Vitamin B12 Deficiency: Symptoms & Treatment

 

Vitamin B12 is not made by plants or animals, but by microbes that blanket the earth. In today’s sanitized, modern world, the water supply is commonly chlorinated to kill off any bacteria. So, while we don’t get much B12 in the water anymore, we don’t get much cholera, either, which is a good thing!

 

Why Vitamin B12 Is Important

Though it may take years for deficiency to develop in those starting out with adequate stores of vitamin B12, the results of B12 deficiency may include a magnitude of devastating physical and psychiatric symptoms, including death.

Newborn infants of mothers who eat a plant-based diet and fail to supplement may develop deficiency much more rapidly—and with disastrous results. Getting enough vitamin B12 is absolutely non-negotiable for those centering their diets around plant-based foods.

 

How Much Vitamin B12 Do We Need?

I recommend:

• at least 2,000 mcg (µg) cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement taken on an empty stomach
• or at least 50 mcg daily of supplemental cyanocobalamin 
• or a serving of B12-fortified foods three times a day, each containing at least 190 percent of the Daily Value listed on the nutrition facts label

Those over 65 years of age should take at least 1,000 mcg (µg) cyanocobalamin every day.

And, here’s a tip: If you’re experiencing deficiency symptoms, the best test is a urine MMA—not serum B12 level).

How much vitamin B12 should be taken at different stages of life? Check out my videos The Optimal Vitamin B12 Dosage for Adults and The Optimal Vitamin B12 Dosage for Kids, Pregnancy, and Seniors which go into detail. This chart may be useful as an overview:

 

What Are The Symptoms of Vitamin B12 Deficiency?

As I elaborate on in my video The Symptoms of Vitamin B12 Deficiency, these include:

• Abdominal distention
• Chronic diarrhea
• Shortness of breath
• Swollen, red, painful feet
• Skin darkening
• Bilateral useless hand syndrome
• Numbness and tingling in the hands and feet
• Muscle cramps
• Dizziness
• Cognitive disturbances
• Difficulty walking
• Erectile dysfunction
• Fatigue
• Depression
• Psychosis
• Coma
• Blindness

 

Vitamin B12 Deficiency Treatment

 

Is A Vitamin B12 Shot Better Than Taking B12 Orally?

Your doctor may want you to get vitamin B12 shots, but did you know that oral B12—even for those who can’t absorb it well—has long been considered one of medicine’s best kept secrets? In fact, it’s been found that B12 supplements taken orally are just as effective as intramuscular shots in overcoming states of deficiency when you take up to 1,000 micrograms a day.

 

Too Much B12 and Acne

You may have heard that vitamin B12 can cause acne, but that isn’t the whole story. As first described back in the 1950s, about one in ten people erupted in acne within days or even hours of getting an injection of vitamin B12, but it disappeared rapidly when the B12 shots stopped. Certainly, those on plant-based diets have to take supplemental B12, but we don’t have to get B12 shots. Vitamin B12–related acne tends to occur only in dosages in excess of 5,000 to 10,000 micrograms a week, which is well in excess of the 50 daily micrograms or single 2,000 mcg weekly dose I recommend. (Those over 65 years of age, however, should take at least 1,000 mcg cyanocobalamin every day.) If you get a B12 injection, the likelihood of it triggering acne may only be about one in ten.

 

What Are The Sources Of Vitamin B12?

If you want to get your B12 from fortified foods rather than take supplements, you’d have to eat three separate servings of B12-fortified foods, ideally with each serving containing at least 190 percent of the Daily Value on the product’s nutrition facts label.

Foods sources of B12 include:

• Fortified plant-based meats
• Fortified plant-based milks
• Fortified breakfast cereals
• Fortified energy drinks

Are there any green light foods that contain vitamin B12?

Nutritional yeast is a commonly B12-enriched food source and one of my favorites. 

How much nutritional yeast would you need to meet the recommended daily B12 dosage for an adult under the age of 65? It depends on the brand. For instance:

• Bragg’s: 1 teaspoon three times a day
• NOW: 2 teaspoons three times a day
• Bob’s Red Mill: 1 tablespoon three times a day
• KAL: 1 tablespoon three times a day
• Red Star: 1 tablespoon three times a day (note that only certain varieties are fortified)
• Trader Joe’s: 1½ tablespoons three times a day

Heads-up that Dr. Fuhrman’s nutritional yeast and Frontier Co-op’s are unfortified.

Check out my video The Healthiest Food Sources of Vitamin B12.

 

What Kinds Of Vitamin B12 Dietary Supplements Are Available?

There are two types:

1. Cyanocobalamin
2. Methylcobalamin

Which is better? I discuss this in my video The Best Type of Vitamin B12: Cyanocobalamin or Methylcobalamin.

I take cyanocobalamin as my B12 supplement for two reasons: its high stability and its track record of safety and efficacy.

Methylcobalamin is less stable than cyanocobalamin and is particularly susceptible to photodecomposition—that is, destruction from light exposure. One study found that even up to 2,000 micrograms a day of methylcobalamin wasn’t enough to correct vitamin B12 deficiency in one of three vegans tested.

There may be one caveat, though. Methylcobalamin may be better for those with impaired kidney function. It’s also been speculated that oral methylcobalamin or injected hydroxycobalamin may be preferable in smokers, but that hasn’t been confirmed. If you do have decreased kidney function and your doctor recommends methylcobalamin, you may need a much higher dose because it’s less stable, so be sure to ask them about what’s best given your condition.

 

Large study finds no added risk of rare artery tear following chiropractic neck care

 by University Hospitals Cleveland Medical Center

Getting your neck adjusted by a chiropractor does not appear to raise the risk of a rare but serious artery injury, according to a large observational study from a multidisciplinary collaboration including researchers at University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland Clinic and Duke University.

The study, published in Chiropractic & Manual Therapies, examined the association between chiropractor-administered spinal manipulation and cervical artery dissection, a relatively rare condition involving a tear in a neck artery that can lead to stroke.

Analyzing data from more than 862,000 adults who sought care for a new episode of neck pain or headache, the study found no evidence of an increased risk of cervical artery dissection among patients receiving chiropractor-administered cervical spinal manipulation compared with those prescribed ibuprofen.

Comparing two care approaches

Researchers analyzed health records and insurance claims from a U.S. database covering patients treated between 2010 and 2025. After excluding anyone with a prior history of cervical artery dissection or related conditions, they used statistical matching to build two comparable groups of more than 431,000 patients each: one that received chiropractic neck manipulation and one that instead received an ibuprofen prescription for neck pain or headache.

By matching the groups and balancing factors such as age, sex and other health conditions, researchers could rigorously compare outcomes between the two care approaches. In the final analytic sample, 31 patients in the chiropractic group and 58 patients in the ibuprofen cohort were diagnosed with a new cervical artery dissection within 30 days of follow-up.

"To address this complex clinical question, we formed a multidisciplinary collaboration, including authors representing chiropractic, cardiology, neurosurgery, physical therapy, orthopedic surgery and biostatistics, and developed and registered a formal research protocol, making this one of the most methodologically rigorous studies on the topic to date," said Robert Trager, DC, lead author and Buoncore Family Endowed Director of Chiropractic Medicine at University Hospitals Connor Whole Health.

"People often ask me whether chiropractic care for neck pain is safe," said Christine Goertz, DC, Ph.D., co-author and researcher at the Duke Clinical Research Institute. "This study is some of the best evidence yet that the answer to that question is yes."

Accounting for early warning signs

Several reasons make studying this question harder than it sounds. First, cervical artery dissection is a rare event, making it impractical to study using a randomized clinical trial. Second, benign neck pain and headache are common reasons to seek chiropractic care, but they can also be early warning signs of an undiagnosed artery tear.

Together, these factors make it difficult to evaluate causation. Because this bias was well established in prior studies, the research team took several steps to mitigate it, principally by restricting the study to adults seeking care for a new episode of neck pain or headache.

Ear infection: a retrospective study examining improvement from chiropractic care

 

• PMID: 8728460

Abstract

Objective: The aims of this study were to determine (a) if the patients improved while under chiropractic care; (b) how many treatments were needed to reach improvement; and (c) which factors were associated with early improvement.

Design: Cohort, nonrandomized retrospective study.

Setting: Private chiropractic practice in a Minneapolis suburb.

Participants: Forty-six children aged 5 yr and under.

Intervention: All treatments were done by a single chiropractor, who adjusted the subluxations found and paid particular attention to the cervical vertebrae and occiput. Sacral Occipital Technique-style pelvic blocking and the doctor's own modified applied kinesiology were also used. Typical treatment regimen was three treatments per week for 1 wk, then two treatments per week for 1 wk, then one treatment per week. However, treatment regimen was terminated when there was improvement.

Outcome measure: Improvement was based on parental decision (they stated that the child had no fever, no signs of ear pain, and was totally asymptomatic), and/or the child seemed to be asymptomatic to the treating DC and/or the parent stated that the child's MD judged the child to be improved. A data abstraction form was used to determine number of treatments used and presence of factors possibly associated with early improvement.

Results: 93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments. Young age, no history on antibiotic use, initial episode (vs. recurrent) and designation of an episode as discomfort rather than ear infection were factors associated with improvement with the fewest treatments.

Conclusion: Although there were several limitations to this study (mostly because of its retrospection but also, significantly, because very little data was found regarding the natural course of ear infections), this study's data indicate that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children.

PubMed Disclaimer

What Are the Health Benefits of Indian Gooseberry (Amla)?

 Amla, also known as Indian gooseberry, is one of the most antioxidant-rich foods on Earth. Though unfamiliar to many, particularly in Western countries, powdered and dried amla fruit is commonly used in Ayurvedic herbal preparations and the subject of hundreds of articles in the medical literature, including papers with hyperbolic titles like “Amla…a Wonder Berry in the Treatment and Prevention of Cancer.”

Are All Gooseberries the Same?

Indian gooseberries are not to be confused with Barbados gooseberries, Cape gooseberries, Chinese gooseberries (also known as kiwi fruit), Jamaican gooseberries, or Tahitian or star gooseberries.

Amla and Cancer

In vitro studies have shown that amla may have anticancer properties and not only appear able to block cancer cell growth, but also cancer cell invasion. Amla kills cancer cells but leaves normal cells alone. It was tested against six human cancer cell lines: lung cancer, liver cancer, cervical cancer, breast cancer, ovarian cancer, and colon cancer. When amla was dripped on cancer cells, the growth rates cut in half, then stopped completely. Amla then began killing off the cancer. By the end, more than half the cancer cells were dead. 

A Powerful Source of Antioxidants

Amla is, on average, the single most antioxidant-packed whole food on the planet. One teaspoon of gooseberry powder costs about four pennies and provides 1,500 units of antioxidant power, which is more than the average person gets in an entire week.

Reducing Our Cholesterol

Just 500 milligrams of powdered amla, which is about a tenth of a teaspoon, may work as well as Zocor, a leading cholesterol-lowering drug.

Improving Our Arterial Function

Amla may reduce artery stiffness, so it may be a good alternative to statins in individuals with diabetes who have artery dysfunction because of its benefits without the adverse effects of drugs, which may include muscle damage or liver dysfunction.

Amla and Diabetes

Some clinical research has also shown that amla powder may work as well as a leading diabetes drug—again without the side effects.

Better Digestion

Dyspepsia is a fancy word for an upset stomach—feelings of fullness, discomfort, nausea, bloating, belching—affecting up to one in five individuals. One teaspoon of dried Indian gooseberry powder three times a day may work as well as a gel antacid every three hours: significant decreases in peak acid output and a cutting of dyspepsia symptom scores in half.

Other Benefits

Indian gooseberries have also been found to have cough-, fever-, pain-, stress-, and diarrhea-suppressing effects.

Where to Find Amla

Amla can be purchased online or at Indian spice stores. Although some Ayurvedic herbal supplements have been found to be contaminated with heavy metals, none of the samples of powdered amla tested so far appear to be contaminated. Whole Indian gooseberries can be found in the frozen section of Indian grocery stores, but some find them inedible—astringent, sour, bitter, and fibrous all at the same time. The powder isn’t much tastier, but it can be disguised in something with a strong flavor, like a smoothie. Alternatively, amla can be packed into capsules.

Eating Amla Fruit

Amla can be bought in various forms: frozen, dried, sweetened, salted, pickled, packed in syrup, packed in nitrogen. Add a teaspoon of powder to smoothies, and you probably wouldn’t even taste it.

How to Reduce Cholesterol Naturally: What Foods Should Be Eaten & Avoided?

 

Eat Heart-healthy Foods

A large body of evidence shows there were once enormous swaths of the world where the coronary heart disease epidemic seemed to be almost non-existent, such as rural China and sub-Saharan Africa. It’s not genetics: When people move from low- to high-risk areas, their disease rates appear to skyrocket as they adopt the diet and lifestyle habits of their new homes. The extraordinarily low rates of heart disease in rural China and Africa have been attributed to the extraordinarily low cholesterol levels among these populations. Though Chinese and African diets are very different, they are both centered on plant-derived foods, such as grains and vegetables. By eating so much fiber and so little animal fat, their total cholesterol levels averaged under 150 mg/dL, similar to people eating contemporary strictly plant-based diets.

Calorie Restriction

In The Benefits of Calorie Restriction for Longevity I discuss the CALERIE study (the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy). It was the first clinical trial to test the effects of caloric restriction. Hundreds of non-obese men and women were randomized to two years of 25 percent calorie restriction. They only ended up achieving half that but lost about 18 pounds and three inches off their waists, wiping out more than half of their visceral abdominal fat. That translated into significant improvements in cholesterol levels, triglycerides, insulin sensitivity, and blood pressures

 

What Foods Lower Your Cholesterol Fast?

 

1. Oats

The fiber in oatmeal can lower our blood cholesterol levels so less gets stuck in our arteries. There are also anti-inflammatory and antioxidant phytonutrients in oats that can help prevent atherosclerotic buildup and then help maintain arterial function. Check out my video Can Oatmeal Reverse Heart Disease? for more on this.

2. Barley

As I discuss in Whole Grains May Work as Well as Drugs, just a single serving a day of barley may lower your cholesterol.

3. Beans

In a randomized crossover trial, adding two servings a day of lentils, chickpeas, beans or split peas cut cholesterol levels so much that many participants moved below the range for which statin drugs are typically prescribed. Learn more about this in Beans, Beans, They’re Good for Your Heart.

4. Amla (Indian gooseberries)

As discussed in the video Amla vs. Drugs For Cholesterol, Inflammation, & Blood-Thinning, 500 milligrams (which is like a tenth of a teaspoon) of powdered amla works just as well as Zocor, a leading cholesterol-lowering drug. 

5. Brazil nuts

A single serving of Brazil nuts may bring cholesterol levels down faster than statin drugs and keep them down even a month after that single ingestion. I go into more detail on this in Four Nuts Once a Month. 

 

What Foods Should Be Avoided?

To drastically reduce LDL cholesterol levels, it appears we need to drastically reduce our intake of: 

1. trans fat, which comes from processed foods and naturally from meat and dairy
2. saturated fat, found mainly in animal products and junk foods
3. dietary cholesterol, found exclusively in animal-derived foods, especially eggs.

For those who have tried eating a whole food plant-based diet and still have high LDL, you should make sure you’re not eating plant sources of saturated fat, such as palm kernel oil, palm oil, coconut oil, and cocoa butter (found in chocolate). Of course if you were you wouldn’t be eating a whole food plant-based diet, but you’d be surprised how many people tell me they are and they’re like “Yeah, and I eat a spoonful of coconut oil a day.” I’d also cut out unfiltered coffee. Then once you have gotten rid of the things that increase your cholesterol you need to pack your diet with foods that actively lower your cholesterol. 

 

What About The “Cholesterol Myth”?

I wrote about the cholesterol “skeptics” in my book Carbophobia (now available free, full text online).

I think the issue was best summarized in a medical journal editorial entitled Cholesterol Myth Club on Par with Flat Earth Society that read: “as mixed up as Flat Earth Society members obviously are, at least you can laugh their dumb idea off, and if you want to believe the Earth is flat, this view is not going to cause serious problems like… coronary artery disease.”

 

Lastly, here are some of the best videos to help understand more about diet and cholesterol. Sometimes folks will ask questions like does cholesterol have a lower limit, or, what about the size of LDL particles does that matter? ​Thankfully Dr. Greger addresses this in his video: Does LDL size matter? and Cholesterol does not appear to have a lower limit. A few concerns with dietary cholesterol is that there’s a plateau effect issue and the postprandial (after eating) issue. These videos explain the issues further: When Low Risk Means High Risk and Eggs and Arterial Function. Find out what’s an Optimal Cholesterol Level to shoot for. 

Is Almond Milk Better Than the Moo?

 

Milk from Almonds vs. Milk from Cows

Almond milk is more healthful than dairy milk, which contains saturated animal fat, cholesterol, and hormones. Cows’ milk has been found to stimulate the growth of prostate cancer cells in vitro, for instance, producing an average increase in cancer growth rate of more than 30 percent. In contrast, almond milk suppressed the growth of these cancer cells by more than 30 percent.

Sweetened vs. Unsweetened Almond Milk

The difference between these two types of almond milk is added sugar in the sweetened variety. In general, I favor cutting down on the intake of empty calories whenever possible. Since we get only about 2,000 in our calorie bank each day, why not make each one count? But, if the only way you’ll drink green tea is with sweetened almond milk, then, overall, it would be healthier for you to choose the variety with added sugar. (Your taste buds would likely adapt to the unsweetened kind, though, so give it a try for a couple weeks.)

Is Almond Vanilla Milk Good for You?

Many almond milks are fortified with calcium, vitamin D, and vitamin B12, which benefit us, but what about the vanilla? That’s an interesting question.

Given vanilla’s popularity, I was surprised to find that there isn’t much science published on the health effects of vanilla orchid fruit phytonutrients. There are two in vitro studies that suggest vanillin, one of the many aromatic compounds in vanilla, may be protective against colorectal and cervical cancers, but, to my knowledge, no clinical or epidemiological studies have been published.

The most unusual study on vanilla may be one that was published out of Germany in 1999. Researchers wanted to know if our olfactory memory goes back even further than our verbal memory. Do we subconsciously remember tastes and smells from our infancy before we could even put them into words? There was a time when certain German infant formulas were flavored with vanilla, so the researchers challenged a group of adults with a vanilla-containing food. Since they couldn’t just use a typical vanilla-flavored confection as it could introduce too many other new variables, they had to choose something no one would have ever associated with vanilla, so they concocted a vanilla-flavored ketchup. Their findings? Two-thirds of those who had been bottle-fed with vanilla-flavored formula as infants preferred the vanilla ketchup, whereas two-thirds of the those who hadn’t been exposed to vanilla at that early age chose the regular ketchup.

Are There Any Downsides to Almond Milk?

Many almond milks available to us in grocery stores often contain added salt and thickeners of questionable safety, such as carrageenan. (For more on that, see my video Is Carrageenan Safe?.)

Kids shouldn’t drink too much almond milk. There have been a few case reports of young children drinking four cups a day and running into problems with kidney stones due to almond milk’s relatively high oxalate content, which averages about five times more than soy milk.

Making Almond Milk at Home

It’s so easy to make your own almond milk. Simple add 2 tablespoons of smooth, raw almond butter and 2 cups of water in a high-speed blender, then blend until smooth. Transfer the almond milk to a glass bottle or jar with a tight-fitting lid, and chill until ready to serve. Shake well before using and enjoy.

How can I boost my metabolism naturally?

 Drinking two cups of water increases the metabolic rate of men and women by 30 percent.

The metabolic boost starts within ten minutes of drinking water and reaches a maximum within an hour. In the 90 minutes after drinking a single, tall glass of water, study subjects burned about an extra 25 calories. Do that four times throughout the day, and you could wipe out 100 extra calories.