Vitamin B12 Deficiency: What It Is, Symptoms & Treatment | 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 DirectLabs.com.

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.

1,962 Comments

Join the conversation

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

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

    Any suggestions?

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

  2. Dr. Kresser,

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

  3. Hi Chris,

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

    Thanks!

  4. Hi Chris,

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

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

    Love this blog!

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

  5. Hey Chris,

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

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

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

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

        Do you have any one per day alternative?

        Would you recommend the variety ‘without iron’?

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

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

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

    The second one was actually started by Sally Pacholok.

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

  7. So glad I found your website, Chris.

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

    Thank you for all of this great information!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    • Adam,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Great post Dr. Kresser.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

                • Hi Cathy,

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

                  Rajeev.
                  New Delhi
                  India

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

                • April 2013 – note to readers of this thread:

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

                  CHRIS ALSO PROVIDED AT THE END OF THAT FOLLOW-UP ARTICLE HIS SUGGESTED LIST OF THE *FOUR* SUPPLEMENTS (BRANDS, TYPES, AND DOSAGES) TO TAKE IF YOU WISH TO REPLENISH YOUR B12.

                  PLEASE CHECK OUT HIS “NEW” POST ON B12 TO GET HIS LATEST THOUGHTS ON B12 DEFICIENCY AND SUPPLEMENTATION.

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

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

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

                  thanks again

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

                  thanks.

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

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

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

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

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

              • Catherine

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

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

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

              .

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

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

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

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

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

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

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

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

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

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

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

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

                • Hi Mark

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

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

                  Mark

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

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

                  Mark

                • Hi Freed

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

                  Thanks Mark

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

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

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

            • Fredd,

              I have a few questions for you.

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

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

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

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

          • Kathy,

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

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

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

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

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

            All the best.
            Miriam Landau

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

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

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

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

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

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

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

                • Judy,

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

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

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

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

                • Hi Judy,
                  That sounds rather strange. I know that they are there did you try [email protected]? They should answer. I know that Greg from B12 oils normally monitors the traffic. If he is there maybe he can help.

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

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

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

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

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

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

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

            • Hi Chris,

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

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

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

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

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

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

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

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

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

                • Hi DDC,

                  http://forums.phoenixrising.me/showthread.php?11522-Active-B12-Protocol-Basics

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

              • Freddd,

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

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

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

            • Question for Dr. Chris Kesser,

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

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

              • Hi Shane,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

              • Hi Martyn

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

          • I agree with Chris

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

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

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

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

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

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

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

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

      • Hi TMAC

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

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

        • I’m curious-are you getting injections? If not, you should be. 800 is not really high for B12 (if you were saying that was your b12 level not your folate level). Serum b12 is not a good indicator of how much active b12 is actually in your system. If you have severe symptoms, it might be a good idea to get injections more often until the symptoms show no more improvement. Depending on what kind of b12 you are given (cyanocobalamin, which is used in the US, hydroxocobalamin is used in UK) would determine how much more to take. Cyano, once a week, hydroxo, every other day. Your doctor will try to discourage you, because standard protocol in US is once a month and UK is once every 3. Protocol doesn’t really address the symptoms, and for the most part, doctors are really not very informed when it comes to B12 deficiency and especially Pernicious Anemia. With a level that low, you are most likely PA, but the IF test is probably 50/50 for accuracy, so even if it comes up negative, you most likely still are. Doctors will tell you that you can overdose on B12-you can’t. B12 is a water soluble vitamin and any excess is excreted. Studies have been done using extremely high doses of b12 with absolutely no side effects. Some people may have an allergic reaction to an injection, but that is usually a reaction to the mixture, not the vitamin. If you are PA, you cannot absorb b12 from food or oral supplements, and only injections will help. If you have questions, I have found this facebook group to be incredibly helpful. https://www.facebook.com/groups/PAB12DSupportGroup/

    • Hello,

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

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

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

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

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

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

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

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

            Any help would be great!

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

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

    • Hi Jesse,

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

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

      Toodles,
      m

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

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

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

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

      http://www.ncbi.nlm.nih.gov/pubmed/8926531?dopt=Abstract

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

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

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

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

        “B12 is found almost exclusively in animal foods such as liver, kidney, meat, fish, shellfish, milk products and eggs but the original source of B12 in nature is bacteria, the only creatures able to manufacture this vitamin. In humans and animals, these bacteria produce B12 in the colon; however, little if any is absorbed across the colon wall so we must get our B12 from animal foods. Bivalves such as clams, mussels and oysters contain high levels of B12 because they siphon large quantities of vitamin B12-synthesizing microorganisms from the sea. Production of B12 supplements involves fermentation procedures similar to those used for penicillin and other antibiotics.
        Interestingly, while eggs contain B12, they also contain substances that block absorption, a fact that leaves only milk as a good source of B12 for vegetarians. Some studies indicate that B12 is better absorbed from milk than from meat. However, one source indicates that B12 in milk is destroyed by boiling. Analysis of B12 in pasteurized milk reveals only a 10 percent loss; however pasteurization deforms the milk proteins that aid in B12 absorption.”
        http://www.westonaprice.org/health-topics/abcs-of-nutrition/vitamin-b12-vital-nutrient-for-good-health/

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

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

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

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

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

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

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

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

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

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

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

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

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