I've seen a few questions on the forum around the relationship between stress and B12. I think this is a very interesting area.
On the one hand, B-Vitamins are well-known to support the body during times of stress. In many ways this makes sense because our bodies run on essential vitamins and minerals and if we're low in any of them our machines (bodies) won't work as well as they should.
So there is the possibility of low b12 levels from lack of intake, which can result in the nervous system not running as effectively as it should. At present, I don't think anyone could possibly measure the levels someone would need to get to before they started to experience nervous system problems, but it seems to make sense in theory.
On the other hand, high degress of stress can impact our guts and the gut-brain axis supplied by the vagus nerve. If the gut is being told 'fight or flight' constantly it can lead to microbial imbaoance and a state of dysbiosis where a proliferation of bad bacteria emerge in the small intestine. And these bacteria can then start to eat up nutrients and particularly B12, which inhibiting absorption at the same time.
So basically, in times of intense stress, the body is under a double-threat:
1) An overworked nervous system, one that's working harder to keep things running smoothly and needs those B Vitamins and B12 to do so
2) A risk to gut microbial imbalance from the brain sending constant messages of fight or flight, putting additional pressure on the GI system.
Alternatively, both of these things could be distilled into one since it's possible that the brain and gut and managing the nervous system anyway. So deficiencies that are not autoimmune or PA related could all potentially be rooted in the gut-brain axis.
There is also the potential theory that B12, in its role as a detoxifier, will be used up quickly if the body is working harder to expunge toxins such as chemicals, pollutants, processed foods, and toxins like alcohol or prescription drugs. And we're living in a VERY toxic world.
Plus - exercise is known to deplete B12 levels and I have experienced that myself. And depression and anxiety are both causes of and consequences of B12 deficiency.
So the potential impact on B12 from any type of stress is enormous! And potentially that is a good reason why most people consume a meat-based diet - consciously or unconsciously.
Perhaps then, this is why medics are so unaware of the impact of deficiency on sufferers? B12 is essential to life and even moreso in our switched on, competitive, overstimulated and highly argumentative world.
Just highlighting this here to share with others who may want to consider increasing B12 intake or supplementing during times of high emotional or physical stress. I think many people on this forum do inject extra anyway as we need to, but I thought it was interesting to consider the paradox of the deficiency. Particularly since we're all being told to eat less meat to reduce carbon emissions (despite these scientists not actually reviewing ANY risks of deficiency in their studies).
Ultimately, like most things, it's about balance. If you exclude animal products or 'reduce intake' which alot of people are doing then there are longer-term consquences. And I think can be avoided with enough knowledge and education!
On that note, do any PA sufferers consciously eat MORE B12 based foods since becoming deficient And do you think that has helped in even a small way (Although I appreciate you wont' absorb it, but since excess Liver was the original treatment I would imagine it's possible that some B12 could seep in?)
Just curious to know!
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Pickle500
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I ate foods with b12 more unconsciously than intentionally. As a vegetarian these were limited to cheese, eggs and milk. No idea if they helped because I've had very few b12 tests done, only 3 over a lifetime I think. Since starting to eat chicken and fish my B12 increased quite substantially. Having researched over the past few days, I don't think I have PA but there aren't any conclusive tests for it.
I agree with your points about stress causing a drop in levels. Same applies to having a cold/flu, I 'feel' my levels drop dramatically. Supplementing at those times seems to help.
I am still and always will be, vegan. However I greatly overhauled my diet in terms of variety, extra legumes to ensure lysine sufficiency and ensuring macro and micro nutrient sufficiency based on the best recommendations from vegan registered dieticians as outlined in veganhealth.org/daily-needs/.
I take a multi which covers my Iodine, Selenium, K2 and Vitamin D and I also supplement Calcium (low dose) , Magnesium, Zinc, Omega 3 DHA, Taurine, Choline (via Soya Lecithin), Creatine and Phosphatidylserine. I calibrated the dosages very carefully only after much research. I can say that from about 4 months on from starting treatment my GI issues have been entirely resolved. Arguably not all of these supplements are 100% necessary such as Taurine, Creatine or Phosphatidylserine, but I did find evidence of their benefit to be convincing enough for me to include them.
I also alternate two Choline "brain supplements" on weekdays - Alpha GPC and CDP-Choline. I calibrated the dosage to match that used in Neurohackers "Qualia Mind" which is one of the most popular and highest reputation "nootropic" blends on the market.
On top of my twice daily 500mcg B12 I take outside mealtimes, I am considering also adding an additional low dosage B12 supplement(10mcg or so) at mealtimes ( so 3x day) to get an extra boost from intrinsic factor uptake.
I think any advertising which encourages reduction of meat or animal food consumption should legally have to include a section or segment on adequate compensatory B12 supplementation as those foods are reduced.
Too many people going 'blindly' into a vegan diet. Or any restrictive diet. Without the necessary informatuon of what nutrienrs you have to buy in tablet form to keep well if food alone not abke to provide enough of what your body needs to work.
It gets more complex as your body changes as my sister found .
Of course if dietary you have to be able to absorb from food and supplements for it to work.
I took for granted i was absorbing nutrients from food.
My PA was caused by becoming addicted to prescribed OxyContin over a period of 9 years from 2006 - 2015. The dose I was prescribed is enough to kill two elephants, because I became addicted I was taking double the amount prescribed.
It wasn't until I got off the OxyContin that I knew something still wasn't right.
My new GP tried me on 3 different antidepressants, none of which helped so I refused to carry on taking them because of what happened before with the Oxy.
Following blood tests he said you have Pernicious Anemia, Macrocytic anemia, Folate deficiency, and your B12 is at 104.
Due to my addiction, I lost my senior manager career that I had worked hard all my life to get to, with a company I worked 26 years for, so my job was extremely stressful.
But I believe it was the Oxy which caused all the damage to my digestive system, as Opiates and Opioids deplete essential vitamins and minerals, along with lots of other issues, thats not to say the stress of my job didn't start the ball rolling.
I've spent the past 7 years researching the Neurobiology of addiction, and backing up what happened to me with science.
I was also diagnosed with severe Central sleep apnoea while on OxyContin, where after a sleep study I was stopping breathing an average of 80 times per hour per night in my sleep. Central sleep apnoea is the one where you stop breathing and your brain doesn't tell you to wake up. I had a brain scan to check my Pituitary gland, thankfully it was okay.
Opiates surpress breathing which is why Heroin addicts die of overdose.
Because of the research I'd done, I knew the sleep apnoea was caused by the medication, but the sleep clinic didn't believe it was. I had to wait for NHS funding of £6,000 for an ASV machine which is a special CPAP for Central sleep apnoea, because it was the Central sleep apnoea and not the usual Obstructive sleep apnoea.
When I got the ASV, I was one of 2 people in Derbyshire to have one, after coming off all the medication I asked for another sleep study, my sleep apnoea had vanished!
When I returned the ASV, I was one of 8 people to have Central sleep apnoea. I asked the sleep clinic to check peoples medication when diagnosed with Central sleep apnoea in the future.
Because initially they didn't believe it was the medication which caused it, they asked if I would write my story so they could use it at sleep study conferences.
Because of what I do now, I see many patients who are either addicted, or dependent on their Opioid medication, with almost all of them prescribed PPI's to help with their acid reflux etc, all caused by pain medication, and we all know PPI's also deplete B12.
Sorry for the long reply, there is so much more i could add, but I would waffle on about this stuff forever 😃
It would be futile to increase intake through food since it can't be absorbed that way when you have PA. Also don't believe it has anything at all with reducing meat consumption. Eating meat comes with it's own complications even ignoring the massive stress its putting on the planet. As a Type 1 diabetic as well as PA sufferer (and Coeliac too) I can tell you that animal products make me insulin resistant and from a diabetes perspective, plant based wholefood diet is definitely the way to go.
But without intrinsic factor it seems like you would have to eat beef liver (70mcg) or Clams several times a day to get any decent amount of B12, supposing that intrinsic factor is out of the equation and passive absorption is at 1%. Health consequences of eating liver several times a day aside, you would get ~ 0.7mcg with each serving of liver. Even three times a day wouldn't get you to the US RDA - only to 2.1mcg. I have read of B12 absorption testing elsewhere that has found healthy people can absorb up to 6mcg per meal of B12 although the mechanisms why are not explained. But I think we can be fairly sure that this level of absorption won't happen if you have PA. Higher dose B12 tablets (1k mcg +) thus make a lot more sense but many with PA find that no amount of tablets have an effect.
I think the average need (no PA) is estimated to 2 mcg a day through food, and 2.4 mcg is recommended to have some margin. A healthy person (no PA) is estimated to absorb roughly 50 % of b12 in food (30 % to 70 %), so an average, healthy person might maintain levels by absorbing 1 mcg a day from food. They can reuse much of the excreted b12 though, through enterohepatic circulation, but that too requires IF.
I believe this has now been revised since levels are too low in most people.
"The recommended amount of Vitamin B12 USED TO BE 2.4 micrograms per day. But after further studies, it has been raised to 4-7 mcg per day. BUT...and that's a big but (!)...that's not how much you should take daily, that's how much you need to ABSORB daily."
This is also corroborated by a review of the EAT Lancet recommendations which suggest we should all be eating a mediterranean diet with red met 'infrequently', EAT Lancet's diet showed consumption of around 2mcg per day, if their weekly intake is divided up.
With B12 contributing to managing stress, toxin removal, and renewing fresh blood cells for energy, it is clearly needed in HUGE amounts to prevent any leakage.
There are also calls to create greater biomanufacturing industries of cobalt and B12 supplements, since there is a possibility of scarcity.
So, not to be too alarmist, but it's a matter of supply and demand here. If the world is switching to Veganism/low-meat diets, more b12 supplements are needed. And this could impact PA sufferers if supplies begin to run dry.
I would agree that 6-7mcg is a better, safer target for optimal health. The easiest way for vegans to cover this would be a 500mcg daily supplement. You can see here the response of several vegans to this impertinent dosage suggestion : healthunlocked.com/veganfoo...
I think it's so difficult to really know how much B12 is needed but it stands to reason that if stress is a major cause of B12 deficiency then higher intake during times of stress could counter any depleting levels.
Unfortunately most people tend to eat sugar and carbs when they're stressed as they're more comforting. But if they're dosing with a daily supplement then this problem is also averted.
I think there is also a bit of a paradox around functional B12 deficiency and diet… I have functional B12 deficiency, but still under investigation as it appears to actually be Methylmalonic acidemia. If it is B12 nonresponsive Methylmalonic acidemia, the treatment is B12 injections, antibiotics to reduce gut flora, and a diet that restricts the proteins that can convert into Methylmalonic acid (the precursor proteins). These proteins are essentially meat, fish, eggs, dairy (and nuts / legumes / seeds to a lesser extent). So having been diagnosed last year with functional B12 deficiency, it is looking like it may actually be a metabolic disorder which may require me to cut out pretty much all natural sources of B12… I have not yet done this, as am waiting for referral to metabolic clinic.
But as an aside, I had a meat aversion as a child, always hated it, and gave up meat, fish and most eggy foods at age 7 (no-one else in my family was vegetarian). Part of me wonders now if this was my body’s response to problematic precursor proteins?
Genetically speaking, I probably don’t have two faulty copies of a B12 metabolism gene, I expect more likely to be one copy, as otherwise I would have been seriously ill in infancy.
Hi Pickle500, thank you so much for your post. I was diagnosed with B12 deficiency (95) and macrocytosis just over a year ago. I had neurological symptoms, confusion, weight loss and GI symptoms, multiple repeated mouth ulcers etc. This followed a number of years of extreme stress, and I have always believed there must be a link somewhere, although the only one I could think of was that we need more B12 when we are under physical or emotional stress.
With very little treatment available from the GP, I have been self-injecting every other day since October 2021, recently cutting down to 3 times a week, but still getting symptoms. I have been a little more haphazard in the past few weeks and missed some doses, combined with being busier than usual. My symptoms are noticeably worse and some have returned.
I was never a vegetarian but didn't eat much meat. In the past year I've almost cut out dairy milk, preferring the vegan alternatives, which are also loaded with B12. I would prefer to cut down on meat and dairy for the sake of the planet and my own general health, and add supplements. I agree that people should be aware of the possible consequences of cutting down on/out meat, but I don't think that should stop us.
Puzzled that my GP has been happily prescribing me HRT since my early 40s (I am now 55) despite the long list of possible side-effects, but refuses to prescribe a water soluble vitamin, I reduced and have now stopped the HRT. I would love to be able to discuss my health and my treatment with my GP, but don't want to be told again that if I am not completely well within a few weeks of starting treatment, the B12 deficiency must be a misdiagnosis. He suggested ME (but I have no aching muscles, just nerve pain) or depression (wouldn't I be suffering from low mood? Even if I were, that could be caused by B12 deficiency). I take a multi-vitamin tablet daily to cover all fronts.
Mostly, we need more research and training of medical professionals. Fortunately the PAS (which I'm a member of) is doing what it can, although I would prefer they renamed themselves PA and B12 Deficiency Society, so that all of us can feel included.
Methylmalonic Acidemia is quite rare and if you survived this long you likely do not have the full-blown version.
Excerpt I found :
"The prognosis of MMA is varied and fluid. Depending on severity, life-expectancy and quality-of-life range from days to years. Overall mortality for isolated MMA has been reported at 50% with a median age of death of 2 years [1]. Upon diagnosis, the newborn’s condition is immediately managed with high-glucose fluids, eliminating protein intake, administration of insulin, and stabilizing the acid imbalance in the blood. However, beyond severe decompensation episodes, treatment guidelines falter, and there is no consensus surrounding mandatory protocols. Early screening and aggressive treatment have improved the outlook for some patients; from data in the 1970s, survival rate past one year has increased from 65% to 90% in the 1990s [1]. Less severe forms of isolated MMA permit patients to grow into adulthood and lead relatively normal lives unaffected by MMA if symptoms are managed properly. Nonetheless, small missteps can still lead to significant acidosis episodes and possible death."
Thanks The haematologist told me that there are increasing numbers of adults being diagnosed with it in recent years. I shall wait and see what further investigations / opinions conclude!
I wish you luck in not getting diagnosed with this! It sounds like an extremely difficult and nutritionally problematic diet would be required as the amino acids involved (methionine, threonine, isoleucine and valine) are all "essential" (cannot be generated by the body and are necessary for life). You can reduce them to minimum amounts but not eliminate them. Although low but adequate Methionine seems to have longevity benefits, being consistently low in several essential amino acids sounds like a recipe for trouble
your comment about meat aversion is so interesting - I was like that as a child and teenager and always chose a non meat option when I can. I have pernicious anaemia, I find I can tolerate meat better when Ive had a recent B12 injection but as it wears off Im back to finding meat literally turning my stomach!
as to the original question I definitely have food cravings when my B12and iron (as I have IDA too) are low, sometimes for carbs or sweet things just for energy boosts which actually makes things worse as I then slump and feel worse and sometimes for eggs or cheese and (here come the hate comments lol) for MARMITE!
I suspect this sort of experience (meat aversion / B12 pathway issues) is much more common than the medical profession realise. And I also suspect there is a link with PA, whether that is because a chronic functional B12 deficiency (and chronically raised MMA levels) destroys your parietal cells (or similar) or because there are genetic / epigenetic links between PA and functional deficiency. I have functional B12 deficiency, but have also had gastritis for 8 years, and was positive for GPC ab last year, but negative for IF ab this year. So I may be on the way to developing PA…
No hate comments from me, I am a firm marmite fan D
Hi Pickle500, thank you so much for your post. I was diagnosed with B12 deficiency (95) and macrocytosis just over a year ago. I had neurological symptoms, confusion, weight loss and GI symptoms, multiple repeated mouth ulcers etc. This followed a number of years of extreme stress, and I have always believed there must be a link somewhere, although the only one I could think of was that we need more B12 when we are under physical or emotional stress.
With very little treatment available from the GP, I have been self-injecting every other day since October 2021, recently cutting down to 3 times a week, but still getting symptoms. I have been a little more haphazard in the past few weeks and missed some doses, combined with being busier than usual. My symptoms are noticeably worse and some have returned.
I was never a vegetarian but didn't eat much meat. In the past year I've almost cut out dairy milk, preferring the vegan alternatives, which are also loaded with B12. I would prefer to cut down on meat and dairy for the sake of the planet and my own general health, and add supplements. I agree that people should be aware of the possible consequences of cutting down on/out meat, but I don't think that should stop us.
Puzzled that my GP has been happily prescribing me HRT since my early 40s (I am now 55) despite the long list of possible side-effects, but refuses to prescribe a water soluble vitamin, I reduced and have now stopped the HRT. I would love to be able to discuss my health and my treatment with my GP, but don't want to be told again that if I am not completely well within a few weeks of starting treatment, the B12 deficiency must be a misdiagnosis. He suggested ME (but I have no aching muscles, just nerve pain) or depression (wouldn't I be suffering from low mood? Even if I were, that could be caused by B12 deficiency). I take a multi-vitamin tablet daily to cover all fronts.
Mostly, we need more research and training of medical professionals. Fortunately the PAS (which I'm a member of) is doing what it can, although I would prefer they renamed themselves PA and B12 Deficiency Society, so that all of us can feel included.
Thanks for sharing this! And yes you're completely right, we need much more awareness raising in general. GP's, family, friends, society. I think the reason we're all gaslit by professionals, or have to work hard to educate them on this, is because society couldn't possibly imagine that a vitamin could create such a long list of variable symptoms such as B12 symptoms.
The conversation around meat reduction and 'saving the planet' with people such as George Monbiot revolves around this idea that people eat meat because 'they like the taste' and 'that's what we've always done'. But I think they say that because they know they MUST eat meat but don't really understand why. But there IS a reason - it's giving us an essential set of nutrients.
Yes charities who can raise awareness are doing good things. But I think there is a battle for the general public to appreciate that Doctors don't cover nutrition in their training. This is surprising, shocking, and scary for most people. So when a GP suggests they don't know much about B12 that's obviously fair enough since GP's can't be experts on everything. But I believe that no-one really knows that much about B12. So we do need more medical professionals on the sidelines to focus their studies on this so that we can get the help we need.
Aside from Europe I have been told that b12 is used to treat stress in South Africa and Iran, by people from those countries. It’s just considered normal when you are a bit low for whatever reason.
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The haematologist told me that there are increasing numbers of adults being diagnosed with it in recent years. I shall wait and see what further investigations / opinions conclude!
B12 deficiency and so desperate for help! 
Sylvia Plath and B12?
B12 supplements or B12 shots?
