Blog
B12 and Depression
There are so many nutrients that play a role in mental health. We can’t accurately test for every nutrient deficiency in a convenient and well validated way. Luckily, B12 is one of the nutrients that we can actually test with a fair amount of confidence about the accuracy of the results in many cases.
There have been a number of studies about B12 and depression. Studies have found that lower levels of B12 in certain populations may be related to depression symptoms. Higher intake of B12 has been associated with a lower risk of depression. However, it’s unclear how much B12 supplements improve depression symptoms. Some studies have show promise, other have not. B12 may also help with other symptoms that are common among depressed patients such as low energy.
B12 might impact mental health because of its role in producing certain neurotransmitters in the brain which are important for mood regulation. It can also help lower other compounds in the body such as homocysteine which have been linked to depression.
Vitamin B12 deficiency can happen when you are not consuming enough of the vitamin. Common sources of B12 are chicken, eggs, fish, dairy and meat. It’s also fortified in certain foods like some brands of nutritional yeast and is easily found in supplement form. Deficiency can also happen when you’re not absorbing enough B12 from the foods you eat. This can be due to a medical reason like gastritis or celiac disease. B12 deficiency has also been linked to certain medications. Sometimes we don’t know why the body is not able to absorb B12 well from the diet.
The easiest way to determine if vitamin B12 deficiency is playing a role in your mental health is to test for deficiency and treat it. Not everyone needs a B12 test but it’s something I do for many of my patients along with other testing to determine if hormones or nutrient deficiencies are playing a role in their mental health symptoms.
Testing For Anxiety - is it Necessary?
Anxiety can involve a whole bunch of confusing and overwhelming symptoms. For some people, all of the symptoms are thought based - overthinking, catastrophizing, constant worrying etc. For others, physical symptoms are associated with the anxiety like heart palpitations, diarrhea, irregular periods, sweating, nausea and so on.
Whether or not you need testing depends on your signs and symptoms. The type of testing you need will be completely individualized to you. Testing can help us figure out potential root causes that could be contributing to your anxiety.
Here are some tests that can be run for certain cases of anxiety:
Thyroid testing - this is sometimes tested when heart palpitations, jitters, constipation or diarrhea, cold or hot flashes, irregular periods, hair issues or skin changes occur.
Iron deficiency testing - this can be considered when symptoms like weakness, fatigue, shortness of breath and heart palpitations are present.
Blood sugar testing - this is sometimes done when symptoms like lightheadedness, weakness and shaking are present.
Other tests like liver testing, triglycerides, reproductive hormones, vitamin d, B12 and many more may also be considered on a case by case basis.
I often get asked if I offer testing as a naturopathic doctor. I have access to many common tests and I often run tests for my anxiety patients when we feel it’s necessary. If you want to talk more about how I can help you with testing, please book a free 15 minute consultation.
Vitamin B12: What You Should Know
Having enough B12 can make a big difference in how well you feel. Here are some quick facts about vitamin B12 that you should know about. Knowledge is power - especially when it comes to your health.
Dietary Sources
Animal protein like fish and meat
Dairy and eggs
Fortified foods and drinks (e.g. some soy-based meat substitutes and beverages)
Signs and Symptoms of Deficiency
Note: you don’t have to have all of these symptoms to have low B12 levels (you don’t even have to have any of these symptoms).
Fatigue
Abnormal CBC results with blood work – this is often the first way that a B12 deficiency is discovered
Heart palpitations
Tongue inflammation
Pallor
Changes in the skin like loss of pigment or darkening
Potential impacts on fertility
In more severe cases it can affect the nerves (numbness, tingling), cognitive function and memory
Who’s Most at Risk for Deficiency
Note: Even if you don’t check off anything on this list, you could still have a deficiency. Also, being at risk does not mean you will definitely have a deficiency.
Patients with stomach and colon issues (e.g. surgeries, auto-immune gastritis, inflammatory bowel disease)
Those using certain medications: metformin, some medications for GERD or stomach ulcers
Vegans and vegetarians
Adults over 50-75 years old
Patients with an H.pylori infection
Testing and Results
The “normal” level for B12 varies widely between countries and even depending on which lab you go to! Anything below 150-220 pmol/L could be considered low. But sitting right at the bottom of the normal range doesn’t feel great for many people. I usually like levels to be comfortably above the low end of the reference range.
Testing B12 isn’t excessively expensive. If your MD tests it, it’s usually covered by OHIP. If I test it, it’s either covered by your workplace/ private health insurance or it’s around $20 out of pocket.
Note that measuring B12 in the blood isn’t a perfect science. If your levels are normal or low-normal but a deficiency is still suspected, other testing may be warranted to confirm deficiency (i.e. testing methylmalonic acid or homocysteine). This extra testing is on the pricey side.
Supplements: Oral Versus Injection
In many cases oral supplementation is just as useful as injections. But injections can have faster results and some people only seem to respond to injections. I wouldn’t consider injections as first line in most cases.
I’m all about getting our nutrients from the diet over supplements but in the case of B12, absorption is often better via supplements than food. So if you’re deficient, supplements may be the way to go. Many B12 products come in a form that you dissolve under the tongue. We don’t know for sure if this is better than swallowing the pill.
How Long Until You Feel Better?
Many patients feel better within a week of taking B12 but just because you don’t, doesn’t mean you should stop taking it. It can take several weeks (even a couple months) for CBC blood test results to normalize and for symptoms to improve.