Nearly three million people in the U.S. each year are found to substantially lack vitamin B12. Fatigue, weakness, dizziness, numbness, tingling, poor balance, irritability, depressed mood, forgetfulness, constipation or diarrhea, sore tongue or mouth sores, shortness of breath, and poor growth and development in children may indicate a higher need for vitamin B12 intake. During these challenging times where food choices and accessibility may be limited, your intake of vitamin B12 may not be as optimal as you need. There are some critical things to note.

Does Your Diet Provide B12?

Vitamin B12 rich foods are found almost exclusively in meat, milk and milk products, eggs, and shellfish. Some unprocessed plant-based foods may provide trace amounts of vitamin B12 but the quantity present in vegetarian or plant-based diets does not come close to the basic RDA level. Fortified processed foods contain low quality vitamin B12 as cyanocobalamin. Supplementation is often needed with dietary challenges.

Vitamin B12 Forms

Vitamin B12 comes in many forms – capsules, tablets, sublingual, and injections. Tablets are typically the most difficult to absorb. There are also many types of vitamin B12 – cyanocobalamin, methylcobalamin, adenosylcobalamin, and hydroxycobalamin.

Cyanocobalamin = Cyanide + Cobalamin

Cyanocobalamin is the most prevalent form used within medical and nutritional supplement industries and is synthetic. Methylcobalamin, adenosylcobalamin and hydroxycobalamin are naturally active coenzyme forms of vitamin B12 readily preferred by your body.

Cyano-cobalamin refers to the fact that a very small amount of cyanide is attached to the cobalamin portion. It is a synthetic compound that requires your body to remove the cyanide particles, detoxify it, and then attach the cobalamin portion to something else like a methyl group before it can really start to work, i.e. methyl group + cobalamin = methylcobalamin.

Methylation SNPs

Another downside to cyanocobalamin is that it may not be helpful for individuals who have methylation difficulties and/or absorption concerns. Methylation gene SNPs like FUT2, MTR, MTRR, and TCN2 are relatively common and are contributing factors to increased nutritional needs. When these gene SNPs are present, the methylcobalamin form of vitamin B12 is often recommended. Cyano-cobalamin use stresses this process and you often don’t feel improvement with B12 intake. Other B vitamins in their coenzyme form may be helpful.

Vitamin B12 Shots Contain Aluminum

If you are one of the millions of individuals who have used vitamin B12 injections, there is another stressor in addition to the cyanocobalamin form. Vitamin B12 cyanocobalamin shots contain aluminum. Like other injections such as vaccines, the aluminum or alum/aluminum salt contained in the injection is considered “non-toxic” unless your kidneys aren’t working very well. Severe allergic reactions or anaphylaxis can also occur with cyanocobalamin.

My concern with B12 injections and aluminum pertains to how much ingested/internalized aluminum from food, beverages, cosmetics, and injections can your body truly tolerate over the course of your lifetime. How much of a burden can your body withstand before it breaks down? This depends on your immune tolerance.

Immune tolerance refers to your immune system not adversely reacting to a toxic challenge like aluminum, other heavy metals, pesticides, herbicides, or germs. However, if you lose immune tolerance, small amounts of these compounds cause your immune system to release numerous inflammatory compounds and set the stage for autoimmune destruction and disorders and neurodegeneration concerns.

These ubiquitous chemicals in the environment and food supply have substantially contributed to the marked rise in autoimmune disorders over the last 2-3 decades. We all must be mindful about toxin overload as there is only so much immune tolerance that your body has before that next “safe” compound becomes the “straw that breaks the camels back”.

B12 Needs Other B Vitamins

It is also important to know, that if you take supplemental vitamin B12 by itself without the other B vitamins, it will disturb the balance of the other nutrients, especially folate. If you supplement with one B vitamin like vitamin B12, you must take a multiple vitamin or a complete B complex to ensure that the levels of the other B vitamins are not depleted. The $10 synthetic, mass produced multiple vitamin or B complex tablet with the cyanocobalamin form of vitamin B12 is not a good resource.

On a Plant-Based Diet?

If you have embarked on a plant-based diet because of the increasing societal “good for the planet” concerns, the medical push for various health concerns, or because of Pandemic meat supply concerns, you will not get enough vitamin B12 in your diet. Vitamin B12 of any support amount is only found naturally in animal products. You must fortify your diet with supplemental vitamin B12. Vitamin B12 is the most common nutrient deficiency in a plant-based diet.

Other Reasons for Not Enough B12

In addition to inadequate dietary intake, SIBO or small intestine bacteria overgrowth is a common cause of vitamin B12 deficiency. Autoimmune disorders, like pernicious anemia or atrophic gastritis, affect vitamin B12 absorption in the gut and commonly lead to depleted levels. As many as 50 percent of the elderly may experience depleted B12 levels which affects mood, memory, balance and movement, and even the ability to eat because of mouth sores. Gastric by-pass, poor digestion with diminished stomach acid or pancreatic enzymes, gluten intolerance and other bowel concerns impact vitamin B12 absorption.

Sometimes blood tests reveal elevated vitamin B12 levels even though a person may not consume excess supplemental B12 or high dietary sources. This may reflect clues of other things going on in your body and should be evaluated by your health care provider.

Why You Need B12

Red blood cell formation, neurological function, DNA synthesis, fertility, mitochondrial function and energy production, methylation function, detoxification, and heart health, etc. require vitamin B12. It is critical for growth and development of infants and is necessary to prevent birth defects like spina bifida and cleft lip. Athletes, children, and teenagers need it too for physical and mental health.

Common Medications Deplete Vitamin B12

Several medications are known to deplete or block vitamin B12 absorption. These include acid blockers/PPIs, antigout/colchicine, diabetic/metformin, steroids, birth control pills, antiseizure meds, and some antibiotics. Check with your pharmacist for further information.

Paying attention to something as common as vitamin B12 can make a difference in quality of life. Just because a food is fortified with a nutrient doesn’t mean that you will have enough of it in your diet or that your body can metabolize well. If the current pandemic has you thinking more about plant-based diets, that too impacts B12 nutrient status. Add in drug-nutrient depletions, age, the decline of absorption and the prevalence of gut dysfunction in so many individuals, the need for vitamin B12 in natural forms is essential and can make a difference at any age.

Here are some additional resources on Vitamin B12 and related concerns:

Super Form of Vitamin B12 – Adenosylcobalamin

MTHFR Gene Defects, Methylation, and Natural Support

B Vitamin Deficiency: Are You at Risk?

Are You Taking Folate or Folic Acid? Read This First

Common Medications That Rob the Body of Nutrients  

Folate & Vitamin B12 for Cognitive Health and Stress 

Sunscreen and Vaccine Adjuvants: As Harmless as You Are Let to Believe? 

B12 and Folate Should Be Taken Together 

Top 5 Nutrients Vegetarians Need  

Taking A Multivitamin? Check Your Label 

Quality Spotlight: Compare B Vitamins

How to Improve Fertility and Prepare for Pregnancy With Nutrition