Jack is a 50 year old successful business owner who came to see me complaining of fatigue and depression that had been going on for about 3 years. He feels uncharacteristically depressed and irritable and doesn’t have the energy or desire to do any of the things that he used to enjoy doing.  Jack’s previous physician checked some routine labs (blood count, thyroid, liver and kidney function) which were normal, diagnosed him with depression and put him on an anti-depressant. Although the medication only helped slightly, he continued to take it for several years until he got tired of the side effects (nausea and decreased libido). An important note, Jack was prescribed an acid blocker about 5 years ago which he takes every day for heartburn.

Upon further testing, Jack was found to have vitamin B12 deficiency, with a B12 level in the mid 200’s. After we corrected his B12 levels, all of his symptoms that had left him miserable for the past 3 years resolved completely within a few weeks. So why is such a simple problem often misdiagnosed? I attribute this to rushed physicians with inadequate time to spend with patients and a pharmaceutical company at the ready with a pill for every symptom. This is not the doctor’s fault but the fault of a dysfunctional healthcare system. We no longer have a healthcare system but a sick-care system that only pays for diagnosis and treatment of disease. But I digress…

Vitamin B12 is an essential vitamin that is important for energy production and proper function of the brain and nerve cells. We get B12 in our diet from animal sources, including fish, meat, poultry, eggs, milk, and milk products. For this reason, vegans are at risk of B12 deficiency.

One of the reasons that B12 deficiency is more common now is the overuse of acid blocking medications. Absorption of B12 requires an acidic environment in the stomach. Acid blocking medications decrease stomach acid production and therefore can decrease absorption of B12. The next step with Jack is to address the root cause of his heartburn so that we can get him off the acid blocker that is causing his B12 deficiency. Stay tuned for upcoming blogs about the overuse of acid blocking medications and alternative ways to address heartburn and indigestion.

Key Points about B12 deficiency:

  • If you have fatigue , depression, headaches, decreased memory, leg pains or numbness/tingling, make sure that your doctor has checked your B12 level. If they tell you it is normal, ask for the exact value. I consider a B12 level below 500 to be low. Most laboratories report a normal range between 200-800; however, symptoms often occur at levels between 200-500.
  • If you take an acid blocker regularly should have their B12 levels checked.
  • For B12 deficiency, I recommend sublingual B12 in the form of Methylcobalamin (Methyl-B12). This is B12 in a spray or tablet that is dissolved under the tongue. Contrary to popular belief, B12 injections are usually not required to treat B12 deficiency.
  • If you are taking an acid blocker, talk to your doctor about whether it is necessary for you to take it and how to go about getting off these medications.



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