Are you a dedicated vegetarian or vegan? Perhaps you decided to follow a plant-based diet to improve your health but over time you’ve started to experience troubling symptoms such as brain fog, fatigue, poor memory, and even numbness or tingling in your hands and feet—issues you never had previously. If you can relate, then you may have a vitamin B12 deficiency.
Research indicates that vitamin B12 deficiency is far more prevalent than previously estimated, with at least 40 percent of Americans demonstrating suboptimal levels, and millions more going undiagnosed altogether. The consequences of B12 deficiency are serious and can cause irreversible damage if left untreated.
Read on to learn about the health implications of B12 deficiency and why it is significantly underdiagnosed, the best methods for testing your B12 status, and how to optimize your B12 intake with food and supplements.
What a B12 Deficiency Means for Your Health
Vitamin B12 works with folate to synthesize DNA and red blood cells and assists in the production of myelin, which protects your nerve cells (neurons) and regulates nerve impulse transmission. A deficiency of vitamin B12 can have significant health implications for multiple body systems.
Vitamin B12 deficiency is exceedingly common—especially if you’re following a vegan diet. Find out how to tell if you have a deficiency and learn how eating nutrient-dense foods can help you correct it. #nutrientdeficiency #vegetarian #vegan
The classic association of vitamin B12 deficiency with macrocytic anemia, a condition in which red blood cells are larger than normal due to impaired cell division, speaks to the importance of vitamin B12 for regulating DNA synthesis. However, anemia is but one symptom of B12 deficiency. There are many other B12 deficiency symptoms that occur long before anemia sets in, including:
- Dementia
- Cognitive decline
- Memory loss
- Brain fog
- Depression
- Cardiovascular problems
- Peripheral neuropathy (numbness, tingling, burning in the hands, legs and feet)
- Impaired immune function
- Infertility
- Developmental and learning disabilities
Unfortunately, many of these symptoms are often mistaken for other health conditions, including Alzheimer’s disease and multiple sclerosis. As a result, B12 deficiency is often missed by physicians in the clinical setting, with serious implications for patients’ long-term health.
If You Have an Undiagnosed Deficiency, You’re Not Alone
B12 deficiency is far more common than most healthcare practitioners and the general public realize. A study from Tufts University found 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 neurological symptoms can occur. Nine percent had an obvious B12 deficiency, and 16 percent exhibited “near deficiency.” (1) Surprisingly, the researchers also discovered that low B12 levels were just as common in young people as in the elderly.
Given the prevalence of B12 deficiency, why aren’t more clinicians and health organizations drawing attention to this serious problem? The answer lies in the fact that B12 deficiency is significantly underdiagnosed. Here’s why it’s frequently missed:
- B12 status is not routinely tested by most physicians.
- Serum B12, the conventional marker of B12 status, only drops in the later stages of B12 deficiency. Relying on serum B12 testing misses many, if not most, people who have an insufficient B12 intake.
- The low end of the laboratory reference range for serum B12 is too low. This is why most studies underestimate the true levels of deficiency.
- The standard serum test for B12 measures the total amount of B12 in the blood but does not rule out functional B12 deficiency. (A “functional” deficiency means that B12 levels are too low for optimum health, but symptoms like anemia may not yet be apparent or diagnosable.) (2) The determination of functional B12 deficiency requires other measures that are infrequently used by physicians.
New and Improved Testing Methods for B12
Fortunately, new, more sensitive tests for B12 deficiency are now available, including tests for methylmalonic acid (MMA) and holotranscobalamin II (holo-TC). Studies using these improved methods of B12 assessment reveal much higher levels of deficiency than studies using only serum B12 testing.
MMA
MMA is a compound in the body that helps with metabolism, via a vitamin B12-dependent enzyme; if MMA levels are high, it suggests that vitamin B12 is lacking. There are two ways to have MMA measured: in the blood serum and in the urine. (3) Some experts believe that urinary MMA is superior to serum MMA as a biomarker of B12 deficiency because MMA is more concentrated in urine than in the blood. However, elevations in urinary MMA can also be caused by kidney dysfunction. Serum MMA, on the other hand, can be elevated in the presence of small intestinal bacterial overgrowth.
If you decide to undergo MMA testing to determine your B12 level, your current health status matters. I recommend urine MMA if you have SIBO, whereas serum MMA is a better option if you have a history of kidney dysfunction.
Holo-TC
B12 is transported around the body by two proteins: transcobalamin II (TCII) and haptocorrin. Eighty percent of B12 is bound to haptocorrin, while only 20 percent is bound to TCII. Holo-TC, the marker that measures TCII, falls almost immediately after B12 intake drops. Serum B12, by comparison, measures total cobalamins (a name for cobalt-containing compounds, like B12). But it measures mostly haptocorrin, and doesn’t decrease until B12 deficiency has been going on for some time.
Homocysteine
Homocysteine is an amino acid in the blood. It’s a marker of B12 deficiency when elevated, though not exclusively. Elevated homocysteine can also be caused by folate and vitamin B6 deficiencies. Homocysteine is more sensitive than serum B12; however, if it is high, you will need additional testing to determine whether the cause is B12, folate, or B6 deficiency.
Holo-TC, MMA, and homocysteine are considered measures of functional B12 deficiency because they reflect whether B12 is being appropriately utilized in the body.
Your Best B12 Testing Option
So, which one of these markers is best?
- Holo-TC is the earliest, most sensitive indicator of B12 deficiency.
- Urinary MMA and homocysteine typically don’t become elevated until the mid to late stages of B12 deficiency.
- Serum B12 is the least sensitive indicator and usually doesn’t fall until the final stage of B12 deficiency.
While holo-TC testing is often the best way to catch an early B12 deficiency, it isn’t widely available in the United States (though it is in Europe). Here, we generally rely on a combination of serum/urine MMA, homocysteine, and serum B12 testing.
If you choose to get a serum B12 measurement, you will need to refer to a different range than the one provided by the lab when interpreting your results. Although most labs define deficiency at <200 pg/mL, it is well documented that many people experience signs and symptoms of B12 deficiency at levels between 200 pg/mL and 350 pg/mL. (4) Also, be aware that a high serum B12 does not necessarily rule out a functional B12 deficiency, which is best detected with MMA or holo-TC.
The same is true for homocysteine. The lab range often goes up to 15 nmol/L, but research has shown that a homocysteine level of 10 to 15 nmol/L is a substantial risk factor for heart disease, and that relationship is linear—the higher the homocysteine, the higher the risk. (5)
The Earlier You Notice a Deficiency, the Better
There are four stages of B12 deficiency, and the earlier B12 deficiency is detected in the progression of these stages, the more likely it is that the symptoms can be prevented or reversed.
Stages I and II
During the first two stages of a deficiency, your plasma and cell stores of B12 become depleted, and the concentration of holo-TC is reduced. Holo-TC is the only available marker for assessing the first two stages of B12 depletion. It’s likely that you won’t experience any noticeable symptoms if you’re in stages I or II.
Stage III
This stage of functional B12 deficiency is characterized by elevated homocysteine and urinary MMA concentrations in the blood. Serum homocysteine and serum/urine MMA are the best markers for detecting Stage III deficiency. At this stage, some people will experience mild symptoms like fatigue or brain fog, but others may not notice any signs or symptoms.
Stage IV
If you’re in the fourth stage of a deficiency, you’ll experience clinical signs, such as anemia, fatigue, and brain fog. Serum B12 and other markers of Stage IV deficiency may not decrease until this point. For some Stage IV patients, the cognitive and neurological symptoms are so severe that many believe they have Alzheimer’s or Parkinson’s disease. (6)
As you can see, signs like macrocytic anemia and symptoms like peripheral neuropathy or brain fog do not appear until the final stage of B12 deficiency. Stages I and II of depletion can precede deficiency (Stages III and IV) by months or even years!
To complicate matters further, the physical manifestations of B12 depletion can take years to appear. In the case of neurological symptoms, it may be too late to reverse them by the time the late stage of deficiency has been reached. (This particularly serious for children and young adults whose brains are still developing, as well as any adult at risk for Alzheimer’s or dementia.)
What Is a Normal B12 Level?
As I mentioned before, the cutoff for serum B12 of 200 to 230 pg/mL, used by most studies and labs, is too low. Other studies suggest that B12 levels greater than 400 pg/mL, double the accepted lower limit of normal, boost the beneficial metabolic effects of B12 and prevent neurological damage.
Importantly, research also indicates that at least one-third of B12 in serum is not cobalamin, the metabolically active form of B12 in humans, but corrinoids, which are not metabolically active. This profound finding means that some people with “normal” serum B12 may actually be deficient because the test is counting metabolically inactive corrinoids as B12.
As a rule of thumb, if your serum B12 level is between 200 and 350 pg/mL, B12 deficiency may be a problem. Just remember that a normal serum B12 does not rule out functional B12 deficiency, which can only be assessed with holo-TC, MMA, and homocysteine.
If You’re a Vegetarian or a Vegan, You Should Be Concerned about B12 Deficiency
Vitamin B12 is found almost exclusively in animal foods. For this reason, vegetarians and vegans are highly prone to B12 deficiency. While early studies showed that vegetarians and vegans had only slightly higher rates of deficiency than omnivores, these studies used relatively insensitive markers, such as serum B12, and less stringent cutoffs for holo-TC, MMA, and homocysteine.
For example, one study that used serum B12 (the less sensitive method) indicated that 7 percent of vegetarians and 52 percent of vegans were B12 deficient, whereas when holo-TC was used, deficiency was detected in 77 percent of the vegetarians and 92 percent of the vegans. (7, 8)
Essentially, conventional B12 testing is missing 70 percent of vegetarians and 40 percent of vegans that are B12 deficient! This is a massive oversight that may have devastating consequences for the long-term health of both vegetarians and vegans.
Interestingly, I have noticed in my clinic that other signs of B12 deficiency, such as elevated mean corpuscular volume (a marker known as MCV), can be obscured in vegetarians and vegans. This occurs because vegetarians and vegans often have iron deficiency and a high folate intake; these factors lower MCV and effectively “cancel out” any increase that B12 deficiency would cause. (9) Calcium deficiency, which is common in vegans, can also lead to B12 deficiency because free calcium is required for the absorption of B12. (10) The possibility of multiple nutritional deficits is just one reason to think twice about following a vegetarian or vegan diet.
Omnivores: You Need to Pay Attention to B12, Too
While rates of B12 deficiency are much higher in vegetarians and vegans than in omnivores, that doesn’t mean it’s rare in omnivores. Approximately one in 20 omnivores is B12 deficient. (11) B12 deficiency is also more common in people with risk factors like:
- Gut problems that decrease intestinal absorption of B12
- Past or present use of gastric acid-suppressing medications, metformin, or antibiotics
- A history of miscarriage and infertility
Vegans: You May Need More Supplementation Than You Think
Proponents of vegan diets promote B12 supplementation as the solution to B12 deficiency. However, supplements do not always solve the problem. In fact, research indicates that even well-educated vegetarians and vegans are not supplementing adequately!
Presumably well-educated vegetarians and vegans at a summer camp in the Netherlands were found to have serum B12 levels less than 200 pmol/L, a level associated with reduced DNA synthesis and other harmful metabolic effects. In another study, vegans taking B12 supplements demonstrated a paltry average level of 192 pmol/L.
Furthermore, the rate of B12 deficiency in vegans who supplemented with B12 was higher than in vegans who didn’t supplement! It is not clear why vegans who supplemented had higher levels of deficiency, but it could be due to the interference of supplemental B12 with active B12 levels. (12) In both of these studies, the subjects were from vegetarian/vegan societies and thus likely to be better educated than the general population. However, this did not prevent them from having a B12 deficiency. (If you need help choosing proper supplements, see the last section of this article for more specifics.)
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Your Kids Need B12 throughout Childhood
Women who consume vegetarian and vegan diets during pregnancy and breastfeeding and families that feed their children vegetarian and vegan diets during infancy and childhood are playing with fire and increasing their children’s risk of serious developmental and health problems.
Vegetarian Moms: You Need to Get Enough B12 during Pregnancy
If you’re pregnant and you have a B12 deficiency, your child could have low B12 throughout infancy and childhood. The longer a mother has been a vegetarian, the higher the likelihood she’ll have low serum and breast milk B12 levels that correlate with a deficiency in her infant. (13, 14, 15)
High homocysteine resulting from low maternal B12 status may promote neural tube defects and congenital heart defects in utero. (16)
The Impact of a Deficiency for Your Child
The prevalence of B12 deficiency is 67 percent in American children, 50 percent in New Zealand children, and 85 percent in Norwegian infants who have followed vegetarian or vegan diets their entire lives. (17) This is extremely concerning, as B12 deficiency can have “extensive, severe, and irreversible” consequences for brain and body development in children. (18)
B12 deficiency impairs fluid intelligence, spatial ability, and short-term memory in children; in fact, vegan children score lower than their omnivorous peers in all of these areas. (19)
B12 deficiency in children leads to:
- Poor school performance
- Depression
- Weakness
- Fatigue
- Nerve damage
- Failure to thrive
Even if a vegan or vegetarian child switches back to a diet that includes animal products, they may not be able to reverse all of the problems that come with low B12. A study of kids raised on a vegan diet found that they were still B12 deficient years after they started eating animal products. (20)
B12 deficiency also has serious health repercussions for adults. Notably, it raises homocysteine, a risk factor for cardiovascular disease, dementia, and Alzheimer’s disease. (23) Ironically, many vegetarians and vegans choose a plant-based diet to reduce their risk of cardiovascular disease, yet several studies have shown that homocysteine levels are higher in vegetarians than omnivores and higher in vegans than vegetarians. (24) Vegetarians and vegans with low vitamin B12 status are at risk of developing circulatory health problems regardless of their favorable profile of traditional heart disease risk factors. (25)
What to Do If You Think You Have a Deficiency
The first step I recommend is to get a holo-TC and/or urinary MMA test. If either of them is abnormal, you should immediately take steps to increase your B12 levels. There are two ways to do this:
- Eat B12-rich foods
- Supplement
How to Get More B12 in Your Diet
B12 contains a trace element (cobalt), which is why it’s also called cobalamin. Cobalamin is produced in the gut of animals and is found almost exclusively in animal foods. Some of the best sources of B12 are:
- Liver
- Clams
- Oysters
- Mussels
- Fish eggs
- Octopus
- Fish
- Crab and lobster
- Beef
- Lamb
- Cheese
- Eggs
A common myth among vegetarians and vegans is that it’s possible to get B12 from plant sources like:
- Seaweed
- Fermented soy
- Spirulina
- Brewer’s yeast
Nearly all seaweed tested has been revealed to contain vitamin B12 analogs (that is, chemically similar) called cobamides that block the intake of—and increase the need for—true B12. (26) The one exception is a combination of dried purple laver (nori) and wild mushrooms, which were shown in one study to reduce MMA.
Using a Supplement
Cyanocobalamin is the most frequently used form of B12 supplementation in the United States. But recent evidence suggests that hydroxocobalamin is superior to cyanocobalamin, and methylcobalamin may be superior to both—especially for neurological disease. This is because methylcobalamin bypasses several steps in the B12 absorption cycle and, unlike cyanocobalamin, readily crosses the blood-brain barrier. (27, 28) On top of that, methylcobalamin provides the body with methyl groups that play a role in various biological processes critical to overall health.
We now know that the dose of B12 in a supplement needs to be 100 times higher than the RDA of 2.4 micrograms/mL to be effective (this comes to approximately 250 micrograms/day). If you’re deficient, your dose should be even higher, at approximately 500 micrograms/day.
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Hi, Really interesting article. I have been diagnosed with Hypermobility Syndrome, Fibromyalgia, severe IBS & also am Hypothyroid. I had a blood test Sep 2012 that should very low B12, doc wanted to give me injections but I really did not want to go down that route every 3 months! so I started on Jarrow Methyl B12 sublingual tabs and noticed a difference after a couple of weeks. Recent blood test showed B12 now back to acceptable levels (whatever that means lol) I still take them daily with my thyroxine and a multi vitimin tablet for the over 50’s..While I cant claim they are a cure all. They can’t for example address pain and mobility problems, but I feel much more alert mentally than before. so will continue to take them.
Incidently my Mother also had years of neauralogical problems before being diagnosed with MS at 50 with no remissions, and sadly died at 60. I wonder if B12 could have helped her as she also had Dimentia linked to the MS, and I have heard that a lot of elderly people with Dimentia are Vit B12 deficient?
I’ve heard taking methylcobalamin can cause problems with people with MTHFR mutations. I have a double mutation so im A1298CC, but when I took methylcobalamin it made me feel even spacier, it was 5,000 mg which is a lot though. I’ve been taking hydroxycobalamin sublingually, about 1,000 mg and it seems to help some but think maybe taking shots or lower dosages over time might help. Im waiting until I get results from my 23andme test to see what SNPs I have besides MTHFR, since that can determine what form would be better to supplement with.
Chris –
If you link to Quest’s site, and go to their lab locations page, you will find that the lab in Indianapolis lists the VitB12 HOLOTC test, which assay is actually performed in Valencia, CA, if I read it right. Seems to me that if they have the wherewithal to do the analysis there, should be easy enough to send the sample from any of their draw locations – yes/no?
I believe it would be. Our lab’s active Vit B12 test requires the plasma or serum to be spun off, then kept at 4 degrees Celcius (about the same as a fridge) then it is considered stable up to 7 days after this.
Great article Chris!
I actually did the blood test you mentioned above and my B-12, along with my Pantho (B-5, I think?) was low as well. I am working to improve my diet to amend this deficiency, but I also started a supplement today, taken after breakfast and lunch. I really did feel better and more energetic today, but I noticed my urine was bright yellow, even though just starting this morning. This makes me think I’m not absorbing the vitamin, yet I feel as if it has given me a lot of energy. So should I be worried about the bright urine color?
Thanks!
Check your supplement for riboflavin (vitamin B2). This is the B vitamin that causes bright yellow urine, and it’s totally normal.
It does have Riboflavin–thanks David!
Hi Chris,
A quick question about B12 testing and the standard complete blood count test. I frequently test as having mildly elevated MCV (around 98) and mildly elevated MCH (33.6 was the highest). These are usually just barely out of the reference range, and my doctor is not at all concerned. I’ve read, though, that much higher readings could be indicative of deficiencies in various B vitamins. In general, do you think such mild elevations are indicative of deficiencies?
Thanks for all you do! You have been so very helpful to me in my quest for better health.
Yes, elevated MCV is often a sign of macrocytic anemia. Red blood cells actually start out large, and as they mature they become smaller. That maturation process requires B12 and folate. The mean corpuscular volume (MCV) measures the average size of the red blood cells; if it’s high, it suggests the red blood cells aren’t maturing (getting smaller), which is usually caused by folate or B12 deficiency (more commonly B12).
That said, a few other conditions like hypothyroidism can also cause elevations in MCV. I would definitely get your MMA checked, along with serum B12.
Megan, I too had mildly elevated levels of MCV and MCH and was diagnosed with pernicious anemia a couple years ago, so I agree with Chris about the testing if you haven’t done it yet. I just did follow up tests last week and will be meeting with my practitioner this week — and I’ve been on B12 injections for two years, too. It’s like night and day for me energy wise, so I am so thankful my practitioner discovered this and this website is here for further information!
Our lab won’t test B12 without also testing folate levels as a reduced Vitamin B12 level can be masked by folate deficiency.
Hi Chris,
Can you please tell me if the B vitamins from kombucha are absorbable? I’m guessing they may be similar to what is found in brewers yeast. I have always considered kombucha to be a valid source of b12, I’d really love to know if that’s not the case.
Thanks!
Hey Chris what would you recommend for vegetarian children? I have an 8, almost 9 year old, who has never eaten any animal products except milk and cheese. He absolutely refuses. Gags, even as a toddler. I have given him iron supplements but his bloodwork always comes back on the low side.
Methyl-B12. I’d say maybe 200-300 mcg, but check with your doctor. The co-factors will also be important for him.
Hi Kris. I’m from New Zealand so sometimes translating American stuff to what is available to us is tricky. I’m hoping I can find someone here who understands about B12. I’ve had Bells Palsy for 11 months. My nutrition is generally good and I supplement with vitamin B complex with extra B5. I take a Nordic cod liver oil and eat grass fed beef etc. My B12 showed normal to high on blood tests but I understand B12 might help heal the nerve sheath or myelin. I still have active Herpes Virus but my doctor seems totally unconcerned.
I am thinking about going to a natural health doctor but feeling cautious as this will be costly.
Any ideas.
MargieAnne: I have read that benfotiamine, which is a lipid-soluble form of B1, can cause regeneration of myelin. See benfotiamine.org.
Thanks for this. I am searching through and will probably purchase a supplement with benfotiamine. Nothing like experimenting on myself but at least it seems exceedingly safe.
Blessings
Chris, do you have any thoughts on the work of Dr Amy Yasko regarding methylation and B12 supplementation? She might be an interesting podcast guest. She has some interesting theories associating certain SNPs with over/under methylation, MTHFR, autism issues etc.
To those feeling fatigued by taking B-complex vitamins. I used to feel low energy after a couple of days of taking methylated b vitamins, and after reading her work and looking at my SNPs, I switched over to hydroxocobalamin and there was no fatigue despite daily supplementation. Yasko associates some COMT SNPs with tolerance of methyl donor supplementation.
ks
I’m aware of Dr. Yasko’s work, and I agree she’d be a great podcast guest. I’ll ask my producer to look into it!
Can people get start up effects when they commence taking activated B vitamins. By start up effects I don’t mean over-methylation, but feeling unwell due to the long dormant biological processes coming back on line and perhaps causing the shift of toxins.
Also, do you think that adenosylcobalamin is worth taking as a supplement?
Yes to your first question. And yes, some have better results with adenosyl. Those with methylation defects may need both methyl and adenosyl.
This is good to know – thought maybe I could not tolerate methylB12 and bought adeno. So these “start-up effects” mentioned – I am assuming this is detox. Would this cause toxins to enter breastmilk?
Start up and detox are totally different things – start up is where you give your body fuel it didn’t previously have and all of its processes speed up which can be uncomfortable until everything settles down. it also means that you can run out of other vitamins and minerals as the B12 uses them up. Most notably potassium. for me start up involved really bad headaches, the jitters and a few mood swings. i drank a lot of coconut water as its high in potassium.
incidentally, adenob12 works on a cellular level while methylb12 works on larger organs and in your bloodstream.
Chris are the supplements you refer to safe and beneficial during pregnancy (obviously I’m already taking solgar folate as part of your healthy baby code)?
They may be, but they’re not necessary unless you you are B12 deficient.
Folks: just added some important information to the testing section:
There are two ways to have MMA measured: in the serum, and in the urine. (4) Each has advantages and disadvantages. Some experts believe that urinary MMA is superior to serum MMA as a marker — possibly because it is more concentrated in the urine than the blood. However, elevations in urinary MMA can also be caused by kidney dysfunction. (5, 6) On the other hand, serum MMA can be elevated in the presence of intestinal bacterial overgrowth. (7). Therefore, which test you choose should depend on your health status. If there’s any question of impaired kidney function, serum MMA would be a better choice. If you have or think you may have SIBO or gut dysbiosis, urinary MMA would be the better choice. Quest, Labcorp and many other labs offer both serum or urniary MMA, so you shouldn’t have any problem getting it provided your doctor will order it. Note that you need to be fasting for the urinary MMA to get an accurate result.
For those interested in testing their B12 levels, it’s one of the tests offered in Talking20’s “vitamin pack.”
http://www.indiegogo.com/talking20/x/2103506
I can’t vouch for the type of B12 test they offer, as I have no affiliation with them. It just seems like a great option for us health-conscious people to stay on top of what’s going on in our bodies without inconvenient and sometimes very pricey doctor visits.
The campaign is over at the end of Sunday, Jan 20, so not much time left.
Chris, any experience with liposomal methyl-B12 like that made by Empirical Labs? (http://www.empirical-labs.com/product_p/liposomalmethyl.htm). A few people have trouble even with the sublingual lozenges, and I wonder if this might be a better option for those with very difficult absorption problems.
Hi everyone,
I just found out that Quest is not, in fact, offering the holo-TC test yet. It’s listed on their website, which is what led me to believe it’s available. However, they aren’t offering it at any of their Quest blood draw locations, which effectively means it’s not. Hopefully someone will get on this soon!
For those looking for a corn-free sublingual methyl b12 supplement, this is what our family uses: http://www.drugstore.com/superior-source-no-shot-methylcobalamin-b12-1000mcg-disolve-tablets/qxp383321?catid=183199
Thanks for the lead. That one is not dairy-free. I have to have one free of gluten, corn, dairy, soy and yeast.
ReneeAnn,
You posted 5 months ago, so you may not see this, but I’m surprised no-one’s mentioned NOW to you. I have a bottle in front of me (rather than a frontal lobotomy – tho, most days, it feels like I’ve had one of those, too!) and it states: –
Contains no salt, yeast, wheat, gluten, soy, milk, egg, or shellfish.
Ingredients: – fructose, sorbitol, cellulose, citric acid, stearic acid, magnesium stearate and natural flavours.
Is that any good…?
always has to have fillers, anti-flow agents etc…i.e. magnesium stearate
Look at the mega B12 drops from holisticheal.com–they may work for you.
you sound so much like me
I would like to supplement with B12 as I have been told by my doctor am I in the borderline low range (from more standard serum tests). I was given Superior Source – No Shot B12 Methylcobalamin Instant Dissolve 10000 mcg to take which includes Vitamin B6 (as pyridoxine HCl), Folic Acid, B12 as Methycobalamin and stevia extract. After a week or so of taking the supplement, I begin experiencing extreme agitation and worsening mood. The symptoms were pronounced and severe. Once I discontinued taking the supplement these symptoms resolved. Has anyone heard of this kind of adverse reaction while supplementing with B12?
I would avoid supplements with folic acid, it’s probably what you’re reacting to. Superior Source makes a B12 without the additional stuff…maybe you can try that?
Ali,
What you mention might be due to the same thing that recently happened to me –
Before I had come across Chris’ 2 blog postings about B12 or the other specialist websites that go in-depth about B12 replenishment (and thus I didn’t yet know that there are several supplements that should be taken ALONG WITH full-strength methylcobalamin), I had been taking a 1000 mcg tablet of methylcobalamin daily for 2 weeks with no problem, and the first steps of healing were really seeming to take place (in terms of my particular deficiency symptoms), but then I suddenly had a “potassium crash” that put me out of commission for about 36 hours (constant heart palpitations, lasting muscular cramps in my back and neck, feeling totally drained).
I tried to find out what was happening to me and discovered that this kind of crash was common with methylcobalamin (this potential potassium imbalance, called hypokalemia, is even mentioned on the Wikipedia page for B12 deficiency, which I had actually read before I started taking the B12 supplement, but I had just not paid enough attention to that part). I rested, ate as many foods as I could find in the house that are high in potassium, and stopped taking the B12 until I could obtain the other 3 supplements that are meant to balance everything out.
I’d suspect the methyl groups. Not everyone needs extra methyl groups–genetics, along with current health state, can play a big part in whether someone benefits from them. Agitation, ragey-ness and mood issues can happen if you consume methyl groups that you don’t need. A lot of people, like my family, do great with the extra methyl groups, but I’d look for a good hydroxy B12 supp in your case.
Low B12 status can cause neurological symptoms when starting supplementation
Thanks for yet another fantastic article Chris!! I found this out for myself through trial and error. My multivitamin company changed their formula and I immediately had some constipation issues. I figured I just needed to adjust so give it a month. As the month progressed my brain fog got really bad and my PN returned to the point it was bothering me. I decided to find a different multi. The lady at the health food store suggested I find one with methylcobolamin so I did. After just one dose I noticed a huge difference!! Went from standing at the stove trying to figure out how to work it one day to feeling sharp as a tack again the next. My ND wants to do some kind of special blood work for B12 and other vitamins, because of my response to the vitamins. Can’t wait to get the results (although do to finances, it will be a month or so before I go). Oh, and I’m a big meat eater. Always have been.
Is it dangerous to have a really high B12 levels (after following Paleo for a while, like I am)… Mine are almost 1000?
No, it’s not. B12 is non-toxic even at relatively high levels/doses.
Over-methylation is a concern for those supplementing with very high doses of B12 over a long period. That should be done under supervision.
But I don’t take any supplements… I get all my B12 from the meats/seafood only. Does this mean I’m overmethylated and change my diet a bit?
As with Beth, my last B12 serum test was 1039. It’s been over 1000 for a few years now, but docs never blink. I was worried as I read scary things about elevated B12 (leukemia, liver disease?).
I also eat plenty of red meat (grassa fed, of course), pastured eggs, etc. I don’t pop B12 sublinguals too often. I decided to stop taking them when I noticed these high B12 levels.
My other blood tests don’t really suggest anemia. Any thoughts?
i was diagnosed w/ severe iron anemia a year ago. took 2 months of liver (2 oz) every day to become low normal. come to think about it ; i may have been in & out of anemia all my life.
the interesting thing was my B12 was also high.
my diet is between of PHD & WAP; i also dont’ take B12 supplements.
Thanks for all of this information. Do you know why so many makers of B-12 supplements (in all its forms) state that the supplements are vegan or “suitable for vegetarians”? Even the Jarrow Methyl-12 bottle says this. I just want to make sure I’m getting the right stuff. Thanks!!
Because they don’t contain any animal products.
In the post you mentioned the only way to get B12 was from animals, but then this supplement is animal parts free. This doesn’t seem possible based on what I read?
The only way to get B12 in the diet is from animal products. The second way to get it is by supplementing.
Chris, Great article on the importance of B12 supplementing…but why do you keep saying B12 is only derived from animal sources? I only ask this, because no mammal is capable of producing this vitamin in vivo…
It looks as though Vitamin B12 is produced commercially for supplements by fermentation of forms of starch using particular bacteria e.g. beet molasses as the fermentation substrate for industrial vitamin B12 production by Pseudomonas denitrificans.