Why is B12 deficiency so common? The absorption of B12 is complex and involves several steps – each of which can go wrong. Causes of B12 malabsorption include: -intestinal dysbiosis -leaky gut and/or gut inflammation -atrophic gastrits or hypochlorhydria (low stomach acid) -pernicious anemia (autoimmune condition) -medications (especially PPIs and other acid-suppressing drugs) -alcohol -exposure to nitrous oxide (during surgery or recreational use) This explains why B12 deficiency can occur even in people eating large amounts of B12-containing animal products. In fact, many of my patients that are B12 deficient are following a Paleo diet where they eat meat 2-3 times a day. Why is B12 deficiency so under-diagnosed? B12 deficiency is often missed for two reasons. First, it’s not routinely tested by most physicians. Second, the low end of the laboratory reference range is too low. This is why most studies underestimate true levels of deficiency. Many B12 deficient people have so-called “normal” levels of B12. Yet it is well-established in the scientific literature that people with B12 levels between 200 pg/mL and 350 pg/mL – levels considered “normal” in the U.S. – have clear B12 deficiency symptoms. Experts who specialize in the diagnosis and treatment of B12 deficiency, like Sally Pacholok R.N. and Jeffery Stewart D.O., suggest treating all patients that are symptomatic and have B12 levels less than 450 pg/mL. They also recommend treating patients with normal B12, but elevated urinary methylmalonic acid (MMA), homocysteine and/or holotranscobalamin (other markers of B12 deficiency). For more information call 796-574-9656. . . . #relaxspa #wellness #B12 #B12shot #lipotropicinjections #salud #holistichealth #holisticwellness #stress #health (at Relax SPA) https://www.instagram.com/p/CM__t3qHzUl/?igshid=2kd9w5bmtal5