Are you deficient in vitamin B-12? A lack of it can be very harmful to your health

Vitamin B-12 is also known as cobalamin, and here you will see why it is a very important water-soluble vitamin that is difficult to absorb because it has a unique system and a number of inactive analogues (molecules that appear to be active B-12, but in fact are not) that possibly interfere with its function.

What is the path of vitamin B-12 to the liver?

The following images clearly and easily show the path of vitamin B-12 until it is absorbed in the liver so that you can see where there may be an interruption in the absorption of this nutrient:

• Vitamin B-12 is attached to proteins in the food we eat.

• When eating, the R protein is released with saliva

• It reaches the stomach and there pepsin is activated by stomach acids.

• Pepsin then cleaves B-12 from its protein binding sites, causing the R protein binder to form a complex with vitamin B-12 and transport it into the duodenum.

• What is called ileal cell intrinsic factor is also released, and in the duodenum the pancreas releases the protease enzyme that cleaves the R protein binder from vitamin B-12.

• In the duodenum, the pancreas releases the protease that separates the R protein from vitamin B-12, where intrinsic factor is waiting to accompany it on the next part of the journey.

• Now B-12 binds to the intrinsic factor to be transported into the ileal cell where the vitamin will be absorbed and transported thanks to cobalamin to the liver.

• Intrinsic factor releases vitamin B-12 to enter the ileum cell.

• Transcobalamin transports B-12 to the liver. This is where the benefits of vitamin B-12 begin to manifest, which are not expressed in the feats of the body, but rather in optimal functioning, preventing the deterioration of important systems in the body.

Functions

Vitamin B-12 is crucial for brain function and red blood cell synthesis.

B-12 protects the nervous system and without adequate amounts of this vitamin in the body, permanent damage can result, for example, blindness, deafness and dementia. Fatigue and tingling in the feet and hands are often early signs of a deficiency.

Vitamin B-12, as well as folate, also known as folic acid, are needed to help red blood cells divide . In some cases, people on a vegan diet must consume so much folic acid that even if they are deficient in B-12, their red blood cells continue to divide properly because both are needed for this function. But in other cases, the B-12-deficient blood of vegans and other populations will not be able to divide properly and they will develop fatigue due to macrocytic anemia, also known as megaloblastic anemia.

B-12 is the one vitamin that most vegans cannot get enough of unless they supplement.

B-12 is the one vitamin that most people on a vegan diet cannot obtain in adequate amounts without supplementation due to current hygiene and farming practices.

Furthermore, the only active forms recognized by intrinsic factor in the body are cyanocobalamin, hydroxocobalamin, methylcobalamin, and adenosylcobalamin. Cyanocobalamin should be avoided due to its harmful metabolites.

People on a plant-based diet can obtain biologically active B-12 supplements that are synthesized from bacteria rather than animal sources.

Most people can get their daily requirement from B-12 extracted from the bacteria Saccharomyces cerevisiae.

Preliminary studies also show that the cyanobacteria Aphaniziomenon flos-aquae is a good source of active B-12, the so-called "blue green algae" from the Northwestern United States.

The so-called sea vegetables also provide usable amounts of B-12. These include nori, dulse, spirulina and chlorella algae.

Even if you consume animal protein, it is very possible to have a B-12 deficiency.

And yes, it is through cooking that the absorbable availability of B-12 is lost. One clinical study ( Tucker et al. 2000 ) indicated that vitamin B-12 from breakfast cereals and dairy products was associated with better absorption of vitamin B-12 compared to that from red meat, poultry and fish, as well as their products (eggs and milk); leading researchers to conclude that it was due to cooking.

Vitamin B-12 found in animals tends not to be cyanocobalamin, which is the form used to fortify foods and is more stable during cooking. For example, in a medium acidic environment (pH 4-7) cyanocobalamin can withstand temperatures up to 120ºC. ( study )

There is actually not enough evidence that B-12 is removed through cooking in fortified foods, only a few foods have been studied, so it is best to consider alternative raw sources of vitamin B-12.

How can you measure B-12 deficiency? You'll see that it's not so obvious

In an article in the online journal Vegan Health , B-12 levels can be measured in the blood, but there is a catch. Blood levels must represent both active and inactive B-12 levels, the latter being unusable by human cells.

In fact, the test should show that B-12 levels are elevated because it has not been able to be absorbed at the cellular level, which is where this vitamin displays its physiological effects. Instead, an intracellular analysis of B-12 that is measured by measuring Homocysteine ​​(HC ) in the blood can be evaluated to obtain a clearer picture of what is happening at the cellular level with B-12.

GH is an amino acid that provides an indirect measurement of the intracellular function of B-12 since the vitamin is a cofactor in its metabolism. That is, normal homocysteine ​​tells us that the body is absorbing an adequate amount of active B-12, that it is circulating in the blood and is being biochemically used in the cell. People with inadequate levels of vitamin B-12 must have an accumulation of GH and consequently, elevated levels in the blood.

Excess HC can have serious consequences for the body. In the brain, homocysteine ​​can cause damage to DNA and neuronal mitochondria. Remember that mitochondria are where our energy is produced. This can cause neuro-psychiatric and neuronal disorders including memory problems and Alzheimer's dementia. Elevated homocysteine ​​is a more reliable indicator of risk factors for heart attack than cholesterol tests. Elevated homocysteine ​​can cause collagen cross-linking leading to defective bone matrix and consequently osteoporosis.

The “normal” reference values ​​reported by many laboratories are not adequate. The ideal homocysteine ​​level in the blood is 6-7. HC levels between 8-10 are acceptable but any level greater than 10 is unacceptable.

A mean corpuscular volume (MCV) on a blood test greater than 90 raises suspicion for inadequate absorption of folate or vitamin B-12. An MCV value greater than 100 would warrant further investigation and intervention. Often, hormonal, nutritional, and lifestyle interventions can rebalance physiological health.

Tests to measure levels of toxicity in the body are also suggested, and a health professional can make appropriate recommendations if these and other abnormalities occur.

 

What then is a normal level and how has this been established?

Let me explain to you how through homocysteine ​​levels you can better see your absorption of B-12 because what is normally practiced when requesting an exam in a medical center, the normal level is established by taking a population number and determining 2 standard deviations of that number and that is considered the “normal range.”

There is often no clinical correspondence to these numbers. Rather, one can observe the processes in which the presence of vitamin B-12 takes place, such as the conversion of homocysteine ​​to methionine. Or measure the levels of homocysteine ​​or methylmalonic acid and if they are elevated, they would be indicators of a decrease in vitamin B-12.

Homocysteine ​​can be elevated by deficiency of vitamins B-6 and Folate as well.

If you are concerned that you may be deficient in your B-12 levels, methylmalonic acid is more specific for detecting vitamin B-12 deficiency. However, both forms run the risk of being missed by the kidneys, and vitamin B-12 levels may appear elevated in patients with kidney failure.

At what levels can a B-12 deficiency be treated?

In the case of dementia , treatment with vitamin B-12 with or without folic acid does not improve the disease. But this is because the treatment was delayed too long, and its symptoms appear when the disorder is already well established.

Vitamin B-12 has an effect on bones :

• Stimulates the proliferation of osteoblasts. A study from the University of Wisconsin, USA, showed that patients with pernicious anemia have a higher risk of fractures and patients with a deficiency in their vitamin B-12 levels were more likely to develop osteoporosis.
• In contrast, patients (15) who were given 1500 mcg of vitamin B-12 orally daily had a reduction in fractures in those over 65 years of age.

According to the same study, the following groups of people are especially vulnerable to a vitamin B-12 deficiency :

• Dialysis patients
• Elderly people
• Alcoholics
• Patients who must receive anesthesia
• People suffering from atrophic gastritis

The elderly group is at a 14.5% higher risk than the others because their diet contains fewer calories and, consequently, less vitamin B-12 content. In addition, due to apoptosis of cells in the intestinal tract, there are fewer vitamin B-12 receptors in the ileum.

Patients with osteoporosis have a higher risk of B-12 deficiency since the test group was on hemodialysis and a little later we will see why it is an extremely vulnerable group.

People who consume high amounts of alcohol or are alcoholics have a higher risk of B-12 deficiency since many of their calories are replaced by alcohol and, in addition, alcohol is toxic to enterocytes , very important cells in the intestine and whose functions include absorbing vitamin B-12.

Patients who must receive anesthesia, especially those with nitrous oxide, are at higher risk because nitrous oxide oxidizes cobalamin and renders vitamin B-12 ineffective.

Likewise, people with atrophic gastritis, which is when the inner lining of the stomach has been inflamed for many years due to infection with the H. Pylori bacteria, which gradually destroys the cells of the inner lining of the stomach.

Patients with gastric bypass, as well as patients on acid suppression, particularly with proton pump inhibitor drugs such as Omeprazole, are at increased risk for vitamin B-12 deficiency.

Medications and other vitamins that reduce vitamin B-12 absorption or availability

Considering the above conditions and how they are treated, here are the medications that reduce vitamin B-12 absorption or its bioavailability:

• Metformin or glucophage : This is a diabetes medication that competes with calcium needed for transport to the recipient ileum, so people taking it should be aware that there is an increased risk of vitamin B-12 deficiency. However, it is reversible by supplementing with calcium.
• Cholestyramine : The quality of vitamin B-12 currently allows it to recirculate very effectively in the hepatobiliary system and therefore cholestyramine, which adheres well to bile, can eliminate large amounts of vitamin B-12, producing a deficiency of this vitamin in patients taking this medication.
• Colchicine, which is used to prevent gout attacks (sudden, intense pain in one or more joints due to high levels of uric acid in the blood), reduces what we call intrinsic factor in the mucosa of the ileum, which shows us that vitamin B-12 has problems being absorbed.
• Vitamin C in high doses of 500 mg or more, taken with meals or within one hour of eating, can decrease the availability of B-12 or even destroy it. The Mayo Clinic recommends taking vitamin C 2 or more hours after taking a vitamin B-12 supplement. ( article )
• Vitamins B1, B3, C, and E, and the minerals copper and iron may interfere with the absorption of vitamin B-12. These vitamins and minerals are analogs of vitamin B-12 and are present in 97% of multivitamins and dietary supplements. ( study )

Sources of vitamin B-12

Toothpaste with vitamin B-12

It is not very well known, but it already exists. Produced by the German Vegetarian Society, recent experiments have confirmed its effectiveness.

Oral Vitamin B-12

According to the Canadian Institutes of Health Research, a study indicated that oral B-12 was as effective as its intramuscular version. It was concluded that doses of 2 mg per day and 1 mg initially per day, then weekly and eventually monthly are effective in obtaining hematological and neurological results in patients with this deficiency.

If you choose to take the oral version of B-12, try to get it in the Methylcobalamin form, which is more easily absorbed by the body.

Multivitamins

Since most multivitamins contain vitamins B1, B3, C, E and the minerals Copper and Iron, you may need to take oral vitamin B-12 separately in addition to the multivitamin you take.

However, if the multivitamin is chewable and contains 25 μg of B-12 ( as cyanocobalamin) or more, and is taken daily, it should be sufficient.

Fortified foods

There are many foods fortified with vitamin B-12. These include plant-based milks, fermented soy or tofu, some cereals, and some types of nutritional yeast.

The RDA for vitamin B-12 found on product labels is based on 6 μg , but that number was stated in 1968. So if the label says 25% of the RDA, you know it actually has 1.5 μg .

Sea vegetables

Nori and dulse seaweed, as well as spirulina and chlorella.

Nutritional yeast

Nutritional yeast itself does not contain vitamin B-12 unless it has been added for fortification. I suggest you look at the ingredients and their quantities on the product information label.

Make sure the nutritional yeast you get is not an active yeast . Do not confuse it with brewer's yeast and make sure it comes fortified with added vitamin B-12.

There are a few reasons why you should NOT rely solely on nutritional yeast to get your daily recommended dose of vitamin B-12. This yeast is highly sensitive to light and often comes in clear jars or packages which does not guarantee that sufficient care has been taken in its handling. So once purchased, it is best to keep it in the fridge or even the freezer, away from light.

Foods rich in folate or folic acid

Since these high-folate foods can help offset vitamin B-12 deficiencies, they should be eaten often. These include spinach, kale, and arugula; asparagus; avocado; nuts (such as walnuts) and seeds (especially flax seeds); beets; Brussels sprouts; citrus fruits (orange, grapefruit, lime, and lemon); and broccoli.

Safe consumption of vitamin B-12

In general, consuming high concentrations of B-12 does not cause harm. The Linus Pauling Institute at Oregon State University, USA, notes that “no toxic or adverse effects have been associated with consumption of vitamin B-12 in either food or supplement form in healthy individuals. Doses up to 1 mg (100 mcg) per day orally or 1 mg per month intramuscularly have been used to treat pernicious anemia without significant side effects.” ( article )