Vitamin B12: Vegetarians, Metformin Users, and Acid Blocker Users Beware Deficiency Risks

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Vitamin B12 plays a crucial role in maintaining the health of nerve cells, which supports both brain function and sensation throughout the body, including in the hands and feet. This article highlights why B12 deserves special attention, particularly for vegetarians, as well as those taking metformin for diabetes or proton pump inhibitors (PPIs) for heartburn or GERD. By understanding the importance of this nutrient and recognizing the signs of deficiency, these groups can take steps to maintain optimal B12 levels and overall well-being.

For more on Vitamin B12, check out our full article titled: Vitamin B12: Essential for Brain, Nerves, and Heart Health. In this article, we’ll be focusing on how Metformin, acid blockers, and a vegetarian diet can conspire to rob you of this vital nutrient.

What Are The Health Benefits of B12?

• Promotes Healthy Nerve Function: B12 is critical for maintaining the health of the nervous system. It is involved in the production of myelin, the fatty layer that surrounds and protects nerves. Myelin acts as insulation, helping nerve signals transmit efficiently and preventing damage to nerve fibers. Without enough B12, nerve function can become impaired, potentially leading to numbness, tingling, and even more severe neurological issues, such as neuropathy.
• Boosts Cognitive Health: Adequate B12 levels are important for brain health, supporting processes that affect memory, concentration, and cognitive function. B12 helps maintain the health of brain cells and plays a key role in the production of neurotransmitters involved in mood and cognition. A deficiency in B12 can lead to mental fog, difficulty concentrating, and memory problems. Severe deficiency may contribute to neurological disorders, such as dementia or Alzheimer’s disease, especially in older adults.
• Supports Energy Production: Vitamin B12 is essential for the production of red blood cells, which transport oxygen throughout the body. Oxygen delivery to tissues is crucial for energy production. In addition to this, B12 helps in the production of ATP (adenosine triphosphate), the primary energy molecule in cells. Without sufficient ATP, cells struggle to carry out basic functions, leading to fatigue. This is why a B12 deficiency often results in feelings of low energy and tiredness.
• May Aid in Fatigue Reduction: B12 supplementation is often recommended for individuals who experience chronic fatigue, particularly if their fatigue is related to a deficiency in the vitamin. Since B12 is essential for energy production and red blood cell health, taking B12 supplements can help alleviate tiredness and boost overall energy levels. For those with B12 deficiency, supplementation is typically associated with a noticeable improvement in energy and vitality, reducing the feelings of exhaustion and fatigue.
• Reduces Risk of Anemia: B12 is necessary for the production of healthy red blood cells. It works together with folate to produce these cells, which are needed to transport oxygen in the bloodstream. When B12 levels are low, red blood cells may become abnormally large and immature, a condition known as megaloblastic anemia. This results in fatigue, weakness, and dizziness. Supplementing with B12 can help restore normal red blood cell production, alleviating these symptoms and reducing the risk of anemia.
• Improves Mood and Reduces Symptoms of Depression: B12 helps in the production of serotonin, a neurotransmitter that regulates mood. Low serotonin levels are often associated with feelings of depression. Supplementing with B12 may help alleviate depression symptoms, particularly in individuals who have low levels of B12. Some research has found that improving B12 levels in deficient individuals can lead to improved mood and overall mental well-being.
• Supports Cardiovascular Health: Vitamin B12 plays an important role in lowering levels of homocysteine, an amino acid that, when elevated, is associated with an increased risk of cardiovascular diseases such as heart attack and stroke. B12, along with other B vitamins like folate and B6, helps break down homocysteine in the body. Maintaining proper levels of B12 may therefore help reduce the risk of heart disease and support overall cardiovascular health.
• Improves Sleep Patterns: Research suggests that B12 may help regulate the body’s internal clock, or circadian rhythm, which affects sleep-wake cycles. Adequate B12 levels can improve sleep quality and help you fall asleep more easily. People who have difficulty sleeping, especially those with low B12 levels, may benefit from supplementation. B12 has been shown to help with sleep disorders, particularly in older adults who may have a deficiency and experience disrupted sleep patterns.
• Helps with Digestion: B12 contributes to the synthesis of digestive enzymes, which are necessary for breaking down food and absorbing nutrients. Adequate B12 levels help maintain a healthy gut by supporting the production of hydrochloric acid in the stomach, which aids in digestion. A deficiency in B12 can lead to digestive issues such as bloating, constipation, or malabsorption of nutrients. Supplementing with B12 can improve digestion and help ensure your body effectively absorbs the nutrients from food.

The Metformin-B12 Connection

Metformin is an indispensable medication for treating insulin resistance that comes with Type 2 Diabetes. But comes with a risk for reducing Vitamin B12 levels. Millions of people take medications for GERD that reduce stomach acid and B12 absorption. And healthy, plant based foods contain almost no Vitamin B12. This article discusses the interaction between metformin, acid reducing drugs and B12 and discusses symptoms of deficiency, available testing, and supplementation to correct low levels. [PMC5874849, PMC6109862, PMC4866329]

It is critical that people taking metformin understand that this medication will reduce Vitamin B12 absorption. This disruption is believed to occur as metformin affects certain calcium-dependent processes in the gastrointestinal tract, impacting the absorption of vitamin B12.

How GERD Medications Reduce B12 Absorption

Gastroesophageal reflux disease (GERD) is often treated with medications such as proton pump inhibitors (PPIs) and H2 blockers. Examples of PPIs include omeprazole, lansoprazole, and esomeprazole. H2 blockers include drugs like ranitidine, cimetidine, and famotidine. These medications work by reducing the production of stomach acid. However, this acid is crucial for the absorption of vitamin B12. Long-term use of these drugs could lower stomach acid levels to the point where B12 absorption is compromised. This could lead to a B12 deficiency, especially in older adults who have decreased stomach acid production. ~PMC6054240 ~PMC9577826

Vitamin B12 Lacking in Plant-Based Diets

Plant-based diets, such as vegetarian and vegan diets, are often praised for their health benefits, including lowering the risk of heart disease, high blood pressure, diabetes, and obesity. But, one downside of these diets is the risk of vitamin B12 deficiency.

This is because Vitamin B12 is found almost exclusively in animal foods, such as meat, fish, eggs, and dairy. It is not generally present in plant foods, unless those foods are fortified with the vitamin. So, people who follow a strict plant-based diet without proper supplementation face a higher risk of developing a B12 deficiency.

Those following a plant-based diet must ensure they are getting enough B12. This can be achieved by consuming fortified foods, like plant-based milks, breakfast cereals, and some types of yeast, or through direct supplementation. It’s always a good idea for individuals following a strict plant-based diet to consult with a dietitian to ensure they are meeting all their complex dietary requirements. ~PMC9189588

Symptoms of B12 Deficiency

Symptoms of B12 deficiency are vague and very easy to dismiss. Worse, they can mimic diabetes complications and other health problems, which makes B12 much more difficult to spot. Early signs may include feelings of weakness, fatigue, or lightheadedness. While these symptoms might be initially dismissed, untreated vitamin B12 deficiency can lead to serious complications such as nerve damage, depression, and anemia. In severe cases, significant neurological issues can arise.

While most people with mild B12 deficiency will only notice a general lack of energy, symptoms vary from person to person, depending on the severity of the deficiency and individual health factors. Here are some common symptoms associated with vitamin B12 deficiency:

• Weakness and Fatigue: This can occur because your body needs B12 to produce red blood cells, which transport oxygen throughout your body. If your cells aren’t getting enough oxygen, you can feel tired and weak.
• Tingling or Numbness: Vitamin B12 is crucial for a healthy nervous system. A deficiency can lead to feelings of numbness, tingling, or a “pins and needles” sensation in the hands and feet. This is called peripheral neuropathy.
• Mood Changes: Adequate B12 is critical to maintaining brain health. B12 deficiency has been linked to depression and dementia, although the connection is not entirely understood.
• Balance Problems: Severe B12 deficiency can affect balance and coordination, making a person more prone to stumbling or falling.
• Glossitis and Mouth Ulcers: Glossitis is an inflammation of the tongue, which can make it red, swollen, and painful. Mouth ulcers and a feeling of pins and needles in the mouth or tongue can also occur.
• Breathlessness and Dizziness: If the deficiency is causing anemia, it might result in shortness of breath and dizziness.

More Medicines That Rob You Of B12

• Cholestyramine: Prescribed to lower cholesterol, this medication can bind to vitamin B12, limiting its absorption in the body.
• Colchicine: This gout treatment may interfere with the normal absorption and metabolism of vitamin B12.
• Antibiotics: Long-term use of certain antibiotics can affect gut flora and, as a result, the absorption of vitamin B12.

Interpreting B12 Lab Results: What You Need to Know

When looking at vitamin B12 lab results, it’s important to understand that the numbers on a test are just part of the picture. B12 levels can vary widely, and a low value doesn’t always mean someone is experiencing symptoms of a deficiency. Understanding the difference between functional ranges and the standard reference range, especially in cases of conditions like dementia, can help make sense of the results.

Functional Ranges vs. Standard Reference Ranges

The standard reference range for B12 is usually between 200-900 pg/mL, but these numbers are based on averages from a broad population, not what’s necessarily optimal for everyone. For some people, particularly those with neurological issues or cognitive symptoms, even levels within the “normal” range might not be enough.

In these cases, healthcare providers often look at a functional range, which is typically considered to be 500-900 pg/mL. Having B12 levels below 500 pg/mL can sometimes lead to symptoms like brain fog, fatigue, and memory issues. So, while your lab result may be considered “normal,” you might still feel the effects of a B12 deficiency if your levels are below 400 pg/mL.

B12 and Dementia: The Importance of Higher Levels

If you or a loved one is experiencing symptoms of dementia, it’s even more critical to ensure B12 levels are in the higher range. Studies suggest that low-normal or deficient B12 levels are common in those with Alzheimer’s or other cognitive conditions. While B12 supplementation won’t cure dementia, correcting a deficiency can help improve some cognitive symptoms and possibly slow the progression of the condition.

For those with cognitive issues, a B12 level of 500 pg/mL or higher is often recommended. Levels closer to 400 pg/mL have been linked to mild cognitive impairment, so maintaining B12 levels within the higher functional range can be particularly helpful for brain health.

Stopping Supplementation Before Testing

If you’re taking B12 supplements, it’s important to stop before getting your lab tests done. Supplements can raise B12 levels artificially, which might mask an underlying deficiency. To get an accurate reading of your natural B12 levels, it’s recommended to stop supplementation for at least 48 hours before the test. This ensures the results are reflective of your body’s actual B12 status, rather than the impact of supplements.

Taking a break from supplementation allows your healthcare provider to see the true picture of your B12 levels, helping them to make the best recommendations based on your specific health needs.

Defining Low B12 Levels: Understanding Standard Deviations from the Norm

In lab reports, a “low” B12 level is typically defined based on standard deviations from the norm. However, this number might not always match up with your experience. Many people with symptoms of deficiency start to show signs of issues like fatigue, cognitive decline, and neuropathy even when their B12 levels are above the 200 pg/mL threshold.

Some researchers argue that B12 levels below 400 pg/mL may still contribute to symptoms, especially in those with neurological concerns. So, when interpreting your results, it’s important to keep in mind that the lab numbers don’t always tell the full story. Symptoms can appear at levels that might still be considered “normal” by the lab but are below the functional range needed for optimal health.

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B12 Supplement Options

Methyl B12

Methyl B12 with Intrinsic Factor

People who might benefit from a B12 supplement that includes intrinsic factor typically have conditions affecting the stomach or small intestine that impair the natural production or function of intrinsic factor. Examples:

• Pernicious Anemia: This autoimmune condition is one of the most common causes of vitamin B12 deficiency due to a lack of intrinsic factor, which is necessary for B12 absorption.
• Bariatric Surgery: Procedures that alter the stomach can reduce intrinsic factor production and B12 absorption.
• Gastritis: Chronic inflammation of the stomach lining can lead to atrophy, reducing both acid and intrinsic factor production, essential for B12 absorption.
• Long-term Antacid Use: Medications that reduce stomach acid can affect intrinsic factor and, in turn, B12 absorption.
• Pancreatic Insufficiency: Since the pancreas aids in B12-intrinsic factor complex absorption in the small intestine, any condition impairing pancreatic function can affect B12 absorption.

B Complex Including B12

As a general principle when choosing vitamin supplements, it is usually a better strategy to choose supplements with a broader set of nutrients that are in balanced to work together. When mixing and matching single nutrient supplements, there is a much greater chance of missing some nutrients while getting excesses of others.

To Sum It Up

B12 is crucial, especially for vegetarians and those on medications like metformin or PPIs that interfere with its absorption. B12 supplements offer a reliable way to support your brain and nerve function, energy production, and the creation of DNA and red blood cells. By including a B12 supplement in your routine, you’re taking a step to safeguard your overall well-being and ensure that your body gets this vital nutrient it might be missing from diet alone. Don’t forget to check out our full article titled: Vitamin B12: Essential for Brain, Nerves, and Heart Health.

This Article is Not a Substitute for Medical Advice

This information is provided for educational purposes only and is not a substitute for medical advice. Supplement Sciences does not provide medical care and cannot ensure the safety or effectiveness of any product for your personal use. Always consult your physician before starting any supplement, especially if you are pregnant, breastfeeding, or managing a serious health condition such as cancer, liver disease, or kidney disease. Dietary supplements are not designed to diagnose, treat, cure, or prevent any disease.

* These statements have not been evaluated by the Food and Drug Administration.