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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

              You said:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      • Hi Molley

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Thank You

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

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

        Again thank you

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

          You can swallow a pill (1% uptake), suck a sublingual (5%) or use the new transdermal approach pioneered by http://www.b12oils.com/ – perhaps 80% uptake.

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

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

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

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

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

      Some answers would be very helpful for me.

      Thank You

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

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

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

      thank You

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

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

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

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

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

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

                • The Australian brand is at http://www.b12oils.com/

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      http://www.mnpoison.org/educators/medicalprofessionals/NewslettersandReviews/Methanol/POISON_DATA_145

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

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

  7. Hi ya’ll.

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

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

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

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

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

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

      Hope this helps in joining some dots.

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

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

      Ref: Toxic Neuropathy: Practice Essentials, Background, Pathophysiology
      emedicine.medscape.com/article/1175276-overview
      Feb 3, 2016 – Toxic neuropathy refers to neuropathy caused by drug ingestion, drug or chemical abuse, or industrial chemical exposure from the workplace …

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      (I have no affiliation with them.)

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

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

    I bought it from http://www.b12oils.com/ (with which I have no affiliation).

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

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

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

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

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

    • Hi

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      http://www.health-boundaries.com/what-is-a-healthy-b12-level/

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

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

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

      http://www.mthfrsupport.com.au/vitamin-b12-reference-range-level-set-low/

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

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

      https://www.thorne.com/products/dp/basic-b-complex

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

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

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

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

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

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

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

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

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

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

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

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

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