Vitamin B12 Deficiency: Gut Related Symptoms

Are your gut symptoms like bloating, pain, and cramping somehow related to your Vitamin B12 deficiency?  They could be!  Many of us know the connection between B vitamins like Vitamin B12 and energy levels, even brain function, but did you know that if you run low on B12 chronically this could be related to your gut?

Vitamin B12 deficiency is more common than you think- it is estimated that 20% of residents over the age of 60 in the US and UK are deficient in B12.  B12 is absorbed in the stomach and small intestine, and as we age we have less intrinsic factor,  which we need to absorb B12.  Other things that can cause low B12 include the use of medications like PPI’s (proton pump inhibitors- think omeprazole, Protonix or Nexium), H2 Blockers (like Zantac or Pepcid), steroids (this includes prednisone, hydrocortisone, dexamethasone, and even inhaled steroids used for asthma or allergies like fluticasone or mometasone), many common antibiotics, and even birth control pills! Vegans are classically known to be B12 deficient because they do not eat animal products, and B12 is naturally found in animal products, but in my practice I find many meat eaters that are low in this essential vitamin also. 

What counts as a B12 deficiency?  Your doctor can easily order a B12 blood test, and if your results are less than 300 you are deficient, if you are between 300-500 you likely would feel better with some extra B12 but you are not clinically deficient.  

Classic symptoms of low B12 include:

  • Fatigue
  • Headaches
  • Pale skin
  • Mental slowness or memory decline
  • An enlarged, painful tongue or pain in the mouth
  • Numbness or tingling in your hands or feet

But what can a B12 deficiency do to your gut and how can gut problems cause a low B12?  This important B vitamin, when low, can relate to diarrhea, constipation, bloating, cramping and gas.  What we don’t know is does it cause these symptoms or is it a result of malabsorption stemming from GI problems like SIBO, IBS, H Pylori infection, or lack of adequate digestive enzymes.  It is quite often, in my medical opinion and based on many studies, a result of the above imbalances.   Bacterial overgrowth, as in SIBO- Small Intestinal Bacterial Overgrowth, does not allow your body to absorb the B12 from your foods.   If you don’t have enough pancreatic enzymes being produced, which is very common when you have a leaky gut or dysbiosis, this impairs your duodenum’s (part of your small intestine) ability to break down the B12 complex.  If this can’t be done then your intrinsic factor, secreted by the stomach, can’t bind with the breakdown products of your B12 and the absorption of B12 is halted.  If you have an H Pylori infection or overgrowth, which is extremely common, you often do not have enough HCL and pepsin.  These factors are needed to break down the protein B12 complex in animal products, and if they can’t be broken down you are not getting the B12 from said animal products. 

I recommend that all of my patients with SIBO, IBS, H Pylori, or even leaky gut be tested and treated for B12 deficiency (if they are below the levels noted above).  Let’s talk about the best way to get your B12 boosted:

  1. Heal your gut! This is easier said than done, but it is essential in order to ensure your B12 is really going to be absorbed, and that you can get your B12 from food long-term- and not rely on supplements.  If you need help healing your gut, book a call with my team to learn more about my coaching program, Trust your Gut: Heal your gut with food and nutrients!
  2. While you are working to heal your gut and your intestinal lining, the quickest way to boost your B12 without worrying about your gut inflammation getting in the way, injections might be your best bet.  
  3. The next best thing to injections are B12 sublingual sprays or lozenges.  This delivery system also helps skip your digestive tract, as it gets absorbed into your bloodstream, and can help you achieve a quicker rise in your levels.
  4. If you have a methylation defect, you likely inherently need more Vitamin B12, so be sure to choose a supplement with methylcobalamin or adenosyl/hydroxy B12, as this is a much better formulation than cyanocobalamin.
  5. Don’t forget your food! Great Vitamin B12 sources are:
  • Salmon
  • Herring
  • Sardine
  • Tuna
  • Trout
  • Beef
  • Lamb
  • Turkey
  • Chicken and beef liver
  • Eggs
  • Organic Greek yogurt
  • Octopus, crab, and lobster

If you are a vegan, using one of the other options above #3 is your best bet! What low B12 symptoms have you had? Share your story in the comments!