Who is at Risk for Vitamin B12 Deficiency ?

Too many people that I see fall into the danger zone for vitamin B12 deficiency; diets low in vitamin B12, people who take medication that deplete their stores, digestive/malabsorptive issues, high intake of alcoholic beverages and the elderly ( > 65YOs).

Are you feeling unexplained exhaustion?

Do you feel mental fatigue?

Do you often feel depressed ?

Do you have trouble sleeping ?

Are you taking acid suppressive, cholesterol lowering or contraceptive medications?

Are you eating predominantly plat-based diet?

Optimizing food sources of vitamin B12 should always be our first line of defense against deficiency. Here are some food sources if your diet allows animal protein.

But what if you are vegetarian or vegan and these foods are not part of your diet? Most animal sources of vitamin B12 are not the healthiest choice for other reasons. Animal proteins are high in cholesterol, saturated far, grown with antibiotics, hormones and can be excluded from one’s diet due to religious or other believe reasons.

Vitamin B12 sources are not created equal, it is important to compare the provision of B12 from food relative to the recommended daily value. One can consume a grass of milk and two eggs per day and still not meet their daily needs. Clams and liver seem to be the winers with 1, 402 and 1,178 % of the recommended daily value. But how often do you eat clams and liver? And is liver good for you to eat in general? Oran meats such as liver can be quite nutritious, but are associated with risk gout attacks (1) Another concern is the toxic load of oran meats, liver is the clearing house of an organism and is the toxic storage place for many unfiltered food and environment contaminants.

Your vitamin B12 stores could be low and you may not have any physical or neurological and signs and symptoms. Unfortunately, testing for blood levels is not always a good indicator of deficiency. Learn more about testing.

B12 is a key essential nutrient involved in energy production, DNA synthesis and neurologic function. Deficiency can lead to a wide spectrum of hematologic and neuropsychiatric disorders that can often be reversed by early diagnosis and prompt treatment with the most appropriate form of B12.

The true prevalence of vitamin B12 deficiency in the general population is unknown. The incidence, however, appears to increase with age. In one study, 15 percent of adults older than 65 years had laboratory evidence of vitamin B12 deficiency. (2)

The nearly ubiquitous use of gastric acid–blocking agents, also leads to decreased vitamin B12 levels(3). The use of contraceptive medications, cholestyramines (cholesterol lowering medications) and Colestipol ( cholesterol lowering medication ) also effect of vitamin B12 stores. See complete list of risk factors below:

Who is risk for deficiency

Risk factors include:

  • Frequent use of alcoholic beverages ( itnake of daily 2 or more alcoholic bevarage )
  • Ederly, Age > 65 years
  • Recurrent peptic ulcers disease or diarrhea
  • Medications: scubas contraceprives, gastric acid suppressive drugs, colestipol, metformin, methylopa, cholestyramines ( cholesterol lowering medications )
  • Chronic gastrointestinal symptoms
  • Gastric or ileal surgery (gastric or ileal resection)
  • Enteritis, Crohn’s disease or Ulcerative Colitis
  • Bacterial overgrowth such as in SIBO or tapeworm
  • Not enough vitamin B12 in diet (vegetarian or vegan diet)
  • Diseases that cause malabsorption (for example, celiac disease and Crohn disease)
  • Lack of intrinsic factor, a protein that helps the intestine absorb vitamin B12
  • Above normal heat production (for example with hyperthyroidism)
  • Pregnancy

Sign and symptoms of deficiency:

  • exhaustion or fatigue
  • rapid heartbeat without exercising
  • brain fog or difficulty concentrating
  • confusion or impaired thinking
  • weakness
  • dizziness
  • lack of interest in activities you used to enjoy
  • trouble sleeping 
  • forgetfulness
  • Psychiatric – in later stages of deficiency
  • Irritability, personality change
  • memory impairment, dementia
  • Depression

Role of B12

  • Helps with energy production by aiding the body’s conversion of foods into usable energy (ATP), therefore lack of B12 leads to fatigue and disturbances in sleep wake cycle.
  • Supports a healthy cardiovascular system by maintaining proper homocysteine, assists in the proper functioning of the biochemical cycle between the amino acids homocysteine and methionine. When we have inadequate B12 there is an accumulation of homosystein leads to increase the risk for cardiovascular disease.
  • Maintains healthy brain function by aiding the body’s natural production of the neurotransmitters (brain chemicals) needed for memory and learning
  • Supports the production of serotonin levels, which affect the sleep-wake cycle as well as supporting good concentration and alertness throughout the day
  • Supports the production and maintenance of healthy red blood cells

Route and type of supplementation

Because some clinicians are unaware that oral vitamin B12 therapy is effective, the traditional treatment for B12 deficiency has been intramuscular injections. (3) However, since as early as 1968, oral vitamin B12 has been shown to have an efficacy equivalent of injections in the treatment of pernicious anemia and other B12 deficiency states (4,5).

B12 supplementation comes in two major forms cyanocobalamin and methylcyanocobalamin. Cyanocobalamin is a synthetic form of vitamin B12 found only in supplements and not in nature, while methylcobalamin is a naturally occurring form that you can get through either food sources or supplements. Unfortunately most supplements provide cyanocobalamin as it is more cost effective, but utilization in the body is questionable. Unlike cyanocobalamin, methylcobalamin is a naturally occurring form of vitamin B12 and it is properly utilized by human body. (6)

Supplementation Can Help With:

  • Brain and nerve function
  • Improvement in energy levels
  • Optimization of alertness and concentration
  • Improvement in sleep quality
  • Achieving safe homocysteine levels
  • Cardiovascular system

Dosing of B12 Supplementation

Most appropriate dose of vitamin B12 is between 1, 000 to 2, 000 mcg of methylcobalamin along with folic acid.

Purchase your B12 supplement Here

This is the most potent form of methylcobalamin.


1. Pennypacker LC, Allen RH, Kelly JP, Matthews LM, Grigsby J, Kaye K, et al. High prevalence of cobal-
amin deficiency in elderly outpatients. J Am Geriatr Soc 1992;40:1197-204.

2 . Bradford GS, Taylor CT. Omeprazole and vitamin B12 deficiency. Ann Pharmacother 1999;33:641-3.

3. Lederle FA. Oral cobalamin for pernicious anemia: back from the verge of extinction. J Am Geriatr Soc 1998;46:1125-7.

4. Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J. Effective treatment of cobalamin
deficiency with oral cobalamin. Blood 1998;92: 1191-8

5. Lederle FA. Oral cobalamin for pernicious anemia. Medicine’s best kept secret? JAMA 1991;265:94-5.