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The Saga Of A B12 Deficiency - And How To Treat It

Disclaimer: I am not a medical practitioner. This article is my own experiences, and my own independent research aimed at helping you understand a B12 deficiency. Please be sure to consult your own medical professional and do your own research on this subject as well.

I’ve not felt totally myself in ten years. It seems to be that one thing triggers another. But due to being young and quite driven, it wasn’t until about four years ago that my sense of well-being really started to decline. And this year, in 2020, I wasn’t able to ignore or deny it anymore.

When you are chronically ill, especially identifying as a womxn, society as a whole seems to want to sweep your existence under the rug. The social aspect, and the personal / existential, are huge pillars in this difficulty, but those elements aren’t what this piece is about, as this is entirely about helping you understand and navigate the details of a vitamin deficiency, specifically vitamin B12, also known as cobalamin. I’ve learned a lot, and can safely say I know more than all of the doctors I encountered on the subject - unless they were simply denying me my rights out of sheer pride. I honestly wouldn’t put it past them at this point, but for the sake of sanity, let’s just say they’re undereducated on this topic.

So firstly...

What Is B12 Deficiency?

Vitamin B12 is one of the most important vitamins in our body. It is involved in so many processes. It helps build DNA, for one, keeps blood healthy, maintains the health of nerve cells, keeps your brain in good balance, helps with ATP production (cellular energy) and the list goes on. When deficient, it can wreak havoc on all systems because of its integral role.

The following is a list of B12 deficiency symptoms, but please bear in mind that this will vary for everyone, and is likely an incomplete list.

~ Fatigue

~ Peripheral neuropathy (tingling, buzzing, humming sensations, nerve pain and twitches in feet, calves, legs, hands - but truly can be anywhere in the body)

~ Brain fog + issues with memory (word recall, short term memory issues, just generally feeling cloudy and “off”)

~ Mood swings, irritability, anxiety and depression

~ Digestive issues, constipation

~ Dental issues (easily broken teeth)

~ Dizziness + gait problems (ataxia)

~ Rapid heart rate + palpitations

~ Painful tongue, canker sores

~ General “malaise” feelings, aches and pains

~ Shortness of breath

So as you can see, it’s a multi-system situation. And yes, these symptoms can be covered by other health issues, so it is important to narrow in on your quest with a select few tests. But first, we will go into the “doctor maze” and discuss what I, and countless, countless others, usually come up against when trying to weed out this health issue.

This section is very important so please do not skip it. Armed with more knowledge you will (hopefully) be able to avoid being turned away or dismissed by medical professionals.

Causes of B12 Deficiency

  1. Pernicious Anemia - an autoimmune condition. It occurs because of a lack of something called Intrinsic Factor, which is a glycoprotein that is secreted by the stomach which enables the body to absorb B12. In people with PA, antibodies to IF will be found. Parietal Cell Antibodies, which, in the same kind of autoimmune response, will attack Parietal Cells. Parietal Cells produce IF, so if there is an autoimmune response up the chain of command, we end up with little to no IF, and Pernicious Anemia results.

  2. H. Pylori - or helicobacter pylori. A bacteria that infects the stomach lining. This can lead to reduced absorption of B12.

  3. Atrophic gastritis - inflammation of the stomach lining. This can be caused by H. Pylori, or chronic gastritis.

  4. Crohn’s disease

  5. Irritable bowel disease or irritable bowel syndrome

  6. Celiac disease - gluten intolerance

  7. SIBO (small intestinal bacterial overgrowth)

  8. Stomach surgery / gastric bypass

  9. Certain prescription drugs

  10. Excessive alcohol consumption

  11. Tapeworm

  12. Extended periods of veganism or vegetarianism with no supplementation of B12

  13. Long periods of chronic stress leading to general gut inflammation.

All B12 deficiencies are as a result of the body’s inability to absorb the vitamin correctly. B12 has one of the most complex metabolic pathways of any vitamin or mineral, so it is no surprise that any of the above inflammatory conditions (and most of them are inflammatory in nature) could lead to this decrease in efficacy.

Anemia Blood Signs and What To Look For In the CBC (Complete Blood Count)

Diagnosing a B12 deficiency is often NOT SIMPLY LOOKING AT THE B12 SERUM LEVEL IN THE BLOOD. Please read and reread this over and over and over again. This is THE SINGLE MOST IMPORTANT POINT TO UNDERSTAND.

If you have been supplementing with B12 at all - and this includes energy drinks, collagen powders, multivitamins etc - your blood serum levels will be elevated even if you are not properly absorbing B12 in some cases. This confuses doctors and patients alike, and this may be the primary cause of untreated B12 deficiencies. It was in my case, as my levels always looked within normal range, and sometimes even abnormally high.

In some cases, B12 serum will be very low and this will be the only necessary test to discover the problem. But also keep in mind, the "normal" ranges used in medical practice are a) different in every country and even many different offices, meaning it is somewhat arbitrary and b) the low end of a “normal” range for many things is abysmally low - and even if you score within the low end of normal, you may be quite sick. So if you are within “normal” range, yet you still have many of the above listed symptoms, this is what you can look for in your CBC to help understand what’s going on.

You do not have to be anemic in order to have a B12 deficiency, and we will cover that in the next section. But unfortunately for many of us, we do become anemic because the signs and symptoms of this deficiency take a good while to develop, and by the time we’re quite sick, anemia can be found.

This is one of the areas that doctors greatly failed me and have failed countless people. Some know what to look for but many don’t. So it is important, again, that you arm yourself with the knowledge below.

What is Anemia?

In short, anemia occurs when there is not enough hemoglobin (a protein that carries oxygen to cells, organs and tissues). This generally occurs because of not enough red blood cells and hematocrit (percentage of total blood volume that is red blood cells). This is usually caused by something impairing the RBC production in the bone marrow - in this case, due to a vitamin B12 deficiency.

From what I understand, all B12-related anemias are Megaloblastic Anemias - this occurs when large, immature red blood cells (megaloblasts) are found in the blood. Large RBCs have a difficult time exiting the bone marrow and as a result hemoglobin is not transported efficiently.

At a glance - what is the CBC?

A CBC blood test is your Complete Blood Count. It generally measures the following:

White blood cell count (WBC)

Red blood cell count (RBC)

Hematocrit - the percentage of the total blood volume that consists of red blood cells

Hemoglobin - a protein that carries oxygen to your organs and tissues, and transports carbon dioxide back to your lungs

Physical features of your RBCs:

Mean Corpuscular Volume (MCV) - measurement of the average size of your RBCs

Mean Corpuscular Hemoglobin (MCH) - average amount of hemoglobin inside of your RBCs

Mean Corpuscular Hemoglobin Concentration (MCHC) - a calculated measurement of the average concentration of hemoglobin inside of RBCs

RBC Distribution Width (RDW) - measurement of the varying sizes of your RBCs.

There are a few other features of the CBC but for simplicity’s sake we will focus on these because these are the markers for anemia if there are any to be found.

RBC count - if low, or on the low side of normal range, this can point to anemia or B12 deficiency that will lead to anemia if left untreated.

Hematocrit - if low, or low side of normal range, can point to anemia or B12 deficiency that will lead to anemia if left untreated.

Hemoglobin - if low, or low side of normal range, can point to anemia or B12 deficiency that will lead to anemia if left untreated.

MCV - if high, or high side of normal range, can point to anemia or B12 deficiency that will lead to anemia if left untreated.

MCH - if high, or high side of normal range, can point to anemia or B12 deficiency that will lead to anemia if left untreated.

MCHC - if high, or high side of normal range, can point to anemia or B12 deficiency that will lead to anemia if left untreated.

~~~ Important point to mention ~~~ iron deficiency anemia (which can happen concurrently with B12 deficiency anemia) pulls down MCV values. So an MCV value for B12 deficiency may be lowered more due to iron deficiency, further confusing matters. So it is important to also know your iron stores (ferritin) levels, and if they are low, you will know that your CBC will be affected by that deficiency as well. Iron deficiency anemias have many of the same symptoms of B12 deficiencies but do not, generally, present with neurological issues.

Deficiency Without Anemia: Blood Tests To Further Investigate

As I mentioned above, you do not need to be anemic in order to be B12 deficient. Sometimes the deficiency is subclinical and does not show up in the CBC. Or sometimes the CBC is just borderline and so doctors will pay no mind. So here are the blood tests you can request if you are not satisfied with your diagnosis, or lack thereof.

Please bear in mind that because some doctors and naturopaths do not understand this condition or what to look for, obtaining these tests may be difficult and you may need to seek out multiple practitioners in order to get the green light.

Before testing: stop ALL B12 supplementation for as long as possible, 4 months is optimal. This is so that the results are not skewed.