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B12 Deficiency – The Silent Epidemic

B12 Deficiency – The Silent Epidemic

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B12 Deficiency – The Silent Epidemic

Vitamin B12 is also known as cobalamin. B12 is a water soluble vitamin. Our bodies are unable to produce B12, hence the reason why getting adequate amounts in our diet is important.

B12 is required by our body to carry out many functions like:

• Nerve health

• Red blood cell production

• DNA synthesis

• It acts as a methyl group donor, which is an important step in our detox pathway.

As we can see, Vitamin B12 is very important for neurological, cardiovascular, digestive and immune functions. In fact, vitamin B12 is involved in the metabolism of every cell in the body.

B12 has many forms and the most common forms are cyanocobalamin and methylcobalamin. Cyanocobalamin is commonly found in supplements and certain energy drinks. Cyanocobalamin has to be converted in our body to methlycobalamin for the functions I mentioned above to happen. The problem arises as many of us are unable to convert cyanocobalamin to methlycobalamin because we lack the genes to do so.

In Japan, a deficiency is found in levels under 550 pg/ml (400pM). Most B12 researchers and advanced functional nutritionists agree with the Japanese model. Research done through Tufts University Framingham Offspring Study has suggested that 40% of people between the ages of 26 and 83 have low-normal plasma B12 levels. They found that 9% had an outright deficiency and 16% exhibited a “near deficiency.”

Many of these individuals were suffering from neurological symptoms. B12 deficiency is present in close to 50% of people over 60 years of age. It’s entirely possible that at least some of the symptoms we attribute to “normal” aging – such as memory loss, cognitive decline, decreased mobility, etc. – are at least in part caused by B12 deficiency.

Here are some of the major causes of B12 deficiencies.

Signs of B12 Deficiency

• Weakness, low energy levels

• Lethargy

• Easy bleeding or bruising

• Heart palpitations

• Diarrhoea or constipation

• Depression or mood swings

• Numbness and tingling of the hands and feet

• Pale skin

• Memory loss, confusion or even dementia The important thing to note is that if these symptoms are ignored and not corrected, a B12 deficiency can affect the entire body leading to permanent brain damage and nerve damage. B12 is also used for treating and or preventing

• Back pain

• Muscle cramps

• Migraines

• Sciatica

• Anxiety

• Poor memory

• Diabetes

• Infertility

Best source of B12

An average adult requires 2.4 micrograms a day. The best dietary source of vitamin B12 are animal products like:

• Meat

• Poultry

• Fish

• Eggs

• Clams

• Liver

• Beef

• Lamb

• Oyster

• Mackerel


What causes B12 deficiency?

• Vegans and vegetarian diets

• Lack of genes to convert or methylate B12

• Pernicious anemia

• Autoimmune diseases like SLE or Graves disease

• Intestinal inflammatory conditions like Chrons disease, leaky gut, SIBO, Dysbiosis.

• Excessive alcohol consumption

• Low stomach acid- we see this in patients on prolonged acid reducing drugs

• Bariatric surgery

• Lack of probiotics in the colon- B12 is also made by the friendly bacteria in your large intestines

• Vitamin B12 deficiencies are common in people who have used medications for a period of time. The medications most commonly associated with B12 deficiencies include metformin (diabetes), antacids, anti-ulcers, blood pressure, cholesterol meds, and birth control pills. If you have ever taken any of these medications it is important to check your B12 levels and supplement if necessary.



Vitamin B12 is a very large molecule compared to other vitamins and requires an enzyme called intrinsic factor to metabolize effectively. High stress, infections, antacids and other medications deplete intrinsic factor. Without adequate intrinsic factor the body cannot effectively metabolize b12 and deficiencies will occur over time.

The stomach must also be able to produce enough stomach acid for optimal B12 absorption.

Testing for B12 Deficiency

These are some of the test that are routinely done for functional testing of B12 deficiency:

Complete Blood Count

If the size of the red blood cells are very large, it can indicate megaloblastic anemia, which indicates the doctor to think of B12 deficiency. This test can be easily done at your GPs office. Most functional medical doctors would probably do other functional testing as well.

Homocysteine Test

Very low or high blood levels of homocysteine can indicate a B12, folate, and/or B6 deficiency

Organic Acid Test

This is a very common test that we use to look at methylation factors, nutrient deficiencies, detox pathways and neurotransmitter function. Elevations in Methylmalonic acid indicate a functional deficiency in B12

MTHFR Genetic Test

When people have MTHFR gene mutations, in particular a homozygous trait, they require more B12, folate, and B6 for their detoxification pathway and body to function optimally. In Malaysia, this test could be expensive and not done frequently.

How do I correct my B12 deficiency?

1. Optimise your nutrition intake of B12 by consuming a diet rich in animal protein

2. Fix underlying gut issues

3. Supplementing with B12

4. This is the most active form in the human body. It converts homocysteine into methionine, which helps protect the cardiovascular system. Methylcobalamin is easily absorbed by the body and crosses the blood-brain barrier without assistance to protect brain and neurological cells.

5. Methyl-B12 is the main form that is used within the body. This is the form that contributes to the key methylation groups that are needed for DNA repair, detoxification and hundreds of other metabolic functions.

6. B12 shots would be given by your doctor if your levels are critically low or in people who are not compliant to supplements.

In conclusion, we should not underestimate the importance of B12 for health maintainance. Ask your doctor to carry out a B12 test or consult a functional medicine specialist to get your B12 levels checked.

Let Health be your Wealth.


Contributed by:

Dr. Sharifa Shahreen

Functional Medical Practitioner at Spectrum Of Life Integrative Wellness Centre