Introduction
In the last post, I discussed how to assess your B12 status, the tests available, reference ranges and other molecules of importance. In this post, I discuss reasons why your B12 status may be poor – and there’s a surprising number and reasons as to why this may be the case.
The Many Many Reasons your B12 levels may be Low
There are so many reasons for Vitamin B12 deficiency. They’re all scientific and complicated, and I’ll try my best to explain them and give the references. Where I can’t explian well, I’ll provide videos and references to better resources.
1. Pernicious Anemia
This is a rare condition as I understand. This is an auto immune disease whereby your immune system attacks the parietal cells on the stomach as well as the intrinsic factor that the parietal cells make. The B12 that you consume goes on an interesting journey before it can get absorbed. When food containing B12 ends up in your stomach, the parietal cells inside your stomach produces a substance/enzyme called intrinsic factor that can strip out the B12 from your food. This intrinsic factor then accompanies the B12 to your small intestine where it can finally be absorbed.
With such an interesting journey, there are many places along the route where things can go wrong. With respect to pernicious anemia, your immune system produces antibodies that attack the parietal cells and/or the intrinsic factor hereby crippling of your body to strip out B12 from your food and then transport it to your small intestine.
Since Pernicious Anemia is an auto immune disease, consuming a plant based whole foods diet can improve this condition significantly since that it does calm the immune system down.
How to test Pernicious Anemia
To test for Pernicious Anemia, you can run two blood tests; the Parietal Cell Ab(Antibody) blood test and the Intrinsic Factor Ab(Antibody) blood test. Last time I ran these tests in 2020 they costs R242.80 each.
I was super surprised to see the depth and breadth of autoimmune conditions that exist, so it may be worthwhile just doing this test once for peace of mind.
The site https://perniciousanemia.org/ has a lot of interesting information about this condition.
2. Gluten Sensitivity – Leaky Gut Syndrome
Leaky gut is a condition where the cells of your intestinal wall become porous, allowing unwanted material getting into your bloodstream, and thereafter into the rest of your body; apparently this can then lead to Vitamin B12 malabsorption.
Depending on your status, consuming gluten can exacerbate Leaky Gut.
If you have Celiac disease, then consuming even the tiniest amount of gluten can wreck you, and I would suspect diminish your B12 absorption.
Apparently, if you have a Non Celiac Gluten Sensitivity like me, then consuming of lots of gluten can inflame your gut which then leads to leaky gut and hence B12 deficiency.
The exact mechanism of how this occurs is not so clear to me, and hence why I’m personally cautious of this claim. Honestly the science is not clear as to why non celiac gluten sensitivity causes B12 deficiency but this is something worth noting.
How to Test Gluten Sensitivity
A. DNA Tests
To find out if you’re gluten sensitive or gluten intolerant you can order can a DNA test. I’ve personally done the DNAlysis Health test which cost me R2530 back in 2020. I was quite impressed with the test as it tells you a whole bunch of other interesting things.
I performed another DNA test in 2024 with 3×4 Genetics. Their test cost R4930 and I found it be a better test not only confirming many of the DNAlysis test results but also providing more information. This test also indicated my having marginal issues with gluten.
B. GIMap gut stool test
You can also do GIMap with the Zonulin add on. This is a gut stool test and these are very useful from a gut health perspective. The Zonulin can tell if you have a leaky gut. I paid R7,795.00 and I found the test to be very insightful, however there are critics of the GIMap test and it’s accuracy.
C. Calprotectin Blood Test
You can also do a blood test for calprotectin, and this is also indicative of leaky gut.
I think you have to take some of these tests with a grain of salt and a large of dose of skepticism. There’s pro and cons with these tests, and I reckon they’re very useful as a guides and they definitely do give you deeper insight into your health.
3. Helicobacter Pylori
This has got some good science behind it and it makes sense. Helicobacter Pylori (more commonly known as H Pylori) is a bacteria that is present in 50 percent of humanity. You probably have it.
This bacteria burrows into the lining on your stomach and decreases the acidity of your stomach diminishing your ability to digest your food effectively; this comes with the associated reduction in downstream mineral and vitamin absorption. Low levels of this bacteria is said to be helpful in that it reduces GERD(Gastroesophageal Reflux Disease), however if this bacteria runs rampant, then it can get nasty resulting in stomach ulcers and stomach cancers. As a quick aside, Broccoli Sprouts are a potent means to address H Pylori – this is a fascinating topic I’ll write about later.
Because H Pylori reduces the effectiveness of your stomach acid, this in turn reduces your capacity to digest and absorb vitamins and minerals. Strong stomach acid is required to cleave away the B12 from your food; weak stomach acid means poor B12 absorption.
It’s interesting to note that parietal cells, intrinsic factor and strong stomach acid are required to effectively liberate B12 from your food; and the B12 hasn’t even reached the small intestine at this point.
How to Test H Pylori
A. H Pylori Blood Antigen Test
This is a simple blood test that can be done at any Ampath lab. However the result is not accurate as it’s reflective of having had an H pylori infection. This does not mean you have a current infection, only that you may have had an H Pylori infection in the past. The value of this test is that it’s a cheap starting point that can give you direction.
B. Urea Breath Test
This test involves drinking a liquid that will interact with the H pylori. The gases that get produced can then be detected in the breath test itself.
C. Stool Test
This can also be done via an Ampath lab and it’s also very inexpensive. There are two versions of this test; an antigen and PCR test as far as I recall. A PCR(Polymerase Chain Reaction) basically tests for an active infection and is quite accurate, whereas a Antigen test will check if you’ve ever had exposure to a virus, bacteria, etc. and a negative test doesn’t rule out an active infection.
D. GIMap Gut Stool Test
This test is quite expensive, and has to be sent to an international lab. It is also a stool test, but it is non-invasive which is really good. There are critics of the GIMap with some valid concerns around the accuracy of it, but I have found that it provides some really insightful information around the gut microbiome, parasites, digestive performance, etc. including H Pylori.
E. Endoscopy Biopsy
This test has to be done at a gastroenterologists office. It’s an out-of-hospital procedure and it’s quite expensive and very invasive although very safe; additionally your medical will likely cover it very easily as it’s quite routine. It’s often done in conjunction with a colonoscopy. It requires an anesthesiologist which means you’ll be sedated. During the procedure they’ll put a scope down you throat into your stomach. Thereafter the gastro will take a biopsy which will be sent the lab for analysis. The value of the endoscopy is that they can uncover other issues like stomach ulcers. Personally I don’t like these procedures because they seem to be big money makers for the gastroenterologists, so you can’t tell if their motivations are purely in your best interest if it’s recommended.
H Pylori Test Prices
| H Pylori Blood Antigen Test | R265 |
| Urea Breath Test | Unknown |
| Stool Test : PCR | ~R250 |
| Stool Test : Antigen | ~R250 |
| GIMap | R7,795.00 |
| Endoscopy Biopsy | Unknown |
The role of Helicobacter pylori in vitamin-B12 deficiency due to metformin use
Helicobacter pylori, a causative agent of vitamin B12 deficiency
4. MTHFR Genetic Mutation
The science on this MTHFR gene mutation is heavy, so I’ll leave it to Gojiman to explain in the video below.
Here’s my layman’s description of it. You a have a methylation cycle that occurs in your body which involves attaching and detaching methyl groups(a combination of 3 Hydrogen and 1 Carbon atoms) to certain other molecules to enable key biological processes. One such process would be convert Methionine into Homocysteine by removing a methyl group, and the reverse process is converting Homocysteine into Methionine by adding a methyl group. Vitamin B12, vitamin B6 and folate are important for these processes because they provide the methyl groups. Keep note of the terms because you’ll see how they all connect.
This latter process of converting Homocysteine into Methionine uses the MTHFR gene which relies on methyl groups provided by vitamin B12, vitamin b6 and folate. If you have acquired a mutated MTHFR gene from one or both of your parents, then the MTHFR struggles to convert homocysteine into Methionine, resulting in a build up of Homocysteine which puts you at greater risk of a stroke and other cardiovascular issues. Now you can see why testing for homocysteine makes sense. The same is true for Folate and Vitamin B6. You need Folate(not Folic Acid found in supplements!) to aid the the methylation cycle as well.
I’ve have a MTHFR gene mutation which means I need to take more Vitamin B12 to enable effective Methylation.
I also have a genetic quirk in that I’m what’s known as a Medium Taster. This means that I can discern a bitter flavor more than most people, and as such I don’t like dark leafy greens because they’re bitter. The crux of this, is that I therefore don’t get enough folate from the best sources of folate – dark leafy greens, so I’ve had to figure out ways to make it palatable.
To sum up, I’ve got two genetic oddities that require me to have more Vitamin B12 and Folate in order for my Methylation to work.
I do take the supplements Metagenics Methylcare and Now Sunflower Lecithin. These have been phenomenal in getting my B12 and homocysteine under control as seen in the previous post.
How to test MTFHR gene mutations
In recent years, genetic testing has become much more afforble. I did the DNAlysis Health Test back in 2020 and the test was R2530 at that point.
I found it to be one of the most useful tests I’ve done, in that it gave me insight around my poor B12 methylation, the Medium Taster quirk, poor choline conversion, lactose intolerance, gluten insensitivity and a couple of other things.
Super-Tasters and Non-Tasters: Is it Better to Be Average?
5. Intestinal Parasite
This is the stuff of nightmares. I was shocked to learn that a tapeworm parasite called Diphyllobothrium Latum could eat all of your Vitamin B12 and send your life spiraling into oblivion. However it’s good to be aware of yet another potential reason as to why your B12 might be low. I have no idea how you would test for this parasite in South Africa.
Dr Neal Barnard does make reference to testing of the parasites here, but I need to delve into this topic more.
6. Certain Combinations of Supplements and Pharmaceuticals can reduce levels of B12
I recently came across an article stating that consuming Vitamin C(ascorbic acid) with Vitamin B12 may reduce the available amount of B12 in your body. This claim sounded dubious to me, so I went in search for better information. I came across this article by the Mayo Clinic expanding on this idea, mentioning that other drugs and supplements can reduce the available amount of B12 in your body. The solution to the Vitamin C & B12 problem is to take the two a few hours apart.
The Mayo Clinic specified a couple of other medications that can diminish Vitamin B12 levels in your body.
- Proton pump inhibitors – This will reduce your stomach acid interfering with absorption of Vitamin B12. It’s interest to note that H Pylori also reduces stomach acid.
- Aminosalicylic acid (Paser) , Colchicine (Colcrys, Mitigare, Gloperba and Metformin (Glumetza, Fortamet, others) – These drugs can also interfere with B12 absorption.
Spirulina – Is It Blocking Your B12 Absorption?
Vitamin B12 supplement interactions
Identify medication-caused nutrient deficiencies with Mytavin’s curated search tool.
7. Viruses can reduce levels of B12
There’s a lot of solid emerging science stating that when you catch a flu or virus, your B12 levels can drop. This makes sense because your body needs more nutrients in order to recover.
It’s actually been known that HIV can result in vitamin B12 deficiency. A common mechanism for viral replication is for the virus to hijack mitochondria and then use it’s machinery to make copies of itself. I find this quite interesting because the mitochondria is where the Krebs cycle and methylation occurs in order to generate energy(ATP) for the body. If these viruses are using the resources for methylation like vitamin B12, vitamin B6, etc. to make copies then that does explain some of the symptoms of B12 deficiency like fatigue.
Given that there’s been an explosion of viruses in recent years resulting in multiple year round infections from things like swine flu, zika, west nile, covid, rubella, measles, cholera, etc. we can expect to see much more vitamin B12 deficiency.
8. Veganism
Being on a vegan diet can also lead to B12 deficiency if you don’t supplement. The issues related to B12 deficiency won’t show up immediately because your liver stores vitamin B12 for a couple of years, usually around three years. This can be problematic because you can experience the profound health benefits of these plant based diets very quickly, and feel great for the first few years. But then the symptoms of the B12 deficiency can kick in and you’ve got no idea what’s happening. So it’s critically important to get good solid nutritional guidance before going on a vegan diet. This can happen on a vegetarian diet, but it’s less likely because vegetarians eat eggs and dairy which does contain B12.
Conclusion
I was gob smacked to see how many ways in which you can become vitamin B12 deficient. Nutrition alone is a complex subject, and now you throw in other factors like genetics, viruses, autoimmunity, parasites, bacteria and supplements amongst others and vitamin B12 deficiency becomes a real major concern. Considering that the worst outcome of B12 deficiency are neurological issues like irreversible brain damage and neuropathies then knowing your status becomes critical.
I hope I’ve highlighted the complex and subtle nature of this intriguing vitamin with this post. In the next and final post, I’ll wrap things up by discussing some of the major insights I’ve had diving into the fascinating topic.
Photo by Dose Juice on Unsplash
References
B12 Absorption – Best Forms Of Vitamin B12 For Maximum Absorption
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