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How do you know if you’re absorbing vitamin B12? Just because you eat plenty of foods that are rich in vitamin B12 (cobalamin), that doesn’t mean you’re getting all the B12 you need for great health. Sometimes, things happen that interfere with your ability to digest vitamin B12, creating an obstacle to absorbing vitamin B12 naturally. This happens more often than you realize…
Why you need to take vitamin B12
You may be asking yourself, “Doesn’t my body produce vitamin B12 on its own? It makes lots of other vitamins.”
The short answer is, “No.” While you are able to store plenty of vitamin B12 in your liver for years to come, your body relies on a constant influx of vitamin B12 from dietary sources like lean beef, chicken, fish, and dairy foods, which it then uses to sustain energy levels, maintain a healthy nervous system, and regulate hormones.
The long answer is more complicated. This constant replenishment of vitamin B12 into your blood supply relies on intrinsic factor for absorbing vitamin B12 and carrying it through the digestive system. As long as you are always able to break down vitamin B12, then you are all right. However, if you are among a large percentage of people who cannot produce the intrinsic factor enzyme, then you must supplement constantly with vitamin B12 supplements, in order to prevent vitamin B12 deficiency.
What is vitamin B12 deficiency?
Whenever you’re not absorbing vitamin B12, you’re drawing it from your liver. Eventually, this store of essential vitamin B12 runs out, and you begin to notice the effects of vitamin B12.
The initial symptoms of vitamin B12 include:
“Brain fog” disorientation
Painful tingling and numbness in the extremities, such as hands and feet
Sore, red tongue
Over time, if untreated, vitamin B12 deficiency can lead to severe neurological damage and a gradual depletion of red blood cells. Also, since vitamin B12 helps to regulate homocysteine, a hormone linked with heart attack and stroke, your risk for cardiovascular disease may increase. In rare occasions, infants solely breastfed by vegan mothers not absorbing vitamin B12 show signs of failure to thrive and feebleness.
What causes vitamin B12 malabsorption?
Many different factors can keep you from absorbing vitamin B12 naturally from foods.
Family history for pernicious anemia
History for autoimmune disorder, such as fibromyalgia or celiac disease
Damage to the digestive system caused by acid reflux, vomiting, or diarrhea
Gastrointestinal disorders, such as Crohn’s disease or ulcerative colitis
Gastrointestinal surgery, such as bariatric surgery or ileostomy
Medications, such as PPIs for GERD, or metformin for diabetes
If you’re not absorbing vitamin B12, then it’s important to understand which kinds of vitamin B12 supplements to take, and which ones to avoid.
Most likely, your doctor will prescribe vitamin B12 shots. These are helpful, as they dispense vitamin B12 directly into the bloodstream, bypassing the need for absorbing vitamin B12 in the stomach.
Certain side effects of vitamin B12 shots are, obviously, pain, as cobalamin requires insertion into the thick fleshy tissue behind the thigh. Sometimes, bruising may occur.
Vitamin B12 shots are also often impractical. In most states, vitamin B12 injections require a prescription, and doctors are sometimes hesitant to prescribe enough monthly doses to relieve all the symptoms of vitamin B12 deficiency.
Instead, many patients opt to supplement with extra vitamin B12 on their own. Certain inexpensive over-the-counter (OTC) vitamin B12 supplements are helpful for “topping off” vitamin B12 between shots. For optimum health and relief from symptoms, find non-dietary vitamin B12 supplements that distribute cobalamin directly into the bloodstream, not through the digestive system.
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If you’ve been diagnosed with vitamin B12 deficiency, you’re probably wondering, “How did this happen?” Unless you’re a vegan or a gastric bypass patient, it’s possible that vitamin B12 deficiency resulted from an autoimmune disorder that causes pernicious anemia.
Vitamin B12 deficiency- what are the symptoms?
Vitamin B12 is essential for maintaining your nervous system, psychological health, and your metabolism. Pernicious anemia causes a wide range of debilitating symptoms that interfere with daily life, and is one cause of B12 deficiency.
Symptoms of vitamin B12 deficiency-pernicious anemia may include:
Everyday fatigue, despite sleeping well
Brain fog- confusion
Painful numbness and tingling in hands and feet
Tingling or burning sensation in mouth and tongue
Difficulty walking normally
Infertility or frequent miscarriages and stillbirths
Vitamin B12 deficiency- what are the causes?
There are many reasons why an individual may develop vitamin B12 deficiency. First off, if you eat a diet rich in sources of vitamin B12, including beef, poultry, fish, and milk, then you should not under any normal circumstances become deficient in vitamin B12 levels.
Following a vegan diet is a major risk factor for vitamin B12 deficiency. Vitamin B12 occurs naturally in animal-based foods, the richest sources being liver, shellfish, and many lean meats. Unless you supplement your vegan diet with vitamin B12, then you will eventually become depleted, as few plant-based products are infused with substantial amounts of vitamin B12.
Certain lifestyle choices may interfere with vitamin B12 absorption, including stomach or intestinal surgery (such as gastric bypass), alcohol abuse, and using certain B12-inhibiting medications (such as metformin or protein pump inhibitors [PPIs]).
Gastrointestinal diseases, in addition to other diseases that include GI malfunction, may cause vitamin B12 deficiency. These include Crohn’s disease, ulcerative colitis, celiac disease, fibromyalgia, migraine disorder, and chronic fatigue syndrome.
The elderly do not produce enough stomach acid to digest vitamin B12 fully, so they are a separate risk group for vitamin B12 deficiency.
If none of the above-mentioned risk factors pertain to you, then it’s entirely possible that you suffer from an autoimmune disorder that prevents you from absorbing vitamin B12 from dietary sources. Autoimmune pernicious anemia may take decades to develop and typically goes unnoticed until you reach your thirties or forties.
Vitamin B12 deficiency from autoimmune disorder
In order to get vitamin B12 into your blood supply, you need certain digestive enzymes to help you access vitamin B12 from the foods you eat. Intrinsic factor is that necessary enzyme that your body uses to absorb vitamin B12.
For some people, certain antibodies interfere withintrinsic factor, causing your immune system to malfunction. If you have one of the antibodies that interfere with vitamin B12 absorption, then you will never be able to digest vitamin B12, no matter how many hamburgers or fish dinners you eat in your lifetime.
Three types of antibodies cause vitamin B12 deficiency- pernicious anemia. They include:
Parietal cell antibody, which prevents the production of intrinsic factor in the stomach.
Intrinsic factor antibody, type 1, which prevents the bonding of vitamin B12 to intrinsic factor. About 50%-60% of pernicious anemia patients have this type of antibody.
Intrinsic factor antibody, type 2, which allows bonding of vitamin B12 to intrinsic factor, but prevents bonding with receptor from the ileum (the bottommost part of your small intestine).
If you’ve been tested for vitamin B12 deficiency, it’s important that you also take a blood test for the pernicious anemia antibody. Many doctors overlook this important screening, so you might need to ask for it.
Vitamin B12 deficiency autoimmune disorder requires vitamin B12 from non-oral sources, such as vitamin B12 injections, which are available only through prescription.
Please tell us…
Have you tested for vitamin B12 deficiency, but not for the intrinsic factor or parietal cell antibodies?
If you get vitamin B12 shots…do you still experience pernicious anemia symptoms like fatigue, memory loss, brain fog, and nerve pain?
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Difficulty absorbing vitamin B12 is sometimes caused by pernicious anemia. Chronic fatigue is one of many symptoms of vitamin B12 deficiency- pernicious anemia. In order to test absorption of vitamin B12, some blood tests are required.
What is vitamin B12 deficiency?
Vitamin B12 is a mineral that we absorb from animal products like meat, chicken, fish, eggs, and milk. Vitamin B12 is essential for your nervous system, red blood cell production, DNA synthesis, and cognitive functioning. Without it, you might experience symptoms like fatigue, memory loss, depression, tingling in the hands and feet, altered sense of taste, difficulty walking steadily, and decreased motor control. (Absorbing Vitamin B12, a Metabolic Gastrointestinal Journey)
Who is at risk for vitamin B12 deficiency?
Most people will never experience vitamin B12 deficiency. That is because generous amounts of B12 are stored in your liver. However, an increasing number of people are falling victim to low B12 levels- individuals who are unable to absorb vitamin B12 naturally from foods.
People who cannot absorb vitamin B12 are:
Individuals who cannot produce intrinsic factor, a protein required for vitamin B12 absorption.
Individuals who have had the part of the small intestine responsible for making intrinsic factor removed, as is common procedure in bariatric surgeries (gastric bypass) and gastrointestinal surgeries for Inflammatory Bowel Disease (IBD), such as Crohn’s disease.
Anybody who is unable to produce enough stomach acids in order to absorb vitamin B12- these include the elderly, sufferers of gastric autoimmune diseases, diabetes patients who take metformin, and people who take strong antacid medications for acid reflux, such as heartburn (GERD) sufferers or pregnant mothers.
What if I am not tested for vitamin B12 absorption?
Left untreated, vitamin B12 deficiency could result in red blood cell depletion. Other dangerous side effects that stem from being unable to absorb vitamin B12 are elevated risk for heart attack and stroke, neurological damage, and dementia.
If you suspect you might have vitamin B12 deficiency…
if you notice symptoms like being tired all the time, talking in slow, unpronounced speech, more difficulty remembering things than normal,
if you’ve been diagnosed with comorbid conditions like fibromyalgia, chronic fatigue syndrome, Crohn’s disease, Celiac disease, or hypothyroidism, or
if you’ve had weight loss surgery or another types of gastrointestinal procedure…
…then it’s crucial that you request a B12 blood test for vitamin B12 levels, in addition to a Schilling test that measures your ability to absorb B12.
The Schilling test is more than just a test for B12 levels. While the standard test for vitamin deficiency checks vitamin B12 levels, the Schilling test determines the reason for your problem with absorption of vitamin B12.
There are four stages of the Schilling test for B12:
In stage one, you take two doses of vitamin B12; one is an oral radioactive dose of cobalamin, and the other is a vitamin B12 injection. A urine test determines your absorption of B12
In stage two, you take another radioactive dose of vitamin B12- this time, with intrinsic factor.
Before going on to stage three, you are required to take antibiotics for two weeks. Next, a lab technician determines if bacterial growth is the cause of your lack of B12 absorption.
Finally, stage four determines if your vitamin B12 deficiency results from a pancreatic disorder. You will take pancreatic enzymes for a few days, followed by another radioactive dose of vitamin B12.
Vitamin B-12 (Cobalamin) originates in most protein foods, but even meat-eaters can get vitamin B12 deficiency. Absorbing vitamin B12 is a tricky process, and people who lack the intrinsic factor protein are unable to digest vitamin B12 from natural sources. Learning about B12 supplement absorption is essential for avoiding B-12 deficiency symptoms.
Vitamin B12- What is it?
Vitamin B12, a member of the B-complex family of vitamins, is a water-soluble protein. Most of the vitamin B12 that you eat comes from meat sources, as animal microorganisms produce it. Beef, liver, chicken, fish, and shellfish are some of the richest sources of vitamin B-12, in addition to eggs, cheese, and other dairy products. The only widely confirmed vegan form of B12 occurs in brewer’s yeast.
This is your Body on B12
The benefits of vitamin B12 for your body are expansive.
Vitamin B12 assists in producing oxygen-carrying red blood cells.
Vitamin B12 also protects the myelin sheathe, which protects your nervous system.
Vitamin B12 benefits cognitive functioning- Cognitive health treatments are essential for treating symptoms of autism, and to delay the early onset of dementia.
Supplementing with vitamin B12 boosts stamina, sustains the memory, enhances mental focus, and imparts feelings of well-being in individuals who suffer from vitamin B12 deficiency.
Long-term vitamin B12 deficiency causes depression, anxiety, fatigue, memory loss, and numbness/tingling in the extremities.
Vitamin B12’s journey through your body is a complicated, tricky procedure, and many things can go wrong.
1. When you consume dietary vitamin B12 (from food), it immediately clings to hydrochloric acid and pepsin, a gastric enzyme that your body makes- except for when it doesn’t. (More on this later.)
2. In your stomach, digestive acids separate vitamin B12 (cobalamin) from its protein part. Also in your stomach, gastric parietal cells produce a substance called intrinsic factor- a necessary glycoprotein for digesting B12.
3. Vitamin B12 combines with “R protein,” thus becoming B-complex. B complex, along with intrinsic factor, travels to the small intestine.
4. In the small intestine, R protein and B-complex separate. B12 then attaches itself to intrinsic factor.
5. The B12/intrinsic factor complex travels through the small intestine, finally arriving at the very bottom, where it reaches the terminal ileum. The ileum then absorbs the vitamin B12 and distributes it into your bloodstream, where it is then stored in the liver.
Things that can go wrong with vitamin B12 Absorption
Some people are unable to digest vitamin B12 properly from food, and must instead receive vitamin B12 injections, which go directly into the bloodstream, bypassing the need for digestion.
You don’t have intrinsic factor. Lack of intrinsic factor is an autoimmune response, in which autoantibodies destroy intrinsic factor proteins produced in the stomach. Since intrinsic factor is required in order to digest B12, the only way to avoid B12 deficiency is to bypass digestion by taking vitamin B12 supplements.
You are among the elderly. The majority of senior citizens don’t produce the amount of stomach acids needed to break down B12 for digestion. Even the minimum amount of vitamin B12 recommended by physicians is not enough to avoid dementia caused by B12 deficiency, so elderly individuals are a high-risk group. To prevent early-onset Alzheimer’s disease or neurological damage, transdermal vitamin B12 is advisable.
You take heartburn medication. As with the elderly, people who have GERD, or others who frequently take medicine for acid-reflux, including pregnant women, are susceptible to B12 deficiency.
You have had your ileum removed.Gastric bypass patients are at high risk for developing vitamin B12 deficiency, as are other patients of gastrointestinal surgery, such as sufferers of Crohn’s disease. Unfortunately, many surgeons neglect to warn their patients about complications regarding vitamin B12 deficiency, and many bariatric surgery patients don’t find out about it until the symptoms- depression, fatigue, brain fog- become too hard to ignore.
You are a vegan. The vegan diet is largely devoid of B-12 sources, so unless you are a vegetarian who eats eggs, fish, or dairy, then you must take regular vitamin B12 supplements in order to avoid B12 deficiency.
You are diabetic. Metformin, a diabetes drug, interferes with the absorption of vitamin B12.
You have an autoimmune disease. Many autoimmune diseases such as celiac disease, fibromyalgia, and chronic fatigue syndrome are highly correlated with B12 deficiency. Scientists are unsure as to the exact cause, but they have noted a decrease in symptoms such as fatigue, irritability, and depression with the inclusion of vitamin B12 supplements.