25/02/2026
Low B12… but you eat red meat, eggs and fish?
It’s not always about intake.
B12 deficiency is often an absorption or utilisation issue — not a dietary one.
To absorb B12 properly, your body needs:
• Adequate stomach acid
• Intrinsic factor (made in the stomach)
• A healthy small intestine
• Balanced gut bacteria
If any part of that chain is disrupted, B12 levels can drop.
Common root causes I see in clinic:
– Low stomach acid (stress, ageing, long-term antacid use)
– Gut inflammation (coeliac disease, chronic IBS-type symptoms)
– Autoimmune conditions like Pernicious anemia
– Medications such as the oral contraceptive pill, metformin or PPIs
– Gut dysbiosis or SIBO
– Impaired methylation (including MTHFR variations)
And here’s something important:
Serum B12 can look “normal” while you’re still functionally deficient.
That’s why in naturopathic care we may also assess:
• Active B12
• Homocysteine
• Methylmalonic acid (MMA)
• Iron and folate status
Because the goal isn’t just to raise a number.
It’s to understand why your body isn’t utilising B12 properly in the first place.
If your B12 is low, don’t just supplement — investigate.
Symptoms like fatigue, brain fog, anxiety, hair loss, numbness or hormonal imbalance are signals.
Your body is always giving clues.