Now the bigger question is why is vit.B12 deficiency so highly prevalent in thyroid patients.
There are various reasons for underactive thyroid and vitamin b12 deficiency can be dietary related.Also, certain people are at higher risk for Vit.B12 deficiency as compared to others.
Like vegetarians, vegans and elderly are all at higher risk for vit B12 deficiency, and if they have thyroid dysfunction, it increases the chances more.
Another big reason for people with thyroid disorders to have low Vitamin B12 levels is —antibodies against the parietal cells(which helps with Vitamin B12 absorption).
This condition is also calledpernicious anemia. Where the body develops antibodies against the parietal cells and destroys them.Parietal cells secrete what is called intrinsic factor which is required for the absorption of it.B12 in our gut.
According to this study,the prevalence of Vitamin B12 deficiency in autoimmune thyroid patients was 28%,so it is not a rare phenomenon but very common one.
In another study, the prevalence of low vitamin B12 was 55% in patients with autoimmune thyroid disease.
The second study raised another important question that — a single test to check for Vitamin B12 levels in the blood might miss a lot of patients which might be deficient in vitamin B12 and not picked up by that test!
So to make sure the vitamin B12 deficiency in thyroid patients does not get undetected –as a functional medicine physician I suggest looking at different markers like MMA, homocysteine levels also in conjunction, in addition to B12 deficiency blood tests.
Upon discussion of B12 and Thyroid relation, most people will have this question —what are the symptoms of B12 deficiency in thyroid patients?
The huge problem is that the symptoms ofB12 deficiency and low thyroid overlap, so it make the situation a little tricky to catch in the first place.
The most common symptoms of B12 deficiency are—
Tiredness and fatigue
Tingling or numbness in hands and feet
Interestingly the majority of these symptoms are also attributed to low thyroid.
So that’s the reason it becomes difficult to differentiate until we check for B12 deficiency.
The most concerning symptoms isthe peripheral nerve damagethat occurs because of B12 deficiency and that can easily be avoided with supplementation from B12, so again very important in thyroid patients to for deficiency of B12.
Unfortunately, the blood tests that are ordered to check for vitamin B12 deficiency don’t give the true picture of functioning B12 in your system and can sometimes miss suboptimal B12 levels.
Vitamin B12 levels in the blood is often an inaccurate reflection of your vitamin B12 status in the body and also there are some concerns about the range that is being used in the labs which are very broad often from 200-900 ng/ml.
The broad range can miss the patients whose levels might be on the lower end of the spectrum and still have symptoms.
For a complete evaluation,functional medicine doctorsrecommend getting a combination of tests is the best way to check for vitamin B12 status.
The following test can be done by any standard lab and can help to evaluate your vitaminB12 status —
Vitamin B12 serum levels
The way these tests are interpreted are very different and have to be carefully understood.I feel Vitamin B12 serum levels should be more than 300ng/ml and ideally above 400ng/ml.
MMA levels have to be understood carefully, as the high MMA levels indicate low vitamin B12 status, any MMA level above 300 nmol/l is concerning for me and reflect suboptimal vitamin B12.Homocysteine levels reflect the functioning status of Vit.B12 andwe want these levels to be less than 10.
So based on these tests people can evaluate their Vit.B12 status and take supplementation accordingly.
Now you got your blood work checked and it came back that you are vitamin B12 deficient, so how much and what form and which route to take vitamin B12.
Vitamin B12 comes in oral tablets, Intramuscular injections and also sublingual tablets.
The concern is that in thyroid patients there is a problem with Vitamin B12 absorption because of the antibodies against intrinsic factor as explained above.
So the oral route might not be the best way of supplementation for people with thyroid dysfunction.
For my patients with autoimmune thyroid conditions like Hashimoto’s,I recommend them sublingual or Intramuscular injection.
Both of them are good ways to get your Vitamin B12 levels up, in fact, a study was done which showed equal efficacy of sublingual as compared to injectable Vit.B12.I generally recommend sublingual 1000mcg of Vit.B12 daily.
The injectable will have different dosages generally around 1000 mcg once a week initially for 1 month and then 1000mcg once a month.
The prevalence of Vitamin B12 deficiency is higher in underactive thyroid patient especially Hashimoto’s.
Often low Vitamin B12 and thyroid symptoms are very similar, so clinically it makes it harder for physicians to diagnose B12 deficiency.
Consult a functional medicine physician, if you have a high index of suspicion for vitamin B12 deficiency with thyroid dysfunction.We do a comprehensive panel to check for Vitamin B12 and how to interpret these results is also important.
Suffering from a chronic disease like thyroid, gut problem, weight issues, autoimmune issues, etc... is not easy. Dr. Gupta is a certified Functional Medicine Physician and his personalized plans have helped thousands of people to reclaim their health back.