Vitamin B12 is a powerhouse. It helps make DNA, nerve and blood cells and is crucial for a healthy brain and immune system. Your metabolism wouldn’t run smoothly without it. But B12 isn’t like other vitamins. It’s only found in animal products like eggs, meat, shellfish, and dairy. Up to 15% of people don’t get enough B12 and they are more likely to be vegetarians, have celiac disease or other digestion problems or be an adult over 50.
1. Vegetarians and vegans are at risk
Vitamin B12 occurs naturally in animal products. So if your diet largely consists of plant-based foods such as fruits, veggies, beans and soy, you are at risk for deficiency. Vegans—who by definition consume no animal products—need to take a supplement or consume vitamin B12–fortified foods, such as breakfast cereal and grains.
2. Adults over 50 are also at risk
As you age, the stomach produces less acid, and stomach acid is key for B12 absorption, says Middleburg. About one in 31 adults over 50 are deficient, estimates the Centers for Disease Control and Prevention. Some seniors actually lose the ability to absorb vitamin B12 from food at all, and must get it via supplements or, if the deficiency is severe, injections.
3. Early symptoms include weakness and fatigue
B12 isn’t nicknamed the energy vitamin for nothing. Inadequate B12 intake makes a dent in red blood cell production and some of the earliest signs of a deficiency include feeling dragged, confused and weak.
4. Heartburn drugs can cause it
Some prescription heartburn drugs suppress the production of stomach acid, which is needed to absorb vitamin B12. A 2013 study from the Journal of the American Medical Association backs this up. Researchers found that taking meds called proton pump inhibitors for more than two years was linked to a 65% higher risk of vitamin B12 deficiency. And two years or more using H2 receptor blocker drugs are associated with a 25% boost in deficiency odds. If you take these regularly, talk to your doctor about steps you can take to protect yourself.
5. It can be mistaken for dementia
It can be hard distinguishing deficiency from dementia, especially since older folks are at risk for both. And the two conditions often overlap; 75% to 90% of B12 deficient people also have neurological complications such as dementia, says Moon. But even when a B12 shortage strikes younger people, it still typically resembles dementia.
6. Taking birth control pills sets you up for it
“Studies show that pills that are higher in estrogen are more strongly associated with B12 and foliate deficiencies, leading to the assumption that the estrogen in the pill is the reason for this impaired absorption, says Middleberg. ” If you’re on the pill, talk to your doctor about the risks, and if you should take B12 supplements as a backup.
7. The best sources are meat and fish
Beef liver and clams are tops in B12, according to the National Institutes of Health. If you’re not a fan of either, plenty of good options abound. Beef, turkey, oysters, chicken, trout and salmon are B12 superstars; a serving of each delivers close to or more than 100% of your RDA, Eggs and milk are also solid sources.
8. Fortified foods and supplements can help
Both can help vegans, vegetarians, and older adults and others who are unable to absorb naturally occurring B12, says Moon. When absorption is an issue, “simply loading up on foods naturally high in B12 may not solve the problem,” she says. “The synthetic form of B12 is more readily absorbed.” Best places to find it in food: fortified cereals, many of which have 100% of your RDA.