B12: A Very Important Vitamin

The significance of maintaining sufficient levels of Vitamin B12

B12 is a very important vitamin which is required for the function of the nervous system; our red blood cells; and our DNA. Therefore, if you are on a low animal-protein, or a vegetarian, vegan diet, you have to be aware that you need B12 supplements.

When B12 levels drop too low in the blood, it can lead to anemia and symptoms of extreme fatigue, palpitations, and dizziness. However, you can have borderline low levels of B12 and develop some symptoms that are often overlooked or addressed with treatments that don’t resolve the issue. All sorts of neurological and cognitive symptoms can occur with B12 deficiency, including mood changes and memory loss. It can sometimes be mistaken with depression or anxiety and treated with anti-depressants which have side effects and may delay the treatment of B12 insufficiency.

B12 levels are often tested in conventional medicine when the red blood cells are low and there is a diagnosis of anemia. I believe everyone should be tested for B12 levels at least once a year as a preventive measure.

What is Vitamin B12?

Vitamin B12 is a water-soluble vitamin that is mainly found in meat, poultry, eggs, fish, and dairy products. Vitamin B12 contains the mineral Cobalt, and it is often called “Cobalamin”, which comes in different forms. Methylcobalamin is the most active form of vitamin B12, and the one recommended in supplementation.

B12 needs to be processed by the GI system in order to be absorbed into our blood stream and our cells. We need to have enough gastric acid in the stomach and enzymes in our gut to process it. Often acid levels are low in the stomach, either due to natural decline with age, or the use of anti-acids. Also stress affects gut function and inhibit enzyme activity in the gut, which may cause low B12 levels even with a diet that is rich in animal proteins.

Because B12 absorption diminishes as we become older, supplementing B12 is a very worthwhile anti-aging measure. B12 is a water-soluble vitamin, meaning that it gets eliminated from the body easily in people with normal kidney function and therefore, it is safe to use it regularly.

Vitamin B12 Deficiency

Causes of vitamin B12 deficiency include:

• An autoimmune disease called Pernicious Anemia. Pernicious anemia is an autoimmune disease that to attacks on stomach cells that produce the “intrinsic factor”, essential for B12 absorption. Pernicious anemia is the most common cause of clinically evident vitamin B12 deficiency around the world.

• Surgery in the gastrointestinal tract. Surgical procedures in the gastrointestinal tract, such as for weight loss or to remove all or part of the stomach, can cause a complete or partial loss of cells that secrete hydrochloric acid and cells that secrete intrinsic factor. 

• Gastrointestinal disorders. Individuals with stomach and small intestine disorders, such as celiac disease and Crohn’s disease, may be unable to absorb enough vitamin B12 from food to maintain healthy body stores.

• Prolonged use of certain medications (e.g., metformin or anti-acids).

  Gastric acid inhibitors include proton pump inhibitors, and histamine 2 antagonists, which can also be found over the counter. These drugs are used to treat gastroesophageal reflux disease and peptic ulcer disease. They can interfere with vitamin B12 absorption from food by slowing the release of gastric acid into the stomach and thereby lead to vitamin B12 deficiency.

  Metformin, which is used as first-line treatment for prediabetes and diabetes, might also reduce the absorption of vitamin B12.

• Dietary deficiency from Vegetarian and Vegan diet, or low calorie intake, eating disorders,

• Helicobacter pylori. H. Pylori infection, possibly because this bacterium causes inflammation that leads to malabsorption of vitamin B12 from food.

Vitamin B12 deficiency can show in blood tests as low white and red blood cells counts, and platelets. It may cause extreme fatigue; palpitations; pale skin; dementia; weight loss; and even infertility. Neurological changes, such as numbness and tingling in the hands and feet, can also occur. These neurological symptoms can occur with borderline low levels of B12, so early diagnosis and intervention is important to avoid nerve damage. In addition, some studies have found that low levels of vitamin B12 can cause depression.

The symptoms of vitamin B12 deficiency can take several years to appear and that is why it’s important to check levels in the blood and start B12 supplements when they start declining.

Typically, vitamin B12 deficiency is treated with vitamin B12 injections, because this method bypasses any barriers to absorption. However, high doses of oral Liposomal B12 are also effective.

Infants of vegan women
Exclusively breastfed infants of women who consume no animal products might have very limited reserves of vitamin B12 and can develop vitamin B12 deficiency, sometimes very early in life. Sometimes, the mother’s own deficiency is clinically mild and not recognized. Undetected and untreated vitamin B12 deficiency in infants can result in neurological damage, failure to thrive, developmental delays, and anemia so it is very important to have B12 levels checked before and during pregnancy and the breastfeeding period.

Dietary supplements

Vitamin B12 is available in multivitamin/mineral supplements, in supplements containing other B-complex vitamins, and in supplements containing only vitamin B12. Multivitamin/mineral supplements typically contain vitamin B12 at doses ranging from 5 to 25 mcg. Vitamin B12 levels are higher, generally 50–500 mcg, in supplements containing vitamin B12 with other B-complex vitamins and even higher, typically 500–1,000 mcg, in supplements containing only vitamin B12.

The most common form of vitamin B12 found in dietary supplements is cyanocobalamin, but methylcobalamin is the most absorbable form especially for those with MTFHR mutations. A liposomal form of B12 may be as effective as B12 injections.

You can find our selected liposomal B12 at vibranthealth.highbe.org

In Vibrant Health, 

Dr. Evee

Evelyne Leone, DO, FAARM, ABBARM