What is Vitamin B-12?
Vitamin B is a group of 8 B -Vitamins that are water soluble, which means that these vitamins are soluble in water and the body only takes up the needed amount of these B vitamins and any excess amount is excreted through urine. Vitamin B-12, also known as Cobalamin, is one of them. Vitamin B-12 plays a very important role in the formation of red blood cells, DNA replication, and the formation of an insulating material around the nerve cells and proper functioning of the nerve cells.
What is different about the absorption of B-12 vitamins?
This very important vitamin is absorbed by the body from the food in a very complex series of events:
Mouth: Vitamin-B-12, which is not bounded by protein, gets absorbed under the tongue.
Stomach: Hydrocloric acid in the stomach separates B-12 from the protein to which it is attached in the food. B-12 then gets attached to R-protein, which is produced by the salivary gland of the oral cavity. This is necessary in order to protect the vitamin from stomach acid. The intrinsic factor, or IF, is secreted into the stomach.
Small Intestine: In the small intestine, the R-protein releases B-12 which is then picked up by IF and then carried into the bloodstream to the cells where it can be used and then stored in the liver.
What causes B-12 deficiency?
A person can be deficient in Vitamin B-12 under following conditions:
- Being a vegetarian can put a person at risk of having B-12 deficiency. This is due to the fact that B-12 is not found in any plant food.
- Taking an antacid, diabetic drugs like Metformin, anesthetics used for sedation in dental, and surgical procedures like Nitrous-oxide can cause B-12 deficiency. Antacid medications usually work on reducing the acid in the stomach. Stomach acid is required to separate B-12 from the protein to which it is attached. In the absence of this acid, B-12 is not absorbed by the body, resulting in B-12 deficiency.
- People with various gastro-intestinal diseases like Chron’s, colitis, diverticulitis, celiac disease, and the presence of worms in the intestine can cause B-12 deficiencies.
- People who have weight-loss surgeries to have part of the stomach or small intestine removed may develop B-12 deficiencies.
- Production of stomach acid reduces as we age, making older people more susceptible to a condition called atrophic gastritis. This condition causes thinning of stomach lining.
- Bacteria like H. pylori damages the lining of the stomach and its ability to produce the intrinsic factor also known as the stomach acid. Sometimes a person may have this bacteria present in the gut and have no symptoms at all. Presence of H. pylori can affect the absorption of B-12 vitamin.
- People with eating disorders like bulimia or anorexia.
Symptoms of Severe B12 Deficiency:
- Chronic fatigue
- Shortness of breath
- Tingling sensations or numbness in arms, toes or fingers
- Cognitive dysfunction including confusion, forgetfulness, brain fog.
- Mood swings
- Feeling unmotivated
- Pernicious anemia
- Rapid heartbeat
- Red, inflamed and sore tongue
- Bruising easily
- Decreased blood clotting
- Gum bleeding
- Yellowing of the skin
- Trouble maintaining balance while walking
Foods High in B12:
- Dairy products
- Fortified Cereals and Energy bars
- Whey protien
- Fortified Tofu and soy milk
- Supplements like nutritional yeast. Do note that though brewers yeast contain other B vitamins, it does not contain vitamin B-12.
How do you know if you have B-12 deficiency?
Because the body stores up to 6 years of B-12 and 3 to 6 months of folate in the liver, deficiency of Vitamin B-12 might not show up until after several years. If you have any of the symptoms mentioned above or the conditions which might make you susceptible to lowered B-12 levels, it is always better to talk to your healthcare provider and get tested for B-12 levels in the blood. Early detection and treatment are the keys to prevent irreversible damage to brain and nervous system. Two tests that are commonly done to find the B-12 deficiency are homocysteine (Hcy) and methylmalonic acid (MMA). MMA is considered a more specific test of B-12 deficiency. If the reason for B-12 deficiency is not obvious, other tests may be required such as, intrinsic factor anti-body measurement to detect pernicious anemia, and B-12 malabsorption and deficiency. Pernicious anemia is an auto-immune disease that destroys the cells in the stomach lining that produces the intrinsic factor. High levels of folate can also mask B-12 deficiency. To prevent this from happening, NIH recommends that the folic acid intake from foods and supplements should not exceed 1000 mg daily for healthy individuals. In the U.S normal range of B-12 vitamin is between 200 pg/mL and 350 pg/mL. But some experts consider that this reference range is too low and people with less the 450 pg/ml should be treated with B-12. At the same time in Japan and Europe, the lower limit for B12 is between 500-550 pg/mL which according to some experts explains the low rates of dementia and Alzheimer’s in these countries.
Treatment for people with B-12 deficiency:
Treatment of B-12 deficiency greatly depends on the cause of the deficiency. This treatment may include supplements which is available in the form of pills, sub-lingual orally disintegrating tables, oral spray, shots, and also metered nasal spray which might be available through a physician’s office. Some people may need a lifetime supplementation of Vitamin B-12. People who are in need daily supplement of vitamin B-12 are:
- Vegan and vegetarians
- People with pernicious anemia
- People over the age of 50
- People with digestive problems like low stomach acid or celiac or Chron’s disease
- Women who are pregnant or nursing
- People with dementia or Alzheimer’s
- People on certain prescription medications like PPI or diabetic drugs.
- Children with autism
- People taking too much folate.
- People with liver disease.
B-12 deficiency is very common and often misdiagnosed as pre-existing diseases and co-morbid conditions. At the same time, current B-12 serum levels for normal is too low. So if you suspect that you may have any of the above discussed conditions, talk to your doctor and get tested for B-12 levels.
Image credit: conceptw / 123RF Stock PhotoDISCLAIMER: The contents of this website is provided for informational purpose only and is not intended as a substitute for professional or medical advice. Do not use the information on this website to diagnose or treat any medical or health condition. If you suspect that you have a medical problem, contact your professional healthcare provider.