Looking to see if your B12 levels are normal? We often get questions like, “My B12 is 201, is that low? It’s within my clinic’s vitamin B12 normal range chart!”. Sometimes, readers ask for a specific chart listing normal B12 levels by age. Sometimes, they ask for the optimal B12 levels for females, males, or children. Let’s clear the confusion.
First, keep in mind that the total-B12 blood level test doesn’t tell us nearly as much as people think it does. This is due to a number of reasons:
- In most countries, the low range of what’s considered normal B12 blood levels is way too low (100-250), often missing desperately deficient folks. People show symptoms of B12 deficiency even in higher levels, as deficiencies begin to appear in the cerebrospinal fluid below 550. This is why Japan is treating anybody with levels lower than 500 with B12 injections. These are levels that are considered normal in the US and in most of the rest of the world. Where 200 is often accepted as a low normal value not needing intervention, Japan and England updated their suggested range with low values of 500-550, and consider anything less to be dangerous.
- The total-B12 blood test isn’t reliable. It measures the total amount of B12 in the blood, not distinguishing between active and inactive forms of B12. Inactive analogues of B12 (transcobalamin I and III) may represent as much as 90% of your blood levels. If a significant amount of your B12 is inactive, a test may show that you have normal vitamin B12 levels. This is why Japan and England updated their charts. Depending on the population, 30-50% of B12 deficiency patients (measured by true, low active-B12 levels) will have ‘normal’ total-B12 levels of 150-300.
- The total-B12 blood test doesn’t record what’s happening at the cellular level. Blood levels aren’t enough; we want to know what’s going on inside the cells and tissues. Therefore, an assessment of B12 status by serum B12 levels is insufficient.
In short, you can’t rely on the regular serum B12 level test to tell you the whole story. You can only use it as an indicator. Now, let’s show some actual charts.
Common Vitamin B12 Levels
In most countries, the observed normal values of vitamin B12 – in both children and adults, males and females – are anywhere from 100 to 1400pg/ml. These observed levels vary from one culture to another. Dr. Ralph Carmel reported that blacks have significantly higher B12 levels (especially active-B12 levels) than whites do, while the lowest levels were observed in India, Africa, and Pakistan. It can be because of racial differences in B12 metabolism, or in societal factors – most obviously nutrition. Probably both.
Let’s take Konya, Turkey, as an example, and compare it other places. We’ll examine kids and teenagers, since this is something for which we have plenty of information.
Normal B12 Levels By Age – Konya, Turkey
We’ll have a look at this study from Turkey, which measures vitamin B12 levels by age (0 to 24 year-olds). Specifically notice the median levels (the center column), and the whole range measured in each percentile group (the three columns on the right):
As you can see, the B12 level range of children and teenagers below 18 are 100-700 approximately. Now, compare it to children from other places in the world:
Clear differences.
Although, as you can see, 13-18 year-old American children have B12 levels similar to the Turkish children in Konya. If England and Japan updated their low threshold to be 500-550, does that mean that most of those children are B12 deficient? Not necessarily, because many people with traditionally normal levels of 300-400 do have high active-B12 levels, and are not deficient. The new, higher values were set as a precaution.
The New Normal Vitamin B12 Levels Chart
Again, total-B12 blood levels are largely inaccurate, and many people suffer from a deficiency even when showing what many places consider normal B12 levels. Japan and England’s new ranges are similar to the B12 levels chart suggested by Sally M. Pacholok & Jeffrey J. Stuart in their book Could It Be B12? An Epidemic of Misdiagnoses:
| B12 Status | B12 Levels (pg/ml) |
|---|---|
| Deficiency | < 550 |
| Normal | > 550 |
| Healthy nervous system & disease prevention in the elderly | > 1000 |
To quote Sally and Jeffrey:
At this time, we believe normal serum B12 levels should be greater than 550 pg/ml. For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml.
The tragedy is with all those people who are symptomatic but are in the low range of vitamin B12 normal levels (200-500). This is the grey zone, and even though these folks show clinical signs of B12 deficiency, they are never tested or treated because their B12 falls within the accepted B12 level range. This results in late diagnosis (if at all) and higher neurological injury incidence. So, don’t rely on blood tests alone.
Note: If you know you’re deficient and you want to quickly replenish your B12 stores, you can now order a B12 injection vial here. We finally made it available 🙂
Finally, how do you really test for B12 deficiency?
How to Check For Healthy B12 Levels?
There are three ways to know if you have good B12 levels or not.
Methylmalonic Acid (MMA)
Vitamin B12 helps converting methylmalonyl-CoA, one of the forms of MMA, into succinyl-CoA. When you’re deficient in B12, MMA levels increase in both your blood and urine. You may be able to find an MMA test in hospitals or private labs.
If you can’t find one, you can order a urinary MMA test from Dr. Eric Norman, founder of the test. The uMMA test is even better than the serum MMA test, because B12 deficiency patients with neurological damage excrete significantly more uMMA than those without damage. Therefore, uMMA tests can predict one’s path toward permanent neurological impairments. The test has a whopping 99% accuracy, making it confirmatory.
Keep in mind, if you have kidney disease you may get false high levels with the serum MMA test, or false low levels with the uMMA test. This is because it’s the kidneys’ job to excrete the MMA in the urine. If they don’t function correctly, MMA may accumulate in your blood. Serum MMA levels may also be high in patients with thyroid disease or bacterial overgrowth in the small intestine. It may also be high in pregnant women or infants suffering from a rare genetic disease called methylmalonic acidemia.
However, if your uMMA levels are high, you probably suffer from B12 deficiency. This is as confirmatory as a vitamin B12 deficiency test can get.
Holotranscobalamin (HoloTC)
Another useful test is the holotranscobalamin (holoTC) test, which only records the active form of B12 in the blood. Available at Viapath. This test should be a first-line diagnostic tool. Low levels may indicate B12 depletion at the cellular level.
We predict that this test will one day replace the current test, as there are often very large gaps between total B12 and active B12 in the blood.
Homocysteine
Another useful tool to help assess your true B12 status is to measure total homocysteine (tHcy). Methyl B12 is needed as a co-factor to convert homocysteine back into methionine. If you have normal B12 values, but high homocysteine levels, this may point to a deficiency or problem utilizing methyl B12. However, high homocysteine levels can also be the result of low B6, folate, renal failure or hypothyroidism.
The above tests will help you get a correct diagnosis. We also recommend to test for folate and ferritin (iron storage), and do a full blood count, because B12 and folate need each other, and optimal levels of iron are just as important as optimal B12 levels.
Rely On Symptoms
To quote NEQAS:
In the event of any discordance between clinical findings of B12 deficiency and a normal B12 laboratory result, then treatment should not be delayed. Clinical findings might include possible pernicious anaemia or neuropathy including subacute combined degeneration of the cord. We recommend storing serum for further analysis including MMA, or holotranscobalamin and intrinsic factor antibody analysis, and treating the patient immediately with parenteral B12 treatment.
The United Kingdom National Quality Assessment Scheme for Haematinic Assays
If you suspect you may be suffering from B12 deficiency, then take action now. Disregard blood vitamin B12 levels and go by symptoms alone, because the risk is too high. Wait too long, and permanent neurological damage may take place.
Remember, you can’t overdose on B12. And perhaps this is why Japan likes to give injections to any patient with levels below 500. There is zero risk to the ones who are not B12 deficient, and the potential risk of not injecting to the ones who are is huge.
The earlier you begin treatment, the more likely you are to avoid damage. Treating early may sometimes reverse symptoms completely. But, there’s a short window of opportunity for effective intervention, especially to those with neurological symptoms.
When you suffer from B12 deficiency, the myelin sheath around your nerves is being stripped off. If you show any symptoms, especially neurological, then start injecting methyl B12. These shots are the best way to rapidly replenish your stores. Do it for at least three months, because this is the life-cycle of red blood cells. Only after 90 days will you have all your bad cells expired and replaced by healthy ones.
Then, see how you’re feeling.
Best of luck.
