B12: Are You Getting Enough?

B12Many people in the United States suffer from what very well could be a vitamin deficiency. In fact it wouldn’t surprise me at all. With the food supply seriously lacking in essential nutrients and minerals it isn’t a surprise at all that people are having issues with things like lethargy, anxiety and depression, and even disorders such as Alzheimer’s. These are just a few problems associated with B12 (cobalamin) deficiency. So lets talk about it shall we?

B12 is a vitamin responsible for healthy nerves, blood cells, DNA production….essentially stuff to keep you alive. B12 is available in many foods including but not limited to; shellfish, liver, fish, meat, eggs, and dairy. It is very noteworthy that plant products don’t have significant amounts of B12. Don’t be fooled by claims that state otherwise. Many of these foods are fortified with B12, but don’t have it naturally occurring or at very small amounts. And the foods that do, like seaweed, have pseudovitamin B12, which competes for absorption with regular B12. [1] One exception may be green and purple lavers, a type of algae. [2]

This is corroborated by studies that show that vegetarians and vegans are 50% and 80% deficient respectively. [3,4]

If you choose to not eat any animal products whatsoever, you need to supplement. More about that in a minute.

As mentioned above, B12 is really important for certain functions in the body. One problem associated with low B12 is many people don’t even know they are deficient. Working in a clinic I do see lab tests a lot, mostly for CBC’s and Cholesterol or A1c’s for diabetics. I don’t see B12 tests unless the doctor suspects something like anemia. But if there is neurological dysfunction, I don’t see it. The point is that since it isn’t something routinely checked for, it gets missed.

As Chris Kresser pointed out in an article:

In Japan and Europe, the lower limit for B12 is between 500-550 pg/mL, the level associated with psychological and behavioral manifestations such as cognitive decline, dementia and memory loss. Some experts have speculated that the acceptance of higher levels as normal in Japan and the willingness to treat levels considered “normal” in the U.S. explain the low rates of Alzheimer’s and dementia in that country.” [5]

The normal reference range in the USA by comparison is 247-911 pg/mL. That’s like the Rockies, one big mother range.

On top of that, a good deal of the population may have deficiency. [6] According to this study as many as 2/5 of America may have a problem. That’s around 125,000,000 people. While not everyone with deficiency show signs, it is still disconcerting. The article which I linked said that there was nothing to worry about though because we can get adequate B12 from more dairy and fortified cereals…..

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Modern dietary advice giving us the only reasonable response.

Modern dietary advice giving us the only reasonable response.

Yeah because hey, fortified cereals are where it’s at nutritionally.   ……NOT!

Make no mistake, the addition of niacin to the US flour supply was probably one of the very few smart things the federal government was able to do to actually influence in a POSITIVE manner the population’s health. By helping people get enough niacin they were able to eliminate pellagra, a very serious condition that resembles schizophrenia. The problem with fortified cereals are the only nutrition you get from them are the spray on vitamins. That might be helpful for some, but meat or liver or fish is probably the much better option.

Another issue is that people experience symptoms even when their levels on are on the lower end of “normal”. It’s entirely possible that our range, like many other medical ranges may be off and probably needs to be increased.

Lets Talk About Absorption Baby, Lets Talk about You and Me!

If you don’t remember back or are new to the blog, a few weeks ago I discussed the adverse effects of taking acid reducers chronically. Here’s the link:

https://pharmacybrute.wordpress.com/2013/12/10/acid-supressing-drugs-lower-nutrients/

Acid in the stomach is an important part of the process to get B12 absorbed in the body. Acid cleaves B12 from the carrier it resides on so that it can be attached to intrinsic factor, allowing for absorption. No acid, no cleavage, no absorption. Other drugs can cause problems too. If you’re diabetic, metformin is known to reduce not only B12 but the other B vitamins as well.

People that have leaky gut or other inflammatory processes going on in the gut may have impaired absorption as well. Don’t assume just because you are a meat eater you’re getting all the B12 you need. Fixing your gut is important for many reasons and B12 is definitely one of those reasons.

Pernicious Problems

If you have problems with energy and have been able to rule out blood sugar dysregulation and sleep as potential problems, B12 might be a great place to look. People with anemia can have B12 or iron deficiencies. Since B12 is also required for myelin sheaths (the insulation on the nerves) it is thought that it is important for prevention of neurodegenerative disorders such as Alzheimer’s and Multiple Sclerosis. It may also play a part in anxiety and depression as well as autism and learning disabilities in children.

Maternal breast milk has a content of B12 that is linked with intake from mom. So if a mom is a vegetarian or a vegan, it is extremely important that she supplement to get adequate supplies for the baby.

Supplementation

You can find B12 in just about any B-Complex. It typically comes in the form of cyanocobalamin. I want to point out that this form of cobalamin is linked with cyanide, hence cyanocobalamin. This form is usually injected at a doctor’s visit. Methylcobalamin on the other hand seems to be the form that is most useful, especially in neurological problems. [7] This is the form most used by the Japanese. In fact they don’t use cyanocobalamin anymore because it doesn’t work very well if at all.

The British also don’t use cyanocobalamin. They use hydroxocobalamin. In a paper addressing some concerns about cyanocobalamin, researchers point out that hydroxocobalamin is preferrable to cyanocobalamin and that it’s use should be discontinued. [8]

Cyanocobalamin, methylcobalamin and hydroxocobalamin are the most common forms.

So if you need it, what do you use? I would recommend methylcobalamin in the oral form. There are sub-lingual tabs which absorb and bypass the gut altogether:

http://www.amazon.com/Source-Naturals-MethylCobalamin-Flavored-Sublingual/dp/B001G7R8J2/ref=sr_1_2?ie=UTF8&qid=1334825392&sr=8-2

This would be a good option to start with if you use acid reducers or have gut problems. The one I listed is 1mg which is likely enough. For those fighting off peripheral neuropathies or trying for nerve regeneration much higher doses are likely required, as in doses used in injections.

I would stay away from cyanocobalamin if possible. I know it’s cheap and for a simple anemia where a low dose is effective then it might be ok. But to really maintain good health it’s better to use the other forms. Much like folic acid is synthetic and not naturally occurring folate, cyanocobalamin is cheap (yes I said cheap) and not as effective.

Get the best forms from your food. Fish, shellfish, meat, liver and dairy are good sources. If your gut is in need of help, get it the help it needs so you can get the B12 you need from food. If you are a vegetarian or vegan please make sure to get enough through supplements. I recommend food first of course.

CIAO

1.Watanabe, Fumio, et al. “Pseudovitamin B12 is the predominant cobamide of an algal health food, spirulina tablets.” Journal of agricultural and food chemistry 47.11 (1999): 4736-4741.

2.Watanabe, Fumio, et al. “Characterization and bioavailability of vitamin B12-compounds from edible algae.” Journal of nutritional science and vitaminology 48.5 (2002): 325-331.

3.Antony, Aśok C. “Vegetarianism and vitamin B-12 (cobalamin) deficiency.” The American journal of clinical nutrition 78.1 (2003): 3-6.

4.Bissoli, L., et al. “Effect of vegetarian diet on homocysteine levels.” Annals of nutrition and metabolism 46.2 (2002): 73-79.

5.http://chriskresser.com/b12-deficiency-a-silent-epidemic-with-serious-consequences

6.http://www.ars.usda.gov/is/pr/2000/000802.htm

7.http://www.nutritionaltest.com/methyl.html

8.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697096/

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.

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Acid supressing drugs lower nutrients

A new study shows that proton pump inhibitors (PPI) may lower b-12 levels in people. B12 is important. It is needed for proper nerve function, brain function, and production of blood cells. The link to the news article is here:

http://well.blogs.nytimes.com/2013/12/10/acid-suppressing-drugs-linked-to-vitamin-b12-deficiency/?ref=health&_r=0

A scientific article published in 2010 looks at many studies that link PPI’s with decreased b-12, iron, magnesium and calcium. While the results of these were mostly from observational studies, which can’t prove causation, they are still worrisome when looking at overall health. 1

Personally the most troublesome to me is the decrease in magnesium in many of the patients studied. Magnesium (Mg) is important for many enzymatic reactions in the body and is essential for bone health. Mg is needed for the proper absorption of calcium in the body as well as regulation of the osteoblasts and osteoclasts, the cells primarily responsible for bone formation and resoprtion. 2

PPI’s work by inhibiting proton-pumps in gastric parietal cells. These pumps are the mechanism by which the stomach is able to produce acid and properly digest food. Many people that take PPI’s use them because of heartburn or GERD. By inhibiting stomach acid, reflux isn’t necessarily stopped, but since the pH of the refluxed food is higher because of lack of acid, it doesn’t hurt. GERD is a serious problem because it can cause an erosion of the esophagus and lead to ulceration or even cancer in severe cases. Neither is good. The problem of lack of nutrients over time, typically 2 years or more in the studies (depending on what nutrient you’re looking at), still hasn’t played out to really clear clinical consequences. Since many of the studies are observational and not randomized controlled trials, there are too many confounders that are present to conclude that these drugs cause problems long term or not. My own opinion is that anything that lowers critical minerals like Mg isn’t something that should be used forever.

If you feel like this, look to diet and stress before medications

If you feel like this, look to diet and stress before medications

Heartburn and GERD can be caused by many things. Stress, poor diet, and a lack of stomach acid are all very common. I know during my 4th year of pharmacy school when I was the most stressed I had horrible heartburn that wouldn’t go away. When I graduated however, it disappeared almost overnight. Stress reduction is a huge help not only for heartburn, but everything else as well.

Eating junk can also cause stomach problems. I’m not just talking about junk food, but what passes as more healthy food as well. Look for anything that has hydrogenated oils (trans fats) and eliminate them. They probably also have lots of refined grains which won’t be helping here either. Many breads, peanut butter and all kinds of other foods have trans fats in them and they really are harmful to health.

Some people have problems with fats. While I’m a proponent of healthy fats, unhealthy fats such as seed oils and other man made oils (canola, corn, soybean etc) are present in many foods. Check the ingredients on your bread and salad dressings, but these aren’t the only things. They are everywhere and while fat is important in the diet, these fats are not, and may be contributing to reflux. I would also note they are present in pretty much all junk food. For reals!

Artificial sweeteners and excessive carbs can also be problematic. I’m not against carbohydrate use, but excessive carbs, just like excessive anything else can cause problems. In a book by Norman Robillard, he cites evidence that undigested carbohydrate can cause hydrogen gas from gut bacteria which leads to reflux. 3

If you have an underproduction of acid, that can also cause reflux. The only way to know for sure is if you have your acid level tested with a device that is swallowed and then measures the acid levels. If you’re low you can supplement with HCl capsules and pepsin. This should be avoided in people with ulcers and those using medications like NSAIDs (ie aspirin, ibuprofen, naproxen).

I would try some of these if you’re having problems with acid reflux. Many times switching the diet up and reducing stress will go a long way in helping not only reflux but also many other things as well.

CIAO

The Brute

1. Ito, Tetsuhide, and Robert T. Jensen. “Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium.” Current gastroenterology reports 12.6 (2010): 448-457.

2.Rude RK, Singer FR, Gruber HE. Skeletal and hormonal effects of magnesium deficiency. J Am Coll Nutr 2009;28:131–41.

3.http://books.google.com/books?id=3DwIy722Qm8C&pg=PA69&lpg=PA69&dq=Suarez+and+Levitt+carbohydrate+hydrogen+gas&source=bl&ots=K1HDywhlfU&sig=Hvw4FaYeklAHTcR3crHKru6tpjg&hl=en&sa=X&ei=_bmnUr_3NMPJqQGBioCYBQ&ved=0CDwQ6AEwAg#v=onepage&q=Suarez%20and%20Levitt%20carbohydrate%20hydrogen%20gas&f=false

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability  for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk.