IBS and Vitamin B12 Deficiency - Causes and Prevention

The Link Between IBS and Vitamin B12 Deficiency

Vitamin B12 deficiency is common in those with irritable bowel syndrome (IBS). In fact, research shows that up to 60-70% of IBS patients have reduced B12 levels. There are a few reasons why IBS and B12 deficiency tend to overlap.

Digestion and Absorption Issues

In order to absorb B12 from foods, stomach acid must detach it from proteins. The B12 then attaches to intrinsic factor and travels to the ileum to be absorbed. For those with IBS, digestive issues can disrupt this process in a few ways:

• Insufficient stomach acid - Up to 50% of IBS patients produce inadequate stomach acid which means the B12 may not properly detach from foods.
• Medications - IBS medications that reduce stomach acid like PPIs also impair B12 absorption.
• Digestion speed - Food passing too quickly or too slowly through the ileum impacts vitamin absorption.
• Gut inflammation - Swelling in the small intestine damages the cells that absorb B12.

These widespread digestive disturbances make it extremely difficult for B12 levels to remain optimal in those battling IBS.

Dietary Restrictions

IBS often coincides with food intolerances that lead to restricted diets. Common IBS trigger foods like dairy, eggs, meat and shellfish also happen to be top sources of naturally occurring B12. Avoiding these foods can quickly increase deficiency risk.

SIBO

Studies show that up to 84% of IBS patients also have small intestinal bacterial overgrowth (SIBO). With excessive bacteria in the ileum, B12 absorption is hampered. Bacteria also compete for the available B12, leaving less to be transported to tissues in the body.

Signs of B12 Deficiency With IBS

B12 deficiency and IBS share some common symptoms which can make a deficiency hard to spot. However, here are a few red flags that likely indicate deficient B12 levels rather than just IBS issues:

• Pale skin or jaundice
• Glossitis - swollen inflamed tongue
• Mouth ulcers
• Vision changes
• Heart palpitations
• Pins and needles sensations
• Impaired balance or gait disturbances

Neurological disturbances point to a B12 deficiency as they go beyond standard IBS problems. Anemia symptoms like rapid heartbeat, shortness of breath, dizziness and fatigue may also arise. Have B12 blood work done if any such symptoms develop.

Testing B12 Levels with IBS

All IBS patients should have their B12 levels checked, especially those with a long history of GI issues. Get baseline testing done even without noticeable symptoms. Around 6% of the general public and up to 26% of seniors have low B12 levels.

Be aware that serum B12 blood tests can be inaccurate, providing both false positives and negatives. Methylmalonic acid tests give more definitive deficiency readings.

Oral B12 Supplements

Address any B12 shortfalls right away to avoid neurological decline. Those with absorption challenges often need very high dose B12 taken regularly. Sublingual tablets, sprays or liquids that absorb directly into the bloodstream are best.

Expect to take 1000-5000mcg doses daily or weekly of a bioavailable B12 supplement long-term. This saturates tissues while overcoming faulty digestive transport. Reduce to monthly doses after B12 levels normalize.

Avoiding B12 Deficiency with IBS Long-Term

Careful nutritional strategies can help IBS sufferers maintain adequate B12 status into the future. This minimizes deficiency and reliance on supplements.

Eat B12 Fortified Foods

Since properly extracting and absorbing natural B12 is difficult with IBS, eat fortified items as your main dietary source instead. These include:

• Plant milks
• Breakfast cereals
• Nutritional yeast
• Some faux meats

Check labels and aim for at least 25-100% DV. This simplifies getting enough B12 each day without worsening IBS symptoms.

Treat SIBO

Get tested and treat any overgrowth in the small intestines. Antibiotics like rifaximin work to reduce bacterial loads. A prokinetic motility agent alongside may also help B12 absorption.

Improve Stomach Acid Levels

Increasing stomach acid production boosts B12 bioavailability. Try betaine HCL capsules containing digestive enzymes with protein-containing meals. Titrate doses slowly as directed.

Eat Raw B12-Rich Foods

Cooking destroys B12, especially when boiling foods. Consume some animal products raw or very lightly cooked. Tartare, beef carpaccio, sashimi or very rare meat maximize B12 intake.

Other Nutrient Deficiencies with IBS

B12 insufficiency often accompanies shortfalls in other vitamins and minerals with IBS:

Iron

GI inflammation, gut ulcers and bloody stools contribute to low iron levels. Oral supplementation is often ineffective. Seek iron infusions if ferritin levels drop too low.

Vitamin D

IBS flare ups and food restrictions limit vitamin D sources. Prioritize sufficient sun exposure daily. Those living in cold climates likely need D3 supplementation too.

Magnesium

Diarrhea and vomiting deplete magnesium storage. Cramping and arrhythmias may emerge unless levels are supported through oral supplementation.

Zinc

Scarce in plant foods, zinc requires strong digestive functioning for absorption. Animal foods high in zinc often trigger IBS symptoms, increasing deficiency likelihood.

Getting bloodwork periodically lets you detect and correct any nutritional shortfalls tied to IBS early.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.