The Powerhouse Vitamin

Vitamin B12 is a dynamo when it comes to keeping you energized, mentally sharp and feeling great. It boosts metabolism by helping convert carbohydrates to glucose and maintains healthy digestion. It also keeps blood cells healthy, promotes mental clarity and helps reduce depression and stress. Plus, B12 promotes vibrant hair, skin and nails—so you look great too—and protects against heart disease and cancers like prostate and breast cancer.

Unfortunately, B12 isn’t like other vitamins. It’s only found in animal-based protein foods like meat, eggs, milk, cheese and fish. This means vegetarians and people with digestive issues are at heightened risk of B12 deficiency and dangerous blood conditions like pernicious anemia. As well, B12 can only be absorbed from food by stomach acid called Intrinsic Factor, which naturally drops with age. Because of this, research by Harvard University estimates 10 - 30% of adults over 50 have low B12 levels, and health agencies are calling B12 deficiency "the silent epidemic."

Signs of B12 deficiency include fatigue, brain fog, mood changes, weakness, shortness of breath, pale skin, constipation and vision problems.

Vegetarians Are At Higher Risk

Vitamin B12 is found in animal-based foods, including fish like tuna, herring and sardines. So if you’re a vegan, you’re at particular risk of B12 deficiency and pernicious anemia.

Doctors and many vegan health organizations recommend taking a daily B12 supplement to maintain production of healthy red blood cells and ward off anemia. In addition to this, look for plant milks, yogurts, cereals, spreads and yeast products fortified with B12.

A common myth among vegans and vegetarians is that plant sources like seaweed, fermented soy and spirulina contain B12. But plants said to contain Vitamin B12 actually contain B12 analogs called cobamides that block uptake of true B12.

For vegetarians who eat eggs and dairy, one large egg has about 186mg of cholesterol. Since cholesterol increases the risk of heart disease, the Mayo Clinic recommends limiting egg consumption to 300mg a day (or 200mg a day if you have diabetes).

Young Adults Are Also At Risk

Adults age 50 or older aren’t the only ones at risk of B12 deficiency because of declining stomach-acid levels. Data from the Tufts University Framingham Offspring Study found that 40% of people between the ages of 26 and 83 had Vitamin B12 levels in the low range. In another study by East Carolina University, 36 cases of Vitamin B12 deficiency out of 89 involved young adults ages 18-40, while 25 cases involved adults ages 40-64.

Heartburn Drugs Only Make B12 Deficiency Worse

Heartburn drugs may have been created to relieve the symptoms of acid reflux, but they inhibit B12 absorption. So heartburn drugs involve trading one problem for another.

In a two-year study by the American Medical Association, researchers examined the association between B12 deficiency and proton pump inhibitors (like Nexium or Prilosec) in 25,956 patients and found that taking PPIs significantly increased the risk of B12 deficiency, as did H2-blockers (like Zantac and Pepcid AC).

If you’re currently taking heartburn drugs, speak with your doctor about what you can do to reduce them or, better yet, get off them altogether.

Early Symptoms Include Fatigue and Brain Fog

B12 isn’t called the dynamo vitamin for nothing. By boosting metabolism and healthy red blood-cell production, B12 adds horsepower to overall energy and mental focus, and promotes well-being.

The trouble is, fatigue, brain fog and other early warning signs of B12 deficiency can easily be dismissed as the result of something else, like an exhausting day at work. And because the symptoms seem vague and are different for everyone, it’s easy to dismiss the warnings by saying, "I’ll be fine tomorrow." Now, a good night’s sleep indeed might be all you need. But if symptoms remain for a week or more, and if other signs like mood changes or constipation come along, talk to your doctor about having your B12 levels tested.

B12 Deficiency May Be Linked to Dementia

Many people just assume that dementia and other cognitive disorders are a natural result of aging and therefore unavoidable. But studies suggest B12 deficiency plays a part in prevention.

In controlled studies published in the Journal of Geriatric Psychiatry and Neurology, researchers examined 19 elderly dementia patients with low levels of B12. Over a year, all 19 were given daily B12 treatment, and after a year, 63% had improved. In a separate study published by the American Academy of Neurology, researchers examined 370 randomly selected people age 75 or older over a year. At the end of the study, researchers discovered that of the 78 people from the group who developed Alzheimer’s disease, more than half had low B12 levels.

While researchers continue to explore the relationship between B12 and dementia, it comes down to this: Those moments of brain fog and forgetfulness just might be previews of something bigger and worse down the road. So if your cognitive health has become a concern, you should speak with your doctor and ask about testing for B12 deficiency.

The Best B12 Sources Are Fish and Meats

Ever wonder why dogs are so peppy and happy all the time? Ever wonder why they go absolutely nuts over liver? The answer to both could very well be that liver is a hands-down B12 sensation. A 3oz. serving of beef liver contains a whopping 18mcg of B12 and exceeds 100% in Daily Value.

If liver isn’t your thing, you have plenty of great alternatives. Beef, chicken, tuna, trout, mussels, clams and salmon are all brimming with B12. A 3oz. serving of salmon has 4mcg of B12 and provides 167% of DRI. Sardines clock in at 8mcg per 3oz. serving (and provide 333% of DRI), and mackerel (a close relatives to tuna) has 16mcg per 3oz. serving—and slam dunks DRI at 667%! For something simpler and quicker, 1 cup of milk contains an average of 1.3mcg of B12, and don’t worry. Bacon makes the list with roughly 0.4mcg of B12 in 24g (or, 3 slices).

Fortified Foods and Supplements Help

According to the National Institutes of Health (and many other medical sources), Vitamin B12 in synthetic form is easily absorbed by the body because it does not require Intrinsic Factor stomach acid to separate it from food. So for vegans, vegetarians, older adults and anyone with B12 deficiency, a daily B12 supplement is a simple and effective way to restore and maintain vitamin levels. You can also find any number of fortified foods, with cereal grains being an excellent source. Yet always read package labels, since some fortified foods also come with sugars, fats, chemicals and other things you likely don’t want in your diet.

Heavy Drinking Increases Your Risk

It’s well known that heavy alcohol consumption impairs natural B12 absorption. By damaging the stomach lining, alcohol can lead to atrophic gastritis, a chronic inflammation that stops stomach cells from producing Intrinsic Factor. Yet research suggests even moderate consumption of alcohol can be harmful. In randomized, diet-controlled crossover studies published in the European Journal of Clinical Nutrition, 53 postmenopausal women received either 0,15 or 30g of alcohol over 8 weeks. Results showed a 5% decrease in B12 levels from just one drink per day.

Low B12 May Cause Birth Defects

Children born to women with low B12 levels shortly before or after conception may have an increased risk of brain and spinal-cord defect, according to join research by the National Institutes of Health, Trinity College Dublin and the Health Research Board of Ireland. Because B12 levels drop sharply during pregnancy, researchers recommended that all women take 2.5mcg of B12 once a day with a meal before pregnancy. The researchers also recommended that women pair B12 each day with 400mcg of Folic Acid to further reduce the risk of birth defects. The U.S. Public Health Service also recommends that all women of childbearing age consume 400mcg of Folic Acid.

B12 Deficiency Triggers Pernicious Anemia

Vitamin B12 deficiency can lead to a dangerous blood condition called pernicious anemia, which can cause permanent health complications and death.

Red blood-cell levels drop when low Intrinsic Factor, poor diet, digestive issues, alcohol consumption or congenital conditions cause B12 deficiency. When this happens, the blood imbalance can trigger neurological complications (ranging from fatigue and headache to irregular heartbeat and faintness) that progressively become worse and more life-threatening.

Fortunately, pernicious anemia (meaning "dangerous" anemia) is treated today with B12 injections, and a B12 supplement is a daily safeguard against it all.

It Impacts Kids and Their Future

B12 deficiency may put some kids at an intellectual disadvantage, cause cognitive impairment and impact their futures.

In studies by the American Society for Clinical Nutrition, researchers gave psychological and fluid-intelligence tests to two groups: 48 kids (age 10-16) who’d been raised until age 6 on vegan-type macrobiotic diets (meaning low in natural B12) and 24 kids (age 10-18) who’d been raised on lactovegetarian or omnivore diets from birth onward. In both tests, the group raised on low B12 diets scored lower, and the low fluid - intelligence scores particularly troubled researchers because fluid - intelligence involves reasoning - the capacity to solve complex problems, think abstractly and learn.

It Can Trigger Terrifying False Positives

As one of the 13 essential vitamins our bodies need to stay alive, Vitamin B12 helps produce Myelin, a soft fatty material that surrounds and protects nerve fibers. A B12 deficiency can compromise the Myelin, resulting in neurological problems that have been misdiagnosed as Multiple Sclerosis. In other cases, B12 deficiency has been associated with abnormalities of cervical and uterine cells, leading to misdiagnoses of cancer.

High Folic Acid Levels Can Mask B12 Deficiency

Like all B vitamins, Folic Acid (or, Vitamin B9) helps convert food into energy, keeps your nervous system healthy and helps your body use fats and proteins. Yet high levels of Folic Acid (found in fortified foods like pasta, rice and breads) can mask the symptoms of Vitamin B12 deficiency. Without early warning signs like brain fog or fatigue to tell you that you’re heading toward worse issues like nerve damage and cognitive disorder, you might not know you’re in trouble until it’s too late. In fact, high Folic Acid levels may only ramp up the deficiency dangers.

In studies published in Nutrition Reviews, for example, researchers concluded that high Folic Acid levels during B12 deficiency didn’t just mask symptoms. They made the risks of anemia and cognitive damage worse.

According to the University of Maryland Medical Center, you should talk to your doctor first if you plan on taking more than 800mcg of Folic Acid. Similarly, if you’re eating foods fortified with Folic Acid and warning signs like fatigue and brain fog set in, you should consult your doctor.

Bypass Surgery Can Cause It

Vitamin B12 deficiency is one of the most common deficiencies caused by gastric bypass surgery because doctors bypass the portion of the stomach responsible for creating Intrinsic Factor. This dramatically reduces the body’s ability to absorb Vitamin B12 from food sources, and people who undergo bypass surgery may need to take B12 supplements for the rest of their lives.

The most effective form of B12 supplement comes as a liquid (or, "sublingual" ) that’s dropped onto the mucous membranes under the tongue and absorbed directly into the bloodstream.

It Causes Depression, Loss of Balance and Numbness

Long-term B12 deficiency can lead to nerve damage, and one of the warning signs is a tingling sensation (or, the feeling of "pins and needles" ) in your hands and feet. Other symptoms of nerve damage include depression, loss of balance, confusion and, in severe cases, dementia.

Now, some of these symptoms can be attributed to other things and have nothing to do with B12 deficiency. If you sit on your foot for too long, for example, you can experience the feeling of "pins and needles" when the blood makes its way back to your foot. But if you suspect nerve damage from B12 deficiency, you should immediately consult your doctor.

B12 Has No Toxic Effects

No toxic effects have been associated with taking Vitamin B12. Unlike fat-soluble vitamins that can build up in your body and pose the risk of side effects from excess, B12 is a water-soluble vitamin. That means your body only absorbs a small amount and the rest is excreted through urine. (That’s why urine takes on a bright yellow or orange color when taking B12.)

Taking too much B12 all at once, however, may cause skin rash, itching and nausea. Also, people with a history of gout, high blood pressure or cancer should use B12 cautiously. Always carefully read the label on any B12 supplement you buy and take only as directed.

Symptoms Include Hallucinations

Severe B12 deficiency can cause hallucinations in a normal healthy person.

In a case example published by African Health Sciences, a 44-year-old woman (with no history of psychiatric issues) was referred to a rural hospital for a blood transfusion due to severe anemia. She’d also been speaking incoherently for three weeks, as well as wandering away from her home, acting aggressively, hallucinating and having trouble concentrating and sleeping. At the hospital, her B12 levels were found to be very low. She was given a daily 1mg injection of B12 over one week, followed by 1mg monthly - and she completely returned to normal.

The case supports what many health practitioners know. Many symptoms of B12 deficiency can be reversed if caught early and treated.

Babies Can Be Victims

Brain growth is rapid in the first two years of any infant’s life, and growth is especially rapid in the cortex (associated with higher-order thinking). So B12 deficiency has serious and long-term effects for a child.

Although B12 deficiency is rare in infants, babies can be victims when fed vegan diets or breastfed from a vegan mother who doesn’t take B12 supplements (since breast milk is the only nutritional source for newborns). B12 deficiency in babies has been associated with demyelination (damage to the protective Myelin coverings around nerve fibers) and brain atrophy (or reduction in brain-cell size). And these things can affect a child for a lifetime.

The best way any mother can protect her child from the dangers of B12 deficiency is to supplement before and during pregnancy, and ensure afterward that children are always getting B12 in their diet or through supplements.

Visible Signs Include Mouth Ulcers and Cankers

Because B12 deficiency causes changes in blood flow, the visible signs of deficiency include mouth ulcers, canker sores and pale yellow ulcers with red outer rings.

Symptoms can also show up on your tongue in a variety of ways. It can feel smooth. Or it can feel itchy and tingly. Or your tongue can be red, swollen and beefy. Other outward signs include skin lesions, pale skin, hair loss and bruising.

Because symptoms of B12 deficiency show up differently in all people, you might experience one or several outward signs. To know for certain whether you’re suffering B12 deficiency, consult your doctor or a certified nutritionist.