With a rise in vegan and vegetarian diets, the need for supplementation of this vitamin has certainly increased, but whilst this demographic may be the most obvious group in need of supplementation, many other people are just not getting the levels they need and are subsequently experiencing the symptoms of a deficiency.
Aside from many of these symptoms being unpleasant or somewhat debilitating, a long term B12 deficiency that is not addressed, could lead to irreversible neurological damage.
Who is at risk of a B12 deficiency?
Vegan and Vegetarian Diets
Whether for general health or ethical reasons, recent years have seen a huge rise in vegetarian and vegan diets, with the latter being naturally devoid of a bioavailable form of B12. Vitamin B12 is only found in food classed as animal products, as it is produced by bacteria in the soil and in the gut.
The same is true for humans but as the bacteria produce it in the large intestine (the colon) it is too far down the digestive tract for the body to be able to effectively absorb it. Therefore, in a completely vegan diet, the need for supplementation of this vitamin is essential. Those following a vegetarian diet would certainly benefit from supplementing as it would be harder to meet their body’s needs through dairy and eggs alone.
Pregnancy and lactation
During pregnancy and breastfeeding, the demand for all micro and macro-nutrients increases, including B12. The importance of this vitamin in relation to DNA and RNA synthesis, and so many other biochemical processes, means it’s crucial that there are sufficient levels for the healthy growth and development of the baby, and which also doesn’t leave the mother depleted. Low vitamin B-12 status has been associated with adverse pregnancy outcomes, including anaemia, low birth weight, and preterm birth. (1)
It’s also worth being aware that nitrous oxide also significantly depletes B12 levels in the body with numerous studies detailing incidents of this. (2) Why is this relevant in pregnancy? Gas and Air (Entonox), is often used during labour to reduce pain. This combination of nitrous oxide and oxygen converts active B12 into a non-active form, rendering it unusable by the body. A nitrous oxide induced vitamin B12 deficiency just before the mother potentially begins a period of breastfeeding could be incredibly damaging for both mother and baby.
Aged 60+As we age our levels of B12 decrease as our gut function becomes less efficient. In fact this decrease actually begins at age 50 when the mucus membrane in the stomach begins to thin, resulting in decreased production of digestive enzymes and Hydrochloric acid (stomach acid). Stomach acid is essential for the absorption of B12 as it unbinds B12 from food into its free form so that it can then (after being combined with Intrinsic factor) be absorbed in the small intestine. Studies (3) show that Up to 38% of older adults may exhibit mild vitamin B12 deficiency and depleted vitamin B12 stores.
Poor gut health
At the root of many B12 deficiencies is poor gut function. As with above demographic, low digestive enzymes and Hydrochloric Acid (HC) diminish our ability to absorb our nutrients from our food. HCL is first required to separate B12 from the protein to which it is bound in food and further in the process it binds to a protein produced in the stomach called Intrinsic factor (IF) where it can then be absorbed in the gut. The problem arises when there is insufficient stomach acid in the first place.
Due to environmental factors, stress and unaddressed food intolerances, many people are suffering with gut permeability (or leaky gut as it’s more commonly referred to) meaning that particles that should otherwise remain in our gastric tract are able to enter into the bloodstream and cause intolerances and inflammation.So if you’re experiencing anything from constipation and bloating, to eczema and anxiety, it can be caused by poor gut health.
Pharmaceutical and OTC medication
There are a great number of drugs that decrease vitamin B12 levels in the body, so if you’re taking prescribed medication or even over the counter drugs, it may be that you need to keep an eye on your B12 levels. Specifically the drug metformin (used in the management of diabetes) has been shown in studies to significantly reduce levels with long term use. It appears this is due to a number of factors such as impaired intestinal motility and bacterial overgrowth and new government advice is to regularly monitor B12 levels. (4) The evidence shows the importance of supplementing with a good quality B12 alongside this drug.
There is also a correlation between the oral contraceptive pill causing a deficiency in around 10% of users. (5)
Listen to your body
If you fall into any of the categories listed above, or you’re experiencing symptoms of a B12 deficiency, it’s important to have your levels checked and begin supplementing with a Quality Vitamin B12 where there is a need. If you’re curious about which symptoms may indicate a B12 deficiency, read my article:
You can also learn more about B12 and its importance in the immune system in my other article ‘B12: THE GREAT MULTI-TASKER AND ITS IMPORTANCE IN THE IMMUNE SYSTEM’
Nutritionist and CEO