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Could a B-12 Deficiency Be Causing Your Symptoms?

  [ 134 votes ]   [ 17 Comments ]
By Dr. Dana Myatt, NMD, and Mark Ziemann, RN* • • January 30, 2014

Could a B-12 Deficiency Be Causing Your Symptoms?
Less than 20 years ago, patients complaining of fatigue were often given a "tonic shot" by their doctor. Many people claimed this worked like magic to improve their energy levels. What was this miracle tonic? A simple injection of vitamin B-12.

Although the practice of administering vitamin B-12 injections has fallen out of favor, modern medical science now understands why vitamin B-12 supplementation makes people feel better, and the reasons extend far beyond just the "placebo effect" of receiving a shot.

The Far-Reaching Effects of Vitamin B-12 Deficiency

Vitamin B-12, called "cobalamin" because it contains the mineral cobalt, is required for a staggering number of physical functions and chemical reactions. Best known for its participation in the manufacture of red blood cells, B-12 is also needed for production and maintenance of the myelin sheath that surrounds nerves and for production of DNA, the genetic material of all cells. And that's just the beginning.

The serious health consequences of vitamin B-12 deficiency can adversely affect nearly every system in the body.

Energy: Even minor deficiencies of vitamin B-12 can cause anemia, fatigue, shortness of breath and weakness.

The Nervous System: Deficiencies of B-12 can cause neurological changes including numbness and tingling in the hands and feet, balance problems, depression, confusion, poor memory and Alzheimer's-like symptoms. Long-term deficiencies of B-12 can result in permanent impairment of the nervous system.

The Gastro-Intestinal System: B-12 deficiency can cause decreased appetite, constipation, diarrhea or alternating constipation/diarrhea, weight loss and abdominal pain.

The Immune System: Vitamin B-12 is necessary for normal functioning of white blood cells. Studies show that B-12 helps regulate Natural-Killer T-cells and prevents chromosome damage.

The Cardiovascular System: Vitamin B-12 participates in the conversion of homocysteine to methionine. Elevated homocysteine levels are a known independent risk factor for heart attack, stroke and thrombosis. Without adequate B-12 levels, homocysteine levels typically rise.

Special Senses: Degenerative changes in the central nervous system caused by B-12 deficiency can also affect the optic nerve, resulting in blue-yellow color blindness.

Other symptoms of vitamin B-12 deficiency include sore mouth or tongue.

With so many physical functions at risk, it is easy to understand why knowledgeable clinicians and researchers consider B-12 supplementation beneficial.

Are You At Risk for a Vitamin B-12 Deficiency?

Medical science once believed that few people were vitamin B-12 deficient. This false assumption may stem from the fact that vitamin B-12 is produced in the body by a normal, healthy population of bowel bacteria.

Secondly, unlike other water-soluble vitamins, B-12 is stored in the liver, kidneys and other tissues. Deficiencies of B-12 often appear so slowly and subtly as to go unnoticed, and blood tests for vitamin B-12 levels miss early deficiency states at least 50% of the time.

So, who is at risk for vitamin B-12 deficiency? Recent research shows that a much larger segment of the population is likely deficient than previously thought.

Because assimilation of vitamin B-12 from food requires adequate stomach acid and intrinsic factor, and because stomach acid typically declines with age, people over 50 were once thought to be the biggest "at risk" population for B-12 deficiency. Previous studies showed 3% to 39% of seniors to be vitamin B-12 deficient, but newer studies suggest that number may be as high as 72% to 78%.

Vegetarians and vegans are another population believed to be at high risk for B-12 deficiency, in part because of low animal food intake of vitamin B-12 and also because many vegetable sources such as seaweed must be consumed in large amounts in order to provide adequate vitamin B-12.

Other high-risk groups for B-12 deficiency include:

• Those who use acid-blocking or neutralizing drugs (such as Prilosec, Prevacid, Nexium and others), or drugs which impair intestinal absorption (such as Metformin, Questron and Chloromycetin),

• People who have had gastric surgery,

• And people who have chronic illnesses such as ME/CFS and Fibromyalgia. (For an explanation of two complex models suggesting a connection between vitamin B-12 deficiency and ME/CFS - The Nitric Oxide Cycle and the Methylation Cycle - see "Deficiency in ME/CFS and FM May Provide Clues & Relief")

Bacterial overgrowth of the small intestine, which occurs frequently in people with low stomach acid, is a predisposing factor for B-12 deficiency because the bacteria themselves use vitamin B-12.

The most recent and disturbing studies suggest that vitamin B-12 deficiency is more prevalent in young adults than previously thought. One study found that vitamin B-12 deficiency was similar in three age groups (26-49 years, 50-64 years, and 65 years and older), but that early symptoms were simply less apparent in the young.

This study also found that those who did not take a vitamin B-12 containing supplement were twice as likely to be deficient as supplement users, regardless of age.

Four Forms of B-12 - Which One is Best?

Cobalamin is a collective term for four closely related forms of B-12 - cyanocobalamin, methylcobalamin, hydroxycobalamin, and adenosylcobalamin (dibencozide).

Cyanocobalamin, the most common form of B-12 found in nutritional supplements, has the lowest biological activity and must be converted in the liver to methylcobalamin or adenosylcobalamin before it can be utilized.

Because it can be converted to other forms of B-12, cyanocobalamin can be considered the "mother form" of B-12. However, this conversion is inefficient and some people may not benefit from cyanocobalamin due to lack of assimilation or conversion.

Methylcobalamin is considered by many researchers to be the most active form of vitamin B-12. It protects the nervous system by regulating glutamate-induced neuronal damage (common in aging) and promoting nerve cell regeneration.

Methylcobalamin is the only form of vitamin B-12 that participates in regulating circadian rhythms (sleep/wake cycles). It has been shown to improve sleep quality and refreshment from sleep, as well as increasing feelings of well-being, concentration and alertness.

Adenosylcobalamin (dibencozide), the second highly active form of vitamin B-12, is essential for energy metabolism. It is required for normal myelin sheath formation and nucleoprotein synthesis. Deficiencies are associated with nerve and spinal cord degeneration.

Hydroxocobalamin is a unique form of B-12 that participates in detoxification, especially cyanide detoxification. Cyanide levels are often elevated in smokers, people who eat cyanide-containing food (like cassava) and those with certain metabolic defects.

Excess cyanide in the tissues blocks conversion of cyanocobalamin to methylcobalamin or adenosylcobalamin. In such instances, hydroxocobalamin may be the vitamin B-12 of choice. Hydroxycobalamin is FDA-approved as a treatment for cyanide poisoning.

Oral Vs. Injectable: Which Delivery System is Preferred?

Although many people including some physicians still believe that injectable vitamin B-12 is the preferred route of administration, it is well-known and widely accepted that oral vitamin B-12 is equally as effective as injection in treating pernicious anemia and other B-12 deficient states.

Conclusions and Recommendations

• Vitamin B-12 deficiency is far more widespread than previously thought, with up to 30% of young people affected and possibly as many as 78% of the over 50 population suffering from deficiency.

Those at special risk include:
- Seniors,
- Vegetarians and vegans,
- People taking acid-neutralizing drugs or various other drugs, and
- Patients with cognitive impairment and/or chronic illnesses.

The U.S. Institute of Medicine recommends that adults over 50 obtain their vitamin B-12 from supplements.

Because symptoms of vitamin B-12 deficiency often manifest months or years before B-12 blood tests become abnormal, early deficiencies are often missed.

Symptoms and side effects of B-12 deficiency are many and varied, can mimic other diseases such as Chronic Fatigue Syndrome, and can produce irreversible changes of the nervous system if not corrected early.

Oral vitamin B-12 supplementation is extremely safe, as effective as injections, comparatively inexpensive, and more convenient than injections.

Those at risk of vitamin B-12 deficiency or with symptoms suggestive of B-12 deficiency should consider adding this important nutrient to their supplement protocol.

References »

* Dr. Dana Myatt, NMD, is a practicing naturopathic family physician, educator, author, and speaker with a special interest in nutrition. She lectures widely to medical and lay audiences, and hosts a website ( Mark Ziemann, RN, Dr. Myatt's husband and collaborator, is also an educator, author, and speaker specializing in holistic nursing practice and patient education.

See also “B-12 Deficiency in ME/CFS and Fibromyalgia May Provide Clues & Relief,” another article by Myatt & Ziemann explaining the possible role of B-12 deficiency in chronic fatigue syndrome, fibromyalgia, and related illnesses.

Note: This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, treat, or cure any condition, illness, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.

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Article Comments Post a Comment

Posted by: Tohui
Jan 7, 2009
I have fibromyalgia and have tried B12 inyections. I notice a difference of energy levels while taking it. Stoped for no reason and notice how my energy slowly decresed. I'm now starting inyections again and will change to a pill form of B12 for convenience.
Reply Reply

Vitamin B-12
Posted by: franlea
Jan 7, 2009
I am glad to see this subject addressed. I have Fibromyalgia and have been getting B-12 shots once a month for several years. It keeps me from being fatigued and weak. I recently started taking B-12 supplements orally once a day between shots and it is helping me avoid the let down between shots. I also have been taking medicine for acid reflux for a long time too and have never seen that related to B-12 deficiency. Thanks for this article.
Reply Reply

B-12 shots
Posted by: wenld
Jan 7, 2009
Every time my Dr. gives me a B-12 shot I am so very tired & exhausted the rest of the day! My husband & I noticed this & because of this I wonder why? Does anyone have an answer to this mystery? Because of this awful fatigue I will no longer accept his shots!!I'm backwards I guess!
Reply Reply

B12 shots
Posted by: hermitlady
Jan 7, 2009
I have CFS/FM with the worst symptom being weakness and fatigue. I received Cyanocobalamin shots once a month for 6 months and never noticed any improvement. For the last 6 wks I have been giving myself Methylcobalamin shots every 3 days and still haven't noticed any improvement. I recently had my blood B12 levels tested, but haven't received the results yet. I am very disappointed thus far in my treatment. I had really hoped to have my energy level increased by now.
Reply Reply

Taking Cerefolin NAC
Posted by: jmq
Jan 9, 2009
I was told that this medication has many of the vit. B in it as well as other folic acid types that make this a very strong and effective vitamin. You even need a percripstion for it. Unfortunately most insurance co. do not cover it so it is expensive. BTW, I have fibromyalgia and a nuerologist gave it to me for the terrible memory and cognitive difficulties I have along with the pain. I just took the first pill today. I was wondering if anyone else has taken this medication/vitamin. Is there any dangers.... Thank you JMQ
Reply Reply

Best B12 delivery protocols
Posted by: Phattemer
Jan 14, 2009
B12 shots once a month aren't the best way to correct a deficiency. The B12 needs to be delivered slowly to get the best effects. The autism community has found that the best protocols are either a nasal spray of methyl-B12 used daily or shots of methyl-B12 used once every three days.

You can read about the nasal methyl-B12 spray at Stan Kurtz's website. and

You can read about the methl-B12 shots at Dr. Neubrander's website. These shots are given just under the skin in the fat part of the buttocks. This fat delivers the B12 slowly into the bloodstream.


ME/CFS-Fibro-B-12-Migraines-DHEA and HRT WOW!
Posted by: TrudyBird
Jan 14, 2009
My doctor diagnosed me as having ME/CFS and Fibromyalgia about a year ago. I was relieved to have a name for how I felt. At 56 years of age, I had also had a hysterectomy when I was 27 years old. I was left with one ovary. I didn’t receive any HRT until a nearly 2 years later; since I believed my GYN when he said the remaining ovary would take over for the missing ovary. I should not have believed him. So… after gaining some relief and calm after finally starting HRT 2 years later… I also began having horrible migraine headaches. I took all kinds of medications for the migraines that were hitting me as often as twice a week, sometimes putting me in the emergency ward. Finally a friend of mine last year gave me a book called, The Migraine Cure. I read this book, not really thinking it would help, but desperate people will consider just about anything. In this book it suggested a barrage of blood tests that I’ve never heard of that checks every hormone level or type of secretions your internal organs can make. What I read finally made sense. Also, my tongue had been sore and ragged for 30 years. (Aha! A clue!) By playing as my own advocate, I went to my current doctor and held the page open of this book and told him I wanted every blood test it recommended. I think he saw by the look in my face I wasn’t joking around. I respect my doctor a lot, because he respects me. He agreed to the testing. What could it hurt? All my levels were in the normal range except my DHEA level. On a normal scale from 1-4… mine was an 11. I was a walking cardiac risk. This is the hormone that most people start making less of beginning as they approach middle age. It’s what helps give you that youthful feeling and helps your libido. They sell it over the counter promising more energy and youthfulness. Yeah… right. I was exhausted, suffering from migraines and still taking HRT after 28 years. I have had lumpy breasts for years, having to have the cysts removed or aspirated. Not fun! I found on line an article that said high DHEA levels could be lowered by a treatment of B injections once a week for a month. I’m sorry; I cannot tell you where I found the article on line. I took this to my doctor and requested the B injections and to follow up with another blood test afterwards. I also stopped taking my HRT by this time. Not only did my Migraines completely go away, but my DHEA level spiraled down to normal levels. My skin improved, my energy level improved, my tongue healed. I haven’t had a migraine in a year. I have hot flashes, but I’d rather have those than migraines. The hot flashes came fast and furious but I’m tough. I deal with them. But you know… even the hot flashes are getting better. I’m out walking 2 and a half miles every other day. I’d never have had that energy 2 years ago. We are all different inside. Our organs are similar, yet we all function differently depending on our circumstances. I take a FOOD BASED B supplement now twice a day, every day. I won’t take the synthetic vitamins because our bodies react to the food based supplements as it would process food… the natural way to absorb them. A synthetic vitamin is something the body as to figure out what to do with and you are not going to benefit as well by taking them. Food based vitamins is the way to go. I’m talking from experience. I’m not a medical professional. I’m just a woman who has had a long road of discovery regarding my body and its function. I work full time, I sing and act in a local theater group and I’m active in my community. There is hope. Keep searching for those answers and don’t give up. Blessing to all!
Reply Reply

B12 protocol
Posted by: Phattemer
Jan 14, 2009
B12 shots once a month aren't the best way to correct a deficiency. The B12 needs to be delivered slowly to get the best effects. The autism community has found that the best protocols are either a nasal spray of methyl-B12 used daily or shots of methyl-B12 used once every three days. You can read about the nasal methyl-B12 spray at Stan Kurtz's website. and You can read about the methl-B12 shots at Dr. Neubrander's website. These shots are given just under the skin in the fat part of the buttocks. This fat delivers the B12 slowly into the bloodstream.
Reply Reply

B12 shots
Posted by: cherylsue
Jan 14, 2009
I take methylcoblamin shots twice weekly. They are best taken at night because the initial delivery will make you tired. Benefits however, are seen the next day with slightly more energy. Yes, I do find them helpful delivering about 10-15% more energy. CherylSue
Reply Reply

B12 and Fibromyalgia
Posted by: Phattemer
Jan 14, 2009
As mentioned in the article, a bacterial overgrowth will contribute to a B12 deficiency. Dr. Pimentel has shown that most people with fibromyalgia have a bacterial overgrowth in their small intestine. The more the overgrowth, the more the pain.
Reply Reply

B12 shots
Posted by: cherylsue
Jan 14, 2009
I take methylcoblamin shots twice weekly. They are best taken at night because the initial delivery will make you tired. Benefits however, are seen the next day with slightly more energy. Yes, I do find them helpful delivering about 10-15% more energy. CherylSue
Reply Reply

Posted by: hcoles2000
Jan 21, 2009
I was always under the assumption that Vitamin B12 is not taken orally because it is not absorbed through the gut. That is why it is given sublingual or by injection. When people say they take it orally, are they meaning sublingual or swallow with water?
Reply Reply

B12 Injections
Posted by: sunhound
Jan 22, 2009
I have just completed 2 years of B12 injections, and believe it truly helps me, and I've tried many things. I think the key is in the strength and the dosage. I was prescribed Hydroxy B12 30/mg/ml-1/3 ml daily. It is available through only one pharmacy in the country and was prescribed by one of the pre-eminent physicians in the CFIDS community, whom I see on a regular basis. I'm far from 100%, but I'm better than I was. A friend has had even better results than I.
Reply Reply

Posted by: Jj65
Dec 30, 2014
Have you ever had the metals in your system checked? Found out that the neighborhood I grew up in was a super fund site.
Reply Reply

Posted by: Jj65
Dec 30, 2014
Have you ever had the metals in your system checked? Found out that the neighborhood I grew up in was a super fund site.
Reply Reply

B12 absorption.
Posted by: gondo41
Mar 24, 2015
If I have had my ileocecal valve removed how is my absorption affected? My understanding is that that is where it is absorbed and it is the only place. My doc told me to take subligual methyl and do a wait and see. Suggestions?
Reply Reply

Alternative to Injections
Posted by: ceh2268
Jun 17, 2015
Not sure if this helps or if anyone is interested but I recently heard about a new oral prescription alternative to the injections called Eligen B12. I recently read that it works even if you don't have intrinsic factor (so even if you don't have normal gut absorption), which would mean no more shots. Apparently it came out a month or two ago. Has anyone tried it??
Reply Reply

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