Vitamin B12 deficiency is back. What to do now?

Many moons ago my body stopped absorbing vitamin B12 (mainly found in animal products) for almost 5 years. Even though I was eating a flexitarian diet back then (including meat or fish 2 to 3 times a week) and adding B12-rich plant foods such as kimchi, miso, pickles, and sauerkraut to my diet, my levels dropped to nearly zero.

Since I was still eating animal products it took doctors quite a while to pinpoint my issues to B12 deficiency. After the diagnosis, I received monthly injections of B12 to bypass the digestive tract. When I asked doctors what was wrong with my body, they couldn't give me a straight answer. Just as they couldn't tell me why my body magically started absorbing this vital vitamin again after 5 years.

Anyhow, having struggled with b12 deficiencies in the past I quickly recognize the symptoms these days. It all started again 2 to 3 weeks ago. Lack of energy, issues with concentration, strange tingling feeling in my feet and fingers, and just being tired and cranky all the time.

One of the downsides of living in Cambodia is the lack of decent health care systems. Doctors and hospitals usually don't know what they are doing and often can make things worse.

But since I recognized the issues straight away (and I studied pharmacy and biology so I know a thing or two about analyzing blood tests myself), I just skipped the Cambodian doctors and went straight to the clinical diagnostic lab to test a few things myself before starting to panic and having to leave the country to seek decent medical treatment.

As I expected, the results indicated that I've got a B12 deficiency again.

WHAT IS B12 AND WHY IS IT SO IMPORTANT FOR US

Vitamin B12 - aka cobalamin - is an important water-soluble vitamin that plays a vital role in the production of red blood cells and DNA, as well as the proper functioning of the nervous system.

Vitamin B12 is synthesized only by certain bacteria, and it is primarily concentrated in the bodies of predators located higher in the food chain [5]. Vitamin B12 is well-known to be the sole vitamin that is absent from plant-derived food sources. Foods (meat, milk, eggs, fish, and shellfish) derived from animals are the major dietary sources of Vitamin B12

Vitamin B12 is synthesized only by certain bacteria. Naturally, vitamin b12 is found in animal products such as (red) meat, fish, shellfish, poultry, eggs, and dairy products. Though some claim adding algal health foods such as spirulina tablets or powder to your diet will prevent B12 deficiency, the contrary is true. These supplements often contain large amounts of pseudo vitamin B12, which is biologically inactive in humans. Some may even interfere with real B12 activity and make things worse.

Vitamin B12 analogs or pseudo vitamins are molecules that are chemically similar to the real vitamin B12. This gives them the ability to bind to the same transport molecules. But they have no vitamin effect on the body. When this happens, deficiency can occur as the real vitamin simply cannot be transported and utilized since the fake b12 is taking up the spots.

Figure - Structural formulae of Vitamin B12 and pseudovitamin B12. (1) Vitamin B12 and (2) pseudovitamin B12 (7-adeninyl cyanocobamide).

PLANT FOODS HIGH IN REAL B12

According to an article published in the journal Nutrients, plant foods that contain real b12 include:

FERMENTED BEANS AND VEGETABLES - Certain strains of the lactic acid bacteria used during the fermentation process can produce certain B vitamins, including vitamin B-12. These foods include tempeh, miso, kimchi, sauerkraut, and pickles.
NORI aka dried purple lavers
SHIITAKE mushrooms
B12 FORTIFIED FOODS such as cereals, nut milk, nutritional yeast, etc.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042564/

What to do now?

Before I start monthly B12 injections, it is important to know if I have absorption issues again or if it is just me not paying enough attention to this nutrient in my daily diet.

So in the coming month, I am upping foods rich in B12 in combination with a b12 oral supplement.... after one month I will repeat the blood test to see whether my levels have improved or not. If nothing changed, malabsorption might be the issue again.

I'll keep you guys posted

Are you a vegetarian or vegan too? Where do you get enough B12 from?

All tips and tricks to get more of this vital nutrient are welcome in the comment box below.

BUCKWHEAT MISO NOODLE SOUP WITH HOMEMADE KIMCHI

As noted above, fermented foods such as kimchi and miso contain B12. I also bought some shiitake mushrooms the other day but I saved them for today's dinner.