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The Importance of B12: Are you deficient?

Before vitamin B12 even had a name scientists knew there was a nutrient in food that joined with something in the stomach to help it's absorption. They named these two substances intrinsic factor (created in our stomach) and extrinsic factor (from food),
Feb 22, 2013 | Joy McCarthy

B12 – one of the most talked about nutrients!

Before vitamin B12 even had a name scientists knew there was a nutrient in food that joined with something in the stomach to help it's absorption. They named these two substances intrinsic factor (created in our stomach) and extrinsic factor (from food), known as B12. B12 is extremely important for energy, growth, blood formation, cell division & function and essential for a healthy nervous system.

In order for B12 to be absorbed in the intestines, it needs to bind with intrinsic factor in the stomach so intrinsic factor and digestive health is of utmost importance. It's not surprising that B12 is one of the most common nutritional deficiencies based on the number of people who have poor digestive health.

Due to the fact I have many clients come to me with low B12 I wanted to interview an expert on this topic. So I interviewed the awesomely smart and sassy Dr. Lisa Knapper of 360 Health Care on the importance of B12.

Here's what she shared with me (this was a phone interview so it's in my joyous words, not quoted directly from her):

Who is at risk of B12 deficiency?

Vegans and vegetarians tend to be most at risk if they are not supplementing because most food sources of B12 are animal products. That being said, many meat-eaters also have B12 deficiency if their digestion isn’t working properly or they are eating poorly.

What are some of the symptoms of low B12?

  • weakness, tiredness or light-headedness
  • rapid heartbeat and breathing
  • pale skin
  • sore tongue
  • easy bruising or bleeding, including bleeding gums
  • stomach upset and weight loss
  • diarrhea or constipation

If the deficiency is not corrected, it can damage the nerve cells. If this happens, vitamin B12 deficiency effects may include:

  • tingling or numbness in fingers and toes
  • difficulty walking
  • mood changes or depression
  • memory loss, disorientation, and dementia

What are some of the reasons for low B12?

  • Poor diet, not eating enough foods that contain B12
  • Low stomach acid, low intrinsic factor
  • Long-term use of acid-reducing drugs
  • Conditions affecting the small intestine, such as Crohn's disease, celiac disease, bacterial growth, or a parasite
  • Excessive alcohol consumption
  • Stress
  • Food sensitivities
  • Birth control pill

Should you take a supplement with B12?

Yes, if you are a vegan or vegetarian it is recommended, or if you have low B12.

What is the best form of supplementation and how much is recommended?

The two best methods are injection (Dr. Knapper does this) or sublingual lozenges (under the tongue) so you don't have to worry about absorption in the gut. Methylcobalamin one of the best forms. In terms of dosage recommendation, it's individual to your needs. It is also helpful to take a B-complex as folic acid can have very similar symptoms of B12 deficiency. It's very safe to take a B-complex ongoing. For those who live in Canada, Dr. Knapper and I both like this brand: AOR, Advanced B Complex.

Dr. Knapper also stressed the importance of getting the gut back on track and I couldn't agree more. Getting your levels up via an injection is helpful to correct deficiencies and bring your body back into balance. However, the root cause of the deficiency must be addressed and starting with improving digestive health is essential.

Food sources of B12 include: Eggs, meat, chicken, dairy products, oysters, fish, cheese, nutritional yeast, fortified food products, some cultured and fermented foods (ie. tempeh, make sure you buy organic non-gmo), dulse. Spirulina is not a reliable source of B12 despite what you may have otherwise heard. (I do not suggest you start slurping back the cow dairy or chowing on heaps of cheese). Whether you choose to be vegan, vegetarian or an omnivore, keep lots of variety in your diet, full of nourishing and delicious foods! 

Also, keep in mind that B12 helps keep levels of homocysteine in check which is an amino acid that may increase heart disease. 

 Lisa Knapper, ND lives and practices in Toronto. She studied at the Canadian College of Naturopathic Medicine, and is a member of the OAND and CAND. Lisa loves blending Eastern and Western medicine to guide people into optimal health. In her practice she focuses on stress management, balancing the mind and body, healthy eating and teaching sustainable healthy lifestyle habits. She is passionate about sharing her knowledge of health and preventative medicine. In her spare time, she can be found strolling around the east end with her dog. Lisa is co-owner and Naturopathic Doctor at 360 Health Care. For more information visit:

Feb 22, 2013 BY Joy McCarthy
Chantal   •   February 22, 2013

Great article. Joy/Lisa I was wondering if either of you had any opinions on the root cause of pernicious anemia? Without my methyl b12 injections my levels drop... I do lack the intrinsic factor you mentioned but I'm wondering if there is any hope of reversing this? I've been this way for over ten years now.


Healthnut Nutrition   •   February 26, 2013

I was taking that exact brand of Bcomplex and really liked it. Unfortunately I'm travelling in Australia and they don't carry that brand. Are there others you would recommend? Or do you know of any websites that shipped internationally for this product?

Joy McCarthy   •   March 3, 2013

Laura   •   February 28, 2013

I eat a healthy omnivore diet (emphasis on plants and very little meat and dairy), however, I take a b-complex. Mostly for mood and assurance. Is this completely unnecessary?

Joy McCarthy   •   February 28, 2013

fred bokler   •   March 12, 2013

I just like that but I haven't use it


  •   April 9, 2013

I went over this internet site i believe there is a lot of fantastic details, saved (:.


Laura   •   April 17, 2013

Joy, this was such a helpful article. I almost never eat meat, and I only eat dairy about once a week. I had assumed that I was getting enough B12 through my soy milk, and other fortified foods, but this made me realize that I probably wasn't. I had no idea that things such as stress and the birth controle pill would effect my amount of B12. Thank you for being such a great resource!


The Benefits of B’s by Joy McCarthy | Living Well at CCL   •   January 23, 2014

[…] Lately I’ve been reading up on Joy McCarthy’s website and her new book, Joyous Health: Eat & Live Well without Dieting. I have really enjoyed what I have been reading so far and have definitely learned a lot. I know some people are opposed to the idea of holistic nutrition, but I love it. I would rather eat the right things (and exercise) to feel better and be healthier rather than popping some pills to mask my issues. One thing I was reading the other night is how much food affects your mood and vice versa. In addition, not having certain nutrients can cause you to feel down and out and not function properly. One vitamin I was really interested in reading about was Vitamin B, particularly Vitamin B12. Based on Joy McCarthy’s blog on her website, here’s some information on B12 that can be found: […]


jackie   •   March 19, 2014

Like many of the health books out there, your book caters to a specific class of people with incomes that can afford the foods listed. In my opinion this is one major reason why unhealthy diets are so prevalant in lower middle to low income families. It is a wide spread issue that many knowledgeble professionals do not address, or provide affordable healthy alternatives.

Joy McCarthy   •   March 21, 2014

Christopher   •   May 13, 2015

I recently heard about a new oral prescription alternative to the injections called Eligen B12. I recently read that it works even if you don't have intrinsic factor (so even if you don't have normal gut absorption). Apparently it came out a month or two ago. Has anyone heard of it or tried it??


Mel   •   April 28, 2016

Hi Joy :) My prenatal vitamin has 1000 mcg folic acid and the B complex vitamin I take has 600 mcg folic acid. Do you think this is harmful (1600 mcg/day)? I've read that you shouldn't have more than 1000 mcg a day. I also have hypothyroidism and read that B12 sometimes is not absorbed properly because of the thyroid condition.. hence why I wanted to take a B complex supplement. Now I'm not sure if I should be taking the B complex. Do you happen to know if this is okay ? Thanks for any advice !

Heather Allen   •   May 2, 2016

kenishia A.   •   October 31, 2017

Thank u joy and Dr knapper for this article. This info is much needed. When I wanted to become veg before I didn't know what supplements to take or what the best brands were.Injections from a doctor, the best doctor are the best to have. I believe to, because they last in your system longer. I wish Dr. Knapper was in the U.S. but u have people who will travel the distance to get the best medical care.The reason why is because sometimes it's hard to find a great doctor.☺ I'm not saying I'm going veg. Even though I would love to still because I love plantbased food a whole lot and love the way vegetarians and vegans eat. I love my veggies and fruits and I really believe it's great for your over all health and body. No offense to eating meat. Just loving the veggies and fruits.😃


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