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The B12 vitamin has an extremely intricate relationship with the body’s chemical balances and thus its healthy function. There are a number of ways in which it protects and supports a variety of chemical interactions necessary for a normal quality of living and even survival. This short guide will introduce you to the basics of B12 chemical functions.

1) Vitamin B12 Regenerates Folic Acid

Without B12, folic acid (B9) becomes trapped in the body in a metabolically useless form. Folic acid is a necessary component in cell division and formation of new cells.

2) Healthy Red Blood Cells Depend on Vitamin B12 Driven Synthesis of DNA. Without usable B12 in the system, the DNA synthesis begins to shut down, resulting in pernicious/megaloblastic anemia. Symptoms of this illness include fatigue, Low energy levels, nausea and diarrhea, decreased appetite, weakening of the muscles, headaches, tingling sensations and a sore tongue.

3) Vitamin B12 Supports Synthesis of the Amino Acid Methionine and Amino Acid “SAM-e”

Methionine is one of the two sulfur based compounds involved in metabolic functions. It is a crucial building block of proteins necessary for a state of a healthy body. SAM-e is involved in over 100 enzymatic reactions required for normal metabolic activity.

5) Vitamin B12 Promotes Activity of Hormones and Neurotransmitters Affecting Your Mood

The hormones include dopamine, serotonin and melatonin. These particular neurotransmitters are necessary for a healthy balanced mood, emotional state and even the sleeping cycle. An imbalance in either the levels or the function of any of these can result in a depression which is likely to need medicating.

6) Vitamin B12 Helps Reduce Dangerous Levels of Homocysteine Homocysteine is a toxic amino acid (protein) associated with a number of different negative side effects in the body. High homocysteine levels can cause any of the following symptoms: tinnitus, anxiety, increased heart beat, worsening symptoms of thyroid disorders, depression and body toxicity. Individuals with high homocysteine levels are at risk for cardiovascular problems.

7) Vitamin B12 Benefits Help Prevent Irreversible Neurological Impairment Peripheral and central nervous system deterioration can occur due to a vitamin B12 deficiency. Vitamin B12 deficiency has been linked to demyelination of the nerve and the onset of Alzheimer’s disease and dementia.

Vitamin B12’s primary functions are in the formation of red blood cells, DNA synthesis and the maintenance of the nervous system. If B12 deficiency occurs, DNA production is disrupted and abnormal cells called megaloblasts manifest, which results in anemia. B12 protect the nerves which are surrounded by an insulating fatty sheath called the myelin. B12 plays a vital role in the metabolism of fatty acids essential for the maintenance of myelin. Prolonged B12 deficiency can lead to nerve degeneration and irreversible neurological damage. When deficiency occurs, it is more commonly linked to a failure to effectively absorb B12 from the intestine rather than the lack of B12-rich foods.

Vitamin B12 can be stored in small amounts by the body. Total body store is 2-5mg in adults. Around 80% of this is stored in the liver. Vitamin B12 is excreted in the bile and is then effectively reabsorbed – this is known as enterohepatic circulation. People on diets low in B12 may be obtaining more B12 from re-absorption than from the food they ingest. Re-absorption of the B12 from the bile is the reason it can take over 20 years for deficiency disease to develop. In comparison, if B12 deficiency is due to a failure in the absorption mechanisms it can take only 3 years for deficiency disease to occur.

The only reliable dietary sources of vitamin B12 are meat, dairy and eggs. The considerable research into possible plant food sources of B12 turned up few positive results. Fermented soya products, seaweeds and algae have all been proposed as possible sources of B12 because they are products which have been “pre-digested” into various amino acids, making them easier to absorb. However, analysis of fermented soya products, including tempeh, miso, shoyu and tamari, found no significant B12.

Spirulina, algae available as a dietary supplement in tablet form, and nori, a seaweed, have both appeared to contain significant amounts of B12 after analysis. However, it is thought that this is due to the presence of compounds structurally similar to B12, known as B12 analogues. These cannot be used satisfy dietary needs. The body is unable to differentiate between B12 and its analogues. Researchers have suggested that supposed B12 supplements such as spirulina may in fact increase the risk of B12 deficiency disease, as the B12 analogues can compete with B12 and inhibit metabolism. The current nutritional consensus is that no plant foods can be relied on as a safe source of vitamin B12.

Bacteria present in the large intestine are able to synthesize B12. In the past, it has been thought that the B12 produced by these colonic bacteria could be absorbed and utilized. However, the bacteria produce B12 too far down in the intestine, and as B12 is not absorbed through the colon lining, this B12 just gets flushed out of the system. Supplementations such as the injections should be used if you begin to experience the symptoms of B12 deficiency and you know that you are at risk.

Research is showing that many older people could benefit from getting more vitamin B12 than they currently do. Some 10% to 15% of people over age 60 are outright deficient, and many more are borderline deficient. Their blood levels of B12 are in what’s called a “low-normal” range, and if their doctor isn’t up on the latest research, they won’t be treated for B12 deficiency with supplemental B12. That’s a shame, because research now shows that low B12 can cause all sorts of problems, and that getting an optimal amount can boost brain power, lift the mood, improve bone density,and help to maintain healthy hearing and eyesight.

Here’s what the latest research shows vitamin B12 does:

Brain health: One study found that older people with lower-than-average B12 levels were correlated with signs of brain shrinkage, an early sign of impaired cognitive function and Alzheimer’s disease. Even B12 levels that are above the traditional cutoff for deficiency — and seemingly adequate — may impact cognition in older people. B12 is needed to maintain the fatty myelin sheath that wraps around and protects nerves, including nerve cells in the brain.

Eyesight: Harvard researchers found favorable results for women aged 40 and older who supplemented with 1,000 micrograms of B12. They attribute it to lower levels of the amino acid homocysteine and better antioxidant effects. Both improved blood vessel function in the retina of the eye.

Keeps your hearing sharp. There may be a connection between B12 deficiency and hearing. One study found that low blood levels of vitamin B12 were linked to a higher risk of hearing loss in women in their 60s. Toxic homocysteine may damage the delicate cells that transmit sound waves in the inner ear.

Mental health: A study from the National Institute of Aging found a high incidence of depression in women with low B12 levels. B12 is needed for the production of important brain neurotransmitters such as serotonin, norepinephrine and melatonin, the “sleep” hormone.

Maintains strong bones. In the Framingham Offspring Osteoporosis Study, people with low B12 levels had lower-than-average bone mineral density. B12 may build stronger bones by aiding osteoblasts, the cells that build bone, and by lowering homocysteine, which weakens bone by interfering with collagen cross-linking, the molecular “stitching” that makes bones strong and flexible.

Older people often don’t absorb enough B12, even when they get enough in their diet. Some experts believe that blood B12 levels should be at least 350 picomoles/liter (or 44 picograms/mL.) It’s a good idea to have your blood level checked if you are over age 50.

Symptoms of B12 deficiency include fatigue, depression, numbness and tingling of the arms and, most commonly, the legs, difficulty walking, memory loss, disorientation, tongue soreness, and appetite loss. Because so many older people are borderline deficient, more experts are recommending anyone age 50 or older get at least 100 to 400 mcg a day of B12.

Your risk for deficiency increases as you get older, and the consequences for your health can be devastating. Taking a B12 supplement is good insurance against deficiency, and B12 supplements are also very well tolerated. It’s a good idea to ask your doctor to check your B12 levels to determine whether you may have a severe deficiency that warrants much higher levels of supplementation.

Intrinsic factor is a protein produced by the cells of the stomach, parietal cells, which also produce the acid (gastric juice) for digestion. The intrinsic factor is the compound which facilitates and allows the absorption of vitamin B12 from food in the stomach and the intestines.

Once ingested the B12 becomes bound to a binding proteins present in the hydrochloric acid of the stomach. In the less acidic environment of the small intestine, these proteins separate from the vitamin, enabling it to bind to intrinsic factor and enter the bloodstream.

 The intrinsic factor is an enzyme-like unidentified substance secreted by the stomach. It is present in the gastric juice as well as in the gastric mucous membrane. The optimum pH for the action of the intrinsic factor is 7 and it is inactivated at temperatures above 45^oC.

In pernicious anemia, an autoimmune disease, autoantibodies direct themselves against the intrinsic factor and/or parietal cells themselves and lead to an intrinsic factor deficiency, which results in malabsorption of vitamin B12. Atrophic gastritis, an inflammation of the mucous membrane of the stomach, can also cause intrinsic factor deficiency and anemia through damage to the parietal cells. Pancreatic exocrine insufficiency can interfere with normal dissociation of vitamin B12 from the proteins, as well preventing its absorption via the intrinsic factor structure. Bariatric surgery is a known risk factor in the development of pernicious anemia, other risk factors include stomach tumors, gastric ulcers, and excessive consumption of alcohol.

Patients experiencing an insufficiency in their intrinsic factor levels cannot benefit from a low dose oral vitamin B-12 supplement, because it will not absorb through the wall of the small intestine. Historically, the disease was thought untreatable before the discovery that it could be managed with regular injections of vitamin B-12, thus bypassing the digestive tract. Other options are available nowadays if injections are not the desired method of supplementation.

Pernicious anemia (also known as Biermer’s anemia, Addison’s anemia, or Addison-Biermer anemia) is a form of megaloblastic anemia which occurs due to a vitamin B12 deficiency. It is most often caused by impaired absorption of vitamin B12 in the GI tract due to the absence of intrinsic factor in the setting of atrophic gastritis, and more specifically of loss of gastric parietal cells. Future posts will fully describe and explain exactly the functions of these processes.

The name of the disease comes from the historical fact that early sufferers were always properly diagnosed after they were classified as anemic (had low blood hemoglobin levels). However, with more modern tests which specifically target B12 absorption, the disease may properly be diagnosed before patients actually become anemic. An individual with this illness will have to supplement his/her B-12 for the rest of their lives or risk the onslaught of extremely unpleasant symptoms. Most commonly the cause for impaired binding of vitamin B12 by intrinsic factor is autoimmune atrophic gastritis, in which the person’s own antibodies are directed against certain cells, resulting in their death, as well as against the intrinsic factor itself, rendering it unable to bind vitamin B-12.

Sometimes the loss of the GI cells may simply due to a weakening digestive system, such as that frequently occurring in elderly people affected and Helicobacter pylori infection. Note that forms of vitamin B12 deficiency other than pernicious anemia must be considered as a B12 deficiency can cause megaloblastic anemia, which is easily mistaken for classical pernicious anemia, The deficiency may also be caused by infection with a tapeworm, possibly due to the parasite’s competition for vitamin B12

The treatment of Pernicious Anemia varies from country to country and from area to area, but there is yet no cure. Cobalamin (one of the forms of B-12) is usually injected and is given every month in some countries and every three months in others. The single most common cause of complaint by members of the Pernicious Anemia Society is that patients needs vary and some patients need more frequent injections than others.

Patients who are needle-phobic, or patients who are unable to receive injections for another reason can be prescribed cyanocobalmin tablets in very high doses, which means that some of the B12 is absorbed in other places in the bowel other than the terminal ileum where B12 absorption usually takes place. The efficacy of using B12 tablets to treat pernicious anemia (by definition due to atrophic gastritis) is likely not to be sufficient, as the body will have trouble absorbing it as it does from food.

How does Vitamin B12 deficiency occur? What are my options if I need B12 supplementation? What will happen to me? These are the questions over 99 % of individuals with B12 deficiency ask themselves. This blog is designed to answer these and other questions concerning vitamin B12, its’ deficiency and its’ supplementation. With instructions concerning lifestyle and dietary changes, as well as information from scientific studies about this specific physiological problem, we hope you will feel 100% well again.

The human physiology of vitamin B12 is very complicated, and due to this is prone to problems leading to vitamin B12 deficiency. Unlike most nutrients, absorption of vitamin B12 actually begins in the mouth where small amounts of unbound crystalline B12 can be absorbed through the mucosa membrane. In the stomach a specific gastric enzyme is needed to separate B12 from the food ingested, and a protein must bind with it for it to be absorbed and processed through the body. Proper absorption of vitamin B12 requires an intact and functioning stomach, exocrine pancreas, intrinsic factor, and small bowel. Problems with any one of these organs makes a vitamin B12 deficiency possible and likely.

However, there can be some genetic aspects in the problems associated with malabsorption, and due to the complexity of B12 assimilation in the body, geriatric patients, many of whom are hypo-acidic due to reduced GI tract cell function, have an increased risk of B12 deficiency. For these individuals supplementation becomes a necessary step, otherwise their life quality and life expectancy can plummet.

B12 supplements come in a few forms, most commonly though in an ingestible pill, sublingual pill or spray and the injection. With malabsorption in the GI tract, swallowing vitamin pills equals to flushing them down the toilet, as around 80%-90% of hard vitamins will not get absorbed. The sublingual B12 becomes the next possible step in supplementation; however this too is a fairly poor choice. Although researchers are not fully sure why this occurs, in most cases of sublingual use, only around 5% of the vitamin is absorbed by the body. The only truly viable choice in this case is to begin B12 injections, which unfortunately are not the most pleasant of experiences, and can be expensive.

When it comes to nerves and nerve conduction vitamin B-12 plays a special role. One of the reasons the body needs this nutrient is to manufacture myelin, the fatty sheath that wraps around nerve fibers, insulating them and allowing them to conduct their electrical impulses at a better pace. A vitamin B12 deficiency can also raise blood levels of homo-cysteine, an amino acid that is thought to be toxic to nerves, which can cause subsequent ringing in the ears.  Vitamin B₁₂ in turn sheathes ear nerves and may help prevent tinnitus emergence and its symptoms.

Vitamin B12 deficiency is associated with chronic tinnitus,” says Dr. Attias. “Long-term exposure to noise depletes the body’s levels of B12 and so makes the ears more vulnerable to noise-induced damage.” If you have tinnitus, and especially if you also have memory problems, ask your doctor to check your blood level of vitamin B₁₂.

Research from the Institute for Noise Hazards Research and Evoked Potentials Laboratory at Chaim-Sheba Medical Center in Ramat Gan and from Tel Aviv University, both in Israel, looked at a group of 385 people with tinnitus and found that 36 to 47 percent suffered from vitamin B₁₂ deficiency. All of the people low in B₁₂ received injections of 1,000 micrograms weekly for four to six months. At the end of that time, their hearing and tinnitus were evaluated. Fifty-four percent reported improvement in their tinnitus, and approximately one-fourth reported reductions in the measured loudness of their tinnitus.

Most people get enough vitamin B₁₂ from foods but often an individual is unable to absorb the B12 in their GI tract, which will eventually cause a deficiency. Strict vegetarians, who eat no meats, dairy products or eggs, are also at risk for deficiency, since B12 comes only from animal products. If your doctor determines that you have issues with absorbing B12 the vitamin you will need to supplement it. Those with an absorption problem will need to opt for either injections of B12 by your doctor or sublingual B12 pills from your pharmacist (studies show this method can also be poor in terms of absorption).

VITAMIN B12 RDA

Sources of Vitamin B12

Watch for these signs of Vitamin B12 Deficiency

Fatigue
Weakness
Weight loss

Constipation

Infertility
Vision problems
Loss of hearing and tinnitus

Alcoholism
Impotence
Incontinence
Hyperpigmentation and hypopigmentation
(dark and light patches in the skin)
Neuralgia, neuritis and bursitis
Anemia, including pernicious anemia
Spinal cord degeneration
Brain degeneration
Insomnia
Any emotional disorder up to and including insanity

Poor growth/failure to thrive in infants
Inflamed tongue
Premature grey hair
Disturbed carbohydrate metabolism
Numbness and tingling in the hands and feet
Irrational or chronic anger
Violent behavior
Lack of balance/abnormal gait
Combat fatigue