Vitamin B-12 deficiencies are common in people with chronic Lyme disease , as well as in the general population. This is for many reasons, including the fact that B-12 absorption is complex and many people, especially those with Lyme, have poor digestion. Intestinal dysbiosis, candida , leaky gut and other gastrointestinal conditions may cause vitamin B-12 to not be well absorbed, as can low stomach acid, pernicious anemia, and certain medications like Metformin, stain drugs and some antibiotics, especially the “cycline” drugs like doxycycline. There are likely to be other reasons why vitamin B-12 deficiencies are common in those with Lyme.
Testing your body’s B-12 level is crucial because the consequences of not getting enough vitamin B-12 can be dire; many studies have shown that severe deficiencies can cause irreversible neurological damage and conditions such as multiple sclerosis (MS) and Parkinson’s. In fact, MS and Parkinson’s have been attributed to not having enough B-12, and B-12 deficiency can mimic these, as well as other neurological conditions like ALS.
Ironically, B-12 deficiency also mimics the symptoms of Lyme , which is another good reason to get tested, so you know whether Lyme or a deficiency is causing your symptoms. The good news is, if your symptoms are caused in part by B-12 deficiency, you may be able to reverse them with the right B-12 supplementation.
Symptoms of B-12 Deficiency
According to Sally Pacholok, RN, and Jeffrey L. Stuart, MD, authors of Could It Be B-12? An Epidemic of Misdiagnoses,  symptoms of B-12 deficiency include:
- Numbness, burning, or tingling in the hands, feet or extremities, often diagnosed as diabetic neuropathy
- Tremors, often diagnosed as pre-Parkinson’s or Parkinson’s disease
- Muscle weakness, paresthesias or paralysis
- Pain, fatigue, weakness
- Confusion and mental fog, sometimes diagnosed as early dementia
- Unsteadiness, dizziness and paresthesias, often diagnosed as multiple sclerosis.
- Weakness, clumsiness of extremities, muscle cramps, twitching
- Psychiatric symptoms such as depression
- Visual disturbances, even blindness
The authors cite a few others, but as you can see, vitamin B-12 deficiency actually looks a lot like Lyme!
Testing for B-12 Deficiency
Further, B-12 testing can be inaccurate. The low end of the laboratory reference range is considered by most experts to be too low, which means that many deficient people have so-called “normal” levels of B12, and many doctors misdiagnose B-12 deficiency in their patients.
Yet, according to renowned health coach Chris Kresser , “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 B12 deficiency symptoms. Experts who specialize in the diagnosis and treatment of B12 deficiency, like Sally Pacholok R.N. and Jeffery Stewart D.O., suggest treating all patients that are symptomatic and have B12 levels less than 450 pg/mL. They also recommend treating patients with normal B12, but elevated urinary methylmalonic acid (MMA), homocysteine and/or holotranscobalamin (other markers of B12 deficiency).”
Kenneth Singleton, MD, in his book The Lyme Disease Solution confirms that B-12 deficiency is common in patients with Lyme and other tick-borne diseases. In his book, he shares some of the vital functions of B-12, as well. He writes, “The reason vitamin B-12 is so often deficient is that it is not found in significant amounts in plant foods. It is also easily depleted by stress, a common co-factor in chronic Lyme disease. Absorption from the intestines may be erratic, especially in the elderly.”
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He goes on to say, “B-12 plays many roles in the body, including helping to manufacture protein from amino acids and aiding in the metabolism of proteins, carbohydrates, and fats. It is also necessary for proper functioning of the nervous system and aids in the body’s production of red blood cells. Additionally, B12 can boost energy levels in the body and help to counteract poor gastrointestinal problems, memory problems, and mood swings.”
In addition, vitamin B12 also works together with folate to synthesize DNA, and is involved in the production of the myelin sheath, which surrounds nerves and plays a role in the conduction of nerve impulses throughout the body.
Vitamin B-12 deficiency is common in pernicious anemia, an autoimmune condition in which the body destroys intrinsic factor, which is a protein necessary for the absorption of B12. This condition used to be fatal until scientists discovered that death could be averted if patients ate raw liver, which contains high amounts of B-12.
Because vitamin B-12 is notoriously difficult for many people to absorb, it pays to find a supplement that will successfully raise your B-12 levels. Some healthcare practitioners have found that giving their patients B-12 injections is the best way to elevate B-12 levels in the body, and even essential for people that have neurological symptoms due to disease or severe deficiency. Methylcobolamin or hydroxocobolamin are the metabolically active forms of B-12 that the body actually uses. It usually converts cyanocobolamin into hydroxo- or methyl-cobolalmin, but sometimes there are problems with this conversion process in those with methylation defects or other B-12 metabolism errors. Ironically though, cyanocobolamin was once the most available and common form of injectable B-12, although compounded pharmacies now routinely make injectable methyl and hydroxycobolamin. Yet research has shown methylcobalamin to be the superior option for managing neurological disease.
What’s more, Japanese studies have shown that methylcobalamin is most effective form for supporting neurological symptoms caused by B-12 deficiency. This may be because it bypasses potential problems with absorption, which are common with the other two forms of B-12. In addition, methylcobalamin provides methylation support to the body, which assists with detoxification  and other vital health processes.
Taking sublingual vitamin B-12 drops or lozenges are the second best way to supplement your body with vitamin B-12, after injections, especially if you are unable to get the injectable form. You’ll also want to take a dosage recommended by your doctor, as if you are severely deficient in vitamin B-12 you may need to choose a product that contains 5,000 mcg per serving or more.
Finally, a few foods contain high amounts of vitamin B-12 and may be a great option for raising your vitamin B-12 levels. They include beef liver, shellfish (including clams, oysters and mussels), and some other types of fish, including mackerel, salmon, sardines and herring. Red meat, low fat dairy, cheese, and eggs also contain some B-12, although liver and shellfish are by far the best sources. Choose liver from fully grass-fed cows if you decide to supplement with liver. US Wellness Meats  has many great liver products.
A friend of mine once shared with me that beef liver raised her B-12 levels more effectively than supplements and even injections. This makes sense to me as our bodies were designed to consume whole food, and studies have shown that we digest nutrients better when they come as part of a whole food source, rather than in supplement form. That said, it is difficult nowadays for most of us to get the nutrition that we need solely from food, which is why supplements may also be important.
Finally, some people may need B-12 injections or supplements indefinitely, especially if ongoing gastrointestinal dysfunction, or neurological symptoms caused by B-12 deficiency continue to be an issue.
This article was first published on ProHealth.com on June 14, 2017 and was updated on February 2, 2021.