We hear a lot about some vitamins (like Vitamin C and Vitamin D) and much less about others. But our bodies are incredibly complex, and there’s a whole array of vitamins and minerals that are vital to keeping us healthy. Sometimes, health problems and symptoms that we can’t attribute to an obvious illness or injury are the result of vitamin deficiencies. When it’s not a vitamin that’s especially well known, that can be more difficult to identify.
Vitamin B12 is one of those often-overlooked vitamins. It’s actually one of the most common nutritional deficiencies in those with gluten sensitivity or celiac disease, as well as those following a vegetarian or vegan diet. Vitamin B12 is only found in meat — chicken, fish, eggs, beef, and so on — so it’s easy to understand why people with meat-free diets would lack it. It’s also problematic for those with gluten issues or with any other food sensitivities, however, because food sensitivities such as gluten damage the cells that act as the carriers for B12. That means that if you have gluten sensitivity, even if your diet contains adequate amounts of Vitamin B12, your body might not actually absorb the vitamin. Keep reading to learn more about the role Vitamin B12 plays in your health, and what you can do if you have a Vitamin B12 deficiency.
Why is Vitamin B12 Important to Health?
Vitamin B12 might not make the A-list when it comes to vitamins and minerals on our health radars, but it’s a critical nutrient that plays many roles in the body. It is important for the repair and replication of DNA and RNA, helping us to grow and to heal. Vitamin B12 has been found to have protective effects against dementia, neuropathy, and cardiovascular disease, and it literally protects the nerves of the brain and spinal cord, helping to produce the insulating tissue that surrounds them. Vitamin B12 plays an important role in activating inactive thyroid hormone, and supports the adrenals, which helps support the crucial hormone cortisol during times of stress. It helps the liver clear out toxins, and aids in the elimination of unwanted hormones such as estrone, which can increase the risk of breast cancer if allowed to build up. It helps to lower homocysteine, which is thought to be an independent risk factor for heart attacks and strokes. It’s also a vitamin that helps keep you on an even keel, maintaining energy production and helping to produce melatonin to regulate sleep. Vitamin B12 is a major multitasker!
What are Symptoms of Vitamin B12 Deficiency?
Vitamin B12’s role in sleep and energy means that lacking sufficient levels can cause an array of symptoms including a lack of mental clarity (“brain fog”), memory trouble, depression, irritability, fatigue, and insomnia (inability to fall asleep or stay asleep). Deficient levels of B12 can also cause ringing in the ears, dizziness or loss of balance, and numbness and tingling in your hands or feet (neuropathy). More commonly, patients can have suboptimal levels of B12 that affect many enzymatic functions without necessarily having obvious clinical ramifications. Its contribution to the later development of breast cancer, heart disease, or decreased energy is underappreciated by most patients and doctors.
For those with gluten issues, the latter set of symptoms is often also accompanied by what’s sometimes called a “magenta tongue.” The tongue has a beefy, dark red appearance, with many grooves. These tongue changes take years to form; even if you eat a gluten-free diet now, this may have begun even before you realized that gluten was causing you health issues. Gluten damage in your stomach and intestines can create problems digesting and absorbing Vitamin B12. It can take six months to a year of a gluten-free diet before the body starts properly processing Vitamin B12 again.
Is There a Test for Vitamin B12 Deficiency?
There are several tests that can help determine if you have adequate levels of B12. The easiest and best test, in Dr. Tang’s opinion, is to get a serum B12 level. Though different doctors will use varying scales, most labs show a level of under 200 picograms per milliliter as low. Dr. Tang characterizes that as severely deficient, though he rarely sees patients with levels that are that low. In most cases, those with B12 in the 300-500 range are considered normal, though Dr. Tang considers it suboptimal since patients at these levels will notice a clinical improvement in their symptoms. Each individual’s physiology varies, but in his experience patients tend to feel best with Vitamin B12 levels that are over 1,000.
Another test that is more sensitive and can help detect an early or mild B12 deficiency is checking methylmalonic acid (MMA). This test alone cannot provide a firm diagnosis, but if done along with a homocysteine test it can be helpful in determining if Vitamin B12 deficiency is a problem for a patient who is in the lower portion of the normal range and is experiencing symptoms. Elevated levels of MMA may indicate a B12 deficiency, though it does not necessarily reflect its severity, likelihood of progressing, or the presence of specific symptoms. It’s also important to note that those with kidney disease may have high levels of MMA that are unrelated to Vitamin B12 — instead, it’s because the kidneys are not properly eliminating MMA from the body.
How Can You Maintain Adequate B12 Levels?
Again, Vitamin B12 is mainly found in meat and other animal products such as eggs. B12 from foods is broken down by stomach acids, then picked up by intrinsic factor and taken to the small intestine, where it’s absorbed into the blood stream. That said, if you are vegetarian or vegan, and/or if gluten has damaged your stomach lining, diet won’t provide adequate levels of Vitamin B12.
Vitamin B12 can be taken as an oral supplement, but it’s important to be sure you’re taking the right form and that you’re taking it the right way. Dr. Tang finds that many oral versions of B12 have a difficult time being absorbed by damaged mucousal lining. If your body’s ability to process Vitamin B12 is impaired, you may also have trouble processing inactive versions of B12. Most supplements contain a type of Vitamin B12 called cyanocobalamin. Research has found that this is less bioavailable than other forms of B12, methylcobalamin and hydroxycobalamin. Dr. Tang prescribes methylcobalamin, which is readily recognized by the body and used as a coenzyme to activate many of the important chemical reactions that B12 is part of.
Dr. Tang recommends a sublingual methylcobalamin — since you hold the liquid under your tongue, most of the absorption takes place in your mouth, so you don’t need to worry about the gut. The amount needed varies depending on your health and existing B12 levels; some patients should supplement daily, while for others a few times a week is enough.
Vitamin B12 injections are another option for ensuring that the vitamin is adequately absorbed. Again, this is especially important for those who may have damaged stomach or intestinal lining. Though this is going directly into the body, it’s still important that the active version of B12 — methylcobalamin — is used. Injections are usually done weekly for patients who have a Vitamin B12 deficiency, though once adequate levels have been achieved the frequency is reassessed. Some patients find that B12 injections give them a boost of energy, which is actually a clear signal that there is a deficiency — those with adequate levels of Vitamin B12 don’t get a boost.
It is difficult to overdose or build up toxic levels of Vitamin B12, because it is a water-soluble vitamin. Your body excretes excess amounts in urine rather than storing it. In rare cases, however, excess supplementation with B12 may cause numbness or tingling in the arms, hands, and face. There also appears to be a link between mega-doses of B12 and certain cancers. One study found that excessive Vitamin B12 intake was associated with a three-fold increase in the risk of developing prostate cancer. People with Leber’s disease should not supplement with Vitamin B12 because of a risk of damage to the optic nerve. For most people however, side effects from B12 supplementation are not a concern.
If you have a Vitamin B12 deficiency that’s linked to gut issues, you should work on repairing your gut health at the same time that you’re using supplements or injections to replenish your levels. Removing foods from your diet that cause inflammation or damage to the mucousal lining — which affects the proper absorption of many vitamins and nutrients, not just B12 — can help improve your overall health.
Are you concerned about your gut health or vitamin levels? If you’re in the Bay Area or San Jose, call Rejuvé today at (408) 740-5320 to set up a supplement consultation or vitamin testing with Dr. Tang.
