Just because your B12 is in range doesn’t mean it’s good!

Serum B12 blood test is pretty ? at detecting deficiency. Be skeptical if your Doctor sais ‘your B12 is in range you’re normal’, yet you’re experiencing adverse symptoms (fatigue, memory problems, weakness, dizziness, infertility) or just want to be proactive with your health.

Who Should Be Concerned? B12 Deficiency High-Risk Groups:

  • Plant-based eaters.
  • Elderly (less intrinsic factor produced as you age which absorbs B12).
  • Gut issues (e.g. chrons, IBD.)
  • Binge alcohol drinkers.
  • Diabetics or athletes taking metformin.

Should all ideally get holo-transcobalamin (active B12) and/or methylmalonic acid and homocysteine testing.

“Serum B12 levels are wrong; the lower limit of the normal range should be 300 pg/ml and not 170 pg/ml or 200 pg/ml. Further, it has been concluded that the serum B12 is too non-specific to be a reliable guide of B12 status; instead, we should look to the serum MMA level.”

b12 graph

‘I take supplements so I’m fine…’

  1. Not necessarily, malabsorption occurs frequently in the elderly, those with gut bacterial overgrowths, low stomach acid, and nutrient deficiencies. Just because you get enough dietarily doesn’t mean you’re meaningfully improving your B12 status.
  2. “Supplements, fortified food, and beverages normally contain the less efficient cyanocobalamin form of vitamin B12, which when it enters the bloodstream must be converted to methylcobalamin, the only form of vitamin B12 that has a methyl donor that is required to neutralise homocysteine. It takes 4–9 weeks for this conversion to take place assuming there are no disruptions by genetic factors, age-related problems, and metabolic obstacles that may be present.”
  3. “Furthermore, research suggests that vitamin B12 that is not dissolved in the mouth will not (up to 88 %) be absorbed, due to the lack of R-binder mostly obtained from saliva, which is required to start the absorption process. The aforementioned study indicates that supplementation with cyanocobalamin can be poorly absorbed, which will have little or no effect on raising vitamin B12 levels.”

Methylcobalamin lozenge supplements dissolved in the mouth are an ideal replacement.

“Measurement of homocysteine and/or methylmalonic acid should be used to confirm deficiency in asymptomatic high-risk patients with low normal levels of vitamin B(12).”

“ The usual dietary source of vitamin B₁₂ is animal products and those who choose to omit or restrict these products are destined to become vitamin B₁₂ deficient.”

Conclusion

Let’s be very careful about removing foods/food groups from our diet. Most health professionals struggle to understand the complex biochemistry of nutrition and supplementation let alone the average person.

You can severely fuck yourself by naively supplementing and removing food groups. A google search and conversation with your pharmacist are not sufficient. You should be studying in the area and/or work with someone who is and does understand this to minimise the eventual risks of nutrient deficiencies.

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References