Vitamin B12 (Cobalamin):
Neurological symptoms of B12 deficiency may include:
- numbness and tingling of the arms and legs; problems walking; disorientation; memory loss; mood changes that may resemble schizophrenia; and dementia. Damage may occur to the myelin sheath which surrounds and insulates nerves like the plastic coating around an extension cord. Nerve damage and mental health symptoms may become permanent with long term deficiency of vitamin B12.
Digestive symptoms may include:
- loss of appetite, a painful tongue, and constipation. The reason for there to be digestive symptoms associated with B12 deficiency is not well understood. One theory suggests that undiagnosed digestive problems might have been an initial cause of the B12 deficiency.
Symptoms of vitamin B12 deficiency may also include:
- pernicious anemia and megaloblastic anemia which are hemoglobin deficiencies that have symptoms of tiredness. Folate deficiency symptoms are also possible because B12 is necessary in folate metabolism. Increased heart disease risk from elevated homocysteine levels may result from B6, B12, or folate deficiency.
People who may be more at risk for vitamin B12 deficiency include:
Those with malabsorption problems, or people with chronic use of antacids and those who are over age 60. A specific protein cofactor called the intrinsic factor and normal stomach acidity levels are necessary for B12 absorption to be able to occur. Some individuals receive monthly injections of B12 after reaching older age and some people need to receive them monthly throughout life due to having chronically low vitamin B12 for other reasons than normal aging such as a genetic issue with their production of the intrinsic factor protein.
Sublingual tablets of the supplement are also available which are absorbed in the mouth, bypassing any problems with the rest of the digestive system.
A genetic difference may exist that causes some individuals to require the methylated active form of B12 rather than being able to benefit from the more commonly available supplement which is an unmethylated and therefore inactive form. [More about methylcobalamin.] A genetic screening test would need to be ordered to find out if there were any differences in the gene that might cause an inability to methylate vitamin B12 or folate/(folic acid is the commonly used supplement which is also in the unmethylated form, and therefore inactive for someone with a genetic inability to perform the methylation reaction – meaning an enzyme is malfunctioning somewhere in the complex chemical chain of events.)
A problem with lower digestive acidity in the stomach could also be managed simply by adding a side dish or condiment to meals that contains vinegar or acidic ingredients. Examples from around the world include chutneys, pickles, lime or lemon juice/fresh wedges, vinegary salad dressing, salsa or Tabasco Sauce, and Worcestershire sauce.
- What is Worcestershire Sauce? (thespruce) (and how do you spell it?)- It is an interesting story – featuring the chemists Lea and Perrins. (Lea & Perrins is still the best selling brand of Worcestershire Sauce). Who knew chemistry could be so delicious?
Schizophrenia may also be associated with an increased risk for low levels of vitamin B12. Read more: (askdrgonzalez.com/deficiency-of-vitamin-b12-and-schizophrenia/)
Low stomach acid may be an underlying issue with symptoms of schizophrenia and in other mental health disorders. The balance and variety of microbes living within the gastrointestinal tract also may be involved in symptoms resembling mental illness. (Digestion & schizophrenia /PMC4437570/)
Pickles that are made fresh and need to be refrigerated can be a source of healthy intestinal microbes, in a similar way to the healthy bacteria found in yogurt with active probiotics or Kefir drinks. A variety of traditional products with live cultures are listed here – and a new one, probiotics are being added to chocolate in some products: (health.com/probiotics & chocolate) Scientists studying the microbiome tend to recommend the live culture foods rather than supplements of probiotics – based on my overview impression of multiple sources. An overview regarding the current recommendations about probiotic supplements is available here: (washingtonpost/people-love-probiotics-but-do-they-really-help/2017/05/19)
Probiotics refers to products that contain actual good guy bacteria, while prebiotics refers to foods that contain fiber or other nutrients which the good guy bacteria need to eat in order to survive and flourish – in competition with the more negative strains of bacteria or with yeasts or other microbes which might be found within our gastro-intestinal tract.
Eating vegetables and other foods that are good sources of some types of fiber also helps support healthier intestinal microbes, a few foods that provide the types of fiber that our intestinal microbes need to eat in order to flourish and protect us from more negative types of microbes, are listed here: (pcrm.org/seven-foods-to-supercharge-your-gut-bacteria)
It is a very good idea to get adequate fiber in the daily diet – because starving microbes will start breaking down and consuming edible portions of the intestinal cells for nourishment – if forced, and it may leave the body more at risk for infection (labblog.uofmhealth.org/gut-bacteria-eat-colon-lining-when-starved-for-fiber) – but why starve your good guy microbes? Our intestinal microbes may also help prevent anxiety. (neuroscienceresearch.wustl.edu.pdf)
Food Sources of Vitamin B12 include:
- shellfish, fish, meat, poultry, eggs, milk, cheese, dairy products, Nutritional or Brewer’s yeast. Vegetarians who don’t eat dairy, eggs, fish or other meat products may need a supplement or nutritional yeast, a vegan food source of vitamin B12. (nutritional yeast/pubmed/11146329)
- See the post on Vitamin B6 for more information about how the group of B vitamins work together in energy metabolism and cell growth.
Reference for more information:
An Evidence-based Approach to Vitamins and Minerals: Health Benefits and Intake Recommendations, 2nd Ed., by J. Higdon & V. Drake, (Thieme, Stuttgart / New York, 2012)
- A description and source for purchasing the text: (thieme.com)
- A review of the text: (ajcn.nutrition.org/content/79/5/892.full)
- The text is produced in cooperation with the Linus Pauling Institute. He is a researcher who used large doses of vitamin C to cure cancer tumors. His work was met with skepticism. More recently research supports his work in that a specific type of cancer cells is very susceptible to vitamin C – while to the rest of the body it is water soluble and non-toxic at the level that was toxic to the cancer cells. (sciencedirect.com/science/article/pii/S2213231716302634)
Last reviewed and revised on 9/30/2017.
Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.
The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)Vitamin B12 deficiency can cause long term nerve degeneration by Jenny