6 Causes of a Vitamin B12 Deficiency You've Never Heard Before

Dr. Eric Berg 04/30/2024

I want to tell you a secret about Vitamin B12 deficiency. It's not just about what you eat (or don't eat). There's a whole world of hidden causes lurking beneath the surface, waiting to sabotage your B12 levels when you least expect it.

Ready to have your mind blown? Let's unpack the surprising culprits behind B12 deficiency, so you can spot the signs and keep your levels in check. Trust me, you don't want to miss this.

Uncovering Hidden Causes of B12 Deficiency

When it comes to vitamin B12 deficiency, the first thing that usually comes to mind is a lack of animal products in the diet. But there's more to the story than just what's on your plate.

Certain conditions and substances can impact your body's ability to absorb and use this crucial nutrient, even if you consume plenty of B12-rich foods. Let's take a closer look at some of these hidden factors that can contribute to a deficiency.

The Role of H. pylori Infection

Did you know that around 80% of the population has Helicobacter pylori (H. pylori) bacteria in their body? While many people with this infection don't experience symptoms, it can lead to some serious stomach issues.

H. pylori can cause ulcers, gastritis, and even atrophy of the stomach lining over time. When the stomach lining is damaged, it can't produce enough intrinsic factor, a protein essential for B12 absorption in the small intestine.

So even if you're eating plenty of B12-rich foods like meat, poultry, and eggs, an untreated H. pylori infection could prevent your body from properly absorbing and utilizing this vital nutrient.

Metformin and B12 Absorption

Metformin is a common medication used to manage type 2 diabetes, but did you know it can also impact B12 levels? Studies have shown that long-term use of metformin can lead to a B12 deficiency in some people.

The exact mechanism isn't fully understood, but it's thought that metformin may interfere with the absorption of B12 in the small intestine.

This is especially concerning for older adults, who are already at a higher risk of B12 deficiency due to age-related changes in the digestive system.

If you're taking metformin, you must talk to your healthcare provider about monitoring your B12 levels and potentially supplementing to prevent a deficiency.

Genetic Factors in B12 Utilization

Did you know that your genes can also play a role in B12 deficiency? Certain genetic variations can affect how well your body absorbs and activates this vital vitamin.

For example, mutations in the MTHFR gene can impact the conversion of inactive B12 to its active form, methylcobalamin. This means that even if you're consuming enough B12, your body may be unable to use it effectively.

While genetic testing can help identify these variations, working with a knowledgeable healthcare provider to interpret the results and develop an appropriate treatment plan is important.

In some cases, high-dose B12 supplements or injections may be necessary to overcome genetic barriers to absorption and utilization.

The Interplay Between Medications and Nutrient Absorption

Not just conditions like H. pylori infection can impact B12 absorption - certain medications can also interfere with your body's ability to absorb and use this essential nutrient. Let's take a closer look at some common culprits.

Dental Procedures and Nitrous Oxide

Have you ever had a dental procedure that involved nitrous oxide, also known as laughing gas? While this sedative can help you relax during a filling or root canal, it can also have unintended consequences for your B12 levels.

Nitrous oxide can inactivate vitamin B12 in the body, leading to a functional deficiency. This means that even if you have enough B12 stored in your liver, your body may not be able to use it effectively.

The effects of nitrous oxide on B12 can last for days or even weeks after exposure, so it's important to talk to your dentist about alternatives if you're concerned about your B12 status.

If you do need to use nitrous oxide, make sure to supplement with B12 before and after the procedure to minimize the risk of deficiency.

The Impact of Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are a class of medications used to treat acid reflux, ulcers, and other digestive issues. They work by reducing the amount of acid produced in the stomach.

But while they can relieve uncomfortable symptoms, they can also have some unintended consequences for nutrient absorption.

PPIs can interfere with the absorption of B12 by reducing the acidity of the stomach. This is because B12 needs an acidic environment to be released from the proteins in food and bind to intrinsic factor for absorption in the small intestine.

Long-term use of PPIs has been linked to an increased risk of B12 deficiency, especially in older adults. If you're taking a PPI, talking to your healthcare provider about monitoring your B12 levels and potentially supplementing to prevent a deficiency is important.

The Masking Effect of Folic Acid on B12 Deficiency

Folic acid is a synthetic form of folate, a B vitamin that's essential for DNA synthesis and red blood cell production. It's often added to fortified foods like breakfast cereals and breads to help prevent neural tube defects in pregnancy.

But while folic acid fortification has been successful in reducing the incidence of these birth defects, it may also be masking a hidden problem: vitamin B12 deficiency.

Pills forming B12 shape

Fortified Foods and Nutrient Interactions

The problem with folic acid is that it can correct the megaloblastic anemia caused by B12 deficiency, but it doesn't address the underlying deficiency itself.

This means that someone could have a serious B12 deficiency but not show any obvious symptoms because the folic acid is masking the anemia.

Over time, untreated B12 deficiency can lead to irreversible neurological damage, even if the anemia is being corrected by folic acid. This is why it's so important to test for B12 deficiency, especially in older adults and vegetarians/vegans who may be at a higher risk.

While food fortification can be a useful tool for preventing nutrient deficiencies, it's important to be aware of potential interactions between nutrients like folic acid and B12.

If you're relying on fortified foods as a major source of your B vitamins, make sure also to include plenty of B12-rich foods in your diet or consider supplementing to ensure you're meeting your needs.

Conclusion

Causes of B12 deficiency go way beyond just skimping on meat or forgetting your supplements. From sneaky infections to medications that do more harm than good, the list of potential B12 saboteurs is longer than you might think.

But here's the good news: armed with this knowledge, you've got the power to take control of your B12 levels. Watch out for those hidden causes, talk to your doc, and give your body the B12 love it deserves.

Your energy levels (and your taste buds) will thank you. Trust me, I've been there. And with a little TLC, you'll be back to feeling like your best self in no time.