When Intrinsic Factor goes AWOL the vitamin B12 package is not delivered

intrinsic factor carrying vitamin B12 to liverYour body should have a stash of vitamin B12 (cobalamin). Except…. when Intrinsic Factor goes AWOL.

When intrinsic factor goes AWOL, you suffer from pernicious anemia. The reason intrinsic factor fails to show up, is because this gentle giant gets bullied by the immune system, to such an extent, that he dare not show his face. His forced absence means the precious vitamin B12 package is not picked up.

At this stage, no one really knows why the immune system starts attacking the intrinsic factor, instead of the bad guys.

A diagnosis of pernicious anemia is a diagnosis of an auto-immune disorder, just like type 1 diabetes and celiac disease, it is not due to poor food choices. So taking a supplement or eating platefuls of liver, will not help – the vitamin B12 is there, it just cannot be absorbed.

To “fix” the problem, you either have to get a SHOT, on a regular basis or you need to take a vitamin B12 supplement which is not swallowed as a pill, but stuck under your tongue.

NOTE : Sticking it under your tongue, allows the vitamin B12 to be absorbed sublingually i.e. it manages to squeeze into the blood supply directly, avoiding the GUT.

Could you be vitamin B12 deficient or insufficient ?

If you have an overt deficiency, signs and symptoms are more obvious.

Blatant vitamin B12 deficiency is easy to spot, you’ll be suffering from one of two problems….

  • anemia i.e. you look pale, feel tired and flat on the outside, on the inside, your blood cells look very big, because they’re having trouble being produced


  • neuropathies i.e. very unhappy nerves which may start out twitching and tingling a lot, these whining nerves are typically located in your hands and feet.

But, sometimes the trouble is not so obvious. You’ve got some vitamin B12, enough to allow the red blood cells and nerves to get by, but not quite enough to function optimally. Your trouble is not deficiency, more insufficiency – a similar problem happens with vitamin D.

Experts are starting to think, running low on vitamin B12 could be contributing to a long list of chronic health problems, shortages have been implicated in blood vessel, brain, bone and eye troubles.

Testing is not so easy

Unlike testing for high cholesterol or high blood pressure, testing for vitamin B12 deficiency is rather complicated, because blood levels don’t always reflect body levels. Ideally, blood levels should be assessed along with levels of methylmalonic acid (MMA) and homocysteine levels.

NOTE : Fortunately, pernicious anemia, can be diagnosed relatively easily, if there are antibodies against Intrinsic Factor present, then your immune system is attacking your gentle giant, intrinsic factor.

Supply is depleted to over time

Our bodies store vitamin B12 – on paper, you should have more than enough to meet your needs.

But, just like vitamin D, lots of people are running low on this important nutrient – try not to be one of them.

  • If you do not routinely eat animal products, then take a supplement, preferably one that just contains vitamin B12 on a regular basis. Too much niacin (vitamin B3) is probably not a health move.
  • If you’re eating animal products routinely, but you have reason to believe your absorption might be compromised#, supplementing with regular pills might not be enough, opt for sublingual formulation or be brave and get a shot.

PS. The good news about cobamalin is, unlike some other nutrients, because it NEEDS to be “attached” to something, a little too much, is unlikely to cause too much trouble for you, it will just produce very expensive pooh (if you’ve taken it orally) and pee (if you’ve has a shot).

#Here is a list of factors which are known to compromise vitamin B12 absorption.

  • Atrophic gastritis
  • Inflammatory diseases eg. Crohn’s, celiac disease, SIBO
  • Malabsorption syndrome
  • Long term use of proton pump inhibitors, metformin and epileptic medications previous one
Vitamin B12 in Health and Disease. Nutrients (2010) 2, 299-316. Fiona O’Leary and Samir Samman


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Further reading

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Balance Eicosanoids Rein in insulin Dial down stress Sleep ! Increase Vit D Culivate microflora Think champion

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