Pages Navigation Menu

Vitamin B12 deficiency – all you need to know

130 Flares 130 Flares ×

By Dr. Nandita Shah

vitamin b12 deficiency


Please read this extensive work on Vitamin B12 deficiency; it is a vastly underestimated problem and should be taken much more seriously. Dr. Nandita Shah has gathered a wide range of information on this matter – we hope you’ll get something valuable out of it.


Vitamin B12 deficiency – all you need to know

by Dr. Nandita Shah

In a random test on 21 diabetics conducted by us, we found that about half of them had B12 deficiency, and none of them were vegan. Of those who were not deficient, some were on B complex supplements, which included vitamin B12.


How is Vitamin B12 produced?

Vitamin B12 is produced by bacteria and micro organisms. Meat and milk are full of bacteria because they are decaying substances and so these foods have plenty of B12. However, many non-vegetarians and vegetarians, especially those aged 35 and up are deficient too. Vitamin B12 is absorbed by the intrinsic factor in the stomach.

High protein from meat and milk force the stomach to produce more acid to digest them. (Proteins are digested mainly in the stomach.) This high acid secretion not only is one of the causes of acidity but also destroys the lining of the stomach so that the intrinsic factor is deficient.

Thus vitamin B12 is not absorbed. Non-vegetarians and vegetarians who become vitamin B12 deficient may not be able to absorb vitamin B12 and need to take injections. Vegans may be able to absorb vitamin B12 but are unlikely to get enough of it on a plant-based diet.

This is because of our present-day lives which are unnaturally hygienic. Micro organisms naturally available in our food are destroyed or removed due to:

  • Irradiation of fruits and vegetables
  • Pesticides used in farming
  • Chlorine or other forms of sanitizing drinking water
  • Washing fruits and vegetables well
  • Preservatives used in packaged food
  • High hygiene levels in our lifestyles
  • Modern-day toothpastes with Triclosan which destroy oral bacteria
  • Alcohol consumption
  • And the use of the microwave


In a more natural world, vitamin B12 could be naturally available to vegans in the form of organic fruits and vegetables straight off the farm, pond water, river water or other natural drinking water, etc.

Nature always made provisions for us to get enough of vitamin B12 in the most natural and cruelty-free ways. In fact, some raw vegans find that their B12 levels are good without supplementation due to the abundance of fermented foods and drinks that they consume.

In the past most cultures ate fermented foods like idli, dosa, miso, kimchi, sauerkraut, rejuvelac and of course present day vegan foods like vegan yogurt or curds, tempeh, natto etc. also provide B12.

Yet, in most cases, vegans do not get enough B12. This can be because some of these foods are made commercially these days, and / or because we don’t eat enough of them to provide for our vitamin B12 needs.

Vitamin B12 deficiency may be less common in the West, especially in the US, where soya milk and other ready-made foods are fortified with vitamin B12. Sometimes people who have come back or are visiting India from the West may develop symptoms after a few months, which they never had in the West.

Many people who want to live naturally, are averse to taking vitamin B12 supplements and this may not cause a problem for a number of years, since vitamin B12 can be stored in our body, but sooner or later this problem can catch up. Therefore it is important that everybody keeps a check.


Symptoms of Vitamin B12 deficiency

Symptoms can range widely and may not manifest themselves at all, because vitamin B12 is required by all cells of the body. Some of the common symptoms of vitamin B12 deficiency are weakness, apathy, memory loss, acidity, loss of weight, nausea and vomiting, anemia, mental confusion, delusions, paranoia, respiratory symptoms, hives and other symptoms of allergy.

A long-term deficiency can lead to heart attacks or stroke – the very problems that a healthy vegan diet can prevent. Long-term vitamin B12 deficiency can cause irreversible damage to the brain and nervous system.


B12 can be stored for up to 3 years

When you first switch to a plant-based diet, you may or may not have vitamin B12 deficiency. This can be determined by a simple test. Even if B12 deficiency is not present, it is likely to occur in the future. It’s always better to keep checking or take a B12 supplement as an insurance.

There are 2 kinds of vitamin B12 – methylcobalamin and cyanocobalamin. Methylcobalamin is the kind which is used by our body. Our body cannot efficiently use cyanocobalamin. Spirulina and Chorella contain cyanocobalamin and not methylcobalamin, and hence are not good sources of vitamin B12. Some vitamin B complex supplements also contain cyanocobalamin rather than methylcobalamin!


How to Test for Vitamin B12

There are 4 main tests for vitamin B12:

1. Serum B12.

The normal range is 200 to 900 pg/ml. (Please note that your B12 may have been measured by another system – pmol/l so you should see the normal range described in your report.) If your B12 is less than 150, it is very low. A good level is around 400. If a cyanocobalamin source is consumed these levels may be high, but the B12 is still not usable by the body. In this case, it’s better to rely on one of the other two tests.

2. Homocysteine level

High homocysteine levels are an indicator that the usable vitamin B12 is low, and should be supplemented. If Serum B12 levels are normal but homocysteine is high (common in people taking cyanocobalamin supplements), a methylcobalamin supplement is necessary.

3. MMA – Methylmalonic Acid, serum

MMA, along with homocysteine, helps diagnose an early or mild B12 deficiency. If MMA and homocysteine levels are increased, then vitamin B12 deficiency may be present, indicating less available B12 at the tissue level. If only homocysteine is elevated, then folic acid may be low or not being metabolism properly. If MMA and homocysteine levels are normal, it is unlikely that there is a B12 deficiency.

4. Holotranscobalamin

This test is not done everywhere and is expensive, but it’s the best test because it measures usable B12.


Under normal circumstances Its ok to rely on Serum B12 if cyanocobalamin supplements not being taken. Otherwise homocysteine levels are more reliable. Alternatively, both, serum vitamin B12 and homocysteine levels can be tested.


How to take Vitamin B12

Some people prefer not to take vitamin B12 because they feel it’s unnatural to take any supplements. I was one of them. However, I now understand that this rule applies only to people who live in a natural world where they can drink water from the river or pond, and the fruits and vegetables grow in their backyard.

However, everyone should still get their B12 levels checked and make sure they have healthy levels. In some countries, foods are fortified and levels may be ok. In others like India, one has to be more careful.


1. Vitamin B12 can be taken orally: If deficiency is low and the absorption of vitamin B12 is not yet affected, one can opt for this. There are many preparations available in India. Methycobal 500Mcg by Wockhardt is recommended.

Other options are Nurokind by Mankind, and Folinext by Otsira genetics. Folinext contains both Folic acid and methylcobalamin. Take one tablet daily initially when the deficiency is detected.

After 3 months, get your blood levels checked again and see if levels are normal. Once your blood levels reach normal take one tablet every alternate day for life. A vegan diet is deficient in B12, but even if you are not vegan, B12 deficiencies are not rare.

In case you are not vegan and your B12 levels are low, it means you are not absorbing B12. In this case, the only option is injections.


2. Injectable vitamin B 12: If the deficiency is very severe, or you are not vegan, but deficient, you should take injections. In case you are a vegan you may be able to absorb, so after the initial injections you could switch to tablets and continue for life, or you may choose to take regular injections (about once in two months).



Injection Eldervit from Elder Company is recommended. It comes as a combi pack of two vials. No.1. vial contains vitamin B12, 2500mcg with Folic acid 0.7mg, and Niacinamide 12 mg. No.2 vial contains Vitamin C, 150 mg. No. 1 vial can be taken as it is or mixed with no. 2 vial. Mixed is better for absorption of vitamin B12.

About 10 injections may be required initially in one month depending upon the severity of deficiency. Later, one injection every two months is good as a maintenance dose.


Injection Vitcofol – this contains B12 and Folic acid. Take a total of 2 vials (each vial 10 ml) in the following way: Take 2ml twice a week of Vitcofol for 15 days. After that, 2ml each week. This should be enough to lift the B12 levels. The second vial would last for one month and one week.


Injection Methylcobalamin – this contains only vitamin B12 but is in the same dosage as the Vitcofol injection and comes in similar-sized vials of 10ml each. This can be taken in exactly the same way as you would take Vitcofol. This is not painful. The other one is a little painful.


In case you experience some side effects after the injection they should not last for long. Injections should be given to you by a doctor after a test dose for the first time.


Many vegans avoid taking vitamin B12 because they are fearful that it will contain animal ingredients. This is unlikely because vitamin B12 is made by bacteria. However, Diana Ratnagar, BWC’s chairperson took the effort of writing to Wockhardt to check about their ‘Methylcobal’.

“Methycobal has no animal ingredients, and it is not tested on animals” was the firm reply from Wockhardt. Please do not hesitate to take it for this reason.


Please note that these suppliers are recommended for Indian citizens – check for others in your respective countries!


Are Vitamin B12 supplements toxic?

Vitamin B12 supplements have no known toxicity for all intents and purposes. Too much will not kill, too little can. Therefore it is better to be safe than sorry.


For more information on B12, see this page.


Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.

Please read our medical disclaimer.


We hope this was helpful to you; please leave a comment below, and don’t forget to follow us for more articles and videos on Google+, Twitter, via RSS feed, or by simply subscribing to our newsletter at the end of this page!  And most important: Visit Dr. Nandita Shah at SHARAN, to find an abundance of information, retreats, workshops, and many, many other things that might be of interest to you. Thanks for being with us!



  1. Thanks for the in-depth information about B12. It makes me think that Cyanocobalamin is just “trash” only indicating the B12 levels are OK and that Methylcobalamin is the “real” B12 vitamin?

    • It is as you say: Cyanocobalamin is a cheap and synthetic chemical made in a laboratory; it’s bound to a toxic, poisonous cyanide molecule that must then be removed by our body (liver) Methylcobalamin: This is the natural form; it is pre-methylated, meaning it’s ready-to-use for your biochemistry. (more expensive and worth the cost) This has been stated in many articles (like and by many doctors (like in this article) Thanks Andreas for your thoughts on this one.

Leave a Reply to Andreas Cancel reply

Your email address will not be published. Required fields are marked *

130 Flares Twitter 1 Facebook 13 Google+ 116 Pin It Share 0 LinkedIn 0 Buffer 0 Email -- 130 Flares ×