- Taylor Leahy - Dietitian
Vitamin B-12 and Dysautonomia
Vitamin B12 is a B vitamin primarily found in animal products, and it is involved in many processes in the body. B12 is responsible for nerve and blood cell health, it helps make DNA, and it prevents a type of anemia called megaloblastic microcytic anemia. To absorb B12, your body needs both hydrochloric acid – located in the stomach – and a glycoprotein called intrinsic factor in order to be absorbed. This multi-factor absorption process means that some individuals may have lower levels of B12 than others, especially if they are missing one of these key factors1.
Vitamin B12 can be found in a wide variety of animal products – such as beef liver, clams, fish, meat, poultry, eggs, milk, and other dairy products. Some foods are fortified with B12 such as varieties of breakfast cereals, and nutritional yeast. B12 is also found in almost all multivitamins, and some supplements contain exclusively Vitamin B12. It is also available in sublingual forms (a type of supplement that dissolves under the tongue) and the vitamin can be given as an intramuscular injection at a doctor’s office1.
Although a B12 deficiency is relatively rare in the United States, there has been some evidence to suggest that a vitamin B12 deficiency can lead to worsening symptoms of postural tachycardia syndrome (POTS). According to a study done on POTS in adolescents, a vitamin B12 deficiency can lead to sympathetic nervous system baroreceptor dysfunction. This means that the receptors in the body that normally detect changes in blood pressure start malfunctioning, leading to worsening blood pressure regulation – a common symptom for individuals with POTS2. A B12 deficiency has also been linked to tiredness, weakness, weight loss, and damage to the nervous system1.
The amount of B12 you need varies depending on your age. For most adults, the RDA for B12 is 2.4mcg/day. A B12 deficiency can be identified using a non-fasting blood test3.
Think you need more B12? Try the recipes below to get more B12 in your diet.
Recipe by Eat This Much
Salmon is a delicious and easy way to add more B12 to your diet. Not only does it have high levels of B12, but it also contains heart healthy omega-3 fatty acids. Half of a fillet of salmon provides 208% of the daily value (DV) for vitamin B12. Along with B12 and omega-3s, salmon also contains a high amount of protein, around 40 grams for half a fillet4.
Pink salmon (4 fillets)
3 tbsp dijon mustard
1 dash salt
1 dash pepper
¼ cup bread crumbs
½ stick butter
1. Preheat oven to 400 degrees F. Line baking sheet with aluminum foil.
2. Place salmon skin side down on foil. Spread a thin coat of mustard over each fillet, followed by salt, pepper, bread crumbs and melted butter.
3. Bake for 15-20 minutes until salmon is tender and easily flakes with a fork.
Ahi Poke Bowl
Recipe Inspiration by Eat This Much
Tuna is another fish that packs a nutritious punch. It contains high levels of vitamin B12, protein, and other vitamins and minerals. A 3.5 ounce serving of tuna contains 453% of the DV for vitamin B12. If you can’t get fresh tuna, canned tuna also contains a good amount of vitamin B12 – 115% of the DV in one can4.
16oz fresh, raw tuna (sushi grade)
½ cup chopped green onions
1 medium chopped shallot
3 tbsp soy sauce
1 tsp rice wine vinegar
1 tbsp sesame seeds
1 cup white rice
1 sliced avocado
1 tsp sriracha hot sauce (optional)
1. Cook white rice per directions on package. Set aside to cool.
2. Pat tuna dry with town, using a sharp knife cut tuna steaks into 1/2 inch cubes. Place in large bowl.
3. Add chopped green onion and shallot to the bowl with the tuna. Add soy sauce, rice vinegar, sesame seeds, and siracha if desired. Stir with spatula until combined.
4. Assemble bowls by adding ½ cup white rice, ½ cup tuna mixture, and ¼ sliced avocado to bowl. Serve immediately.
Recipe from Damn Delicious
Beef (surprise) is another great source of B12, and besides liver and kidney, beef has the highest amount of B12 compared to any meat. For example one grilled flat iron steak provides 467% of the DV for vitamin B12, while also providing B2, B3, B6, and over 100% of the DV for selenium and zinc. To preserve the B12, grill or roast the beef instead of frying4.
2 tbsp olive oil
1 sweet onion, chopped
2 lb beef chuck, chopped into ½ inch thick cubes
Salt and pepper to taste
2 large carrots, peeled and diced
2 celery ribs, diced
3 cloves garlic, minced
8 ounces cremini mushrooms, halved
3 tbsp all-purpose flour
2 tbsp tomato paste
1.2 cup dry red wine
2 ½ cup beef stock
4 sprigs fresh thyme
2 bay leaves
1 large russet potato, peeled and cut into ½ inch chunks
2 tbsp chopped fresh parsley leaves
1. Heat olive oil in large pot over medium heat. Add chopped beef to pot along with salt and pepper to season. Cook until browned, around 6-8 minutes. Set aside.
2. Add chopped onion, carrot and celery. Cook until onions are translucent and veggies are tender, around 3-4 minutes.
3. Add onions and mushrooms, cook and stir frequently, 3-4 minutes.
4. Whisk in flour and tomato paste. Stir in wine making sure to scrape the bottom of the pot for any bits stuck to the bottom.
5. Stir in beef stock, thyme, bay leaves and steak. Bring to a boil, reduce heat and simmer for around 30 minutes, until beef is tender.
6. Add chopped potato, simmer until potatoes are tender and soup has thickened, around 20 minutes. Remove thyme and bay leaves. Stir in parsley.
7. Season with salt and pepper to taste, serve immediately.
Slow Cooker Cuban Salsa Chicken
Recipe from Eat This Much
A 3oz roasted chicken breast contains over 100% of the DV for B12, and is a good meat option for those who may not like fish or red meat. Chicken also contains other B vitamins and minerals that make it nutrient dense5. It is also considered a leaner meat compared to red meat like beef or pork, which makes it lower in saturated fat; the least healthful fat.
3 tbsp paprika
2 tsp pepper
1 cup garlic
2 tbsp salt
1 cup tomatoes
2 ½ cup salsa
1 medium onion, chopped
6 lb chicken breast
1 medium bell pepper, chopped
1. Combine all ingredients in a slow cooker. Cook on low for 7 hours. Serve over rice, use in a burrito, in tacos or a salad.
Tomato, Arugula and Goat Cheese Omelet
Recipe Inspiration by Simply Recipes
Another source of B12 are eggs and cheese. These are great B12 options for lacto-ovo vegetarians or religious groups who don’t consume large amounts of meat. One egg supplies 46% of the DV for B12, and is also a good source of riboflavin and vitamin D. Cheese and yogurt are other dairy options that contain B12 along with other vitamins and minerals. According to several studies, the body can absorb the vitamin B12 in milk and cheese better than B12 in other sources like meat and fish4.
1 tbsp butter
1 cup arugula
½ tomato, chopped
2 tbsp crumbled goat cheese
1 dash salt
1 dash pepper
1. In an 8 inch skillet, heat butter over medium-low heat
2. In a small bowl, whisk eggs until even consistency. Pour into greased pan.
3. Cook without stirring until the edges begin to set, push eggs towards the center of the pan and tilt the pan so the uncooked eggs move towards the edge. Repeat for around 6-7 minutes until eggs are somewhat set but still soft in the center.
4. Sprinkle goat cheese, tomatoes and arugula over omelet
5. Cook omelet for an additional minute.
6. Fold omelet over, and serve. If desired, top with additional goat cheese and chopped tomatoes.
1. Office of Dietary Supplements—Vitamin B12. (n.d.). Retrieved September 4, 2020, from https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/
2. Öner, T., Guven, B., Tavli, V., Mese, T., Yilmazer, M. M., & Demirpence, S. (2014). Postural orthostatic tachycardia syndrome (POTS) and vitamin B12 deficiency in adolescents. Pediatrics, 133(1), e138-142. https://doi.org/10.1542/peds.2012-3427
3. Vitamin B12 Test & Normal Levels. (n.d.). WebMD. Retrieved September 4, 2020, from https://www.webmd.com/a-to-z-guides/vitamin-b12-test
4. Top 12 Foods That Are High in Vitamin B12. (2020, February 25). Healthline. https://www.healthline.com/nutrition/vitamin-b12-foods
5. Solan, Matthew (2016, August). The A list for vitamin B-12 sources. Harvard Health. Retrieved September 4, 2020, from https://www.health.harvard.edu/staying-healthy/the-a-list-for-vitamin-b-12-sources