B12 Malabsorption

Drawing of stomach with too little acid to release vitamin B12 from foodYou can eat well, choosing healthy, organic foods, but still suffer from malnutrition. How can that happen? Malabsorption occurs when your body isn’t able to get the nutrients it needs out of the food you eat, even when the food contains them. Malabsorption robs you of the benefits of eating well.

Why won’t my body absorb B12, you may ask. Malabsorption is caused by insufficient stomach/gastric acid to release nutrients, like vitamin B12 and magnesium, that are bound in protein. If you think about the foods most cited for containing B12, they are meat, eggs, seafood and cheese, all of which are protein foods.

If you use antacids, have h.pylori or use NSAIDS like Ibuprofen, you are likely to have less stomach acid than is needed to release B12 and magnesium from food even if the food you eat is rich in B12 and magnesium.

h.pylori ~ Read more.

Advil and other NSAIDS ~ Read more.

malabsorption is like a house that looks great on the outside but has termitesWhen I think about malabsorption the image of a charming house often comes to mind, lovely in every respect on the outside, but with the possibility that unseen, inside its very structure, there can be termites eating away its framework. Malabsorption, causing low vitamin B12 levels, is a lot like termites eating away at your nerves and blood.

In the absence of sufficient B12 your body has a problem making new red blood cells. Instead of your blood cells maturing and dividing, they enlarge but don’t divide. Technically, this is called “Macrocytic Anemia” macro meaning large.

Oftentimes very pale skin is a sign of anemia. This is because large blood cells, laden with needed oxygen but starved of vitamin B12, can’t get into the small capillaries closest to the surface of the skin. As a result, a rosy complexion, associated with good health, is impossible.

While it’s relatively easy to live with pale skin, it’s not as easy to live with numb feet and hands that come about when red blood cells can’t deliver oxygen. Numb feet can take the pleasure out of walking and be dangerous. A small injury that isn’t felt can become infected or harbor bacteria that lead to serious disease, which is exactly how I got tetanus and how people with diabetes become amputees.

Red Blood Cell in Tiny Capillary - Dennis Kunkel Microscopy
Image provided and copyright Dennis Kunkel Microscopy, Inc. http://www.denniskunkel.com/

The microscopy image by Dennis Kunkel of a single red blood cell in a tiny capillary shows that there’s not a lot of room to spare around the blood cell. This image makes it easy to understand how blood cells that get large, without dividing for lack of vitamin B12, will no longer be able to travel through tiny capillaries.

If you wonder what the large, darker blue shape above the blood cell is, it’s the nucleus of the endothelial cell that forms the interior wall of the capillary.

When your red blood cells are large, they show up as a high MCV (Mean Corpuscular Volume). That is, your blood cells have a lot of volume, and, there are fewer of them in your blood sample than there would be if your cells were smaller. A high MCV can indicate a B12 Malabsorption Illness.

What can you do?

NOW Methy B12 1000 mcg

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B12 replacement heals blood cells. It’s easy for you to get Methylcobalamin and use it to replace the vitamin B12 you’ve lost. Your body will excrete any B12 it doesn’t use, so it’s safe for you to use Methylcobalamin.

Be aware that sometimes B12 replacement turns painful. Why? When blood cells heal they begin to use more potassium. As your potassium levels decrease, you may experience weakness, even painful muscle spasms unless you restore your potassium level.

Foods containing Potassium ~ Read more.

If you choose to go a doctor to establish whether or not you need vitamin B12, it’s important to know a bit about blood work.

The opposite of Macrocytic Anemia is Iron Deficiency Anemia, technically called, “Microcytic Anemia” micro meaning little.

When you have Iron Deficiency Anemia and B12 Malabsorption Illness, your MCV may appear normal because the two illnesses balance each other in terms of how your blood appears (MCV).

But, these two negatives don’t make a positive. Quite the opposite.

If your doctor glances at your blood work and doesn’t ask you specific diagnostic questions, your low vitamin B12 levels and possible B12 Malabsorption Illness may escape detection.

Thus, you need to be aware that the inevitable result of untreated low vitamin B12 levels is nerve damage.

Diagnostic Questions ~

Soldier Termite To locate “termites” your doctor has to ask the right diagnostic questions.

Do your hands and feet fall asleep?

Large red blood cells cannot pass through smaller blood vessels, like those in your hands and feet. So, those parts of your body become low in oxygen and nutrients. The result is numbness: “falling asleep.”

Is there Pernicious Anemia in your family?

Pernicious Anemia is a well known disease decreasing the level of B12 in a person’s body. In Pernicious Anemia, a lack of Intrinsic Factor stops the body from getting B12 from the foods that contain it, such as meat, particularly liver, as well as eggs. (Hard to believe it’s really called Intrinsic Factor, and, that there’s no B12 in vegetables.)

Pernicious Anemia can be hereditary, so your doctor should ask if relatives have it. But now that you’ve read this, be forewarned. My doctor didn’t ask.

Do You have Memory problems?
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Jarrow Methyl B12

This is a critical question. Any memory or cognitive test questions that you are given by your doctor, and answer wrong, should alert your doctor to the fact you may have a potentially devastating illness, which needs to be diagnosed and treated early to be held in check. Don’t lose 2/3rds of your working memory like me.

Are you Depressed?
photo of cat hanging its head as if it's depressedAbundant research links Depression and low vitamin B12. If you feel depressed read the research. If you’re one of the millions of people to whom the drug companies advertise antidepressants every day, let me tell you what they aren’t telling you, “Depression and low vitamin B12 are often medically linked.”

Personally, I think depression is a natural result of memory loss — that’s because the good times of the past disappear, allowing a horrible moment to seem like that’s all there is or ever was. Add to that being tired because your large red blood cells aren’t carrying enough oxygen, and Depression begins to sound like a fit.

You may genuinely be someone who needs antidepressant drugs, but if you’re someone who needs vitamin B12, don’t you want to know?

Incidentally, B12 is IN-expensive (cheap). Several month’s supply of injectable Cobalamin that I used before switching to sublingual Methylcobalamin was $6 at Wal*Mart with my AAA discount; needles were .26 each. Sublingual (under tongue) B12, is around $10 ordered online. (Sarafem, an antidepressant, was $67/mo.)

If you have the symptoms above or lines on your Fingernails, buy sublingual Methylcobalamin and start using it. Remember, do not buy the kind of pills you swallow because if you have malabsorption problems in your gastro-intestinal system, the pills won’t work any better than liver or eggs.

Would you like a B12 blood test?

Vials of blood The answer is, “Yes.” In fact, if your doctor doesn’t offer the test, ask for it. And, insist that you be given your results. Your doctor may say, “They’re fine.” Still insist on getting your actual results. It is important for you to know your own vitamin B12 test results because the labs may say you have a normal level if it is 180; consequently your doctor may rely on this and tell you your level is normal.

But, is it? In many countries they recognize that a B12 level lower than 500-550 can result in cognitive dysfunction. For them 500-550 is the low, not 180. Here in the U.S., doctors, laboratories, and drug companies have agreed that a level of 200 is fine and “normal”, And of course you need Anti-Depressants.

What is a health B12 level? ~ Read more.


Check out research excepts on these pages: Research and Sally Stabler, and search the Internet for more B12 information. When you search “Vitamin B12” you get a lot of vitamin ads. “Cobalamin” or “Methylcobalamin” is a more medical approach, yielding better search results.

We want to get rid of “termites”, Right?

timebombOf course. No one wants to be eaten by a voracious disease that is perniciously slow. So slow that as the years go by we think we are fine, except for our age. Blaming our age, we accept our deterioration as if it were normal, much as if we mistook a time bomb’s ticking for that of a grandfather clock.

The fact is that low vitamin B12 is vastly abnormal and leaves us, you and me, a shell of our former selves.

So, check your fingernails. If they have lines or their moons are gone, get sublingual B12, and take it. The methylcobalamin form is excellent/best because it’s ready for your body to use (there are several different forms).

Be sure you become familiar with the active form of B12. It works most quickly. Do this before you buy B12, else you may buy the less effective kind and not get the results you need.

(Remember, vitamin pills won’t work because having B12 Malabsorption Illness means your stomach and intestines are no longer properly absorbing B12.)

After you begin taking sublingual methylcobalamin (B12), watch your nails improve. Keep track of them and of how you feel: write down when your hands and feet fall asleep, when you are depressed, when your gums bleed, when you can’t sleep, have memory problems… the whole kit and caboodle. I did this because my neurologist said to keep a “Time Line” showing my shots, test results, and symptoms. He said that the Time Line could be used to verify the B12 diagnosis. Without a doubt my Time Line showed me major improvements I might otherwise have failed to attribute to B12.

Within a few weeks to a couple months, you will see a contrast develop between the old and new texture of your nails, and between the old and new you.

Keep an eye on your brown spots, too. I had a lot of brown spots when a news segment said that in large numbers they could be associated with cancer. I went to my doctor, who said not to worry, they were common. My doctor, who hadn’t seen the news segment, said they were, “sebaceous keratosis” and nothing to worry about.

The pictures in the link are not me, nor were my spots in the same locations as those shown. But, the way the brown spots looked individually was very similar, if not in some cases exactly the same.

Because I had one patch of brown spots that was exactly a circle, I was able to recognize that half went away when I started having regular B12 shots.

Back to the contrast of Before and After B12: When the improvement happened for me, I could not believe I wasn’t as Old as I’d felt. It was like being made young again: to get my memory back, though I had to retrain myself to use it — no kidding. To feel full of life, even when distressing things happened and to no longer wake up each morning feeling exhausted felt miraculous.

So, write things down or you won’t believe the amount of change there is. Seriously.

Because it took too long for me to get the B12 (cobalamin) I needed, I haven’t regained my full working memory, nor the speed with which I used to be able to think. That’s why you don’t want to wait if you see lines on your fingernails.

At a more underlying level you want to get rid of what might be causing your malabsorption. Two primary causes are h.pylori and hypochlorhydria, though in fact the h.pylori may cause the hypochlorhydria.

h.pylori ~ Read more.

Hypochlorhydria ~ Read more.

My Impetus to Create this Page

Note: I originally did this page in 2003, when I was still extremely distressed that the doctors had not diagnosed my B12 malabsorption illness in time to prevent nerve damage and cognitive dysfunction.

At the time, I was trying to sue so that in the future doctors would be more aware of B12 and other people would get properly diagnosed.

As I did this page I was looking at my blood test results and seeing the warning signs the doctors had overlooked. That’s why oarts if this page sound critical of doctors.

In the end I wasn’t able to prosecute effectively because I was having more and more memory and balance problems. I believed that my feet were going numb and I was losing my balance because of the length of time my B12 problem had gone undiagnosed. That is to say, I did this page before I knew my condo had been built over a full outdoor toilet pit.

I believe that if I had not had cognitive dysfunction from undiagnosed B12 malabsorption, I would have been better able to think and I could have figured out that there was something wrong in my home before the pit’s effect on me was as bad as it was in the end.

As an aside, I tried to get the doctors and St. Vincent Hospital to settle: I wanted them to agree to do B12 education, to look at this article about how 550 is a better “low” for B12 than 180 or 200, and for each of them to pay me $6,000 so that I could go on. They refused.

The funny thing is that I had really believed they would want to do that kind of education since I was pretty sure that they would be able to get quite a lot of free tv and newspaper space since it was for the public good.

Karen Kline, 6/13/06

TAKE NOTE: I am not a doctor.

I am talking to you from my own experience. Because my B12 Malabsorption Illness was not diagnosed and treated for almost two years after I had severe symptoms, I now have two-thirds less of my working memory and about half of my cognitive processing speed; plus, my feet lose feeling sometimes when I’m walking so that I feel as if I am falling. Sometimes I do fall, which besides hurting is dangerous for an older person. (I’m 60; but don’t let that stop you from taking this seriously if you are much younger. The fact is that the loss of B12 is very slow over years. Your best bet is to begin doing something before the situation is dire.)

When I tried to sue the doctors who ignored my substantially low serum B12 test results, I was pro se — representing myself — and my impaired working memory made it a gargantuan task. At which I failed. On the other hand, this web page is another way I can increase awareness of the serious problems that are caused by having too little B12. I had thought the doctors would want to educate, as a settlement, but their lawyers uniformly rejected the idea.


Tell your friends about this web site. Tell your relatives about the information — in person if they don’t have computers.

Get Methylcobalamin lozenges. You can order on line, which is quick and easy and you’ll be sure to get the right thing. Methylcobalamin Lozenges.

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Vitamin B12 Malabsorption
Article Name
Vitamin B12 Malabsorption
You can eat healthy but still suffer from malnutrition. How? Malabsorption occurs when your body can't release nutrients from food, even food rich in them.
Publisher Name
Health Boundaries
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3 Replies to “B12 Malabsorption

  1. Hi I became quite ill recently. Poor memory loss dizzynes restless sleep. Numb hands and fingers, depression. blood pressure shot from 117 over 84 to 191 or 50. crying contantly, couldn’t breath propably. Sickness nausea. Doctor said large blood cells but blood test normal 3 times. Ended up kneck pain and under an osteoptath. But told normal. In end went hospital said low vit D which was 26 and low B12 296 told to take 1000mg a day. I then took 2 iron tablet too. At last getting better but need all these tablets to function. Is 296 B12 low?? im told its not but have large red cells of 97.6fl. Also should I be taking two iron a day.

  2. Hi Sandra,

    296 is a low Vitamin B12 level, except many countries accept 180 as “normal.” Here is a page I did on B12 levels:

    I think the best way to stay on top of your B12 level is to know the symptoms of low vitamin B12, and then use Methylcobalamin or the form of sublingual B12 available in your country till your symptoms go away.

    I recognize most of your symptoms from my own experience with low vitamin B12.

    I was constantly, from the time I was a child, told I had iron deficiency and was therefore prescribed iron. But, after I had B12 replacement I no longer had the symptoms of low iron.


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