Summary

B12 is an essential vitamin found in organ meats, seafood, and diary products. This vitamin is also synthesized by bacteria (including those in your gut), fungi, and algae. Therefore, one vegetarian option is Saccharomyces cerevisiae, a form of nutritional yeast. The caution with this option is that the dosage needed for adequate B12 absorption is not consistent and a high quality product of this yeast is hard to obtain. Some plant sources such as Tempeh, miso, and sea vegetables have been reported to contain vitamin B12, but they are not a reliable source. For this reason, strict vegans and vegetarians need to be careful that they obtain enough Vitamin B12.

Here is just a short list of the important functions of vitamin B12:

v It works with folic acid to aid in the formation of red blood cells & absorption of iron

v It is involved in energy metabolism (the Kreb’s Cycle) in the mitochondria

v In a coupled reaction, methylcolbalmin (coenzyme of B12) helps to convert folate to tetrahydrofolate which is used in making genetic proteins for DNA and cyanocbalamin (free vitamin B12) assists in transforming homocysteine to methionine

v It assists with the oxidation of fatty acids

v It is important for Nervous system function and is involved with the formation of the myelin sheath

v It is important for female reproductive health

v It has been linked to emotional health and memory skills (probably due to its relationship with iron and folate in the production of serotonin)

v B12 is a precursor to many pathways in the body, including melatonin

Dr. Mercola recently posted an article on vitamin B12. It contains some interesting facts on the vitamin (along with a product advertisement, which I haven’t used clinically so I can not endorse it).

I will be discussing Vitamin B12 in more detail and share you with you some interesting facts and symptoms of a B12 deficiency. This will explain why I am diligent in requesting blood work to assess vitamin B12 status. I will also highlight some updates on Vitamin D.

My comment:

Even if one is not a vegetarian or vegan, it is still hard to obtain enough vitamin B12 from diet alone. This is due to the increased consumption of processed foods, additives, and caffeine. The RDA for Vitamin B12 is 2.4 ug/d for adults, but please remember that the RDA is only the amount needed to prevent disease occurrence from a deficiency syndrome. It is not a recommendation for optimal health intake and vitality. Most people are obtaining their B12 from enriched, processed sources. This is not the optimal form for body composition and general health.

Another reason for deficiency of vitamin B12 is due to digestive disorders. With aging, digestive enzymes decrease along with absorptive capacity, so B12 status will also decline. Digestive issues of the stomach, such as heartburn or ulcers, also cause a decline in vitamin B12. Here, the body will not produce enough of intrinsic factor, the protein needed to bind to and absorb vitamin B12 for assimilation into the small intestine.

Other causes of decreased B12 absorption include: absence or surgical removal of the ileum or stomach, bacterial overgrowth of the small intestine, chronic mal-absorption syndromes, tapeworm, and medications including: anti-ulcer medications, diabetic medications, nitrous oxide, birth control, chemotherapy, and antibiotics (especially tetracycline).

Deficiency Symptoms:

Severe:

1. Depression:

I recently gave a lecture to health care practitioners on drug-nutrient interactions. While researching for this seminar, I found an interesting link between vitamin B12 and depression straight from the Merck manual. Here is what it said: Irritability, mild depression to “paranoia (megaloblastic madness), delirium, confusion. “ The confusion may be difficult to differentiate from age-related dementias, such as Alzheimer’s disease.”

Side note: megablastic anemia is the term for B12 deficiency hence megaloblastic madness (sounds like a punk-rock band!J)

2. Liver and spleen enlargement and various digestive disorders

3. Severe neurological symptoms (develop independently from and often without blood abnormalities)

Other symptoms:

Mood imbalances

Digestive disturbances

Fatigue

Low uric acid

Diabetes

Trouble sleeping

Problems with memory

Skin issues such as cracks around the mouth

Therefore, I am diligent in requesting blood work for my patients to assess vitamin B12 status, especially in vegans. One of the basic tests for B12 is a simple CBC with differential panel; this can be done with routine blood work. I have found that this assessment tool is being underutilized.

I assess through correlation of labs and clinical symptoms if client needs additional vitamin B12 supplementation beyond their chief complaint protocols. I have found a few sublingual B12s to be very effective for vegetarians and vegans. There is also a whole food supplement called cataplex B12 that contains intrinsic factor, which is very useful for my older clients. It’s also important to remember that you should never just supplement with B12 alone, folate must also be taken along with it, either in a multivitamin or in combination if high doses of B12 are being used.

As always, if you have any questions related to whether you could benefit from additional vitamin B12, feel free to contact me and set up a consultation or a referral. I’d be happy to help you improve your health to my best ability.

For the Latest News on Vitamin D and Cancer:

http://www.saratoga.com/living-well/2009/08/