solution? I’ve been on b12 shots in the past but maybe not enough or consistently enough.

  82. So you never explained what b12 is? Is it a vitamin or a bacteria? I also could not find any links to studies!! You are not a MD or even a doctor so you can’t advise people without providing evidence to the studies you reference? This is dangerous information Chris and you are misleading the public. I feel sorry for people that take your paleo advice, A diet never proven to be healthy or primal for that matter and in fact the studies show the opposite. Seriously I feel sorry for you that you make money while claiming to help people improve their health. You need to provide peer reviewed studies or it’s just an opinion from a guy who created a website.

    • Jon – with all due respect – you need to wake up and smell the carbohydrates. This unsubstantiated ‘Paleo diet’ as you refer to it at heart is simply eating real food. Not food from boxes and plastic wrappers. I do not eat Paleo style – I eat about 100% meat. Now there is something to get worked up about.

  83. Not sure if this helps or if anyone is interested but I recently heard about a new oral prescription alternative to the injections called Eligen B12. I recently read that it works even if you don’t have intrinsic factor (so even if you don’t have normal gut absorption). Apparently it came out a month or two ago. Has anyone heard of it or tried it??

    • Yes, I’ve heard of Eligen but none of my doctors have. I would love to know whether it will work for those of us with pernicious anemia, who cannot absorb B12 from food. It would be great to just take a pill every day.

      My guess is that it will be heavily marketed to users of PPIs and H2 blockers. Those drugs decrease stomach acid, and low/no stomach interferes with absorption of B12 from food, eventually leading to a B12 deficiency. This could be a way around that problem since many don’t know the danger of long term use of those drugs.

      It may also be prescribed to those who have gastric surgery.

      • I am finally feeling well again. But a year and a half ago I was extremely B12 deficient. No energy, couldn’t see or walk straight. My Dr’s couldn’t help etc.. Anyways, after carving pumpkins before Halloween, roasting the seeds and eating a lot of them one night. I passed a long tapeworm! (I know, it was aweful) it’s embarrassing too, but after that, I started getting b12 shots and am better now! Noone would have known it was a tapeworm if I hadn’t eaten those pumpkin seeds!

        Just don’t rely on dr’s. Luckily I found out the cause randomly. But they would not have found that out. One Dr. tried putting me on anti depressants b/c I was so tired.

  84. I began using an organic vegan based B12 spray after I had an oral surgery that left my lip and chin numb for weeks after surgery was done. I developed severe recurrent yeast infections. I realized that this was in part due to the antibiotics which were given to me after surgery. BUT as Chris Kresser states if the only true form of B12 comes from animals and the vegan version of B12 spray uses Brewers yeast (saccharomyces cerevisiae) to derive B12 then does that mean it’s pointless to be taking vegan B12 supplements? This seems to be the appropriate conclusion. So my question is: how do B12 injections differ from vegan sources of methocobalymin? Is it safe to inject B12 if the vegan methocobalymin (derived using Brewers yeast) may have been the culprit in my yeast infection? How are the shots different?

    • Candida albicans is the yeast that causes yeast infections. You can combat it with Primal Defense ULTRA (contains Saccharomyces boulardii, very beneficial), caprylic acid, gymnema sylvestre, etc.

      Before abandoning the spray, have your B12 levels tested. Sublingual B12 can be comparable to shots and much less expensive. Best of luck.

  85. Can anyone chime in on this process to make homemade B12 mineral brews. You ferment a mineral solution which contains trace amounts of cobalt. The idea being the bacteria can produce b12. Here is the process…

    “What I have been doing is to buy a very high quality probiotic with more than twelve strains (I would like to synthesize one myself from a pristine organic source when I learn the process). I then add this probiotic to water or coconut water in a good sized mason jar or a fresh local organic fruit juice you may have ripe in your area… then I add some ionic minerals and I fill up the jar with liquid and place a loose cap on it and let it brew for one to three days in a warm and dark place- if you have water kefir grains this is better to add to as well- if you are using only water and no juice then it is important to add about one to two ounces of sugar to a quarter to half gallon of water this way the bacteria can “wake up” and start metabolism and proliferation using the sugar as a fuel source. After one to three days the brew will not have sugar and it will have bubbles because of bacteria releasing Carbon Dioxide. The Key is to give the bacteria enough minerals to convert into usable forms for the body for example high quality Ionic Minerals Eco Organics Augustus Dunning in Texas is well made and he can give you an idea how this process works by the analogy of making compost tea. In essence instead of making compost tea for your garden you are making a highly utilizable mineral brew for your body, these bacteria will become house cleaners in the body. One the brew is done you can drink half of it in a day, at the end of the day refill with water and add sugar- or add fresh juice or coconut water and let brew again, because of the activity being present in the brew it will be ready in around twelve hours at around 75 degrees F. So this may well be a source of B twelve if cobalt is present in the trace minerals you feed the brew”

  86. I feel so frustrated. My results came back as 142 p/mol and my doctors response was that i need to ‘stop reading up on B12 deficiency on the internet’ as my level is ‘normal’. I would like to start trying for a baby and would like my levels to be a lot higher. My GP told me that my B12 levels are of no concern. I could accept this if it were easy to simply get a second opinion however I live in a remote community and there is no other doctor. She honestly made me feel like I was a moron for requesting a B12 shot with my current levels. Crap Doctor award goes to her.

    • My B12 level was 232 pg/mL and my doctor had me come in everyday one week and get a shot, next week twice and I did twice a week for a month, then once a week for a month, then the following month bi-weekly, and then finally once a month. My symptoms were fatigue, tired all the time, depression, memory loss, body aches, and dizziness. But also my vitamin D level was horribly off along with the B12. If I were you I would get a second opinion. My level was 232 pg/mL but my physician said that was extremely too low. Good luck!!

    • Hi Kristy,

      Unfortunately, a lot of doctors are ignorant about B12. They feel it is homeopathic nonsense. I had CLASSIC B12 symptoms, right down to the red sore tongue, but my doctor didn’t diagnose me. She was only worried about my blood pressure.

      If I were you, I would definitly start taking at least 5000mcg a day of B12. I take Natural Factors that I get through You should also take Folic Acid. Some B-complex pills have it, and some don’t (you should take a B-complex, but ignore their B12). Check out different OTC pre-natal vitamins for the rest of your vitamins. See if your doctor will test you, and give you the right info for D. She might, they are all into D now. I don’t know what the right number is, but if it is low, make sure you spend 15 minutes in the sun every day without sun block — that includes face cream with sun block. If you have to take a supplement, I take VitaFusion D3.

      Good Luck!

      • Many people cannot utilize folic acid, especially if they have the mthfr gene mutation. A prenatal with folate or methylfolate is much better than folic acid.

        • Ally, that is not really true. For a start folate is the ionized form of folic acid. It is used as the back-bone for many derivatives of folate. All people, regardless of their MTHFR status can use folate for their folate cycle, as it does not involved MTHFR. In contrast, you cannot use methyl-folate in the folate cycle unless you first remove the methyl group to make tetrahydrofolate. For this you need the enzyme methionine synthase, BUT in order for that enzyme to work you need methyl B12 as a co-factor for methionine synthase. Thus you cannot use 5MTHF if you are severely B12 deficient. This is regardless of your MTHFR status. MTHFR only becomes involved in this process in order to move folate out of the folate cycle so that you can use the resultant 5-MTHF as a methyl donor for the methylation cycle. So theoretically you can use either folic acid (folate) or 5MTHF for the folate cycle, but you can only use 5MTHF if you have sufficient B12 for methionine synthase to work.

          • Yes, I absolutley agree that methylcobalamin is needed. It’s very important to have adequate levels of b12, specifically adequate intracellular levels, in order to utilize methylfolate and improve methylation. I disagree on two things, however. Folic acid is NOT the same as folate. Folic acid is synthetic, while folate is found in food. The terms cannot be used interchangeably. Those with the mthfr mutation, especially those who are homozygous, lack the ability to break down folic acid. If one is heterozygous, the ability is approximately 30% reduced. If homozygous, the ability can be dangerously low at around 20-30%. Depending on other factors, including lifestyle, nutrition, other snp’s, etc, folic acid can build up in the blood in those who aren’t methylation well and cause many problems. If a woman knows she has mthfr, she is much better off supplementing with a prenatal that contains methylfolate. Pregnancy is a time of high demand for folate, and if the mother or baby have mthfr, and are not receiving adequate amounts of folate or methylfolate needed for growth, repair, methylation, etc, problems can arise. Again, I defenitley agree other cofactors are needed, but as a dietitian and someone with mthfr, I whole heartedly disagree that folic acid is safe for those with mthfr, especially women of child bearing age.

            • No Ally, you are not correct about folate. Folic acid, is the unionized form of the vitamin, the ionized salt form is folate, thus sodium folate, would be how you describe the sodium salt of folic acid. Thus if you take folic acid the carboxyl group is COOH, now if you then add sodium hydroxide to a solution of folic acid the change in pH will ionize the folic acid from COOH to COO-, The sodium ion (Na+) will then associate with the negative charge on the now ionized folic acid and form the complex sodium-folate Na+Folate-. This an incredibly basic bit of chemistry and I cannot understand why people don’t just check this. The same thing happens with most organic acid, such as acetic acid (R-COOH), when this is neutralized with sodium hydroxide, it becomes sodium acetate (Na+RCOO-), which you can purify as a salt. When you put folate into the stomach, the reduced pH in the stomach turns it into folic acid as the carboxyl group is now not ionized.
              Once either folic acid (folate) or 5MTHF enter the folate cycle THEY ARE IDENTICAL no matter which form was administered.

              • I think we’re going to have to agree to disagree on this. I understand what you’re saying, but that doesn’t change the fact that those with mthfr cannot break down and utilize folic acid. They lack the enzyme to do so. Folate contains some methylfolate, but not enough to support methylation. Thus, with low amounts of the usable form of methylfolate in food, and an inability to breakdown folic acid, supplementation with methylfolate is necessary for those with mthfr. Again, as someone who has been directly affected by this mutation and who works in the field of nutrition (and yes, I took a lot of chemistry), I stand by my original statement. I encourage you to read and learn about how the two are different and how those with the mutation are affected. Here’s an article from Chris kresser himself explaining it. There are MANY others if you do a simple search. There are even some comments from those on this thread with mthfr who commented about the need for methylfolate and methylcobalamin. I’m not tring to argue. I’m merely passionate about this topic because of how poorly it began affecting my life after having a baby.

                • Hi Ally, You seem to be mixing up two cycles, the folate cycle and the methylation cycle. In the folate cycle, the backbone molecule folic acid(folate) is modified to form different analogues/derivatives of folate. If you start with folate, you then make dihydro-folate, tetrahydro-folate, 5,10-methyelene-tetrahydro-folate and N10-formyltetrahydro-folate. Now these are all analogues/derivatives of folic acid, but in the pH of the body they would be derivatives of folate. They are NOT folate, they are folate analogues or derivatives. Nor are any of them involved in methylation directly. You can make all of these derivatives of folic acid by consuming folic acid as a supplement. So folic acid as a supplement will make all of the folate cycle analogues. For the folate cycle you do not even need MTHFR, as in the presence of enough SAH it is turned off.
                  Now the methylation cycle is very different. Here, technically you don’t need folate analogues at all. If you eat enough methionine you can get your methylation from methionine and thereby make SAM. Now you would have to eat a lot of methionine though. Similarly, if you provided enough methyl B12, you still wouldn’t need 5MTHF, you only need 5MTHF to regenerate methyl B12, once it has donated its methyl group to homocysteine to make methionine. Technically, if you provided enough folic acid, you technically don’t need to provide 5MTHF at all, as you borrow it from the folate cycle, strip it of its methyl group and RETURN it to the folate cycle. Being a cycle the folate backbone goes round and round being modified and forming the various folate analogues.
                  So the problem happens when you want to move the folate analogue out of the folate cycle so that the methyl group that was put onto THF by SHMT can be used to regenerate demethylated methyl B12. This is when you use MTHFR. It has nothing to do with dietary folic acid, 5MTHF or folinic acid, it has to do with modifying 5,10-MTHF and reducing it to 5MTHF. Thus, regardless of the source of the folate backbone, be it folic acid, folinic acid, THF, 5MTHF, it is the 5,10-MTHF that is modified to form 5MTHF. What appears to have happened in the “Great Folate Debate”” is that somewhere along the debate someone has shortened the common “folate analogues” description of all of the folate derivatives in the folate and methylation cycles and changed the terminology to “folates”. One would normally only do this in a paper, or similar publication where you would tell the reader that you were going to group all of these analogues under the terminology “Folate” with the added “analogues” being then understood. FYI despite the claim that folic acid did not exist before supplementation, this is incredibly unlikely as you have the enzyme dihydrofolate synthase. From an evolutionary point of view one would not bother making an enzyme for which their never had been a use, and then maintaining it in the population. Similarly it was the addition of folic acid to food that reduced the incidence of spina bifida, not 5MTHF.

            • Ally, you are also wrong about MTHFR. MTHFR has nothing to do with the initial processing of dietary 5MTHF. This B2/B3 dependent enzyme is responsible for reducing 5,10-methylene-THF (hence the name reductase) to form 5-MTHF. So the enzyme moves and converts folate out of the folate cycle and makes it available to donate the methyl to regenerate Met from homocysteine. Thus, MTHFR has no idea where the 5,10-methylene THF originated from, either as folate or as 5MTHF. Thus MTHFR mutations have no variable influence on the processing of either type of folate analogue. In fact in the absence of B12, only 5,10-methyleneTHF, which has originated from folic acid (folate) will be processed by MTHFR. The good news is though that most people have at least a very small amount of B12 (they would be dead otherwise).

              • I’m not wrong, but maybe you’re misunderstanding what I’m saying. Yes, that’s what mthfr does, but those with the mutation, esp those who are homozygous, have a greatly reduced ability to convert 5,10-methylene-THF to 5-MTHF. 5-mthf is what the body needs and uses to function. Folate from food is a better option for those w the mutation because it already contains some methylfolate. With a 70-80% reduced capacity to metabolize folic acid, it starts to build up in the blood and cause many problems (high homocysteine, birth defects, etc), esp for those who are homozygous, meaning both copies are defected and do not function properly. Low b12 only adds to the issues. Most people with mthfr have problems utilizing b vitamins as well. Generally speaking, supplementing w methylfolate and other b vitamins, bypasses the ineffectiveness of the defected genes, and provides the body with the necessary amount needed for methylation.

                • Ah, Ally, we have a saying, “convince a person against their will….”. We have studied the incidence of over 165 SNPs in many people with CFS and in the children and mothers of children with ASD. There is no difference in the incidence of MTHFR alleles than in the general population. I even have people who are “-” for all of the common alleles in MTHFR and yet they have CFS. IT IS NOT THE REASON THAT THEY HAVE CFS. What is more they were perfectly fine with their genetics for all their life until they got sick. What is more we have been able to basically cure the CFS without using 5MTHF at all, so once again IT IS NOT THE SOLUTION. It is your nutrition, not your genetics that is the problem.


                1. Folate is vitamin B9
                2. Critical regulator of methylation
                3. Essential for DNA synthesis and repair
                4. Essential for neurotransmitter production
                5. Essential for WBC, RBC and platelet formation and maturation
                6. Essential for detoxification of homocysteine
                7. Folic acid is unnatural to the human body
                8. There are over 150 forms of folate in food
                9. Use the appropriate term – don’t just say ‘ folate ’ – be specific
                10. Folic acid must undergo numerous steps in order for humans to utilize it
                11. Various nutrients and enzymes are needed to convert folic acid into methylfolate
                12. MTHFR is the last and final step from the conversion of folic acid into methylfolate


                • Thank you Molley for those functional aspects of the “folate derivatives. Technically you only need to convert folic acid to DHF, which can be used for regeneration of BH2, so it doesn’t need a lot of steps to contribute. Most of the functions come from the folate cycle. In addition, I would regard 5MTHF as being more a regenerative molecule to make methyl B12. It is methyl B12 in combination with methionine synthase that reacts with homocysteine, but it is also betaine. Further, homocysteine should not build up in the cell if CBS is working properly. Evidence now suggests that it is lack of function of CBS that leads to Hcy accumulation. MeCbl is probably really only used when dietary methionine is low and you need to recycle the Hcy, though to Met, then make SAM.
                  As for the 150 different “analogues of folate” most of these would be accounted for by polyglutamate modfication of the various analogues, thus having 1,2,3, 4 or 5 glutamates would increase the number of analogues,. I am sure that you realize that this is required to keep the analogues in the cell. 5MTHF from diet is not polyglutaminated but (like folic acid) must enter the folate cycle for this to occur. In contrast to folic acid though, in the absence of MeB12 this won’t happen with 5MTHF and leads to elevated serum folate, confusing the picture for the diagnostician, particularly when B12 levels are low.

    • Kristy–If you have the insurance or simply can afford the b 12 shot–Demand It. I live with a b 12 deficiency. I get a shot every 2 weeks and I’m not even 40. It has taken a permanent disabling toll on my body–overlooked for so long. Lord knows–those babies will suck the life out of you! Babies get ‘fed’ first, right? Don’t be afraid to tell your doctor–“It’s my body–Give me the shot.” Then-do your research. Sometimes we just can’t trust the doc to take care of us. Try to find your underlying cause and start there. Best of luck. Get em.

    • Kristy,

      Dug up that Japanese study and take it to your doctor, along with info from the CDC that says under 200 is low.

      There are also some writeups by doctors for doctors online. Print and take to the doctor as well.

      Good luck!

      • Learner,

        That was very nice of you but I am willing to bet that Kristy’s doctor will not read anything, make a face, and say something nasty.

    • Kristy,

      At 142 your B12 is low. The gray area where neurological damage can occur is 200-450 pg/mL which corresponds to 148 – 332 pmol/L. I sincerely hope you have gotten treatment by now as you are definitely deficient.

      To convert pg/mL to pmol/L, multiply by 0.738. In the US, we typically use pg/mL. For the lower level of 200 pg/mL, 200 * 0.738 = 148 pmol/L.

      Or to convert your 142 pmol/L to pg/mL, divide it by 0.738. So in more familiar units to those of us in the US, your B12 was 192 pg/mL. Low!

      • Kristy,
        10 yrs. ago I was having numbness and tingling in my feet.
        Went to numerous doctors who couldn’t find out what was causing it. Two years later a doctor did bloodwork on me and found out I had a severe B12 deficiency. By then nerve damage and muscle weakness had already set in. The doctor had me get a B12 injection every day for a month and then broke it down to where I hasd to get a shot once a month.At the time when my deficiency was found my level was an extremely low 41.
        Don’t let this happen to you. Start to get injections or some sort of absorbable way.Good luck.

        • Is there anyone that has severe spacticty from a B12 deficiency in their legs? And if so, is there anything to help it. My legs get so very stiff cuz of neuropathy.

    • According to my drs, that is a low level. Years ago, mine hit 102. I now have nerve damage, irreversible and progressing. Don’t waste time, you nerd to be treated. I was started on b12 shots, 2 per week first month, then 1 a week for a month and then one per month since. Until recently my level has stayed between 500-700.

  87. Hi, I’d like to suggest you add symptoms of allergy to your list of things b12 def mimics. At age 21, I was diagnosed with b12 deficiency, at the same time I had random strange allergic episodes of facial swelling/itch etc. The b12 deficiency was put down to vegetarian diet. The facial oedema just stopped happening (I think now because my B12 defiency was treated). Ten years later I was b12 deficient again, and again was having random allergic reactions that included severe facial swelling (I did not connect the 2 things back then). Allergists were never able to come up with an answer other than to take antihistamines. At the same time but unconnected, my b12 defiency was treated and the swelling episodes went away. Fast forward another 15 years and I am plagued by urticaria, again an allergist can’t explain adequately why this has come on but recommends daily antihistamines. I continue on these for a few years – then I am diagnosed with b12 defiency again (and finally confirmed as pernicious anaemia). And again, treatment of the b12 deficiency leads to complete resolution of my allergic symptoms. Can’t be coincidence?

  88. Just asked my primary care doctor to test me for PA. B12 was 214 and intrinsic factor antibody test was 1. Both were stated to be normal on the report but since they were both borderline, I was told to follow up with a GI. I have numbness/tingling in hands and feet, severe fatigue, anxiety, cold intolerance and eye twitches. My mother had PA otherwise I would never have thought to get checked. I want to be sure I am prepared with the right questions for my appointment. Any advice? I am also hypothyroid. I am quite disappointed that since the two conditions are often seen together I was tested for RA, Lupus, Celiac and kidney issues but never PA until my request. How can I trust the next doctor and yet I am unsure of what might be involved to ask the right questions. Appointment is five days away and everyday it seems symptoms are a little worse. So hard to be patient while feeling so unwell. Nothing I can do but wait.

    • I guess you are waiting to see if you can get the shots. I think you should accentuate your B12 symptoms — though I had CLASSIC symptoms right down to the red painful tongue, and nobody thought I was deficient.
      Anyway, if the next doctor doesn’t give you the injections, don’t wait, start taking the sublinguals or start using the oils.
      For hypothyroid, make sure you eat foods with high iodine, and use iodized salt.
      For the eye twitch, take Magnesium. A word of warning, though, if you get the poops often from the lack of B12, magnesium might worsen that.
      See if you are D deficient, that’s any easy one to diagnose.

      Be careful on the dosage of the other vitamins and minerals, they are not as safe as B12, but you don’t have to worry too much if they are, I’d say, as a rule of thumb, up to 200% the daily recommended allowance.

      There was a study recently that Vitamin E intake might seem like it is adequate, but it can attach itself to certain fat molecules ( I don’t think they were specific about which ones) in the bloodstream, and never make it into the cells at all. Well B12 is the same way, only more things can keep it from doing its job. Then “they” say that taking vitamins does nothing. How they quantify this, I don’t know. The medical community really needs to wake up and learn how bodies really work rather than how they theoretically work.

    • You sound like my clone. I just had a doctor’s appointment today and found out I have this problem. The thing that gets me is I’ve had every symptom almost over a 10 year period. A fluke thing had me at this gastrologist who thank God knew what was going on! I’ve had so many tests over the years and never once was tested for this.

  89. Over the last 3 months, I have started to suffered from what seems like musclular pains, started, in my shoulder and moved around to my knee, foot arm and hands causing a lot of swelling, and stiffness. I have now had 2 blood tests that have ruled out iron and B12. Also, I tend to start having a period 1st one after 19 days lasting 10 days 2nd after 17 days lasting 7 days,started to feel numbness and swelling to the hands and shoulder, and started to bleed after only 6 days, doctor has suggested more bloods to be done in a month I am so tried – think I should go and get bloods tested earlier, any advice.

    • Hi Dawn,
      First, the muscle pain could simply be caused by your pillow. Every time my arm goes numb and my hip and knee hurt, I know it’s time for a new pillow — use a higher, firmer one rather than two.
      With regards to your period woes, you didn’t say how old you were, but I am in my early 50’s, and starting to go through menopause. I was originally getting my period every 31 days exactly. Then last yearish, I started getting it every 3 weeks, then 33 days, then 3 weeks. Now twice (I am on the second time) I haven’t gotten one for about three months. In between I had 3 in 1 month. The first day of the 3rd one, I had to call my husband at work to ask him to buy me iron on his way home. I definitely think you should be taking iron and zinc to help absorption. I use Feosol (Bifera, the purple one that doesn’t stop up your colon). I have used the regular Feosol in the red, every once in a while I couldn’t go, and it turns my stool the same color as the pill, but it works well and is a lot cheaper.
      Problems with periods can also be caused by cysts/fibroids. I’m not sure, but I think your OB/GYN can use an ultrasound to detect them. You should ask.

      Defintely try B12 5,000mcg, it couldn’t hurt, and it might help. Try it before they diagnose you with Lupus or some other thing when all you might need is B12.
      I did have joint pain and problems with my period for about six months before I started taking B12, so you might have luck with it as well. Good Luck.

        • Hi MJ,

          I had such pains in my legs and feet that I could barely walk. I started by trying cyanocobalamin, and 2 weeks after I started, I realized that I didn’t have as much pain, and within a month, I could walk up and down stairs with no problem at all.

          The feeling that everything was just too overwhelming took about 2 months to START going away.

          I actually started by taking FOUR 5,000mcg pills a day for, I think, about a year. I eventually lowered the dose to ONE 5,000mcg a day, but my symptoms, especially the foot pain came back after about one month, so now I take 2 about every other day, and that seems to work out well for me.

          I also take TWO Phillips Magnesium pills a day
          TWO VitaFusion Platinum gummies a day
          FOUR VitaFusion D3 a day (I was practically negative)
          ONE Nature Made Super B-Complex every so often. I should take it more often, but it makes me so instantly hungry that I feel extremely nauseous. Vitamins can do that.
          ONE Feosol Bifera a week. ONE a day if I get my period.
          ONE Zinc when I take my iron, but I should probably take one a day, or every other day.
          TWO Sundown Prebiotic every day(ish).
          TWO Sundown Probiotic every day(ish).
          ONE Cod Liver Oil pill or 1 TEASPOON Cod Liver Oil in the bottle a day.
          ONE pill Jet Alert when I need energy — sometimes none, sometimes 4x a day.

          It’s 4 1/2 years since I first started taking B12, and about 3 years since I started the other supplements, and I noticed a few weeks ago that I am starting to feel like my old self again! I still get super tired super fast, and I do still have a real problem with mucus, but I feel pretty good! I don’t feel overwhelmed by the smallest thing, I feel a lot more lighthearted again, and I have my balance back — another symptom was that I kept walking into walls.

          Hope this helps.

        • MJ-
          I get b 12 injections every 2 weeks. You can tell when I need them–I get, let’s say-cranky. I can’t find my words, constant headache, unsteady, nauseous, over-tired etc. If I go too long I start to get the numb tingling in my face and limbs. To answer your question–I feel better immediately after my shot. Makes my jaw drop. My Father-in-law was the same way. I don’t know how you go from one extreme to the other- but I tried the supplement pills and the sub-lingual liquid…nothing works like the shots. My underlying cause is pernicious anemia if that applies to you.

    • Dawn,
      I just saw on Doctor Oz PCOS — poly cystic ovarian syndrome (I think syndrome).
      So, take B12, but it’s one more thing to check out.

  90. I have recently been diagnosed with ME/CFS. My b12 level is 268 which is in normal range, however I believe if I was given b12 injections my symptoms would improve. But I am having trouble getting the doctor to listen to me. I am thinking of getting a second opinion and getting further tests done. Listening and reading other peoples stories b12 does seem to be a miracle in helping people rid or easing the symptoms

    • Go get a second opinion. You may want to try a naturopathic doctor, they seem to be much more aware of B12 and gluten issues.

      You can always supplement B12 yourself. Amazon has sublinguals and mouth spray. Cyanocobalamin, the form most US doctors usually administer, is the worst option as the body has to convert it to a usable form and rid itself of the cyanide. Hydroxocobalamin (used in the UK) or methylcobalamin are much better. You can find injectable methylcobalamin over the internet, I did and from a YouTube video learned how to inject myself subcutaneously. I have pernicious anemia so sublingual B12 doesn’t work very well.

  91. Thank you so much for this forum! In the last two years, I have experienced worsening tingling in my legs, arms, and just recently around my lips. I had blood work done and my b12 is low, but still in the range. I’m a vegetarian of 5 years, but I still eat cheese on a daily basis. I thought that would provide the b12 I needed. When I became a vegetarian, the books advised b12 supplements but I had no idea that a deficiency could have such lasting effects. What’s the best way to reverse all this? I’m really concerned now about lasting nerve damage. What’s the best route – is a supplement sufficient or should I ask my doctor for shots? She didn’t suggest anything because my levels were still in the acceptable range. Thank you!

  92. My B12 is under 100. Four months ago I was getting shots and it was at 1500. Four months later its under 100 and Im so weak, dizzy, muscle pains, cant think, overly moody when Im not a moody person. All I want to do is cry because NO one will help me. What do I do next? Please I beg for help

    • Hi, Karen,

      I used to have many of the symptoms you describe too, before I took charge of my health and started taking B12 supplement daily. I feel MILES better now that I’ve been taking it daily for some time.

      You can buy it on

      This is the brand I use and it works great, though I’m sure any brand offering the same ingredients would work equally well.

    • Karen, have you been tested for pernicious anemia?

      If you have PA then oral supplements won’t work very well as you have antibodies to intrinsic factor in your gut which is what absorbs the B12 from your food and transports it to where it is needed in your GI system.

      With PA you will need B12 supplemented for life (usually by injection but there is a nasal spray available). Pay attention to the kind of B12, cyanocobalamin is readily available in the US but considered inferior as the body needs to convert it to a usable form and flush out the cyanide.

      With your B12 so low, you can get serious neurological damage. My B12 was 196 and even at that level I could hardly walk. I had terrible sciatic pain and pain in my feet for months before finally diagnosed with a B12 deficiency. Then I tested positive for PA.

  93. I am have been veggie for years and always had normal Blood results, until recently, my latest tests show B12 deficiency. Nothing changed in my diet, i guess I just finally depleted my reserves.

    • Hi Sacha,

      I have never heard of a B12 deficiency causing weight loss, only the opposite. Though it’s possible I suppose.

      One friend of mine started losing weight rapidly, and it turned out she had diabetes. Another friend of mine had an overactive thyroid that caused her weight loss. I would see my doctor and ask about those two as well as any other thing he could think of that would cause unexplained weight loss. However, it also wouldn’t hurt any if you took B12.

    • Yes I think for some B12D can cause weight loss. You may not have sufficient stomach acid, which aids in digestion. Then you could have malabsorption of nutrients from your food.

      I lost 15 lbs. over several months and I was quite thin to start with (my BMI is currently 19, low for a woman). Not sure whether it was my Paleo diet which is pretty lean in starches, or my deficiency (I have pernicious anemia), or both. Still struggling to gain some of it back. I don’t tolerate fat well, a higher fat diet makes me feel horrible.

      • Hi Tracy,
        Do you know if you have hypothyroidism as well as the PA, or have you not been checked?. There is quite a bit of evidence to suggest that hypoT may precede PA in some cases.

        • Hi Roy,

          I certainly had hypothyroid symptoms (severe insomnia, night sweats, weight loss) but my lab tests never showed TSH to be out of normal range. My endocrinologist did not run any other thyroid tests (T3, etc.). When I was so very ill it felt like my thyroid was fluctuating between hypoT and hyperT but never could catch it in the labs. And docs in the US won’t treat thyroid based on symptoms alone. Part of my treatment has been acupuncture, the actupuncturist said those symptoms were classic PA where red blood cells becoming enlarged (mine are currently at the top of the normal range in size).

          I recently learned I also have erythromelalgia (feet turn red at night, are very hypersensitive) and hypohidrosis (I don’t sweat much, real danger of heat exhaustion). So maybe some of my symptoms were related to that.

          • That would seem to be a problem. There are many steps between the secretion of thyroid hormone and making active B2 as FAD/FMN, one of which of course is the iodination to make T3/T4, which requires dietary iodine (hard to get naturally without seafood), selenium (which is low in many areas), then of course there is dietary B2, which is hard to get enough of if you don’t eat dairy. You would be surprised at how many “euthyroid” people come up as functionally B2 deficient.

          • Hi tracy
            My problem is also similar to yours. When i had b12 deficiency last year i had unexplained weight loss. This time also from the past 2 months my weight is decreasing along with some other symptoms. Did you get any solution now?

  94. Hi, I had the MTHFR test done and i am not sure what i need to be taking. I have two mutations. C677t and A1298c. My doctor have me a cream but i dont think it is working too well. What other things could i try. Thanks!!

  95. I had to ask my primary care to include testing for homocysteine in the course of a routine exam and blood workup (age 64) and he wanted to know why I wanted it. It turned out my homoscysteine level was 20 (which I think is dangerously high) and I immediately switched some of the B12 folic acid supplement to a folate 5- methyltetrahydrofolic acid alternative. When I had first started taking B12 years ago my urine turned quite pungent and strong. I didn’t notice over the years that to have changed. As soon as I started the folate, the strong pungent urine returned…… which I take to be an indication that the folate is doing its job. I have a retest coming up and will be waiting to see that verified.

  96. Hi Everyone, I had gastric bypass Oct 2014 after surgery I started getting weekly B12 injections and soon as I get the injection I start to feel like in having a allergic reaction to it. I loose my voice, my throat gets tight and I loose my train of thought. I’ve had food allergies my whole life this is the same type of symptoms I get when I have a allergie to food. Has anyone ever heard of someone being allergic to a b12 shot? Oh and I receive mine from a natural path and I use a vitamin B 12 with methyl.

    • I got the shots at first when my B-12 was low. Yes, I also had some kind of allergic reaction after my 3rd shot. My chest and neck got a large red rash all over my skin. Looked like I had been in the sun way to long. Told my Endo and he stopped the shots and put me on B-12 1000 mcg sublingual. I’ve been on this for almost two years now. Just had my B-12 checked and it was high so they are having me to take 1 every other day or 500 mcg daily. I’m also taking D3-5000 IU daily. Doc will see me again in June.

  97. I am male 37 year old
    I am use cholesterol medicine.
    Imy vitamin d level 28.
    b 12 level 128.
    use injection last 2 week.
    I a have pain chest tightness every time.
    heart palpation.

    any experience pls share


    • Bukky – you need to take a potassium supplement until your body has built up its B12 reserves. Correcting B12 anemia temporarily drains your own potassium reserves.

      Same thing happened to me, palpitations and chest pain. Once I started taking potassium the pains went, and I was able to stop taking it once the B12 levels had got up to normal. I used a soluble potassium “Sando-K”

      Your doctor should know about this.

      Hope this helps.

    • Start taking Vitamin C (Food Based like Rose Hip or Camu powder or the one by MegaFood) to help the absorption and to increase levels of B12. Usually Vitamin C deficiency is the cause of low B12.

  98. I’m wondering that since Chris says there are no vegetarian forms of B12, why do some methylcobalamin supplements say “suitable for vegans”. I’ve tried unsuccessfully to find out how B12 supplements are made. Someone online mentions that they are made from bacteria, and that the only reason animals have this in their gut is because they eat the plants that have the bacteria on them. Ultimately I need a methylcobalamin supplement, but want to make sure I’m taking one derived from the right source?

    • I have been vegan for over 4 years and vegetarian for over 10 years and I am not deficient in b12. i am also currently pregnant, so my b12 needs are higher. I take a vegan methylcobalamin spray once a day and my most recent blood test showed my b12 to be in perfect range. The methylcobalamin spray I take is from Garden Of Life, Kind Organics (certified vegan) and is produced from Saccharomyces cerevisiae ( a food yeast grown on molasses solution). I am living proof that Vegan b12 exists and this article is BS, meat eating propoganda. We have 0 nutritional requirements for animal flesh or their secretions. period.

      • I believe that Chris was talking about FOOD sources of B12–and he is right.

        I’m not sure exactly why you are taking such a nasty tone. I don’t consider this to be ‘meat-eating propaganda,’ I consider this to be factual. The supplement you are taking is industrially produced, and is not ‘food.’

        Incidentally, I’ve been a vegetarian since 1969, so I’m not exactly a tool of the meat industry.

        • I agree with David. I always find it curious that a supposedly “normal vegetarian or vegan” life-style is in fact one highly supplemented with B12. You may be surprised at what they feed the yeast or bacteria that they use to make the B12. Normally the amino acid supply comes from acid hydrolysed casein, which is obviously a milk product from cows, so it is hardly Vegan. I would also be very careful of assuming that your B12 levels are “normal”. What you are measuring in serum is what you put into serum, and in your case it was methyl B12. This does not necessarily correlate with what is in your cells, where you need both methyl and adenosyl form of B12.

          • OK David and Roy, please tell me then – why, after being vegan for 20 years do I have a normal B12 level along with a normal blood cell count and full blood work up?

            I have been tested various times over the 20 years, and there is no variation from when I was a massive meat and dairy eater. Why? After seeing these kind of articles this shouldn’t be the case, but it is. I am wondering what the real cause of B12 deficiency is, and whether it actually has anything to do with being vegan or not.

            I heard that humans used to be able to produce B12 in their gut like other animals, but somehow lost the ability. Maybe that is not a universal truth. I’m not saying to ignore the issue. I think people need to pay more attention to their B12 levels. I’m just asking you to check your rhetoric and tell me why I don’t have a B12 deficiency.

            • Cathy, I’m happy for you in that you are healthy and have good B12 levels, albeit having to supplement.

              What I find frustrating is your apparent superiority because you don’t eat meat. This is a choice and as far as I am aware always is rather than your bodies intolerance. Unlike many including my daughter who has Fructose intolerance (the sugar in fruit and veg, also no gluten, wheat, or spices), without eating meat she would live on potatoes and rice and would probably not survive long (also has cfs due to above plus vitamin deficiency). It’s great that you’re healthy and able to make a lifestyle ‘choice’, but others aren’t so fortunate.

        • Great response. I have in my life been all over the board. 16 years vegetarian many on and off years as vegan. I’m often anemic and b12 deficient. Started getting chronic uticarea( hives), but no one ever diagnosed it to be related to the b12. Currently I’m having like mental fog and constant headaches and haven’t been taking supplements for a long time. I’m only about 80% vegan if there is such a thing. Any recommendations on the right form of B 12 that I could get from Amazon that would help me right away? Thanks

      • Laurie, a vitamin b12 deficiency is an insidious condition and you have stores of the vitamin in your liver, estimated to last 2-4 years so it will take several years to become deficient but it will happen, your body can not survive without b12, it’s vital, so please don’t believe that this article is BS, because it’s not. You are correct when you say that your unborn baby will be drawing on your nutrients and I am happy to read that you are supplementing. Please continue to do so and if you are intending on your child following a vegan diet then it is paramount that you supplement your child too because during their years of growth and brain development, vitamin b12 is essential. Trust me when I say that having irreversible neurological damage from an undiagnosed vitamin b12 deficiency, is the last thing that you would want.

  99. I have MTHFR polymorphism. I just found out that my B12 is very low. I know from reading Dr. Ben Lynch’s website that I need to be careful with methylfolate but does that include being careful with methyl B12? I need B12 injections and not sure whether to take the methyl B-12 my doc wants me to use (which has methylfolate included) or ask for hydroxocobalamin. I am already having severe neurological symptoms. Any ideas? Thanks.

    • Do you see a Endocrinologist? This type of doctor deals with these kind of chemical problems in the body. A Endocrinologist will test your B-12, folate, thyroid function, Vitamin D, with a few other test. My family doctor has never tested my B-12 or my vitamin d. I’ve had long term symptoms and was being treated but medication never helped. I had depression, crying spells, body aches/spasms, fatigue, mild seizures, memory loss. The family doctor stated he thought with all of these symptoms, i was bipolar. The word depression … So off i go to see a doctor for depression and this guy orders new lab work and he never checks my b-12 or my vitamin d level! I ended up in the ER after passing out in the shower. The ER tested me for B 12 deficiency and told me to get to an Endo first thing the next morning. I started out with B-12 injections for a few months to get my level back into a normal range. Then I changed over to 1000mg B12 sublingual once a day. Also, When your b-12 is low it effects your thyroid levels, they correlate together.
      I know methylcobalamin treats the neurological symptoms and occurs naturally in the body. When you start the shots it can take a few months before you start feeling better. If you’re seeing an Endocrinologist he will know the best treatment for you based on your test results.

      • I’ve been to many, many endocrinologists and not one did any type of nutritional testing. No, I find if you have B12 deficient tingling feet and go to the average endocrinologist you get put on Lyrica. Your endo is very unique. If the nutritional tests he gives you are serum testing instead of red blood cell tests I would find a more knowledgable alternative doctor.

        California recently passed a bill making it mandatory that its medical schools require substantial nutritional training… first state in the union to require it. Right now future doctors have minimal training in nutrition and can opt out of it.

        “On average, (medical) students received 23.9 contact hours of nutrition instruction during medical school”

        • A good Endocrinologist does more than just a CBC or give you a prescription telling you to try it and see if it helps your symptoms. They do Metabolic profile, Amino Acids, A1C, etc. These are the chemicals your body needs to sustain life. Tingling feet? I never had that with B-12 or vitamin D deficiency. I do know a few people that are diabetic and they complain of tingling feet. They’re also being treated with Lyrica.
          I have been with the same endocrinologist for 22 years. You couldn’t pay me to see his assistants, much less a different endocrinologist. No matter what your medical situation maybe, he talks about weight and nutrition with all of his patients.

          • I am a PA working for an Internal Medicine practice and I routinely check patients for their Vit B12, Vit D, etc. I must agree that during my schooling I received very little nutrition education. I have learned a lot from this and other sites.

            Not all PAs are the same. You could always tell your physician what it is you like about him/her and why you don’t want to see their assistants. They may have one that has a similar thought process they would recommend to you should the physician not be available.

      • I had foot surgery late last summer for pain I’d had for well over a year, which was diagnosed as a neuroma (swollen nerve). A couple weeks post surgery, I started having major problems (horrible insomnia, surgery foot just didn’t feel right, felt depressed, had terrible pains in my legs and feet, heart palpitations, fatigue). My PCP referred me to an endocrinologist who had me get a whole battery of tests. But she NEVER ordered a B12 test (or vitamin D test for that matter). My cortisol was a little higher than normal, but that’s about all she found.

        My PCP then decided I needed an antidepressant, Lexapro. That made me feel just awful and it was causing me vision problems, so I quit taking it after a week. Fast forward two months later, I was using a walker to get around and was seriously feeling like I wasn’t going live to see the New Year. No one at my HMO could figure out what was wrong with me, nor did they care. About every couple of weeks I would make an appointment to see my doctore and ask for yet another set of tests, hoping to figure out what was going on with me.

        Finally in late Oct a doctor who was substituting for my regular physician for that day ordered a B12 test, which was found to be 196. My PCP said it was so close to the low cutoff of 200 that he didn’t think it was significant. Since by then it was the ONLY test that appeared abnormal, I did some internet research and learned my symptoms matched many of those for B12 deficiency. I then insisted he begin treating me for B12 deficiency. Another blood test later on determined I had pernicious anemia.

        It’s now 5 months after I began treatment and am still recovering from neurological symptoms and may have permanent nerve damage to my feet. As yet I am unable to to work (I was an engineer and lost my job since I’ve been out since Aug) and have difficulty walking due to pain in my feet.

        I am so angry with the medical system for 1) not catching this simple vitamin deficiency, 2) using a low cutoff of 200 which is WAY TOO LOW, and 3) doing a poor job of helping me manage my treatment (cyanocobalamin worked for me at the beginning but now makes me very sick for about a day after I get a shot and I have had to find alternatives on my own as the HMO formulary only has cyanocobalamin).

          • Lisa,

            Yes I am still having symptoms and I would like to talk to you too. How do you suggest we connect? There isn’t a private message capability on this site. I am a member of the Pernicious Anemia facebook group so you could find me there.

  100. Hello!
    I am experiencing symptoms that are exactly associated with B12 deficiency.
    I have numbness in my legs and feet, twitching/spasms in muscles and a finger, memory loss, loss of concentration and hairloss. I do have a lot of dairy in my diet and i do eat red meat. Which doctor should i go to for these symptoms ?

    • i just was told by my ”stroke Dr.” that my b-12 and vitamin d is serverly low and i have to take injections .i had 2 strokes 2 yrsa ago and have had alot of mental and physical problems.but finally 2 months ago i can walk without a cane or worrying when i will tumble.i was early fifties when i had my stroke just lost alot weight the right way and walking 3 miles a day then it hit me .so i am concerned about the supplements because i take my blood thinners .i was also told i had corti basal degenration diease.the stroke damaged 2 parts of my brain memory short term the other i do not know.could being low in these vitamins cause the symtoms

  101. I am new to all this although I have suffered with constant pain for a lot of years now And I think now that I have been mis diagnosed I have ostio arthritis in a lot of my joints I have had both hips and one of my shoulders replaced also my knees are bad and now my feet more left than right has started with very serious pain my hands are now very swollen and my fingers are quite bent now so sore some days it’s just like toothache the swelling is round all my knuckles as well .I also have depression which seems to never go away I cry and get very emotional all the time .this has gone on for years. I take mess for depression,my stomache(gallbladder has been removed due to stones and pain) Flicky legs and arms pain patches and paracetamol and trampoline I get what I can only describe as electric shocks in feet and hands .my hands also go in to spasms and lock very painful when this happens . I was very obese .But I had a gastric bypass in 2010 and that’s when they discovered my B12 was low and I was started on B12 injections at first 3 monthly then and and now every 8 weeks ( and for a few days I do feel more myself .) I do have fatigue were I will just go to sleep can’t stop it and then most nights don’t sleep tired but can’t sleep. The pain is the worse thing it’s all over my body my joints,muscles in my legs and arms and although they have replaced joint I still get pian in them .Anyway I am know thinking that all this may well be caused by the B12 not being right I have seen lots of doctors for all the different thing but never for all of the symptoms together They all seem to latch on to the depression. But I get tearful every time I see a doctor it’s like banging my head against a wall .I have had this (depression) for years or have I ? Sorry for the long post but I am at the end of my tether P.S I am now being sent to see a rumatoligist but they say I don’t have that .

    • Hi Yvonne,
      Gastric bypass? If you weren’t deficirnt B12, you are now. Better to be at a healthy weight, though, and then deal with anything that comes up!

      Besides B12, first, try to eliminate problems with your thyroid, pituitary, and any other endocrine gland you have. Second, I’ve been reading about the problems an overgrowth of Candida (the yeast in your body naturally) can do, so have that checked out. I know this is weird, but if you can, get your heart checked for holes. It’s always in the back of my head, because every once in a while, I hear a story of someone who had seemingly unrelated symptoms, until doctors found a “pinhole” in the patients heart, and once it was fixed, the person’s various symptoms disappeared.

      B12 deficiency can cause all kinds of problems, unfortunately, bringing your levels up to normal doesn’t help fix what it helped break, but it will help you to feel better, and stop any more problems from occurring. If you can’t increase the frequency of your shots, at least take B12 supplements in between. Make sure you also take Magnesium, Zinc, Potassium ( but watch the levels), and B complex with Folic acid. In order to absorb vitamins, even the water soluble ones, you need to take them with some kind of fat — if you are not lactose intolerant, regular homogenized milk with the red cap will do. Plus, if you take them with food or milk, they usually don’t cause nausea. I know from experience, that some brands/forms of vitamins will give you GAS! If you take them at least 12 hours before you go out, you should be o.k.. If it doesn’t let up after a month, try another brand or form of a particular vitamin, like, oh, say, if supposedly easy-to-absorb Magnesium Citrate gives you so much gas you offend a skunk, then switch to Phillips’.

      Fats are more important to your diet than modern medicine would like to admit. I know you are counting calories (understatement, right?), but if you can, add 2 tablespoons of olive oil, avacado oil or grapeseed oil to your diet. If you take the oil straight up, you will need to take a half a slice of bread right after in order to stop it from repeating on you.

      A lot of people are claiming miracles after they take Turmeric pills for joint pain. Please, try drinking chamomile or Sleepytime tea 3 times a day for two weeks, and see if it doesn’t help ease your mind, help a little with that depression, and help you sleep. Two things I realized when I had trouble falling asleep or falling into a deep sleep: even though I felt warm enough, once I put on an extra blanket, I fell right to sleep, and, if I had a collar on my pajamas, I was a lot more likely to have trouble sleeping than if I had no collar. Which leads me to add, always block the light from stereos, cable boxes, alarm clocks, etc., and always wear 100% cotton to bed.

      Lastly, try daily Yoga and meditation.

      I hope this can help, even a little.

    • Hey Yvonne,
      I found this on the web today .. Your diet after gastric bypass surgery!
      After gastric bypass surgery, your body will not absorb some important vitamins and minerals. You will need to take these vitamins and minerals for the rest of your life:

      Multivitamin with iron
      Vitamin B 12
      Calcium (1,200 mg per day) and vitamin D. Your body can absorb only about 500 mg of calcium at a time. Divide your calcium into 2 or 3 doses during the day. Calcium must be taken in the “citrate” form.
      You may need to take other supplements also.

      You will need to have regular checkups with your doctor to keep track of your weight and to make sure you are eating well. These visits are a good time to talk with your doctor about any problems you are having with your diet, or about other issues related to your recovery.
      I hope this helps you too.

    • Your symptoms identical to mine re pain and electric shock feelings. Living in Australia was put on antidepressants. Moved to UK where a specialist took 5 mins to diagnose Fybromyalgia. An Aussie doctor I emailed said “that doesn’t exist” although the UK specialist gave me a whole book on living with and managing it produced by arthritis UK. A UK eye specialist (elderly lady) echoed that it didn’t exist but my heart surgeon, cardiologist and gastroenterologist say it does exist and is diagnosed via clinical observation rather than a blood test. Existing or not I am getting on top of it and it is months since I had a bad day. You will tell from the number of specialists I see that I have a lot of health issues but my local doctor (she is young and very on the ball) guides me constantly with nutrition etc and slowly we are unravelling the mess of issues and improving my life. You too may have many intertwining conditions but keep up the search. Incidentally, the book I mentioned is available online from Arthritis UK. Best wishes. Michael.

    • It sounds like you have food allergies. I used to wake up with tingling arms, swollen hands and bloating off and on. I went to Center for Advanced Med. and they took me off Night Shades (tomatoes, potatoes, peppers) b/c I could not digest them. They are very acidic. Also, my intestinal bloating went away when I went gluten/dairy free(couldn’t digest the milk protein, cassein. I would get heart palpitations too, but this got better at first with some extra potassium and cal/magnesium. I suggest you do a ten day elimination diet, w/ doc’s approval. You can do bone broth every day with green veggies. You may feel worse the first few days, but by day 7 or 8 you should feel better.

  102. i was diagnosed with vit b12 deficiency when i was 18.
    had continuous pain in my left wrist and left calf.
    when i take the injection the pain goes away and comes back in 5 days.
    have taken more than 30 2 ml injections.
    still there is no relief

    • also i forgot to mention that i feel tingling sensation in my right thigh and upper left back.
      my knees get cold very quickly.
      my b12 level in 2012 was 180 and after 30 injections in 2 yrs it is 230 .
      i am from india.
      and a strict vegetarian.
      should i take any other vitamins for efficient absorption of B12????
      any tips ??

      • First, I have to say, that although many people do well being vegetarians, once you know you have vitamin defifiencies, particularly B12, you might want to think about eating meat. I am convinced that the best thing is to eat soups and stews, particularly ones that use blood and bone as well as meat, because so many nutrients depend on one another for absorbtion. This is more like do as I say, not as I do — my own diet is HORRIBLE! No stews, and I don’t suppose you would call instant Ramen soup.

        More to the point, if you only feel the effects of your injections for 5 days, you really should have them once a week. You will have to take B12 for the rest of your life, sorry. Unless, of course, you start eating meat and your levels shoot up. Even then, I would still recommend taking a tablet once a day.

        I take the B12 you can dissolve under your tongue (3 a day for 15,000 micrograms) but somebody here mentioned the B12 oils which are supposed to be better absorbed.

        Make sure you take other vitamins, such as Magnesium, Zinc, and Folic Acid as well.

        Good Luck!

        • thanks a lot.
          can you help me with self injecting vit B12.
          the amount of the liquid and the ideal place for injecting?
          any precautions i should take?
          and also the procedure?

          • I have never taken the injections, so I have no idea. Others here might write back about that. In the meantime, try YouTube. It always surprises me howmuch different info they have on there.
            I was just thinking, with the cold knees, you might be deficient in iron as well. I know the one from animals is better absorbed, but I haven’t had any problems with the regular ferrous sulfate. Just take it with vitamin C and zinc.

  103. I have Hashimotos Thyroiditis and severe Graves eye disease. My labs just came back and my B12 was 299pg/ml. After reading this article I an assuming that is low. What type of B12 would you recommend to enhance my levels…

  104. HI, I found this site very helpful for me. Since last 10 years I have been feeling very tried, always feel sleepy, can’t getup from bed in morning. I did lots of tests and couldn’t find any thing.poor apatite, always looks like lazy. I was scared about this.Last year I came USA and I went to the hospital and it is identified as vitamin B12 deficiency. My B12 level was only 98. Since then, I took shot every week for one month and once a month for next four month. I am very new to USA. I don’t know the treatment process here. I had Free insurance in New York. Now I moved Texas due to my work and stopped getting shots and started getting oral supplement ( 1000 MCG Daily) I still feel fell same pain and tried. Because of this continuous pain (specially in the feet) I couldn’t sleep properly for couple of days and had to visit even mental doctor. Now I am also having sleeping pills as prescribed by the doctor. Can anybody please help me how long does it take to have effect of injection/ Tablet of vitamin b12. How long does it take to get well . How dangerous deficiency is. I am new immigrant here. I am scared lot regarding my health as I need to do physical work for long hour even for my survival. I am mentally also disturbed because of this problem. My age is 30. I am sorry for my bad English

    • I’ve been doing a lot of research recently, and most of us cannot absorb b12 from pill form. Go get regular injections in a local clinic. Should be around $35 per shot.

        • Part II Yadab. Sorry I disconnected by mistake. I went to HEB and bought Nature’s Bounty Vitamin B12 Quick Dissolve Methylcobalamin 1000 mcg. My doctor told me this is the BEST. It is “sublingual”, which means you put it under your tongue and let it dissolve. It is a small pink pill and dissolves very quickly.

          From reading my google sites, I have also started eating red meat again (grass feed cows), eggs (free roaming non-caged), beef liver, natural salmon, tuna, scallops (not farm bred), and organic milk. Two weeks ago, Dec 8, 2014, my doctor ordered another blood test and my Vitamin B12 is now 650 (from 320 in Aug 2014).

          I am feeling so much better. The semester is over and I can now run and exercise without too much pain. It takes time. I still feel tired and my energy is not 100% for running , exercising – but I feel is is 75% from one year ago. I will continue my B12 vitamin and good diet (meat, eggs, fish, milk, cheese – all natural, organic). My next B12 blood test will be in Mar 2014 – but I feel much better now.

          Your culture may be vegan/vegetarian, and that will be a problem if you can’t change that (B12 deficiency is major in vegan countries). In that case, maybe two B12, 1000 micrograms a day would be ok. My doctor told me two vitamins a day is ok during treatment because our bodies need it at this point and it can’t harm.

          Note: there is nothing else wrong with my health according to the tests, just a major diet change with no V-B12. Hope this helps.

          • Rudy,
            Check your vitamin bottle. I’m pretty sure that Nature’s Bounty is Cyano, not methyl. If it’s working for you, fine, but I try to avoid cyanide, even when small, because a lot of things have it in, and it builds up. I use Natural Factors.
            I found out I needed Magnesium as well. I thought I was getting enough through my diet, but I wasn’t, so I think everyone should take Magnesium as well. Just be prepared, some of them give you GAS.

            • As I recall (from the shelves at my own H-E-B–like Rudy, I’m an Austinite), Nature’s Bounty actually sells *both* forms, presumably for the simple reason that there’s a market for both. (The one virtue of cyanocobalamin is it’s cheaper to synthesize, but the bioavailability frankly cancels that out.)

          • A B12 level below 100 is a severe deficiency and I would not recommend taking sublingual in preference to injections. Even though sublingual bypasses the stomach absorption, you are still only getting small amounts of B12 – certainly not enough to treat a severe deficiency. Please find a doctor who will administer the shots again – once you start injections, you should be on them for life.

      • If you have been doing a lot of research, perhaps you should check out the Cochrane Reviews. The general conclusion from carefully controlled and reviewed studies is that oral administration CAN work as well as injection.

    • Hi Yadab,

      I am from Austin, Texas, and also in treatment for Vitamin B-12 deficiency. I hope I can help you – there is hope. I am male and was always active in sport and good, health food, and vitamins. In Jan 2012 I started studying at college and working full time every semester. My diet changed – I became a vegan/vegetarian – no red meat, eggs, fish, cheese, milk. I ate lots of salads and chicken, turkey. Working so much and studying – I often ate from cans and junk food. I also stopped my vitamins.

      Last year, I started to feel sharp pains in both my legs and feet. Like pins and needles. In fact, they felt like they were on fire. I also felt nerve sensations in my lower back – I could feel electric currents in my lower spine. I was so scared.

      I could not walk very well either. I would lose my balance when walking, and always the “fire” in my legs and feet. Many times my feet and legs would jerk because of the electric current. I would become so tired and could not work in gym or run (I would just lose my energy).

      In Aug 2014 I FINALLY went to my doctor of many years and told him. He did exams on me, and had me walk for him, and I lost my balance. I told him my history and he did a blood exam. I found out my B-12 was at 320 (normal is between 1000 – 1100 !!). In American, doctors still think levels are at danger below 250. In Europe, the danger level is below 500. I really thought I was going to be paralyzed and never walk again.

      He was a smart doctor. He did not want to give me injections. He started me with 1000 micrograms of B-12 Methylcobalamin right away.

      • If you ate chicken and turkey, you were not a vegetarian/vegan, because chicken and turkey are meat, and vegetarians and vegans do not eat any form of meat. Seafood is also meat, so if a person eats seafood they are not a vegetarian.

        You are still classified as a vegetarian if you eat dairy and eggs, but vegans do not eat dairy and eggs. If you are a vegetarian for ethical reasons, an ethical vegetarian, then I can’t see how such a person could justify still eating eggs, since ALL hatcheries, cruelly kill all of the male chicks, including hatcheries sourced by free range egg farms.

        Hatcheries have been caught suffocating the chicks crammed in large plastic bags and then just tossing them like that in the dumpster because it’s too much trouble and cost to bother gassing them, which is also hideously cruel and vile.

    • Hi Yadab,
      I started taking FOUR 5,000mcg pills a day, so 20,000 mcg a day, and it was about 2 weeks before me feet and legs stopped hurting. I started with Cyanocobalamin, and have now switched to Methylcobalamin. I took the four pills for 2 years, then went down to one pill, but have had to go back to taking two a day. someone here writes about the oils, but I haven’t tried them yet.
      Try taking Calms Forte by Hyland in order to help you sleep. It’s an all-natural pill. It used to be better, but it’s still o.k., or simply try chamomile or Sleepytime tea — you’d be surprised how well they work.
      Be careful of any kind of prescriptions you are taking. I took one form of Blood Pressure pill, and noticed that I was jittery, depressed and paranoid, so I switched pill type right away.

    • You may want to either check your vitamin D or just get some subligual vitamin D at least 2000IU, I take 5000iu.. Vitamin B12 and V. D kind of go together.. if your deficient in B12 and D, taking just one of those isn’t going to help you.. If someone is deficient in Vit. D then they will always be deficient in B12 and Vice Versa.. usually not always of course.. Getting out in the sun isn’t always going to work either.. if you came from a Country where people work outdoors and it’s always sunny and you come here to the US.. you will surely be missing your usual Vt. D (which is actually a hormone by the way, and once it is low then all your other hormones get thrown off).. I bought myself a Sperti Vt. D sunlamp and take Vit. D by LA Naturals.. it’s the best I have found..highly absorbable.. good luck

    • Yadab, I agree with sunshine. If you have an absorption problem, you will need the injections, and you will need to monitor the B12 levels with regular testing.

      Your feet might be hurting if you are working on your feet every day and constantly lifting things without a shock absorbing mat to stand on and/or without proper footwear. In this situation you can develop some kind of bone spur and even small fracturing of the bone. I had this happen to me and I had to do really firm massaging to the area on the bottom of my feet that were hurting, and switched to footwear with air cushioned soles that solved the problem, because I didn’t have mats to stand on at work. Target and K-mart usually sell air cushioned sneakers really cheap if you can wear sneakers to work, otherwise a shoe with a lot of cushioning in the sole, and you can add sports insoles too, which I add to all my shoes for shock absorption to prevent foot pain.

      Also, in your situation, you may need a good general vitamin and mineral supplement to support your functioning because of the extra demand that your work schedule is having on your body’s entire system, which could even be contributing to the problem of absorbing B12. You don’t need an expensive vitamin and mineral supplement, just a good broad spectrum one that has everything in it.

      Lastly, if you haven’t already, I urge you to get your thyroid gland functioning checked. My aunt and mother both had hypothyroidism (underactive thyroid) and it was a downhill slide of fatigue and tiredness that ended up with not being able to get out of bed. Of course fatigue and tiredness are symptoms that mimic symptoms of a whole range of things, but thyroid malfunction should be tested for. I hope things improve for you.

  105. excellent article, Vitamin B like Vitamin D has numerous powerful effects on the body. Women are especially vulnerable to vitamin B deficiency. You can find supplement give away’s at However eating foods high in vitamin B is also helpful (liver, fish, fortified cereals)

  106. I’ve had B12 deficiency since my teenage years. My mainstream doctors would give me B12 injections, get my levels back and then stop giving injections. Since seeing my Naturopath in June, I’ve been diagnosed with pernicious anemia. My levels were below 200 (187 in fact) and I was having serious neurological symptoms … many of the ones mentioned in this article. I started off receiving weekly shots of methylcobalamin. I’m now getting them once every 3 weeks and the majority of the neurological symptoms are gone now. My insomnia and anxiety are almost completely gone now … it’s amazing how much a deficiency can affect.

  107. Please help! My wife started having seizures a few years ago that present as grand mal seizures, but she is totally awake and can communicate. She has had every test you can think of. Recently, we were working with a neurologist and a rheumatologist and found out her b12 levels were insanely low and that that could possibly be the reason for the “seizures”. She started with sublingual b12, because the rheumatologist suspected that she was not processing the b12 inher intestines. Her levels did not improve. We started injections and they seemed to work at first but slowly the results diminished, with the only result be back acne. She was re tested and her levels were 83l…nmol/L. I don’t know how to read that! All of her other results were in pg/ml and she was at 186 then. She is in constant pain-nerve, muscular and joint. The rheumatologist just informed us that there’s nothing else she can do that we need to see the neurologist. My wife is done, she is so upset and depressed she is suicidal. I do not know what to do. She does not want to waste any more time with another doctor or waste our time and money. If anyone knows anything or can help I would be eternally in your debt!

    • Hi Frank, it sounds like the rheumatologist was part of your solution. Chronic inflammation such as in rheumatoid arthritis eventually leads to B12 deficiency, which can explain the symptoms. Once you are deficient, oral or sub-linguals are not really a very good option. If she hasn’t responded to the B12 injections, it was probably because it was cyanocobalamin, not methyl/adenosyl cobalamin. Many people can’t process cyanocobalamin (a pro-vitamin) into the two active forms adenosyl and methyl cobalamin. Now the problem is that after the injections, she will show up as having very high levels of B12 in her blood. This is a real reading, however, the B12 will be the B12 that was injected. Thus, if it is cyanocobalamin, what you measure in serum will also be cyanocobalamin, not the active adenosyl and methyl cobalamin. The next problem is that if she can’t actually process the cyanocobalamin you will have to wait until the levels drop until she gets the proper Adenosyl/methyl B12 (cobalamin). As she was so low, she will need months of daily injections to get better. Alternatively you could use the topical Adenosyl/methyl mix from , which I have used before. It is probably best to contact enquiries there and ask for their help

    • Frank,
      I agree with Madge that her B12 injections were likely cyanocobalamin. People with common genetic polymorphisms can’t metabolize cyanocobalamin and need either methylcobalamin or hydroxycobalamin, which the body uses in the cytosol of cells. People also need adenosylcobalamin, which is used in the mitochondria. Using the topical B12oils that Madge mentioned may be the easiest course of action right now, unless you can get a doctor to prescribe high dose methylcobalamin injections. Adenosylcobalamin can be taken orally.

      Was your wife tested for pernicious anemia, where the body makes antibodies against intrinsic factor? That could explain why her B12 was so low.

      Your wife might also have a deficiency of B12 in her central nervous system. That will require very high dosing of B12 to overcome. To learn about that, go to and search on “central nervous system” for posts by Freddd.

      The serum B12 test measures both active and inactive forms of B12, and it measures what is in the blood, not in the cells. A high value doesn’t mean there is enough of the active transcobalamin form, especially if there is a CNS deficiency. As long as your wife has symptoms, the serum B12 level is probably meaningless. A urinary MMA test is a better test than the serum B12 test.

    • HI – Any chance your wife has been test for the MTHRFR mutation that affects how B vitamins are metabolized? I have both mutations (C667T) so I have trouble metabolizing folic acid and B12 especially (estimates range from 5% – 30% efficient). I take methylcobalamin (B12) and methylfolate – bioavailable forms – and avoid regular B12 and folic acid supplements (or fortified foods). Note: I have learned there are very few doctors aware of the mutation or its implication beyond pregnancy and neural tube defects. BTW there are estimates that 30-50% of the population have one mutated gene and 5-10% have both copies mutated.
      Prayers and warmest wishes on your search and healing!

    • No caffeine, no alcohol, no processed foods. Protein and good fats at every meal. No more than 2 starches a day, not to eaten with protein. A cup of homemade ginger tea (3-4 tbls of chopped ginger steeped for 10 minutes) 1/2 hour before meal, no fluids consumed with meal. Cabbage, sea salt, tomatoes, olive oil, home made nut milks, sardines, clams, beef liver, plain yogurt, 2% milk. Vitamin supplements: iron, cod liver oil, ( vit D depending on where you live), K2 and a zinc tablet before bedtime.

      I also take enzyme Q10 and brewer’s yeast tablets. Breakfast: Sunflower seed/almond milk, vegetable and cheese omelet with half an orange. Snack: glass of milk or a small bowl of oatmeal. Lunch: a quick clam tomato sauce over a large bowl of lettuce. Recipe: 1/4 – 1/3 cup of olive oil med heat add one peeled chopped carrot sauté for 3 minutes add 4 – 8 minced garlic cloves, 30 seconds later add two medium chopped tomatoes, 1/4 tsp salt, 1 tsp dried oregano, 1 tsp dried basil, 1/4 tsp chili pepper, some ground black pepper and 1/4 cup white vermouth simmer on medium for 4 – 5 minutes. Remove from stove, add 1/2 can of drain clams and juice of half a lemon and stir. Pour your sauce over bowl of washed and dried lettuce. Optional finely grated Parmesan cheese. This recipe also works with a can of sardines, replace carrot with 1/2 a fennel bulb, less 1/2 a tomatoe and 1 tsp of fennel seeds. Snack: Julia Child’s potato salad made with white vermouth. Dinner protein and veges. Snack: 2% milk.

      Never give up hope! 🙂

    • I know this is an older post but I am doing my own research for me and this came up. However, in reading your post this sounds exactly like what my daughter-in-law was going through and it was diagnosed as Celiac disease. She cut out all gluten and within days she was feeling much better. She too had suicidal thoughts from the pain being so bad. This may not be the case with your wife, but you might want to check it out if you haven’t already.

      • i too believe that celiac disease can cause this. i have learned that i am allergic to wheat. i was wondering if it could be a gluten allergy. a few days after stopping wheat (and gluten) my nerve, stomach, and heart problems went away. my nerve pain and twitching, stomach pain, and heart palpitations were scaring me. my heart would beat rapidly, stop (skip few beats), continue slowly, then quickly, etc. my stomach would cause me so much pain, swell up, felt like it was full of razor blades.. since i was a child i remember having pain after eating bread, didn’t know it could be an allergy. i went to the doctor who (i know i’m not the first one to experience this) basically said i was making it up. i never thought the heart and nerve problem could be related to wheat. i stopped eating wheat because of my stomach. i didn’t know it would solve the other issues. it’s been a few months of not eating wheat and i’ve had a few accidents of eating wheat. usually i first notice when my muscles start twitching. then i realize i had wheat. maybe it allows b12 to be absorbed, maybe it’s independent of b12.

    • This is not intended to be disregard the tremendous suffering your wife is experience but your post reminded me of this video. Some argue that conversion disorders do not exist but the mind/body is an infinitely complex system so who knows.

  108. My daughter starting loosing her eyesight about eight weeks ago an after a lot of tests the dr has said he thinks it down to her b12. She had to get injections for 14 days every day an now twice a week until things improve but the eyesight hasn’t got any better. She is only 19 so this is a very worrying time for everyone, we have been told there is no guarantee the sight will return to normal

    • It may help to find a doctor who works with genetic methylation and the MTHFR genes to see if they can help your daughter with the B12 problem. There are companies that do genetic testing that could refer you to a doctor.

    • What type of vision loss is she experiencing? Has she had a lumbar puncture to determine her intracranial pressure? Many folks with Idiopathic Intracranial Hypertension (IIH) seems to also have low B12 (not sure why), but one of the symptoms of IIH is Papilledema. IIH is often misdiagnosed, and incredibly frustrating and painful for the patient and loved ones. I hope it’s just B12 – much easier to treat, but vision loss is not something to sit around waiting idly hoping for a solution.

    • A friend of mine had an episode where she lost her sight for some time then returned. At the time, they put it down to the fact that she was pregnant. A few years later she was diagnosed with an under active thyroid and told that her loss of eye sight will have been linked to this – maybe worth getting tested? Must be very scary for your daughter I hope she finds a resolve x

    • I have no real idea what has happened to your daughter, but please also consider taking a look at other vitamin deficiencies as well, notably vitamin A. Many people cannot convert carotenes into vitamin A efficiently, so they become deficient – this particularly applies to vegans and vegetarians. Only animal foods have actual vitamin A in them, and supplements almost all have synthetic – not as good. The best source I can find seems to be cod liver oil that has not been stripped of its vitamins in the processing techniques. There are only a very few, most American cod liver oil has synthetic vitamin A added back in at the end of the process, unfortunately. Synthetic may be better than nothing, but the real deal is always best.

      You can find info here:
      And here:
      And here: This is not cod liver oil but ratfish liver oil. This is what I use.

      You can find cod liver oil here:
      1 – This is from Norway, not cheap, but excellent. I use their ratfish oil, and my kids take it as well.

      2 – This is fermented cod liver oil, very good for health, but very strong tasting. I used it, but my kids refused to take it.

      3 – Carlson’s cod liver oil is a good second choice, and is available at market’s like Whole Foods and co-ops and health food stores, as well as online, like Amazon.

      I wish you the very best.

    • Dear Veronica and well wishers, My parents and I have experienced temporary vision loss/complaints/weakness of some sort at varying levels. Both parents suffer from other underlying problems, and I was recently diagnosed with B12 deficiency! Please give “schizandra berry” a go for your eye problems as it’s worked a treat for us. It also helps aid a healthy liver (which we all know stores our B12). To good health x

  109. Can anyone help me?
    I don’t know if it’s because of the B12 deficiency or something else, but I have asthma and sinus problems. The problem is mucus ( sorry, gross I know) that goops up my whole respiratory system and even traps food on the way down.
    Any vitamins I should take, teas I should drink, foods I should eat or avoid? Anything? It’s kind of the last thing that’s holding me back, but it’s really a big thing.

    • Hi Ann, you might want to check into Patrick Mckeown’s dvd/book/cd set called “Buteyko Clinic Method 2hr DVD, CD, Manual; the Complete Instruction to Reverse Asthma…”. It’s available on Amazon.
      I bought it for a reason other than asthma, but it’s really directed at asthma sufferers. I find the excercises helpful so far and I believe will help you resolve your symptoms.

    • My wife had sinus problems all her life and two years ago it was so bad that she was coughing for four months non stop. Every winter she was on different kinds of antibiotic and her nasal was always congested and very weak as a whole.
      As a result of her sinuses she got pneumonia few times in past and consequently she got scar on her lungs. Two years ago pathology expert suspected of aggressive cancer in her lung, but thank God he was wrong. As a result of that we went to a lung specialist and the doctor diagnosed my wife with severe sinusitis which was the cause of her pneumonia problem.
      They put her on heavy antibiotics, but after clearing this time, I thought enough is enough, and after long research on internet I asked my wife to start to take (Bragg)Apple Cyder vinegar with mother in it, and as a result of that, for the first time in her life she is free from sinus problem for last two years.
      She was a frequent visitor to doctor for common cold and influenza but thank God for this simple solution she hasn’t visited doctor since two years.
      She started taking one tea spoon mixed with water three times a day before breakfast, lunch and dinner.

      Hope this help. God Bless.

      • Robert,
        Thanks! I kind of do take a tablespoon of Bragg (the best!) with water and honey, but only once a day. Though I like the taste, and it makes me feel pretty good, I’ve unfortunately only taken it sporadically. I think I’ll get another bottle today and stick with it.
        I started a cold on September 3, and it’s just going away now. My sinuses still hurt. So, here’s hoping it works as well for me.

        • I can’t take Braggs for my coughing(asthma/mucus)because I also have Barrets(esophigyle erosion)it burns too much.Has anyone tried ACV tablets with any luck?

          • Bee,
            I’ve taken Swanson Double-Strength Apple Cider Vinegar that I bought from Amazon.
            I haven’t taken it for long enough periods of time to tell how good it is, though it does give me that calm feeling that Bragg gives me, but it received good reviews on Amazon.

            By the way, I don’t know if it still helps anything when cooked (I don’t see why not), but I use it in things like pancake batter. The batter smells of vinegar, but the pancakes don’t taste of it. They taste gooood.

          • Bee,
            I forgot to say that the pills helped my heartburn. The one time, they worked instantly, even better than Tums. I figured I’d let you know if they helped with that, they must be doin’ sumpin’.

      • finndian,
        Thanks for your help! I looked up NAC on Amazon, and quite a few people complained about stomach upset, so I think I’ll wait to see how the Apple Cider Vinegar and the breathing exercises go, but I’ll definitely try NAC if things don’t improve in 6 months.

    • Thanks so much for everyone’s help. My inhaler barely works, and this past month and a half has been really bad. I must admit, I have been pretty lazy, and not followed through with a lot of health plans, but your quick replies have made me determined to get better, starting today. In six months, I’ll let you know how it’s going.

  110. I have the opposite issue- my levels of B12 are very high -1300 per last blood test done (without supplementation). I have a huge gut issues for already 8 months (not digesting anything without help of digestive enzymes) and everything started with Advil pill I took on an empty stomach. After this, my digestion completely stopped. Having all this indigestion/malnutrition issues , one would think that I would not absorb B12 as well. Homo-cysteine levels are normal and I don’t have MTHFR gene mutation. The blood tests don’t show any sign of malignancy (often connected with high levels of B12).
    The only thing I could think of is that my liver is not working properly (although standard liver tests are OK) and it’s dumping B12 into my blood instead of inserting it into the cells so the test show high levels although my cells are maybe lacking B12.
    Any other ideas?

    • Did you just have a blood test, or MMA, or any other test mentioned here? It could be just that the test you took is at fault. You are right to be concerned. It is strange that with such a bad digestive problem that any test would show a high B12 level.
      As for your stomach issues, have you thought of a cleansing fast done at a facility? I have heard quite a few stories about how it can release toxins and “reset” your system. However, I would wait for a few more months to see if your body slowly but surely heals itself.

      • Thank you Ann for responding to my post.
        This B12 level was determined by routine blood test- so I guess it’s total B12. I didn’t get MMA test as I didn’t know it exists- I will have to check with my FD if I can do more specific testing.
        As for the digestive issues- I didn’t try fasting diet as I lost 30 lbs because of all of these digestive issues (I had 90 something lbs on 5”5′ heigth) and I regained half of it back now….but when this all started I barely ate anything for 2 weeks and it didn’t help at all:)
        Answer is somewhere there I just need to keep searching for it.

        • Yeah, I don’t know if barely eating and fasting are the same thing, I would assume they are. Any info I have on fasting is anecdotal, so I don’t know the specifics. It should be done as one of the last things to try, I don’t know why it popped into my head right away, maybe because I heard when something stops working, fasting helps to start it again.

          Glad to hear that you’re slowly coming back. I am still puzzled about your B12. Maybe your liver is releasing extra B12 in order to help heal yor stomach, or to compensate for it, or maybe your levels were even higher before. Let me know if you find anything out.

        • Hi Tanja,

          I have really high b12 – been tested for blood disorders like PV and leukemia and liver function is fine. Did you ever manage to get a resolution/answer to your high b12?

    • I sure do have comments. My b12 level on the CBC test is more than 1500. A few years ago my b12 level was at 235 and my doctor put me on b12 shots. Getting an injection every month did not do the trick. I was exhausted and dizzy. I asked to have injections at least twice a month. I became so much better. By big mistake was to quit the injections and started on b12 tablets. I was so ignorant and did not know that the tablets were not being absorbed through my small intestine. For the last year and a half stayed at home because I suffered from sudden bouts of diarreha

      • Sorry I was cut off. Anyway, I had many symptoms of b12 deficiency fatigue, dizziness, anxiety. I went many doctors who practically threw me out of their office because my b12 levels were so high due to taking high doses of tablet b12. I begged to have a parietal antibody cell test and the folate which both showed problems with the absorption of b12 through the small intestine and that despite the high levels of CBC test I was b12 deficient.

        I have pernicious anemia in my family. Unbelievably, the doctors still deny me b12 shots. I am about going crazy. I was able to find a b12 supplement that absorbs more easily and some of my symptoms have subsided. I know that injections are the true answer for helping my b12 problems. Keep your fingers crossed for me I am going to another hematologist, hopefully he will give me the help. I need.

        • Hi Dorie,

          You have another option available : B12 patches , you will baypass the gut this way. I don’t know if the patches really work but a lot of people say they helped them.
          And there is also a sublingual B12 spray.

          • I use the oils from
            These are great. They have even been shown to be of great benefit to people with acute B12 deficiency such as is found with chronic fatigue syndrome. You simply rub them on your skin. They gradually release the B12 over hours and hours. Much easier to use than the Patches, which I have tried and which didn’t work

        • I have the same issues as my B12 is over 2000 no suppliments at first.Been doing injection now once a week.Forget the hematologist go find a N.P. to prescribe it.Down side it’s a self injection.No biggie after a couple of times!

    • Have you had your lithium levels tested? That helps transport B12 into the cells. I would also suggest getting a DNA test from a place like 23andme. I did and I found out I had genetic errors that cause me to be unable to convert b12 into methyl b12.

    • You are deficient in B12 – in US anything under 300 is.
      And if you ask EU/Japan – anything under 500.

      I suggest starting with B12 shots or big doses of sublingual methylcobalamin ASAP.

  111. I have to have B12 injections, and will have to have them for the rest of my life, my Doctor is not very knowledgeable on the subject and feels normal levels should be between 200 and 600, I was so ill with a level of 192 I was falling over and so tired I was unable to function I am a young 77 year old and believe these levels quoted are much too low. Ann

    • Ann, I totally agree that the levels used are much too low and need to be revised. My level was 196 and I was severely ill, fatigued, depressed, shooting pains in my legs, lost a lot of weight, and had to use a walker. Referring to the minimum of 200, my doctor said he doubted that my slightly decreased B12 level was causing my symptoms. Wow was he ever wrong about that!

      I’m so very thankful for the internet, because I did some research and learned that my symptoms matched those of B12 deficiency. I knew that had to be what was ailing me. I had to be a real pest to get my doctor to start treatment.

  112. Sadly a lot of drs are not aware of the genetic mutations MTHFR with Vit b 12 .Both my husband & I have been diagnosed.So an infant can be born with it especially if the mother is a vegetarian.My lifesaving book was Sally’s book Could it be B12 ? Just so frustrating when I have seen 15 drs including 7 specialists waste of money A dr at Ed suggested because of my symptons but was dismissed as level was 290 in norm range.My husband almost killed himself with memory loss .I just wish we could get it out there istead of being told its in your mind hardly with severe tinnitus numb feet approx 25 other symptons.

    • That is a revelation to me that tinnitus can be a symptom of Vitamin B12 deficiency! I have recently been diagnosed with a very low Vitamin B12 level. My Naturopath was amazed I could still function normally with the levels I had. But my tinnitus is pretty bad. Perhaps with me that is where a low Vitamin B12 level has revealed itself.

  113. I was diagnosed as being anemic when I was very young. Maybe 8 or so. About 30 years ago my B-12 level reached a low of 75 and I was having problems remembering where I was going, almost falling asleep at traffic lights, and not remembering peoples names. I also was getting short and upset and having heart problems. I went to several doctors and no one checked my B-12 levels. One day when I was driving on the freeway, my vision became double and I had to close one eye in order to get off safely. My wife and I spent several days going to various doctors, when a neurologist finally discovers I had a b-12 deficiency. They started me on immediate injections and told me I would have to take them the rest of my life. I was told that my body destroyed any B-12 orally and that my body no longer produced it. I found that when my level was over 1000 I felt best and had more energy and strength. Because of health insurance I have had to switch doctors. So far I have had to train 4 different ones on my condition. Perhaps it would be good for them to teach this in medical school. I did have the same problem walking when this started as many of you. Everything was on my left side and that is the way I kept walking. My wife had to hold me by the belt to keep me going in a straight line. When my level of B-12 went up, I was able to correct the nerve that controlled the eye and get ride of the double vision. It took about 8 weeks.

  114. I was diagnosed with a B12 deficiency at 8 years old. My teacher called my mom to tell her there was something wrong with my health, and it was discovered I was severly anemic due to a B12 deficiency. I was given B12 shots at first but since I was needle phobic, I ended up taking prescription B12 pills. I am now 40 and take B12 pills to this day. It is a scary thought to know that if I had been born just 100 years earlier, I would most likely not have survived to adulthood.

  115. Hi there,

    I have what my MD is calling neuropathy in my left arm. It tingles and there’s a spot that itches although there’s nothing there to be itchy. It kind of travels down my arm and sometimes feels kind of like an electric shock. She’s never done any tests just said that’s what it is. After reading about B12 and how people who take acid reducers and Metformin have a higher chance of their levels being depleted I decided I should have it checked. I just got back the results on just a straight up B12 test and the result is 540. I’ve read on some websites that even though the blood test says number is normal that it’s still low. Does anyone know? Could the level I have still cause neuropathy? I’m considered “pre-diabetic” my A1C is 5.3. Thanks for any ideas!

    • Hi There, your B12 levels would not normally be considered to be low at over 500, but it depends if you have been supplementing and what you have been supplementing with. Other causes of peripheral neuropathy can be low intracellular folate, low B group vitamins in general, and low vitamin D. Your intracellular folate should be above 7 ng/ml, whilst with vitamin D, it should be as high as possible (.50 ng/ml).

      • Thanks for the response Madge, no I hadn’t been taking any vitamins except for Vit. D. Before I started taking the D years ago my level was 8. So, I guess I need to ask my doc to check my folate then. I’ve started supplementing some B12 now just in case. It’s just some cheapy stuff I got at the drug store. 5000mc I figured that might help some even if it’s not a better brand. 🙂

        • Hi Zowiezombie, looks like you have a bit of sleuthing to do. If your genetic profile is normal it will be different to if you have methylation associated mutations. If you are deficient in B12 you will have to try to work out why. If you have a vegan or vegetarian diet, then it is quite simple, you need to supplement with B12. If you are hypothyroidic (and you will need tests to determine this) you will need to fix this. Folate and B12 are very inter-related in how they work together. It is actually quite hard to get enough folate if you don’t eat lots of green leafy vegetables. If your genetics is fine then normal folate will also be, but if you have methylation problems, particularly MTHFR, you will need 5-MTHF (deplin). The easiest thing will be identifying why you are deficient.

    • ZowieZombie…From what I’ve gleaned from the internet, the serum B12 test doesn’t differentiate between active and inactive B12. Your result can actually be up to as much as 90% inactive B12. I have ‘failed’ all my B12 tests. They all come back as normal to high B12, but my RBC count was as low as 3.8 at one stage, MCH and MCV levels were both slightly elevated, I felt like a rag doll, had no energy, just couldn’t function at all unless I took transdermal B12. GP swears I don’t have a B12 issue even though I now have a swollen tongue. I am doubling my dose of B12 in case I’m just not taking enough. It would be a big help if doctors would go back to the old ways and read the symptoms. Numbers on a chart are totally useless IMHO.

      • @Rose,

        that is very interesting.
        once i was diagnosed with severe anemia (RBC was also like 1/2 of lowest normal & many others also abnormally low;
        my B12 was really high

        (800 i think; i don’t remember the numbers — dont’ have the test results handy right now)
        i was tired all the time & hair was brittle & thinning.

        then i ate liver everyday for 2 months & finall bright it to low end of normal.
        mmm i wonder if my high B12 level was “inactive” so even it was high.

  116. Should I take my B Complex containing Folic Acid and C, with my B12, or some hours later? I know B12 travels with folic acid, and was wondering if that’s a good thing, or if they have troubled separating.

    Also, all my life I feel sea sick whenever I read. Does anyone know if that’s B12, or something else, like some form of dyslexia? I can read well, it’s just that I feel sea sick.

    • Ann, I just have to chime in here and tell you to go google Irlen Syndrome. My daughter has it and it made a huge difference in her life when she started wearing her special glasses, and later, contact lenses. I think it’s something that too few people are aware of, and I hope the info helps you.

      • Laurie,
        Thanks for the info. I looked very quickly, but I don’t think that’s it, because it seams that the quick info I looked at pairs it with trouble with reading comprehension, or some other learning difficulty. The only problem I have is the nausea, but I definitely will look further into it. I’ve had sinus problems for a long time, and I’m kind of thinking that is really what it is. However, I saw a show — “The Incurables”, I think — and a man had problems reading, along with a feeling of motion as he tried to concentrate on the words on the page. He was diagnosed with dyslexia, but found a doctor in California that prescribed a certain color glasses for him to wear, which make his dyslexia go away. Are your daughter’s contacts tinted? Was her only symptom the feeling of movement? What type of doctor can diagnose this?

        • It’s thought that Irlen Syndrome may be a form of dyslexia, so the man in the movie being helped by colored glasses would make sense. My daughter hated to read because it caused her discomfort. She would get headaches, preferred to read in the dark, and although brilliant, she had a lot of trouble with comprehension because of what she perceived as movement of the words on the page. The end of one word would “run” into the beginning of the next sometimes. Florescent lights are the worst! My daughter’s contact lenses were specially colored (several layers of colors, in fact) and looked light gray. She actually no longer needs them because she learned over time to adjust and be aware of circumstances in which she might have a problem. After struggling to get through 8th grade, she went on to be graduate High School as Salutatorian of her class, get an Associate Degree in Graphic Design, a B.S., then a Master’s in Teaching by the time she was 22! The glasses/contacts got her through a tough time. I hope you figure out what your problem is.

          • Great! I’m a classic underachiever myself, and I admire people with drive, like your daughter.
            The man in the show described what he was experiencing almost the exact same way. I’ve had sinus problems for most of my life, and I just had a virus that lasted for over a month and a half and really did a number on my sinuses — even the pressure of my readers made me queazy. That’s why I was thinking recently that that must be the cause. However, some of what you said does sound like it could be right, and the one site did have as an added note that some people only experience nausea. So I will definitly look into it some more.
            Who diagnoses it, though, a regular Ophthalmologist, or someone else?

    • You would be better off taking folate rather than folic acid, which is a synthetic substance, High intakes of folic acid have been associated with cancer, they can mask a low B12. Also, regarding B12 there are a couple of paragraphs above that read: “A high intake of folic acid might mask detection of vitamin B12 deficiency and lead to a deterioration of central nervous system function in the elderly. In one study, consumption of folic acid in excess of 400 micrograms per day among older adults resulted in significantly faster rate of cognitive decline than supplement nonusers. (11) Another study found a higher prevalence of both anemia and cognitive impairment in association with high folic acid intake in older adults with a low vitamin B12 status. (12) As vitamin B12 deficiency is a common problem for many older adults, these studies suggest that high folic acid intake could cause serious cognitive consequences in the elderly.

      Despite the risks associated with high levels of folic acid intake, it is well established that adequate folate intake from the consumption of folate-rich foods is essential for health. Folate aids the complete development of red blood cells, reduces levels of homocysteine in the blood, and supports nervous system function. It is well known for its role in preventing neural tube defects in newborns, so women of childbearing age must be sure to have an adequate intake prior to and during pregnancy.

      Excellent sources of dietary folate include vegetables such as romaine lettuce, spinach, asparagus, turnip greens, mustard greens, parsley, collard greens, broccoli, cauliflower, beets, and lentils. (13) Not surprisingly, some of the best food sources of folate are calf’s liver and chicken liver.”

  117. How long does B12 from an injection stay in the body?
    ND says could be around and affect blood test result after 2.5 months; MD says it can only be around 2-3 weeks.

    • Hi Lan, the real answer is “it depends”. Thus, the half-life of stored B12 is over 200 days. The half-life of injected B12 is different, and it depends upon how it is administered. IV injected material seems to have a half-life of around 16 hours. Thus a 1 mg dose would be almost totally gone (less than 4 ug left) by 9 days. IM injected material lasts slightly longer, but probably not much. Topically administered material in b12oils would be longer due to the depot effect of the skin. IM injected material given 4-6 weeks apart doesn’t actually top up areas such as the brain or restock the liver, because if it did, you would only need to have 3 or 4 injections every 4-5 years, In stead the IM injected material give you this massive peak and trough effect. What is also important is that the B12 has to be around to saturate any “free” transcobalamin (holotranscobalamin), as this is the protein that is required in order to get cellular uptake. Only about 25% of protein bound B12 in serum is bound to TC.

    • Sorry to hear about your UC. Make sure that you get your vitamin D levels up as high as you can. Vitamin D is supposed to be very good for UC. Apparently there are lots of vitamin D receptors on the gut wall, and they help with the maturation of the gut cells. I’d also make sure that you check out on iron deficiency as well as B12 deficiency. Apparently 85% of people with IBD conditions, including UC get iron deficiency. The reason is most likely due to poor maturation of the gut wall, plus loss of uptake of recycled transferrin as this is compromised in UC. Sorry haven’t tracked out the best method for iron supplementation, but evidence suggests that you are wasting your time unless you get injections. You will of course need vitamin B12 via a non oral route, such as injection or transdermal oils.

    • Can you take vinegar with UC? I know the unfiltered Apple Cider Vinegar — the one that is cloudy, and has a goo on the bottom called the mother — is good for heartburn/ acid reflux, and many other gastro-intestinal issues. I would also avoid wheat products, and I believe you should avoid dairy, but you can still take pills for any nutritional loss.

  118. I have pernicious anemia and have received injections monthly for years. I am told there is a shortage of the vaccine now and am unable to receive the injection. I have had balance issues and extreme tiredness for no reason recently. I now take one 1000 mcg daily. Having trouble figuring how much I really need. This concerns me. Doc says ask pharmacist, Anyone know?

    • Yeah, and when you ask your pharmacist, she’ll say to ask your doctor. I was taking 20,000 mcg for over a year — probably 2. That was 2 5,000mcg sublinguals in the morning, and 2 at night. I eventually lowered the dose to 1 sublingual a day, but pain in my legs kept coming back after a month or two, so now I’m keeping it at 2 pills once daily, and that seems to work well. there is someone on here touting an oil version, and I might give that a try. In my opinion, 1,000 is O.K. for anyone who hasn’t shown symptoms yet. As I’ve said elsewhere, there are VERY, VERY few cases where someone can’t take B12, but everyone else should take it, because it’s so important.
      Also, make sure your D levels and Magnesium levels are good. I ignored Dr. Oz about magnesium, saying to myself, “It’s a trace element, I’m sure I get enough,” but he was right, and I was wrong.

      • You basically can’t overdose with methyl or adenosylcobalamin, although some people react badly to cyanocobalamin (the normal supplement type in the US) or hydroxycobalamin (now a replacement). If you are one of 30% of people you have trouble converting cyanocobalamin or hydroxocobalamin to the two active forms methyl and adenosylcobalamin due to mutations in the methionine synthase reductase gene. This doesn’t normally affect people that much if they are getting dietary B12, as the forms in the diet are adenosyl and methyl B12 (cobalamin). This may be a reason why the ultra high doses are not really doing much for you. I had this problem which is why I use the mixed Ado/MeCbl from b12oils. It is an oil that you rub into your skin. Works a treat.

        • Thank you for reply. I started taking magnesium on ma own because of severe leg cramps. Still get them but less frequent and shorter in duration. I am learning a lot from you and others input. I agree, most drs. do not know much about b12 or pernicious anemia. Would you or others recommend a neurologist instead of internist?
          I also was on folic acid many years ago but new doc says do not take. I am losing faith.

          • Doe,
            It really depends on the doctor, from what other people write, neurologists don’t seem any better than any other type of doctor. I don’t know how to find one that actually believes in vitamins as therapy. I complained to mine all the time about symptoms I was having, but she was just worried about my BP and if the medicine lowered it enough, nothing, and I mean nothing more.

            Anyway…did your doctor say why he didn’t want you to take folic acid? As far as I have seen, most doctors advise to take a general B supplement, and specifically, Folic Acid. My reading has advised this as well.

        • Madge,
          There are one or two diseases I’ve read about where taking extra B12 can be harmful. I can’t remember what they are, because I didn’t have them, but if you do have them, you more than likely have seen a doctor and know. I think they even advise against eating liver and other things high in B12.

          • Hi Ann, that is very curious. It must be extremely rare as I have never heard of it. There is one disease Leber’s disease where you shouldn’t give cyanocobalamin, but adenosyl and methyl are fine. VB12 is essential for life. If you don’t have it you basically die, so it is hard to imagine that these conditions ever survive the womb, and anyway the foetus gets B12 from the mother, to the baby so it would die before birth. Can you give us more details? Was it from a publication, or from “web” chatter?

            • Sorry, but as I said, I didn’t have them (I think there were 2), so I didn’t pay too much attention, but I did feel a little guilty saying EVERYONE should take B12.
              I believe I read about one on, is it NIH or NIMH website?, or some other med site like that. The other was an ailment that has to to with the digestive tract, especially the colon, I’m pretty sure. Or maybe the bladder, I think I was looking up Interstitial Cystitis because I had been looking at marshmallow root tea on Amazon, and a lot of people used it that had IC. So, I googled and looked and followed links, and it could be IC, or one of the dozen or more other diseases that had links — now you know why I don’t know which disease it was…and why my house never gets cleaned.
              Sorry I can’t be of more help, but I definitely know I saw the warning(s) against B12.

  119. The exact same article could be written about magnesium. Just replace “Vitamin B12” with magnesium, and, well, same article. You could say the same about thiamine too – another B vitamin.

    When are people, doctors in particular, going to start looking at what depletes cellular minerals and B vitamins? When you start looking at a bigger picture, you might actually find some culprits. The culprits are the pharmaceutical industry. One, of probably many, class of drugs that depletes magnesium, B vitammins and iron – and causes mitochondrial damage / oxidative stress – is fluoroquinolone antibiotics (cipro/ciprofloxacin, levaquin/levofloxacin, avelox/moxifloxacin and floxin/ofloxacin). But doctors give them out like candy despite the 43 PAGE warning label.

    Here is a great article about how fluoroquinolones are a risk factor for type-2 diabetes – A similar one could be done for all of the diseases mentioned at the top of this article.

    • Thank you Lisa! I totally agree, and I had no idea about a warning label of any length, let alone 43pgs! I also think there has to be more to this issue (nothing is ever simple, is it?) than just the fluoroquinolones. I have never taken them, yet I have chronic fatigue with fibromyalgia, and I battle chronic migraines – I’m coming down from one right now so if I sound out of it, it’s because I am a bit, sorry. Fluoride and bromine (used to bleach flour in breads) each do a real number on the thyroid and displace iodine, the only nutritive halogen as far as I know.

      Could we add to your knowledge with the hypothesis that any fluoride from any and every source is also a possible contributor? I’m thinking of toothpastes, fluoridated water, fluoride tablets (no joke, this happened to me) that pediatricians and dentists prescribe for small children ‘for their teeth’, and industrial fertilizers. I’m under the impression that those fertilizers have a lot of hidden poisons in them under the ingredient “inert ingredients” and one of those is fluorides. These may either be uptaken by the plant foods we eat or those fed to animals, or they may interfere with normal plant uptake etc. ultimately rendering the plant deficient at best, toxic at worst.

      Some vaccines have or have had fluoride as an ingredient, too. [What genius dreamed that one up?!] Here’s a pdf chart, you have to click on the link:

      What’s your thought on all F sources? And possibly bromides as well, since they are also in some vaccines and in our food now, too? I think these ingested and injected toxic halogen compounds can and do ruin many pathways in the body, not the least of which is this B-12 issue.

      • Hi Molly,

        It’s funny, you’re the third person in 24 hours to ask me about the fluoride connection. I think that it may be a sign that I should look into it more thoroughly. 🙂

        Dr. Mercola thinks that the fluoridation of fluoroquinolones is the main problem with them. Here is one of his articles on the topic –

        I believe that the problem with fluoroquinolones (FQs) is more in what they do to cellular magnesium levels and mitochondria. FQs deplete intracellular magnesium. Intracellular magnesium is really, really, really important. It is vital for more than 300 enzymatic reactions – including the utilization of all of the B vitamins within cells and the production of ATP in mitochondria. When cells are deficient in magnesium, the mag/calcium balance is thrown off. Too much calcium can translate into too much superoxide production. Superoxide is a potent oxidant that can wreak havoc on the whole body. FQs are a big culprit in depleting cellular magnesium, but they’re not the only one. Here is a list of drugs that deplete magnesium –

        A fluorine atom was added to the quinolone molecule to make it more potent and so that it could more easily penetrate tissues (and cells?). The fluorine/fluoride may be the key to how FQs break open cells to deplete magnesium. I’m not completely sure about that though.

        Thank you very much for your thoughtful comment! I definitely need to take a closer look at the role of fluoride in the mess that is Fluoroquinolone Toxicity.


        • Thank you very much Lisa, I follow Dr. M too, he’s very helpful. I didn’t realize about the magnesium connection, and I have never taken an FQ, but I’ve had 2 flu shots, and vaccines of course, and I am horribly magnesium deficient. So deficient that I have had to change my (already organic whole foods) diet to try to fix it, and I take a ton of Mg every day. And I have Chronic Fatigue, so I believe it’s all tied together somehow. Thank you for the link and your info which is new to me. Ever onward!

          • Molly, you’ve listed migraines, fatigue, b12 and magnesium deficiency that you can’t seem to cure. All signs point to undiagnosed food allergy and/or under-treated hypothyroidism. You’re sure not going to cure your magnesium deficiency and all those symptoms orally until you cure the problem causing the stomach issue.

      • You know, not to sound all “conspiracy theory-ish” about it, but it seemed to me awhile ago that a lot of municipalities have been quietly stopping the addition of fluoride to the drinking water.
        Also, I noticed about 15-20 years ago that the bleached flour I was buying always tasted stale. Then, on some cooking show, they mentioned that the chemicals that they used to bleach the flour left a taste that some people noticed. I tried unbleached, and no taste! I now only use “big brand, not organic or anything” flour. I thought it would change the look or texture of my baked goods, but it hasn’t. That goes to show you, let your senses be your guide. Unfortunately, a lot of people have overloaded their senses, which also reminds me — and this is partially a do as I say, not as I do thing — try not to wear perfume, cologne, or use scented stuff. I have heard from different sources that prolonged use can screw up your body.

        • Sorry, I meant to write, I now only use “big brand, not organic or anything” UNBLEACHED flour.
          Sure wish there was a way to edit, yeah, ok, and wish I had proofread.

  120. Hi,

    I’m looking for any scientific papers that relate to this paragraph:

    “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.”

    I have a result of 330pg/mL and I have many symptoms but the NHS won’t treat. I’m hoping to go to my doctor armed with evidence in favour of treating me.


    • Hi Becky, there are a couple of points of relevance here. Firstly, what is regarded as normal in any country is actually determined by the pathology labs. It has nothing to do with clinical deficiency. Basically the path labs average out their data and then define normal as what falls within 90% of the values that they assess, with low being the lowest 5%. Thus, normal B12 is different in every country and is totally dependent upon diet. I have no idea who came up with this concept as it is absolutely ludicrous. Second, levels in the USA are relatively high because of B12 and folate supplementation of many foods. In Japan they eat lot of sea-food which tends to boost the levels. Many studies have shown that sub-clinical deficiency (as defined by elevated MMA and Hcy) starts at 250 nmol/L or 340 ng/ml. There are, however, a lot of problems even with this assessment. The most accessible way to tell if you are deficient is via MMA, Hcy levels combined with B12 and most importantly symptoms.

    • That paper indicates that 36% “of the total corrinoid vitamin B-12 activity in Spirulina is human active.” However, if some cobamides inhibit b12 activity, I have to wonder about the remaining 64% in that form of Spirulina. Further, it is not clear that the percentage comes from any of the papers cited at the bottom of that article, so I don’t see how to verify their claim.

  121. Please help! I have horrific optic nerve pain and the only reason found could be low b12 ( 150). The doctors say “that is a little low”, but in reading the thread it seems it is really low. 6 months of b12 injections and nerve pain subsided, just had it checked and I am in the 400 range and all of a sudden I have horrific optic nerve pain again??? I have no appetite yet have put on 20 pounds! I have read that low b12 causes both weight gain and loss. I seem to find conflicting arguments on anything I read.

    • Hi Christine, interesting problem that you have. Be aware that the serum B12 that you measure (400) will be the same type of B12 that was injected, it may not represent active B12. Thus, if you were injected with cyanocobalamin, that is what is most likely in your serum. Cyanocobalamin is a sort of pro-vitamin form of vitamin B12, and must be converted to methyl and adenosyl cobalamin within the cell. The next thing is that when they measure serum B12 it can be on one of two different proteins (i) transcobalamin (the active transporter to take the B12 into the cell and (ii) haptocorrin (this is not active for cellular transport). Hence, just because your B12 level is now 400, if your symptoms have returned it suggests that first, the analogue measured in serum is the inactive one, and second, the B12 that is there is not bound to transcobalamin.
      As for weight gain and weight loss. You need both methyl and adenosyl cobalamin (B12) to properly process your energy derived from fat, and proteins, without it you may feel hungry and so put on weight but feel like you have no energy. You also need vitamin B1 to properly process sugar, so if you are low in this you won’t get energy even from sugar. As an adjunct to this you need riboflavin (vitamin B2). If you are hypothyroidic all of this can be a problem.
      The most important thing is to treat the symptoms as the diagnosis can be ambiguous.

    • Christine T.,
      What do you mean by optic nerve pain? Could you describe the way it feels, and where it is located?
      Have you ruled out diabetes or problems with your endocrine glands such as thyroid and adrenal?
      Make sure you take Magnesium, Zinc, get enough iodine, and take a B complex vitamin as well as B 12. Also, get your D tested.

  122. This message is for Jerry Boucher
    I’ve been suffering from B12 deficiency for 9 yrs.
    My level was 41, by the time drs. found the problem, nerve damage had happened. I use Nascobal and my levels have been anywhere from 700’s to 800’s except when I had breast cancer it was 200. Right now I’m using the red oil along with my nascobal. I’ve been using the oil for about 4 weeks now and
    haven’t noticed any difference. I wonder if the oil is even going to help my nerves.

    • Hi Judy, Have you been checked for other vitamin deficiencies? Once you are critically deficient in B12 and/or folate your gastro-intestinal tract can become very compromised and you may find that you can’t absorb the majority of your B group vitamins. You need them all if you are going to recover. Also you need to have your vitamin D levels very high for neuronal recovery. All this in combination with both Ado and Methyl B12. If your B12 levels were SOOOO low, you undoubtably would have gut damage and poor absorbtion.

      • HI Judy,
        Me again. I was thinking about this a bit, and then it swigged to me that you are using cyanocobalmin in the Nascobal (I am pretty sure that that is right). I would stop using this. If you are one of the people that can’t convert cyanocobalamin to the active forms (Adenosyl and methyl) the cyanocobalamin may block up the machinery inside the cell that processes the other active forms and stop them from working, The other thing is that the Nascobal B12 will get first look at transcobalamin , which is the protein responsible for uptake into the cell, and may further interfere with uptake of the adenosyl and methyl B12.

  123. Actually, you can find B12 from vegan sources (algae’s and sea vegetables) and multiple studies prove that they are linked to higher levels of B12, so it’s clearly being absorbed to some extent. – “Compared to the control period, in the intervention period participants improved their vitamin B12 status, significantly reducing Hcy blood concentration (p=0.003). In conclusion, the Klamath algae product AFA-B12 appears to be, in a preliminary study, an adequate and reliable source of vitamin B12 in humans.” – “The vegans consuming Nori and/or Chlorella seaweeds (n = 16) had serum vitamin B-12 concentrations twice as high as those not using these seaweeds (n = 5) (mean 221 pmol/L, range 75-408, vs. 105, 35-252, P = 0.025). In the longitudinal study, six of nine vegans showed slow, but consistent deterioration of vitamin B-12 status over a 2-y observation period. On the basis of these results we conclude that some seaweeds consumed in large amounts can supply adequate amounts of bioavailable vitamin B-12.” – “Chlorella supplement may be useful as a resource of natural folate, vitamin B-12 and iron for pregnant women.”

    In my opinion, the algae’s are a necessity on a vegan diet. It’s not that vegan diets are unhealthy, it’s that most people aren’t properly educated on how to follow a well-planned vegan diet so they don’t run into serious nutritional deficiencies over the long-term. Chlorella provides large amounts of iron, zinc, chlorophyll, nucleic acids, and high-quality bioavailable amino acids.

  124. Hi:
    This is very interesting article. My mom is taking this supplement “Calomide S.C. Tablets 250 µg”, I searched the net and it said contains Cobamamide, in your article you mentioned Cobamide, which is not a true B12 but analog, are they the same thing? The box said B12 supplement.

    Thanks for your help.

    • Cobamide ≠ Cobamamide. I think cobamide refers to the general class of all of the B12 analogs:
      Whereas cobamamide refers to adenosylcobalamin only. That seems to be the ingredient in Calomide:
      Here’s the best of all, though, this page gives synonyms and cobamamide is a synonym for adenosylcobalamin:

      Looking at the structure on both the wikipedia page and this next page, it looks like adenosylcobalamin to me:
      for comparison, just type adenosylcobalamin into a google search and then click on images.

      It seems that it is actually a very good form of B12, as it is adenosylcobalamin. Whether it is well absorbed in the form it is in is another matter. Sublingual tablets are designed to dissolve under the tongue and absorb across the mouth’s membranes; some of them work fairly well according to those who use them. Pills that are swallowed don’t work so well as the B12 is destroyed during digestion and never makes it to the small intestine where it can be absorbed. Injections of methylcobalamin or hydroxocobalamin work well because the digestive tract is bypassed.

      Your mom’s Calomide seems like a low dose after reading this article, being 250 micrograms, but if it works, then it works.

      • Regarding B12 pills not being absorbed from the stomach. I have a friend who is a district health nurse, and her department gets all the people newly diagnosed with B12 depletion. They start by giving methylcobalamin shots weekly, and then the person switches to oral. They also have all the latest research on B12, and supposedly if you give very large amounts by mouth then it will be absorbed. She said that large amounts by mouth are better absorbed than the sub-lingual type..but I have to confess that i am sticking to sub-lingual.

  125. Dear Chris: I am desperate for your expertise on B12 deficiency. I am 59 years old and at the age of 35 my Dr. Told me I was very low on b12, I wasn’t told I was b12 deficient, I changed Dr’s and did not take my medical records. The doctor I have now had tested my levels, they were 222, this was about 7 years ago. She told me my levels were fine and I have been experiencing many symptoms for all these years. The symptoms I have been experiencing are, insomnia, lack of appetite, weight loss, fatigue, depression, memory loss, panic attacks, I have colitis, vitiligo and the last visit with my Dr. She said that my levels should be at least 300, and to take the b12 pills. I took them for about 3 years with no success, she doesn’t believe in giving the shots. I have very little energy and I am so sick of feeling this way for all of these years. I spoke to many of pharmacist that told me that usually shots are given to bring up your levels then the pills will work. I would greatly appreciate any help you can give me, I am so sick of feeling terrible! I’m afraid that I have a lot of damage because of the length of time this has been going on. Please, please reply, it would me the world to me. Thank you, any info would help, I am feeling so defeated, and you cannot get another doctor in my area. Thanks again

    • Oh my word you poor thing! Many people here know a lot more about this than I do, so hopefully they will chime in, but just to give you more info, here is what I think:

      1 – Read Chris’ articles, here’s another:

      2 – Here’s Freddd’s protocol, lots of good info:

      3 – Check out the book Chris recommends on Amazon: “Could it Be B12?” by Sally M. Pacholok and Jeffrey J. Stuart. There isn’t a particular protocol in this, but there is a good check list on P. 189-193 to self-diagnose and the book is full of info. even if you don’t have a decent doctor at the moment.

      4 – Then write up a protocol that seems good to you, for your own body and situation using Freddd’s guidelines. He gives wonderful info that is not anywhere else, just at least read that one page I linked in #2 above.

      You can get spray on oils for B12 deficiency and use them instead of the sublingual tablets. You spray on your skin and rub in. Here’s the product page:

      You can also get spray sublingual methylcobalamin at a dose of 500mcg per single spray. This is what I’m using but I need a lot, and more cofactors that I am learning about from both Chris and Freddd (Thank you both!). I get mine from Just type B12 into the search bar and then look for Pure Advantage brand. Yes I can actually feel a positive difference when I use it, but it is slight. (Perhaps I am not using enough? Perhaps I need more cofactors that I am unaware of?)

      I do believe that injections are the best way to go in the beginning, but I went to an ND who still didn’t believe my symptoms, written down and told to her, with me standing in front of her, because the MCV was in range. She is blind in one eye, can’t see out of the other! I got precisely one injection and felt like a new person for 1.5 days, then no more. Bummer. The spray I use is nowhere near as good as that was, so the search continues…

      Try to find another doctor, preferably an orthomolecular MD/DO or a holistic MD/DO or a naturopath (ND) that actually believes there is such a thing as B12 deficiency. Use google to search. You may be able to find someone to help you that will do it online or long distance. It may be worth it to travel once just to get started, and then continue on your own.

      Best Wishes!

    • Hi Marlene, Your description certainly sounds as if you B12 deficiency, particularly when you combine your B12 levels with your symptoms. You will see many protocols on the web-site for getting better. One thing that you need to do before you decide which one is best for you, you need to work out why your are deficient. as this may help you choose the correct protocol. Thus, do you think it is your diet (vegan or vegetarian), genetic problems (methylation associated mutations),, metformin use, hypothyroidism, atrophic gastritis, etc, etc., or is it the colitis? Colitis can be the cause or the effect. If you have colitis, you will also have other B group deficiencies, and possibly vitamin D deficiency, and in addition most oral, sublingual, nasal spray treatments will be almost ineffective.

    • Hi Marlene,
      Here are all the supplements that I take. I still have my period, and I definitely notice a cycle as to how good or bad I feel, so keep in mind, as a woman, it doesn’t matter if you are post or pre menopausal, you are going to have a certain number of good days and a certain number of bad days each month.

      Anyway, I take
      Natural Factors Sublingual Methylcobalamin 2 5000mcg daily
      Phillips Magnesium Caplets. 2-3 daily
      Feosol Bifera 1 caplet daily-ish
      Vitafusion PowerC 2 Gummies Daily
      Phillips Colon Health. Probiotic caps. 1 Daily
      Sundown Naturals inulin Fiber Prebiotic. 4 capsules daily
      Vitafusion. Platinum 50+. 2 Gummies Daily
      Nature Made Super B Complex. 1 caplet Daily
      Vitafusion Vitamin D. 2 gummies Daily

      I avoid artificial sweeteners as best I can. I would avoid them altogether, but they put them in so many products now, even Wrigley’s gum, that I can’t eliminate them completely.

      I drink unfiltered apple cider vinegar diluted in water, or take the apple cider pills about once a week. More often makes me feel better, but, you know how it is.

      I haven’t tried it yet, but I probably will, try Royal Jelly. If you are severely allergic to bees, you can’t use it, and you have to only start with like 1/8 of a teaspoon a day, but it is supposed to be good for what ails ya.

      I don’t exercise at all (I know, I know). I took a Tai Chi class a few years back, and it did give me a feeling of well being. Something like that, or yoga might help you.

      So, try taking the things I listed for a month or two, and see how you feel. Though, I you may want to take 2 B12’s in the morning, and 2 at night. Also, wait a little while if you are going to try the Royal Jelly, or even the Vinegar. See how you feel with the vitamins first.

      If you don’t notice an improvement after 2 months, have yourself checked for allergies, viruses and the like, and parasites.

      I also drink only water most of the time. Soda gums up the works,and I can feel alcohol in my system for days. I do take aspirin almost daily, but I only use enteric (coated), and never take it on an empty stomach. I also try not to take acetaminophen — I find the fact that they keep lowering the dosage and telling us what not to have with it troubling (after it being sold for over 60 years, they’re just finding out about it now?)

      Just one more thing, coffee was giving me heartburn, so I now take roughly 2-3 Jet-Alert tablets a day until I can kick the caffeine ( yeah, right). They don’t have the same kick as coffee, but one pill gives me quite a bit of stamina for 3-4 hours. That might help you a bit, and for nausea, get some Clove gum, Amazon sells it.

      In the summer I take Zyrtec, sudafed, and sometimes for dizziness, prescription Meclizine, which is GREAT, I can even read a map while my husbands driving, and I don’t feel like I need to throw up.

      I know where you’re coming from, so I hope my drug list helps.

  126. If you haven’t had genetic testing and don’t know if you are COMT V158 positive, then according to Amy Yasko (expert on nutrigenics) I don’t see how you can know what kind of B12 you need. Double COMT like I am is very sensitive to B12 of any kind and I can only use Hydroxy and or Adenosyl B12. On top of that, if your lithium is low, any b12 you take may not be available since lithium is thought to transport it. She says find out your lithium levels through hair metal analysis to determine if you need to get that balanced before moving onto B12 support. Google her protocol for autoimmune, autism , chronic disease……it is based on your genetics…….otherwise you are shooting in the dark on this stuff !!!

    • I am not sure that I agree with this. One of the reasons that people think that they do better on the OH/Ado b12 mix is because basically the OHB12 is not really working and for good reason. They can’t reduce the OHB12 to turn it into MeCbl. Even the science doesn’t support the idea that you won’t do well on MeCbl. It now looks like many of these people need riboflavin (as FAD or FMN) as it is used in the enzymes that are involved in breaking down adrenalin and histamine using SAM. If they are hypothyroidic or have low riboflavin then they appear to be bad responders to methyl, as they can’t make FAD, and so can’t inactivate DOPA, histamine or adrenalin once it is stimulated. The whole hypermethylation story is unproven scientifically and has not even a rational reason to be right.

  127. You all need to go on the internet and look up Methylation Cycle/Methy B12/Methylfolate. You will get tons of information about brain chemistry cycles that involve B12 and folic acid. You may want to get a genetic test done (you can self order thru the ” 23&me” website for $100). You will get a report of genetic deficiencies, but you may not know how to interpret it, so It would be best if you could work with a Dr (MD and or homeopathic) that is aware of “MTHFR” (the genetic defects that cause B12 & Methylation deficiencies). Having said that, most main stream Dr do not even know about this and cannot (will not??) help you. I have seen a neurologist, an ENT, a cardiologists and a family practitioner – non of which had a clue how to help me. Note: If you are not biology or chemistry minded it may seem overwhelming at first, but there are many articles written by laymen that are easier to understand. My main Symptoms: Light headed every day for 2 years, feet burn at night, brain fog. balance issues. Hope you all find answers to your problems.

    • Genetic Genie on the net can decipher your 23& me test and puts it in a understandable format . I think they ask for a small donation for the service but ($15 ?) but it was well worth it.

    • Hi Pat,
      Yes it is a pretty good book, but probably her web-site has quite a bit of additional information. She doesn’t appear to have linked the deficiency to variants in methylation related enzymes (MTHFR, MTRR, etc) nor to the prevalence in CFS. Good on her for trying to make the population aware of the problem. Now if you can just get the doctors to be aware many of us will be better off!

    • Her book is o.k. to show to your doctor if he is not a believer in the harm low B12 can cause, but frankly, she’s preaching to the choir. I really don’t like the fact that she tells people to wait to take B12 until they get a diagnosis from their doctor, when her main complaints are that doctors won’t listen, and that the tests aren’t definitive.

      If I hadn’t started taking B12 on my own 3 years ago, I don’t know where I’d be — probably in a wheelchair waiting for another test to come back. Seriously.

  128. Hi,chris i had vitamin b12 low when i had my total blood count 6 weeks back and it was 186 only as the normal range is between 198 and 500 .I started having symptoms like buzzing in my ears or brain,memory problems,thinking problems,shortage of breath,lack of energy.Doctor suggested me jamieson sublinguil 1000 which didnt really helped me of which i use to take 2 daily almost 6 weeks still have neuorological problems,now i have switched to ola loa b12 with hydroxycobalamin and folic acid also magnesium bisglycinate plus ,i am not sure if its really gonna help me its affecting my social life including my exams,plz suggest me something as my main problem is neurological.

  129. “This is especially important for vegetarian or vegan children or pregnant women, whose need for B12 is even greater than adults.”

    You do realize that pregnant women are adults, right? It would probably be prudent to re-word this sentence.

  130. There are plenty of sources of B12 for Veggie and Vegan eaters. I hope you did not deter anyone from their own choices by stating false information as fact.

    It’s also stated that vegans and vegetarians live an average of 10 years longer than meat eaters. Doesn’t seem like a B12 deficiency to me.

    • Ed,
      What are the vegetarian sources for B12, because I’ve never heard of any. Also, what studies show that vegans and vegetarians live longer (and hopefully without more problems) than meat eaters?
      This isn’t meant to sound confrontational, just wondering.

    • Ed, I don’t know that anyone would agree with you on this. Even meat eaters can have trouble getting enough B12. For instance you would need to eat 4 lbs of chicken to get your daily allowance and up to 10 eggs. As for non-meat sources, the only one of any note is mushrooms, where you would need to eat a whole room of mushrooms to get your daily allowance. Other “supposed sources” have generally been found to be due to bacterial contamination, or shrimps (in the case of seaweed). Having had to deal with someone who had B12 deficient dementia I am very careful about dietary B12 intake.

  131. I’m a vegetarian and also use a proton pump inhibiter, so that may likely be the cause. I saw the Dr. today and he was pretty surprised it was so low so he ordered another test to make sure. We’ll wee how that comes back. He mentioned that there is a nation wide shortage on B12 injections and said that the nasal spray may be the way to go depending on how the re-test comes back. Anyway have any experience with that?

    • Hi Chris, a double whammy. PPI’s are known to cause B12 deficiency, put that in with a vegetarian diet and you would have to have a miracle not to be deficient!!
      I wouldn’t bother with the nasal spray, they are an experiment and a way to get around a couple of patents, all they do is slowly dribble the dose down the back of your neck slowly into the stomach.

      • Thanks for the information. I guess I’ll try to call around and see if I can find any place to get the injections and if so try to convince my Dr to prescribe them. Is it possible to get injections online from a reputable place if you have a doctors prescription. I’m in a fairly big city, but in case I can’t find any.

  132. Well, I ended up going to get the B12 test on my own and figured that if it came back on the borderline I might opt for getting the MMA on my own as well. The B12 blood test came back at <31, so it doesn't seem to be necessary to do the MMA. Seems pretty low. I'm going to see my Dr. to get his take.

    • Well Chris, looks like you now know what is wrong. Your levels should be above 300, so you have a long way to go to get back to that. Now you just have to work out why it so low, and then how you are going to get your levels up and stay up. This will depend a lot on why you are low.

  133. I have b12 deff, fibromyalgia and like another person on here I cannot raise my left arm above my head anymore and now have pain in my left foot as though it’s broken, but doc says it is poss plantar facilitus. I am about to have a active b12 test.

    • Jacquie,
      If you already know you have B12 deficiency, why are you going for a B12 test? No matter what the test says, I would recommend taking two 5,000 mcg sublingual b12 tablets (1 in the morning and 1 at night) each day and see how you feel after a month. Also, see if you are low in D, and take that if you are, but wait for the test on that one because too much D can cause you harm. I was REALLY low, and the doctor prescribed a super-duper D3, but it upset my stomach so much that I had to stop. I tried lower dose over the counter pills, but they upset my stomach also. I then tried Vitafusion gummies, and found that I can tolerate those. Look for low Zinc and Magnesium as well.
      I have been taking Amlodapine and Hydrochlorathiazide for blood pressure, and have had a lot of problems since I began that didn’t go away after taking my vitamins. I decided to lose weight, exercise, and step down from the pills, and am now taking one half dose every other day, and have noticed that I feel a lot better. I haven’t lost the weight or exercised, so my BP will more than likely go up when I’m done with the pills. If you take medicine, it could be that, but don’t be like me. Make lifestyle changes (I know It’s hard when you really, really don’t feel well), and plan with your doctor so you can get off any meds you can.
      I have been taking Unprocessed Apple Cider Vinegar in water with honey every night, and when I can’t, I take an Apple Cider Vinegar Pill, and it seems to help.
      Some people have tried Royal Jelly (bees make it) for fibromyalgia, and they say it works, but I’ve never tried it for anything, so I don’t know how good it is.
      Good Luck!

  134. I’m going to go to a local lab to get a B12 blood test and a urinary MMA test myself and bypass the Doc for now and then decide how to proceed. After looking at all the posts in this blog, I’m confused on what to use as a value for the MMA test to determine if I should pursue B12 shots. Do you just follow the guidance on the report or is there some other level I should use?

    Also, I take a daily multivitamin and separate D vitamin and a B-complex vitamin (just the recommended one a day dosage). Is it recommended to not take these prior to the tests?

    • Chris,
      It’s good that you are taking the B-complex, but they can mask B12 deficiency, especially if they contain Folic Acid. I would stop taking them AT LEAST a month before the test.
      Are you in the U.S.? You can go to a lab without a doctor sending you? Also, I have asked for an MMA test, and other B12 tests from three doctors, and they don’t know what they are.

  135. Hi Chris

    I have been Diagnosed has a
    Having a stroke, vascular diamentia and the onset of Alzheimer,s . My B12 has been low for many years and last checked was 240 My sister has been diagnosed with pernicoi

    • Hi Chris, you need to really address the deficiency. Many studies have shown that you would need high dose repeated injection or the B12 oils to start to repair the damage to your neurons. Nerve velocity measurements suggest that it will take at least one year, but if you are really, really bad it will possibly take longer. Sounds like you may have some genetic predisposition to B12 deficiency. Do you know if you have mutations in your methylation associated enzymes?

  136. Hi Everybody,
    I am from India, Female 41 , 65 Kg Weight , 5′ 5” got recently tested vitamin B12 with 156 pg/ml (Picograms per milileter) ?
    How much medication of Methycobalamine Injection or HydroxyIcobalamine Injection I should take per day till how many days for replenishment?? What happen if i took excess medication??
    You can advice me any other options if necessary…
    Looking forward for your reply.

    • Hi Tanisha,
      In December 2011, I diagnosed myself with low B12 after reading an online article, “Antacids Ruined My Life”. For the longest time, I had severe fatigue, but by 2011, my hair was falling out; I had extreme memory loss and brain fog; my sight was weird, I could see, but yet couldn’t see was how I described it; my periods were so painful, that I would double over and wouldn’t be able to a stand straight for 5-10 minutes; I was always dizzy, and had a severe attack of Vertigo the year before; my feet hurt as though I had Plantar Faciitis, the pain then went up to the back of my leg to my knee — I was in pain at night in bed, and during the day, I could barely walk; and everything in my life started to overwhelm me, even putting up the Christmas tree was too much for me.

      After the article, I started off with the sublingual cyanocobalamin — 4 pills of 5,000mcg each. I took 2 in the morning and 2 at night. Before 2 weeks was up, my feet and legs were much better, and by the time 1 month had passed, most of my symptoms were either gone, or much, much better. I then switched to the methylcobalamin at the same dose. There is supposed to be no limit to the amount of B12 one can take, but it’s also processed by the liver and goes through the kidneys, and the dose I was taking was high, so for my own peace of mind, I tried lowering the dose, but each time, the pain in my feet came back instantly. By about December 2013 (2 years), I was finally able to lower it to the one 5,000mcg pill. I tried to lower it to 1,000mcg, but the foot pain returned after 2 weeks.

      I still have a few slight problems, and the fatigue, though better, never did go away, but I am taking Blood Pressure and Water Pills which have quite a few side effects (like fatigue), so I am trying to slowly go off of them, too.

      I hear the B12 injections are better than the pills, but my doctor won’t give them to me. If you watch “Living With the Fog” on YouTube, they say that every person is different.

      I’m Female, 51, 65 Kg (if the calculation on Google is right), and am 5’3″.

      Good Luck, and Be Well.


      • Hi Ann, it sounds like you are experiencing the problems with oral tablets and B12. The amount that you absorb is only a tiny fraction of the dose that you take. This means that whilst it can help with some of your symptoms it won’t really make you better. You probably would be better with the product from which is a topical oil which gets a much higher dose in. I have found it marvellous. Good luck.

        • Madge,
          Many of my extra problems are definitely being caused by my BP meds, but I will try the oils, and see if they do better than my sublinguals. Thanks.

      • Ann – I had similar symptoms.
        For your eyes, I think you should try vitamin B2. That gave me amazing results. My dry eyes and eye fatigue has improved significantly. I tried Natures Plus B2 or Solgar, about 50 to 100 mg initially and can lower the dose later.

        • Thanks for the advise Vin, but my eyes were better after I started the B12. I also take a B complex, and vitamin D gave an extra boost.
          I am over 50, so I need the drugstore readers for reading, but only 1x.

        • Vin,
          I think I will look into the B2. My eyes aren’t as dry as they used to be, especially since I stopped taking my BP meds, and I don’t need my allergy medicine this year. The dry eye flare ups still bother me, and I came across your post again, so I will try the B2 out. Thanks.

      • AnnF, you described everything I have been dealing with lately including the plantar faciitis, and ever since I was diagnosed with Fibromyalgia in 2010. The doc had put me on Cymbalta which gave me intestinal issues so I got off it and Ive been struggling for 5 years now trying to self treat myself with organic foods, mineral supplements and vitamins. None of the doctors ever thought of B12. One mentioned I had Low D3 but never stressed the importance of it. But NOW after having my blood work faxed to me this time around from being sick and tired, of being sick and tired and in constant pain and overweight, I started googling each result. My MCH was high indicating B12 deficiency and megloblastic anemia? And my D was showing as <4.2 how does one just shrug their shoulders to these results knowing I have these symptoms of fibro, fatigue, unable to lose weight no matter what I did, and then digestive issues that went from 5 years of constipation to suddenly diarrhea! I recently ordered a multivitamin patch since I realized I cant digest anything correctly at the moment, which includes 5000iu D3 and 1000mcg B12 AND a straight patch of B12 5000 mcg only. Directions say the patch is supposed to be used once per week but Ive been wearing one per day since I got them. Seems to be helping but I need more to recoup faster so maybe 4 patches a day (20k mcg) on me would help for a couple months? What say you? (Although they are not cheap they are convenient and I might be able to talk them into a bulk discount)

        • If you can’t get the B12 shots, I think you should try the oils that a few people wrote about on here. I keep saying I am going to try them, but I haven’t yet, just because I’m a little confused about which one to use.

          As for D3, spend time in the sun, drink milk if you can, and try the GummyVites D3. I wrote before (I wish we could sort the posts by name at least), that my doctor was concerned about my D levels, and prescribed, I don’t know, 15,000 units or more of D3, but the pills made me sick, so I tried a few OTC brands until I found the GummyVites. I have been able to tolerate all the vitamins I take, except for the B complex, and that is not so bad if I take it with milk, and especially with food. Make sure you take probiotics.

          I did have the opposite issues in one department. I had diarrhea all the time until I started the B12, and now I am constipated. The Magnesium really helped, but now I can only take one a day, and I know I really have to exercise.

          I think that most of the doctors people go to are competent, it’s just that they have been trained in a certain way. It doesn’t help when stupid reports come out that state that vitamins don’t help at all. How can they quantify something like that?

          Anyway, look at the list of vitamins I put on here in a few places. If you can’t find them, I’ll write them down again. Try for the shots. You never know. Don’t avoid oils and fats — use the whole egg, drink whole milk, use mainly olive oil — imported if you can afford it, I like grapeseed oil as well, try to buy as much organic/non GMO produce as your budget will allow, use raw honey daily, and drink diluted unfiltered apple cider vinegar daily. Get off the coffee if you drink it!

          It takes a long while, but one day you’ll notice that you are starting to feel better, and that really gives you a boost. Good Luck!

  137. I have been trying to sort out my symptoms and have suspected everything from metal poisoning to Lyme and co-infections to Candida and leaky gut. It started after a tick bite, birth of my first child, and amalgam fillings (8 years ago). I had extreme stiffness in my ankles upon waking in the morning. Also, pain in my spine upon jarring. Lyme and lead tests were normal but SED rate was 35.
    Over the years, I developed sharp pains in my neck (thyroid), heart palpitations, chest pain, nose burning when coughing, and more. Last year, after the birth of my 3rd child, IV antibiotics during labor (another tick bite during pregnancy), and metal ortho. braces two months post partum, I suddenly noticed that I was having problems with balance. Subtle, but noticeable. Also, for about two weeks after getting the braces, I had extreme fatigue upon waking and my feet were sore at night and upon first steps in the morning. I didn’t pay much attention, because it subsided. But, then general fatigue and other symptoms began to surface. Shortness of breath, sharp ice-pick head pains, temple tension, facial fat loss, intestinal and eye muscle twitching, then all over muscle twitching. Then I began to panic and woke up with one leg burning and creepy crawly sensations. Cold sensations, tingling, sound sensitivity, smell sensitivity, hyper-nerves and more. It would take pages to describe it in detail. When I had the braces removed, I had instant relief, but have been struggling with finding an optimal balance with diet, supplements and detox. My SED rate has remained around 28-35. My B12 was low normal. 312, I think. My Vitamin D was 28. I have had a few amalgam fillings removed and the supplements and the toxins caused tremors, increases sound sensitivity and brain snapping sensations. A month of Doxy and no supplements solved the brain snapping and sound sensitivity, but the muscle twitching persisted. It has been the most persistant and hard to deal with symptom. Heart palpitations and chest pains and upper torso pains, are the others. Magnesium and B12 has recently almost stopped the twitching, but weakness and sore muscles have started. Also, I have noticed a strange reaction to alcohol for years. I get weak all over my body within seconds of sipping wine. Any insight about what tests to order, or supplements to try would be greatly appreciated. Can I expect to get well?

    • I should also mention that the supplements I have been taking include MethylCobalamin B12, Vitamin D 1000, Glutathione cream, Pectasol C, Fish Oil, CoQ10, Magnesium w/wo calcium, Pau D’Arco. Grapefruit Seed Oil for a short time.
      I have only taken most supplements for a week or so at a time, with a week or so off. Busy life, makes it hard to be regular with anything, and also the flair up of symptoms can usually be attributed to something I am taking, but on so many things, that I have a hard time knowing what.
      Yesterday, I took the b12 twice and today my left arm and hand feels like the blood supply has been cut off and I have a cold sensation in it. I noticed threads about potassium, so yesterday and today I ate a banana. Hasn’t helped, yet.

    • Hi Danielle,

      First, what is Doxy and SED?

      Tests — Lupus, there are other tick diseases besides Lyme, MS, check all your endochrine glands, your Lymph system, Hodgkin’s and non-Hodgkin’s lymphoma, diabetes, liver, kidney, HEART, lungs, particularly asthma, brain, and D3. Long list, I know.

      If you look back, you might remember signs of B12 deficiency, but never realized. For me, you know the end scene from Queen of the Damned, where the vampires are walking in slow motion, while everyone else is speeding? That was me as child, and still is as an adult. I can relate to the tick bite and childbirth (though tick bite just kind of made me more aware. Seriously, I do think what you have is B12 deficiency. So many things — EYE TWITCHING — sound exactly like what I was going through.

      B12 deficiency really sneeks up on you. I remember whem I was 19, feeling slower than I had been, then at 30, complaining to others that I felt so tired, and that everything just seemed so hard, and them saying that everyone felt like that, and me saying to myself, “I don’t think so..”. At 32, even though I was eating the same or less, and exercising more, I gained so much weight in one month, that none of my clothes would fit. Slowly, until, like you, everything started breaking down. I laughed when you mentioned the alcohol, because the same thing always had happened to me.

      My advice to you, stick with the vitamins I listed a few times now. Do not take fish oil. Take cod liver oil. Lately I have been taking Carleson Norwegian Cod Liver Oil. I take a teaspoon a day, and it doesn’t taste fishy at all. Stop taking the more “different” supplements. I have found they are not worth it, and the grapefruit seed, I love grapefruit, and eat it a few times a year, but really, it effects too many things, so I am very wary of it.

      I think you know this, you already said it yourself, you have to stick with it. A banana a day is a very good idea, but a banana EVERY day. I’m a housewife, so I can make sure I take my supplements every day. I still can’t sleep too well at night, but I can take a long nap