The lowdown on B12: The under-rated catalyst in women’s health, energy + hormones
Photo by Siobhan Calder
In the vast world of essential nutrients, the crucial role of Vitamin B12 in women's health and hormonal harmony is often underestimated. Especially considering that women can be more susceptible to nutrient deficiencies than men, an aspect thoroughly explored in our previous article here.
Is deficiency common, and what is B12 needed for?
Vitamin B12, or Cobalamin, is an irreplaceable part of your nutritional needs. Marginal depletion affects 15%of those aged 20-59 and increases with age (where our ability to absorb B12 decreases) (1). Alarmingly, the state of B12 status could actually be worse than these statistics, with it being very under-diagnosed and optimal levels thought to be much higher than many lab ranges.
Essentially, Vitamin B12 is involved in:
Red blood cell production
Proper functioning of nerve tissues
DNA synthesis and regulation (hence, important when TTC and for pregnancy)
Cellular energy production (helping to convert the food you eat, into energy)
What are symptoms of B12 deficiency?
A deficiency, or below optimal levels of Vitamin B12 can present several symptoms, including:
Fatigue and weakness
Constipation and loss of appetite
Weight loss
Numbness or tingling in fingers and toes
Sore or red tongue, sometimes with mouth ulcers
Mood changes or depression
Neurological problems such as confusion, balance issues, and brain fog
Megaloblastic anaemia, if the deficiency is prolonged
How does B12 deficiency occur?
Unlike some of the other nutrients, B12 isn’t just about intakes. B12 deficiency can arise from:
Dietary deficiency: particularly in vegans and vegetarians. However, this can take years to manifest with symptoms as the body can store B12 for years in the liver.
Malabsorption disorders: Conditions like Coeliac or Crohn's disease interfere with the body's ability to absorb nutrients from consumed food, including Vitamin B12. Poor gut health and stomach acid levels can also impact absorption.
Certain medications: Some medications, such as certain antacids, diabetes drugs, and even the oral contraceptive pill can decrease the body's ability to absorb Vitamin B12 effectively (2).
Age-related factors: our ability to absorb B12 decreases with age
Alcohol intake: sorry, but even moderate alcohol intakes can diminish B12 status in women (and rob the body of other B vitamins) (3)
Pernicious anaemia: an autoimmune condition that affects your stomach, and ability to absorb B12, resulting in deficiency and megaloblastic anaemia.
Nutrigenetics: scientists have started uncovering how an individuals genetics may have a profound influence on the way their body utilises nutrients. Nutrigenetics is the science of how genetic variations (SNPs) influence a person’s nutritional status. Several SNPs have been identified to have the potential to influence B12, including FUT2, MTR, & TCN2. Individuals can have variations on these genes that can lower the capacity to absorb, utilise, and/or transport B12. I sometimes carry out genetic testing with clients in clinic to understand their personalised nutrition needs further. These are always looking at actionable SNPs, so we can always manage these with our lifestyle and environment. Personally, I know I have some of these and adjust my requirements of B12 accordingly. It also helps me understand why I wouldn’t thrive on certain diets, which someone else may feel great on.
I’m vegan, should i supplement?
Vegans and vegetarians are particularly prone to B12 deficiency due to the lack of animal products in their diet, which are the primary sources of B12. Regular supplementation, or consuming fortified foods (but watch out for ultra processed foods) can help prevent this deficiency.
Remember, it can takes years for deficiency to manifest due to the body’s storage capacity. I see vegans in clinic who haven’t ever regularly supplemented and have felt brilliant for years, but suddenly are very fatigued. This can often follow pregnancy, where utilisation of B12 is increased further.
Photo by Siobhan Calder
Are B12 supplements effective?
Addressing Vitamin B12 deficiencies involves identifying the root cause and then devising an appropriate course of action. Here are some strategies:
Dietary Changes: Increasing your intake of foods rich in Vitamin B12 can be beneficial. These foods include animal products like meat, dairy, and eggs, and fortified foods such as nutritional yeast.
High-Quality Supplements: If dietary changes aren't enough or not an option (as in the case of vegans or vegetarians), oral Vitamin B12 supplements can be effective. These are available in several forms including tablets, capsules, and liquids. Always work with a healthcare provider before starting a supplement regime.
B12 Injections: In some severe cases or where malabsorption issues exist, Vitamin B12 injections may be necessary. This should always be provided and approved by your healthcare provider. They bypass the digestive system, allowing for direct absorption into the bloodstream.
High-Dose Oral Supplements or Sublingual Tablets: For some people with absorption issues, high-dose oral supplements, such as sprays or sublingual (under the tongue) tablets or drops can be really effective.
Probiotics + Gut Repair: Working at the root cause on gut health and gastrointestinal issues that interfere with nutrient absorption is key. Certain probiotics can help to maintain a healthy gut microbiome, promoting better absorption of vitamins, including B12.
Medication Review: If a medication you're taking is causing the B12 deficiency, your healthcare provider may adjust the dosage or switch you to a different medication. Never change a medication, without consulting your healthcare provider.
What are the different forms of B12?
You may have heard about different forms of B12, which can make things feel even more confusing. Some you may come across:
Cyanocobalamin: This is a synthetic form of B12 that's used in a lot of (often cheaper) supplements and fortified foods. Your body must convert it to the active forms of B12 (methylcobalamin or adenosylcobalamin) before use.
Methylcobalamin: This is a naturally occurring form of B12 that's readily available for use in the body. It is often found in food and in certain high-quality, food-based supplements.
Hydroxocobalamin: This commercial form of B12 is produced by bacteria and is commonly used in B12 injections.
FOod sources of B12:
Beef, liver, clams, fish, meat, poultry, eggs, milk, and dairy products. Certain fortified products such as breakfast cereals, and nutritional yeast.
Photo by Siobhan Calder
How do I know my B12 levels?
A motto I use with all my clients, test don’t guess. The best thing you can do (aside from eating a well balanced healthy diet), to ensure you aren’t deficient in any key nutrients is to test. However, B12 can be trickier to accurately assess. There are various markers I’ll consider in clinic and we have to also take into account any recent supplementation.
In my clinic, I always try to work collaboratively with a client’s GP to organise any blood tests. Sometimes more in-depth blood panels are required and I work directly with private labs for this. If you are concerned about your nutrient status, going through a stage in your life where nutrient demands change (e.g. pregnancy, TTC, menopause), or want to just find out more about the functional testing I use in my clinic; feel free to book in here for a complimentary nutrition review call where we can chat more about this.