All Eyes on B12…
I recently finished up a book called Could it be B12? An Epidemic of Misdiagnoses and found it to be quite eye-opening. The authors are husband and wife and both work in the emergency room as a nurse and doctor.
The nurse, Sally, personally experienced serious health impacts of B12 deficiency and she continued to see symptoms of it with the patients that she saw. These symptoms were commonly misdiagnosed as something else. This sparked her passion to spread awareness about B12 deficiency—a passion that is evident in the words within the book.
Turns out B12 plays many key roles in your body including maintenance of healthy nerves, your brain, and the formation of DNA. It is essential for the production of red blood cells and is needed for a healthy immune system.
Vitamin B12 is produced in the gut of animals. So to obtain it you need to eat meat, poultry, fish or eggs. B12 is a water-soluable vitamin, which means it needs to be “restocked” frequently.
If you do not consume these things then supplementation is necessary.
The authors noted research that showed that vegetarian options thought to contain B12, like spirulina, tempeh or nori, are really “pseudo” vitamin B12. These pseudo versions are not “real” B12 and without further supplementation could still result in B12 deficiency.
What Causes B12 Deficiency?
A big take away I took from the book… even if you consume meat you still may not be absorbing B12. In fact, most cases of B12 deficiency stems from malabsorption problems
Metabolism of B12 is complex and is easily disrupted by a variety of problems that can stop B12 in its tracks. These disruptions come about as a result of issues with:
- digestion issues especially in those with low stomach acid, Crohn’s or celiac disease;
- metabolic issues;
- multiple surgeries (Nitrous oxide inactivates B12 in your body. Be aware that repeat surgeries, even short ones, increases your chances for B12 depletion)
- pharmaceutical use;
- the presence of mercury in your body;
- autoimmune conditions.
These disruptions help explain why B12 deficiency is so common, despite the readily available sources of this vitamin in the typical diet.
Symptoms of B12 Deficiency
As I read through the book, I realized that many of the issues that I’ve dealt with in my life could be a result of deficiencies in vitamin B12. Some of these symptoms include:
- Numb hands or feet
- Shooting leg pains
- Abnormal pap smears
B12 deficiency can also cause nerve damage in your stomach, which prevents the stomach from emptying properly. This results in symptoms of bloating, heartburn, gastro reflux, nausea, vomiting and constipation. Those greatest at risk for B12 deficiency are those of us with autoimmune conditions, especially thyroid conditions such as Hashimoto’s or Grave’s disease. (That’s me too).
Hypothyroidism is often found in association with an autoimmune condition called pernicious anemia, which is the most common cause of B12 deficiency.
B12 Deficiency & Your Reproductive Tract
B12 deficiency is a leading factor behind infertility issues, which was news to me. This is because it causes abnormalities of the cells of your reproductive tract, which could extend to the lining of your uterus. This can result in anovulation and also interferes with the implantation of a fertilized egg. Therefore, B12 deficiency is very common among women with a history of infertility or multiple miscarriages.
Blood abnormalities due to B12 deficiency could affect the lining of your uterus and cervix, causing cervical dysplasia, or an “abnormal pap smear” that could be mistaken for pre-cancerous. This is something that I dealt with in my early twenties. My B12 levels were never tested before undergoing years and years of painful procedures to remove cells of my cervix for biopsy. Grrr….
B12 and Methylation
I have had a growing interest in the role of B12 since I got back my genetic testing results and saw just how many breakdowns are present in my body’s methylation cycle. I’ve learned that B12 plays a key role in methylation.
Your body needs ample B12 in order for folate to work and one of folate’s crucial jobs is to synthesize the nucleotide “building blocks” of DNA.
When folate is trapped in an unusable form, due to lack of B12, then it is unable to do its job properly. This forces your body to make changes in DNA structure that can lead to genetic mutations.
B12 deficiency causes a breakdown in a crucial metabolic pathway that detoxifies the potentially dangerous amino acid homocysteine. High homocysteine levels resulting from low B12, folate or B6 levels can cause your body to break down estrogens abnormally.
According to the book, low B12 levels is often a gateway to developing breast cancer.This made me wonder what role B12 deficiency plays in endometriosis? That my friend is a question of curiosity to be further explored 🙂
Testing for B12 Deficiency
It is pretty simple to test for B12 through a serum blood test, however the authors pointed out different factors that can skew the results, making this test alone less reliable.
These factors include the presence of high levels of folate (or folic acid), which can make the complete blood count (CBC) test appear normal even though a B12 deficiency exists.
B12 serum testing can also show falsely elevated results for patients with underlying liver disease, alcoholism, lymphoma or intestinal bacteria overgrowth. And as mentioned above, pseudo vitamin B12 in spirulina, temph and nori can throw off blood tests results.
According to the authors, the range of “normal” B12 levels is traditionally set too low. They suggest raising the minimum from 200 pg/ml to at least 450 pg/ml, since deficiencies start to appear below 550 pg/ml.
Since the threshold of “normal” is set too low by doctors, the authors suggest implementing a couple of more tests to make sure there is in fact a deficiency. These include a urinary Methylmalonic Acid test (MMA) and testing for homocysteine (Hcy) levels. When you are low in B12 the three lab results should agree with one another:
- Serum B12 is low
- MMA is elevated
- Hcy is elevated
The authors recommend supplementing with B12 if your serum B12 levels are under 450 pg/ml, regardless of what MMA or Hcy results are. Also, treat normal B12 serum but elevated MMA or Hcy results. The book gives further breakdown on what the ranges should be for each test.
How to Supplement Vitamin B12
If you find that you have a B12 deficiency then the authors suggest supplementing with at least a thousand micrograms of B12 everyday.
Keep in mind that not all forms of B12 are equal and not all B12 can be easily changed to what is needed for reactions in your body. There are three forms of B12: Hydroxy, methyl and adenosyl.
Hydroxy B12 (Hydroxocobalamin) is more easily converted to the form that is actually used for reactions in your body. If you are to supplement, this is the recommended form.
Those of us who have issues metabolizing B12 from food are often unable to make use of it efficiently in pill form either. If you are very low in B12 and have absorption issues then the authors suggest getting injections, rather then taking it in a pill form.
Injections get the largest amount of B12 to deficient tissues in the least amount of time. This is the recommended way to take B12 if you have a severe deficiency (less than 300-400 pg/ml). The authors suggest injections of 1,000 mcg once to twice a week for six to twelve weeks.
Apparently injections can be made at home with kits similar to those used by diabetics.
On the Positive Side?
After reading this book and gathering much more information on the importance of B12, I am very curious to see where my levels are.
The book includes a questionnaire to help you determine if you likely have a deficiency. My results showed that I likely do. They recommend getting tested before starting supplementation so you know just how severe the deficiency is.
The positive side is that if caught in time a lot of the symptoms of B12 deficiency can be overridden through supplementation. The book includes many examples of stories of people with chronic conditions that were nearly healed by adding in B12 supplementation.
Have you had your B12 levels checked? Do you supplement with the suggested high levels of B12? Do you have endo and low B12? Think there is a connection? Would love to see your thoughts in the comment section below….