I have received countless emails from Hashimoto’s readers who have started feeling so much better after digging at their own root cause, making adjustments to their diets and lifestyles, and finding supplements that restore the nutrient depletions which are so common in those with thyroid disorders.
One of the nutrient deficiencies that people with Hashimoto’s are particularly prone to is vitamin B12. In fact, in my survey of 2232 people with Hashimoto’s, 33 percent reported that they had tested as deficient in this all-important vitamin, and 76 percent said they felt better after taking a B12 supplement. (Please note: Not everyone in this survey had been tested for a B12 deficiency!)
Why do people with Hashimoto’s have so many nutrient depletions? It really is a vicious cycle… but addressing depletions, including those in B12, can be a game-changer.
Read on to learn about:
- The importance of B12 for the thyroid and the body
- Why people with Hashimoto’s are prone to developing a B12 deficiency (and other nutrient depletions)
- Lab testing for B12 deficiency
- How to boost your B12 levels
The Importance of B12
Vitamin B12 is an essential water-soluble vitamin that is commonly found in animal proteins such as fish, shellfish, meat, eggs, and dairy products. The recommended dietary allowance for adults is 2.4 mcg per day (although women who are pregnant or breastfeeding may require more, and this can be discussed with one’s healthcare practitioner).
B12 is required for cognitive function, protein synthesis, cell reproduction, and normal growth.
Vitamin B12 is also an important cofactor for energy production, and plays a role in immune system health and healthy homocysteine metabolism. Homocysteine is a naturally-occurring amino acid found in blood plasma. High levels of homocysteine in the blood are believed to increase one’s risk of heart disease, stroke, Alzheimer’s disease, and osteoporosis.
Symptoms of B12 deficiency include:
- Fatigue
- Low mood or personality/mood changes
- Irritability
- Lethargy
- Headaches
- Palpitations
- Loss of appetite
- Pale yellow tint to the skin
- A feeling of pins and needles (paraesthesia)
- Poor memory
- Impaired cognitive performance
- Depression
- Weakness
- Impaired digestion
- Inflammation
- Gastrointestinal lesions
- Neurological damage
Since B12 is primarily found in animal products, any change in one’s diet that leads to a decrease in the consumption of such products — such as a vegan, vegetarian, or low-fat diet — can increase the chance of a person developing a B12 deficiency.
(For this reason, taking a vitamin B12 supplement is essential for vegans, and may be particularly helpful for those with low stomach acid, until the condition is corrected. More on low stomach acid in a minute.)
Why Are People with Hashimoto’s More Likely to Have B12 Deficiency?
Individuals with autoimmune thyroid disease also have a high prevalence of vitamin B12 deficiency. In fact, one study found that 28 percent of individuals with autoimmune thyroid disease (in a sample pool of 115 patients), had a B12 deficiency.
Some of the most common medications prescribed to people with Hashimoto’s are notorious for both altering one’s gut flora and depleting the body of nutrients. These include medications for acid reflux, synthetic estrogens, progesterone, (such as the birth control pill), and antibiotics.
Altered gut flora, or dysbiosis, can also reduce or prevent the extraction of nutrients (such as B12) from food.
Hypothyroidism itself can lead to poor extraction of minerals and vitamins from our food sources. Since thyroid hormones determine our metabolism throughout the entire body, including the digestive tract, a lack of sufficient thyroid hormones makes nutrient extraction more difficult and less efficient, leading to nutrient deficiencies.
Other factors related to Hashimoto’s which can lead to a B12 deficiency include:
- Suboptimal functioning of the digestive system
- Pernicious anemia
- H. pylori infections
Suboptimal Digestion
For people with thyroid disorders, a B12 deficiency is often a result of damage to the digestive tract that prevents the absorption of vital nutrients.
Most people with thyroid conditions will have low stomach acid (hydrochloric acid or HCl), which is necessary to break down digested proteins and food. This condition is known as “achlorhydria.”
They may also present with a lack of digestive enzymes and may not be able to properly extract nutrients from their foods. They could eat large amounts of steak day after day, but if they don’t have enough stomach acid on board, they’re not going to be able to get enough B12 (or other nutrients) out of that steak. Symptoms may include gas, heartburn, bloating, and heaviness in the stomach after eating a protein-rich meal. (Read more about digestive enzymes and Hashimoto’s.)
As B12 is released for absorption with the help of hydrochloric acid (stomach acid) and protease, an enzyme in the stomach, low stomach acid can result in severe deficiencies for many people who have hypothyroidism.
Supplementing with Betaine with Pepsin can help improve one’s digestion, and you can read more about that here.
Another digestion-related risk factor for B12 deficiency is small intestinal bacterial overgrowth, commonly known as SIBO, which may be present in up to 50 percent of people with Hashimoto’s. The bacteria “eat” this vitamin and produce a molecule that is similar to the structure of B12 — this molecule competes with vitamin B12 receptors, resulting in decreased absorption of B12.
Pernicious Anemia and H. Pylori Infections
Hashimoto’s often co-occurs with other autoimmune conditions. One of these conditions is specifically tied to B12 deficiency and is known as pernicious anemia. In pernicious anemia, the immune system attacks a protein called intrinsic factor, which is required for B12 absorption, and it results in low B12 levels.
It’s important to note that Hashimoto’s, low B12 and pernicious anemia can be caused by an H. pylori infection, and addressing this infection can potentially help and even resolve all three. H. pylori triggers auto-antibody production through a mechanism called molecular mimicry, which occurs when a foreign substance mimics the structure of a molecule naturally present in the body.
Autoantibody production leads to the immune system’s attack on intrinsic factor. Additionally, H. pylori destroys the gastric parietal cells that produce intrinsic factor proteins. Having a history of an H. pylori infection can make an individual more susceptible to developing pernicious anemia and B12 deficiency.
The good news is that H. pylori can be reversed! If you suspect this is the root cause of your B12 deficiency, I recommend ordering a GI-MAP test to confirm this is indeed the case. Please note, stool antigen tests are more sensitive for H. pylori, while conventionally-ordered breath tests often miss this infection. If you do test positive for this infection, consider an herbal H. pylori protocol to eradicate it. (Learn more about treating H. pylori.)
Stages of B12 Deficiency
B12 deficiency takes a long time, sometimes years to decades, to manifest. As it develops, not only do B12 levels decrease, but other metabolites or biomarkers of B12 — such as holotranscobalamin, methylmalonic acid (MMA), and homocysteine — are affected as well. How B12 and each of the biomarkers are affected, depends on which stage of B12 deficiency the individual is in. There are four stages of B12 deficiency.
In the first and second stages, lab testing will show declining levels of vitamin B12 and holotranscobalamin (transporter of B12), while MMA and homocysteine levels will remain within or around the normal range.
In the third stage of B12 deficiency, MMA and homocysteine will be elevated (having elevated levels of homocysteine is called hyperhomocysteinemia).
In the fourth and last stage of B12 deficiency, clinical manifestations are experienced by the individual — including macrocytic anemia (a form of anemia in which red blood cells are larger than usual, hence the term “macro”) and, if left untreated, irreversible neurological damage.
The more progressed the deficiency is, the more detrimental it may be to an individual with Hashimoto’s. For example, research has found that hypothyroidism is associated with coronary artery disease due to elevated homocysteine levels being a common cofactor.
Do You Have Low Levels of B12?
If you have a thyroid condition and/or any of the risk factors of B12 deficiency as outlined above, there is a very good chance that you are not properly absorbing B12, even if you eat a diet rich in animal proteins, so it is important to get tested if you suspect a deficiency.
Normal serum vitamin B12 levels range between 200-900 pg/mL, with concentrations less than 200 pg/mL usually resulting in deficiency.
It’s important to be aware, however, that lab tests for measuring B12 levels do not always tell the whole story.
Established “low” ranges are often too low, and researchers have found that “normal-low” B12 levels have been associated with neurological symptoms such as difficulty balancing, memory lapses, depression, mania, fatigue, and even psychosis!
B12 is a water-soluble vitamin, so any amount that is not used by the body will simply be eliminated. However, an elevation of B12 in one’s serum can be tied to the MTHFR gene variation, as those with the MTHFR gene variation may be unable to properly use non-methylated B12. In such cases, someone with the MTHFR gene variation may seem to have elevated levels of B12 (as well as elevated levels of homocysteine), but will actually have low levels of B12 in the form that their body can utilize.
To find out if you have low levels of B12, you can ask your health care provider for the B12 (or cobalamin) test. This test can be ordered individually or added to a blood panel. Your levels may be low, even if all other screening tests for iron/ferritin and anemia come out within the reference range.
Alternatively, you can self-order the B12 test via Ulta Lab Tests. When you receive your test results, it’s important to note that optimal B12 levels should be between 700-900 pg/mL. As mentioned above, most labs will not flag B12 levels unless they are under 200 pg/mL.
Additionally, testing for biomarkers such as methylmalonic acid (MMA), may provide valuable insight and help catch B12 deficiency in the earlier stages — you can also self-order an MMA lab test via Ulta Lab Tests.
Please note: The consumption of bread and cereals fortified with folic acid (synthetic folate) may mask a B12 deficiency on standard lab tests.
What do elevated levels of B12 mean? Elevated B12 levels can be a marker for liver diseases, kidney diseases, and blood diseases, including different types of leukemia (chronic myelogenous leukemia and promyelocytic leukemia). However, most cases are due to excess supplementation or due to a functional deficiency, where the person is actually deficient in B12.
How to Take B12
If your levels of B12 are below the optimal range, I highly recommend optimizing your B12 levels today. There are a few options for supplementation, including tablets, sublingual (under the tongue) liquids, and injections. I prefer the sublingual route, as it is highly absorbable, making it a more convenient and effective option for those with pernicious anemia (this condition can create issues with absorbing B12 orally).
Sublingual doses of 5 mg (5000 mcg) of B12, daily for ten days, then 5 mg once per week for four weeks, then 5 mg monthly, have been found to be effective in restoring B12 levels in those with a deficiency.
Pure Encapsulations B12 comes in a convenient liquid form that can be administered sublingually for optimal absorption. The active form of B12 in this formulation is methylated and, thus, highly bioavailable. It has also been shown to support neurological function, nerve cell health, healthy cognitive and nerve function, memory, and emotional well-being.
Please note, there are different forms of B12 that may be beneficial for individuals with different Single Nucleotide Polymorphisms or SNPs (genetic variations). While I usually recommend the methylated version of B12 (such as the one by Pure Encapsulations), individuals with the COMT genetic SNP may benefit more from the hydroxy- or adeno- forms of B12.
If you have tested your genes in the past, I recommend checking out Adenosyl/Hydroxy B12 from Pure Encapsulations, as well as their PureGenomics line. (If you are interested in testing your genes, consider ordering a genetic saliva test kit from 23andme.com, or from your practitioner. You can then upload your results to geneticgenie.org to uncover any genetic variations you may have, so that you can determine the form of B12 that would work best for you.)
The Takeaway
Individuals with Hashimoto’s are more susceptible to nutrient deficiencies, particularly that of vitamin B12. Testing for B12 levels can be a proactive way to prevent a deficiency. However, if you do find yourself deficient in vitamin B12, there is something you can do to improve it!
I recommend digging into root cause factors such as not consuming enough dietary sources of this vitamin, as well as underlying issues that may be impairing the absorption of B12 (such as H. pylori infections and low stomach acid). If you find it difficult to get enough vitamin B12 through diet alone, consider adding a supplement.
If you are low in B12, you may also want to look into whether you may have other nutrient depletions as well, including depletions in iron, vitamin A, vitamin E, the B vitamins, potassium, and iodine, which are all required for proper thyroid function. (Other nutrients, although not directly involved in thyroid function, are also essential for optimal immune system, gut, liver, and adrenal function.)
Most people who are diagnosed with Hashimoto’s will also present with low levels of selenium, vitamin E, and glutathione, as well as zinc and ferritin (the iron storage protein).
You can read more about nutrient depletions in my articles The 7 Most Common Nutrient Deficiencies in Hashimoto’s and How Nutrient Extraction Affects Everyone with Hashimoto’s.
My book, Hashimoto’s Protocol, goes further in depth on strategies for getting to the root cause of your thyroid disorder and addressing nutrient deficiencies so you can start feeling better.
I wish you well on your journey to health!
P.S. You can also download a free Thyroid Diet Guide, 10 thyroid-friendly recipes, and the Nutrient Depletions and Digestion chapter for free by signing up for our newsletter. You will also receive occasional updates about new research, resources, giveaways, and helpful information.
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References
- Vitamin B12. Therapeutic Research Center website. https://naturalmedicines-therapeuticresearch-com.mwu.idm.oclc.org/databases/food,-herbs-supplements/professional.aspx?productid=926. Updated March 7, 2018. Accessed March 22, 2018.
- Zaidel O, Lin HC. Uninvited guests: the impact of small intestinal bacterial overgrowth on nutritional status. Pract Gastroenterol. 2003;27:27–34.
- Ness-Abramof R, Nabriski DA, Braverman LE, Shilo L, Weiss E, Reshef T, et al. Prevalence and evaluation of B12 deficiency in patients with autoimmune thyroid disease. Am J Med Sci. 2006 Sep;332(3):119-22.
- Catargi B, Parrot-Roulaud F, Cochet C, Ducassou D, Roger P, Tabarin A. Homocysteine, hypothyroidism, and effect of thyroid hormone replacement. Thyroid. 1999;9(12):1163-1166. doi:10.1089/thy.1999.9.1163
- Antinoro L. Getting Enough Vitamin B12. Harvard Health Publishing website. https://www.health.harvard.edu/vitamins-and…/getting-enough-vitamin-b12. Published April 2015.
- Vitamin B12 or folate deficiency anemia. NHS website. https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/symptoms/. Updated May 23 2019. Accessed April 30, 2021.
- Cuskelly GJ, Mooney KM, Young IS. Folate and vitamin B12: friendly or enemy nutrients for the elderly. Proc Nutr Soc. 2007;66(4):548-558. doi:10.1017/S0029665107005873.
- Gowdappa HB, Mahesh M, Murthy KV, Narahari MG. Helicobacter pylori associated vitamin B12 deficiency, pernicious anaemia and subacute combined degeneration of the spinal cord. BMJ Case Rep. 2013;2013:bcr2013200380. Published 2013 Sep 30. doi:10.1136/bcr-2013-200380
- Desai HG, Gupte PA. Helicobacter pylori link to pernicious anaemia. J Assoc Physicians India. 2007;55:857-859.
- Al Aisari F, Al-Hashmi H, Mula-Abed WA. Comparison between Serum Holotranscobalamin and Total Vitamin B12 as Indicators of Vitamin B12 Status. Oman Med J. 2010;25(1):9-12. doi:10.5001/omj.2010.3
- Nexo E, Hoffmann-Lücke E. Holotranscobalamin, a marker of vitamin B-12 status: analytical aspects and clinical utility. Am J Clin Nutr. 2011;94(1):359S-365S. doi:10.3945/ajcn.111.013458
- Ermens AA, Vlasveld LT, Lindemans J. Significance of elevated cobalamin (vitamin B12) levels in blood. Clin Biochem. 2003;36(8):585-590. doi:10.1016/j.clinbiochem.2003.08.004
- E. Andrès, K. Serraj, J. Zhu, A.J.M. Vermorken, The pathophysiology of elevated vitamin B12 in clinical practice, QJM: An International Journal of Medicine. 2013;106(6): 505–515. doi: 10.1093/qjmed/hct051
Note: Originally published in February 2015, this article has been revised and updated for accuracy and thoroughness.
B12 supplements generally come in either of two forms, cyanocobalamin or methylcobalamin. The cyano- type is generally cheaper and easier to find, but I’ve read elsewhere that the methyl- type is nutritionally superior, kind of like the difference between artificial folic acid, commonly found in highly processed foods like bread, and the natural folate that is found in real food. I don’t know how important the difference is, but I always buy supplements that list the methylcobalamin form of B12 on the label.
Greg – thank you for sharing what has worked for you!;) I hope you keep me posted on your progress here.
Can you please help me. I am 29 years old. I feel very sick. My hair is falling out in clumps. I had to drop out of college due to being so sick. After comparing my lab ranges to optimal ranges some are very low. Last “functional” doctor told me everything was normal. But I do not feel normal. I have spent so much money seeking answers. But do not know where to turn now. This full panel was done in September. What do I do?
After reading the article I now know my B12 is low…And have developed dangerous histamine intolerance/food intolerance to nearly all foods since then…Please help…
THYROID
T4, TOTAL (7.9) 4.5 – 12.5 mcg/dL =Functional Lower End
THYROID STIM. HORMONE (1.60) 0.34 – 5.60 mIU/L = Low
ANTI-THYROGLOBULIN AB. (0.1) 0.0 – 5.0 IU/mL
T3, FREE (2.9) 2.39 – 6.79 pg/mL = Low End
T3, TOTAL (0.69 L) 0.8 – 2.0 ng/mL = Low
T4, FREE (0.88) 0.58 – 1.64 ng/dL = Low
T3, REVERSE, SERUM (20) 8 – 25 ng/dL *2 = Low?
THYROID PEROXIDASE AB. (1) 0 – 60.0 U/mL
VITAMIN B12, SERUM (612.0) 200 – 1100 pg/mL = Low
My results are in parentheses. The lab ranges are beside them.
Thank you,
Jen
Jen – thank you for reaching out! <3 I am so sorry to hear about your struggles. Don't give up! Hashimoto’s often is a combination of food sensitivities, nutrient deficiencies, adrenal issues, gut issues as well as an impaired ability to get rid of toxins. Any of those things would prevent a person from getting better.
Hashimoto's is very much an individual condition. While there are root cause commonalities, each person will have their own or in some cases, more than one root cause. You will have to start with the simplest modifications, by removing triggers, followed by repairing the other broken systems to restore equilibrium, allowing the body to rebuild itself. You will need to dig down to why the immune system is imbalanced in the first place and this will tell you how you begin to finally feel better, reduce your thyroid antibodies and even take your condition into remission.
You will have to create your own health timeline. Look back at your overall history as far back as you can remember. Look for infections, periods of severe stress, the use of medications (especially antibiotics, antacids, and oral contraceptives), accidents, and exposure to toxins. These are events that may have contributed to Hashimoto's. Once you do, you will know what types of changes you need to implement to make yourself feel better.
If you need further support, please check out the list of lab tests inside the “Testing” chapter of my book, Hashimoto’s Root Cause. I also offers a 12-week program, Hashimoto's Self Management Program. I hope this helps, please keep me posted on your progress here! Here are some links to articles and resources I hope you find helpful.
BUILDING YOUR OWN HEALTH TIMELINE
https://thyroidpharmacist.com/sample-health-timeline/
TOP 10 THYROID TESTS FOR DIAGNOSIS
https://thyroidpharmacist.com/articles/top-6-thyroid-tests/
Hashimoto’s Self-Management Program
https://thyroidpharmacist.com/enroll-in-hashimotos-program/
And here is the link to my book in case you haven’t read it already:
Hashimoto’s Root Cause
http://amzn.to/2DoeC80
Hashimoto’s Protocol (this is my latest book)
http://amzn.to/2B5J1mq
Izabella, I thought if you have a P.A or a B12 deficiency then the only treatment that works are injections?
Christian – thank you for reaching out. <3 Some people may have a difficult time absorbing B12 orally, it works best when taken as an injection or as a sublingual (under the tongue) drop. Here is an article you might find interesting: https://thyroidpharmacist.com/articles/strategies-overcome-hashimotos-fatigue/
I am really confused as to which kind of b12 is best if you have pA. I am currently doing injections of cyanocolbalin. Would methocolbaliman work just as well?
Judi – thank you for reaching out. ❤️ Hashimoto’s often co-occurs with other autoimmune conditions. One of these conditions is specifically tied to B12 deficiency and is known as pernicious anemia. In some cases, pernicious anemia, the immune system attacks intrinsic factor, a protein in our stomach that is required for B12 absorption. Low levels of hydrochloric acid (low stomach acid) and leaky gut, commonly found in those with Hashimoto’s, put people at risk for B12 deficiency because we need stomach acid to extract B12 and iron from our protein-containing foods. Many people have been able to improve their levels of B12 through improving their stomach acid, working on their leaky gut, and getting rid of gut infections Removing common trigger foods such as gluten, grain, dairy and soy can go a long way to improving your gut health and ability to absorb your B12 again. Focusing on improving your stomach acid can also help in absorbing B12. While thiamine can help with increasing stomach acid naturally, betaine with pepsin is another supplement that can be used to raise stomach acid levels. Betaine HCl and pepsin are naturally occurring components of the gastric juices that break down protein bonds in our food to make nutrients and amino acids more bioavailable. They are especially important for proper absorption of protein, calcium, B12, and iron.
Here is an article with more information:
Hashimoto’s and Low Stomach Acid
https://thyroidpharmacist.com/articles/hashimotos-and-low-stomach-acid/
Does this information apply if I don’t have a thyroid? Had it removed in 1979.
Cindy – thank you for reaching out! Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target.
We need to rebalance the immune system to prevent this. Sometimes the autoimmunity can be reversed as well! The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition. Here are the links to my books:
Hashimoto’s Root Cause
http://amzn.to/2DoeC80
Hashimoto’s Protocol
http://amzn.to/2B5J1mq
Hi Dr. Wentz! I tried Betaine HCL (Thorne) for a few days, just one per day. Somehow, the capsules caused a 2nd degree burn at the back of my throat that formed a large blister. Ugh! Do you know if digestive bitters could be used instead of Betaine HCL to help low stomach acid?
Thank you!
Jen – thank you for sharing your journey! I am so sorry you had this issue with the Betaine. It would not be legal or appropriate for me to give any type of medical advice here. I highly recommend that you work with a functional medicine clinician to be a part of your own health care team. It’s an entire medical specialty dedicated to finding and treating underlying root causes and prevent serious chronic disease rather than treating individual disease symptoms. Here are some resources you may find helpful.
FUNCTIONAL MEDICINE APPROACH TO THE THYROID
https://thyroidpharmacist.com/articles/functional-medicine-approach-to-the-thyroid
CLINICIAN DATABASE
https://www.thyroidpharmacistconsulting.com/clinician-database.html
FIND A FUNCTIONAL MEDICINE CLINICIAN
https://ifm.org/find-a-practitioner/
Hi I am 29 and diagnosed with Hashimoto a few weeks ago. I am currently reading your protocol book, on the liver support protocol. I have a few questions with regards to supplements and when I can take them, as much as I would love to purchasing all the suggested supplements I cannot afford to, is there one or two in particular that combines some together? And can you take them at any point of the day with one another? And I also have a sweet tooth when it comes to the evening I’m finding it so hard to not eat something.. are things like sorbet ice cream, or yogurt and nuts of an evening a no go?
Thank you so much for all your help so far
Olivia
Olivia – thank you so much for reaching out! I am so happy you are finding my book helpful and I’m looking forward to seeing your progress here. For information pertaining to the supplements please email my team at info@thyroidpharmacist.com and they will be happy to help you! 🙂
Great article! In my experience with Hashimoto’s and low B12 the only thing that seemed to help me was drinking kefir. I was lucky to be able to handle dairy products and it helped me quite a bit. I now drink kefir everyday and have put my Hashimoto’s into remission- yea! Thank you for this wonderful website and all the research you do. Your book “Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause” helped me realize that I could heal. I have journaled my experience of healing my thyroid on my website: http://storyofmyhealth.com/index.php/2018/03/19/finding-remission-hashimotos-thyroiditis/
HI I have thyroid alteration i am not taking any medicine right now before 6 months i got high tsh level and low iron level. I started ayurvedic medicine and took iron sucrose injections. That after taking 3 month medicine thyroid became normal. But totake when i checked b12, d3 and TFT, b12 and d3 are low and only tsh is high t3 and t4 are normal so what i have to do?
Harsh – thank you so much for reaching out. Please, understand that due to liability issues, I am unable to answer specific medical questions here. I recommend that you discuss this with your practitioner. The advice of a skilled medical practitioner who is familiar with your health history is always best. <3
Hello. I am 71 and have been dealing with Hashimoto’s for about two decades. I cannot seem to take any form of B12 because the tip of my tongue becomes very sore. I have been taking Armour but suddenly, when refilling the prescription, my thyroid began to swell every time I took it. I had to cut back more than 50%. Cutting back helped get rid of some symptoms like racing & flip-flopping heart beats. Dr. then did an ultra sound but wasn’t too concerned about results. My biggest problem is that I can’t sleep at night more than about 3 1/2 – 4 hrs. max for all these years, and that’s with sleeping pills.
Do you have any idea why I can’t take B12? Other vitamins give me headaches so I must attempt to get through foods. Sensitive to a lot of foods & meds.
Thank you.
Judy – thank you for reaching out and sharing your journey. Not all supplements are created equally and you may be using a brand that contains fillers and additional ingredients that could be causing a reaction. <3 Did you know that reactive foods trigger an inflammatory response in the GI tract, leading to malabsorption of nutrients (gluten sensitivity, in particular, has been implicated in causing a Selenium deficiency, a well-known risk factor for Hashimoto's), and can also produce intestinal permeability whenever they are eaten? Most people will see a dramatic reduction in gut symptoms, brain symptoms, skin breakouts, and pain by eliminating the foods they are sensitive to. Some will also see a significant reduction in thyroid antibodies! An additional subset of people will actually be able to get their Hashimoto's into complete remission just by getting off the foods they react to, normalizing their thyroid antibodies, and some even normalizing their thyroid function!
I have created my own supplements brand, which is named Rootcology. Rootcology’s mission is to provide safe and effective supplement solutions for people struggling with autoimmune thyroid conditions. These supplements are composed of high-quality premium ingredients which are gluten, dairy, soy, pesticide, and toxin-free and undergo third-party testing to ensure that the ingredients on the label match the ingredients inside each bottle. Here is a link to the website: https://www.rootcology.com/collections/supplements
Pure Encapsulations is another high-quality pharmaceutical grade brand that has extremely tight quality
control and manufacturing guidelines. Here is the link:
https://www.purerxo.com/thyroidpharmacist/rxo/company/my_recommendations.asp
Here are a couple of articles you may find helpful as well.
FOOD SENSITIVITIES AND HASHIMOTO’S
https://thyroidpharmacist.com/articles/food-sensitivities-and-hashimotos
AUTOIMMUNE PALEO DIET
https://thyroidpharmacist.com/articles/autoimmune-paleo-diet
Would this apply if you have secondary hypothyroidism due to panhypopituitarism caused by a pituitary tumor?
Joe – thank you for reaching out. I am not able to advise on whether this would apply for you and your specific health needs without a comprehensive health assessment. I recommend that you discuss this with your personal doctor. <3
Dear Dr. Wentz,
Thank you for your nice website. My wife’s thyroid gland is a little sluggish. She is 30 years old and her thyroid disorder was diagnosed 5 years ago. 7 months ago, she felt numbness, tingling and pain in her hand and leg. A blood check revealed that her B12 level was 247. Her doctor prescribed B12 (1000 microgram/ml) shots, one a weak for first month, and one a month for 4 months. Several days after taking the first shot, all symptoms disappeared. Everything was fine until 2.5 months after the last shot, when she started feeling numbness in her hand again. According to her new blood check, her B12 level is 284 which is low again.
Now I have 3 questions:
1- What is the best way of taking B12 for her to maintain the B12 level in the optimum range?
2- what is the optimum B12 range for her?
3- I read that the hypothyroidism can cause B12 absorption problems. But since her hypothyroidism has been treated for 5 years, I expected she must not have digestion problems associated with hypothyroidism. Despite my expectation, she seems to have B12 absorption problems. Why ? Cannot we cure her digestion problem so that she doesn’t have to take B12 supplements anymore ? Can her digestion problem be the result of incomplete hypothyroidism treatment? Maybe her hormones are only partially balanced.
It will be highly appreciated if you help me find out the truth.
Hossein – thank you for reaching out and sharing your wife’s journey. <3 My heart goes out to her. Low stomach acid is very common in Hashimoto’s. Signs and symptoms that would lead me to believe that a person with Hashimoto’s had low stomach acid include: acid reflux symptom (this condition that is conventionally treated with acid suppressants can actually be caused by low stomach acid), low B12, ferritin, or iron levels, fatigue despite thyroid medications and constipation/diarrhea. Gut healing is a journey; she may need various interventions like removing reactive foods and infections, taking enzymes and probiotics, and balancing nutrients. Remind her to be kind to herself and learn to listen to her body so that she can support and feed it properly! Here are some articles that might be helpful as well.
WHAT'S CAUSING YOUR LEAKY GUT
https://thyroidpharmacist.com/articles/whats-causing-your-leaky-gut/
SUPPLEMENTS ACTUALLY HELP HASHIMOTO’S
https://thyroidpharmacist.com/articles/which-supplements-actually-help-hashimotos/
ENZYMES TO OVER COME HASHIMOTO’S
https://thyroidpharmacist.com/articles/using-enzymes-to-overcome-hashimotos/
Hi Dr. Wentz!
I’m so happy to have found your site! It’s chocked full of useful information!
For the last 2.5 years, I’ve had tons of symptoms, but the worst has been very painful feet, ankles, and shins. I’ve literally been to podiatrists, orthopedic specialists, had weeks of physical therapy, chiropractor visits, & acupuncture, plus MRI, X-Rays, PAD testing, heart tests (to check circulation), etc. No doctor found anything, until a young doctor tested me for Hashimotos; it was positive (TPO was 102, Free T3 &T4 were low). She tested for lots of other stuff, too. (I’ve had hypothyroidism for years.) My D was also low (25). She is now treating me, and I finally have hope. I’ve also gone gluten free, and because of your site, I’m going for a vitamin B12 test next week. Can you please tell me if there are any other vitamin deficiencies that may cause muscle and joint pain? I can only walk/stand for very short periods, and was very active until just over two years ago. Any direction you can head me in would be GREATLY appreciated. Thank you very much!!
Kelli – thank you for reaching out and sharing your journey with me. <3 Nutrient deficiencies can be a root cause of pain in some cases, and supplementing with key nutrients can be very helpful for treating pain and reducing inflammation. Here is an article you might find helpful:
PAIN MANAGEMENT AND HASHIMOTO'S
https://thyroidpharmacist.com/articles/pain-management-and-hashimotos/
Thank you very much, Dr. Wentz!
Kelli – you are very welcome! <3
Thank you for all your informative advice, its all very helpful. I’ve been diagnosed with hashimoto’s for 12 years and am amazed at how misled I’ve been by my conventional doctors for so long. Im looking forward to changing my diet and supplementing with some helpful herbs to get these antibodies down. Im having almost all the symptoms of a b12 deficiency, my labs showed my rbcs weren’t producing at the norm but my doctor brushed it off and told me it was normal, so that was when I changed my mind and switched to a functional doctor. I am wondering if the fast dissolving b12 tablets could work, I was distracted when I got them
Kate – thank you for reaching out. I am so happy to hear you have found a functional practitioner. <3 Please understand, I am not able to advise on whether the b12 supplement would be appropriate for you and your specific health needs without a comprehensive health assessment. I recommend that you discuss this with your doctor.
Hello dr.
I was tpo positive for 15 years.but now I am negative for this test.
But I have problem in gut and I have palpitation after eating food.
Is it because of gluten intolerance?
Gm – thank you for reaching out. 🙂 About 95% of people with Hashimoto’s have elevated Thyroid Peroxidase Antibodies, while 80% will have elevated Thyroglobulin Antibodies. They can both be important in monitoring the autoimmune attack on the thyroid, and can both be used to monitor the effect of interventions. Some interventions will lower TPO antibodies more, while others will have a greater effect on TG antibodies. This can depend on the individual and their body’s response.
Some people with Hashimoto’s test negative for thyroid antibodies because their overall immune health is so weak, they do not produce enough antibodies. I tested negative for antibodies several times. Now, I insist on a thyroid ultrasound. A thyroid ultrasound can be used to detect changes in the thyroid, associated with Hashimoto’s. Given that Hashimoto’s is one of the leading causes of hypothyroidism worldwide, it’s best to be certain, one way or another. I have written several articles about how to best decrease thyroid antibodies.
Here are some articles I think you might find helpful:
HASHIMOTO’S AND THYROID ANTIBODIES: PART 1
https://thyroidpharmacist.com/articles/hashimotos-and-thyroid-antibodies/
HASHIMOTO’S AND THYROID ANTIBODIES: PART 2
https://thyroidpharmacist.com/articles/part-2-mechanisms-reduce-thyroid-antibodies/
Thank you so much for your answer.
For the first time (15years ago) my Tpo test was 250 (normal range <40).
I check tpo level every year.(my job is lab technical)
Now after 15 years my tpo test is negative.
By the way my anti tg test always have been negative.
In your idia why have my tpo level been negative?
What does it mean?
Does my immune system have no sensitvity to tpo enzyme?
Thank you
Thank you, Dr. Wentz, for the helpful information you provide for those of us living in rural mid-America where we have no access to alternative care. I am on levothyroxine for a hypothyroid diagnoses. My Dr. declined to do a TPO test because he said it would make no difference in my treatment. I remain very tired.
In all the information about vitamin B12, I have not been able to find anything about my situation. My CBC testing indicates several areas which indicate that I am low in B12; however, my B12 levels are very high–greater than 2,000. The last definitive test I had was 10 years ago when my B12 level was 3,136. How can my B12 be so high when I am not supplementing (except what is in my multi)?
But, for the most part, I am doing well for a 90 year old.
Lori – thank you for reaching out and sharing! <3 An elevation of B12 in your serum can be tied to the MTHFR gene variation. When the body is unable to properly use B12, it will show up as elevated on the test. As B12 is a water soluble vitamin, any amount that is not used by the body will simply be eliminated. Here is an article you might find interesting:
MTHFR
https://thyroidpharmacist.com/articles/mthfr-hashimotos-and-nutrients/
Hello ,
I have been taking a vitamin b complex for approximately two months and just added in a vitamin b2 I have felt no energy help from this and actually when I take the vitamin b complex it makes me feel like I’m hoping to fall asleep . Is there something with this disease that would cause me to not absorb these vitamins?
Ashlee – thank you for reaching out. ❤️ Vitamin deficiencies are common in Hashimoto’s are often a result of damage to the digestive tract that prevents the absorption of vital nutrients. Here are some articles you might find helpful:
B12 AND YOUR THYROID
https://thyroidpharmacist.com/articles/b12-thyroid/
7 MOST IMPORTANT NUTRIENT DEFICIENCIES IN HASHIMOTO’S
https://thyroidpharmacist.com/articles/6-important-nutrient-deficiencies-hashimotos/
IMPORTANCE OF GUT HEALTH
https://thyroidpharmacist.com/articles/importance-gut-health/
Hello Dr.Wentz,
Thank you for your article.
Pernicious anaemia should be always treated with intramuscular injections of B12. All other cases seem to be fine with sublingual way. My family member died after they stopped his injections of B12. Sublingual tablets were not enough for him.
All with PA have lifetime with injections of B12.
There might be a benefit from sublinguals only if someone needs immediate kick of methylated form for brain- methylcobalamin- which can only pass through blood brain barrier.
Adenosyl cobalamin is useful for peripheral neuropathy.
So injections of hydroxocobalamin are for PA only way to survive. Cyanocobalamin (synthetic unactive form) is not so good since weak retention than Hydroxocobalamin injections, which is better for those with liver diseases too.
But your article is generally very informative. Thank you,
Nora
Nora – thank you so much for sharing your feedback. 😉