b12 deficiency

Vitamin B12 Deficiency – Why Your Levels Are Low and How to Fix It

Taking a B12 Supplement Is Not Always The Answer

Anytime we’re told that we’re deficient in a nutrient or vitamin, the first thing we think of doing is taking a supplement. Low vitamin D? Take a pill. Low iron, take a pill. Low calcium, take a pill. Low vitamin B12, take a pill. You get the drift.

Even better, increase your intake of foods rich in these nutrients. Right?

On one level, this is a sound strategy. Many people are not getting a sufficient variety of nutrient-dense foods in their diet to meet their needs AND their stress levels and lifestyles are putting great strain on their bodies, which causes them to use up and require even more nutrients.

Sometimes it’s just an issue of adequate intake. But, there’s also something else to consider.

When it comes to nutrient deficiencies, there’s usually a bigger problem going on that has a lot to do with how much of that nutrient you’re actually absorbing. So, even if you take a supplement, you may not absorb what’s in it.

Malabsorption is considered the most common cause of B12 deficiency (1).

So many of my clients come to me taking high doses of B vitamins, vitamin D and iron and their levels are still low. (This post is true for those deficiencies as well.)

HINT: your doctor may say your levels are fine, but if your B12 levels are below 400 pg/ml, you may actually be deficient.


10 (Mostly Unknown) Facts About B12:

  1. B12 is not made by plants or animals, it’s made by soil bacteria and algae.
  2. Your gut bacteria makes B12, but not for use within your body. Because it’s made by bacteria in your colon (not in your small intestine where nutrients are absorbed), the B12 is either kept for the bacteria’s own needs or excreted in feces. This is why  many vegetarian animals eat their feces, to obtain B12 and other nutrients. (Gross, but true.)
  3. Animals we eat obtain B12 from eating soil bacteria and the bacteria within their own body and intestines make B12 that they can actually absorb. The B12 then gets incorporated into their meat and milk. In the body, B12 is stored in the liver – eating liver is the best source of B12.
  4. Cultures who live outdoors or spend a lot of time in nature are more exposed to soil bacteria and have a lower likelihood of developing megaloblastic anemia (B12 anemia). We can get small amounts of B12 from the bacteria as they pass through our GI tract, before they get to the colon. Due to our “super clean” and hygienic lifestyles, we don’t get exposed to the soil and bacteria as much. While we can get sufficient B12 from meat, our reduced exposure to bacteria and soil organisms is a loss of another small source that would also provide countless other health benefits to us.
  5. The two active forms of B12 are methylcobalamin and adenosylcobalamin, found in meat, eggs and dairy products
  6. Fortified breads and cereals, as well as many supplements, usually contain the inactive form of B12, cyanocobalamin, which is not ideal for human consumption.
  7. The B12 in dairy products in bound up tightly and it’s yet to be determined if we actually absorb it that well, though cultured dairy like yogurt or kefir may make it more available.
  8. Because bacteria make it, cultured vegetables like saurkraut and kimchi do contain small amounts of B12, though studies have found that the B12 in these foods are not the active form that we need (1).
  9. Even if you eat meat, you can be deficient in B12 since absorption requires healthy digestion.
  10. 40% of the population is deficient (and don’t know it!) – meat eaters and vegetarians alike.

b12 deficiency



We are a predominantly meat-eating country, yet lots of carnivores end up deficient in B12 and many other nutrients found in meat, like iron.

If you are deficient in B12, you’ll want to consider that your digestion is to blame, not simply that you may not be consuming enough.

Because B12 is bound up in protein, you need to be able to break it away from the protein structure, carry it safely through the stomach and intestines to your gut lining, where it can be absorbed.

If you’re interested, here’s how it works in the simplest terms:

Stomach (key!) – acid and enzymes break down meat/protein, releasing B12.

B12 can now connect with R-protein from saliva you swallowed, which will protect it as it travels to the small intestine.

In small intestine, an enzyme from the pancreas breaks B12 + R protein apart so that intrinsic factor (IF) made by stomach can now  connect with B12.

IF transports B12 to the lining of the intestines where it will allow B12 into bloodstream ONLY if it’s connected to IF.


The Real Problem is Poor Digestion

You may be thinking, but I don’t have any digestive symptoms! You don’t have to have any digestive symptoms to have poor digestion and inadequate nutrient absorption, and that is all too often the case.

All disease begins in the gut and so do most nutrient deficiencies.

Technically, you are NOT what you eat, you are what you absorb.

Factors That Block or Prevent Absorption of B12:

  1. Poor saliva amount and quality, basically, dry mouth (prescriptions are a big factor here)
  2. Low stomach acid and poor stomach health – very common, read about it here. Therefore, protein is not well digested, B12 is not released from the meat and sufficient intrinsic factor (IF) is not produced.
  3. Pancreatic insufficiency – your pancreas produces digestive enzymes that are critical to making B12 available for IF to bind to it; many people have low pancreatic enzyme output. If this happens, the R protein is never broken off from the B12 and now it can’t be absorbed.
  4. Poor gut health – reflux, bacterial imbalances, yeast overgrowth, leaky gut, Crohn’s disease, ulcerative colitis, celiac, consuming food you’re allergic or sensitive to, other inflammatory bowel disease, etc. The inflammation can block or disrupt the receptors that let B12 into the blood stream. (Don’t assume you digest and absorb food just fine if you don’t have digestive symptoms!)


How To Raise B12 Levels

  1. Eat a low-inflammatory diet to support gut health.
  2. Take a probiotic (healthy gut bacteria) – a Stanford University study showed that it can improve B12 levels by supporting the overall health of the gut. Remember that even though we don’t get B12 from our gut bacteria directly, their presence keeps our digestive tract healthy.
  3. Take a digestive enzyme (different from a probiotic). I discuss this more here.
  4. Remove foods you are allergic or sensitive to from your diet to decrease gut inflammation. (Read #1 and #2 in this post for more on that)
  5. Eat healthy animal products – grass-fed beef, wild fish, etc. If that’s cost prohibitive, understand that you still need what’s in the meat and eat the healthiest versions you can.
  6. Add bone broth and fermented foods (saurkraut, kimchi, kefir, miso) to your diet.
  7. Eat locally grown vegetables WITHOUT scrubbing them or using soap. This may seem gross, but it’s actually how we’re designed to live. Sure, wipe off the visible dirt or give it a rinse with water, but DO NOT SANITIZE your food.
  8. If you take a B12 supplement, remember that you still need to be able to absorb what’s in the pill, so you’ll need to follow the above recommendations. Find one that uses one of the active forms, typically methylcobalamin.
  9. Eat liver – sauteed with onions, as liver pate, or in capsules. This is HUGELY beneficial.

b12 action steps


Questions? Comments? Leave them below or send me a message!


(1) https://www.ncbi.nlm.nih.gov/pubmed/12650116

(2) https://www.ncbi.nlm.nih.gov/pubmed/10552882

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5 replies
  1. Elizabeth says:

    Just what I needed. Curious to learn your thoughts on calcium bentonite use/benefits/cautions beyond what’s advertised.

    • Veronica Verhoff
      Veronica Verhoff says:

      Thanks, Elizabeth. I love bentonite clay. It has so many uses. I would say the number one precaution would be to take it away from supplements or medications as it can bind to them and reduce how much of it you absorb. Of course, talk with your doctor if you plan on using it regularly. I typically use it to stave off stomach illness or for other digestive upset, not on a daily basis. Check out coconut charcoal from the company bulletproof. It’s a clean source.



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