Fatigue, Weakness & Depression? Might Be Low B12
Vitamin B12 (Cobalamin) is an essential water-soluble vitamin that plays a HUGE role in your nervous system, red blood cell formation, DNA synthesis, detoxification, ATP production and more! Depending on the literature, 6-15% of people under the age of 60 and 20% or more over the age of 60 are deficient! This is concerning as the symptoms are so common and often blown off yet the treatment is so simple!
If you have low B12, you’re likely to experience:
Fatigue or weakness
Shortness of breath
Numbness or tingling in your hands and/or feet
Balance problems (maybe difficulty walking or shuffling)
Memory loss, confusion or cognitive issues
Depression
B12 is naturally found in foods such as beef, liver, fish, chicken, turkey, lamb, shellfish, eggs, and dairy. You can also find it in some fortified foods such as cereals. If you don’t regularly eat these foods (or if you never eat these foods), you’re at risk for having low levels.
You can also have low levels if you’re not absorbing it properly or if you are on certain medications that block the absorption or deplete it. These medications can include antacids, proton pump inhibitors (PPI’s), birth control pills, Metformin (Glucophage), and antidepressants.
Always look up your medications or talk with your pharmacist to see what nutrients they might cause problems with such as B12.
Thankfully testing for B12 is really easy and done through blood tests.
The two main tests are:
Complete blood count (looking for megaloblastic anemia with an MCV>100. Often a peripheral smear is also ordered so they can look at your blood under a microscope)
Vitamin B12 serum level
You can get more advanced with:
A reticulocyte count
Methylmalonic Acid (MMA) where high levels indicate a need for Adenosylcobalamin (a form of B12)
Homocysteine and Methionine where low levels can indicate a need for Methylcobalamin (a different form of B12)
You may also request Intrinsic Factor Antibodies especially if you are eating those foods or supplementing and your levels remain low. Same for if you have type 1 diabetes, Hashimoto’s or Grave’s disease, Addison’s disease, vitiligo and and alopecia.
Certain autoimmune conditions and positive Intrinsic factor antibodies go hand-in-hand.
If your Intrinsic Factor Antibodies are positive, this means your stomach struggles to get B12 released from your food and absorbed. This is called pernicious anemia and your practitioner may recommend B12 injections to bypass the stomach.
There are 4 forms of Vitamin B12 of which 2 forms are considered metabolically active in the body.
Cyanocobalamin - this cheap, effective form does have a cyanide molecule attached to it. And while it is considered safe and used quite regularly, I have concerns for my patients who are already struggling with their health to add this in to the mix.
Hydroxocobalamin - this highly effective form can become either adenosyl or methylcobalamin in the body with no cyanide molecule.
Adenosylcobalamin - considered one of the metabolically active forms that supports the Kreb’s cycle and thus production of ATP (cellular energy).
Methylcobalamin - considered the other metabolically active form that supports the methionine (or methylation) cycle and the over 200 methyltransferase enzymes that use it.
Depending on your lab work and your needs, your practitioner may suggest one or a combination of these forms of B12. If you have a positive intrinsic factor, they will likely suggest an injectable option to by pass the stomach.
Vitamin B12 deficiency should not be missed, especially in someone older who is struggling with memory, shuffling gate, balance issues, fatigue and depression. Don’t chalk it up to “aging.” Treating B12 is so easy!