B12 Deficiency | Podcast #223

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In today’s talk, Dr. J and Evan Brand discuss some important points regarding B12, a topic that is so common yet so overlooked by conventional medicine but could change one's life. 

B12 deficiency was a problem of Evan Brand that stemmed from gut infections. He believes because he had H-Pylori, it reduced his stomach acid even though he was eating grass-fed beef. Having low B12, it resulted in nausea, digestive issues, and fatigue. B12 is huge even for someone like him who thought they were doing it right. Watch the video and answer your own questions too! Don’t forget to share!

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

04:48    How Does B12 Deficiency Happen?

08:33    B12 Shots

10:10   Food Sources of B12

11:03    Why do We Need B12?

16:12    More Food Sources of B12

17:14    Neural Tube Defects


Dr. Justin Marchegiani: Hey there it's Dr. Justin Marchegiani, welcome back to the podcast. Evan Brand and I are in the house, we will be discussing on all topics: B12. Let's dive in. Evan, how we doing today man?

Evan Brand: Hey man, I'm doing pretty well. I'm excited to talk with you about something that is so common, yet so overlooked by conventional medicine, but it could change your freakin' life, and it's B12 deficiency, which is a problem that I have, and I had previously, and I think it was all stemming from my gut infections. I believe it was because I had H-Pylori, which reduced my stomach acid, therefore even though I was eating grass fed beef I still wasn't getting the B12 from my meat, and therefore I was low. And I had definitely some nausea, I definitely had some uh, digestive issues, fatigue, uh it showed up on my testing too. So, B12 is huge even for somebody like me who thought they were doing it right.

Dr. Justin Marchegiani: Yeah, B12 is really important. A couple of things off the bat, just to kinda highlight, B12 is really important for methylation. So, methyl groups are- are carbon and essentially free hydrogens and we methylating neurotransmitters, detoxification pathways, uh we activate various uh genes through methylation. So B12 and- I would say B12 tends to work really well with its sibling, uh folate. Folic acid is kind of uh- uh let's just say uhm, one of the more slang not so good qualities or not so good uhm, types of uhm folic acid or folate. Folic acid has to get converted to folate and a good chunk of the population, 70% or has at least heterozygous, meaning, they're missing one gene to help uhm basically convert that folic acid to folate be it as enzyme called MTHFR, methylenetetrahydrofolate reductase. So, essentially, B12 is really important and it uses folate, activated folate along with it for methylation and gene activation.

Evan Brand: Yeah, and a lot of people talk about MTHFR, then I'm really sure what's going on. You're just had a reduced- you're had a reduced capacity than other people to- to work this conversion process. So, that can result in fatigue and the- the question maybe, well, does that mean I go straight on a methylfolate supplement? The answer is not always, 'cause some people don't feel well with those, so there's- there's a- a goldilocks that Justin and I figured out with people. Sometimes you can go too high, sometimes you go too low. So, there's always a tweak with this, so on this podcast we're gonna say, “Hey, your magic dose of B12 and folate is gonna be X milligrams or X micrograms per day”, 'cause you gotta figure it out. Uh there's just not a- a- a number.

Dr. Justin Marchegiani: And then there's a couple different types of B12 that's out there. You have your conventional cyanocobalamin, right. Cobalamin is the B12 and it's bound to a- a- basically almost like a- a cyanide type of molecule, right? And then you have the more bile available types, you have the methyl B12 which is it's methylated, it's bound to a methyl group. Then you have the hydroxyl group. Hydroxyl group is bound to a hydroxyl, and then have the adenosyl group. Hydroxyl is gonna be uh- I think it's gonna be a lot more mitochondrial based, and then B12 can help uh on the methyl side, will help more with detoxification and- and will help more with the methyl donor side. So detox on one side, and then on the uh hydroxyl side will help more with the mitochondria and help with uh nitric oxide which is really important for mitochondrial function.

Evan Brand: I've had a lot of people actually react pretty poorly to doing supplemental methylcobalamin B12, er- myself included, I don't feel well on methyl. So I end up doing- using a combination of hydroxocobalamin and/or the adeno-cobalamin-

Dr. Justin Marchegiani: I think [crosstalk] is from a detoxification like we were loading to I think some of that could have a detoxification effect, and then going more with adenosyl or hydroxyl or combination of those two can help with the mitochondria, a little bit more help with energy, help with nitric oxide. Know you have- with some of the stress issues, you had more blood pressure issues, so of course, nitric oxide is vasodilator, it opens things up.

Evan Brand: Yup. So we've got some symptoms of- now, we can test this, we'll talk about testing towards the end, if you have too little vitamin B12 in your system, what may happen? Uh, could be poor vision, weakness, tingling in your hands and feet, clumsiness, fatigue, nausea, mental confusion, anemia, digestive issues, skin infections, nerve problems. And so, uh Linus Pauling Institute, they've got their own opinion of major problems that could be linked to B12 deficiency like breast cancer, depression, osteoporosis, thyroid issues, gastric cancers neural tube defects, chronic stomach inflammation. So this is pretty nuts, and they've got quite a lot of literature on this too. So, uh, it makes sense.

Dr. Justin Marchegiani: Yeah, it's a use. So let's kinda dive in first. How does B12 deficiency happen? So, number 1, it can happen if you're a vegan or vegetarian and you're not getting- let's just say any animal products, uhm even- even plant-based products, a good vegan or vegetarian is gonna have to supplement B12. You just not gonna get enough in plant-based products, you're gonna get it in egg yolks, you're gonna get it in meat and animal products. So, being vegan or vegetarian is one risk factor. Risk factor number 2 is you have poor malabsorption, you have gut issues, absorption issue, whether it's an- irritable bile disease, or crohn's, also of colitis type of thing, or even just poor digestion, 'cause, remember, the intrinsic factor is produced in the stomach, and it's produced by the parietal cells, the same cells that make hydrochloric acid. And we- this intrinsic factor basically- basically tags B12, it grabs on to it, and then from the stomach, you go to into the small intestine, the duodenum is the first part, the jejunum, and then the ileum, it is then released and then reabsorbed back up in the ileum. So it's like you have this carrier, this tag, or this relay race, where intrinsic factor binds to that B12 in the stomach, and then releases it back down to the very end of the small intestine in the ileum. So it's really important because if we have gut inflammation, and let's say we have poor parietal cell function, which tends to mean we also may have low stomach acid. That poor digestion is gonna create more leaky gut, more gut inflammation, and continue to decrease intrinsic factors. So, if we have low intrinsic factor or if we have intrinsic factor antibodies, uh or parietal cell antibodies, this is called pernicious anemia, where we have an autoimmune attack, it's attacking either the cell or the compound that's produced to help basically run that relay race for the B12. So the more you have leaky gut, the more you have gut inflammation, there's a greater chance of autoimmunity, which could affect B12 absorption. And for those kinds of people, which tends to go more on the sublingual side, with intrinsic factor we may even do the adenosyl-hydroxy versions, go sublingual, bypass the guts, and we may also uhm even opt for an injection.

Evan Brand: Great point. Yeah, people were gonna ask, “Well, why can't I just take a supplements, swallow a pill for this”, well, you just alluded to the gut infections or other problems, inflammation, autoimmune gut conditions, that may reduce the absorption. So just because it says on the label, you're gonna get “X” amount, that- uh- you know, we always say, “Oh, you are what you eat” but not necessarily, you really are what you digest. So if your digestion is compromised, then you're not gonna get what's on the bottle, and therefore you might not get the clinical improvement you're looking for. No I just sent you a link to a- a PubMed study here, they call it “Impact of Helicobacter Pylori on the Development of B12 Deficiency”. And long story short, the findings prove, strong evidence, H-Pylori infection is associated with cobalamin deficiency. So that probably started it all for me, you know, diet wasn't great as a kid, but me having that H-Pylori infection, that was probably a huge trigger for my B12 to be so low.

Dr. Justin Marchegiani: Exactly. Yup, totally makes sense. So, this is why it's so important that if you have B12 issues, you have to make sure the diet is right. And the diet is gonna be super important. Uh, vegan, vegetarians are maybe gonna have a problem, uh, the next is, if there's a leaky gut or any inflammation in the gut, that has to be rectified and addressed. Now in my line, we use like methylated B12, and- and uhm methylated B-Vitamins, 'cause typically you wanna take you a B6 and folate, and B12, uhm but some people they may need to go sublingual. So we may wanna go in adenosyl-hydroxy form which gets absorbed more in the mitochondria, versus the plasma for the methyl B12. So, very important, you gotta get to the root cause. So, what are some great food sources, or anything else you wanna highlight before we go into the food component Evan?

Evan Brand: Well, I wanted to get your opinion on the whole B12 shot thing. I mean, you and I work with so many people, and we hear every single week someone going into a naturopathic clinic, or some other clinic to go get a B12 shot, yet, we run their testing, and they still look low in B12. So, what are your thoughts on B12 shots?

Dr. Justin Marchegiani: I think for some people it may make sense to do it especially with severe malabsorption and severe gut issues, I think for most people, uh, just a sublingual or just a capsulated B12, with uhm other methylated B's like the MTHF folate and- and pyridoxal phy- phosphate or good quality pure- uh, you know pyridoxine HCL, uh B1 to 3, that's gonna be enough for most, some may have to go 1 step up and go to a sublingual, and- and adenosyl or hydroxyl form, for most, that's gonna be enough. If there's severe issues, maybe an injection in the beginning, like if we have a- and also of col- colitis or crohn's issue, we have blood in the stool, maybe-

Evan Brand: Yeah.

Dr. Justin Marchegiani: -to that degree that makes more sense in the beginning, but uh, in general, I work with dozens of IBD patients in, we typically are able to get their choline and their digestion stable and the de-inflammation downward or that stops, and then we're able to get their uhm- their levels up, which is uh sublingual.

Evan Brand: Yup. The uh- that's uh- I mean, that's- that's my whole point too, I- I've really don't wanna go get a shot. The sublingual works so good. Uh, so, I mean, here's the thing with the- with the B12, you know, even if you do take more than you need, it's more fo- a people having problem with deficiency, 'cause if you take excess, your excess B12 gets stored in your liver. So even if you do take more than you need, that's fine, we're more concern about you having too little, you know, rather than too much.

And then you mentioned the foods. So yeah, let's get into that. I mean, organ meats are gonna be number 1. So, I've seen a lot of companies out there now where people don't wanna eat organ meat. So these companies will take like a grass fed liver or a grass fed kidney of a- of a cow, and- or a lamb, and then they'll put that into capsules. So you can take like liver pills, you can take kidney pills if you want, I personally don't do that, uh, maybe when I get more into hunting, I will eat, you know- you know, eat- eat the deer or eat the other animals' liver, but- but currently me personally, I do not do uh liver.

Dr. Justin Marchegiani: Yeah, exactly. So, I mean, I think it- it's a great source to do it. A lot of my women that are cycling and uhm me- menstruate heavily, I'll 'em do liver during that time frame just to get some extra B12 and store it up in their liver, even just an ounce or two, per day during that time is enough, uhm, there's a lot of B12 and- or Iron in the liver.

So, couple of things I wanna highlight, so, we need B12, 1, to help develop our nervous system. So, early on, we can have neural tube defects, which is basically our- our s- our nervous system doesn't close all the way up, and essentially, we can have it on the back side where we have spina bifida or we can have it on the front side, or we may- we may even have a cleft palate, right? Those are all B12 or neural tube defect issues. Uhm, next we may see macrocytic anemias, right? Megaloblastic macrocytic anemia is where our blood cells are really big. So, red blood cells, unlike us, we start off small and get bigger right? Red blood cells actually are bigger and then get more smaller as they mature and get older. And we need healthy levels of B12 and folate and methylate and B-Vitamins to help this conversion happen. If not, we'll run an RBC or uh- uh- a CBC I should say – complete blood count – within the C's. So we'll run like MCH, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular volume MCH, MCHC, MCV, these are markers to look at how big the red blood cell is. And of we see a really big red blood cell, that can give us a big sign that uhm, where we don't have enough of those B-Vitamins onboard, especially if we start to see lower RBC, low hematocrit, low hemoglobin that tells us we got some B-Vitamin issues.

Evan Brand: You know what I found this true in- is women, or I mean, men too, uh do too much alcohol, you know, I've looked at some of the literature on how alcohol can damage your liver and as well as your red blood cells, so when you look at some of these like not “let's freak out level”, but when you look at some of these low red blood cell levels, it could be linked to, you know, a woman doing 2, 3 glasses a wine every night. And all we do, we don't even have to supplement, in that case, we'll just say, “Hey, pull out the alcohol for a month”, then if we look blood looked at again, now all of a sudden, the red blood cell count looks normal. Uhm, you and I talked about this book before but I loved it, uh, Dr. Dicken Weatherby's book, “CBC and Blood Chemistry Analysis”, he's got some really good functional markers in there for like your red blood cells and white blood cells and all that, so that has a good resource for people if they wanna look at their blood work and see, you know, “How do I stack up compared to a functional range”, which is tighter than conventional range, that's a good book for that.

Dr. Justin Marchegiani: A hundred percent. Yup, a hundred percent. So, a couple of ways to test like I mentioned, right? You can do the MCV, MCH, MCHC which is, you know, it's gonna be good to your- give you a good medication, we could also run B12, and if you're vegan, vegetarian, that could be really good, that could be a good marker. You may have, let's just say enough B12 in your blood but not enough in your cell. So this is where we like to look at methylmalonic acid or trans holo cobalamin. So if we had adequate levels of B12, we convert methylmalonic acid into suc- succinic acid. So there's this conversion, right? And then if methylmalonic acid goes high, it's- could- it’s not able to convert it and- to a succinic acid and then we can make that inference that there's not enough B12 to make that conversion happen. That make sense?

Evan Brand: Yeah it does. So, you're saying, with blood- blood might not always show the true picture, correct?

Dr. Justin Marchegiani: It not always show it, I mean, we serum B12, you may have- you- you know, you may show an- an okay amount but we may still have issues, we have to run that organic acid that we always talk about, and then on that test, we'll look at- for amino glutamate, which will give us a folate marker, we'll look at methylmalonic acid which will give us a B12 marker, and we may also look at ___[14:29] and ___[14:30] which will give us markers in the B6, we like to look at those key methylating nutrients: B6, B12 and folate together.

Evan Brand: And this is on- I think you said it already but just to be clear what this test is. This is a urine test, it's a first one in urine-

Dr. Justin Marchegiani: Right.

Evan Brand: -sample. We run it on everyone, it's an organic acids test, and often what I'm doing now is I'm having that organic acid test combined with a chemical profile or even a mold test. Uh, which- which is a mycotox panel. So we can take one urine sample, run it through multiple machinery at the lab and then we get multiple read out which is pretty cool, that way you- or not just guessing on why this is happening.

Dr. Justin Marchegiani: Yes, and I had a podcast with Tim Jackson just on last Friday and he talked about the idea that lithium helps with B12 transport, and Dr. Amy Yasko talks about this too. So, lithium orotate, not lithium carbonate, the drug, lithium orotate can really help with B12 transport. So that can be something if we're having issue with B12, you may wanna look at adding, you know, 5 or 10 milligrams of lithium orotate with that as well.

Evan Brand: Yeah, I was gonna say it probably be a low dose, right?

Dr. Justin Marchegiani: Mm-hmm.

Evan Brand: Just a- just to get that effect going in, and then lithium too, that's also used for a lot of brain issues, right? Lot of like-

Dr. Justin Marchegiani: Yeah.

Evan Brand: -depression and- and-

Dr. Justin Marchegiani: Yeah you can see that help with dep- depression, mood, anxiety issues, and we're not talking lithium carbonate which is commonly used for bipolar, right? We're talking lithium orotate, the- the nutrient.

Evan Brand: Wow, I've heard of lithium orotate being really calming for people-

Dr. Justin Marchegiani: Yup.

Evan Brand: -I wonder if that's because it's helping to transport the B12 as you're mentioning. Maybe that's why it does- it has the effect that it does, it has multiple mechanisms.

Dr. Justin Marchegiani: Hundred percent, yup. And [crosstalk] on it? Studies showing that it's connected with lithium- with uh B12 transport, so I think it's- you know, it's another tool that we'll put in our “tool belt” so to speak.

Evan Brand: Well, let's get back to food just for a couple of minutes-

Dr. Justin Marchegiani: Yeah.

Evan Brand: -and then we gotta wrap up. So you- you know, we talked about the liver. So beef is gonna be good especially your pastured animals, your grassfed beef, uh, you could do your elk, your bison, whatever type of meats you like, eggs are gonna be great if you can tolerate 'em, you know, good pastured eggs, happy chickens that roam the grass and ate bugs like they're supposed to, uh, clams, I personally don't eat clams but that was on a huge list of “Hey, here's all this B12 foods”, clams was up there, uh, there was another one, dairy, but I personally don't do much dairy except for butter. Would you say there's some B12 in some good grass fed butter, probably yes.

Dr. Justin Marchegiani: I think so. I think you're gonna get some of it just for the fermentation of lot of the grass i- in the gut-

Evan Brand: Yeah.

Dr. Justin Marchegiani: -right? You know, the cows gonna basically ruminate a lot of that good healthy butyric acid though, and I think you were gonna- you will get some B12 out of that as well.

Evan Brand: Okay, okay. And then, so we talked about blood, talked about urine, talked about supplementation, talked about foods, what are the mechanisms, what is B12 cause if its low, I think we hit on every point unless you wanna bring a- a couple others.

Dr. Justin Marchegiani: Yeah, so, kind of going back, we talked about neural tube defects if you have low B12, that's kinda more in the pathological side, and of course that starts early on. So, of course, if you're a woman, you're looking to get pregnant, you should be on a really good- your multi should automatically have f- folate in there, not folic acid and it should have at least good methylated B12 if you're not having any problems. And then we should be eating our leafy green vegetables, we should be getting egg yolks, we should be getting grass fed, high quality meat, maybe even a little bit of liver, especially if- is a woman if you're having your period, you're gonna be losing blood, so getting that liver will help with extra Iron as well, and then some good B12 which you'll store up in your liver. So, that's a really good starting point to prevent a lot of this. And then number 2, uh, on the back end, we can have let's call it- uhm, subacute combined systems disease, or posture lateral sclerosis could we need healthy levels of B12 to build our myelin, to build our ner- to build our nervous system up. So it's really important that we have enough B12 uh for those issues. I already talked about uhm, B12 in the gut, and how that can be a sign of pernicious anemia or other IBD or irritable bowel issues, or just a lot of gut inflammation and extreme malabsorption in the gut. So I think these are all really important things. And then uhm, I would say, I mean, of course you're gonna see thyroid issues, right? If we uhm, had un- inadequate levels of B12 because we don't have enough mature red blood cells. Mature red blood cells carry nutrition, carry oxygen, and we need that for healthy metabolism. So we could have lower thyroid function as well, we need B12 to be able to methylate, so we do drugs like the- the methotrexate, chemotherapy drugs for let's say massive gut issues. A lot of these- a tricky irritable bile disease is with typically corticosteroids and chemotherapy on the gut, methotrexate, that inhibits a lot of B12 and folate, and that can create more DNA damage. So we need adequate levels of B12 to really have good healthy DNA, uhm repair. And that's really important in activation.

Evan Brand: Yeah, well, just to mention too on the drug front, think of all the people on acid blocking medications, whether prescribed by their GI doctor, their regular doctor, or, even just the over-the-counter zantac, prilosec, any of these proton pump inhibitors, those are all gonna be reducing your ability to digest and absorb B12. So even if you eat a paleo diet, but you're on acid blocking medications, or you have infections like we test for, parasites, bacterial overgrowth, candida, H-Pylori infections, anything that's disturbing that gut balance, and they're stealing the nutrients from you, you could have low B12 there. So always make sure you're working towards that root cause, don't just take the pill- a B12, get a good quality as we mentioned but make sure you figured out why. Why did this happen in the first place? Always ask why. Make sure you get there with the practitioner. So I know Ju- Justine and I gotta wrap up, so if you wanna say a couple comments-

Dr. Justin Marchegiani: Yeah. And also, if you have let's say an elderly parent or grandparent, some dementia and Alzheimer’s like symptoms can come from low B12. So, if you know anyone on your family whose older and has these issues, this is where I think it's really great to de- bring in, “Hey let's get 'em a good quality injection, let's get some nutrients”, 'cause sometimes that can be turned around with simple high quality injectable uh methylated or you know, adenosyl-hydroxy B12 can be super helpful. There’s been some studies on Alzheimer’s dementia patients where, you know, I think it was 10%, so on massive improvement in their memory with the B12 injection. And then also say look for the canker sores. Canker sores are a big uh- big sign that you could have B12 issue, also it's a big sign of a gluten-sensitivity, right? These are aphthous ulcer, so, that's another big thing I would say to look at. And I think the B12 injections are really big one, you already mentioned the foods, the eggs, the venison, the beef, the liver, some of the sea food, I think we hit all the major things Evan. So I'll just say if you guys enjoyed this great info, give us a thumbs up, we're clinically applying this information with patients every day, so it's not theoretical for us, or in the trenches applying it. So hoping that listeners here can use it to make them- make their health better. If you like it give us a thumbs up, give us the share. Let us know your comments below, we appreciate it, and uhm we appreciate you guys supporting the podcast. You guys have phenomenal day. Evan, great chatting man.

Evan Brand: Yeah. Take care. If people wanna reach out to you, justinhealth.com, you could schedule consults around the world. If you wanna reach out to me, evenbrand.com we look forward to helping you. Take care in the meantime.

Dr. Justin Marchegiani: Awesome. Evan, you just take care man. Thanks so much. Bye everyone.

Evan Brand: See you, bye.


A study on Impact of Helicobacter Pylori on the Development of B12 Deficiency by PubMed

CBC and Blood Chemistry Analysis by Dr. Dicken Weatherby




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