High B12 But Still Exhausted? Here's Why

In this episode, Dr. Hugh explains why vitamin B12 matters so much for your body and what can stop you from absorbing it the right way. He breaks down how B12 absorption, intrinsic factor, stomach acid, and the small intestine all work together. He also explains why some people can have normal or high B12 on lab work but still have deeper problems. 

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In this episode, you will learn:

• What vitamin B12 does for your nerves, red blood cells, brain, energy, and heart 
• Why B12 is water soluble and why extra B12 is often flushed out in urine 
• How stomach acid helps release B12 from food 
• Why intrinsic factor is needed to carry B12 so your body can absorb it 
• How low stomach acid, gut inflammation, and autoimmune problems can block B12 absorption 
• Why high homocysteine may point to a B12 problem
• How MTHFR can affect folate and B12 pathways
• What lab markers may help show when B12 is not being used well 

Who this episode is for:

• People with fatigue
• People with brain fog
• People with nerve symptoms
• People with gut problems
• People trying to understand B12 labs and homocysteine

Main takeaway:

• B12 is important, but absorption is the real key
• Your stomach, intrinsic factor, and small intestine all need to work well
• If one part breaks down, your body may not get the B12 it needs

Need help?
This is the new address to schedule a Zoom call:
https://dochugh.com/schedule-your-zoom-call-with-dr-hugh-wegwerth

Transcript

0:01

Hey, community. This is Doctor Hugh coming at you today. And we have a very, very special webinar. And this webinar is all about B12 and how to absorb B12, because I've been getting tons and tons of questions on B12, you know, how to increase B12. What if my lab says I have high B12? What does that all mean? So I'm going to break this down in this webinar today. So you know exactly what's happening. So boost your vitamin B 12 easy B12 absorption. So that's what we're going to be talking about. And if you like this video, please give me a like share and comment with someone that you may need or know that needs to hear this information. Let's get in. All right. First thing right here is one thing that we need to know for sure is that B12 is water soluble. So B12 dissolves in water and does not get stored in the body. Now this is really critical right here. Extra B12 dissolves in water and is flushed out in the urine. This is what's so unique about B vitamins is they're water soluble. So other vitamins such as. Here we have vitamin D. So what's the difference between vitamin D and B12 or B vitamins is basically vitamin D is fat soluble. So what does this mean at the end of the day. So if this is fat soluble this is going to be stored into fat. So vitamin D is not excreted in the urine. So this is why when we talk about B12 when we have high B12 in the urine, that is pretty much a meaningless marker because you're just going to urinate any excess out. And at the end of the day, if you've been damaged by antibiotics, you have fibromyalgia, you have brain fog, brain fatigue, whatever it is you have, you're going to need extra B12 because you probably don't have the normal channels to actually absorb and get B12 into your body. So really the simple thing at the end of the day is B12 is water soluble. You're going to urinate it out, you're going to flush it out. So you don't build a toxicity. I guess that's really what I'm going for. You don't build a toxicity such as like vitamin D. Now I've never heard of anyone that has a vitamin D toxicity. But at the end of the day, vitamin D is stored in the fat. So it's takes a longer time to bring your vitamin D down. If you have a vitamin D of 120, it might take you, I don't know, three months to bring it down to 80 without taking vitamin D, but with with B vitamins B12, like literally, if you don't take B12 the next day or two days later, it's going to be out of your system and you're going to show that you have normal B12 levels. Now, if you want to geek out on any of this content right here, this is all referenced in here. This is the references. So I've put a lot of time into going over these references. Now what I want to show you right here is these are my labs. So I just had these labs done recently here. Um, so these right here is what you're looking at. This is the labs from, uh, 125 of 24. Okay. So this right here, these are my labs right here. Now you can see what you're looking at right here is you see that B12 actually is lab high. And when I did it basically a year ago, it was lab high. So no big deal because you're going to urinate B12 out. And at the end of the day, I actually need more B12. And one of the markers that we use to determine this is what we call homocysteine. So I'm going to show you my lab. This is currently my lab right here. So this is my homocysteine was basically 1212 of 24. And I just recently had this done like this year, this April of 2026. And you can see my homocysteine here actually went up. It's actually lab high. So yes, even me, I have problems that I need to be dealing with. And I need to start taking more B12 on a consistent basis. So this is important. I want to show you my lab so you can understand what's going on with me. So what does B12 do in your body. So first thing it does it makes red blood cells. It helps with memory and brain function. It helps healthy heart. It helps your digestive system. It helps your immune system. It synthesizes DNA. This is very, very critical. Um, when it comes to B12. So B12 helps DNA what they call methylation or synthesis. If you have poor B12 absorption, which if you have a chronic illness, you probably do imagine this. You take a copy of a copy of a copy and the thousandth copy. What's going to happen to that copy? It's going to be very, um, not very clear and crisp. This is what happens when it comes to your DNA. If you continue to take a copy of a copy of a copy, that copy is very, uh, unclear. It's blurry. This is what happens is when you have B12 problems, when you have the Mthfr genetic SNP, which if you have a chronic illness, you probably do. Basically, the building block of your DNA is not very good. It's not very crisp. And then you start to get problems after problems after problems. So here another thing it does is it helps with nerves. It helps with liver and it helps with obviously with energy production. So all these things here are going to be contributed to B12. So how important is B12. B12 is massively important to make sure that you have enough B12 that you're getting enough B12 consistently day in and day out. Because if you're not, you're going to have problems. So right here, neurological problems. What happens right here is this is the myelin sheath. So B12 helps make the myelin sheath. So if you don't have this this can have you can have peripheral neuropathy brain fog depression. It helps build red blood cells. So this is really critical. If you don't have enough B12, you're not going to have a very good red blood cells. I'll be showing you some examples of that and what that actually looks like. Cardiovascular we're going to be talking about homocysteine. And we already talked about homocysteine. Homocysteine is a very, very dangerous marker to have high. Just imagine homocysteine is like little glass shards running around in your bloodstream, slicing the endothelium, slicing your liver, your pancreas, your muscles, fibromyalgia. So we do not want to have high homocysteine. You can see right here I have high. What's the sweet spot for homocysteine. The sweet spot for homocysteine is between 5 and 6. So you can see mine 16.6. So I need to get some action. I get more on my B12 supplements. Okay, here's what happens. We have poor B12. Uh, poor B poor B12 can lead to large red blood cells or this is what we call a high em CV right in here. Now, what this does. Is you have B12 right here. So you can have B12, poor B12 absorption for many, many reasons. And we will be going over that in a second. But people have B12 that's not being absorbed properly. And then what happens when you have poor B12 absorption? B12 is needed to produce bones in your. Or is needed to produce red blood cells in your bone marrow. So this is your bone marrow. So you consume, let's say, red meat. Okay, so red meat has B12. Um, if you don't absorb that for all the reasons we're going to go over in a second, the B12 does not get to the bone marrow. So you're unable to use B12. And bone marrow doesn't have enough B12. And what happens with your red blood cells is they become larger. So this is the MCV mean corpuscular volume. That's what that stands for. Mcv mean corpuscular volume. So what happens is when red blood cells are born, they're born large. And then as they get older, they start to get smaller. So if you don't have enough B12, if you're not absorbing enough B12, that B12 is not going to your bone, right? Your bone marrow and your bone marrow takes that B12 and it makes red blood cells. And when those red blood cells come into your bone marrow, they should be nice and small, not big. If your blood cells are are nice and big, that's telling you that there are problems. So in your body not pulling in enough B12 from food. So it has trouble making normal red blood cells. So what does this look like on a lab. So let's go over some labs. So you can actually look at some labs. And you can actually see this. What's going on with your labs. So what you want to do is pull out your labs. You're going to look at this. You're going to see this MCV right here. You can see this is high. It's at 100. And you can see the range right in here. You can see the range right there is 79 to 97. Now this is 100. So this tells you right away that this person is not getting enough B12. Now the sweet spot, the sweet spot that I like to see this MCV. I like to see this at around 92. Anything that's greater than 92, I start thinking that there's something going on here. This person has some kind of malabsorption problems when they have a high MCV. And you can see right here these are normal red blood cells. And these are big ones. That's what that stands for right in there. Now if you're going to look at your blood work, so you want to pull this out and you're going to see this, uh, CDC, this CBC with differential, and you can see the MCV right here. And in this person right here it is 91. So just to kind of give you an orientation so you can actually see, um, so you can actually see this on your blood work. Just simply pull your blood work out and take a look at it. And then down in here we have the one that we just showed you is MCV is high at 100. So this is one indication that's telling you that you don't have enough B12. And there's a lot of problems that can be happening if you don't have enough B12. So B12 not being absorbed through the stomach. It stops this from an array of reasons. Your body cannot pull B12 from the digestive system. And we'll be discussing that in a second. Now here's what can happen is why low B12 causes homocysteine. So your body needs B12 to handle homocysteine. So one of the things that happens is B12. If you absorb it properly you're going to break down homocysteine. Homocysteine is a very pro-inflammatory hormone. And every disease known to mankind grows in a body that's inflamed. So when we see homocysteine on your labs, we want to see that between five. And we want to see this between 5 and 6. So if it's. Other than that, if it's higher than if it's seven, eight, nine, ten, 11, 15, whatever it is, the homocysteine that's telling me that there's some B12 problems and we really want to look at that and see what's happening. Here's the homocysteine right here. You can see this is 15.6. Um, so that's telling us that there are some significant problems with homocysteine. Now this is one of my clients. And you can see this original marker right here was taken on April 1st of 2025. So this is absolutely insane. I want to show you this, show you this to you. This is one of my clients. Absolutely insane is we took this marker homocysteine. And I never seen a homocysteine this high in my entire life. 16.2 I said, no way. I said, there's no way that this homocysteine is actually that high. So we immediately checked it about five days later because, you know, hey, labs make mistakes. And nope, we got recon, we got reconfirmation. It is 64.6. So massively high. So what do we know for sure about his B12? It's in the tank. He probably has some genetic problems Mthfr. All these things. So we want to address these things. This is the same client down here. This is the same exact client. This is about four weeks later. You can see this lab right here. You can see it's the exact same number. And then after we did the protocol, we got it down to 12. Right? So we went from 69 to 12 in a matter of about five weeks. So if you have the Mthfr genetic SNP, you can totally handle this. There's a lot of things that can be done when it comes to B12. Now what you're looking at right here is the majority of B12 is going to be absorbed in your stomach. So if you have any stomach problems, if you have H pylori, if you don't, if you're not producing enough hydrochloric acid, if you have food sensitivities, you're not going to be absorbing B12 and breaking B12 down. So right over here we have the stomach, right? So we have the stomach right in here. And then what this is showing, you can see this little area right in here, this little area right in there. Okay, so what this is, is this is blown up right here. So we have three things. We have this right here. We have the first thing right in here. Then we have the second thing which is blowing up. And then we actually have the the cells of your stomach. So what you're looking at is this is the lining of your stomach. So you're looking at the very lining of the stomach. And what you want to see right here is you're going to be looking at this cell right in here, which is called the parietal cell, the parietal cell right in here. The parietal cell is within your stomach. And this is what really initially breaks down B12 and allows you to absorb B12, which is in the stomach. So what we're blowing up here is we're blowing up this little cell right here, this parietal cell. So what you're looking at right here is this little slide right in here. This is the parietal cell. Okay. So this is the parietal cell right in here. And it produces two things. So your parietal cells are going to produce two things. They're going to they're going to produce hydrochloric acid and they're going to produce intrinsic factor. So within your stomach your stomach cells which are called the parietal cells, produce two things HCl hydrochloric acid and intrinsic factor. So these things need to be working properly. So when this cell right here is producing hydrochloric acid and it's also producing intrinsic factor guess what happens. You have B12 that is absorbed. This is a normal healthy functioning gut. This is what you're you're this is what you're you want your gut to do is you want it to function optimally. And the parietal cells need to produce two things, the HCl bam. And it has to produce the intrinsic factor in order for you to absorb B 12. Now this is a test. This is a test that I run. It's called the Anti-parietal cell antibody. So what the heck is that. What is the anti cell. And what is the anti-parietal cell antibody. Very very simply it means that your immune system is attacking your gut lining. Just like this picture shows. These are the antibodies right here. Remember this is in your gut. This is in your stomach. All these cells are in your stomach. So what happens here is when you have these antibodies which this test for. This is one of my clients 27. You can see the range right in here. Okay. You can see the range right in here. Right in here. I like to see this at zero. I want to see this marker at zero. Anything above zero tells me that there's some beginning stage of some kind of autoimmune disease when it comes to the anti-parietal antibody test. Right in here. So you can see what happens here. It's attacking the parietal cells. They are getting inflamed. These are antibodies. You don't produce intrinsic factor and you don't produce hydrochloric acid. And then down here what happens. You have decreased absorption of B12. Antibodies attack parietal cells reducing intrinsic factor and B12 absorption. And not only intrinsic factor they also affect hydrochloric acid. So this is really critical that we're looking at a very close analysis of your gut. Here's just another test. You can see this is the one I just showed you. And then down here you can see this is eight right here. You can see that that is eight. Now I don't like to see eight. I like to see zero. And I've seen plenty of zero. So anytime I see anything that's above that's one or greater. This is telling me that there is probably some kind of autoimmune disease, low grade autoimmune disease that is affecting your gut. Now, I love this graphic. I've worked really hard on these graphics right here. So how is B12 absorbed? So B12 is strictly through meat, right? This is primarily where you get B12 is through meat. So the first thing that happens is going to be right in here is the food. The B12 is bound to protein. So you can see right here. So the B12 is bound to protein in the food that you eat eat just like a piece of steak. So the B12 is is attached to the protein. It's attached. It's attached to the amino acid. So the first thing that we need to do is we need to release hydrochloric acid. This is a four step journey four step journey here. So the first thing we do is the parietal cells right. The parietal cells release hydrochloric acid. And then what does hydrochloric acid do. The hydrochloric acid from parietal cells releases B12 from the food protein. So we have a couple of things going on. You eat a steak loaded with B12. The parietal cells produce two things HCl and intrinsic factor. The HCL basically breaks up the B12 and disconnects it from the steak, from the meat, from the amino acid. Okay, so that's step number two. Then what happens here? Then we have step three right here. And this is where the intrinsic factor comes in. So the intrinsic factor acts like a glove okay. It's a glove that's going to grab the B12 and absorb it into your blood system. But injured blood system. But what happens if we have that antibodies right up in here. What happens if we have these antiparietal antibodies? Guess what. You don't have any. Catcher's mitt happening in here. You can see right in here. These b12's here. This is like the little catcher's mitt. Like this is the catcher's mitt, the catcher's mitt. It's going to catch it. And then what happens right in here? The intrinsic factor produced by parietal cells binds to B12, protecting it and preparing it for absorption. And then finally, in step four, here we have the small intestine. So you have the stomach. You have the stomach. And then basically you're going to have your small intestine. So once the B12 is bound by an intrinsic factor in your stomach, that leaves your stomach goes to the small intestine. And then from there you have to absorb it from your stomach or the ilium, the ilium in the ilium, the part of the small intestine, the B12 intrinsic factor is absorbed into the bloodstream. So this in here is a whole process that you can see if any one of these processes are messed up, you're not going to have proper B12 absorption. So first thing right here you need food, right? So B12 from food. Second thing, each cell releases it from the food from the protein. The intrinsic factor catches it. And then this goes in your small intestine and then you absorb it. So what does normal healthy digestive system look like. So normal healthy digestive system looks like this. No gas, no bloating, no diarrhea. Right. So you make 1 to 3 bowel movements every single day, day in and day out. No gas, no bloating, no diarrhea. You don't have to take fiber supplements. You're not on the purple pill. Nothing like that. This is normal healthy GI system. If you have anything other than that, your gut's not well and there's a high probability that you are not absorbing B12 to the fullest. Now, what I want to talk about right now is the Mthfr pathway. B12 helps helps the MTA. The B12 helps the pathway work better when Mthfr is not working. So let's go over a couple things right here. So if you've heard this is, oh, a lot of people say I have Mthfr and now I'm doomed. Like that's not the case at all. There's a lot of things that can be done to help Mthfr. So these are all visuals here. Right. So I'm giving you visuals. So you see this right here. You can see this enzyme, the MTH fr enzyme. So what the heck does the MTHR enzyme do? It's very very simple. I'm going to break it down. It takes B12 and then it converts it into active B12. Very simply it's converting B12 into active B12. When God designed us, he designed these vitamins and minerals that they need to be converted to form an active form. So not everything, not every vitamin in your body is what I would call an active form. We have to convert it into an active form. So this Mthfr, when it's working well, when it's working well, it easily can converts folate, which is, which is B9 and active folate. Okay. That's really the gist of it. Now here you can see this Mthfr makes active folate. Okay, so the Mthfr is going to make active folate. Now what does B12 do. B12 helps use it properly. So we have a couple of things. Let me go over this very very slowly. We have the Mthfr enzyme. The Mthfr enzyme. And that converts folate into active folate. Very simple. Okay. So when this is when this enzyme is working properly, you're going to get a high turnover of folate to active folate. So everyone has the Mthfr enzyme. Everyone does. The problem is some people it's not working very well. So when it's not working very well, what happens is you're not converting folate into the active folate. Okay. So this slows down this whole cycle. Then what happens on top of that, once active folate is converted, then what happens is you actually need B12 to utilize it. Okay, so B12 helps utilize it properly. So once it's made, B12 helps utilize it properly. So one if you're not making enough active folate, if you have a genetic tendency, if you have any inflammation. And then on top of that, if you're not absorbing B12 properly, you can see on how all these downstream factors are going to be affected. Like initially when we went over all the things that B12 does, these are all the things that will not work properly. So here I love this graph right here. So this is a normal Mthfr enzyme. And then we have this carpenter right in here. You can see his hat there. It says Mtfhr. And he knows exactly what he's doing. He's very on the ball and it's working and it's converting folate to active folate. And then you're using the B12 to reduce the homocysteine and all these down, uh, stream metabolisms. Now, when you look at this, I just want you to show this really briefly is look at the carpenter in here when you see this carpenter. Okay. All he's really doing is he's taking a piece of wood. He's taking a piece of trim, let's say at the bottom of your wall, there's a piece of trim or crown molding. And you just by the crown molding. And what the Mthfr or the carpenter is doing is he's very precisely cutting it and trimming it. So it fits nice and perfect. The crown molding, the crown molding on the top of your ceiling. So when you look at this picture right here, what's happening is when we talk about the craftsmanship, this is the only thing that's changing is these two things right in here. This is the crown molding. And here and in here these are called methyl groups. So the only thing that this carpenter is doing, or one of the main things that this carpenter is doing is he's taking the crown molding and doing precise cuts and basically putting on two methyl groups. And that changes the whole structure and the whole function of your entire body. So it's very, very simple. So this is the active form of folate. Now the good news is if you have some of these genetic tendencies, you can bypass this pathway and you can take active folate, right? So you can actually bypass some of these pathways and go right to the active folate. So in here you can see what's happening is now in here we have a slow, we have a slow Mthfr. So this is not working properly. Right. So folate here is getting this is getting built up. It's not converting into active. And then homocysteine does what. Homocysteine massively starts to develop and increase. This is why you have 64 right here, because this whole cycle, this whole pathway is not working because this Mthfr just isn't functioning the way it should. I like this picture. So here's the carpenter that you have right here working on the folate. He's had too many beers when he has too many beers. There's slow Mthfr and you have less active folate. When you have less active folate, you have homocysteine that goes up besides just homocysteine, tons of other processes in your body that just are not functioning properly. So this is where it's very, very critical. And you can see with my client right in here is he started off at 6464. And then we did the proper support and we got him down to 12. So Mthfr makes active folate. B12 helps utilize it. So this is the carpenter that we want. We want folate to go to active folate. Very simple. But if you have any genetic problems, if you have inflammation, if you don't have enough hydrochloric acid, guess what happens here? You got the drunk guy, the drunk guy, the carpenter that's going to cut off his hand. And the methylfolate, the active methylfolate is not going to develop in your body and you're going to have problems. So there's lots of different products on the market that can support this pathway. I in particular love this product right here. This is from Fullscript's. And these are the pathways right here that support that whole cycle. Right. So if you have this carpenter right in here, the drunk carpenter, you can bypass this by using these nutrients right in here to bring down the homocysteine. So you can see here it has, um, it has folate right here. This is the active folate right here. And then it has active B12. And then it has trimethylglycine which is another product to bring down homocysteine. And it has some B6 and riboflavin. So I've had very, very good success with this product. And in fact, this product right here, this product right here is a product that helped me reduce this client's homocysteine to 64 to 12. Okay. Now why B12 stays low. So let's go over all the causes. There's lots of causes that cause B12 to go low. So the first thing here is you could have hypochlorhydria, which is just a fancy word for saying not enough hydrochloric acid. Second thing you could have is your stomach could be inflamed. You could have some kind of gastritis, which is going to inflame your gut, and you're not going to absorb B12. Here we talked about this. You can have lack of intrinsic factor. Remember the parietal cells do two things. They do two things. They produce hydrochloric acid and intrinsic factor. So if you have any of these pathways that are not functioning optimally you can have chronic illness. So if you have chronic systemic inflammation guess what? These cells just don't function the way they should. So there's lots of things that can cause and contribute to these things. Gastric bypass surgery. Here's another gastric bypass surgery. Small bacterial overgrowth. Excessive bacteria in the small intestine can hijack and consume B12. So you have small bacterial overgrowth. I have a bunch of content on the GI map test. These bacteria love the B12 and they eat this up. Celiac disease. So this could be you know, celiac disease is specifically for gluten. But you can have food sensitivities. You could be sensitive to nightshades potatoes, tomatoes, potatoes and tomatoes, right. You could be sensitive to gluten, dairy. So all these things here can inflame the gut. Parasitic infections. I see a lot of these things right here. Parasitic infections can also be a contributing factor. We have pancreatic insufficiency. So a lot of people have pancreatic insufficiency, which is just saying that your pancreas is not producing enough digestive digestive enzymes and you cannot break down the food that you just ate. And then finally, here I see lots of this liver and gallbladder issues. All these things here will contribute to poor B12 absorption. And finally here the genetic Mthfr, which um, will reduce that whole pathway and mess things up. And then finally we have excessive alcohol. So this is really been, um, you know, you should go back and rewatch this and rewatch this if you have some questions about it. It can be very technical, but these pictures go back and just study the pictures. I created these graphics, these infographics, so you can understand these concepts. Uh, and if you have problems you're looking for help, reach out. I help people all over the world through Zoom call, zoom calls. And remember, this is where there is help. There's help. Where there's hope, there's hope. Take care. Bye bye.