Vitamin B12 Deficiency: A How-To Guide to Prevent It

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Liquid extracts are an effective way to absorb vitamin B12 directly via the blood vessels in the mouth. This supplement is incredibly popular among users. B12 liquid supports nerve cell health, neurological function, energy production and immune system health. It also helps to form red blood cells, and in the metabolism of fats, carbohydrates, and proteins.

Vitamin B12 is also an important cofactor for energy production and plays a role in immune system health and healthy homocysteine metabolism. Each serving of this product contains 1000mcg of vitamin B12.

Nature’s Bounty Adult Multivitamin, Helps Maintain Bones and Immune Function, 150 Gummies

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A delicious way to help get the nutrients your body needs. Each Nature’s Bounty adult multivitamin gummy provides 4 key B vitamins, vitamin C and vitamin D to help maintain your immune system and bone health. Naturally flavoured in orange, cherry and grape, you’ll look forward to adding them to your daily routine.

These vitamins help add to your health lifestyle. With 3mcg of vitamin B12, they will help you so that you don’t have a deficiency of this vital vitamin. Also benefiting at the same time from the other many vitamins included in these gummies.

Vitafusion B12 Gummy Vitamins for Adults, Naturally Sourced Raspberry Flavour, 140 Count

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If you prefer to chew on gummies for a potent vitamin B12 boost, this supplement is an excellent option. Each delicious cherry-flavored gummy will provide you with 1,500 micrograms of cyanocobalamin. In addition, they are gluten-free and do not contain dairy products.

The new Vitafusion Extra Strength line includes high potency vitamin B12 fused into delicious gummies. Two Extra Strength B12 gummies provide 50,000% daily value (3000 mcg) of B12.

Webber Naturals Vitamin B12 Methylcobalamin Sublingual Tablet, 1000mcg

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This made in Canada vitamin B12 methylcobalamin sublingual tablet helps produce red blood cells and prevent vitamin B12 deficiency. Methylcobalamin is the most active form of vitamin B12. It acts immediately upon absorption. These sublingual tablets simply dissolve under your tongue and appear to have advantages over all other forms of B12.

Daily use keeps blood levels high. Vitamin B12 is a water-soluble vitamin necessary for energy production. It also improves our nervous system function as it is needed to produce myelin, the fatty substance that forms a protective sheath around nerves. Moreover, it helps with the production of acetylcholine. B12 is also a neurotransmitter that improves memory and learning.

Bobs Red Mill Large Flake Nutritional Yeast, 142 Grams

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Nutritional yeast is found in most vegan and vegetarian people’s pantries. This highly nutritious food isn’t just a great way to add flavor to your recipes; it’s rich in different vitamins and minerals and known to offer various health benefits. These premium nutritional yeast flakes are enriched in vitamin B12, each serving giving you 880% of your daily need. It is a great source of fiber, too, and fully suitable with a gluten-free diet.

Nutritional yeast provides an excellent way for plant-based eaters to get the essential B12 vitamin while maintaining their diet. And is great for vegans and vegetarians alike. It comes at a great price.

Everything You Should Know About Vitamin B12 Deficiency

Natural aging, damage to the digestive tract, and plant-based diets can all lead to a depletion of the body’s reserves of vitamin B12. The prevention and treatment of this condition are essential to avoid severe and permanent disorders such as dementia or blindness.

Woman and child laughing with fresh food — People who eat meat have higher levels of vitamin B12 than vegans.
(Source: Choreograph: 106032815/ 123rf.com)

Why is vitamin B12 deficiency considered a problem?

Vitamin B12 (cobalamin) plays an essential role in your metabolism. This molecule is necessary for the production of amino acids and the proper synthesis of cellular DNA. It acts synergistically with folic acid, contributing to the formation of blood cells and the preservation of nerve function (, ).

If your vitamin B12 levels are insufficient, DNA formation in new cells is impossible. The synthesis of myelin, a substance that surrounds nerve fibers, will also be reduced. In addition, the paralysis of enzymatic processes will lead to the deposition of molecules such as homocysteine.

If your organism cannot create new cells, you will have anemia. At a microscopic level, you can observe how the cellular precursors grow in size, preparing for a division that isn’t possible due to the B12 deficiency. This is known as megaloblastic anemia, which literally means few large-size blood cells (3).
If your nervous system loses its protective lining, it will undergo degenerative changes. Nerve fibers need to be protected by the myelin sheath in order to transmit electrical impulses to the brain. A lack of B12 will cause demyelination; this affects your balance, vision, memory, and concentration, among other things (1, 4).
If a homocysteine deposit occurs, the cardiovascular risk may increase. Some studies have linked increased plasma homocysteine concentrations to a higher risk of cardiovascular events or stroke. These findings are currently under study (5, 6).

These alterations will harm your quality of life. Megaloblastic anemia will decrease your resistance to fatigue. At the same time, degeneration of the nervous system can cause you to experience brain fog, the lack of concentration that vegans worry about so much. We have listed more symptoms of vitamin B12 deficiency in the following table (3, 4, 6, 7):

Symptom or sign	Description
Fatigue	Consequence of the inability of red blood cells to transport oxygen and nutrients to the muscles. It can lead to reduced athletic performance and muscle pain.
Skin paleness	This is due to reduced red blood cells. If you have a yellowish tone, you may suffer from hepatic alteration.
Digestive alterations	Digestive lesions may appear, resulting in diarrhea, nausea, an increase in the size of the liver, and loss of appetite, with the consequent weight loss.
Palpitations	They are a consequence of anemia. Oxygen transport decreases, forcing the heart to beat at a higher-than-normal rate to supply the demands of the organism.
Behavioral alterations	Unexplained sadness, irritability, or apathy have been reported as a consequence of vitamin B12 deficiency.
Intellectual alterations	This is a sign of neurological degeneration. They can manifest themselves as difficulty concentrating (brain fog), alterations in memory, or a decrease in mental performance. If it is not treated, it can lead to dementia and hallucinations.
Clumsiness	Consequence of the deterioration of the neurological systems responsible for your balance.
Sensitivity alterations	Consequence of the deterioration of the neurological system. They can appear in the form of pain or tingling (paresthesias).
Visual alterations	This is a rare but severe consequence of B12 deficiency (optical neuropathy). If left untreated, it can lead to blindness.
Developmental alterations in the fetus	In pregnant women, B12 deficiency has been associated with an increased rate of malformations in the fetus.
Elevation of cardiovascular risk (controversial)	Some studies link the elevation of homocysteine concentrations with an increased risk of coronary pathology or stroke. Hypothesis currently under study.

Am I exposed to vitamin B12 deficiency?

Some people are at higher risk than others to suffer from this condition. Certain lifestyles, many drugs, and specific diseases can make it difficult to absorb or store cobalamin, increasing the chances of being deficient. In the following lines, we will answer the most frequently asked questions regarding this:

I’m a vegan. Am I at risk? Vitamin B12 is found almost exclusively in foods of animal origin. Individuals following plant-based diets cannot get the cobalamin they need naturally, which is why they have to turn to supplements or fortified foods (8, 9).

I am an ovo-lacto vegetarian. Can I have low vitamin B12 levels? Dairy products and eggs contain small amounts of cobalamin. The intake of B12 from these foods may be insufficient, depending on the individual. Some experts recommend that vegetarians supplement to prevent any deficiencies (9, 10, 11, 12).

I often eat meat. Why do I have low B12 levels? Diet isn’t the only factor that predisposes to this type of deficiency. As you will see in the table below, B12 levels can be lowered by any kind of gastrointestinal injury or condition, in response to chronic illness, or as a result of natural processes such as aging (4, 13).

In the table below, we have listed the many possible causes of vitamin B12 deficiency:

Cause	Description
Gastric pathology	Pernicious anemia (intrinsic factor deficit) Consequence of stomach surgery Consumption of toxic substances Functional diseases (alterations in the secretion of gastric acid)
Intestinal malabsorption	Pancreatic diseases Zollinger-Ellison type malabsorptive syndromes Infections by bacteria or parasites Surgical bowel resection Crohn’s disease
Medication and drugs	HIV treatment Antibiotic treatments Oral contraceptives Methotrexate Chemotherapy drugs Nitrous oxide Metformin
Other causes	Congenital diseases Heart failure Hyperthyroidism Increased needs during pregnancy

As you can see, your risk of a vitamin B12 deficiency will depend on a variety of factors. While you can manage some of them (such as your diet), others (after-effects of surgery, autoimmune diseases, or drug treatment) are out of your control. Consult a health professional if you think you have any of the conditions listed above.

Food rich in vitamin B12 — Vitamin B12 deficiency can cause anemia and alterations in the nervous system.
(Source: Elena: 73882253/ 123rf.com)

How can I prevent vitamin B12 deficiency?

Fortunately, this is quite straightforward in young, healthy people. From the age of 14 onward, it is recommended to take 2-2.5 micrograms (mcg) of cobalamin per day to prevent any deficiency. Children and pregnant women will have slightly different requirements, as you can see in the following table (, , ):

Population group	Recommended daily allowance (RDA)
Babies, 0-6 months	0.4
Babies, 7-12 months	0,5
Children, 1 to 3 years old	0.9
Children, 4 to 8 years old	1.2
Children, 9 to 13 years old	1.8
Men and women from 14 years old	2.5
Pregnant women	2.6
Breastfeeding women	2.8

A balanced diet is the first step toward keeping your vitamin B12 reserves full. Animal-based products will be the main source of cobalamin for omnivorous individuals. The largest amounts of B12 are found in mollusks and the entrails (such as the liver or kidneys) of animals (19).

Food (100 grams/milliliters)	Amount of B12 (micrograms)
Canned clams	99
Lamb liver	90
Veal liver	83
Squid	36
Mackerel	19
Turkey meat	9
Foie gras	9
Egg	5
Milk	4
Pork	1

Individuals who do not consume products of animal origin for ethical, religious, or health reasons won’t be able to take advantage of the B12 content of these foods. This is why they are advised to consume fortified foods or supplements. The vitamin B12 present in these products is of bacterial origin, which means that no animal needs to be killed to obtain it.

Fortified foods: You can find yeasts, vegetable drinks, and cereals enriched with vitamin B12 in any specialized store or online. These products will provide you with varying amounts of cobalamin. You may need to include several of these foods in your daily diet to meet your RDA for vitamin B12.
Vitamin B12 supplements: These nutritional products contain high concentrations of synthetic (cyanocobalamin) or natural (hydroxocobalamin, methylcobalamin, or adenosylcobalamin) vitamin B12. Injectable supplements are used by doctors, while oral preparations in the form of drops, pills, or sublingual tablets are readily available in supermarkets and online.

How should I use vitamin B12 supplements?

Vitamin B12 supplementation is considered safe, simple, and inexpensive. Cyanocobalamin or hydroxocobalamin injections are prescribed by health centers, which will indicate the appropriate dose (1,000-5,000 mcg every other day, weekly or monthly) depending on your needs.

Oral supplements, on the other hand, may be prescribed by a health professional or purchased directly by the consumer. If you buy them yourself, keep in mind that there are different dosage guidelines based on certain characteristics. We have listed them below (20, 21):

Dosage	Guideline	Target population
25-100 mcg	Daily	Elderly population (WebMD)
1 mcg	Three times a day	Young, healthy vegans (The Vegan Society)
At least 10 mcg	Once a day	Young, healthy vegans (The Vegan Society)
2,000 mcg	Once a week	Young, healthy vegans (The Vegan Society)

You should always check the label of your vitamin B12 supplement for the manufacturer’s instructions regarding use and recommended doses. You can also ask your physician for more information. While they are considered safe, these products may cause digestive discomfort or allergic reactions. In addition, they interact with certain medications (such as chloramphenicol) (20, 22).

Seafood — Mollusks are rich in vitamin B12.
(Source: Teen00000: 83995643/ 123rf.com)

Buyer’s Guide

In the section below, we will delve into the main characteristics of products designed to keep B12 deficiency at bay. In any case, remember that your intestinal tract must be able to absorb this vitamin if you want to make the most of these supplements and fortified foods.

Foods Fortified With Vitamin B12
Multivitamins With Vitamin B12
B12 Supplements for Daily Use

Foods Fortified With Vitamin B12

Flour, breakfast cereals, soy drinks, and yeast are available to enrich your dishes. Their price will depend on the type of food you want to purchase. Generally, you can expect them to cost a few dollars more than their standard counterparts, although the quantity you buy naturally influences this.

High-quality fortified foods will feature detailed nutritional information about the type of vitamin B12 they contain. It should either be active or bioavailable. In addition, you should cook these products with caution; cobalamin is unstable at high temperatures.

Woman smiling in the kitchen — Some diseases can cause vitamin B12 deficiency.
(Source: Leenanuruksa: 117629911/ 123rf.com)

Multivitamins With Vitamin B12

What would a multivitamin supplement be without vitamin B12? Virtually all of these nutritional products contain cyanocobalamin or methylcobalamin. However, they are often intended for omnivores. If you plan to make them your only source of B12, make sure they provide at least 100% of your RDA.

Multivitamin supplements are generally very affordable, although this will depend on the manufacturer and the ingredients they contain. In the table below, you can get a rough idea of their prices compared to vitamin B12 supplements:

Type of supplement	Vitamin B12 content (mcg)	Average price per 100 capsules
Vitamin B12	1,000	C$10
Multivitamins for vegans	50	C$12
B vitamins	25	C$14
Multivitamins and multiminerals	20	C$20
Multivitamins, multiminerals, and fruit extracts	250	C $30

B12 Supplements for Daily Use

Most commercially available vitamin B12 dietary products are sold as daily-use items. The synthetic (cyanocobalamin) or natural (methyl, hydroxyl, and adenosylcobalamin) cobalamin content of these supplements ranges from 100 to 5,000 micrograms. They are marketed in the form of capsules, chewable tablets, or liquid extract.

Since there have been no reports of severe effects from excessive intake of vitamin B12, many brands choose to administer large doses to achieve greater bioavailability. However, we warn you that the prestigious vegan organization The Vegan Society advises not to exceed 5,000 micrograms of vitamin B12 per week.

Dr. Dawn HarperIn Live Well to 101: A Practical Guide to Achieving a Long and Healthy Life

“Water-soluble vitamins (vitamins B and C) can be destroyed by heat and they can be lost in water used for cooking. Wherever possible, steam or grill food to ensure the vitamin content is preserved.”