EP.286/Low B12 and endometriosis
A week or two ago and I did an episode about low vitamin D levels and the symptoms that can disguise themselves as endo symptoms or endo related issues, and today, I want to talk about low B12 and how it can affect our population.
So, let’s get straight to it and look at common B12 symptoms and how we may mistake them for endo problems…
Palpitations
B12 is involved in the production of haemoglobin, which transports oxygen through our body, via our red blood cells. When we are low in B12, we can develop B12 anaemia, which causes a lack of haemoglobin and symptoms can include a racing heart or heart palpitations.
With endometriosis, many people are now also being diagnosed with dysautonomia or postural tachycardia syndrome, and both of these cause heart palpitations as well, so if you have POTS or dysautonomia, don’t just put your symptoms down to these conditions, especially if they are worsening or you’re not able to get them under control with POTS management strategies. If you suspect POTS and dysautonomia, your doctor should test for B12, as the process of diagnosis includes ruling our deficiencies which could be affecting the heart.
Mental health problems and depression
Low B12 and B12 deficiency has been heavily associated with an increased risk of depression and mood disorders with data showing better depression treatment outcomes when patients have also been supplemented with B12 and folate. This is thought to be due to several factors but two key areas are high homocysteine levels and lowered neurotransmitter levels.
Homocysteine is a naturally occurring amino acid which is produced when protein is broken down in the body, normally, B12 and folate work together to convert homocysteine into other substances, but when levels of these nutrients lower, homocysteine levels rise. High levels of homocysteine have been associated with depression (as well as increased risk of stroke, osteoporosis, heart disease and dementia so it’s very important to get this checked!).
B12 is also involved in the production of feel good neurotransmitters like dopamine and serotonin, and low levels of this nutrient can affect these, which can lead to lower moods and depression.
Endometriosis and chronic pain conditions are associated with an increased risk of depression, anxiety and mood disorders, so it can sometimes be put down to the reality of living with endo or ongoing pain, but if you notice other symptoms I’m raising today, I really urge you to get tested!
Fatigue and brain fog
A pretty obvious result of low oxygen levels is chronic fatigue, but B12 deficiency also causes fatigue in numerous other ways.
B12 is absolutely essential for the conversion of food into energy, without enough of this vitamin, we literally cannot make enough energy.
Additionally, as I shared above, low B12 can contribute to lowered serotonin and dopamine levels, two neurotransmitters which can help us to feel more engaged, motivated and focused – and I think most of us know what it feels like to be the opposite of that! Feeling demotivated, distracted and disinterested in everyday life, can often go hand in hand with feeling fatigued and lethargic and of course, brain fog.
This leads me to cognitive struggles we can see with B12 deficiency. B12 plays a role in regulating the nervous system, when this becomes affected by low B12 levels, it can significantly impair cognitive function and cause brain fog, confusion, difficulty focusing, memory impairment and more. Research does show an improvement in these symptoms with supplementation, however, if B12 deficiency is left untreated, the cognitive impairment can be permeant due to the extent of the neurological damage.
So many of us put our brain fog and fatigue down to endometriosis and the resulting full body inflammation, but it could be more than that, so worth getting checked.
Dizziness
Low levels of B12 or deficiency can also cause dizziness or light-headedness due to anaemia affecting the amount of oxygen that the brain receives. Additionally, the neurological changes that occur with low levels of B12 can cause problems with walking and balance, which can trigger or manifest as feelings of vertigo, dizziness, etc.
B12 deficiency has also been linked to orthostatic hypotension, which is a drop in blood pressure upon standing, causing dizziness, a racing heart or palpitations. This is also a classic POTS symptom, so it’s important to investigate both.
Migraines and headaches
Whilst migraines and headaches can be associated with high inflammation and histamine levels (both common with endo) and hormonal issues (again, something I see a lot in our community), migraines and headaches are typical symptoms of B12 deficiency.
Pins and needles
Finally, a common symptom of B12 deficiency, especially with the more advanced stages, includes pins and needles. Many clients come to me reporting nerve pain in their legs, and also mention pins and needles and numbness, which they have put down to endometriosis on their ligaments and nerve endings. A number of these clients have actually been deficient in B12, so it’s important to not dismiss this if you experience these kind of symptoms.
Causes
There are some causes of low B12 levels that our community should be aware of.
Number one is low stomach acid. Stomach acid is absolutely essential for the absorption of B12, as the process first begins in the stomach and then is finalised in the small intestine. Stomach acid can be depleted from chronic stress and chronic fatigue and I would argue that chronic pain or generally just living with endo, is an ongoing form of stress. In fact, I see low stomach acid in many of my clients.
Signs to watch for with low stomach acid include feeling very full after protein heavy meals, food not going down for a long time and feeling like it’s just sitting in your stomach, low B12 levels (surprise), burping a lot after meals, bloating and heart burn to name a few.
If this sounds like you, I encourage you to listen to some of my podcasts or read my articles on gut health. I have a few of them linked in the show notes.
Number two is small intestine bacterial overgrowth, which may affect as many as 80% of us with endo! SIBO competes with us to absorb and utilise B12, but it can also cause lowered stomach acid, and damage the small intestine, resulting in impaired B12 uptake. If you want to learn more about SIBO and how to test for SIBO, I’ve linked to a few of my podcasts and articles in the show notes.
Number three is diet. Whilst healthy vegan or veggie diets can help lower inflammation and so some of us may use these diets to potentially manage endo (though you do not need to entirely cut out meat, fish, eggs or even dairy in some cases to lower inflammation if you don’t want to, but that’s another podcast and is covered in my courses and masterclasses), without supplementation of B12, these diets can lead to deficiencies. The main sources of B12 are eggs, meat, dairy and fish, though fortified nutritional yeast is a good source as well, so if you do follow a vegan or veggie diet, it’s important you regularly check your B12 levels (as well as iron).
Number four is the MTHFR gene mutation variants. Now, this is a big, complicated topic on its own and there’s not a conclusive link to endo just yet, but it is a relatively common gene mutation in general and there are some links to endo. The MTHFR gene is essential for processing folate, which works together with B12 on many essential processes in the body. If folate is lowered due to an MTHFR gene mutation, then you will still absorb B12, but you won’t be able to use it properly, which causes the symptoms of B12 deficiency. Essentially, you have enough in your body, but your body just can’t use it. So, if you’re having these symptoms but your B12 looks normal, make sure to test folate. To be honest, if you’re getting your B12 levels checked, it’s typical that your GP will test your folate levels too.
Number five is coeliac disease. As we’ve discussed on the podcast before, people with endometriosis have a higher risk of developing coeliac disease. An autoimmune condition where gluten triggers the body to attack the small intestine, as a result, the body is less able to absorb nutrients, one of them being B12. In fact, B12 deficiency and folate deficiency are two signs of celiac disease to look for. Celiac disease is not the obvious condition you may think it is, it’s not a clear and violent reaction to gluten, it can be much more subtle and hard to detect, so I encourage you to listen to my podcast episode on signs to look for and how to test.
Testing
Now, this leads me on to the tricky issue of testing for B12 because it’s not straight forward I’m afraid.
The obvious, go to test is a blood test, also called a serum test. Your doctor should do this for you, especially if you’re experiencing the above symptoms.
However, the problem with a blood test is that it doesn’t always show deficiencies in time, there can actually be a delay in the start of B12 deficiency and that showing up in the blood. So, if your levels look normal but you have the symptoms, there are two other options.
Check your homocysteine levels, if these are high, whilst there are other causes, the likely scenario is that your folate and B12 are low.
The other test is a methylmalonic acid test. When B12 levels start to lower, methylmalonic acid levels rise, and this tends to happen very early on in low B12 and B12 deficiency, before a deficiency shows up in the blood.
If these two tests come back abnormal, this suggests your B12 levels are low or you have normal B12 levels, but your body cannot use it properly, due to an MTHFR gene mutation, so at this stage, it would be worth getting this tested as well.
I’ve linked to all the tests in the show notes, and you can order them direct to the consumer and they’re not affiliate links, by the way! I wish I had the time to organise affiliate links, but I don’t!
So, what are you looking for with your blood test results? As you probably have heard me say by now, conventional medicine ranges and functional medicine ranges (which I’m trained in), differ.
Conventional medicine ranges calculate normal ranges based on the general population, including people with healthy levels and people with low or deficient levels of nutrients. In contrast, functional medicine looks at optimal levels, based on healthy participants only.
So, we’re looking at wanting B12 levels as being at least 550 pg/mL picograms per milliliter but ideally higher.Levels of around 200-300 picograms per milliliter, especially in the presence of symptoms, would be considered too low and below that, would be deficient.
If you’re coming in below 550 pg/mL and you have symptoms, I would then consider checking your homocysteine levels and methylmalonic acid levels. Of course, if you’re under 200, you wouldn’t really need to do that.
Supplementing
Supplement wise, B12 is generally safe and most supplements will average in at about 1000 to 2000 mcg, with the NHS advising that 2000 mcg should be about the upper limit. However, if you are deficient, you may need more and may even need B12 injections, so work with your GP or health practitioner.
The other thing to consider, is that if you have an MTHFR gene mutation, you may be better off having methylated B12 supplement, which is an active form of B12 that the body does not have to convert and so you can use it more readily. However, some people find active B12 too stimulating and may struggle with nervousness, anxiety, palpitations, etc. so it’s best to start on a low dose and test your tolerance. If you cannot tolerate methylated B12, you can still take regular B12 but you may need to take a higher dose and also focus (of course!) on B12 rich foods.
Additionally, if you are B12 deficient, it’s important to identify, especially if your levels don’t improve, why you are having trouble in case its something that needs addressing like SIBO or low stomach acid.
Show Notes
Gut heath and SIBO
https://www.theendobellycoach.com/podcast/10-root-causes-of-bloating-with-endometriosis-endo-belly-ibs
https://www.theendobellycoach.com/podcast/what-is-the-endo-belly-endometriosis-ibs
https://www.theendobellycoach.com/podcast/endo-belly-treatment-endometriosis-ibs
https://www.theendobellycoach.com/podcast/endo-belly-treatment-endometriosis-ibs
https://endometriosis.net/clinical/stress-gut-stomach
https://www.theendobellycoach.com/podcast/endo-belly-coeliac-disease?rq=coeliac
POTS/dysautonomia
https://www.theendobellycoach.com/podcast/pots-dysautonomia-with-endo?rq=POTS
https://www.theendobellycoach.com/podcast/endo-and-dysautonomia?rq=POTS
https://www.theendobellycoach.com/podcast/endometriosis-and-ehlers-danlos-syndrome?rq=POTS
Tests
Homocysteine - if levels of this are high, it'll indicate B12 and/or folate are low
Methylmalonic acid - early indicator of low B12
MTHFR gene variants - common mutation which you do'n’t need to worry about or test unnecessarily, but if you’re having trouble with B12 and folate as described in the episode, you may want to test.
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The vets have given us a very stark picture of the reality. If Jelly goes back on the streets, his condition will deteriorate and he will suffer until he eventually passes away. We have been told to find him a home where he can continue getting care or put him to sleep.
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This episode is sponsored by Semaine. Semaine is a plant-based supplement for reducing period pain and inflammation, that you take for 7 days of your cycle, during your period. Semaine is made up of 9 super-powered plant extracts and minerals that are all vegan and sourced for maximum quality and bioavailability and selected based on the latest clinical research. If you want to try Semaine, they are currently offering 20% off your first order with code: THEENDOBELLYCOACH and they deliver worldwide! Head to: www.semainehealth.com
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Produced by Chris Robson