With the number of people diagnosed with a Vitamin B12 and Iron deficiency increasing every day, it’s important we address an underlying cause that not many sufferers are aware of: the gut. Too many of those deficient in Iron and/or B12, are simply given supplements, sometimes indefinitely, to try and raise their levels.
What they’re not doing is addressing the reason the deficiency came about in the first place. And for a lot of people, the issue is with their ability to absorb Vitamin B12 in the gastrointestinal tract – a problem that is also often accompanied by IBS-type symptoms. With Vitamin B12 and Iron both essential for almost all functions of the body, a deficiency can contribute to serious long-term ill health.
Here is a summary of what we are going to cover:
> How low levels of Vitamin B12 can cause Iron deficiency anemia
> Symptoms of Vitamin B12 deficiency
> What causes Vitamin B12 deficiency
> The functional lab testing you need to do to uncover the root cause of Vitamin B12 deficiency
> How to correct a Vitamin B12 and Iron deficiency
How Vitamin B12 can Cause Iron Deficiency Anemia
Let’s get this sorted first. Why are we talking about both Vitamin B12 and Iron? Well, it’s because blood loss is one of the primary causes of Iron deficiency. And given B12 is required for the production of red blood cells, a deficiency in Vitamin B12 can lead to a deficiency in Iron. This is why the onset of anemia is often the result of a B12 deficiency rather than an Iron deficiency on its own.
So, if you’ve been diagnosed with low Iron levels, the problem might actually be with your Vitamin B12 levels – our focus for this specific post.
Common Signs and Symptoms of Vitamin B12 Deficiency
Symptoms of a Vitamin B12 deficiency can include:
> Tiredness, fatigue or low energy
> Muscle weakness and aches
> Shortness of breath
> Dizziness or feeling light-headed
> Heart palpitations
> Loss of appetite
> Digestive issues including diarrhoea, cramping and nausea
> Mood changes including depression and anxiety
> Numbness and tingling sensation in hands or feet (peripheral neuropathy)
> Poor concentration, brain fog, memory loss, confusion
> Low Iron levels (explained above).
What Causes Vitamin B12 Deficiency
The causes of Vitamin B12 deficiency generally fall within one of the three following categories:
1. LOW DIETARY INTAKE OF VITAMIN B12
As our bodies do not make Vitamin B12, we must rely on dietary sources or supplementation. The average adult’s daily requirement is estimated to be 2.4 micrograms a day, with the best dietary sources of B12 coming from animal products.
While plant-based sources of B12 exist, studies have shown they are poorly absorbed and have little to no effect on our B12 blood levels. This presents a challenge for those who follow a vegan and vegetarian way of eating, placing them at risk of Vitamin B12 deficiency.
2. IMPAIRED ABSORPTION OF VITAMIN B12 IN THE STOMACH OR SMALL INTESTINE
Even with adequate intake of B12, if our body can’t absorb the vitamin then we may still develop a deficiency. The absorption, assimilation, and methylation of B12 is a complex process that involves many steps, as summarised in the diagram below.
Here are the most common reasons for poor absorption of Vitamin B12:
> Low stomach acid – without sufficient HCl and pepsin, the animal proteins that are bound to Vitamin B12 are unable to be digested. This means the B12 is not ‘free’ to bind with other glycoproteins and move through the GI tract for absorption. Anyone with Atrophic Gastritis or Hypochlorhydria as a result of conditions like H. pylori bacterium infection are at particular risk. As is anyone who has been prescribed proton pump inhibitors (PPIs) or acid suppressing medications.
> Exocrine pancreatic insufficiency – without the production of sufficient pancreatic (digestive) enzymes, the body is unable to breakdown the Cobalamin-R complexes in the Duodenum. As a result, the B12 cannot bind with Intrinsic Factor (IF) and make its journey through the small intestine to be absorbed.
> Surgical resection or disease of the distal ileum – because B12 is absorbed at the lower end of the small intestine, any surgical removal (e.g. weight loss surgery) or an inflammatory condition (e.g. Crohn’s and Celiac disease) that impairs the distal ileum will also impair absorption of Vitamin B12.
3. MTHFR GENE MUTATION
Individuals with gene mutations such as MTHFR or MTRR have trouble with the process of methylating B12 into its usable form. So, while the body might absorb sufficient amounts into the blood, it is unable to absorb it into the tissues where it’s ultimately needed. Your Vitamin B12 levels might still be normal or high, however your body just struggles to use it properly.
This has become a relatively hot topic recently and one that many people may be too quick to jump to. Only once you’re eating enough high quality sources of Vitamin B12 and have tested and healed your gut, whether that’s H.pylori, SIBO, parasites or other sources of inflammation, should you be looking to MTHFR gene testing. And if you do decide to complete gene testing early on, make sure you’re onto the gut testing as well.
THE FUNCTIONAL LAB TESTING YOU NEED TO DO TO UNCOVER THE ROOT CAUSE OF VITAMIN B12 DEFICIENCY
While you might have already done the standard blood test to identify low levels of Vitamin B12 and Iron, the important testing you need now is to find out the underlying root cause. These are a comprehensive Stool Test, Organic Acids Test and/or SIBO Breath Test.
If none of these tests reveal underlying gut dysfunction and/or you have already healed your gut, that’s when it’s important to look to MTHFR gene testing.
How to correct a Vitamin B12 and Iron Deficiency
1. DIETARY SOURCES HIGH IN VITAMIN B12
As discussed above, the average adult’s daily requirement is 2.4 micrograms a day, with the best dietary sources of Vitamin B12 coming from animal products. And although the exact rate of absorbability depends on a person’s digestive health, here are the top food sources of B12:
> Beef and chicken liver
> Organic greek yoghurt
2. HEAL THE GUT TO IMPROVE VITAMIN B12 ABSORPTION
Given the importance of a healthy and well-functioning GI tract for the absorption of Vitamin B12, healing your gut could be the key to healing a B12 deficiency. The most common gut related conditions I see that impair B12 absorption, are:
> H. pylori – lowers stomach acidity and the animal proteins that are bound to Vitamin B12 are unable to be digested.
> SIBO – bacterial overgrowths in the small intestine can consume the Vitamin B12 before it is absorbed by the body.
> Parasites – infections like Giardia can also compete with the body for the absorption of Vitamin B12.
If you have a Vitamin B12 deficiency and also suffer from GI related symptoms then it is advisable to have a practitioner order some functional lab tests to identify potential gut infections or other imbalances.
Only once you have identified the underlying cause of the Vitamin B12 malabsorption (and deficiency) can you work to eradicate the infection and heal the lining of the gut. While healing the gut, I often recommend supplementing with HCl and digestive enzymes to help B12 absorption from food sources.
3. SUPPLEMENT VITAMIN B12
For those with permanent B12 malabsorption, such as individuals with MTHFR gene mutations, vegans/vegetarians, IBD or ileum resection, Vitamin B12 supplementation is generally recommended.
For anyone healing their gut to correct a B12 deficiency, short-term supplementation might still be advisable depending on your current B12 levels and the amount of gut healing that is required.
When looking for B12 supplements, be sure to look for it in the form of methylcobalamin, rather than cyanocobalamin. This Methyl-B12 form is typically the easiest for the body to absorb and utilise, giving the biggest impact on your B12 levels. There are three main ways you can get your B12 supplementation:
> Orally in capsule form – easiest to find at the store or available on Amazon here (USA) or iHerb here (Australia).
> Sublingual drops – recommended for those with SIBO or other gut infections or imbalances that are affecting absorption. Normally available via practitioners or available on Amazon here (USA).
> Injections – recommended for more serious cases of deficiency including pernicious anemia and severe depletion causing neurological disorders.
If you suspect you have a Vitamin B12 and/or Iron deficiency, the first step is to get tested. If you are deficient in B12, step two is to identify the underlying mechanism or cause of your deficiency. Once the root cause is identified, the appropriate form of supplementation (oral, sublingual or injection), dosages and length of treatment can be determined, as well as any gut healing and rebalancing that needs to occur to heal the root cause. I hope you found this post useful and continue to work towards vibrant health, minus the B12 deficiency.
Healing the gut is a journey. If you are ready to begin yours, please head to the Work With Me page to learn more about how I work online with clients in many countries to test for and treat the many root causes of IBS symptoms and other GI condition
Get Your Gut Back On Track!
An estimated 110,000 people consume antibiotics daily in Ireland, between December/March. (Source: Health Protection Surveillance Centre).
We asked Nutritional Therapist Rosanna Davison for her Top Tips to get your gut back on track after an illness.
1. Take time out
Don’t push yourself too quickly. Remember your body needs time to rebuild its reserves and regain strength.
Take more rest than usual. If you need to sleep longer, go to bed earlier.
Cut back on non-essential activities; they can wait until you are feeling 100%.
- Embrace fibre-rich foods full of protective nutrients
Fresh vegetables and fruits are rich in dietary fibre, vitamins and antioxidants. Try eating seven to nine portions over the course of each day. Choose different colours so that you nourish your body with a variety of phytonutrients.
Eat a portion of complete protein at each meal, such as poultry, fish, eggs, beans, pulses or tofu.
Consume essential omega-3 fatty acids daily. Avocados, seeds (flax, chia) and oily fish (mackerel, wild and organic salmon), are naturally rich in anti-inflammatory fats.
- Go ‘fermented’
Fermented foods are rich in ‘friendly’ bacteria. Sauerkraut is simple to make at home or buy kefir or kimchi in your local health store.
- Reduce or eliminate sugary foods
Processed foods often contain refined sugars to enhance taste. Excess refined sugar and processed foods may encourage the growth of ‘unfriendly’ bacteria, so aim to buy and eat fresh food.
If you have a sweet tooth, try eating berries (strawberries, blackberries, blueberries, raspberries). They are rich in antioxidants and naturally low in sugar.
If you need a sweetener, try Stevia which is extracted from plant leaves and doesn’t impact blood sugar levels.
Do vegans need to take supplements?
A varied, wholesome vegan diet provides almost all essential nutrients in sufficient quantities. I hear you shouting ‘Noooo! It provides absolutely everything we need!’ and you may be right, but only if you regularly eat certain fortified foods. The sad truth is that modern food production systems and lifestyles make it more difficult for everyone – vegans or not – to get all they need from diet alone. It doesn’t mean a vegan diet is unnatural or unhealthy, in fact the opposite is true. It means that how we grow, produce and consume food has changed and, with an ever-growing population, the demands on the systems that produce our food are so high that certain nutrients become harder to obtain.
I get a lot of questions about supplements and understand why people are confused. Over the years, I’ve worked on many vegan research projects and as science and population studies reveal ever more data, the guidelines and recommendations change and evolve. Hence, what we were told 10 years ago may no longer be up-to-date and that’s why different opinions arise, depending on where and when we got our information. It’s my job to keep up-to-date, so hopefully I can bring some clarity to the supplement discussion!
So what’s needed? The trio of nutrients to keep a close eye on are vitamin B12, vitamin D and iodine. You may not need to supplement with all these, all year long, but it depends on several factors. Read on…
Vitamin B12 naturally comes from bacteria in the soil and both people and animals would traditionally have got it from eating unwashed plants. However, we not only wash vegetables before we eat them (and for good reasons), but food production is now so sanitised that most vegetables are washed in chlorine, or other sterilising solutions, so there’s not a trace of B12 left.
People are not generally aware that most farmed animals are given B12 supplements and this is how the vitamin eventually ends up in their flesh. So, the argument that meat is a natural source of B12 doesn’t really stack up as meat-eaters essentially consume B12 supplements recycled by the animals that were given them!
It is absolutely necessary that we have a reliable source of vitamin B12 for our bodies. We need it to make red blood cells, for a healthy heart and circulation, and it’s essential for the nervous system. It takes years to develop a B12 deficiency, so on one hand, you don’t need to worry about not having taken B12 for a while. On the other hand, you do need to pay attention, as when symptoms develop, it’s usually serious.
To ensure adequate intake, you should have at least 5µg (micrograms) daily from supplements or fortified foods. The B12 used in both foods and supplements is produced commercially by growing bacterial cultures in large vats – and it’s always suitable for vegans.
There are two forms of B12 in supplements – cyanocobalamin (cheap) and methylcobalamin (expensive). Cyanocobalamin is the stable ‘inactive,’ form of B12 and is used in supplements and to fortify foods and drinks. Once ingested, it’s activated by your body so it can be used. Methylcobalamin is the ‘active’ form of vitamin B12 as it does not require any metabolic reactions to be activated. It costs more and is not so stable.
So which one to choose? Unless you’re a heavy smoker, have kidney failure or any other serious condition affecting your metabolism, cyanocobalamin – the cheap form of B12 – is perfectly fine. Intakes up to 2,000µg a day are safe and you can take either a lower dose daily or a higher dose a couple of times a week.
We need vitamin D for healthy bones, teeth and muscles and it also performs other essential functions in our metabolism. It is produced in the skin when exposed to sunlight and this is the main source of vitamin D for most people. However, if you always use sun-block, cover most of your skin or live in a country, like the UK, where we don’t get enough sunlight over the winter, you need a supplement, whether you’re vegan or not.
The UK Government now recommends that we all take a supplement from October to April and, if you protect your skin ferociously over the sunnier spring and summer months, you should take a supplement all year long. Otherwise, just 20 minutes of sunlight on the face and arms is all that is required by the body to manufacture sufficient vitamin D.
Fortified breakfast cereals, bread, plant milks and vegan margarines can be useful sources if exposure to sunlight is not practicable, but may not be enough. When it comes to supplements, there are two types and your body can use both, but it’s advisable to check the source – vitamin D2 is always vegan, but vitamin D3 can be of animal origin. Many vegan foods are fortified with vitamin D2 and labelled so, but if not specified, especially on cereal products, vitamin D tends to be of animal origin. If you choose to supplement your diet, there’s a range of quality and affordable vegan supplements with vitamin D2. There are also those made from algae or mushrooms that contain D3 and these are recommended if you need a higher dose. When deciding on your dosage, 10µg per day is enough and you shouldn’t go above 25µg.
Iodine has been a hot topic lately, especially with plenty of tabloid ‘experts’ warning that vegans are missing out. This mineral is necessary for thyroid function and helps to regulate how energy is produced and used in the body.
The amount of iodine in plants depends upon the iodine content of the soil in/on which they are grown. The closer to the sea, the more iodine and therefore vegans can get enough from plant foods, but there’s no guarantee. Seaweed, which of course grows in seawater, is always a good source and includes nori, laver, dulse and the kelp family (kombu, arame, wakame). But be warned – kelp absorbs far more than other seaweeds and you can get too much iodine from it. So, while seaweed consumption is encouraged, kelp should be used only sparingly.
It’s best to use a kelp supplement so you know exactly how much iodine you’re taking – it’s cheap, reliable and you don’t have to worry about taking too much. The recommended daily intake is 140µg and intakes up to 500µg are considered safe. In many countries, iodised salt is commonly used to ensure iodine intake, but it’s not the norm in the UK.
The dairy industry has been boasting about the iodine content of cow’s milk. What they don’t tell you is that it’s not a natural component of milk, but comes from iodinated cattle feed, supplements, iodophor medication, iodine-containing sterilisers of milking equipment, teat dips and udder washes. Cow’s milk is neither a natural nor the best source of iodine, so we can happily leave all that dairy out of our diet.
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