B12 deficiency is common due to its unique requirement for absorption. All vitamins are either water soluble, meaning they absorb along with water when taken orally, or fat soluble meaning that they absorb along with the digestion of dietary fat. Vitamin B12 is the exception. This vitamin is unique in that it will not be absorbed unless it is bound to intrinsic factor, a molecule secreted in the stomach from the same cells that produce hydrochloric acid.
Hydrochloric acid production often diminishes with age, and this decline aggravated by overconsumption of acid blockers make B12 deficiency a widespread health concern that typically goes undetected. Many think that B12 deficiency is a concern of the elderly, however the Framingham Offspring Study revealed that people over the age of 26 show just as much likelihood for B12 deficiency as those 65 and older.
Vitamin B12 is the largest and most structurally complicated of all vitamins. Humans and animals cannot make their own B12; it has to come from a carnivorous meal. There are three forms of B12: cyanocobalamin, hydroxocobalamin and methylcobalmin. Hydroxocobalamin, produced from bacteria, is what we get from our diet. Rich food sources of vitamin B12 include: fish, shellfish, meat (especially liver), chicken, cooked eggs, milk products and termites if you are so inclined.
There is a pseudo-B12 that can be found in certain food such as algae, seaweed, Spirulina and barley but is not a form usable by the body. Gut bacteria can synthesize some B12, but it is not enough for the whole body. This is why vegans need to supplement to get enough B12.
Standard blood tests for serum B12 are unreliable because serum B12 does not accurately reflect intracellular concentrations. Elevated serum Methyl Malonic Acid (MMA) levels are a better indicator of B12 status because this occurs only if there is a B12 deficiency. I don’t usually do this type of test because improvement of symptoms with B12 supplementation is the best test.
B12 injections are essentially painless and provide nearly 100 percent delivery by by-passing the digestive system. If there is insufficient intrinsic factor, as with pernicious anemia, or other digestive absorption issues then injections are indicated. The frequency will depend on the individual’s health history.
Cyanocobalamin injections are the least expensive; however they are synthetic, contain cyanide, and not very effective. Hydroxocobalamin is a natural form of B12 that works well providing many benefits. The most effective form of B12 is methylcobalamin. This is the active form of B12 that the body uses in hundreds of metabolic pathways. It is the fastest and longest acting form of B12 and is especially beneficial for the nervous system.
When supplementing with a therapeutic dose of B12 on a regular basis it is important to also get extra Folate (5MTHF) either in a multiple vitamin, B complex, injection or by itself. The reason is that B12 supplementation may mask a Folate deficiency anemia on blood tests. By supplementing with Folate (5MTHF) this is not a concern. As Folate is water soluble like all the other B vitamins except B12, an oral supplement works very well, from 100-1,000mcg daily. For further information on Folate (5MTHF) & Folic Acid, see my website newsletters: Folic Acid and Methylation.
People with allergy to cobalamin should not take B12, and people with Leber’s optic disease need to consult their physician before taking supplemental B12. B12 supplementation beyond what you’d get in a typical multiple vitamin formula for infants, toddlers, pregnant and lactating women should also be accompanied by a physician’s guidance. For all others, at even high doses, oral B12 has no side effects. B12 injections have minimal side effects beyond occasional bruising and rarely, redness, swelling and itching.
People usually experience an improvement from a B12 shot within a few hours, however for some it may take a day or two with benefits lasting a few days to a month depending on levels of stress and state of health. Most people who need B12 will get a positive response with the first shot. If not, adding 5MTHF, the active form of folate, will often bring good results.
I hope you have enjoyed this month’s newsletter. As always, feedback and comments are welcome.
Jon Dunn, ND
B12 provides energy, clarity of mind and memory, enhanced sleep, mood, immune system, physical stamina and aides in weight management.
B12 supplementation is to be considered with neurologic disorders such as neuralgia, multiple sclerosis, Parkinson’s disease, and in some cases can correct mania and psychosis. Studies have shown that seniors with low B12 are six times more likely to exhibit brain atrophy than those with higher levels of B12. Deficiency of vitamin B12 can lead to irreversible brain and neurologic damage. Adequate levels of B12 in the body are essential for proper function of DNA and RNA, the building blocks of every cell in our body.