Updated: Apr 5
Preventative Health Series Part. I
As a naturopath it is my mandate to practice preventative medicine with my patients and assessing basic nutrients levels such as iron, vitamin D and vitamin B12 is one way to support their optimal health. In the next series of articles I will review the most basic nutrients, their function in the body, signs of deficiency and ways to support them.
Too many times I have had patients tell me they were informed by their medical doctor at their physical that a nutrient level was low but that they didn’t bother to address it, or stopped taking supplements without confirming with their doctor that their levels had improved. It very important that you support deficiencies and follow up with your doctor. As you will learn, nutritional deficiencies can occur gradually over time, and the symptoms can be hard to identify. In the case of Vitamin B12, the side effects of long term, severe deficiency can be permanent (nerve damage). Also, when our levels are low there is collateral damage – increasing levels of cortisol as you struggle to function with inadequate nutrient levels, resulting anemias, immune system disruptions and many other conditions can develop even if just one nutrient level is off.
The purpose of this series is to encourage you to check the status of these nutrients on a regular basis and to make sure you address any imbalances that exist to prevent further health issues and to be sure you are feeling your best self!
Yours in health,
What does it do?
Vitamin B12 is necessary for the brain and nervous system to function properly. Without B12 cells cannot produce adequate energy or synthesize DNA. We also need B12 to make red blood cells, which supply oxygen to all the cells in the body that need it. This is where the energy part comes in. A deficiency of B12 can lead to a condition known as anemia. The type of anemia associated with B12 deficiency is known as “pernicious anemia” and occurs when the vitamin cannot be absorbed from the digestive tract into the bloodstream in adequate amounts. B12 is needed for the maintenance of myelin, the protective coating around nerve cells.
What are the sources of B12 and how is it absorbed?
B12 is not made by the body, and instead, must be sourced from food or supplements. The only foods that deliver it are meat, eggs, poultry, dairy products, and other foods from animals.
Beef, beef liver, turkey, oysters, chicken, trout, clams, salmon, eggs and milk are the best sources of B12. A serving of each delivers close to or more that 100% of your RDA (2.4 mcg for men and women over 14, going up to 2,6 and 2,8 for pregnant and breastfeeding women respectively).
The absorption of vitamin B12 is a complicated process:
Step one – in food, the vitamin is bound to proteins, which have to be broken down before it can be absorbed. This can only happen when there’s adequate acid production (Hydrochloric acid or HCL) in the stomach, which as we get older, tends to be a problem since acid levels decrease with age.
Step two – absorption actually takes place in the small intestine and requires the presence of a special protein produced by the cells in the stomach called “intrinsic factor”.
Recap: Vitamin B12 levels are dependent on dietary intake, HCL production and intrinsic factor.
Are you at risk for developing a B12 deficiency?
Some people don’t consume enough vitamin B12 to meet their needs, while others, due to various reasons, can’t absorb enough, no matter how much they take in.
As the sources of B12 are meat, fish, eggs and dairy, strict vegetarians and vegans are at high risk for developing a B12 deficiency (1) if they don’t eat grains that have been fortified with the vitamin or take a vitamin supplement.
When the “parietal” cells in your intestine do not produce enough intrinsic factor; this happens when, for some unknown reason, the immune system attacks and destroys the parietal cells thereby causing an inability to absorb B12.
WEIGHT LOSS SURGERY
Any surgery that involves a reduction in stomach capacity will result in a reduction in the ability to absorb vitamin B12.
INFLAMMATORY BOWEL DISEASE
Inflammatory bowel diseases such as celiac, ulcerative colitis and Crohn’s disease can result in a decreased ability to absorb vitamin B12.
Deficiency is more likely to occur in older people due to the reduction in stomach acid production that often occurs with aging. (2) If you are > 60 you should be checking your B12 levels regularly.
But checking for B12 levels should not be reserved only for the elderly. A study showed that 40% of young adults studied had low levels of the vitamin, despite their “healthy” diets.
Do you take heartburn medication? Proton Pump inhibitors (PPI) reduce acid production in the stomach – acid is needed to absorb vitamin B12!!! Researchers found that taking PPI’s for more than two years was linked to a higher risk of vitamin B12 deficiency. (3)
Consuming more than a few drinks of alcohol on average each day can cause gastritis, or irritation of the stomach lining, This can lead to low stomach acid and reduced B12 absorption. But that’s not it. B12 is stored in the liver, and drinking too much alcohol can impair liver function and deplete B12 stores or make it harder for the liver to use it.
Vitamin B12 deficiency can be slow to develop, there fore symptoms appear gradually and get worse over time.
Strange sensations, numbness, or tingling in the hands, legs, or feet
Difficulty walking (staggering, balance problems)
A swollen, inflamed tongue
Difficulty thinking and reasoning (cognitive difficulties), or memory loss
Your ND or MD can test for serum Vitamin B12 levels. (this is a blood test)
A vitamin B12 deficiency can be corrected two ways: weekly or monthly (depending on the level of deficiency) shots of vitamin B12 (methylcobalamine), or a daily dose of a B12 sublingual lozenge (best absorption vs tablet) of 1,000 mcg per day.
Left untreated, the deficiency can cause severe neurological problems and blood diseases. So please check you levels regularly.
Only you can be proactive about your health!
Wong CW1. Vitamin B12 deficiency in the elderly: is it worth screening? Hong Kong Med J. 2015 Apr;21(2):155-64.
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