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Kirsten Jackson Consultant BSc Hons PG Cert RD

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Vitamin B12 Deficiency

by Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert Leave a Comment

Vitamin B12 deficiency is caused by inadequate dietary intake or malabsorption of vitamin B12 (1).

This post will discuss the role of vitamin B12, your daily needs, sources of vitamin B12, and the cause and symptoms of deficiency. 

vitamin b12 deficiency

Table of Contents

  • WHY DO I NEED VITAMIN B12?
  • WHAT ARE THE VITAMIN B12 REQUIREMENTS? 
  • HOW TO MEET THE NEEDS FOR VITAMIN B12 IF YOU ARE VEGAN? 
  • SOURCES OF VITAMIN B12
  • HOW IS VITAMIN B12 PROCESSED?
  • VITAMIN B12 DEFICIENCY
  • WHO IS AT RISK OF VITAMIN B12 DEFICIENCY?
  • HOW IS VITAMIN B12 DEFICIENCY TREATED?
  • SUMMARY

WHY DO I NEED VITAMIN B12?

Vitamin B12 has many roles in your body. It has the following roles: 

  • Is used to make red blood cells
  • Helps to release energy from food
  • Is used in processing folic acid
  • Used within the nervous system to maintain healthy nerve function (2)
  • Contributes to the normal function of the immune system and reduction of tiredness and fatigue (2)

WHAT ARE THE VITAMIN B12 REQUIREMENTS? 

Daily needs for adults (aged 19-64) are 1.5 micrograms (3). Your requirements may be higher if you are vegan (4).

For most people, a normal balanced diet will provide them with enough vitamin B12 as it is found mostly in animal products. 

HOW TO MEET THE NEEDS FOR VITAMIN B12 IF YOU ARE VEGAN? 

It is quite difficult to get vitamin B12 from a vegan diet. Many vegans often suffer from a deficiency if they don’t take extra measures to ensure their diet has a regular source.

If you are vegan, you should follow one of the listed recommendations to avoid vitamin B12 deficiency (4):

  • Eat 2-3 portions of fortified foods a day to get at least 3 mcg of vitamin B12.
  • Take a supplement that provides at least 10 mcg of vitamin B12 every day.
  • Take a supplement that provides at least 2000 mcg of vitamin B12 once a week.

The less often you consume vitamin B12, the higher dose you will need to cover your needs. This is because the vitamin is better absorbed when consumed when taken little and often (4). 

SOURCES OF VITAMIN B12

As already mentioned, vitamin B12 is present in animal products. Examples of animal source foods include:

  • Dairy (e.g cheese/yogurt/milk)
  • Eggs
  • Meat
  • Fish

You can get vitamin B12 also from a vegan diet as many products are fortified:

  • Fortified breakfast cereals
  • Fortified vegan spreads
  • Fortified soya/almond/coconut milk
  • Fortified nutritional yeast

Always check the label to make sure the product is fortified as B12 does not occur naturally in these foods.

HOW IS VITAMIN B12 PROCESSED?

Foods containing vitamin B12 are first broken down in the stomach. This allows vitamin B12 to be released and bound to specific proteins. 

These proteins then carry the B12 out of the stomach and into the small bowel, where they are separated by pancreatic juice (5). 

This time the vitamin is bound to a ‘glycoprotein’ known as an intrinsic factor. This intrinsic factor acts as a key for the B12 which is then absorbed into the blood (5). In the blood, it again binds to another protein and becomes ‘active B12’ (5).

VITAMIN B12 DEFICIENCY

A survey from the USA showed that the prevalence of B12 deficiency is around 3% in the age group 20-39 years old. Prevalence increases with age and in people older than 70 years old, it reaches 6% of the USA population (1).

Symptoms of vitamin B12 deficiency are (6):

  • Muscle weakness
  • Disturbed vision
  • Depression
  • Memory problems
  • Extreme fatigue
  • Mouth ulcers

As mentioned, it is fairly uncommon to have a vitamin B12 deficiency due to lack of dietary intake diet, unless you are vegan.

WHO IS AT RISK OF VITAMIN B12 DEFICIENCY?

Aside from vegans, some medical conditions can lead to vitamin B12 deficiency.

This means that the body may be unable to process vitamin B12 correctly, leading to deficiency regardless of the amount eaten.

The following medical conditions can lead to vitamin B12 deficiency;

1. Surgeries

Surgeries that have removed all or part of the stomach and pancreas will reduce a person’s ability to process vitamin B12 (7).

2. Medications

Certain medications may affect a person’s ability to absorb vitamin B12 e.g diabetes type 2 medication (metformin) and proton pump inhibitors (8, 9).

3. Intestinal conditions

Inflammatory bowel disease like Crohn’s disease and the autoimmune condition coeliac disease will cause damage to the lining of the intestine, reducing its ability to absorb vitamin B12 (10).

4. Helicobacter pylori infection

Helicobacter pylori infection causes gastritis and impacts gastric acid production and availability of intrinsic factor. Intrinsic factor is needed for transport of the vitamin B12 (11).

5. Pernicious anaemia

An autoimmune condition where your immune system is attacking healthy cells, destroying the ability of the intrinsic factor to work effectively (12).

NOTE: Whilst it is important to ensure your diet has good sources of vitamin B12, you must speak to a doctor if you feel you have a deficiency. You may have an underlying condition which needs the appropriate management or require B12 injections.

HOW IS VITAMIN B12 DEFICIENCY TREATED?

Treatment of vitamin B12 deficiency depends on the cause.

If your vitamin B12 deficiency is due to inadequate B12 dietary intake, the deficiency should improve by taking oral or inject supplements dependent on the level of vitamin B12 in your blood. To maintain healthy levels you should consider dietary modification or take supplements to prevent further issues (
13).

Whether you have B12 deficiency due to taking certain drugs (e. g. Metformin), oral supplements should improve it (
13).

If the cause of deficiency is malabsorption due to Crohn’s disease or Coeliac disease, serum level usually corrects as the bowel heals. But you may need oral or injection supplements depending on the level (
13).

If you have pernicious anaemia, you will need an injection as oral supplements won’t make a difference (
13).

SUMMARY

Vitamin B12 has a role as a cofactor in many different body functions.

Vitamin B12 needs to be obtained from the diet – it is found in animal source foods and fortified products. If you can’t ensure sufficient intake with diet, you should supplement it to avoid deficiency.

There are some medical conditions that cause deficiency regardless of the intake. If that is the case for you, talk to your doctor.

Written by Barbara Lešnik Student Dietitian 2022, reviewed by Serena Bansal Registered Dietitian BSc Hons, and Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert 

Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert

Kirsten Jackson is a UK registered Consultant Gastroenterology Dietitian and founder of The Food Treatment Clinic. She has undergone many qualifications to get where she is today, including a UK BSc Honours Degree in Dietetics and Post-Graduate Certificate in Advanced Dietetics. In addition to this, she has FODMAP Training from Kings College London University. Kirsten set up The Food Treatment Clinic in 2015 after first experiencing digestive problems herself. She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before opening a bespoke IBS service. Kirsten also participates in charity work as an Expert Advisor for the IBS Network. In addition, she can be seen in publications such as Cosmopolitan and The Telegraph discussing IBS as an Official Media Spokesperson to the IBS Network.

Filed Under: Supplements Tagged With: vitamin deficiency

About Kirsten Jackson Consultant Dietitian BSc Hons, RD, PG Cert

Kirsten Jackson is a UK registered Consultant Gastroenterology Dietitian and founder of The Food Treatment Clinic. She has undergone many qualifications to get where she is today, including a UK BSc Honours Degree in Dietetics and Post-Graduate Certificate in Advanced Dietetics. In addition to this, she has FODMAP Training from Kings College London University. Kirsten set up The Food Treatment Clinic in 2015 after first experiencing digestive problems herself. She felt that the NHS was unable to provide the support individuals needed and went on to specialise in this area before opening a bespoke IBS service. Kirsten also participates in charity work as an Expert Advisor for the IBS Network. In addition, she can be seen in publications such as Cosmopolitan and The Telegraph discussing IBS as an Official Media Spokesperson to the IBS Network.

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the.ibsdietitian

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😩What other methods have you tried? SAVE THIS P 😩What other methods have you tried? SAVE THIS POST!​​​​​​​​​

😭Diarrhoea can be distressing and often embarrassing, especially when you don't know when it will strike! The thought of leaving the house might terrify you, but you want to get on with your day-to-day life... does this sound like you?

😤Tired of feeling this way? I recommend some of the tips provided in this post that we use in the Take Control Programme. For example, try to fit some gentle movement into your routine, such as walking, yoga, jogging, or anything you enjoy! By making these small changes, you'll be able to tackle your day without the fear of your IBS-D ruining your plans!

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HOW DOES BLOATING MAKE YOU FEEL? COMMENT BELOW ⬇ HOW DOES BLOATING MAKE YOU FEEL? COMMENT BELOW ⬇️​​​​​​​​​
😔Bloating is a common symptom of IBS that can really affect an individual's self-esteem. I have seen it time and time again in clinics where my clients don't want to leave the house for fear of bloating. It can ruin your whole day and make you feel downright rubbish!

❤️Life should not and does not have to be like this! Invest in yourself by investing in a qualified professional, such as an IBS dietitian, so that you can take control of your life and live bloat free!

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CAN YOU ADD ANYTHING ELSE? Comment below 👇

🤷‍♀️IBS is such a frustrating condition it can take a lot to mentally process. Why you? What did you do to deserve to get a condition that no one understands, that impacts your whole life and for which there is no cure?

🙋‍♀️I often hear awful client stories about how when they finally pluck up the courage to reach out for help, they are dismissed. This could be opening up to a friend about trialling the low FODMAP diet or perhaps seeking medical help from a doctor. Again frustration, anger and hurt can build.

🤓Whilst you have SO much to be angry about (yes, even in a world where others have it worse, it is ok to be angry about your own situation), you need a support network. 1 in 5 people have IBS, so my suggestion is this (if you can build that courage back up) try to be open about having IBS because you will be surprised about how many other people around you also have the condition! Talking to other people who have it = immediate understanding.

🎉 Download my FREE morning routine guide (link in bio).⠀⠀⠀⠀⠀⠀⠀⠀⠀
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🙏 Are your symptoms worse during your period? S 🙏 Are your symptoms worse during your period? SHARE THIS POST.

🤷‍♀️Do you know that more women are diagnosed with IBS than men? We don't know 100% why, but my guessing is this cycle has something to do with it!

🙋‍♀️In the week before your period, your progesterone and testosterone levels drop, causing your gut to become more sensitive. Your behaviour also changes. Research has shown that our portion sizes tend to be larger at this time, AND to top it off, your mood will be lower. All these things will impact your IBS.

😅 You may wish to curl into a ball, but this will only worsen the situation. So here are some easy-to-implement tips;
1. Balance your portions of food.
2. Move daily (even a gentle walk or stretching for 30 mins).
3. Prioritise sleep.
4. Try meditation.

🎉 Fed up of trying everything, but it’s not working? Download my FREE IBS morning routine guide (link in bio).

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💩 Do you suffer with gut problems during Ramada 💩 Do you suffer with gut problems during Ramadan?

😭 Many of my clients find that Ramadan worsens their constipation which means they feel uncomfortable instead of feeling like they can embrace the holy month.

➡️ The truth is that constipation during this time can easily be avoided by making small changes to your diet and lifestyle. One example of this is to add psyllium husk to your diet which will boost your fibre intake without causing more gas or bloating.

🙏 If you would like further support check out my FREE morning guide (link in bio) which can be implemented at Suhoor.

#uaeramadan #ramadankareem #theibsdietitian #fasting
🤷‍♀️Which tests have you had done? Commen 🤷‍♀️Which tests have you had done? Comment below ⬇️​​​​​​​​
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🙋‍♀️At the start of the Take Control Programme, I talk through the importance of testing. The reason is that IBS symptoms could also be symptoms of numerous other conditions such as IBD, coeliac disease and even cancer. So best to get tested!​​​​​​​​
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🤓The tests above are recommended tests from NICE guidelines (the gold standard in the UK). You will also need testing for an inflammatory marker known as CRP. Your doctor may wish to do additional testing if you are showing symptoms or potential increased risk of other conditions, but these are not standard and not always required.​​​​​​​​
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🤓On the right-hand side, you have tests which are NOT required. The first one is mapping or testing your gut microbiome. Regardless of how accurate this is, it is pointless. This is because we don't yet know what a normal gut microbiome looks like, so what are you going to do with those results? It is a waste of $.​​​​​​​​
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🤓The next test is for food intolerances - VERY inaccurate! The only way to accurately diagnose a food intolerance is through elimination and reintroduction.​​​​​​​​
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⏩⏩ fed up with trying everything? I have a FREE ‘morning routine’ guide for you in my bio!​​​​​​​​
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#bloating #diarrhoea #constipation #tummypain #bloatingremedy #irritablebowelsyndrome #ibs #ibsdiet #foodanxiety #chronichealthcondition #chronicallyunwell #bodyimage #celebratingwomen #foodbaby #ibstriggers #lowFODMAPdiet #fodmapfree #lowFODMAP theibsdietitian #foodsensitivity #iggtesting #gimapping #microbiome #gutflora #foodintolerancetesting #foodintolerance
🌙 Ramadan Kareem to all my Muslim followers, fr 🌙 Ramadan Kareem to all my Muslim followers, friends and colleagues.

May you all have a blessed Ramadan.

#uaeramadan #ramadan2023 #ramadankareem
CAN YOU RELATE?.​​​​​​​​ ​​​ CAN YOU RELATE?.​​​​​​​​
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🤷‍♀️Anyone else feels like IBS zaps their energy?​​​​​​​​
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🙋‍♀️When I ask people what their main IBS symptoms are, yes they say diarrhoea/constipation, bloating BUT also fatigue. It is crazy how your digestion can make you feel like you are in this big cloud and only have enough energy to do the minimum each day. The problem is that you were not put on this planet to just do the minimum in life, and knowing this will make you feel sad and helpless. The good news is that when your digestion is actually functioning well, you will feel like the light has been turned on inside your brain.​​​​​​​​
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🎉Do you want the light to be turned on again? Download my FREE morning routine guide (link in bio).​​​​​​​​
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #mumlife #dubaimom #constipation #chronicpain #chronicallyunwell #women'shealth #periodsandpoop
What are you incorporating into your routine? SAVE What are you incorporating into your routine? SAVE THIS POST! ❤️​​​​​​​​
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😫 It can be so stressful when IBS strikes at work! The fear of a flare-up, the embarrassment of sharing a toilet, and fatigue can all can stop you from feeling comfortable and confident at work.​​​​​​​​
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🙋‍♀️ It doesn't have to be like this! Why don’t you try adopting some of the examples above which can help alleviate some of your symptoms! 🙌​​​​​​​​
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🎉 🎉 Fed up of trying everything you can, but nothing seems to be working? Download my FREE IBS morning routine guide! Link in bio.⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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Is IBS dictating your schedule? Comment below! 👇 ​​​​​​​​
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😫 Your day may not go to plan when you have IBS - you could spend ages on the toilet, unsure what clothes to wear due to the bloat, and be in so much pain that you have to cancel your plans with your friends and family!​​​​​​​​
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🙇‍♀️ Tired of constantly cancelling your plans? Why not use the low FODMAP diet to identify your triggers so you can predict your symptoms? Therefore, your life will not revolve around cancelling plans at the last minute!​​​​​​​​
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🎉 🎉 Fed up of trying everything you can, but nothing seems to be working? Download my FREE IBS morning routine guide! Link in bio.⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibs #ibsd #ibd #ibsc #chronichealth #multifactorial #chronicallyunwell #ibstype
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#theibsdietitian #kirstenjackson #ibsguidance #lowfodmapdiet
CAN YOU RELATE? ​​​​​​​​​​​​​​​​​​​​​​​​
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😭 I think this post emphasises the point that NOT EVERY DISABILITY IS VISIBLE. As IBS sufferers we often hide our pain in silence day in day out, hoping nobody notices or asks questions. When people ask how we’re doing, we do the polite thing and reply with “I’m fine”. Leaving the burden of IBS to be dealt with alone…​​​​​​​​​​​​​​​​​​​​​​​​
​​​​​​​​​​​​​​​​​​​​​​​​
🤔 But what about instead of struggling alone in silence, you embody the Take Control Method whereby you prioritise emotional support. Open up to a friend, a colleague or a loved one - problem shared is a problem halved. ❤️​​​​​​​​​​​​​​​​​​​​​​​​
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🎉 🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE IBS morning routine guide! Link in bio.⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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#ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #lowfodmapdiet #bloating #irritablebowelsyndrome #fodmapfree  #gutinstinct #healthygut #ibsd #ibd #tea #5steps #chronichealth #multifactorial. #chronicallyunwell #endo #ibstype #ibstyping #ibsc
💩💩 Check out my new gut health advice in the 💩💩 Check out my new gut health advice in the @guardian

Link in stories 😊
CAN YOU RELATE? Comment below👇 ​​​​​​​​
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😭 Do you feel like you've lost the previous you? You're trying to shove your symptoms & feelings under the rug. This takes a toll on not only your physical but also your mental health.​​​​​​​​
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Your feelings ARE validated. Being open about your feelings instead of hiding them can allow you to receive the support you need. By taking this approach, you won't have to fight this battle alone ❤️​​​​​​​​
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🎉 Fed up trying everything you can, but nothing seems to be working? Download my FREE morning routine guide! Link in bio. ​​​​​​​​​​​​​​​​
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Post credits to @the_migraine_life​​​​​​​​
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#ibs #irritablebowelsyndrome #fodmap #lowfodmapdiet #lowfodmaprecipes #guthealth #guthealthy #gut #ibsdietitian #ibsdietician #ibsdiet #ibsfood #guthealthy #guthealthdiet #guthealthiskey #fodmapfree #chronicillness
💩💩 30% of people in this study who were diag 💩💩 30% of people in this study who were diagnosed with IBS-D were found to have bile salt malabsorption.

🤓 Bile salts are needed in digestion to break down fats. After the salts have been used they are recycled and when this process is broken you can end up with inadequate amounts of bile acid available. This means that your dietary fat is unable to be broken down and you can end up with loose stools.

➡️ If you have watery stools 3 or more times a day and have IBS please mention this to your doctor 🙏.

📚 DOI: 10.1111/apt.13227

#theibsdietitian #irritablebowelsyndrome
Do you have these symptoms? Comment below ⬇️ ​​​​​​​​​
🤔 Endometriosis is when the lining of the uterus is found in other areas of the body. Many IBS symptoms are also symptoms of endometriosis, so it often is misdiagnosed as IBS. Unfortunately, many women wait 7-10 years before a diagnosis.

🙋‍♀️ Interestingly, following the low FODMAP diet for 4 weeks showed a 50% improvement of symptoms in 72% of women who suffer from endometriosis. However, please consult a doctor for a proper diagnosis and a dietitian before following a restrictive diet!

🩸ALWAYS mention any unusual period-related symptoms to your doctor!

#endometriosis #endometriosisawareness #endometriosisawarenessmonth #ibsawareness #pain #menstrual #menstrualcycle #periods #ibs #bodypositivity #ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #gutmicrobes #gutscience #dietitian
😭 Can you relate? Comment below 👇 ​​​​​​​​​​​​​​​​​​​​​​​​
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😢 Having IBS can really take a toll on your mental health. In turn your IBS can cause anxiety and your anxiety can then cause IBS symptoms leading to a viscous cycle. Your fears are REAL and they are VALID and they can be really debilitating! IBS can impact so many aspects of your life big and small! ⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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🤔 But what if you no longer had to deal with any of these fears and could get your symptoms under control! Instead of continuing with these behaviours adopt the take control method of social support and open up about your IBS to someone!⠀⠀⠀⠀⠀⠀​​​​​​​​​​​​​​​​
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🎉 Fed up of trying everything you can but nothing seems to be working? Download my FREE morning routine guide! Link in bio. ​​​​​​​​​​​​​​​​
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#ibs #ibsdietitian #guthealth #irrtablebowelsyndorme #guthealth #lowfodmapdiet #guthealth #healthygut
Do you suffer from bloating? ❤️ SAVE THIS CHEC Do you suffer from bloating? ❤️ SAVE THIS CHECKLIST ​​​​​​​​​
Bloating can impact our daily lives - lower our self-esteem as we look like 9 months pregnant and trying to find loose clothing to wear 😫

💨 Wouldn’t it be amazing if we could beat the bloat? These 8 tips are based on the Take Control approach, which can help you to lessen the bloat and ultimately let you achieve symptom relief 😮‍💨

🎉 Tired of advice that just doesn't work? Download my FREE IBS morning routine! Link in bio.​​​​​​​​

#ibsawareness #ibsbloating #bloatingtips #ibs #bodypositivity #ibsdiet #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #dietitian
Can you add any more? Comment below!👇👇​​ Can you add any more? Comment below!👇👇​​​​​​​​​​​​​​​​​​​​​​​​
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😥 IBS has widespread implications on our overall health and well-being and it can feel like a never ending battle.​​​​​​​​​​​​​​​​​​​​​​​​
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😊 Our gut health plays a big role in our overall health and well! The Take Control Method focuses on all aspects of well-being not just nutrition! ​​​​​​​​Sleep, movement and mental health optimisation are just as important!​​​​​​​​ This this can help you achieve that ultimate symptom relieve! ​​​​​​​​​​​​​​​​
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👏👏Fed up of trying everything you can but nothing seems to be working? Download my FREE IBS morning guide! Link in bio.​​​​​​​​​​​​​​​​​​​​​​​​
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#loveyourgut #loveyourgutweek2022 ibsdiet diet #ibs #guthealth #ibsfood #guthealth #lowfodmapdiet #guthealthy #guthealing #guthealthdiet #guthealthiskey #bloating #gutmicrobes #gutscience #healthylife #bloating #irritablebowelsyndrome #fodmapfree  #healthygut #goodguthealth #gutfood #fermentedfoods #trustyourgut #chronichealth #microbiome #tipsforgoodguthealth #guthealth #guthealthtips
💩 What movement are you planning today? Comment 💩 What movement are you planning today? Comment below👇

➡️ Did you know that regular movement has been proven by research to improve IBS symptoms?

➡️ I use the term 'movement' in my Take Control method because we have already built up so many negative emotions and ideas around 'exercise.'

💩 Movement should be daily and can be anything from an HIIT class to simple stretches.

➡️➡️➡️ For more tips like this one, check out my FREE IBS morning routine guide (link in the bio) 

#theibsdietitian #lowfodmapdiet #irritablebowelsyndrome
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