I have received countless emails from Hashimoto’s readers who have started feeling so much better after digging at their own root cause, making adjustments to their diets and lifestyles, and finding supplements that restore the nutrient depletions which are so common with thyroid disorders.
One of the nutrients that people with Hashimoto’s are particularly prone to being deficient in is Vitamin B12. In fact, in my survey of 2232 people with Hashimoto’s, 33 percent reported that they had tested as deficient in this all important vitamin, and 76 percent said they felt better after taking a B12 supplement. (Please note, not everyone has been tested!)
Why do people with Hashimoto’s have so many nutrient depletions? It really is a vicious cycle…
Read on to learn about:
- The reason why people with Hashimoto’s are prone to nutrient depletions
- The important role of B12 in the body
- Who is at greatest risk for developing a B12 deficiency
- The best way to boost your B12 levels
Hashimoto’s and Required Nutrients
Selenium, iron, Vitamin A, Vitamin E, the B vitamins, potassium, iodine, and zinc are all required for proper thyroid function. Other nutrients, although not directly involved in thyroid function, are also essential for optimal immune system, gut, liver and adrenal function.
Most people who are diagnosed with Hashimoto’s will also present with low levels of selenium, Vitamin E, and glutathione, as well as zinc and ferritin (the iron storage protein).
Why Do People with Hashimoto’s Have so Many Nutrient Depletions?
One of the reasons so many of us suffer from nutrient depletions is due to the way that conventional farming methods and food processing are robbing our food supply of good nutrients. In conventional farming methods, the same vegetables are grown on the same soil year after, depleting the soil of nutrients. Vegetables are also harvested before they are ripe and have had a chance to pull all of the nutrients from the soil they were planted in. These conventionally grown vegetables are far less nutritious than organic varieties. I always recommend that people eat organic vegetables, fruit, and meat whenever they possibly can to gain the most nutrition from their food.
Poor digestion can be another root cause of nutrient depletion for many people with Hashimoto’s. A person who is deficient in digestive enzymes will not be able to properly extract nutrients from their foods. They could eat large amounts of steak day after day, but if they don’t have enough stomach acid on board, they’re not going to be able to get enough iron out of that steak. Altered gut flora, or dysbiosis, will also prevent the extraction of nutrients from food.
Some of the most common medications prescribed to people with Hashimoto’s are notorious for depleting the body of nutrients. These include acid blockers, synthetic estrogens, progesterone (such as the birth control pill) as well as antibiotics.
Many of the diets that people with hypothyroidism follow to help relieve their symptoms can actually be a root cause for nutrient depletions. Going gluten-free or Paleo can have a substantial, positive effect on people with thyroid disorders, but it can also eliminate some essential vitamins from the diet, including the B vitamins, that will need to be supplemented.
Vegan, vegetarian, and low-fat diets will, likewise, put us at risk for deficiencies, including Vitamin A, Vitamin B3, Vitamin B9, Vitamin B12, Vitamin D, calcium, chromium, copper, iodine, iron, magnesium, manganese, zinc and omega-3’s.
Additionally, hypothyroidism, in itself, will lead to poor extraction of minerals and vitamins from our food sources. Thyroid hormones determine our metabolism throughout the entire body, including the digestive tract. Lack of sufficient thyroid hormones makes nutrient extraction more difficult and less efficient, and can lead to nutrient deficiencies.
Risk Factors for B12 Deficiency
Vitamin B12 is an essential water-soluble vitamin that is commonly found in animal proteins such as fish, shellfish, meat, eggs, and dairy products. B12 is required for protein synthesis, cell reproduction, and normal growth.
The risk for Vitamin B12 deficiency is higher with increased age. It has also been found to be more prevalent in males and in people of Caucasian and Latin American descent. It results from insufficient intake, malabsorption from food, and other medical conditions that may prevent absorption.
In the case of people with thyroid disorders, a B12 deficiency is often a result of damage to the digestive tract that prevents the absorption of vital nutrients.
B12 is released for absorption with the help of hydrochloric acid (stomach acid) and protease, an enzyme in the stomach. Low levels of hydrochloric acid, commonly found in those with Hashimoto’s, put people at risk for B12 deficiency. The consumption of bread and cereals fortified with folic acid (synthetic folate) may mask this deficiency on standard lab tests.
Because Vitamin B12 is only found in animal proteins and not in plant foods, those that have been following a vegetarian or vegan diet are at an especially high risk for developing a B12 deficiency. Taking a Vitamin B12 supplement is essential for vegans, and may be helpful for those with low stomach acid until the condition is corrected.
If you have a thyroid disorder, there is a very good chance that you are not absorbing B12, even if you eat a diet rich in animal proteins. Along with removing problematic foods and supplementing with Betaine with Pepsin to restore healthy gut function, adding in a B12 supplement may go a long way to restoring your energy, cognitive function and overall sense of well-being.
Most people with thyroid conditions and adrenal fatigue will also have low stomach acid (hydrochloric acid or HCl), which is necessary to break down protein. This is known as “achlorhydria”. This lack of adequate digestive enzymes leads to a depletion of amino acids, iron, zinc and other nutrients obtained from protein. Symptoms include gas, heartburn, bloating, and heaviness in the stomach after eating a protein-rich meal.
Achlorhydria and the inability for the digestive tract to break down and absorb many important nutrients can result in severe deficiencies for many people who have hypothyroidism.
Hashimoto’s often co-occurs with other autoimmune conditions. One of these conditions is specifically tied to B12 deficiency and is known as pernicious anemia. In pernicious anemia, the immune system attacks intrinsic factor, a protein in our stomach that is required for B12 absorption. (Please note, pernicious anemia, Hashimoto’s and Graves’ can all be caused by Helicobacter pylori, and treating the H Pylori can lead to a remission of all three of the conditions.)
Another risk factor for B12 deficiency is small intestinal bacterial overgrowth, commonly known as SIBO,which may be present in up to 50% of people with Hashimoto’s.
Do You Have Low Levels of B12?
Lab tests for measuring B12 levels are available but do not always tell the whole story. Established “low” ranges are too low, and researchers have found that “normal-low” B12 levels have been associated with neurological symptoms such as difficulty balancing, memory lapses, depression, mania, fatigue, and even psychosis!
Normal serum Vitamin B12 levels range between 200-900 pg/mL, with concentrations less than 200 pg/mL usually resulting in deficiency. B12 deficiency may result in gastrointestinal lesions, and neurological damage, as well as symptoms such as depression, memory loss, weakness, personality and mood changes, and impaired cognitive performance. Impaired digestion and inflammation are also symptoms of a B12 deficiency.
An elevation of B12 in your serum can be tied to the MTHFR gene variation. When the body is unable to properly use B12, it will show up as elevated on the test. As B12 is a water soluble vitamin, any amount that is not used by the body will simply be eliminated.
To find out if you have low levels of B12, you can ask your health care provider for the B12 (or cobalamin) test. This test can be ordered individually or added to a blood panel. Your levels may be low, even if all other screening tests for iron and anemia come out within the reference range.
Alternately, you can self-order the B12 test via Ulta Lab Tests. When you receive your test results, it’s important to note that optimal B12 levels should be between 700-900 pg/ml. Most labs will not flag B12 levels unless they are under 200 pg/ml.
How to Take B12
Options for B12 replacement include tablets, sublingual (under the tongue) liquids, and injections. I prefer the sublingual route as there may be advantages for those with absorption issues, and it is more convenient than injections.
Sublingual doses of 1 mg (1000 mcg) to 3 mg (3000 mcg) of B12 daily for ten days, then once per week for four weeks, then monthly, have been found to be effective in restoring B12 levels in those with a deficiency.
Pure Encapsulations B12 comes in a convenient liquid form that can be administered sublingually for optimal absorption. The active form of B12 in this formulation is highly bioavailable and has been shown to support neurological function, nerve cell health, healthy cognitive and nerve function, as well as memory and emotional well-being.
Vitamin B12 is also an important co-factor for energy production and plays a role in immune system health and healthy homocysteine metabolism. Homocysteine is a naturally occurring amino acid found in blood plasma. High levels of homocysteine in the blood are believed to increase the chance of heart disease, stroke, Alzheimer’s disease, and osteoporosis. For this reason, I highly recommend optimizing your B12 levels today!
For more information on nutrient depletions and Hashimoto’s, I encourage you to read the articles What’s Going on in Hashimoto’s, Nutrient Depletions Part I: Selenium, Nutrient Depletions Part II: Nutrient Extraction, and Hair Loss and Your Thyroid.
My latest book, Hashimoto’s Protocol goes further in depth on strategies for getting to the root cause of your thyroid disorder and addressing nutrient deficiencies so you can start feeling better.
I wish you well on your journey to health!
P.S. Be sure to sign up for my weekly newsletter to get a free book chapter, recipes, Thyroid Diet Starter Guide and notifications about upcoming events and my latest research.
- Vitamin B12. Therapeutic Research Center website. https://naturalmedicines-therapeuticresearch-com.mwu.idm.oclc.org/databases/food,-herbs-supplements/professional.aspx?productid=926. Updated March 7, 2018. Accessed March 22, 2018.
- Ness-Abramof R, Nabriski DA, Braverman LE, Shilo L, Weiss E, Reshef T, et al. Prevalence and evaluation of B12 deficiency in patients with autoimmune thyroid disease. Am J Med Sci. 2006 Sep;332(3):119-22.
Note: Originally published in February 2015, this article has been revised and updated for accuracy and thoroughness.