Functional Friday: Do I need Vitamin B12 and Folate?

I recently completed my functional blood chemistry certification and want to make the art more accessible to you all. Blood chemistry is a great way to discover what your body needs to be balanced, and with a few tricks and tips, you will know exactly what you need to do to support your bodyโ€™s optimal health.

Every Friday, I will be sharing a new marker and what you can do to bring it into balance through primarily food and sometimes supplementation. Remember- food is medicine ๐Ÿ˜‡

Today we will be starting with Vitamin B12 and B9, which many people are deficient in, especially if they have a history of being plant based or take certain medications like PPIs, or have low stomach acid.

B12 and folate are critical for methylation, DNA synthesis, red blood cell production, the health of our nervous system, and energy production in the body.

A good way to determine a vitamin B12 and/or folate need is to look at your Complete Blood Count (CBC) which most people have run every year by their doctors. The MCV is a Good Marker to help determine this.

The MCV stands for mean corpuscular volume, and measures how big red blood cells are. This marker is very dependent on nutrient status and is influenced by deficiencies.

While the lab range for MCV is a bit broader, the functional range for the MCV is 83-91! In an upcoming post, I will be discussing the implications of an MCV that is too low!

In order for red blood cells to be produced, stem cells in the bone marrow need to grow and split. The red blood cells are composed of a cytoplasm and a nucleus, Which need different substrates to mature. Once the cytoplasm and nucleus have reached a certain size, the cell will split.

The maturation of the nucleus is dependent on B12 and B9 which are needed to synthesize DNA. If you are deficient in these nutrients, your nucleus cannot mature and the cell will not split.

The growth of the cytoplasm is dependent on protein, the body will always find a way to supply amino acids for its growth. In other words, if you are deficient in B9 or B12, the cytoplasm will be the size of that of 2 cells, but the nucleus is only enough for one. The cell will not split, which then results in a larger than average red blood cell volume.

On this patients lab work, you can see that the MCV is elevated which means that the volume of the red blood cells is larger than optimal. This type of red blood cell is called a macroblast.

The MCV is one of the easiest way to determine if a patient has a B12/B9 need because serum levels of the vitamins can sometimes be elevated even though the client has an intracellular deficiency. However, if blood levels or B12 are below 1000, it can be concluded that the patient is deficient. Serum folate levels are a good way to assess B9 status!

If one wanted to assess B12 levels more directly, it would be best to measure methylmalonic acid, which is a metabolite of B12 produced when our mitochondria utilize B12!

What can I do?

The first thing you can do to support your B12 and folate levels is to increase foods rich in these nutrients. Most people are able to absorb them from food if they have sufficient stomach acid (more about that later).

B12 is found primarily in animal foods, especially beef and beef liver, but also in eggs, seafood, algae, chlorella, seaweed, some cheeses, and bee pollen. As you can see, vegans and vegetarians donโ€™t have much chance and to ensure optimal B12 levels, I donโ€™t think itโ€™s wise to abstain from animal products.

B9 can be obtained from a plant based diet, and is rich in leafy greens, avocado, nuts, cruciferous veggies; and beans. Beef and beef liver are also rich in folate. If one decides to supplement with folate, stay clear of folic acid! Folic acid is the synthetic form of the vitamin and actually blocks our bodies folate receptors, so that the real deal cannot do its job.

Since both vitamins are needed for the proper development of our cells nuclei, itโ€™s best to consume them together. Below are some yummy ideas you can incorporate into your weekly meal plan to help fill up your stores. Itโ€™s important to note that B vitamins are water soluble, meaning that your body excretes any excess, and that they need to be replenished ideally daily.

After deliberately consuming more b12 and b9, itโ€™s a good idea to testest 3-6 months later, since it takes about 3 months for a red blood cell to mature and changes to be documented.

Some breakfast ideas include:

Baked avocado eggs with sautรฉed greens and ghee ๐Ÿฅฌ

Egg pancakes work guacamole and bacon ๐Ÿฅ“

Omelette with spinach, asparagus and avocado slices ๐Ÿฅ‘

Grain-free breads topped with liverwurst and soft-boiled eggs with buttered spinach ๐Ÿณ

My go-to breakfast bowl ๐Ÿฒ


Fat fueled salad with canned salmon ๐Ÿ 

Steak and mashed cauliflower with butter or avocado ๐Ÿฅฉ

Burgers with a lettuce wrap and curried broccoli ๐Ÿฅฆ

Salmon and egg salad on nut bread ๐Ÿž

Veggies with spinach dressing and roasted fish or chicken ๐Ÿ—

Salmon spinach noodle bowl ๐Ÿฒ

Bolognese Sauce with a Pasta Swap ๐Ÿ

Ancestral Taco Bowl ๐ŸŒฎ


I always like to make sure that diet is rich in nutrients, but sometimes, we need to help out with supplements. B12 is absorbed with the help of intrinsic factor in the stomach and small intestine. Intrinsic factor is produced in the stomach by parietal cells, which live in the mucosal lining.

Sometimes, parietal cells are attacked and cannot produce intrinsic factor, this is a condition known as pernicious anemia. If you have antibodies against parietal cells or intrinsic factor, you can eat all the B12 you want but your body cannot absorb it. Thatโ€™s the case with me, so I have to be injected with B12. This condition is pretty rare though, and many people are very responsive to diet and oral supplements.

Other reasons diet alone may not suffice include methylation problems or low stomach acid, since the stomach needs to be acidic enough to cleave the nutrients off of the food.

The best way to supplement B12/9 is sublingually with bioavailable forms like methylcobalamin/hydroxycobalamin (both B12) and methylfolate/folinic acid (B9). ๏ฟผ

Stay clear of cyanocobalamin and folic acid which are synthetic forms of the body that can block receptor sites and methylation pathways.

My family takes lozenges from Biotics called B 12 2000 which can be taken under the tongue twice a day until levels are restored and then as needed. B vitamins can boost energy so donโ€™t take them too late in the day!

The lozenges are great because the sublingual delivery is not dependent on the stomachs ability to cleave off the vitamins and is a balance of B6/B9/B12!

Alternatively, you could also supplement with liver capsules, which will give you not only the B vitamins, but other nutrients like zinc, which can help support healthy stomach acid production, As well as vitamin A, iron, and phosphorus.I use Heart and Soil capsules!

I hope you enjoyed this little series, and I will get back to you next week about why your MCV maybe too low.

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