Vitamin B12: Effects, symptoms and causes of deficiency & the best sources

Vitamin B12 is a term that is primarily known to vegans. This vitamin is only found in animal products. However, omnivores can also develop a vitamin B12 deficiency.

Why is vitamin B12 so important and how can you prevent a deficiency?

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What is vitamin B12?

Vitamin B12 is one of the B vitamins and is an essential nutrient that we must consume through food. It serves as a cofactor for many enzymes.

Vitamin B12 is needed for cell division and blood formation and has important functions in energy metabolism. The brain also needs vitamin B12, especially because it is essential for nerve cells. It regenerates the myelin sheath of nerve cells and supports the formation of connections (synapses) between nerve cells. The myelin sheath is an insulating protective layer that surrounds nerve cells and ensures rapid signal transmission. ¹

The Federal Office of Consumer Protection and Food Safety confirms the following health claims for vitamin B12: ²

Vitamin B12

• supports memory performance

• supports brain performance

• is important for cognitive functions in old age

• is important for cell formation

• contributes to the formation of red blood cells

• is involved in all growth processes

• serves to regenerate damaged nerves (myelin sheath)

• is important for maintaining bone health

Symptoms of vitamin B12 deficiency

A lack of vitamin B12 can cause many problems. These are the most common symptoms of a deficiency: ³

• cold hands and feet

• Concentration and memory problems

• Tiredness, exhaustion and fatigue

• Senile dementia

• Numbness and tingling

• Depression

• schizophrenia

• Muscle weakness

• Unsteady gait

• Anemia

• Hair loss

Vitamin B12 test

Unfortunately, the symptoms of a vitamin B12 deficiency are very unspecific. This means that the individual symptoms can have many causes and do not clearly indicate a vitamin B12 deficiency.

A diagnostic test is therefore necessary to detect a vitamin B12 deficiency. People who are at increased risk of a vitamin B12 deficiency should have their vitamin B12 status checked regularly. This is because a vitamin B12 deficiency is not without danger. Vitamin B12 is important for the nerves and their ability to regenerate is very limited. Therefore, the damage caused by a vitamin B12 deficiency can, in the worst case, be irreversible.

Unfortunately, the serum test that the family doctor performs as standard is not very informative and is not suitable for clearly proving a vitamin B12 deficiency.

Holotranscobalamin test

The holotranscobalamin test (Holo-TC) measures active vitamin B12 in the blood, which the cells can absorb and use. ⁴ This test is significantly more expensive than the standard serum test, but it is worth the investment: because it is also much more informative.

The holo-TC value should ideally be above 50 pg/ml. If the value is between 35 and 50 pg/ml, further tests (homocysteine ​​determination and MMA test) are necessary to rule out a deficiency. If the value is below 35 pg/ml, a vitamin B-12 deficiency is very likely. ⁵

MMA urine test

The methylmalonic acid test (MMA test) is an indirect test for vitamin B12 supply. If there is a vitamin B12 deficiency, the body produces large amounts of MMA. These are excreted in the urine and can be detected there. ⁶

The MMA value should ideally be below 0.23 mg/g creatinine. Between 0.23 and 1.59 mg/g creatinine lies the grey area in which the vitamin B12 supply is probably not optimal. If the value is above 1.59 mg/g creatinine, a vitamin B12 deficiency is very likely.

Cause of vitamin B12 deficiency

A vitamin B12 deficiency can have various causes. These are the biggest risk factors:

• Medications: Certain medications such as proton pump inhibitors (PPIs) and the diabetes drug metformin can inhibit the absorption of vitamin B12. ^{7 , 8}

• Lack of intrinsic factor: This protein is produced in the stomach and is important for vitamin B absorption. ⁹

• Vegans and vegetarians: Since vitamin B12 is only found in significant quantities in animal products, people who eat a predominantly plant-based diet usually do not consume enough vitamin B12. Vegans are particularly at risk. They are strongly advised to take a vitamin B12 supplement. ¹⁰

• Reduced absorption: e.g. due to chronic inflammatory bowel disease. ¹¹

• Age: Older people often have several risk factors. ¹²

The liver can store large amounts of vitamin B12, approximately 2,000 - 5,000 ug. The daily requirement is 4 ug. Ideally, the stores can last for several years and a deficiency develops gradually, even in the presence of clear risk factors.

Foods with the highest vitamin B12 content

The daily requirement of vitamin B12 for an adult is 4 ^ug.13 This requirement can easily be met with a normal diet, since vitamin B12 is found in abundance in most animal foods.

In the table you will find the best sources of vitamin B12. ¹⁴

Groceries	ug vitamin B12 per 100 g
Mussels	99
Beef liver	71
Octopus	36
Oysters	35
mackerel	19
Crabs	11
beef	6
Cheese	3
Eggs	1.3
Milk	0.4

Conclusion: Vitamin B12 is not only important for the nerves

Vitamin B12 fulfils many important functions in the body. It is needed for blood formation, has important functions in energy metabolism and is important for nerve cells.

Vitamin B12 is found in abundance in most animal foods. However, a vegan diet or reduced intake can lead to a vitamin B12 deficiency.

A high-quality vitamin B12 supplement helps to ensure an adequate supply and prevent a deficiency. You should make sure that it is free of unnecessary, potentially harmful additives and comes from a German laboratory that ensures the highest quality standards.

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