Understanding Your Blood Tests: Vitamin B12 and RBC-Folate Levels (Folic Acid)

Your body needs thousands of nutrients to thrive. What we call "vitamins" are simply the ones we can't manufacture ourselves and must get from our diet. Together, we can understand these essential nutrients better.

Of all the known B-vitamins (there are eight wonderful helpers: B1, B2, B3, B5, B6, B7, B9 and B12), B12 and B9 (Folate) levels are two of the most important for maintaining your physical, mental and emotional wellness.

Folate levels, for example, are routinely checked in pregnant women as insufficient levels can affect baby's development.

And if you're feeling low on energy, over the age of 60, following a vegetarian or vegan lifestyle, or experiencing challenges with memory, mood or neuropathy, many doctors will run B12 tests, as insufficiencies have become increasingly common.

We understand that reference ranges in blood work only capture variation in a population.

Just because a vitamin level appears "normal" doesn't mean it's optimal for you. Let's explore together what your optimal levels of B12 and folate should be, and how to naturally support these crucial vitamins.

In today's article (the third in our "Understanding Your Blood Work" series), you'll discover everything you need to know about your B12 and folate levels and blood tests including:

• Why checking your levels matters for your wellness journey
• Signs your body might need more B12 and folate
• The optimal/functional ranges that support vibrant health
• Understanding the root causes of insufficiencies
• How to naturally optimize your levels safely

B12 and folate are considered the "wellness champions" of the B-vitamins, which is why we test for them as part of our comprehensive blood work at Knew Health.

One of the main reasons these two nutrients are so important is their beautiful partnership, which supports a key bodily function known as methylation.

Methylation is a metabolic process that occurs in every organ and cell of your body at an incredible rate of about 1 billion times per second. Think of it as your body's natural recycling and renewal system.

Methylation supports your body in numerous ways, including how genes are expressed, neurotransmitter synthesis, hormone balance, and natural detoxification processes (to name just a few).

When methylation is working smoothly, you're naturally detoxifying well, breaking down nutrients efficiently, expressing genes optimally, and producing energy properly. When it's not, you might experience various wellness challenges.

B12 and folate also play essential roles in other key bodily functions including:

• Supporting your entire nervous system, including brain health
• Blood wellness (both play key roles in forming healthy red blood cells)
• DNA synthesis and repair
• Mood balance and memory support
• Muscle health and strength

B12 insufficiency affects millions of adults, children, and seniors every year. We're here to help you understand if this might be affecting you.

In fact, it's estimated about two-fifths of the population may have suboptimal levels.

This widespread B12 insufficiency has somewhat puzzled the medical Community, as many who have low levels consume adequate B12-rich animal foods and protein.

We'll explore the "why" behind this shortly, but some common signs your body may need more B12 include:

• Low energy or persistent fatigue
• Cognitive challenges such as memory concerns, brain fog, or difficulty focusing
• Muscle weakness or tiredness
• Anemia
• Tingling sensations in hands or feet (or other types of neuropathy)
• Mental wellness challenges such as low mood, anxiety, or paranoia
• Impaired natural detoxification
• Irritability or mood changes
• Difficulty with walking or balance

A special note on the mental wellness aspects of B12: our good friend, Dr. Kelly Brogan, holistic psychiatrist and author of the NYT best-seller "A Mind of Your Own" once shared:

" One of the most remarkable papers I have read in the psychiatric literature was about a 57 year old woman who was treated with months of both antipsychotic and antidepressant medications and given two rounds of electroconvulsive treatment before anyone bothered to check her vitamin B12 level." – Kelly Brogan, kellybroganmd.com

In other words: having your B12 levels checked can be transformative, especially if you're experiencing any mental wellness challenges.

Many signs of folate insufficiency mirror those of B12. And like B12, folate is typically readily available from foods, especially fruits and vegetables. Plus, many packaged foods are now fortified with "folic acid" to help support healthy pregnancies.

So, it's worth understanding that there are other factors at play beyond diet alone (hint: quality matters when it comes to your sources of folate).

Signs your body may need more folate include:

• Fatigue or low energy
• Weakened immunity
• Digestive challenges
• Anemia
• Canker sores
• Mood changes, irritability, or anxiety
• Pale skin
• Impaired natural detoxification
• Developmental concerns during pregnancy

But even if you're not experiencing these symptoms yet, your levels of these key nutrients may benefit from proactive support before any challenges develop. This is the heart of preventive wellness.

If there's one thing we'd love you to remember from this article, it's this: low-normal B12 and folate levels won't support your best wellness if you're interested in preventative health and optimizing your well-being long-term.

If you want vibrant energy, mental clarity, good muscle tone, efficient detoxification, and a healthy nervous system, you'll want to aim for the higher end of normal for these markers…not the lower end.

Optimal/functional ranges of serum B12 are likely:

• 800-1000 ng/L

Optimal/functional ranges of red blood cell (RBC) folate are likely:

• 1000-1500 ng/ml

If you're working with your own doctor or healthcare provider, keep in mind that different labs have different reference ranges, particularly for folate. We're here to help you understand your unique results.

We mentioned earlier that the root causes of B12 or folate insufficiency often go beyond diet. Let's explore these causes together:

• Diet —typically those following a vegan, vegetarian, or very restrictive diet may be at higher risk of B12 insufficiency, because B12 is only found in animal foods.

For folate, anyone who isn't eating enough dark leafy greens, nuts, and seeds may benefit from additional support, as these natural sources are the most easily absorbed.

The synthetic "folic acid" found in some supplements and fortified foods is typically less well absorbed by much of the population, especially those with genetic variations (more on this coming up).

• Absorption challenges —beyond diet, certain digestive wellness issues such as Leaky Gut Syndrome, gut microbial imbalances (e.g. SIBO), and H.Pylori infection can affect your body's ability to absorb B12 and folate.

In particular, we need ample stomach acid to prepare Vitamin B12 for absorption in the intestines, and we tend to make less optimal levels of stomach acid as we age, when thyroid function changes, and when we're stressed.

• Autoimmune conditions —if you have an autoimmune condition like celiac or Crohn's disease, it typically impacts your digestive wellness, which can contribute to vitamin insufficiencies.

Pernicious anemia is also an autoimmune condition that directly—and significantly—affects Vitamin B12 absorption.

• Medications —specific medications such as proton pump inhibitors and metformin can impact your B12 levels, especially with long-term use. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880159/

• Genetic variations —such as MTRR and MTHFR can affect your body's ability to store Vitamin B12 for ongoing use (requiring more frequent intake) or to produce methyl folate from the forms we typically consume (especially synthetic folate found in most processed foods and mainstream vitamins), both of which can create insufficiencies.

At Knew Health, we often recommend dietary changes and, where appropriate, supplementation to help you achieve optimal B12 and folate levels naturally and safely. We're in this together!

For B12 supplementation, we typically recommend:

• 1000 mcg of methylcobalamin 1-2 times daily

If you have digestive challenges, sublingual B12 (taken under the tongue) or a lozenge is often your best choice to enhance absorption.

For folate supplementation, we typically recommend:

• 400-800 mcg of methylfolate daily

Why do we recommend the methyl forms of B12 and folate?

Methylated B-Vitamins provide superior absorption even in the presence of genetic variations like MTHFR. They're already in the form your body can readily use.

If you need support with both, it may work best to find a high-quality B-complex supplement to cover all your bases.

• An elimination diet —is an affordable and accurate way to identify trigger foods that may be affecting your digestive tract, causing those pesky symptoms like reflux and impacting your ability to absorb B-vitamins.

"Trigger foods" to eliminate for a period of time may include gluten or other grains, dairy, sugar, soy, and eggs.

• Probiotic support —this may mean taking a multi-strain probiotic supplement and/or increasing your intake of probiotic-rich foods like kombucha, kim chi, cultured vegetables, real pickles, yogurt, and kefir.

Probiotics can naturally increase synthesis and production of B-vitamins and other nutrients in the gut, such as B12 and folate respectively.

• Digestive enzyme support —plant-based digestive enzymes or hydrochloric acid supplements offer an effective way to support digestion while you work on nurturing your GI tract. Food-based sources of enzymes such as papaya, pineapple, cultured or raw vegetables may also be recommended.

If you're experiencing a more chronic condition such as an autoimmune challenge or infection, your Health Coach may recommend additional measures and/or connect you with a functional medicine physician in our Community.

This should be determined on an individual basis with your Health Coach or Functional Medicine practitioner. We believe in personalized wellness plans that work for you.

If your B12 levels are very low and you're experiencing life-altering symptoms, or if you're pregnant and have low folate levels, for example, re-testing may be recommended in as little as 1-3 months.

Curious about how your B12 and folate levels may be supporting your wellness journey? We're here to help.

All Knew Health Members receive a B12 and RBC-folate blood work assessment as part of their initial wellness evaluation, along with a dedicated Health Coach to help you optimize your levels for long-term vitality. Together, we'll create a plan that empowers you to take control of your health naturally.

-The Knew Health Team