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


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Reviewed by Chris Masterjohn, PhD

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: Their signs and symptoms can all be mimicked by 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. #B12 #B12deficiency #cognitivedecline

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.

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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:

  • 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)

Seaweed is another commonly cited plant source of B12, but this idea is controversial. Research indicates that there may be important differences in dried versus raw purple nori; namely, raw nori may be a good source of B12, while dried nori may not be. One study indicated that the drying process used for seaweed creates B12 analogs, making it a poor source of the vitamin, while animal research suggests that dried nori can correct a B12 deficiency. (10, 11) Seaweed may provide B12, but it’s not clear if those benefits are negated when that seaweed is dried. I recommend caution for that reason.

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. (12)

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 or high-dose oral cobalamin indefinitely. This may also be true for those with a severe deficiency that’s causing neurological symptoms.

Typically in the past, most B12 experts recommended injections over high-dose oral cobalamin for people with pernicious anemia and an advanced deficiency involving neurological symptoms. However, recent studies have suggested that high-dose oral or nasal administration may be as effective as injections for those with B12 malabsorption problems. (13, 14)

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. (15, 16) On top of that, methylcobalamin provides the body with methyl groups that play a role in various biological processes important to overall health.

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Chris Kresser in kitchen

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.


Join the conversation

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

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

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

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

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

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

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

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

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

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

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

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

  6. Hi Chris,

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

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



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

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

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

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

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

        • Hey all,

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

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

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

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

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

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

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

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

  10. Chris Kresser May 16, 2011 at 5:39 pm

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


  11. Hello all,

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


    • Jan, To recover my feet I have to maintain my cobalamin serum level at about 200,000pg/ml.

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

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

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

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

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

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

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

  16. Hi Chris

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

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

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

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

      • Hi

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

  17. Hi Chris,

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

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

    Thanks bunches!

      • Okay. I will ask if he has that. If not, is there a place/brand you’d recommend?

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

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

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

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

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

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

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