<img height="1" width="1" alt="" style="display:none" src="https://www.facebook.com/tr?ev=6048136207047&amp;cd[value]=0.01&amp;cd[currency]=USD&amp;noscript=1"> 6 tests you can do in case of a vitamin B12 deficiency
April 28, 2017
in Blogs
10 min. reading time

6 tests you can do in case of a vitamin B12 deficiency

How do you know if you have a vitamin B12 deficiency? You don't feel well, but you can't figure out the cause. If the blood results at the family doctor are good, but the symptoms persist, a long road to psychologists or neurologists is started. Often the cause is a vitamin deficiency. How do you find out?

Some tests are still unknown to regular health care providers

Recently, a hospital referred a man to with a diagnosis of neuropathy. He had exhausted his treatment options and was prescribed methadone as a last resort. He had many side effects and was willing to do further testing himself at Bloodtesting.nl. The results showed that his active vitamin B12 level was very low. Was this perhaps the cause of his symptoms? His neurologist thought it was a good thing that he had done his own research, but even though the neurologist has a lot of experience, the HoloTC test was new to him. Fortunately he was open to it and, with the new information about the vitamin B12 deficiency, adjusted the plan.

If the normal vitamin B12 serum result is within the reference values, no further testing is often done in The Netherlands. But the fact is that your body can draw on reserves for a long time and therefore show a good value in the serum blood, while there is actually a vitamin B12 deficiency.

What 6 steps can you take when you suspect a vitamin B12 deficiency?

1. Test other vitamins and minerals and your thyroid as well

Test besides your vitamin B12 also other vitamins such as vitamin D and magnesium. In practice, we often encounter people who think they are sure they have a vitamin B12 deficiency, but then it turns out to be a vitamin D deficiency.

You can also search on our website on complaint if you check "Search in product name and description".

Test your homocysteine too!

Homocysteine is a sulfur-containing amino acid found in the blood. Homocysteine is a body's own substance produced during metabolism the necessary amino acid methionine. Increased homocysteine levels can be caused by genetic disorders, but also by a lack of vitamin B11 (folic acid), whether or not in combination with a lack of vitamin B6 and vitamin B12. We need the substance for protein metabolism in our body. Excessive levels of homocysteine are a risk factor for cardiovascular disease. Homocysteine may be elevated due to a deficiency of vitamin B12, folic acid and/or vitamin B6. If homocysteine is elevated, folic acid and vitamin B6 should also be tested and combination treatment with all three vitamins should be given.

Both Methylmalonic acid and Homocysteine should be tested frequently before injections are given.

2. Test your vitamin B12 serum value

With a B12 value between 150 and 300 pmol/l, a follow-up test of the Active B12 test is recommended. This can show a deficiency earlier than the regular B12 test. It can happen that a total B12 value of 300 pmol/l results in Active B12 dropping below 20 pmol/l.

You can also skip step 2 and go straight to step 3.

3. Test your Active Vitamin B12 HoloTC

This test indicates in time that a Vtiamine B12 deficiency is developing and that you need to supplement vitamin B12.

Research has shown that the Active B12 value decreases faster than the total B12 value (serum B12). As a result, the Active B12 level can already be too low when the total B12 level is still normal. A vitamin B12 deficiency can therefore be detected sooner.

Holtranscobalamin (HoloTC) is an indicator of biologically active Vitamin B12 and is independent of the serum blood (total) vitamin B12 concentration.

  • Result higher than 60 pmol/l: vitamin B12 deficiency not probable
  • Result between 40-60 pmol/l: doubtful

The determination of methylmalonic acid as a metabolic marker for intracellular vitamin B12 deficiency is then recommended.

  • Result lower than 40 pmol/l: biologically active vitamin B12 deficiency is established, no further testing is required.

4. Test your Methylmalonic acid in urine or in serum

Methylmalonic acid is a fairly expensive test that can show that you have a vitamin B12 deficiency, even if this is not immediately apparent from the previous tests. Methylmalonic acid is measured in urine, so you don't have to go to a clinic for it. If you have already submitted blood to the lab and you want to do a post test, it can also be done from serum that is already in our possession.t, can also be done from serum already in our possession. You do not have to take a new sample.

5. Test your antibodies against Intrinsic Factor

Do you have an inflamed stomach lining or are you anemic? Maybe this is caused by antibodies to intrinsic factor and you can't make vitamin B12.

Vitamin B12 is absorbed in the last part of the small intestine. Vitamin B12 is mainly absorbed by the body when it is linked to the substance "intrinsic factor." This substance is in your gastric juice, which is produced by the stomach lining. If the stomach lining is damaged, it can hardly produce gastric juice anymore. Intrinsic factor is then also no longer produced. This can cause a vitamin B12 deficiency because the body can no longer absorb vitamin B12.

A vitamin B12 deficiency can also occur when there is still sufficient intrinsic factor is produced. You can use this test so the cause of the vitamin B12 deficiency.

Because vitamin B12 is an important building block for the production of red blood cells, lack of vitamin B12 can lead to anemia. This specific form of anemia is called "pernicious anemia.
Normally, the immune system makes antibodies to fight off foreign invaders, such as bacteria or viruses. But sometimes things go wrong and antibodies are produced against a body's own substance, in this case intrinsic factor, disrupting a body function and causing disease. We speak of an autoimmune disease. So the formation of autoantibodies can be seen as a "mistake" by the immune system.
In healthy people, antibodies against intrinsic factor are not present

  • A large group of patients do not have anemia or excessive red blood cells so diagnosis should not depend on that. Pernicious Anemia is more common in combination with other autoimmune diseases, such as Hashimoto, Graves, Type I Diabetes too slow-working parathyroid gland, vitiligo and muscle diseases.

6. Test if it is hereditary MTHFR genetic mutation

You can also have genetic testing to determine that you have a genetic mutation that prevents you from producing bioactive folic acid. This bioactive form of folic acid is needed to produce bioactive vitamin B12.
This gene mutation affects:

Producing antioxidants, processing toxins, and creating dopamine, serotonin, melatonin, norepinephrine, and adrenaline

  • Immune System Quality
  • The ability to detoxify the body
  • DNA construction and repair
  • The ability to produce neurotransmitters
  • The ability to make muscle fuel for muscle tension and energy.
  • The ability to produce biologically active vitamin B12

You may often recognise the same symptoms in your sister or children that you have yourself. Some people develop fertility problems and psychological problems because of this gene abnormality.

New iGene test with gene mutation vitamin B12 uptake exclusively at DNA-Expert (by BloodValue Test)

The danger of too high a Vitamin B12 level

It happens regularly that people think that high values of B12 are harmful. However, this does not apply if this is done by injections or other forms of supplementation.
The Active B12 test does not exceed 128 pmol/l and is not suitable for measuring high values. This can only be determined with the vitamin B12 serum test.

The body can in a high intake of vitamin B12 from food limit. There are no known adverse effects on the body of a high vitamin B12 intake.

The absorption percentage of vitamin B12 decreases with increasing intake. At an intake of 1 microgram dietary supplement is 50% absorbed, at an intake of 25 micrograms is only 5%.

More on an elevated value without ever having had injections or high-dose tablets below:

The majority of dietary vitamin B12 (cobalamin) is stored in the liver. Normally the liver contains a stock of several milligrams, which can cover the body's requirements for several years.
Disorders of the binding proteins or disorders of the storage capacity in the liver can lead to an increase in the serum vitamin B12 cobalamin level.

Excessive vitamin B12 levels, without supplements or injections, can indicate;

  • Blood diseases such as:
    Leukemia in which usually strong elevation of serum vitamin B12 is seen, sometimes up to 10 times the upper limit.
    - Polycythaemia vera (PV): increase in serum vitamin b12 in 30 to 50% of patients. The increases are less significant compared to leukemia. The disease is caused for an increase in the production of red blood cells by the bone marrow. This disease is very rare and occurs annually in only 300 people in the Netherlands.
  • Liver disorders such as:
    Acute hepatitis.
    - Liver cirrhosis: here serum vitamin B12 may rise to 4-5 times the upper limit of reference values.
    - Liver cancer: with more than 50% increase in serum vitamin B12
    - Other types of cancer.

When are you at increased risk of vitamin B12 deficiency?

  • If you have undergone gastric bypass surgery. Gastric surgery in which (a large part) of the stomach is removed. The stomach lining then does not produce enough intrinsic factor, so that vitamin B12 cannot be absorbed.
  • If you have Crohn's disease or PDS Irritable Bowel Syndrome. In connection with gastrointestinal symptoms and diarrhea, it is wise to keep an eye on vitamin B12
  • If you are an alcoholic. If you drink too much alcohol on a daily basis and don't eat much, you have a big chance of getting too low in vitamin B12. Your stomach and intestines do not absorb vitamin B12 as well as they should.
  • If you can't tolerate gluten, a vitamin B12 deficiency occurs more often with celiac disease. Due to the damage to the intestinal lining, it is important that the vitamin B12 is supplemented with injections. This supplementation does not always have to be lifelong. Once the intestines have recovered, the absorption can be normal again.
  • If you have a stomach ulcer. This causes the gastric juices to not work properly, which can lead to a vitamin B12 deficiency.
  • If you use antacids, the gastric juices do not work properly, which can lead to a vitamin B12 deficiency.
  • As you get older. A vitamin B12 deficiency is common in the elderly. Often the symptoms are attributed to getting older. But because of the seriousness of the consequences that can occur, the risk of a vitamin B12 deficiency in the elderly should be taken very seriously. In the elderly, the amount of vitamin B12 in the body decreases by 18-28 pmol/L annually. A normal value can drop to the level of deficiency within a few years. Hence, regular monitoring is important. In the elderly, the production of gastric acid can decrease. This makes it harder for vitamin B12 to be absorbed. Elderly people have therefore more often a vitamin B12 deficiency.
  • If you are pregnant or want to become pregnant. Vitamin B12 is important both before and during pregnancy. Studies have shown that a deficiency of vitamin B12 is associated with infertility, miscarriages and neural tube defects. The importance of folic acid is now widely publicized (and rightly so), for the same reasons. However, when vitamin B12 is deficient, folic acid cannot be metabolized in the body. The value of Folic acid in the blood rises, while there may be a shortage of it in the red blood cells.
  • If you are taking certain medications. In rare cases, vitamin B12 deficiency can occur as a result of medication use.
  • If you have Pernicious anemia. This is a certain type of anemia that occurs as a result of an autoimmune disease of the stomach lining. Because of this autoimmune disease, the stomach produces little or no 'intrinsic factor'. However, this substance is important for a good absorption of vitamin B12 in the small intestine.
  • If you have an Infection with the Helicobacter pylori bacteria. This infection can be the cause of atrophic gastritis. In this case the mucous membrane on the inside of the stomach is much thinner than normal, so that less intrinsic factor is produced by the stomach. However, this substance is important for a good absorption of vitamin B12 in the small intestine.
  • If you are at risk of reduced intake of vitamin B12. This is especially common among vegans and vegetarians because vitamin B12 is mainly found in animal foods.
  • If you have a Bacterial overgrowth in the small intestine. For example, Candida Albicans. This makes vitamin B12 less well absorbed by the body.

What are the symptoms of a vitamin B12 deficiency?

  • Tingling, numbness, burning sensations in arms, legs, hands and/or feet, nerve pain, walking on "cotton wool", loss of function
  • Concentration problems, memory problems
  • Aphasia: not being able to come up with the right words, using the wrong words, slips up.
  • Ataxia: unexplained falls, or running into something, loss of positional awareness, knocking things over, stumbling, difficulty walking
  • Reduced pain perception,
  • Reduced fine motor skills,
  • Reduced sense of smell and taste
  • Depression, nervousness, irritability, mood swings, behavioral changes, apathy
  • Dementia, confusion
  • Psychosis, paranoia, hallucinations
  • Muscle pain and loss of strength
  • Inflamed tongue, burning, aching or tingling tongue, sensitive mouth
  • Fatigue, drowsiness
  • Nausea, loss of appetite, weight loss
  • Menstrual complaints, such as absence of menstruation, heavy menstruation, too long menstruation, aggravated menstrual pain
  • Joint pain
  • Shortness of breath, tightness of chest, palpitations
  • Dizziness
  • Paleness of the skin
  • Being cold
  • Impotence
  • Infertility
  • Hair loss
  • Changes in visual field, blurred vision
  • Intestinal problems
  • Incontinence and/or frequent urination
  • Headache
  • Muscle twitching and cramps
  • Tinnitus

Vitamin B12 has an influence on the homocysteine level in the blood. Homocysteine is a substance that is produced during the metabolism of proteins. High homocysteine levels are associated with the development of Alzheimer's disease and cardiovascular disease.

What is vitamin B12 in?

The necessary B12 vitamins are found in animal products such as dairy, eggs, fish and meat. People who follow a diet in which little or no animal products occur, such as vegans, are forced to supplement this deficit with vitamin B12 tablets, yeast supplements or B12-enriched foods.

A well-balanced vitamin B12 diet consists of a diet with enough cheese, fish and meat is eaten. It is not necessarily necessary that large amounts of meat or fish consumed. Provided there are enough dairy products and eggs are eaten even a vegetarian diet does not lead to a vitamin B12 deficiency.

Would you like to order one of the mentioned tests?

Click here for more information on how this works

1. Test your other vitamins and minerals, homocysteine and your thyroid gland

2. Test your vitamin B12 serum value

3. Test your Active Vitamin B12 HoloTC

4. Test your Methylmalonic acid in urine or in serum

5. Test your antibodies against Intrinsic Factor

6. Test if it is hereditary by the MTHFR genetic mutation

About the author
Ellen is the founder of Blood Values Test. She gained her experience with health examinations for companies, schools and government institutions at HumanCapitalCare arbo- en gezondheidsdienst. In 2009 she became director of Diagnostics Netherlands, a collaboration between all major general practitioners laboratories in the Netherlands. At the U- Diagnostics laboratory in Utrecht, she was responsible for blood testing at GP surgeries. Until she founded Blood Values Test for individuals in 2013.


at Nov 18, 2017

Also a cause... The mthfr gene, also very little controlled.



at Nov 18, 2017

Rare caused by certain medications. Don't overlook stomach protectors and Metformin (diabetes)!

Dieter de Jong

Dieter de Jong

Retrieved from 29 Jan 2021

I used to feel languid and weak too and then I started exercising more which made me feel much better. With the corona crisis I stay at home more often because I am a risk patient (I only have 1 lung). Because of this I can do less and less sport and I thought a supplement would help me? I was wondering what brand you would recommend? I often see the brand Flinndal on the internet, especially https://www.flinndal.nl/multivitaminen/multi-kauwtablet. I would like to hear your opinion.

Post comment