Low B12 symptoms can be mistaken for other health issues, that’s why it’s important to assess B12 levels and learn how to properly address a deficiency.
As always, I am a practicing physician in Washington state but more than likely I am not your physician so please do not take this as medical advice as an opportunity to educate yourself on B12 and its relationship to your body.
How do we assess for B12 sufficiency?
About 7 years ago, I had a 16 year old girl come in complaining of daily frontal headaches. She took Advil every day to take the edge off.
Her previous doctor had run all the tests (supposedly) and she was told that it was likely hormones (maybe the headaches would go away after having a baby) or potentially stress related. Well we did a full blood workup that included B12 and her serum B12 was 130. Very low.
We started her on B12 injections and then moved to B12 lozenges and amazingly her chronic frontal headaches stopped.
Many times in looking for answers we skip over the simplest things.
Remember, the body desires to be nourished. Make sure it has all the tools necessary to succeed and more times than not, the body will heal itself.
So when it comes to B12 deficiency, the first thing to consider is your symptoms and your age.
If you are over 60, you are at a high risk of B12 deficiency.
Now for the rest of us, symptoms like chronic headaches, fatigue, balance issues, cognitive or focus issues, depression, vision issues, neuropathic pains in the extremities would all be symptoms that could be related to low B12.
If any of those symptoms are present, you may want to consume B12 in a lozenge or dropper form to see if symptoms improve over 3-4 months or have some blood tests run.
The following labs are easily accessible via labcorp or quest labs and inexpensive.
- Serum B12 test – This is the standard B12 test, it measures the total amount of B12 in the blood. I check this on every patient and if it is low, then the person is low in B12, but one of the challenges is that if a person has high B12 levels, it doesn’t necessarily mean they are sufficient in B12, as Serum B12 doesn’t differentiate between the active and inactive versions of B12.
- Homocysteine test – High homocysteine levels suggest decreased B12 activity. However, in order for B12 to decrease homocysteine, it needs to be methylated. So usually recommend a methylcobalamin type B12 in order to clear the homocysteine most efficiently. You may want to do this because elevated homocysteine is associated with increased clotting risk, hardening of arteries, decreased bone quality, cognitive impairment and decline, as well as pregnancy complications. The question we really don’t know the answer to is, are the health challenges due to insufficient B12 or because of elevated homocysteine, since having sufficient B12 decreases neurological and cardiovascular disease risk.
- MMA (methylmalonic acid) test – if MMA is high, then this suggests a B12 deficiency as B12 is required to convert methylmalonic acid into its useable form. Often people will have normal levels according the lab reference range but elevated MMA levels. If you feel like your symptoms are in line with low B12, you have digestive issues, are over 60 years old, are vegetarian or vegan, then asking for an MMA test would be of high value.
The majority of people over 60 could benefit from B12. I suggest taking a supplemental active form of B12 on a weekly basis in the form of a tincture, drops or as a lozenge.
The negative ramifications of low B12 on mental health and dementia are so extraordinary and there is little to no side effect associated with extra B12 in the body, so it is well worth the small investment.
Also, if you are on anti-depressants, sleep meds, acid blocking/heartburn meds, birth control pills, B12 absorption or utilization will be impaired and thus the need for extra B12.
If you find that you need a B12 supplement, be sure to check out Methyl B12 + 5-MTHF and B12 Squared (non-methylated).
