Many people associate vitamin B12 with their energy levels. If you’re living with systemic lupus erythematosus (SLE) or another type of lupus, you may be curious whether symptoms of lupus, such as tiredness and fatigue, could be connected to levels of vitamin B12.
One MyLupusTeam member asked, “I found out my vitamin B12 was a little low. Has anyone else had this with lupus?”
While researchers don’t know if lupus can directly cause low vitamin B12 — also known as a vitamin B12 deficiency — some medications and conditions associated with lupus may make it more likely.
Vitamin B12 — also called cobalamin — is an essential nutrient that helps your body function properly. It’s important for maintaining healthy red blood cells (RBCs) and nerve cells. Your body can’t make vitamin B12, which means you have to get all your body requires through food or vitamin supplements. The recommended amount of vitamin B12 is 2.4 micrograms daily. Most Americans get enough vitamin B12 in their diet and don’t need vitamin supplements.
Vitamin B12 is naturally found in foods of animal origin, such as meat, fish, eggs, and dairy products. This vitamin is often added to foods like breakfast cereal, bread, or nutritional yeast — known as fortified foods. These fortified foods are essential for people with plant-based diets to maintain adequate vitamin levels without B12 supplements.
If you have a vitamin B12 deficiency, it means you don’t have enough B12 in your body. People with less than 160 picograms per milliliter (pg/mL) of B12 in their blood might have vitamin B12 deficiency. To confirm this diagnosis, however, you will need to get an additional blood test that looks for a substance called methylmalonic acid.
You may develop a vitamin B12 deficiency if you don’t get enough vitamin B12 from food or supplements, or if your body has trouble absorbing it from your digestive system.
Some people may be more likely to have low vitamin B12. Risk factors for a vitamin B12 deficiency include:
The symptoms of low vitamin B12 can differ from person to person. Some people don’t have any signs of a vitamin deficiency, while others have more severe symptoms. “I’ve been diagnosed with a vitamin B12 and vitamin D deficiency. So, I’m feeling more drained than usual,” explained a MyLupusTeam member.
Symptoms of low vitamin B12 may include:
Low vitamin B12 can affect your risk of developing some medical conditions. Vitamin B12 is extremely important for making RBCs and keeping the nervous system functioning. To stay healthy, it’s important to get enough vitamin B12 from your diet or with the help of supplements.
Vitamin B12 deficiency can cause anemia — a condition when you don’t have enough healthy RBCs. About half of people with lupus are already affected by anemia. Vitamin B12 and another B vitamin, folate, are needed to make RBCs that can efficiently carry oxygen to your body’s tissues. Without these vitamins, your body makes RBCs that are the wrong size, which affects their ability to carry oxygen and causes anemia.
Vitamin B12 deficiency may affect your risk of cardiovascular (heart) disease. People with lupus have about twice the risk of developing heart disease as the general population. Vitamin B12 helps manage levels of the protein homocysteine. People who have low vitamin B12 can then have higher homocysteine levels. Researchers have found links between high levels of homocysteine and increased risk of heart disease and stroke. Although research shows that taking vitamin B12 supplements can reduce homocysteine levels, there isn’t consistent evidence to show supplementation reduces the risk of heart disease.
Researchers have found that vitamin B12 levels are lower in people with SLE. The reason for this isn’t clear, but some of the medical conditions that increase the risk of vitamin B12 deficiency are associated with lupus.
Sjögren’s disease is an autoimmune condition that causes dry eyes and dry mouth. It happens when the immune system mistakenly attacks the glands that make tears and saliva. Between 14 percent and 18 percent of people with SLE also have Sjögren’s disease. Decreased saliva production could make it harder to absorb vitamin B12 from the digestive tract.
Between 8 percent and 40 percent of people with active SLE have complications with their digestive system, including with their mouth, esophagus, intestines, liver, pancreas, and gallbladder. Inflammation in your digestive system can decrease vitamin B12 absorption.
People with lupus often experience gastrointestinal reflux disease (GERD) — also known as heartburn. GERD can be treated with medications that block stomach acid production, like proton pump inhibitors and histamine blockers. These medications can make it harder for you to absorb vitamin B12. This is because your stomach acid helps separate vitamin B12 from food.
People with SLE may have an increased risk of developing type 2 diabetes, a disease that causes your glucose (blood sugar) levels to be too high. A possible side effect of metformin — a widely prescribed medication for diabetes — is decreased vitamin B12 level. In one study of 1,111 people living with type 2 diabetes, 22.2 percent developed a vitamin B12 deficiency after taking metformin for at least six months.
There is no evidence that lupus can cause high vitamin B12 levels. In fact, high vitamin B12 levels are very rare. Your body doesn’t store extra vitamin B12, so even high doses of vitamin B12 are considered safe.
Talk to your healthcare provider if you’re concerned about a vitamin B12 deficiency. They can use a blood test to check your vitamin B12 levels. Your healthcare provider might also check for signs of anemia with a complete blood count.
If your vitamin B12 is low, your doctor may prescribe B12 or a laboratory-made type of vitamin B12 called cyanocobalamin. Vitamin B12 comes in different forms, such as:
You can prevent low B12 by eating animal products, like meat and dairy, and/or fortified foods. You can help prevent damage to your digestive tract by avoiding alcohol or drinking it in moderation, which may help your body absorb more vitamin B12.
Never start taking vitamin supplements, including vitamin B12, without checking with your healthcare provider first. They will consider any possible interactions with your current medications or existing health conditions to provide you with the best guidance.
MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 234,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.
Do you have low vitamin B12? What symptoms do you notice? Share your experience in the comments below, or start a conversation by posting on your Activities page.
A MyLupusTeam Member
My go to for the last ten years for a littlt extra energy has been 5hr Energy. It's B-6 and B-12 with one cup of coffee's worth of caffine. It helps me get out of my chair when I need to.