Vitamin B12 Malabsorption
Vitamin B12 Malabsorption

You eat well, choosing healthy, organic foods, but still suffer from malnutrition. Isn’t that impossible? How could 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. B12 Malabsorption robs you of the benefits of eating B12 foods.

Why won’t my body absorb B12, you may ask. The most likely reason for B12 malabsorption is insufficient stomach/gastric acid to release vitamin B12 from protein. If you think about the foods most cited for containing B12: meat, eggs, seafood, and cheese, they’re protein foods.

If you use antacids, have h.pylori, or use NSAIDS like Ibuprofen, you likely have too little stomach acid to release B12 or the mineral magnesium from food. Even if the food you eat is rich in B12 and magnesium with low stomach acid the nutrients remain trapped.

B12 Malabsorption is a lot like Termites

When I think about B12 malabsorption the image of a charming house comes to mind — lovely on the outside, but unseen, inside its structure, termites eating away its framework. B12 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.


Very pale skin

Oftentimes very pale skin is a sign of anemia. Blood cells, starved of B12, are too big to bring needed oxygen into tiny, surface capillaries; as a result, a rosy complexion, associated with good health, is impossible.

While it’s easy to live with pale skin, numbness from large red blood cells failing to deliver oxygen is different. 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. In fact, that’s 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.

The microscopy image by Dennis Kunkel, above, of a single red blood cell in a tiny capillary shows there’s no 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 B12, will no longer be able to travel through tiny capillaries.

The large, darker blue shape above the blood cell is 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

Methyl-B12 1,000 mcg 100 lozenges

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


Sometimes B12 replacement turns painful. Why? As blood cells heal they use more potassium, causing your potassium levels to fall. As a result you may feel weak, even have painful muscle spasms. But, potassium foods are some of the best, so it’s easy to raise your level.

If you 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 at a casual glance.

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 ~


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


Do your hands and feet fall asleep?

Large red blood cells can’t pass through smaller blood vessels, like those in 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 decreases 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.

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?
Jarrow Methyl B12, 5000 mcg, 60 Lozenges

Jarrow Methyl B12

This is a critical question. Your answers to any memory or cognitive test questions your doctor gives you, may provide valuable warning signs. Once your doctor is alerted to the fact you may have a potentially devastating illness, diagnosis and early treatment become possible. Early treatment holds dementia in check. Don’t lose 2/3rds of your working memory like me.

Are you Depressed?


Abundant research links Depression and low B12 levels. If you feel depressed read the research.

Drug companies advertise antidepressants to millions of people every day. What the commercials don’t say is, “Depression and low vitamin B12 are often medically linked.”

For me depression was a natural result of memory loss ~ the good times of my past disappeared, making a horrible moment seem like that’s all there is or ever was. Add to that being tired because my large red blood cells aren’t carrying enough oxygen, and Depression sinks its claws.


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 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 cents each. Sublingual (under tongue) B12, is around $10 ordered online for a month’s supply. (Sarafem, an antidepressant, was $67/mo.)

If you have the symptoms listed above or lines on your Fingernails, buy sublingual Methylcobalamin and use it. It works as well as, or better, than B12 injections.

Would you like a B12 blood test?

Blood Test

The answer is, “Yes.” In fact, if your doctor doesn’t offer the test, ask for it. And, insist on seeing your results. Your doctor may say, “They’re fine.” Still insist on getting your actual results. It’s important to know your B12 test results because the lab may say your B12 level is normal if it is 180. Your doctor may rely on this and say your level is normal. But, is “normal” a healthy B12 level?

What is a healthy vitamin B12 level? In some 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. 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.


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

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

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

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


Check your fingernails. If they have lines or their moons are gone, get methylcobalamin sublinguals and use them. Methylcobalamin B12 is excellent. It’s ready for your body to use because it’s the active form of B12. ”

Become familiar with the word “methylcobalamin” before you buy B12, else you may buy the less effective kind and not get the results you need.

Remember, vitamin B12 pills don’t work as well as lozenges.

After you begin using sublingual methylcobalamin, watch your nails improve. Keep track of how you feel. Write down when your feet fall asleep, when you’re depressed, when your gums bleed, you 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 the Time Line could 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

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. Today they are referred to as seborrheic keratoses.

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. I felt young again after getting my memory back. But, 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.

Why I created this page

Note: I originally did this page in 2003. I was still extremely distressed that doctors didn’t diagnose my B12 malabsorption illness sooner. I felt they should have helped me prevent nerve damage and cognitive dysfunction.

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

As I did this page I looked at my blood test results and saw warning signs the doctors overlooked. That’s why parts of this page sound so 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 was undiagnosed. That is to say, I did this page before I knew my condo was built over a full outdoor toilet pit.

Cognitive dysfunction from undiagnosed B12 malabsorption made it harder to figure out there was something wrong in my home.

As an aside, I tried to get the doctors and hospital to settle: I wanted them to look at this article about 550 being a better “low” for B12 than 180 or 200, and agree to do B12 education. They refused.

The funny thing is, I really believed they would want to do that kind of education. I was pretty sure that they would be able to get quite a lot of free tv and newspaper space. Unless public service ads don’t get significant price breaks.

Karen Kline, 6/13/06


TAKE NOTE: I am not a doctor.

I am talking to you from my experience. Doctors failed to diagnose and treat my B12 malabsorption for almost two years, despite severe symptoms. As a result I have two-thirds less of my working memory and half of my cognitive processing speed. Plus, my feet sometimes lose feeling 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 73; 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. I had thought the doctors would want to educate, as a settlement, but their lawyers uniformly rejected the idea.

To fill the gap, I started this website. That’s two decades ago.


Tell your friends about vitamin B12 and fingernails and this website. Tell your relatives about the information — in person if they don’t have computers.

Image credits:

Malabsorption Illustration by Karen Kline

Hundley Cannady House photographed by David Hoffman on August 8, 2010.

Termite taken on January 3, 2015 by Katja Schultz 


Depression taken on May 10, 2008 by Laerpel 


Blood Test taken on October 5, 2010 by Phillip Jeffrey. Cropped. 


3 thoughts on “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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