Cooked clams
Cooked clams is one of the best foods to eat when trying to put vitamin B-12 into your diet. (Federico Stevanin/Free Digital Photos)

Have you been experiencing a personal energy crisis lately? If so, you may want to have your levels of vitamin B-12 checked. Ditto if you’ve been having symptoms like muscle weakness, constipation, numbness, tingling in your hands and feet, balance problems, depression, brain fog, memory lapses or unexplained swelling or soreness in your mouth.

Your body needs this water-soluble vitamin for proper formation of red blood cells, neurological function and synthesis of DNA (the genetic material in all cells), among other reasons. Yet many people don’t have nearly enough of this vital nutrient in their bodies.

Hidden Deficiency

“It’s a bigger problem than most people think—B-12 deficiencies are underdiagnosed and under-recognized,” says Lisa Hark, a Philadelphia-based family nutrition expert and co-author of Nutrition for Life. Research from the prestigious Framingham Study found that 12 percent of older adults were deficient in B-12.

Unlike other nutrient deficiencies, lack of B-12 often goes unrecognized because the symptoms generally develop gradually and are somewhat vague.

Besides draining your energy, a vitamin B-12 deficiency can lead to anemia, and it can damage the nervous system. What’s more, a 2012 study from Australia found that even mild B-12 deficiencies are associated with an increased risk of cognitive impairment, dementia and Parkinson’s disease.

Who’s at Risk?

Anyone can develop a B-12 deficiency, but your risk is especially high if you have a digestive disorder like celiac disease or Crohn’s disease or if you have pernicious anemia (an autoimmune disease that prevents the body from making the intrinsic factor that’s needed to absorb vitamin B-12). Vegetarians and vegans are also at risk because only foods that are derived from animals contain B-12 naturally.

Medications that are used to treat heartburn, gastroesophageal reflux disease (GERD) and peptic ulcer disease—such as proton pump inhibitors and histamine H2 receptor antagonists—can slow or block the release of acid into the stomach, thereby interfering with the body’s ability to absorb B-12 from food. In addition, Metformin, a drug that’s used to treat diabetes, may also reduce B-12 absorption.

Get Tested

A blood test, which your family doctor can order, can usually reveal if you’re deficient in B-12. But if there’s any question about a false-normal reading (which can and does happen sometimes), it’s smart to have your levels of homocysteine (an amino acid) and methylmalonic acid (a substance produced when amino acids in the body break down) checked, Hark says. Measures of these substances can get out of whack when a B-12 deficiency is present.


Treatment for B-12 deficiency depends on the cause. If it’s simply because you’re not consuming enough foods rich in B-12, increase your intake of fish, shellfish, beef and beef liver, poultry, fortified cereals, milk, yogurt and eggs.

“If you’re a vegetarian, hemp milk and soy milk are often fortified with B-12,” Hark notes, or you can take supplements. The recommended daily intake is 2.4 mcg.

If you’re deficient because your body is not producing enough stomach acid or you’re taking acid-blocking medications, supplements may not work. You may have trouble absorbing the vitamin without enough stomach acid, Hark warns. In that case, a once-a-month injection of B-12, available by prescription, may be recommended.

For those who don’t like shots, there’s also a daily sublingual (under the tongue) tablet that passes through the mucous membrane in the mouth and into the bloodstream and a nasal spray that’s used once a week. Keep in mind that a B-12 deficiency that’s due to absorption problems requires treatment for life.

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