Could it be B12?

Fatigue, mood issues, depression and bloating all linked to B12 deficiency

There is a silent crippler that affects millions of people across the globe. A deficiency in vitamin B12 can cause a raft of problems such as depression, fatigue, cognitive decline and strokes and the problem is more widespread than people recognise.

Because vitamin B12 plays a role in such a wide range of body processes it can affect different people in different ways. One person may manifest with fatigue, another with depression or body pains and bloating in another. It can mimic multiple sclerosis, Parkinson’s or chronic fatigue syndrome. It can stealthily increase your risk of stroke, heart disease and even cancer.

Doctors tend to think of a B12 deficiency only in the elderly, but over the age of 40 many people live with dangerously low levels of Vitamin B12 which can greatly impact their health. This is in part due to digestive secretions diminishing as we age so that levels of stomach acid maybe too low to be able to extract the B12 from foods. But there are many other factors which put people at risk for low B12.

Do you fall into any of the categories below?

·        Use a PPI medication such as Omeprazole or Lansoprazole or any antacid

·        Using metformim

·        Are vegan/vegetarian

·        Tested positive for helicobacter pylori

·        Had gastric bypass surgery

·        Have a diagnosis of celiac disease

·        Gut conditions that affect absorption (IBS/IBD)

·        Small Intestinal Overgrowth

·        Suffer from thyroid problems

·        Have an autoimmune disorder

·        Family history of pernicious anaemia

·        Have fibromyalgia

Even if you get enough B12 from your diet, you may still go on to develop a deficiency. This is because absorbing B12 is complicated. Firstly, hydrochloric acid and pepsin in the stomach are required to split the B12 from the protein. Protease enzymes then help Intrinsic factor (IF) latch onto the B12, allowing transport into the bloodstream. Without good levels of stomach acid, pepsin and IF, absorption can be compromised.  


So, if you have any of the following symptoms, continue reading:

Symptoms of B12 deficiency:

·        Balance problems

·        Numbness or tingling sensations

·        Brain fog or forgetfulness

·        Tremor

·        Depression

·        Mood swings or irritability

·        Anemia

·        Fatigue

·        Tinnitus

·        Constipation/diarrhea

·        Bloating

·        Acid reflux despite diet

·        Hormonal imbalances

·        Palpitations

·        Early onset menopause

·        Infertility (both male and female)

·        Insomnia or sleep disturbance

·        Hair loss

If you recognise two or more symptoms on this list, it is worth getting tested for B12 deficiency.

What does this mean?

Many who have a B12 deficiency may never get diagnosed because doctors often only recognise pernicious anaemia, an autoimmune illness, to cause significant B12 deficiency. However, I have seen many patients with chronic symptoms improve dramatically with intramuscular B12 injections. Most doctors rely only on serum B12 for diagnosis, but we know that testing is much more complicated (see further down in this article for testing to consider).

As levels of B12 drop, your red blood cells become enlarged. This should lead your doctor to consider a folate or B12 deficiency.  However, many things can mask this, including iron deficiency or folic acid supplementation, resulting in many people not getting an appropriate diagnosis. Also, you can have high levels of serum B12 but the vitamin is not able to get into the cells where it is needed.

Why is B12 so important?

B12 is essential for allowing thousands of chemical reactions that build your tissues, provide you with energy, remove toxins from your body, repair cell damage, enable cells to communicate with each other and protect you from infection. It is also because of this wide range of actions that people’s symptoms can be so diverse when there’s a deficiency.


Which foods contain B12?

To get B12 from your diet, you need to eat meat, poultry,fish and eggs.  If you are vegetarian or vegan it is necessary to supplement with B12. Vegans are often advised to eat algae to increase B12. However, what's found in algae are B12-analogues (false B12) that can imitate true B12 in blood tests while interfering with B12 metabolism and can mask a critically low B12 level.

Testing to aid in the diagnosis of B12 deficiency:

·        Serum B12 – this is the test most likely to be covered by the NHS but is not very reliable, especially not for vegans who are eating B12 analogues.

·        Blood homocysteine testing is more reliable,with levels less than 7 micromol/litre being desirable.

·        The most specific test for B12 status is MMA testing.

·        Holotranscobalamin II (HoloTC) or Active B12 can give a more accurate picture than serum B12 of early B12 deficiency

·        Gastrin - Gastrin is a hormone that regulates the production of acid in the stomach and can be helpful in determining gastric issues that cause B12 deficiency

·        Intrinsic Factor  and Parietal cell antibodies are helpful in diagnosing pernicious anemia.

If your doctor is refusing to test your levels, consider private testing. There are many private accredited laboratories that can perform the testing for you and it could save you thousands of pounds further down the line if this simple issue is the cause of your health issues.


Vitamin B12 injections can bypass all the difficulties that the gut has in absorbing this nutrient. Many people will feel an instant improvement in symptoms within days if they have a deficicency.

Although Vitamin B12 has not been shown to cause any harm, it is important to note that the POM (Prescription Only Medicine) form of Vitamin B12 requires proper care in its use.

As vitamin B12 is water soluble, any excess B12 should pass quickly through your system as there is minimal risk of overdosing. Be cautious with the type of B12 that is offered, there are also different types of synthetic Vitamin B12 and unfortunately many are fake or illegal for use in the UK, so it is vital that the POM being used is legal, genuine and safe to be administered by a properly trained and insured professional.

To find out whether B12 injections are suitable for you, or if you are interested in testing, please contact me for a consultation.