Despite it’s overwhelming success, the Paleo Diet still gets attacked for “eliminating entire food groups,” which, according to Paleo critics, puts Paleo adherents at risk for certain deficiencies, including B vitamin deficiencies.
While concentrating on the Paleo diet’s exclusion of cereals and legumes, some of which provide healthy amounts of B vitamins, they glaze over the many Paleo-compliant foods that are rich in B vitamins. As we’ll see in this article, the Paleo diet, when done correctly, supplies all your B vitamin needs and more.
Before presenting our practical B vitamin tips, let’s briefly recap why B vitamins are so important in the first place. In a recent article, we discussed the relationship between B vitamins, homocysteine, and cognitive decline. Homocysteine is a protein breakdown-molecule, which is always present in the blood, but usually at low levels. Having high homocysteine levels is a big problem. High homocysteine is associated not only with cognitive decline, including Alzheimer’s disease, dementia, and depression, but also with cardiovascular disease, stroke, osteoporosis, and infertility.1
Many causative factors contribute to high homocysteine, including genetics, lifestyle factors (smoking, drinking, drug use), decreased estrogen levels, and even environmental factors, such as lead exposure.2 Around two-thirds of high homocysteine prevalence, however, is attributable to poor B vitamin status.3 Three B vitamins – B6, B9 (folate), and B12 – are extremely important with respect to maintaining low homocysteine levels.
Vitamin B6 is essential for healthy red blood cell function while also supporting the immune system and regulating blood glucose levels. According to a study conducted by the NIH and USDA, the following four population sub-groups have above average risk for B6 deficiency:4
- Women of reproductive age, particularly those who have taken or are taking birth control pills
- Male smokers
- African-American men
- Men and women over 65 years of age
Vitamin B9 (folate)
As discussed in another of our recently published articles, there’s a big difference between folic acid and folate. The former is added to a wide array of processed foods and wheat-based products (pasta, bread, etc.), whereas the latter occurs naturally in many foods. From a health perspective, folate is superior to folic acid and should therefore be your focus with respect to B9.
According to the Framington Offspring Study, nearly 40% of the population has vitamin B12 levels in the “low normal” range or lower.5 Besides contributing to high homocysteine, inadequate B12 can also cause vitamin deficient anemia, which means immature or incompletely developed red blood cells displace healthy red blood cells. Symptoms include fatigue, muscle weakness, decreased appetite, diarrhea, and numbness.
Tip 1: Liver
It’s odd for critics to disparage the Paleo diet for “eliminating entire food groups” because most mainstream diets do the same; eliminating not just any old food group, but our ancestors’ most treasured food group – organ meats. All types of organ meat are nutrient dense, but liver is particularly rich in B vitamins, especially our all-star trio of B6, B9, and B12. Many people don’t like the taste/texture of liver, but it definitely grows on you. Try pan-frying it with some olive oil and serving it with a squeeze of lemon.
Tip 2: Walnuts
Walnuts are a great source of B6 as well as B9. Walnuts make great additions to salads. You can gently roast them or, for a different texture, try soaking them for 6-8 hours before you eat them.
Tip 3: Fatty Fish
Fatty fish, particularly mackerel, sardines, trout, and salmon, are among the richest dietary sources of B12. As an added bonus, they are also very rich in omega-3. This is important because omega-3 works synergistically with B vitamins to reduce homocysteine, thus preventing the conditions associated with high homocysteine, especially cognitive decline.6,7,
Tip 4: Fruits and Veggies
Individual fruits and vegetables can’t compare, for example, with liver when it comes to B6 and B9. However, within the context of the Paleo Diet, fruits and vegetables as a whole are significant and necessary contributors of these two B vitamins. Some particularly good choices for B6 are bell peppers, okra, shiitake, broccoli, and cauliflower. Good choices for B9 include spinach, broccoli, cauliflower, blueberries, and zucchini.
Tip 5: Heal Your Gut
A common problem regarding B12 is inadequate absorption (as opposed to insufficient consumption.) Having low stomach acid and/or low gastric intrinsic factor (GIF) impedes B12 absorption.8 In natural food sources, B12 is bound to protein and gastric acid is required to cleave the vitamin. Moreover, the same cells that produce gastric acid also produce GIF, a compound required for B12 absorption.9
According to a 2013 JAMA study, the use of medications that suppress stomach acid, including proton-pump inhibitors, H2 blockers, and other antacids, can interfere with B12 absorption.10 If you are taking them, you might want to consult with your doctor to determine whether they are really necessary.
By following the Paleo Diet, you’ll remove cereals and other foods that can damage your gut while eating foods that strengthen it. You may consider adding bone broth to your diet, which can further improve gut health. Finally, for many people, supplementation with probiotics may be an appropriate strategy for gut health improvement.
References Smith AD, Refsum, H. (Jul 2016). Homocysteine, B Vitamins, and Cognitive Impairment. Annual Review of Nutrition, 36. Retrieved from (link).
 Tchounwou PB. (May 2015). Ethnic Differences in the Prevalence of High Homocysteine Levels Among Low-Income Rural Kazakh and Uyghur Adults in Far Western China and Its Implications for Preventive Public Health. Int J Environ Res Public Health., 12(5). Retrieved from (link)
 Selhub J. (Jun 2008). Public health significance of elevated homocysteine. Food Nutr Bull., 29(2 Suppl). Retrieved from (link).
 Morris MS, et al. (May 2008). Plasma pyridoxal 5′-phosphate in the US population: the National Health and Nutrition Examination Survey, 2003–2004. Am J Clin Nutr., 87(5). Retrieved from (link).
 Tucker KL, et al. (Feb 2000). Plasma vitamin B12 concentrations relate to intake source in the Framingham Offspring Study. American Journal of Clinical Nutrition, 71(2). Retrieved from (link).
 Bree A, et al. (2004). Evidence for a protective (synergistic?) effect of B-vitamins and omega-3 fatty acids on cardiovascular diseases. European Journal of Clinical Nutrition, 58. Retrieved from (link).
 Severus WE, et al. (Nov-Dec 2001). Omega-3 fatty acids, homocysteine, and the increased risk of cardiovascular mortality in major depressive disorder. Harv Rev Psychiatry., 9(6). Retrieved from (link).
 Alpers DH, et al. (May 2013). Gastric intrinsic factor: The gastric and small intestinal stages of cobalamin absorption. A personal journey. Biochimie, 95(5). Retrieved from (link).
 Toh BH, et al. (Nov 1997). Pernicious Anemia. New England Journal of Medicine, 337. Retrieved from (link).
 Lam JR, et al. (Dec 2013). Proton Pump Inhibitor and Histamine 2 Receptor Antagonist Use and Vitamin B12 Deficiency. JAMA, 310(22). Retrieved from (link).