What is vitamin B12 and what does it do?
Vitamin B12 is a nutrient that helps keep the body's nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 also helps prevent a type of anemia called megaloblastic anemia that makes people tired and weak.
Two steps are required for the body to absorb vitamin B12 from food. First, hydrochloric acid in the stomach separates vitamin B12 from the protein to which vitamin B12 is attached in food. After this, vitamin B12 combines with a protein made by the stomach called intrinsic factor and is absorbed by the body. Some people have pernicious anemia, a condition where they cannot make intrinsic factor. As a result, they have trouble absorbing vitamin B12 from all foods and dietary supplements.
How much vitamin B12 do I need?
The amount of vitamin B12 you need each day depends on your age. Average daily recommended amounts for different ages are listed below in micrograms (mcg):
| Life Stage |
Recommended Amount |
|---|
| Birth to 6 months | 0.4 mcg |
| Infants 7–12 months | 0.5 mcg |
| Children 1–3 years | 0.9 mcg |
| Children 4–8 years | 1.2 mcg |
| Children 9–13 years | 1.8 mcg |
| Teens 14–18 years | 2.4 mcg |
| Adults | 2.4 mcg |
| Pregnant teens and women | 2.6 mcg |
| Breastfeeding teens and women | 2.8 mcg |
What foods provide vitamin B12?
Vitamin B12 is found naturally in a wide variety of animal foods and is added to some fortified foods. Plant foods have no vitamin B12 unless they are fortified. You can get recommended amounts of vitamin B12 by eating a variety of foods including the following:
- Beef liver and clams, which are the best sources of vitamin B12.
- Fish, meat, poultry, eggs, milk, and other dairy products, which also contain vitamin B12.
- Some breakfast cereals, nutritional yeasts and other food products that are fortified with vitamin B12. To find out if vitamin B12 has been added to a food product, check the product labels.
What kinds of vitamin B12 dietary supplements are available?
Vitamin B12 is found in almost all multivitamins. Dietary supplements that contain only vitamin B12, or vitamin B12 with nutrients such as folic acid and other B vitamins, are also available. Check the Supplement Facts label to determine the amount of vitamin B12 provided.
Vitamin B12 is also available in sublingual forms (which are dissolved under the tongue). There is no evidence that sublingual forms are better absorbed than pills that are swallowed.
A prescription form of vitamin B12 can be administered as a shot. This is usually used to treat vitamin B12 deficiency. Vitamin B12 is also available as a prescription medication in nasal gel form (for use in the nose).
Am I getting enough vitamin B12?
Most people in the United States get enough vitamin B12 from the foods they eat. But some people have trouble absorbing vitamin B12 from food. As a result, vitamin B12 deficiency affects between 1.5% and 15% of the public. Your doctor can test your vitamin B12 level to see if you have a deficiency.
Certain groups may not get enough vitamin B12 or have trouble absorbing it:
- Many older adults, who do not have enough hydrochloric acid in their stomach to absorb the vitamin B12 naturally present in food. People over 50 should get most of their vitamin B12 from fortified foods or dietary supplements because, in most cases, their bodies can absorb vitamin B12 from these sources.
- People with pernicious anemia whose bodies do not make the intrinsic factor needed to absorb vitamin B12. Doctors usually treat pernicious anemia with vitamin B12 shots, although very high oral doses of vitamin B12 might also be effective.
- People who have had gastrointestinal surgery, such as weight loss surgery, or who have digestive disorders, such as celiac disease or Crohn's disease. These conditions can decrease the amount of vitamin B12 that the body can absorb.
- Some people who eat little or no animal foods such as vegetarians and vegans. Only animal foods have vitamin B12 naturally. When pregnant women and women who breastfeed their babies are strict vegetarians or vegans, their babies might also not get enough vitamin B12.
What happens if I don't get enough vitamin B12?
Vitamin B12 deficiency causes tiredness, weakness, constipation, loss of appetite, weight loss, and megaloblastic anemia. Nerve problems, such as numbness and tingling in the hands and feet, can also occur. Other symptoms of vitamin B12 deficiency include problems with balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue. Vitamin B12 deficiency can damage the nervous system even in people who don't have anemia, so it is important to treat a deficiency as soon as possible.
In infants, signs of a vitamin B12 deficiency include failure to thrive, problems with movement, delays in reaching the typical developmental milestones, and megaloblastic anemia.
Large amounts of folic acid can hide a vitamin B12 deficiency by correcting megaloblastic anemia, a hallmark of vitamin B12 deficiency. But folic acid does not correct the progressive damage to the nervous system that vitamin B12 deficiency also causes. For this reason, healthy adults should not get more than 1,000 mcg of folic acid a day.
What are some effects of vitamin B12 on health?
Scientists are studying vitamin B12 to understand how it affects health. Here are several examples of what this research has shown:
Heart disease
Vitamin B12 supplements (along with folic acid and vitamin B6) do not reduce the risk of getting heart disease. Scientists had thought that these vitamins might be helpful because they reduce blood levels of homocysteine, a compound linked to an increased risk of having a heart attack or stroke.
Dementia
As they get older, some people develop dementia. These people often have high levels of homocysteine in the blood. Vitamin B12 (with folic acid and vitamin B6) can lower homocysteine levels, but scientists don't know yet whether these vitamins actually help prevent or treat dementia.
Energy and athletic performance
Advertisements often promote vitamin B12 supplements as a way to increase energy or endurance. Except in people with a vitamin B12 deficiency, no evidence shows that vitamin B12 supplements increase energy or improve athletic performance.
Can vitamin B12 be harmful?
Vitamin B12 has not been shown to cause any harm.
Are there any interactions with vitamin B12 that I should know about?
Yes. Vitamin B12 can interact or interfere with medicines that you take, and in some cases, medicines can lower vitamin B12 levels in the body. Here are several examples of medicines that can interfere with the body's absorption or use of vitamin B12:
- Chloramphenicol (Chloromycetin®), an antibiotic that is used to treat certain infections.
- Proton pump inhibitors, such as omeprazole (Prilosec®) and lansoprazole (Prevacid®), that are used to treat acid reflux and peptic ulcer disease.
- Histamine H2 receptor antagonists, such as cimetidine (Tagamet®), famotidine (Pepcid®), and ranitidine (Zantac®), that are used to treat peptic ulcer disease.
- Metformin, a drug used to treat diabetes.
Tell your doctor, pharmacist, and other health care providers about any dietary supplements and medicines you take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients.
Where can I find out more about vitamin B12?
- For general information on vitamin B12:
- For more information on food sources of vitamin B12:
- For more advice on buying dietary supplements:
- For information on the government's food guidance system:
Disclaimer
This fact sheet by the Office of Dietary Supplements provides information that should not take the place of medical advice. We encourage you to talk to your health care providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific brand name is not an endorsement of the product.
Glossary
- anemia
- A condition in which the number of red blood cells in the blood, or the amount of hemoglobin in them, is lower than normal, causing a condition in which red blood cells are not able to supply enough oxygen to all the tissues in the body. Hemoglobin is the substance in red blood cells that carries oxygen to your body's cells.
- antibiotic
- A drug used to treat infections caused by bacteria and other microorganisms.
- celiac disease
- An autoimmune disorder in which eating gluten (a protein found in wheat, rye, barley, and possibly oats) causes the immune system to damage the small intestine, making it unable to absorb nutrients. It is a genetic disease that sometimes becomes active for the first time after surgery, pregnancy, childbirth, viral infection, or extreme stress. Also called sprue.
- Crohn's disease
- A long-lasting (chronic) disease that causes severe irritation in the gastrointestinal tract. It usually affects the lower small intestine (called the ileum) or the colon, but it can affect any part of the digestive tract from the mouth to the anus. It is painful, causing severe watery or bloody diarrhea, and may lead to life-threatening complications. Crohn's disease is a form of inflammatory bowel disease.
- deficiency
- An amount that is not enough; a shortage.
- dementia
- Damaged brain function (thinking, learning, making decisions, remembering) that worsens over time. It disrupts activities of daily living such as bathing, dressing, and walking.
- diabetes
- A disease in which blood sugar (glucose) levels are high because the body is unable to use glucose properly. Diabetes occurs when the body does not make enough insulin, which helps the cells use glucose, or when the body no longer responds to insulin.
- dose
- The amount of medicine or other substance taken at one time or over a specific period of time.
- failure to thrive
- A condition in which infants and children are dramatically smaller or shorter than other children of the same age and gender, and physical, mental, and social skills are significantly delayed. Causes include medical disorders, environmental factors, malnutrition, and neglect.
- fortify
- To add nutrients to a food during processing or to replace nutrients lost when a food product is produced or stored. This process is sometimes called enrichment. For example, when calcium is added to processed orange juice, the orange juice is said to be "fortified with calcium." Another example is adding folic acid to flour.
- gastrointestinal
- GI. Having to do with the gastrointestinal tract (the large, muscular tube that extends from the mouth to the anus, where the movement of muscles and release of hormones and enzymes digest food).
- gene
- The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.
- H2 receptor antagonist
- A medication that reduces the amount of acid made by the stomach. It is used to treat conditions such as stomach ulcer (peptic ulcer) and gastroesophageal reflux disease.
- homocysteine
- An amino acid (a building block of protein). At high blood levels, it may increase the risk of developing coronary heart disease, heart attack, stroke, and Alzheimer's disease. Elevated homocysteine may also increase the risk of developing osteoporosis and bone fractures.
- hydrochloric acid
- An acid made in the stomach. It works with enzymes (substances that speed up chemical reactions in the body) to break down proteins during digestion.
- interaction
- A change in the way a dietary supplement acts in the body when taken with certain other supplements, medicines, or foods, or when taken with certain medical conditions. Interactions may cause the dietary supplement to be more or less effective, or cause effects on the body that are not expected.
- intrinsic factor
- A protein made by the stomach that is needed to absorb vitamin B12 in the large intestine.
- megaloblastic anemia
- A disorder in which red blood cells are larger than normal, immature, and few in number, which reduces the amount of oxygen that can be carried by the blood to the body's tissues. It is caused by a deficiency in folate or vitamin B12.
- nasal
- Having to do with the nose.
- nutrient
- A chemical compound in food that is used by the body to function and maintain health. Examples of nutrients include proteins, fats, carbohydrates, vitamins, and minerals.
- oral
- By mouth; having to do with the mouth.
- peptic ulcer disease
- A sore or hole in the lining of the stomach or the first part of the small intestine, causing burning pain in the gut. Most ulcers are caused by an infection with a type of bacteria called Helicobacter pylori (H. pylori); other causes include long-term use of nonsteroidal anti-inflammatory drugs (such as aspirin and ibuprofen), alcohol, and tobacco.
- pernicious anemia
- An autoimmune disease that prevents the body from making intrinsic factor (a protein made by the stomach and needed to absorb vitamin B12 in the intestine). If left untreated, pernicious anemia causes vitamin B12 deficiency which leads to megaloblastic anemia (a disorder in which red blood cells are larger than normal, immature, and few in number, which reduces the amount of oxygen that can be carried by the blood to the body's tissues).
- proton pump inhibitor
- PPI. A drug that reduces the amount of acid made by the stomach. It is used to treat peptic ulcer and gastroesophageal reflux disease.
- red blood cell
- A cell that carries oxygen to and removes carbon dioxide from all parts of the body.
- vegetarian diet
- A diet based on foods that come from plants, such as vegetables, beans, fruits and grains. There are many types of vegetarian diets, some including foods that come from animals. A diet that also contains eggs and dairy products is called lacto-ovo vegetarian. Strict vegetarian and vegan diets include only foods made from plants. In addition, people who follow a vegan diet also may choose not to use products that come from animals such as honey, leather, fur, silk, and wool.
- vegetarianism
- The practice of avoiding all or most animal products for environmental, philosophical, and health reasons. Vegetarians (people who practice vegetarianism) eat a diet based on foods that come from plants and may include some dairy products and eggs. See: vegetarian diet.