B12 Deficiency and SIBO

We routinely send our clients out for bloodwork, and one of the most common deficiencies we see is B12. There are a number of reasons for this, and in this blog we’ll cover the most common ones.

B12 (cobalamin) is a water soluble vitamin and is part of the methylation cycle, and as such is important for DNA synthesis and repair. It plays a role in nervous system development and in neurologic functions, as well as formation of red blood cells. Deficiency can cause anemia,  tingling in the hands and toes, and has been correlated with dementia. 

B12 interacts with homocysteine and folate in the methylation cycle, so when homocysteine and folate are high, that usually indicates deficiency in B12. It’s an inverse relationship.

Humans cannot synthesize B12, so it has to be acquired in the diet. B12 is high in liver, red meat, eggs, and seafood. You may read that B12 can be found in plant foods such as algae, but that is a myth. B12 is cobalamin, and algae contains cobamides, which is pseudo B12 and can actually inhibit the absorption of B12. So this is one of the most common reasons for B12 deficiency, inadequate intake. 

Another common reason for B12 deficiency is malabsorption. This comes in two forms, hypochlorhydria and SIBO. Hypochlorhydria means low stomach acid. Stomach acid helps break down our foods and if it’s too low, you won’t get the appropriate amount of nutrients out of your food. Several factors can influence low stomach acid. It naturally decreases as we age, but certain things can influence that. Excess alcohol intake depletes stomach acid. Also, use of PPIs (omeprazole) reduces it almost to zero in some cases. If you are concerned about reflux, read this blog on the correlation between low stomach acid and reflux. 

If the food is not fully digested, it moves into the small intestine. This is where B12 is usually digested by the body. There is a natural balance of microbiota that occurs within our guts. Most of the beneficial bacteria should be in the colon, and only a small amount in the small intestine. When stomach acid is low, food is inappropriately broken down, and the small amount of bacteria in the small intestine get a crack at that food and then they proliferate. This is what is known as SIBO (small intestinal bacterial overgrowth) and has a laundry list of possible symptoms. The over represented bacteria also gobble up the B12, so B12 deficiency may be a sign of SIBO. 

Typical symptoms of SIBO include gas, bloating, fatigue, skin issues, brain fog, constipation or diarrhea, halitosis, and muscle aches. So the symptoms are not confined to the gut. SIBO can also negatively impact fat absorption, so some of the fat soluble vitamins may also be deficient such as D, K2, and A.

The good news is that there is a breath test for SIBO that is cheap and easy. It will determine what type of species of bacteria that have become overgrown. There are specific botanical protocols to correct it based on the results of the breath test.