Feeling tired and run down? Struggling with depression or anxiety? Dealing with poor memory or focus? Experiencing numbness or tingling? You may be low in B12 and require a B12 supplement. But not all B12 supplements are created equally. Here are some B12 basics:

B12’s Role in the Body

Vitamin B12 is involved in DNA synthesis and repair, red blood cell formation, cellular energy production, and homocysteine metabolism. It is involved in the proper function of the nervous system, for it is essential for the preservation of the myelin sheath around neurons and for the synthesis of neurotransmitters. Studies have shown that as many as 30% of patients hospitalized for depression are B12-deficient.

What causes B12 deficiency?

• Malabsorption due to IBS, celiac disease, IBD, leaky gut, and SIBO
• Certain medications, such as acid-reducing medications and birth control pills
• Pernicious anemia (autoimmune condition)
• Low stomach acid (or hypochlorhydria)
• Vegan or vegetarian diets

Food sources of B12

B12 is found in animal products, such as meat, eggs, dairy, fish, and poultry. This is why vegan and vegetarian diets can cause B12 deficiency. A vegetarian source of B12 is nutritional yeast. Nutritional yeast is seasoning with a nutty, cheesy flavor that can be added to vegetables, soups, and stews (in place or sprinkling parmesan cheese, for example). It is found at most health food stores in the bulk section.

Supplementing with B12

Ideally, I like patients to get nutrients through food when possible. However, if the diet is limited or restricted and/or B12 levels are quite low on lab tests, a B12 supplement may be indicated. Always look for methylcobalamin (active and most bio-available form of B12) in supplements. Most over-the-counter B12 supplements contain cyanocoblamin, which is poorly absorbed and under-utilized. This is especially true if you have the MTHFR mutation.

If absorption is an issue (due to celiac, IBS, leaky gut, IBD, or SIBO), a sublingual (under the tongue) B12 may be indicated. B12 is absorbed in the distal part of the small intestine, and if there is any inflammation in this part of the gut, B12 will not be absorbed. A sublingual form of B12 bypasses digestion and is therefore readily absorbed into the bloodstream.

We only carry B12 in the form of methylcobalamin at Lakeside.

Lab tests

Conventional lab ranges are based on the average of what is found in the general public, not necessarily healthy individuals. We all know that the average American is overweight, sick and tired. It is not optimal to simply be “in range.”

Serum B12 Testing:

Conventional range: 200-800

Optimal range: 600-1000

Methylmalonic acid (MMA): this is a very sensitive blood test and will reveal a true B12 deficiency if high. If your serum B12 was “normal” but you still have signs of B12 deficiency, ask your doctor to order the MMA test.

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.