Vitamin B12 – are you deficient?
I was going to write about all the B Vitamins this week, but realized pretty quick that that would be WAY too involved for such a short post. So B12 it is, since it is the one in particular in which many people are deficient. Vitamin B12 deficiency comes in two forms – the more rare autoimmune problem which attacks the stomach cells and causes pernicious anemia, a potentially deadly blood disorder in which the red blood cells are immature, very large, and don’t carry oxygen well, or the more common inability to absorb food-bound B12. Unlike the other B vitamins in which excess is secreted daily in the urine, B12 is stored in the liver, so it may take a few years before symptoms of B12 insufficiency show up.
Vitamin B12 (also known as cobalamine) along with folate, is inversely related to homocysteine levels, and high homocysteine levels are not only associated with depression, but are much more closely related to cardiovascular disease than cholesterol is. More and more studies are backing up the idea that bringing B12, B6 and folate levels back up to optimum reduces homocysteine levels, arterial inflammation, and heart disease. I go back again to the fact that at around 1900 there was virtually no heart disease. Since that time we have lowered our intake of nutrient-dense foods (particularly quality meats and organ meats) and raised our intake of nutritionally-deplete processed foods. Drugs are not going to fix this problem, but eating nutrient-dense, quality food will.
B12 deficiency mimics the symptoms of Alzheimers, and some studies seem to indicate that bringing B12 levels back up to optimum can go a long way to improving memory in those with early cognitive decline. If the deficiency has gone on too long, nerve damage may result, and at that point B12 supplementation won’t help. Nerve symptoms such as tingling and numbness in the legs and arms, difficulty walking, and disorientation in addition to memory loss can occur, and a persistent insufficiency of B12 may eventually damage the myelin sheaths of the nerves. Gut function is frequently compromised with age, which may be why B12 deficiency is extremely common in those over 60, as are symptoms of dementia and cardiovascular disease, not to mention osteoporosis and hearing loss. Vitamin B12 plays a role in all of those issues, in addition to depression, asthma from sulfite sensitivity, low sperm count, diabetic neuropathy, shaky-leg syndrome, bells palsy, tinnitus, hearing loss, among others.
So why is B12 deficiency so common? The molecule is huge, and is very hard to absorb due to the many steps required in the process. So, if for any reason, one’s body does not have enough hydrochloric acid (very common), pepsin (the enzyme that breaks down protein), pancreatic enzymes, calcium, adequate good gut bacteria (take probiotics after antibiotics!!) and an enzyme called “intrinsic factor”, then B12 cannot be absorbed by the gut, even if it is consumed in adequate amounts.
Which brings me to the other reason many of us are deficient. The best food sources of Vitamin B12 are liver and kidneys, and unfortunately, those foods have pretty much disappeared from our plates. (I’m thinking I should write a cookbook – 100 Delicious Ways to Cook Organ Meats” – what do you think?) There are small amounts of B12 in dairy products, but it is exceedingly difficult for vegetarians to obtain adequate B12 from a plant-based diet. Furthermore, due to the fact that vegetarians tend to eat a diet high in green leafy vegetables, (a good thing!), they consume a great deal of folic acid or folate, and high amounts of folate decreases absorption of B12 even further.
And many medical drugs interfere with B12, especially those used to treat GERD, acid reflux, and peptic ulcers which decrease stomach acid in the gut (proton pump inhibitors like omeprazole and lansoprazole, and H2-receptor antagonists like Tagamet, Pepsid, Zantac). Other types of drugs that are problematic are cholestyramine, a drug to treat high cholesterol, metformin, a drug used to reduce blood sugar in type 2 diabetics, hloramphenicol and neomycin (antibiotics), and colchicine (anti-gout medicine).
Therefore, due to the lack of food sources, the problem with interfering drugs, and the poor absorption issue, especially for vegetarians, B12 supplementation is quite necessary. Monthly B12 shots or daily sublingual supplementation are the methods used, in order to successfully get the B12 into the bloodstream. Many people notice a significant boost in energy levels once supplementation has commenced. 2.8 mcg per day should cover the requirement for most people.
I think that B12 blood levels should be tested as part of a routine annual check-up, as so many problems would be avoided if low levels of this vitamin were treated.
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Linus Pauling Institute: Micronutrient Research for Optimum Health Vitamin B12
Sally Fallon and Mary Enig, PhD Vitamin B12: Vital Nutrient for Good Health Weston A. Price Foundation
Robertson J et al. Vitamin B12, homocysteine and carotid plaque in the era of folic acid fortification of enriched cereal grain products. CMAJ 2005 Jun 7;172(12):1569-73.
Ray JG et al. Persistence of vitamin B12 insufficiency among elderly women after folic acid food fortification. Clin Biochem. 2003 Jul;36(5):387-91.
Ray JG et al. An Ontario-wide study of vitamin B12, serum folate, and red cell folate levels in relation to plasma homocysteine: is a preventable public health issue on the rise?. Clin Biochem. 2000 Jul;33(5):337-43.
Sumner AE et al. Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. Ann Intern Med. 1996 Mar 1;124(5):469-76.
Selhub J et al. In vitamin B12 deficiency, higher serum folate is associated with increased total homocysteine and methylmalonic acid concentrations. Proc Natl Acad Sci U S A. 2007 Dec 11;104(50):19995-20000. Epub 2007 Dec 4.
Rush EC et al. Dietary patterns and vitamin B(12) status of migrant Indian preadolescent girls. Eur J Clin Nutr. 2007 Dec 19 [Epub ahead of print]
Bhat AS et al. Psychiatric presentations of vitamin B 12 deficiency. J Indian Med Assoc. 2007 Jul;105(7):395-6.
Coppen A et al. Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol 2005 Jan;19(1):59-65.
Kamphuis MH et al. Dietary intake of B(6-9-12) vitamins, serum homocysteine levels and their association with depressive symptoms: the Zutphen Elderly Study. Eur J Clin Nutr. 2007 May 30 [Epub ahead of print]
Osimani A et al. Neuropsychology of vitamin B12 deficiency in elderly dementia patients and control subjects. J Geriatr Psychiatry Neurol. 2005 Mar;18(1):33-8.
Malaguarnera M et al. Homocysteine, vitamin B12 and folate in vascular dementia and in Alzheimer disease. Clin Chem Lab Med. 2004;42(9):1032-5.
Dimopoulos N et al. Association of cognitive impairment with plasma levels of folate, vitamin B12 and homocysteine in the elderly.Association of cognitive impairment with plasma levels of folate, vitamin B12 and homocysteine in the elderly. In Vivo. 2006 Nov-Dec;20(6B):895-9.
Kitchin B et al. Not just calcium and vitamin D: other nutritional considerations in osteoporosis. Curr Rheumatol Rep. 2007 Apr;9(1):85-92.
Copyright 2007 Vreni Gurd
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Mary said,
January 20, 2008 @ 2:59 pm
Definatley a cookbooki Vreni…..maybe only one section on organ meats..YUK!!!
How much B12 should I take?
Vreni said,
January 20, 2008 @ 3:24 pm
Hi Mary!
I guess I better learn how to cook before writing a cookbook, eh??
I think 2.8 mcg per day is enough, but the supplements (drops, sublingual tablets) have considerably more than that in them (250mcg). As far as I know there is no unsafe upper limit, so increasing stores should not be a problem.
Hope that helps!
Vreni 🙂
Ann Marie said,
January 22, 2008 @ 11:27 am
I would buy that cookbook!
I was just reading The Body Ecology Diet last night and she said that kefir and kombucha and other fermented foods are rich in B vitamins — and they help the body absorb it.
Ann Marie
Elisabeth Illes said,
March 29, 2008 @ 1:32 pm
Your website would be terribly informative if ALL the letters were to be BLACK. I have poor eyesight and have to read the information with a magnifying glass! If you didn’t know, the older generation also likes to get information!
Thank you
Vreni said,
March 29, 2008 @ 3:22 pm
Hi Elisabeth,
Thanks for your suggestion. The coloured letters are links to other posts or websites, but perhaps I can look into a darker colour for those links. I believe you can make the type larger on your browser, which may also make it easier to read. Once I know how, I’ll get back to you. Go into view, text size and change the text size to a larger size. If you use Firefox press control plus to increase the text size.
I hope that helps!
Ashish said,
July 11, 2008 @ 2:26 pm
Elisabeth and other older generation folks,
if you are using Microsoft’s Internet Explorer as the browser, do the following to increase the text size of the letters on the page:
Click on “view” and you’ll see a list of options.
Take the cursor to “Text Size” and then select “Larger” or “Largest”
You’ll see the the size of the text has become large and is easily readable.
Enjoy reading…
Ashish
Glenn said,
July 16, 2008 @ 8:59 pm
Thanks for the info…I have the tingling and loss of feeling in outer extremities. I am taking orally b12 pills and waiting to see a good doctor after living in the carribean for two years. I also have very high cholesterol and blood pressure so i guess we’ll see.
pam said,
September 21, 2008 @ 10:45 pm
I would like to know if i take B12 12 mcg daily. I am mid 40’s and feel tired all the time. Please suggest if its ok and how long.
Vreni said,
September 22, 2008 @ 9:33 am
Hi Pam,
Inability to absorb B12 from your food may be a reason you are tired, especially if you do not eat meat. There are all kinds of other reasons that may be at the root of your fatigue too, like poor adrenal function and low thyroid for example.
I’d try the B12 and see if it helps. Also make sure you get a good 8 to 9 hours of sleep and dark time a night to help your body heal. If those measures don’t help, perhaps look into getting a circadian saliva hormone test done to see what your cortisol and thyroid hormones are doing during your day. If you can’t find a functional medicine doctor in your town that can do this, contact Biohealth Diagnostics in San Diego. You can do a lot of this through the mail.
Hope that helps!
Vreni
Jane said,
September 30, 2008 @ 7:31 pm
Excellent info on Vitamin B12 – being a vegetarian i have realised that after symptoms of dizziness and fatigue it could well be attributed to low B12 levels.. thanks ! Obviously iam not keen on the how to cook organs cookbook! sorry!
clint said,
July 16, 2009 @ 11:27 am
my B12 levels are at 92, and im on 1000 mcg weekly, im only 25 and want to know if my poor work and social drive will improve as time progresses with my injections?
Sharon Moore said,
October 14, 2011 @ 4:00 am
“B12 deficiency mimics the symptoms of Alzheimers, and some studies seem to indicate that bringing B12 levels back up to optimum can go a long way to improving memory in those with early cognitive decline.”
Yes, one main symptom of vitamin B12 deficiency is Alzheimers, others are hair loss, depression and many other. My son have the symptoms hair loss and depression then my doctor friend told me to use this http://products.mercola.com/vitamin-b12-spray/ and as of now he’s really good.
foot misalignment said,
November 27, 2013 @ 11:19 pm
Thanks for sharing your thoughts on Vitamin+B12. Regards