New Vitamin B12 Test

New Vitamin B12 Test
4.66 (93.13%) 32 votes

Who should get tested for vitamin B12 (cobalamin) deficiency, and which is the best test to use: serum B12, methylmalonic acid (MMA), or holotranscobalamin levels?

Discuss
Republish

Should people who eat plant-based diets be tested for vitamin B12 deficiency? In my opinion, medical tests should only be ordered if the results, one way or the other, are going to change what you do. If your test came back showing your B12 levels were low, what would you do? You’d insure a regular, reliable source of vitamin B12. If your tests came back showing your levels were okay, what would you do? You’d ensure a regular, reliable source of B12, because you wouldn’t want them to become not okay.

So, if it’s not going to matter either way, I wouldn’t worry about it—with two exceptions. I recommend anyone with unexplained neurological, psychiatric, or developmental symptoms be tested—especially in infants, toddlers, vegans, and anyone over 50. And, out of an abundance of caution, I’ve always tested all my pregnant and breastfeeding vegan patients, just because the consequences of deficiency are so potentially devastating.

Better than getting a serum B12 level drawn, though, which most doctors do, a methylmalonic acid level is a superior test for B12 deficiency, which can be blood or urine. You can just pee in a cup for it.

Here’s why measuring MMA levels is better. About 50 people started eating vegan. Within a few years, half became B12-deficient. But look at their B12 levels. All these vegans had functional B12 deficiency, despite normal levels of B12 in their blood—showing that MMA is a more effective test.

Now, there has been a case report published of someone with apparent B12 deficiency, who had normal B12 and MMA levels. So, we’re always looking for a better test, and it looks like HoloTC is it, measuring Holotranscobalamin levels; shown to be more sensitive and specific, meaning fewer false negatives and false positives. If your level is under 20, you start treatment. If it’s over 30, you can be pretty sure you’re okay. And if it’s in the middle, you follow up with a second-line test.

If you are deficient, you can be treated with a ruby-red mad-scientist-looking injection of B12. The color is from the cobalt in the molecule. But one of medicine’s best kept secrets is the efficacious use of high-dose oral B12 — safer, cheaper. 2,000 microgram supplements every day for two weeks should do it, before having patients starting or resuming their regular, reliable regimen of B12.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is transcript contributed by Bruce A. Hamilton.

Please consider volunteering to help out on the site.

Image thanks to Bobjgalindo via Wikimedia Commons

Should people who eat plant-based diets be tested for vitamin B12 deficiency? In my opinion, medical tests should only be ordered if the results, one way or the other, are going to change what you do. If your test came back showing your B12 levels were low, what would you do? You’d insure a regular, reliable source of vitamin B12. If your tests came back showing your levels were okay, what would you do? You’d ensure a regular, reliable source of B12, because you wouldn’t want them to become not okay.

So, if it’s not going to matter either way, I wouldn’t worry about it—with two exceptions. I recommend anyone with unexplained neurological, psychiatric, or developmental symptoms be tested—especially in infants, toddlers, vegans, and anyone over 50. And, out of an abundance of caution, I’ve always tested all my pregnant and breastfeeding vegan patients, just because the consequences of deficiency are so potentially devastating.

Better than getting a serum B12 level drawn, though, which most doctors do, a methylmalonic acid level is a superior test for B12 deficiency, which can be blood or urine. You can just pee in a cup for it.

Here’s why measuring MMA levels is better. About 50 people started eating vegan. Within a few years, half became B12-deficient. But look at their B12 levels. All these vegans had functional B12 deficiency, despite normal levels of B12 in their blood—showing that MMA is a more effective test.

Now, there has been a case report published of someone with apparent B12 deficiency, who had normal B12 and MMA levels. So, we’re always looking for a better test, and it looks like HoloTC is it, measuring Holotranscobalamin levels; shown to be more sensitive and specific, meaning fewer false negatives and false positives. If your level is under 20, you start treatment. If it’s over 30, you can be pretty sure you’re okay. And if it’s in the middle, you follow up with a second-line test.

If you are deficient, you can be treated with a ruby-red mad-scientist-looking injection of B12. The color is from the cobalt in the molecule. But one of medicine’s best kept secrets is the efficacious use of high-dose oral B12 — safer, cheaper. 2,000 microgram supplements every day for two weeks should do it, before having patients starting or resuming their regular, reliable regimen of B12.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is transcript contributed by Bruce A. Hamilton.

Please consider volunteering to help out on the site.

Image thanks to Bobjgalindo via Wikimedia Commons

Doctor's Note

This concludes our five-part video series on B12 this week. If you’re new to the issue, Vegan B12 Deficiency: Putting It into Perspective, and Safest Source of B12 are good places to start. The consequences of B12 deficiency can be grave (see Inverted Rabbit Sign). But getting enough is easy; B12 can be taken weekly (see Cheapest Source of Vitamin B12), or daily (see Daily Source of Vitamin B12). See my full recommendations.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

123 responses to “New Vitamin B12 Test

Comment Etiquette

On NutritionFacts.org, you'll find a vibrant community of nutrition enthusiasts, health professionals, and many knowledgeable users seeking to discover the healthiest diet to eat for themselves and their families. As always, our goal is to foster conversations that are insightful, engaging, and most of all, helpful – from the nutrition beginners to the experts in our community.

To do this we need your help, so here are some basic guidelines to get you started.

The Short List

To help maintain and foster a welcoming atmosphere in our comments, please refrain from rude comments, name-calling, and responding to posts that break the rules (see our full Community Guidelines for more details). We will remove any posts in violation of our rules when we see it, which will, unfortunately, include any nicer comments that may have been made in response.

Be respectful and help out our staff and volunteer health supporters by actively not replying to comments that are breaking the rules. Instead, please flag or report them by submitting a ticket to our help desk. NutritionFacts.org is made up of an incredible staff and many dedicated volunteers that work hard to ensure that the comments section runs smoothly and we spend a great deal of time reading comments from our community members.

Have a correction or suggestion for video or blog? Please contact us to let us know. Submitting a correction this way will result in a quicker fix than commenting on a thread with a suggestion or correction.

View the Full Community Guidelines

  1. This concludes our five-part video series on B12 this week. Please leave any questions you may have below. If you’re new to the issue, Vegan B12 Deficiency: Putting It into Perspective and Safest Source of B12 are good places to start. The consequences of B12 deficiency can be grave (see Inverted Rabbit Sign), but getting enough is easy: B12 can be taken weekly (see Cheapest Source of Vitamin B12) or daily (see Daily Source of Vitamin B12). See my full recommendations and check out the other 1000+ topics I cover here at NutritionFacts.org.

    1. In my research B12 seems to be the most confusing and unadressed  nutrient in the vegan community and is fraught with ignorance and misinformation.

      This is how I see the B12 problem:
      1) Ignore the topic as because they don’t perceive it to be an issue or at least no issue since they have no symptoms.
      Many vegans are people who spent years destroying their health – especially damaging their digestive track, decreasing intrinsic factor… and those and many other factors lower B12 creation and absorption and tend not to just magically get fixed immediately on a vegan diet.
      2) Many vegans do not eat very health vegan foods.
      3) RE: 1) do don’t get tested or tested using methods that are well known to be fairly inaccurate (e.g. blood tests)
      4) RE: 1.2.1) Try increasing with things that have either not been scientifically vetted yet to increase B12 and/or no proven scientific track record of increasing B12 levels.
      5) RE: 1.2.2) Believe they just need to eat better and don’t need to test or can skip the retesting.Comments, additions, corrections…?

        1. I was quite surprised to read your recommendation of B12 as cyanocobalamin over methylcobalamin. I’d read in more than one source that B12 as methylcobalamin is more bioavailable when ingested and that there were eliments of cyanide in cyanocobalamin. As an older adult, I was mostly concerned wth my ability to absorb the product, not to mention fear of cyanide content in the larger doses. With that information I chose the methylcobalamin. Have I made a mistake? Please advise!

      1. Hi, Mumma.

        Could you add a bit more?

        1) “Do don’t get tested or tested using methods that are well known to be fairly inaccurate (e.g. blood tests).” – which test(s) to use? Ones mentioned in the video?
        2) “Try increasing with things that have either not been scientifically vetted yet to increase B12 and/or no proven scientific track record of increasing B12 levels.” – could you be more specific, which “things”? What should be used instead?

        My opinion on:
        1) “Many vegans do not eat very health vegan foods.” – I think this is a small part of the problem. Much greater chance is that certain individuals have low intrinsic factor or that the produce in western countries is low in B12. For example, I eat no junk food and still have B12 deficiency (I am now in the process of addressing it).

    2. What are the differences between the methyl and cyano types of cobalamin (B12)?
      Do you see any advantage or disadvantages on taking one over the other?

      1. Tfincham,

        The differences include the naturally occurring cyanide in the cobalamin or a methyl group substitution in the methylcobalamine.

        There are numerous suppliers of both of the products with those in the methyl group noting longer resident times in the body and entry into more metabolic pathways without the same need for cyanocobalamin
        conversion.

        Dr. Kadish moderator for Dr. Greger

  2. Question for you: My husband, who has been vegan for 4 years, has numbness in the balls of his feet. He went to his doctor, who did a blood test which indicated his B12 levels were ok. From there he went to a neurologist, where no reason for the numbness could be found. He is suggesting that he take a high dose of B12 without bothering to get a test. Thoughts?

    1.  I assume the test was as serum B12 which is insufficiency sensitive. If he doesn’t want to get a better test (like a urine MMA), I would recommend he take a B12 replenishment regimen of 2000 mcg every day for two weeks before going back to supplementing normally.

      1. Thank you for addressing this important and neglected issue. Going back to supplementing normally is risky. If the person is malabsorbing severely, and that is possible, they should stay on at least 1000 mcg dose. Your video is great, until the end. 

      2. Hi. I am Vegan and was diagnosed with B12 and iron deficiency (they said borderline) and put on supplements. Within two weeks I could hardly get out of bed. I also have Chronic fatigue and IBS and find that every time I start to supplement with any form of iron or B12 I have this reaction.

        Have you come across this at all? Do you have any suggestions?

        1. Mira,

          I have seen this occur and would suggest that you consider a quick test by reducing or eliminating the iron supplement initially and see if you’re feeling better. You may be increasing the level of oxidants with the additional iron and not having an adequate amount of anti-oxidants to compensate or you may be taking a form of iron that is irritating your GI system or…… There are a number of potential issues to would give you this response. Have you also checked the excipients in the two supplements for any potential allergens/irritants ?

          Remember this forum in not a substitute for medical care and I encourage you to see a functionally minded physician as the CFS and IBS go hand in hand with many chemical upsets. A more thorough evaluation of your condition sounds warranted. I’d encourage you to think in terms of a Comprehensive Digestive Stool test coupled with an Organic Acids test to start your labs.

          Keep in mind that without addressing the IBS your CFS may/will not optimally respond. Hang in there as you can get well.

          Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com

    2. Working at it,

      Consider taking the B12 supplement, per the neurologist’s suggestion, with out the test. Why, the test for b12 in the serum does not fully reflect tissue levels and often time is very misleading. The correct test is the MMA test: methylmalonic acid testing, not the serum B12. https://labtestsonline.org/understanding/analytes/mma/tab/test is much more accurate.

      When you consider the low toxicity, cost and the high potential for a change the ratio is well within your husbands favor. Keep in mind it may take a few weeks to make a significant difference, so don’t just take a few days worth. If you want a better testing method I would use high dose injectable methyl B12, assuming that was the only criteria being addressed. Don’t forget to address gut integrity as this will have an impact on B12 absorption along with other nutrients directly related to many patient’s neurological symptoms.

      Dr. Alan Kadish Health Support Volunteer

  3. Hi Dr. Greger,
    I’ve viewed the videos on vitamin B-12 and have a question regarding supplementing just this one B vitamin. I read somewhere a long time ago that taking single B vitamins alone can cause imbalances in the other B vitamins. Is there anything to this?
    Thanks for Nutrition.org which is a great resource.

  4. Raw Food World has B-12 patches available. But it’s confusing because the B-12 researcher who spoke about B-12 states that the cobalamin is not the human active form and that we need to consume the methylcobalamin form. He says the MMA score should be between .58 and 3.56. The Homocystine test should score between 2.2 and 13.2. It’s confusing because you are recommending oral cobalamin.

  5. So, after watching a couple videos about the importance of B12, I decided to break down and buy a bottle of B12 supplements at the health foods store. But I noticed while I was there that there are also “B-Complex” supplements which contain other B-vitamins such as B1, B2, and B6. Should vegans supplement their diet with these vitamins as well or just with B12? Are all the other B’s not as important or are they like the multivitamin – leading to higher mortality rates in excess? It seems that they are not talked about as much as B12. Why is that?

    1. A b complex vitamin is unnecessary. We can acquire more than enough of all the b vitamins through food except vitamin b12. Vitamin b12 is the only byproduct of bacteria. If you search http://nutritiondata.self.com/ for any plant food you can see a full vitamin and mineral profile. You will find that all plant foods not only contain all b vitamins, but they also are all complete proteins and all contain sufficient levels of omega 3.

  6.   I’d like to know too! I have been taking the Methylcobalamin because I read years ago that IT was the correct one to take. :?

    Dr. Greger, am I in the danger zone?! I’ve been taking the Methylcobalamin for years now. Should I switch to the  cobalamin??

    1. Hi everybody. I see quite a few of you have asked about which B-12 supplement is best. When I took the Plant Based Nutrition Certificate program by T. Colin Campbell via eCornell University, we had a lecture on this exact topic. The lecturer was Dr. Matt Lederman, below is what he advised based on my notes from the class:

      There are B-12 analogs – substances which are very similar to B-12. However, analogs are not biologically active in the human body, meaning they do not perform the functions that B-12 does. Examples of a supposed B-12 analogs would be Spirulina & some algae.
      Dr. Lederman advises the use of methylcobalamin, which is a natural derivitive used by the body and he advises against the use of cyancobalamin, which is a synthetic version of B-12. And that when broken down by the body to methylcobalamin and adenosylcobalamin, the process leaves a minimal amount of cyanide behind.

      1. That’s not what Dr Greger advises, he says the cyanocobalamin is the one we should be taking. See http://nutritionfacts.org/questions/what-is-the-best-way-to-get-b12/ blog quote:

        “In my opinion, the easiest and cheapest way to get our B12 is to take at least 2,500 mcg (µg) cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement (you can’t take too much–all you get is expensive pee).”

        I also read in the comments section of this video, http://nutritionfacts.org/video/vitamin-b12-recommendation-change/ , Dr Greger’s advice:

        “re: cyanocobalamin (the inexpensive form) vs. methylcobalamin. Vitamin B12 supplements are so cheap to produce that supplement manufacturers try to come with all sorts of fancy ways to “add value” to products so they can make more money. The coral calcium scam is the classic example–how else can you charge $20 for a bottle of chalk? Likewise, unless you’re a smoker, have kidney failure, or base your diet around cassava root, cyanocobalamin should be fine. If it’s unavailable, then I would shoot for about 2,000 mcg a day of methylcobalamin.”

        So, I guess, if you are taking the methylcobalamin form, make sure you’re taking plenty.

        1. Aha! Thanks for that!
          Never been tested for b12 before (going to next week). When I found out about methylcobalamin last year and started taking it (2500mcg per day), my tingling in arms/hands & feet disappeared and I felt great. Took it for about 3 months, then switched to cheaper uk version, which I didn’t realize was 5 times weaker. Now the tingling is back, and according to Dr. Greger’s advise, I just started on cyanocobalamin. Maybe not such a good idea a week before my blood test. But because my doctor’s never heard of MMA test, I’m just getting the serum test, so might be useless in the end anyway…. Will see, if the tingling doesn’t disappear with cyanoc., I’ll order mma or holoct test privately.

      2. MaryAnn – Re: “B-12 analogs would be Spirulina & some algae.”
        It seems that either your notes from Dr. Matt Lederman are inaccurate or his claim is inaccurate.
        Ether way, “Spirulina & some algae” are known to HAVE (not “be”) B12 analogs, and still they can also have active B12.
        Therefore, an accurate claim would be: Spirulina & some algae are examples of some foods that contain B12 analogs.

  7. Dr. Greger, there is a video in which you talk about vegan longevity vs. meat-eaters longevity. You mentioned that a study discovered that meat-eaters live as long or longer than vegans and vegans are more propense to heart attacks and neural damage due to the low levels of B12. Can you point me in the direction of the conclusion of that video? Is there a happy conclusion for vegans? How old are those findings? Thank you

  8. Dr Greger, three of my local collection sites have not been able to locate a lab that performs the holotranscobalamin levels test. Please supply contact information for labs that can perform this test. TNX

  9. Thank you for the explanative video.

    I was diagnosed 17 years ago after the birth of my first child with a vitamin B deficiency after experiencing depression, brain fog and a series of other symptoms commonly experienced by breast feading mothers. After further testing the naturopath who was treating me at the time established that I was not able to assimilate the B’s orally due to IBS and made me undergo a regimen of B injections which seem to clear the matter, along with supplement of stevia for a lazy thyroid if I remember well.

    Over the years my digestive issues have gone from bad to worth and looking back at it I have most certainly experienced episodes of mild depression and the likes, though never fully paid attention to it.

    In the last 5 years I started to experience serious insomnia issues often associated with extreme bloating which led to difficult breathing only bearable in standing position. Then a little less than 2 years ago I fell pregnant with my third child, now just over a year old and whom I am still breast feading, and to the bloating was added an extreme case of restless leg syndrome, constant day and night throughout my pregnancy which in turn transformed the episodes of insomnia to a constant state as well. Aside of that the pregnancy was great and easy but I reached delivery utterly exhausted and i am presently barely recovering from the lack of sleep.

    Shortly after delivery I experienced a sharp pain in the right side of my body, my right leg having been the one most affected by the restless syndrom as well. This vanished somewhat within a few hours, though an ongoing twitchy feeling settled down after that with a constant sensation of electric current running through my nerves from my little toe, with strong sensation in the sole of my foot and incessant debilitating itching up the outer side of my legs seemingly ending in the area of my reproductive organs. I thought at first that it must be related to the slight urethrocele that seemed to occur after the delivery, but that issue seem to resolve after a couple of months and the itch remained.

    Then all at once it seems the IRS came back in force, I started to experience irritating burning sensation in my bladder and a couple of excruciating pain in my chest and back below my rib cage. Concerns for gall stones, yeast infection were raised but quickly turned down after appropriate screening test were done and came back clear.

    Other symptoms experienced which seemed unrelated to the ones above and rather common to the aftermath of pregnancy were fatigue, brain fog though rather extreme with incapicity to focus on anything, sensitivity to light and a strange sensation of seeing fleeting shadows pass by….

    That is when my gyn mentioned that i probably was experiencing a lack of vit B, which seemed to have become quite severe. She then sent me to an internist who put me on a regimen of vit B 12 complex, first orally with dosage of 15 000 mg a day for a week with no results and then shots of 5000 mg twice a week. The latter seemed to have quite positive effect and within 2 months the brain fog, sensitivity to light, fleeting shadows and inability to focus seemed to have disappeared. The nervous itch sensation though lesser at first is now slowly creeping back in :-(, along with the burning sensation and last but not least my buttocks are covered with bruises from the injection spots.

    The midwife who administrates them suggested that I get tested for the B levels to see if what they are presently at….though as I had not previously done a serum or any of the other test you mention in the video, I feel that the answer will require more than a mere testing for vit B.

    With much hope the above is clear and you’ll be able to provide with some light and advises.
    Many thanks,

    niinest

    P.S.:In addition, as this will probably come to be relevant at some point, I have had to change my diet quite early on since breast feeding my little one, as I noticed that like his older brothers he seemed to develop a crying habit and some rashes around a month old. After on going an elimination diet and reintroducing the avoided food one by one, I was able to assess that wheat product would make him cry for long periods, dairy resulted in specks of blood in his stools, eggs gave him peeling off rashes and meat/fish resulted in diarrheas. So all the above were eliminated from my diet for good and he has been an easy hardly ever crying baby ever since.

  10. Try searching home blood tests for the accurate, active B12 test. Make sure injections are methylcobalamin rather than cyanocobalamin and preferably preservative free or with minimal preservatives. Dr.Greger, please could I find out whether supplements would affect the U/MMA test or homocysteine test? My body is not retaining the supplements so I’m going to buy the injections from Trim Nutrition. I would also like a test for my records. Many, many thanks.

  11. Dr Greger, I wanted to know – is there any evidence that if a person takes a B12 supplement daily (when B12 is normal) that a person’s body could eventually not produce it’s own and become dependent on the supplement? I have heard this but have not seen any evidence of it. I would like to know if you have. Thank you so much for your work.

    1. DrBarbaraHoldeman: Dr. Greger has a great set of videos on B12. I highly recommend watching them. This is just one of the videos.

      What other NutritionFacts videos tell us is that B12 is made by bacteria in our lower gut. The B12 is so far down in our lower gut, our bodies do not absorb it properly. What is one way that we know this? People who are deficient in B12 and then eat their own poop pills (I kid you not), see their B12 levels rise.

      In other words, it’s never about how much B12 our bodies make. The issue is how we get B12 to go into our bodies. We could get it naturally say by drinking dirty water and eating non-washed fruits and veggies the way our ancestors did (or eating feces encrusted chicken the way our friends do today), OR we could take a cheap, safe supplement one a week.

      That’s a summary of the videos. Dr. Greger does a better job of explaining it. Hope that helps answer your question though.

      1. Okay, since you started it…we are the only species I can think of who doesn’t lick their behinds. (..and don’t plan on it either)! BUTT seriously… lol!

    2. You bring up a question that I believe needs to be properly addressed based on so much misinformation on this B12 topic and especially the persistent claim that – internal B12 production will be reduced from B12 supplementation!

      I understand that your question was directed to Dr Greger. I am not speaking for him, yet I thought I might provide an informative response to your question.

      My experience so far is that every person who has made such a claim has been unable (and even unwilling – mostly what seems to be delusional arrogance) to back up (they are the ones tasled with the burden-of-proof) their claim with any form of empirical medical science data. I have yet to have someone make such a claim that has had any long term formal education in nutrition/biology. Mostly the people who make such a claim (reduction of B12 from supplementation) seem to be enthusiastic diet advisers (guru’s) or from their unquestioning followers who are simply repeating their guru’s B12 statements.

      Maintaining my critical thinking and skepticism (belief and/or acceptance AFTER sufficient facts) their claim remains as a wishful hypothesis (if that) and does not yet (if ever) qualify as a medical science theory.

      My understanding of B12 in regards to the claim that, internal B12 production will be reduced from B12 supplementation (Note: the first three are my premises and #4 is my conclusion):
      1.) B12 can be made by several types of bacteria.
      2.) In order for B12 to be controlled (reduced or increased) by the human body it would require that our body control the amount and type of bacteria that produces B12.
      3.) The B12 produced in the human body is to far down the intestinal track to be absorbed sufficiently enough to raise B12 levels.
      4.) Therefore, even if our body was able to control B12 bacteria quantity and production it would not be enough to overcome the limitations of #3

      I am open to my premises and conclusion (already verifiable by medical science studies) being proven incorrect and await (without holding my breath) for their different and/or opposing evidence that is verifiable through medical science that will have the possibility of validating their claim.

      “The great enemy of the truth is very often not the lie, deliberate,
      contrived and dishonest, but the myth, persistent, persuasive and unrealistic.” John F. Kennedy

  12. Hi dr Greger, fantastic site

    i am on raw food, vegan, and was hoping to find some info —friends and i wonder if we can get B12 f.i. from germinated and then fermented chickpeas

    they get a ´´french cheesy´´ smell, mixed in salads quite good, if you like frech cheese that is…

    i seem to have heard (foodnsports.com) that slightly ´´off´´ vegetables have b12 in them

    or is that myth??

    thank you

  13. Doctor, I am confused. Didn’t you say in a previous video that we can only take 250mg of b12 a day? Is taking above that only in case of cobalt deficiency?

    1. Ted: Dr. Greger’s Optimum Nutrition Recommendation page includes the following for B12:

      >> At least 2,500 mcg (µg) cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement *OR*
      >> at least 250 mcg daily of supplemental cyanocobalamin (you needn’t worry about taking too much) *OR*
      >> servings of B12-fortified foods three times a day, each containing at least 25% U.S. “Daily Value” on its label

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

      from: http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      My understanding is: The reason for the non-linear amounts is because of how the body absorbs and holds B12. Now you can put this into perspective with the video information. Here is the last paragraph of the transcript:

      “If you are deficient, … one of medicine’s best-kept secrets is the efficacious use of high-dose oral B12 — safer, cheaper. 2000 microgram supplements every day for two weeks should do it, before having patients starting or resuming their regular, reliable regimen of B12.”

      I believe he is talking about deficiency in B12, not cobalt.

      1. Is this “high dose” stuff the same stuff we buy at the store or is it a prescribed pharmaceutical grade B12 supplement?

        1. Tobias: I’m not 100% sure of the answer to your question, but since the quote is talking about cheap supplements, I’m pretty sure he is just talking about the sublinguals that you can get at probably any place that sells supplements. I’ve seen such supplements (that dosage) at stores near me.

          I’m not an expert, but it looks like it wouldn’t hurt to try? You could see what happens after a few weeks?

          1. That’s the big question. To wait until tested or just try high doses for two weeks of a higher quality product and see if there’s an effect. I need to study the tests more and inquire with my doctor. I want to challenge her to think a bit more about this without sounding like a know-it-all, as I’m pretty sure that most doctors are clueless. A Kressler has some good articles but he’s Paleo. How can I trust those guys. :)

          2. Just past this by my MD and the outcome wasn’t impressive.

            I wrote: Although my serum B12 level tested well at the high end of the normal range recently, I’m concerned because this test apparently doesn’t rule out possible B12 absorption issues. I regularly have days when I wake up feeling quite tired, fatigued for whole days 2-4 times per week, plus I eat a vegan diet, though I supplement with B12. It appears that the homocysteine and methylmalonic acid tests would allow a more definitive assessment of my B12 status. Would these tests be merited in my case?

            MD’s reply: Methylmalonic acid (MMA) testing is really only need if your B12 is low or low normal. It helps to evaluate if that low level is truly significant. If it is completely normal or high no need to do follow up testing. Our level was in th 800’s which is on the high end of normal, so I would not recommend getting any further levels checked. I only use B12 +/- MMA, and don’t check a homocysteine level.

            So, my only choice now is to get private testing. This could run $300. I have not located the best service to go with yet. Anyway. If these test come back indicating a B12 problem, this will finish off my already negative view of the medical establishment.

            1. Tobias: I agree that your MD’s reply is disheartening. How can that person properly be on your medical team if she/he doesn’t seem to understand the basics, especially of a condition you are trying to deal with? And I would feel that way regardless of how your numbers come back.

              If it were me, my thinking at this point would be: I don’t want to spend $300 on a test, especially if a cheap pill will help me solve the problem. On the other hand, the test may keep me from wasting time on extra doses of B12 when I really need to be focusing on something else. Ie, the test may tell me that my B12 levels are fine. So, best to find that out. And even more than that, if the problem is even partly related to B12, then I would want some before numbers to compare to after so that I can figure out what future steps might be needed.

              I feel for you. I hope you are able to figure this out soon and without going into debt. :-)

              1. The kicker is that I’ve paid steep health insurance monthlies for a long time and NEVER (ever) used the system for anything, so now I ask for a $150 test (MMAu), which is a far better test than the serum test, and I have to accept the doctors judgement call. Oh, gracious! :)

  14. Dr. Greger,
    HELP. I can’t find an answer about this anywhere on the internet. Question: Was there, or is there enough B12 for us in streams, lakes, & rivers? I’m curious about what the source of our B12 had to be for the last few hundred thousand years.

    1. And, what percent of livestock are given a B12 supplement? I’ve heard the bacteria is depleted. Shed light on the B12 rumor mill.

    2. Aqua, it is possible. It is also possible that it was on plant foods in the wild on their surface. Humans were never strict vegans throughout human history, though. Even if we did eat some meat back in the day, we know what is healthier for us. We are not simply trying to survive (for those of us that are lucky), we have choices. It is preferable to follow the weight of evidence rather than evolutionary ideals.

        1. “I’m curious about what the source of our B12 had to be for the last few hundred thousand years.” What I am saying is that this does not matter for the purposes of our health. You started with HELP, so clearly you think this is a significant issue. Hence, why I said “evolutionary ideals”.

                1. Exactly, and I’m still trying to sort out why it wouldn’t YET be in well water or spring water-from which about half my county (and myself) gets their water supply. I’d really like to find some testing information for water and B12. Also wonder how much B12 I might be getting from Sassafras roots pulled from their natural soils? Sure it’s safer to take a supplement, but I like to know things.

                  1. Supplementation appears to be the only reliable source due to our water supply now being chlorinated. Even the farmed animals are supplemented with B12.

  15. I know this is an older video, but hoping you guys check out new comments from time to time and this seems the most appropriate place to ask this question. My serum B12 level, when last checked, was 416 pmol/L, which if I’m understanding correctly translates to 561.6 pg/mL. I notice in your graph that higher serum B12 seems to correlate to less MMA, and my B12 level would chart off this particular graph. I wasn’t consuming many known B12-analogue containing foods, to my knowledge, at the time. I get lots of folate from my 100% plant-based diet, but not much folic acid (small amounts from occasional nutritional yeast consumption). I asked about getting my MMA tested, but my doctor had never even heard of this test.

    I’ve been researching this matter heavily lately, as I do have some concerns, but here’s the thing. I had no odd neurological symptoms at the time I got the test done, with a marginal intake of B12-containing foods (soy and almond milk, nutritional yeast, etc.) but upped by B12 intake anyway (as well as overall eating a more healthful diet, paying more attention to nutrition), and since then (2 months later or so), I did start having some odd “shock” or pinching sensations, usually in my hands/wrists and legs, but also in my torso and on my face, and sometimes even in one eye (which I injured awhile back). I’ve had numbness in my left fingers and thumb (location varies) when they get cold, but I think that might be from the way I’ve been sleeping (wake up with a sore neck often, on the left side); this seems to be getting better, though (but it’s also getting warmer). I also get canker sores somewhat frequently. I also get occasional random “headaches” that last a couple to a few seconds (which always makes me wonder about mini strokes).

    I’ve been plant-based for going on 15 years, with some milk and egg consumption up until 5 years ago. B12 intake has varied over the years from almost none to regular consumption of fortified foods and some supplements. My health has improved dramatically since dropping all animal foods, with the exception of these new issues.

    And here’s the thing. I’m not 100% sure, but I believe that the shocking/pinching sensations get worse, not better, after taking B12 supplements (only 50 mcg, cyanocobolamin). Within 24 hours they’re happening more frequently, and the next day they’re at their worst. After this, they go back to being milder and less frequent. At least, I’m pretty sure that’s what’s happening. The sensation gets sharper after B12 supplementation. Sometimes it’s quite painful, though luckily short-lived. What am I to make of this? It doesn’t feel like I’m doing something good to my body, and the word iatrogenic floats into my mind… Any advice? To sum up, I’m wondering

    1. Come to think of it, maybe the overdose on B12 thread would have been a better place for this. I think I was planning on leaving a shorter comment just asking about the tests when I started writing this.

      1. Almost forgot. B12 supplements also seem to be causing mild acne, which I almost never get now normally.

    2. Confused about B12: I’m not a doctor or expert, but after reading your story, I had a thought: I have read other people posting that they have various troubles with the B12 supplements. So, what if your body just can’t handle the high-dosage that you get from those pills? You still need to be concerned about getting enough B12, but maybe for you, you have to forgo the convenience of a weekly pill and just make sure you get enough in a single day? It could still be from fortified foods (ex: nutritional yeast, etc) because the amounts would be a whole lot less. Or maybe you could try a pill that comes only in the daily dose amount???

      Due to absorption issues, the daily recommended amount is exponentially less than the weekly amount. Here’s Dr. Greger’ recommendations:
      >> At least 2,500 mcg (µg) cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement
      >> or at least 250 mcg daily of supplemental cyanocobalamin (you needn’t worry about taking too much)
      >> or servings of B12-fortified foods three times a day, each containing at least 25% U.S. “Daily Value” on its label
      **Those over 65 years of age should take at least 1,000 mcg (µg) cyanocobalamin every day.
      from: http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      My bottom line is that you shouldn’t be experiencing those symptoms. So, it is worth trying to figure out the cause so that you can do what you need to to fix it.

      Good luck.

      1. Thanks for taking the time to reply. I’m still trying to figure this all out, but one thing that’s worrying me is that the dose that’s causing me problems, if this is in fact what’s happening, is only 50 mcg! So taking a 250 mcg supplement once a day wouldn’t help matters! I have been experimenting with smaller quantities over the course of the day (from almond milk, nutritional yeast), but issues are not gone yet. It’s possible my symptoms have nothing to do with B12 at all (confounding factors?), but Idk. Anyway, thanks again. Will post an update if I figure this out.

        1. Confused: Thanks for the clarification.

          Dang. That’s a tough situation. I was mostly responding to this part: “I had no odd neurological symptoms at the time I got the test done, with a marginal intake of B12-containing foods (soy and almond milk, nutritional yeast, etc.” – thinking that you might be able to capitalize on what you were doing before you had problems, but just a little more. But it sounds like you are already trying to do this, to no avail.

          I agree that it is very possible that your symptoms have nothing to do with the changes in B12 intake. I can say that I have several people in my life who have developed neurological symptoms over the last couple of years, with varying degrees of successfully addressing it. I would definitely do research an try to figure out other possible sources. For one person I know, the problem was a B1 deficiency, not B12.

          re: “Will post an update if I figure this out.” That would be great! I’m sure it would help other people too.

      2. Thea, Monsanto is genetically engineering sugar beets (that is sugar on labels). Molasses comes from sugar on which the food yeast (nutritional yeast) is grown. I would assume that since everything that comes from a plant contains the gmo, that the yeast would also. And, perhaps that’s the reason that I and others, are having problems not getting enough B-12. Also, research gathered by Jeffrey M. Smith uncovered that cyanocobalamin is also genetically engineered by Monsanto.

        “Cyanocobalamin is commercially prepared by bacterial fermentation. Fermentation by a variety of microorganisms yields a mixture of methyl-,
        hydroxo-, and adenosylcobalamin. These compounds are converted to
        cyanocobalamin by addition of potassium cyanide in the presence of sodium nitrite and heat. Since a number of species of Propionibacterium produce no exotoxins or endotoxins and have been granted GRAS status (generally regarded as safe) by the Food and Drug Administration of the United States, they are currently the preferred bacterial fermentation organisms for vitamin B12 production.[5]” Source: https://en.wikipedia.org/wiki/Cyanocobalamin

        Of course, the U.S. FDA claims there is no significant difference between gmo and non-gmo products, a policy that was put into place after Michael Taylor, then lobbyist for Monsanto, visited with the Bush-Quayle administration and some say wrote the policy. Taylor has graduated from a lobbyist to Monsanto’s Vice President in charge of policy at the U.S. Food and Drug Administration. Perhaps this is the reason cyanocobalamin does not work for me either..

  16. Dr. Greger,
    I heard a nutritionist recommend methylcobalamin. I bought and use cyanocobalamin. Is there a difference ? AL Wood :)

  17. It’s really a useful post because for making awareness among the people about Vitamin B12. By this test we can know about our vitamin B12 level and after knowing this we can make our later steps. If we are having a low level of vitamin B12 then we can take foods which are contained with vitamin B12 and also can take supplements or even can take injection.

  18. Hello. I eat only raw food approximately 3 year(vegetables, nuts, fruits) So, my blood test show 135 result of Vitamin B12 and white blood cell count 3.2 and red blood cell count 4.38 The question is where can I take b12?

    1. Andre: Are you asking where you can purchase B12? In America, B12 sublinquals (the kind that dissolve under the tongue) can be found in just about any grocery or health food store.

    1. Andre: B12 comes from bacteria that lives in the lower intestines of animals (which means that it can be found “naturally” in feces, dirty streams, etc). To my knowledge, there are no vegetables, nuts or fruits that contain reliable amounts of B12, especially if those foods are clean. Even if those foods look dirty, you can not be sure of getting enough B12. (What if the soil is clean?) And not having enough B12 can have very serious health consequences. For someone on a diet like yours, it can save your health to take a B12 supplement. Check out some of these pages from NutritonFacts:
      http://nutritionfacts.org/?s=b12+deficiency

  19. Is 1447 pg/mL result worrisome on B12/FOLATE/SERUM PANEL test? Lipid panel was 3.2 ratio, 149 total cholesterol. Blood cell count normal for red and white. Showed a Vit D deficiency. Low sodium.

    1. It is usual to have a high result post supplementation, but the test shows does not show how much the cells are taking up. You could buy an active B12 test on-line by searching home blood tests. An alternative is a urinary MMA test. If MMA is high, B12 is low.

  20. Hello! I’ve been following a 100% whole foods plant based diet, and I would like to know what are the optimal levels of MMA and Homocysteine.

    I greatly appreciate your help!

    Thank you!

    1. Hi Yulia, I’m a volunteer medical moderator here on the NF site. The reference range for MMA is 0-.4 umol/L with optimal being less than .25umol/L. For Homocystine the reference range is 4-10 mmol/L with optimal being less than 8. Depending on the lab the reference ranges may vary slightly but optimal ranges are the same regardless. The graphic in this video depicts the optimal ranges. http://nutritionfacts.org/video/vitamin-b12-recommendation-change/

  21. There is a genetic blood test for issues with B12 and methylation.. It is called MTHFR. If you have this then you need to supplement accordingly. Ask you practitioner to order this blood test.

  22. This study found an ASSOCIATION between high intake of those vitamins and lung cancer in males. This does not mean that the vitamins CAUSED lung cancer in these men. Eating ice cream is also associated with drowning, but this does not mean that eating ice cream causes drowning. It could be that during the summertime people are more likely to go swimming as well as eat ice cream. With lung cancer and B vitamins, it could be that men who had a history of smoking tended to take higher doses of B vitamins because they knew they were sick or were trying to do something to “cancel out” the smoking.

    1. Would be great to get some insight from dr greger on that published study recently. What should we make of it? Is it b12 supplementation increasing risk of cancer? only on smokers? Is it a daily dosage of a 250mg qualifying as high dosage? Wasn ‘t it stated on nutritionfacts.org that the only drawback on exceding b12 would be expensive pee? Thanks!

  23. Hello Jose,
    Thank you for your question. I have just responded to another reader who had the same question. Here is my reply to Bjorn:
    ——————————————————————————————————————————
    Thank you for your question. I am a family physician with a private practice in lifestyle medicine, and am a volunteer moderator for this website. I also have a master’s degree in epidemiology. This is an interesting study. I just looked at it in detail, and scrutinized the tables of data. I do not think their conclusion is warranted.

    Here is their conclusion: “When the 10-year average supplement dose was evaluated, there was an almost two-fold increase in lung cancer risk among men in the highest categories of vitamin B6 (> 20 mg/d; hazard ratio, 1.82; 95% CI, 1.25 to 2.65) and B12 (> 55µg/d; hazard ratio, 1.98; 95% CI, 1.32 to 2.97) compared with nonusers.”

    I see several problems with this conclusion:
    1) If B12 consumption is associated with lung cancer, then the more B12 you consume, the higher your risk of lung cancer should be. This is called a “dose-response” relationship. But here are the data for men (Note: there was no significant association for women), using their figures for 10-year average daily consumption of B12. First, their categories of consumption, with the number of cancer cases in each category in parentheses:

    Non-user (n=179), 0.1-5 mcg/day (n=78), 5-25 mcg/d (n=138), 25-55 mcg/d (n=23), >55 mcg/d (n=28).

    The relative risk of cancer in these groups, when adjusted for a bunch of different variables, including smoking:
    Non-users RR=1.00 (by definition); 0.1-5 mcg/d: 0.93, 5-25: 0.94; 25-55: 1.04; >55: 1.98 (confidence interval 1.32-2.97).

    There is not much of a dose-response relationship here.

    2) The number of cancer cases in each group is very small (23, and 28 for two of the B-12 consumption groups). This means that any association they find is somewhat suspect — even if it is “statistically signifiant” — i.e. the confidence interval doesn’t include 1.00.

    3) There is clearly confounding, by smoking status. By their own admission, “the risk was even higher among men who were smoking at baseline.” But what they don’t say, until you delve into the tables, is that, due to the small number of never-smoker lung cancer cases (n=20), this group was excluded from the analysis! Note, that they DID analyze (see immediately above) two groups of size 23, and 28. Is that because there is actually NO relationship between B12 intake and risk of lung cancer among non-smokers?**

    4) If there really is a relationship between B-12 intake and lung cancer, why does this only occur in men, but not women? It doesn’t make sense biologically. They try to give a rationale for this sex difference in their discussion, but I don’t buy it.

    So, my conclusion is that if you are a male smoker, there may be some reason to worry about taking B-12 supplements, but given the very small numbers in this study, and the lack of a consistent dose-response relationship, this is a long ways from being proven.

    Dr.Jon
    PhysicianAssistedWellness.com
    Volunteer moderator for NutritionFacts.org

    ** NOTE: Researchers love to have significant results, and manipulating the data to make results look more significant has been documented to occur.

  24. Hi,
    thanks for the brilliant explanation. I was wandering though, Dr. Jon, what do you mean by your statement that the sex-difference doesn’t make sense biologically? In which respect? And secondly, is there a mention in the study which cobalamin was actually used?
    Thanks and best

    1. Hello George, RE my statement about the difference between men and women: What I mean is that lung cancer is not an illness where gender plays much of a role, based on my understanding of previous studies. There are some illnesses, such as migraine headaches, where hormonal factors in women play a large role – hence “menstrual migraines” is a well-accepted phenomenon. Like I said, in their paper, they do make a meager attempt to explain why this sex difference might occur, but it did not make sense to me. (Maybe that’s only because I’m not smart enough to understand what they said, but at the least, they did not make a good case for the mechanism they gave). Dr.Jon

      Sent from Mail for Windows 10

  25. Thanks, Dr.Jon, once again for the explanation. Could you briefly summarize what was actually said?

    And as I asked before, do they say WHICH cobalamin they used? This may be of importance. I know Dr. Greger recommends Cyanocobalamin, but I think using the natural occuring ones might be wiser. Plus all those B12 products don’t vary a lot in terms of cost, at least in (Western) Europe.

    By the way, is there actual data which Dr. Greger’s recommendation is based upon? If I judge him correctly, it can’t just be the price to qualify for a recommendation. He’s too genuine and hones for that. :-)

    1. George: Here was their main conclusion, from the abstract: “When the 10-year average supplement dose was evaluated, there was an almost two-fold increase in lung cancer risk among men in the highest categories of vitamin B6 (> 20 mg/d; hazard ratio, 1.82; 95% CI, 1.25 to 2.65) and B12 (> 55µg/d; hazard ratio, 1.98; 95% CI, 1.32 to 2.97) compared with nonusers.” I showed why we should doubt these results:
      1) What they actually found was that ONLY AMONG MALE SMOKERS, there was an elevated risk of lung cancer in the group with the highest consumption of B-12 supplement. (Relative risk compared with non-users of B-12 was 1.98 for those who consumed >55 mcg/d). They completely excluded non-smokers from their analysis — so their results are only applicable to male smokers.
      2) The number of cancer cases in this top consumption group was only 28, which is a very small “n”; any results based on only 28 cases are suspect.
      3) This relationship did NOT hold true for women. You have to wonder why.
      4) There was not a dose-response relationship. If eating A causes disease B, then you would expect that the more of A that you eat, the higher the rate of B, in a step-wise fashion. What they actually found was that as B-12 consumption went up, the cancer rate was virtually unchanged for the first 3 levels of B-12, and then shot up for the small group with the highest consumption.

      Regarding what type of B-12 to take, my understanding of Dr. G’s recommendation for using cyanocobalamin is that it is by far the least expensive, and that the other types offer no advantages. Here are some of his videos about B12:
      1) https://nutritionfacts.org/questions/which-type-of-b12-is-best/
      2) https://nutritionfacts.org/video/cheapest-source-of-vitamin-b12/.

      I hope this helps. Dr. Jon

  26. Hi Dr.Jon,

    yes that helps, thanks for that! :-)

    Ad 1. The smoker-cancer relationship is indeed true for smokers – so the vitamin B12 isn’t a cause. They could have found the same relationship if they had put kale in there instead of B12, right?
    Ad 4. I’m not a professional in medicine or epidemiology – but could it be that the relationship can (if it’s not dose-dependent) also be threshold-dependent? I mean maybe they had no results for the first three doses because they were too low and maybe dose X is the threshold where it shoots up?
    I’m not disputing you, I just try to understand correctly what you’re saying.

    Here’s an older study though: https://jamanetwork.com/journals/jama/fullarticle/184898 They found a relationship and cyanocobalamin was used. I’m not sure if you or Dr. Greger are aware and if it’s worth to include in a review or video?

    Let’s assume the results at least in the latter study are valid and correct – would that generalise over all forms of B12? Or are they inherently different?

    Thanks and regards

    1. Hello George,
      I’m sorry I didn’t see this reply until just now, when I was responding to a more recent comment on the same video. Your comment about kale is a humorous illustration of meaning of confounding, and very aprapos.

      Your comment about whether the lack of a dose-response relationship might be due to a threshold effect is a good point, and one that I had thought about. So, yes, there might be a threshold for vitamin B12 dosing, beyond which it could increase risk of lung cancer among male smokers. However, I still say that basing this conclusion on the results of a sub-group of only 28 people makes it highly suspect.

      Dr. Jon

  27. Thanks Dr Greger, really love you work. I have a question on if I might have a B12 deficiency on a wholefoods plant based diet even though I supplement? Below I will briefly outline why.

    I’m 33 and supplement with 2000mcg a week cyanocobalamin sublingual empty stomach.. I’ve been eating plant based plus a little dairy milk in my coffee for about 1.5 years and now strict vegan for at least the last 3-4 months (no milk). I recently had a blood test in Spain where I live and requested MMA but they didn’t understand and in the end didn’t do it, so maybe I need to re-test but here are some of my findings and why I think I might be deficient. Some of my previous tests were in Australia so I apologise but the units of measurement change.

    Total cholesterol 2.4mmol/L or 94mg/dl in European and USA measurements. AMAZING! Or could it be too low? Power of plants. *previously I used to be 3.5 (135mg/dl), my best ever in 2012 was 2.7* Quite remarkable as I was eating meat and dairy must be genetic! They didn’t do fractions but in the past my LDL was .8 and HDL 1.7mmol/L. when I was 2.7 in total.
    White cell count 3,1 x10³/mm³, below range but normal for plant based according to your videos. But a pubmed study says this could be low b12?
    Platelets 140 *used to be 170 or 180*, under the range of 150-370. Same number now as my vegan wife interestingly. I saw some pubmed studies this can be from low b12 found in vegans? I also feel that I bruise much easier than I ever used to like after the blood test, I had a sore arm and big bruise, never happens to me in the past. My wife also bruises easier. Her b12 number is like double than mine but we can’t trust that test.
    ESR 2
    CRP less than 0.2
    B12 231.92pg/ML range (206-678) *not to be trusted from what the research says.
    homocysteine 12.63 umol/L *high I think and indicative of a b12 or folate deficiency?
    Vitamin D 25OH 32.3 ng/mL range 30-100. I used to supplement D in australia as I was deficient from working indoors. Have not supplemented in 1.5 years.
    When I was a meat eater my b12 (the test we can’t really trust) was 266pmol/L, 309 and 243 in different years. Range is >150 in these tests.

    Is 2000mcg a week simply not enough in my case? Without the MMA test I can’t be certain but it seems my homocysteine is too high?

    I was thinking of changing to 2500mcg Methylcobalamin *active b12* (so 500mcg extra per week in active form) weekly sublingual on an empty stomach because of my 23andme genetic test showing I have a heterozygous mutation on my MTHFR gene meaning I don’t process folic acid or non active b12 as well as other people (70% effectiveness) though not as bad as someone that is homozygous (30% effectiveness). In fact folic acid could build up in me boosting homocysteine in combination with not enough b12 to clear it? So I might try taking methylfolate 5-MTHF *active folate* and active b12 to reduce my homocystine? I do eat lots of leafy greens and beans as a vegan *which have the methylated forms of folate* but might not be enough for me or I might just supplement once a week or maybe 200mcg a day lets say. I was hoping it might help with my anxiety which has been linked to this. See below article.

    I’m hoping for you advice as most websites that talk about this are trying to sell their snake oils and most doctors don’t understand enough about this..

    http://www.adelaidenow.com.au/lifestyle/sa-weekend/how-a-vitamin-cured-my-anxiety-elisa-blacks-story-of-lifelong-struggle-and-new-hope-for-the-future/news-story/058666cc978da7ee1fca0f1ee043212c

    Many thanks,
    Damian.

  28. Also in regards to different countries using different units, I can convert them using websites but then the range dodesn’t seem to make sense. For example

    Serum B12 in Spain 2 weeks ago, B12 231.92pg/ML range (206-678) should be the same as 851.3783199999999 pmol/L in Australia which makes sense and is well above their range of >150pmol/L. In Australia my B12 was 266pmol/L, 309 and 243 and now I take a supplement. But if I convert the Australia number of 266pmol/L for example I get 72.45982021247617pg/ML which would make me deficient in the range of 206-678 and in Australia I was a meat eater daily almost and above their 150 range.

    Is it accurate to say it’s not really possible to convert test scores and compare them.

    1. Hello again, Damian,
      There are two issues here:
      1) variation of “normal” levels between two different labs: this is a fairly common problem. The only thing I suggest is just to use a reputable lab, and to interpret your result in terms of what THEIR normal range is.
      2) conversion of pmol/L to pg/ml: this is strictly a matter of using the correct number for conversion. For Vitamin B12, 1 pg/ml = 1.355 pmol/L.

      Dr. Jon

  29. Hello Damian,
    Thank you for your questions. You have quite a few. I am a family doctor with a private practice in lifestyle medicine, and also a volunteer moderator for Dr. G’s website. I’ll try to respond to most of your questions:

    1) MMA test vs. B-12 level: the methylmalonic acid test is far superior to a B-12 level to detect vitamin B-12 deficiency. You should absolutely have this test done. It is most frequently done as a urine test — probably less expensive than the blood test, and gives just as much information.

    2) Dose of cyanocobalamin: your dose is a little on the low side. (But the way to know for sure is to get the MMA test done, on the 5th or 6th day after your last dose). Here is one of Dr. G’s videos about his suggested dose of 2500 mcg per week:
    https://nutritionfacts.org/video/cheapest-source-of-vitamin-b12/.
    I personally take 500 mcg per day, and when I turn 65 in a couple years I will increase this to 1000 mcg per day. I am not an expert in the pharmaco-kinetics of B12, and maybe once a week dosing is fine, but I feel more confident in daily dosing, especially since this is a water-soluble vitamin.

    3) Your cholesterol level: 2.4 mmol/L (=93 mg/dl) is indeed extremely low; your level of 3.5 mmol/L (=135 mg/dL) while eating meat is also extremely low, so yes, I think you have some good genes for cholesterol.

    4) Your low WBC count: your WBC count of 3.1 is absolutely no causes for concern. Dr. G has done a couple of recent videos emphasizing that a lower WBC count is actually healthier for you:
    https://nutritionfacts.org/video/what-does-a-low-white-blood-cell-count-mean/; and
    https://nutritionfacts.org/video/what-is-the-ideal-white-blood-cell-count/
    Furthermore, I am not aware of any published data that low B12 can cause low WBC count. What is the PubMed study you refer to?

    5) Your low platelet count: your platelet count of 140 is not at all concerning. Usually bruising doesn’t occur unless it drops below 50. Bruising is more likely due to taking medications such as aspirin or ibuprofen. Again, I am not aware of studies showing that low B12 causes low platelet count. Common causes of low platelet count are: viral infections (especially mononucleosis or cytomegalovirus), certain medications (sulfa drugs, heparin, phenytoin), and (less common) autoimmune diseases such as lupus.

    6) Your vitamin D level: 32.3 is borderline-low for 25-hydroxy Vit D. Here is a video by Dr. G which suggests that a level of 75 is probably optimal:
    https://nutritionfacts.org/video/the-optimal-dose-of-vitamin-d-based-on-natural-levels/
    I would strongly recommend that you take 2,000 IU per day of vitamin D3.

    7) Your homocysteine level of 12.63 umol/lit: this is indeed high (normal is 4.4-10.8), and is somewhat concerning, giving the increased risk of both heart disease and dementia. See this video by Dr. G: https://nutritionfacts.org/video/preventing-brain-loss-with-b-vitamins/
    High homocysteine is likely due to deficiency of one or more of: Vit B-12, vit B-6, or folate. Normally someone who eats a whole foods plant based diet gets plenty of folate as well as vitamin B6. However, see point #8, below: you don’t process folate normally. So, you might indeed need to take more vitamin B12.

    8) Your MTHFR (methylenetetrahydrofolate reductase) gene mutation: this might actually be the key problem for you. Here is a recent article I found about this mutation. Please note that this is from “Wellness Mama”, which is clearly NOT a peer-reviewed source of information.
    https://wellnessmama.com/27148/mthfr-mutation/
    What is clearly true, though, is that this mutation decreases your ability to methylate folate into its usable form, and that this can lead to an unhealthy buildup of homocysteine.

    Your plan to take methylcobalamin, and 5-MTHF seems like a good one. NOTE: Dr. G recommends cyanocobalamin for the vast majority of people, because it is way cheaper. But your situation is different. Good luck with all this. I hope this has helped.

    Dr. Jon
    PhysicianAssistedWellness.com
    Volunteer moderator for NutritionFacts.org.

    1. Dear Dr Jon,

      Thank you so much for your super quick and detailed response!!! I really appreciate it! I waited so long to reply as I decided to go back and get the MMA test and now I have the results, it was done using blood not urine in my case. I haven’t taken any B12 for 1.5 months before the test as I decided to stop the weekly cyano until I buy the methyl.

      MMA 0,20 µmol/L range [ 0,08 – 0,56 ]

      So I was expecting it to be elevated and now I’m a bit confused. Would this indicate I’m not B12 deficient or maybe borderline low but folate deficient? I do eat lots of leafy greens as a whole foods plant based eater but maybe it’s just not enough with my MTHFR and my homocysteine is elevated as you said, so I must be deficient in one of them. My serum b12 is in range but I would say at the very low end.

      Unfortunately I don’t have a B9 folate test, not sure with the MTHFR if it would be a low reading or high but not being used by my body properly. All I know is that years ago my results were in 2012 RBC folate 1860nmol/L range (>900)
      2013 RBC folate 770nmol/L and 880nmol/L in 2014 range (>150) but not relevant in this moment perhaps.

      In regards to the pubmed study you asked for about platelets, I found two:
      “Vegans had significantly lower leukocyte, lymphocyte, and platelet counts”
      https://www.ncbi.nlm.nih.gov/pubmed/10479236

      and this one
      “Lower lymphocyte and platelet counts and higher MCV were found in subjects with elevated MMA and HCY, compared to those with normal metabolites. Lower lymphocyte and platelet count were accompanied by metabolic evidence that indicated vitamin B12 deficiency.”
      https://www.ncbi.nlm.nih.gov/pubmed/?term=b12+vegan+lymphocytes&report=abstract
      ‘The impact of vegetarianism on some haematological parameters.’

      Thanks for the advice on Vitamin D, I will start supplementing again and also buy some omega 3 algae derived pollutant free long chain fatty acids as Dr G recommends. I eat the 1tbps ground flax seeds already for the short chain.

      There are a lot of studies saying dropping your homocysteine does not improve cardiovascular outcomes but I found one study in young health males with no other CVD risk factors that it does. Anyway I think it’s better to get it down and it’s probably a marker in my case of low b vitamins.

      Thank you for the article on MTHFR, I think I have read every article and pubmed study on this in the last few weeks. I found my mother also has the defect as I tested her DNA ages ago for ancestry reasons and this week I ran the raw data through to check her MTHFR. She by chance started supplementing with Methyl B12 1000MCG a day as I told her to because she is 76 and she is eating vegan meals 3 times a week now. She reports more energy and feeling better.

      I guess my only question is dosages but no one seems to know, I found a pubmed case study of a doctor treating one patient with very similar symptoms to me, anxiety, high homocystine, MTHFR and it shows all the results based on months of trying different combinations so I might follow that. I might start with Methyl B12 then a few weeks later add Methly folate and see what happens. Maybe worth also adding adenosylcobalamin b12, the fuel b12. Although my body *should* convert the methyl b12 to the adenosylcobalamin coenzyme. And in some cases supplementing with SAM-e has helped people but if I boost my levels of the b vitamins, SAMe should naturally follow unless I have other pathway disorders.

      I have other RBC results that might help, and I have more results if you think it is useful but I have only shared what might be relevant.

      hemoglobin 14.6 g/dL (12.5-17.2) in Australia it was 147 to 160 g/L
      MVC 88fL (78-99) same number I had in Australia since 2012.
      Erythrocytes 4.92 x10^6/mm^3 (4.1-5.75)
      Mean corpuscular hemoglobin concentration (MCHC) 33.9g/dL (31.5-36)
      Mean corpuscular hemoglobin (MCH) 29.7pg (26-33.5)

      many many thanks!
      Damian.
      p.s. I will be happy to share my outcome in the hope it can help others. And my exact MTHFR mutations if people find it useful. In short Heterozygous on C677T among some other findings.
      10 years ago I studied a Bachelor of Science (Neuroscience and Biomedical) before changing to a career in IT. So I do understand some of the studies better than others but not as good as you!

      1. Hello Damian, You seem extremely well educated about medical matters in general, and about your MTHFR gene mutation in specific.

        Responses to your new questions: 1) Your normal MMA level: means that, despite your borderline-low B-12 level, you are not functionally deficient in B12.
        2) Your folate level: Your RBC folate was normal both in 2013, and 2014. As you probably know, RBC-folate is a better indicator of long-term folate status than is the serum test; but the serum test is more widely used. 3) Your elevated homocysteine: If you have normal levels of B12, folate (B9), and B6, then there’s not much you can do about this. If you haven’t been tested for folate level in 3 years, you might want to get re-tested. You didn’t mention whether or not you’ve been tested for Vitamin B6 level.
        4) Your mildly low WBC and platelet counts: as I said, these are not a cause for concern; and as I said before, having a low WBC count is actually a good thing – indicates less inflammation in your body (see Dr. G’s videos I mentioned last time). Regarding the articles you cite: I did not look at them, as yet. However, it occurs to me that because vegans have lower WBC counts (both lymphocytes and leukocytes), and lower platelet counts; AND vegans tend to be deficient in Vitamin B12. So it makes perfect sense that B12 deficiency is correlated with low WBC and platelets – because both are due to being associated with a vegan diet. Note that a high MCV (mean cell volume, of RBCs) is a well-known effect of B-12 and folate deficiency. 5) Dosing of methyl-cobalamin: I think 1000 mcg per day is standard, but you should check. There is a very reputable supplement company called Thorne Research, which sells methylcobalamin capsules. 6) Your other lab results: all look very normal.

        Good luck! Dr. Jon.

        Sent from Mail for Windows 10

        1. Many many thanks Dr Jon, I find medicine fascinating to read about! It’s highly probable I was taking a multivitamin years ago when I had the folate tests, can’t recall. No I haven’t tested B6, was hoping I was getting enough from food but it’s possible, I will keep it in mind when I re-check my homocysteine.

          I agree on point 4 and I had seen those videos, good point. Yes my MCV seems normal, sorry I wrote MVC (Spanish translation).

          After researching vitamin companies, I also came to the conclusion Thorne Research and Pure Encapsulations were the best for purity, quality etc. Dr G says to get the cheapest but studies have shown some vitamins can have twice the amount written or half etc. In fact I read an interesting report by consumerlabs on testing various products and also how the DV’s have now changed but won’t be updated on bottles for a few years. Also really interesting on how our body absorbs much more synthetic folic acid vs folate from food, recommend you read this: https://www.huffingtonpost.com/entry/vitamin-labels-are-wrong-and-will-be-for-years_us_594350dae4b0940f84fe2d43

          However in the end I decided to go with a product from Seeking Health called Active B12 with L-5-MTHF lozenge, it has 800mcg active folate (not folic acid which I don’t process properly) and 1000mcg b12 as methlycobalamin and adenosylcobalamin. It’s run by a Dr who is a bit of a guru in MTHFR and I didn’t really want to support his company because I don’t like Dr’s that provide knowledge whilst trying to sell the ‘snake oil’ to fix it haha but in the end a lot of reviews show people with low energy, anxiety and MTHFR defects got great results from this combination and it is exactly what I may need, so worth a shot and it’s only $20 for 60 lozenges. He runs mthfr.net in addition to seekinghealth.com and he also had products aimed at lowering homocystine which are just b vitamin complexes but he has a lot of information on it all, so worst case I will just have expensive pee! I’ll report back in a month or so and I will try to do the PROMIS anxiety self test and DASS plus re-check my bloods so I have some quantitative data if there is an improvement. Dr G recommends 2000mcg daily he wrote in one comment if taking methylcobalamin but I hope 1000 should be enough, I don’t think there is enough data for anyone to know, it is definitely a different requirement to the other forms. How I feel and occasional blood testing will provide the answer.

          Again thank you for your guidance. I will be sure to make a donation to this wonderful resource.
          Damian.

          1. p.s. I’m also homozygous (both copies of the gene mutated) for BHMT-08. I don’t think there is much on this except what I pasted below but suffice to say it probably explains my homocysteine. I’m sure once I find the right combination of supplements, I can lower it, TMG and Zinc apparently help.

            “BHMT (betaine homocysteine methyltransferase) acts as a shortcut through the methylation cycle helping convert
            homocysteine to methionine. The activity of the enzyme can be negatively influenced by stress. The Information on
            this enzyme related to methylation is mostly based on Dr. Amy Yasko’s clinical experience and research.
            According to Dr. Yasko, a homozygous mutation of BHMT 01, BHMT 02, BHMT 04, can produce results similar to
            one with a CBS upregulation even if you don’t have a CBS upregulation. In her book, Autism: Pathways to Recovery,
            She also states that a BHMT 08 mutation may “increase MHPG levels relative to dopamine breakdown (HVA)”. This
            can result in attention type symptoms. It is common to see elevated glycine in someone with a homozygous BHMT
            08 mutation.”

  30. Hi,

    I have been reading Dr. Greger’s “How not to die” book which, I have to say, is enlightening!
    As proposed in the book it is much better to get vitamins and nutrients from foods themselves, instead if popping pills since they may not have the same effect as the food itself. Indeed, this is what I am doing with a plant based diet.

    However, the proposal to get a B12 supplement is against the suggestion of getting it from food. Shouldn’t we opt for foods that contain B12 naturally?

    Thanks,
    Thomas

    1. Thomas: It is a good question. The thing to understand is that B12 is a unique situation. B12 is made by bacteria that lives in the lower guts (ie, the colon where poop is being made) of animals. We know this from a number of experiments – including where they fed poop pills back to people who were B12 deficient and their deficiency went away. There’s a NutritionFacts video about this experiment if you want to learn more.

      The problem is that the bacteria which produce the B12 live too far down the colon to be absorbed by the human body. This leaves us with these options:
      1) Get your B12 “naturally” from animal products like poop encrusted chicken (you can research how chicken is processed in the US to understand why I wrote it like that). Even then, it may not be enough since many meat eaters are B12 deficient. Also, you then face all the drawbacks of eating meat since food is a package deal. You don’t get the B12 without the cancer, heart disease and diabetes too.

      2) Get your B12 “naturally” from dirty vegetables (ie, veggies grown in dirty soil where the B12 producing bacteria live) But with this method, you can’t wipe off the veggies, so you get the potential health problems with eating dirty food and you have the problem of not necessarily getting a steady/reliable amount of B12. Or from dirty water, but then you face cholera… Food is a package deal.

      B12 deficiency is a problem of living in our modern, cleaner world. You can get your B12 “naturally” from the sources above, or:

      3) Get your B12 from a safe and cheap supplement. This is a prove, reliable way of supplying B12 and it does not appear to have any drawbacks–at least nothing like the drawbacks one gets with options 1 and 2.

      Does it make sense why Dr. Greger would choose to recommend option #3?

    2. Hey Thoams, thanks for writing. Your question is a logical one. I have often wondered the same thing. I believe the best way to answer it is to appraise the risk associated with eating B-12-containing animal foods, and then decide for your self if the risk is worth getting the minuscule amount of B-12 we need each day. Considering that you can meet this need with a cheap multivitamin, or you can meet it from taking in foods that contain cholesterol, oxysterols, cancer-causing toxins, advanced glycation end products, and other noxious compounds, the supplement seems like the lesser of two evils.

  31. Hi Steven, I have the same question as Ismith asked earlier.
    You have supllied the reference to Dr Greger’s suggestion of cyanocobalamin, though I must admit I’d love to see a video or more detaited info on the difference in absorbtion between cyano and methyl cobalamin.
    I found out a while ago my B12 was at the lower end of the recommened spectrum (while my homocysteine was unfortunately very high, 19) despite the fact that I was taking cyanocobalamin supplements daily. Hence the reason I did some research and read that methylcobalamin would be much easier absorbed, especially the sublingual version.
    So why is it that Dr Greger still sticks by the cyanocobalamin?
    A video on the difference between the various types of cobalamin would certainly be immensely appreciated!

  32. Question: after a serum B12 test, which from the video I understand can be inaccurate, my level was 1174 pmol-L. The normal range says 153-655 and my Dr. says I should supplement less. In another video Dr. Greger says you can’t get too much, as your body excretes excess? I’m confused? Is my level really too high? I asked for the MMA test, but she said she wasn’t aware of another test. Why is this so tricky? Thanks

    1. Hi there HappiestOutdoors. Let me ask you, which is your current dose of supplementation and how often are you taking your supplement?

      Quoting this article by Dr. G the correct dose of suplementations should be:

      *At least 2,500 mcg (µg) cyanocobalamin once each week, ideally as a chewable, sublingual, or liquid supplement taken on an empty stomach or at least 250 mcg daily of supplemental cyanocobalamin (you needn’t worry about taking too much)
      or servings of B12-fortified foods three times a day, each containing at least 25% U.S. “Daily Value” on its label
      *Those over 65 years of age should take at least 1,000 mcg (µg) cyanocobalamin every day.

      https://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      High levels of vitamin B12 is very rare, however, the excess vitamin B12 is removed in the urine because they are part of the hydrosoluble vitamins. On the other hand the IOM hasnt stablished an upper limit for this vitamin, as it has a low potential for toxicity:

      Health Risks from Excessive Vitamin B12

      The IOM did not establish a UL for vitamin B12 because of its low potential for toxicity. In Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, the IOM states that “no adverse effects have been associated with excess vitamin B12 intake from food and supplements in healthy individuals” [5].

      Findings from intervention trials support these conclusions. In the NORVIT and HOPE 2 trials, vitamin B12 supplementation (in combination with folic acid and vitamin B6) did not cause any serious adverse events when administered at doses of 0.4 mg for 40 months (NORVIT trial) and 1.0 mg for 5 years (HOPE 2 trial) [62,63].

      In case you’ve not seen it, there’s a whole collection of Vit. B12 videos here https://nutritionfacts.org/topics/vitamin-b12/

      Hope this helps

      1. Hi Janeth. I have followed Dr. G’s recommendations of 2500 mcg once a week in a sublingual form and cyanocobalamin.

        I also get some from other food choices and fortified soy milk.

        Thank you for your detailed answer. I have watched the videos and feel like I’m probably good, but my number just seemed so out of the given range.

        I really appreciate the time and thought you put into your reply.

  33. Also my WBC is low at 3.3 where normal is 4-11 and I read that B12 deficiency can be a factor (along with other things of course). So maybe I’m low not high. Who knows. I wish I could find a Dr. knowledgeable in plant based nutrition!

    1. HappiestOutdoors: I don’t know if this would apply to your situation or not (ie, maybe your numbers indicate a problem or not, I don’t know), but NutritionFacts has some videos on white blood cell counts and why it makes sense for those numbers to be lower in someone who eats healthy. You may want to search this site for those videos.

      Also, if you can’t find a knowledgeable plant based doctor in your area, there is a famous and well-respected doctor who does phone consultations. It may be worth your while to consult him to at least get a second opinion and some support. His name is Dr. Michael Klaper: https://doctorklaper.com/contact

      Good luck.

  34. I’ve gone to three vitamin shops can’t find the B 12 cyanocoalic 250mcg . Where can I get this ?
    Not too up on ordering on line. It’s a generational related thing , I am 80.

    Also everywhere I’ve tried ,tries to sell me fish oil
    Need the pollutant free , long chain , 250 omega 3
    If some one can give me the brand names that would help.
    Thanks , Diana

  35. Every vitamin store, walmart, walgreens,etc has cyanocobalamin 2000mcg or thereabouts. That should meet your needs.
    Fish oil? For what? It contains carcinogenic pollutants and has been shown to provide no health benefits.
    Dr. G covers the topic in many videos as can be seen here:

    https://nutritionfacts.org/?s=fish+oil

    Dr. Ben

  36. In one of Dr. Greger fabulous videos or in a email response , he mentioned the name of the vegan B 12 he used, which he also mentioned he did not like mentioning products by brand but only did
    Because he had such a large interest as to where to get this type of B12. Now my problem is I can’t remember where I saw that . I’ve looked for hours , I am sure I am lacking in this area as my brain is shrinking for sure .i take salmon oil and I can’t quit til I find out where I can get the brand he mentioned. I know I should have jotted it down , but I didn’t . I am now jotting now the video that I am typing this request under. So I can find any reply . Thank you , Diana

  37. Opp! I goofed . in my above email , I meant to ask about the vegan brand of omega 3 , pollutant free,
    250 mcg daily .long chain . I forgot to write the brand name down , can’t find any around where I live . He stated the name in an email response I believe. Appreciate any help !

Leave a Reply

Your email address will not be published. Required fields are marked *

Pin It on Pinterest

Share This