Understanding what vitamin B12 does and why is important is critical in understanding the absolute need for the vitamin. Equally important is understanding the causes and symptoms of a B12 deficiency as well as understanding how to get the vitamin through diet or supplementation and why B12 deficient patients are sometimes misdiagnosed even today.
Vitamin B12 is the largest and most complex vitamin molecule and it is also an essential vitamin for normal human growth and development. It is the only vitamin with a mineral element, cobalt, which is why it is called cobalamin.
When B12 is ingested a protein called intrinsic factor binds with the vitamin and is converted to methylcobalamin in the liver which is then used in blood and nerve cells.
The vitamin is quite difficult to metabolize and absorb so adequate B12 consumption is key.
The Role of Vitamin B12
Vitamin B12 has many critical rules in the human body and not consuming enough B12 or having an underlying condition can lead to many short and long term health problems.
An adequate level of vitamin B12 is needed for:
• Making genetic material (DNA) within cells
• Protecting the myelin sheath around nerves cells, keeping them healthy
• Forming healthy red blood cells and also allowing them to divide normally
• Odd chain fatty acids require B12 to properly metabolize
• B12 (along with Glutathione and Folate) is required for liver detoxification
• Homocysteine is a greater predictor of heart disease than cholesterol; low levels of vitamin B12 can increase homocysteine levels
B12 Deficiency Risk Factors
There are a number or potential causes of a vitamin B12 deficiency, many of these can be solved by normal supplementation and a diet with adequate protein consumption from meat, eggs and dairy products.
There are a number of issues that can cause a B12 deficiency.
• Inadequate B12 consumption, vegans and vegetarians are often at risk if they do not find a way to supplement their B12 intake. There are an estimated 7.3 million vegetarians in the US which can be at risk if they are not taking precautions
• Intrinsic factor is a protein that is required to effectively use vitamin B12, anyone deficient in intrinsic factor is at risk for a deficiency
• Malabsorption is simply a hampered ability to digest food products. B12 is one of the more difficult vitamins to absorb so someone with malabsorption issues can face a deficiency
• Low stomach acid disrupts the ability to properly digest food. This is common as we age (50+) as well as in people who take either prescription or over the counter acid blockers such as Tums or Rolaids etc…
• Bowel surgery
• Stomach and Gastric surgeries
• Chron’s disease
• Metformin is a diabetes medication that disrupts B12 absorption
• Bacterial overgrowth in the stomach
• Lyme disease
• Nitrous Oxide
B12 Deficiency Symptoms
There are actually more risk factors for a B12 deficiency so being able to recognize symptoms are key in getting the correct treatment and/or diagnosis.
Some of the symptoms present themselves early and others are late indicators of a deficiency in any case it is important to understand some of the warning signs, which are often attributed to other diseases or conditions which results in patients being misdiagnosed and given the wrong treatment.
• Blurry Vision
• Tingling in fingers or toes
• Mood swings, Irritability
• Hair loss, dry skin
• Weakness, stiffness in muscles
• Frequent headaches
• Incontinence of the bladder or bowel
• High Alcohol Intake
• Allergies to Meat products
There are some handy forms online that might be able to help determine if you MAY be suffering for a B12 deficiency, you can find one such form here.
Diagnosing a B12 Deficiency
There are a number of tests that are available that can help diagnose a vitamin B12 deficiency, some are common and others not so common. There are also some issues with some of the ways some Doctors may be diagnosing the issue.
For example when someone is B12 deficient their actual blood cells may appear larger than normal, when a Doctor recognizes that they usually recognize the deficiency immediately. The problem is the enlarged red blood cell is a late stage sign of a deficiency and Folate as well as an iron deficiency can shrink red blood cells which would normalize the size.
Most grain type foods are fortified with Folate (B9) therefore anyone eating cereal, bread and other grains will likely not show any red blood cell enlargement. A high level of folate in conjunction with a low B12 level can increase the damage caused by a deficiency vs a deficiency alone.
Another issue is the RDA (recommended daily allowance) may be out of date or just incorrect.
A commonly used clinical cut-off for low vitamin B-12 status is 148 pmol/L the problem is that symptoms of a B12 deficiency have been found in people at that level or above. In fact symptoms of a B12 deficiency has been found in people with blood plasma levels as high as 258 pmol/L.
Requesting Blood Tests
If your doctor will only do a Full blood count request:
• Vit D status
• Full vitamin panel if possible
If told you do not have B12 deficiency – request a referral for the Active B12 test. Your
local insurance company may not provide the funds for this, so you may have to pay for this
yourself. Alongside the Active B12 test, request homocysteine and MMA levels be
checked. Note: Once supplementation has started it is not worth having these tests
done as supplementation will skew results.
There are a number of other diseases that are frequently diagnosed when the issue was a an easily treatable and inexpensive B12 shots.
• Multiple sclerosis
Unfortunately sometimes catching the B12 deficiency late can result in permanent damage and in worst case scenarios, even death.
Vitamin B12 Supplementation
For the most part if you are eating an appropriate diet and you do not have any risk factors associated with a B12 deficiency then you are probably getting enough B12 to function normally.
On the other hand if you have absorption issues, pernicious anemia, are on the wrong medications, drink too much or suffer from any other condition that hampers absorption then you should consider vitamin B12 supplements to boost levels of B12.
An oral vitamin is sufficient for most but if the cause of the deficiency is a lack of intrinsic factor or other digestive problems then the only way to get the correct level of B12 is to take a vitamin B12 shot.
B12 shots are readily available, easy to do and relatively inexpensive. Another important note is the World Health Organization (WHO) has not established an upper limit of B12 dosage. This means there is very little risk of toxicity when taking B12 and in fact victims of smoke inhalation are often treated with doses of B12 as much as 5000 times higher than what a single shot of B12 would contain.
Vitamin B12 deficiencies may be far more common than we realize, according to the Framingham research study (which studied 3000 people) they estimate that perhaps 40% of people are at or below the “low normal” range of 258 picomoles per liter, a level which still shows signs and symptoms of damage commonly associated with B12 deficiencies yet still above the suggested blood plasma level of 148 picomoles per liter. With the ease of getting the vitamin, the low cost of the vitamin there is no reason anymore not to add a supplement and if deficient to introduce a B12 shot schedule to your protocol.