So, should you be concerned about vitamin B12 deficiency ? If you answer Yes to any of the following questions you are either at risk for vitamin B12 deficiency or you already have vitamin B12 deficiency and may not even know it. So what are the questions : Are you vegan? Do you take any antacid medication? Do you have diabetes and take medication called Metformin? Do you smoke? Do you drink alcohol? Do you have bad heartburn? Do you have Crohn’s or celiac disease or did you have gastric bypass surgery?

If you said yes to any of these, there is a chance that you may Vitamin have vitamin B12 deficiency. But you say – I don’t feel anything? You are right; you may not feel anything initially and still have vitamin B12 deficiency. The noticeable symptoms of vitamin B12 deficiency that we will cover in a bit can show up much later.

But wait a minute, don’t panic yet. Just because you don’t eat meat for a few days, smoke few cigarets, or have a few beers a week won’t get you necessarily vitamin B12 deficient. If your diet is semi-decent and you are not a heavy alcoholic, it would take usually up to several years to develop vitamin B12 deficiency. Our body has a great ability to store vitamin B12, so it is impossible to get vitamin B12 deficiency overnight just because you suddenly changed your diet or lifestyle.

We will talk about the different forms of vitamin B12 for supplementation, and if there is really meaningful difference between them, as well as the big argument if you should get a vitamin B12 injection or simply take vitamin B12 pill. But let’s first see what are some of the symptoms that you may experience with vitamin B12 deficiency if you said yes to any of the above questions.

So one of the first and probably most common symptoms of vitamin B12 deficiency is feeling fatigue and weakness.  That’s because vitamin B12 deficiency prevents your body from making enough red blood cells – so basically, you are developing a form of anemia. Some people may develop inflammation of the tongue and mouth ulcers as the first signs of vitamin B12 deficiency.

Later on, when the vitamin B12 deficiency becomes more serious, people will start developing some neurological symptoms such as sensations of pins and needles. They may feel this tingling or numbness, especially in the hands and feet, and develop a condition called Peripheral Neuropathy. That’s because you need vitamin B12 to protect your nerves.

Vitamin B 12 helps to create a protective sheet called myelin sheet around the nerves to insulate it. Long-term vitamin B12 deficiency causes loss of the protective sheet and exposes the nerves. This leads to the tingling and pins and needles sensation. If this doesn’t get corrected, people start developing more serious symptoms such as difficulty walking, balance problems, and cognitive changes such as memory loss, confusion, and difficulty concentrating.

All of that is happening because more and more nerves are getting damaged, and the damage is now moving from the periphery – the hands and feet – into the spinal cord and brain.

Great, so what do we do about it? Well obviously if you drink and smoke heavily the first thing is to get help and get out of it, because you will eventually have a lot more problems than vitamin B12 deficiency.

But when it comes to supplementation, lots of people immediately think about vitamin B12 injections – I had so many people asking me about that, saying that it gives them an instant energy boost. So are the injections better than vitamin B12 pills?

Now, there are three ways you can get Vitamin B12 into your body. The best way is obviously from food. You can find Vitamin B12 primarily in animal-derived products such as meats, dairy products, eggs, and fish.

So, you may ask, do I have to eat food high in Vitamin B12 every day to prevent becoming deficient in Vitamin B12? The answer is no. The main reason is that the body is very good at storing Vitamin B12 in our liver, creating sufficient stores of Vitamin B12 for up to several years.

But what if you are vegetarian or vegan? Well, in that case, you either need to rely on food that is fortified with B12, or what I generally suggest is to use a multivitamin specifically designed for vegans or vegetarians to ensure that you also get other vitamins and minerals that you may not be getting enough of because of your diet. But that is up to you.

Now if you are a diabetic who takes Metformin to control blood sugar, in about 1 year after starting Metformin, you might start developing vitamin B12 deficiency because metformin interferes with absorption of vitamin B12. In this case it is a good idea to not only start having your vitamin B12 levels check regularly, but also to take a daily vitamin B12 supplement.

The same goes for people who take antacids. You need stomach acid to absorb vitamin B12, so if you are constantly suppressing the production of stomach acid, you will not be absorbing  vitamin B12 from food, and eventually, you will deplete the stores of vitamin B12 in your body.

That being said, if you can’t get your acid reflux under control with diet and need daily antacids for a long time, a multivitamin containing vitamin B12 might be helpful. But if you only take antacids occasionally and you have in your diet the above foods high in vitamin B12, you don’t need an extra vitamin B12 supplement.

The caveat is that if you have heartburn all the time and you can’t control it with diet, you should talk to your healthcare provider to get tested for what’s called H. pylori, which is a bacteria that can be present in your stomach and manifest as heartburn. If you test positive for it, you will need antibiotics to get rid of it. That’s important because, besides many other problems that H. pylori causes, it also interferes with vitamin  B12 absorption.

Now, I won’t get deeply into the rare autoimmune condition known as pernicious anemia, which leads to vitamin  B12 deficiency. This is primarily because it is relatively rare condition. But basically what happens is that, in pernicious anemia, the body lacks a crucial protein called intrinsic factor, produced by stomach cells.

Intrinsic factor is essential for  vitamin B12 absorption and without it, your body can’t effectively absorb Vitamin B12.

But lets get back to vitamin B12 injections. So, vitamin B12 shot or the pill? Look, studies have clearly shown that there is no difference in effectiveness between getting the vitamin B12 injection or taking the vitamin B12 pill in the majority of cases.

That’s because even if you have poor absorption of vitamin B12, you can still get the vitamin B12 into your body through passive diffusion in the intestines. Basically, the high concentration of vitamin B12 from the supplement will seep through the intestinal wall and get into your body.

The only time that a vitamin B12 injection might be preferred is if you have a very severe vitamin B12 deficiency and you need to replenish vitamin B12 very fast. But after that, to just maintain the vitamin B12 levels, you can save yourself money, the discomfort, and time going to see your provider and just take the daily pill. You get the same results. I left the link to the study that discusses that in the description below.

Now, one important note is that if you are taking Vitamin B12 to correct a deficiency, you will need to have blood work to check if it works. In general, you can see changes in the correction of anemia from a couple of weeks to about a month, so a recheck in one month is reasonable.

To see the difference in neurological symptoms may take longer and is more gradual. It may take even several months to start seeing changes.

So, what is the best form of vitamin B12 to supplement? There are several forms of Vitamin B12, but for most people, the synthetic form cyanocobalamin offers the best balance between cost and effectiveness.

This is the form of Vitamin B12 that you find in most supplements and fortified foods. It is well-absorbed and has the advantage of a longer shelf-life. Now, some individuals may have difficulties metabolizing cyanocobalamin.

For these individuals, methylcobalamin is a better choice. That’s because methylcobalamin is one of the active forms of Vitamin B12 used directly by the body. Unlike cyanocobalamin that we just mentioned, which needs to be converted into methylcobalamin to be used effectively, methylcobalamin bypasses this conversion step.

Now, how do you know if you are that person who does not effectively convert cyanocobalamin into the active form, methylcobalamin? Well, you can’t tell unless you don’t respond to the supplementation with the standard Vitamin B12 form, cyanocobalamin.

The only other way is to do genetic testing since mutations in the MTHFR gene can affect how well the body processes Vitamin B12. Genetic testing can identify these mutations, but this testing is not done routinely. So if you are really concerned, just take the methylcobalamin form of Vitamin B12.

I will also point out though that the methylcobalamin form of Vitamin B12 is preferred if you have neurological complications such as neuropathy from B12 deficiency because it is in its active form. That’s based on some studies, but it’s still not very conclusive if that makes a huge difference.

Lastly, can you develop toxicity from taking too much Vitamin B12? Vitamin B12 is water-soluble and generally has a low risk of toxicity, even when taken in high doses through supplements. And it is pretty much unheard of to get toxicity from Vitamin B12 by eating regular food.