Is It Neuropathy or a B12 Deficiency?

Peripheral neuropathy is a condition that affects people in a “stocking and glove” pattern, meaning the hands and feet. This can cause numbness and tingling, and/or loss of sensation. As it progresses, it can lead to balance problems as the sensation in your feet help you stay balanced. There are many things that cause this such as diabetes, peripheral artery disease, smoking, alcoholism, and certain viral infections. However, one under-appreciated cause is B12 deficiency. The good news is it’s treatable.

Vitamin B12, also known as cobalamin, is a water-soluble vitamin that plays a key role in nerve function, red blood cell production, DNA synthesis, and brain health. In fact, you can develop anemia from B12 deficiency due to its role in red blood cell production. But it’s role in nerve function is what can mimic peripheral neuropathy.

B12 deficiency can cause demyelination, which means the protective coating (myelin sheath) around your nerves starts to break down. Without that insulation, nerve signals misfire, causing symptoms almost identical to those of peripheral neuropathy.

In severe cases, it can even lead to cognitive decline, mood changes, or difficulty walking.

There are several reasons why your B12 levels might drop:

• Dietary deficiency: Especially in vegans or vegetarians, since B12 is found mainly in animal products.
  

• Malabsorption issues: Conditions like pernicious anemia, celiac disease, or Crohn’s disease can prevent proper B12 absorption.
  

• Medications: Long-term use of drugs like metformin or proton pump inhibitors (PPIs) can interfere with B12 absorption.
  

• Age: Older adults often produce less stomach acid, which is needed to absorb B12 from food.
  

The tricky part is that B12 deficiency can either cause peripheral neuropathy or mimic it so closely that doctors may miss the root cause. That’s why it’s essential to check B12 levels, especially in people experiencing new or worsening neuropathy symptoms.

A simple blood test can measure your B12 levels. It’s also a good idea to check methylmalonic acid (MMA) and homocysteine, which can indicate deficiency even if B12 levels are borderline.

B12 deficiency may be a silent impostor, hiding behind the mask of neuropathy, but it’s also one of the most treatable causes of nerve symptoms out there.

If you’re experiencing strange sensations, fatigue, or balance issues, don’t just assume it’s “just getting older” or jump straight to a diagnosis of peripheral neuropathy. Check your B12 status. Sometimes, a small vitamin can make a massive difference.

A Hidden Reason for Fatigue: Pernicious Anemia

Anemia is a condition that reduces the ability of blood to carry oxygen, leading to fatigue and a whole host of other symptoms. This may be due to a reduction in hemoglobin, or a reduction of the production of red blood cells. Some common deficiencies that cause reduced red blood cells are B12 (cobalamin), folate, and iron. 

Unfortunately, it is common for someone to have low iron and low hemoglobin and get a diagnosis of iron deficiency. They are then told to supplement with iron. The problem with that is too much iron can be very detrimental, and even fatal in some cases. Although iron deficiency anemia is much more common, iron overload is also common and there is less awareness of it. So having an accurate diagnosis is very important. 

Pernicious anemia is the most common cause of anemia due to B12 deficiency. It can lead to irreversible blood and neurologic disorders. In fact, the word ‘pernicious’ means deadly. But don’t worry, it was named that way before we had answers. You can live a healthy life with pernicious anemia as long as you know what to do about it. However, that means you need to supplement it for life. 

Common symptoms of Pernicious Anemia: 

Feeling tired or weak

Shortness of breath

Feeling faint

Smooth red tongue

Pale skin

Chest pain

Nausea

Vomiting 

Loss of appetite

Heartburn

Numbness in the hands or feet

Memory loss

Blurred vision

Depression

These are just some of the symptoms of pernicious anemia. What exactly is pernicious anemia? It is an autoimmune condition that attacks the parietal cells of the stomach. The inner lining of the stomach has parietal cells and they have two functions; to secrete hydrochloric acid for digestion, and to secrete intrinsic factor. Intrinsic factor is a glycoprotein that binds to B12, where it then enters the small intestine where it is absorbed. 

There are other conditions that will inhibit the absorption of B12 such as SIBO (small intestinal bacterial overgrowth), low stomach acid, atrophic gastritis, H. pylori infection, celiac disease, and alcoholism. Use of metformin, a diabetes drug, also depletes B12 stores. B12 deficiency can also just be due to inadequate dietary intake. Plants do not need B12, so they do not store it. So you cannot get B12 from a plant-based diet despite what you may have heard. Some vegetables contain cobamides, a B12 analogue and actually inhibit the absorption of B12. B12 comes from animal products. 

B12 is an extremely important nutrient involved in the methylation cycle, genetic repair, and keeps your body’s blood and nerve cells healthy. Because of its role in blood cell production, when deficient, it can cause megaloblastic anemia. The important roles that B12 has explains the wide variety of symptoms. 

How do we detect pernicious anemia? Bloodwork is a good starting point. From there you can determine your B12 status and see your red blood cell levels. There is a test called a Schilling’s test that can help tease it out. You can also test antibodies for intrinsic factor. Seeing a functional medicine practitioner is likely your best bet. 

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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.