{"id":31136,"date":"2023-10-30T13:07:52","date_gmt":"2023-10-30T18:07:52","guid":{"rendered":"https:\/\/wholehealthchicago.com\/blog\/?p=31136"},"modified":"2023-10-30T14:58:14","modified_gmt":"2023-10-30T19:58:14","slug":"vitamin-b12-our-most-curious-vitamin","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2023\/10\/30\/vitamin-b12-our-most-curious-vitamin","title":{"rendered":"VITAMIN B-12: OUR MOST CURIOUS VITAMIN"},"content":{"rendered":"\n<p>Over the years of writing Health Tips, I was surprised to discover that one I\u2019d written a few years ago, about vitamin <a href=\"https:\/\/wholehealthchicago.com\/blog\/2021\/02\/22\/six-commonly-missed-diagnoses-b12-deficiency-2\" target=\"_blank\" rel=\"noreferrer noopener\">B12 deficiency<\/a>, had received the most comments and questions from readers. Since there have been some interesting developments in both the diagnosis and treatment of B12 deficiency, and since B12 deficiency remains so common, this seems like a good opportunity for some updates.<\/p>\n\n\n\n<p>The symptoms of low levels of vitamin B12 can be pretty vague. You\u2019re just not feeling right and you\u2019re tired, maybe a little depressed, a bit achy. Your digestion might feel off and you\u2019re not thinking clearly. Balancing a checkbook becomes an exercise in higher math.<\/p>\n\n\n\n<p>When your B-12 numbers are low, any of the following can occur:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>extreme tiredness,<\/li>\n\n\n\n<li>a lack of energy,<\/li>\n\n\n\n<li>pins and needles (paraesthesia), <\/li>\n\n\n\n<li>ringing in ears (tinnitus),<\/li>\n\n\n\n<li>a sore and red tongue,<\/li>\n\n\n\n<li>mouth ulcers,<\/li>\n\n\n\n<li>muscle weakness,<\/li>\n\n\n\n<li>disturbed vision,<\/li>\n\n\n\n<li>psychological problems, which may include <a href=\"https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/mental-health\/depression\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">depression <\/a>and confusion,<\/li>\n\n\n\n<li>problems with memory, understanding and judgment.<\/li>\n<\/ul>\n\n\n\n<p>Your doctor\u2019s empathetic, not at all dismissive of your symptoms, but after a physical exam and some apparently appropriate tests with normal results she can\u2019t find anything really wrong. On the surface, this is reassuring. After all, the main reason we go to doctors is to ascertain that nothing serious is going on.<\/p>\n\n\n\n<p>Still, could she be overlooking something?<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">All About B12<\/h3>\n\n\n\n<p>One of your eight B vitamins, B12 is involved in the metabolism of every cell in your body. Years ago B12 was called \u201cmaturation factor\u201d because your cells need B12 to mature from being young and ineffectual whippersnappers to fully functioning, mature cells. Imagine a child, about seven years old, who\u2019s stuck at that age and can\u2019t grow into adolescence and later adulthood. Now imagine a magical substance that will allow her to grow and mature. That\u2019s vitamin B12.<\/p>\n\n\n\n<p>In fact, B12 is so potent a factor in cell maturation that some of the original studies on it showed that cells in the bone marrow (where blood is manufactured), when deliberately deprived of B12, could mature to adult forms in <span style=\"text-decoration: underline;\">just a few hours<\/span> when B12 was added. This phenomenon explained how B12-deficient patients reported feeling magically rejuvenated within a day or two of their first B12 injection.<\/p>\n\n\n\n<p>Years ago, I read that the late Bruno Bartoletti, conductor of the Lyric Opera orchestra, would not go onstage unless he\u2019d had a B12 injection earlier that day. At the time, I thought it was a placebo effect. Now I think differently.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">B12 Deficiencies<\/h3>\n\n\n\n<p>Three major systems in your body are affected by B12 deficiency: your blood, nervous system, and, less often, gastrointestinal tract. These three are targets because their cells either have a high turnover rate (blood and intestinal lining) or need a lot of B12 to function smoothly (nervous system). The symptoms of low B12 are related to each of these areas.<\/p>\n\n\n\n<p>Low B12\u2019s effect on blood is a specific type of anemia called megaloblastic anemia (as distinct from the more common iron deficiency anemia). A megaloblast is an immature, undeveloped red blood cell, large and bulky (megalo=large, blast=immature form). Remember, B12 is needed for this cell to mature, so with insufficient B12 megaloblasts accumulate in your bone marrow and large red cells called macrocytes appear in your blood. Symptoms are the same as for anemia from any cause: fatigue, breathlessness, and lightheadedness. Your skin becomes a pale yellow, most likely because the red cells that do make it to maturity are very fragile and easily broken, releasing their yellow bilirubin pigment.<\/p>\n\n\n\n<p>In the nervous system, B12 deficiency causes symptoms affecting your nerves (numbness, tingling, tremors, balance problems and the ringing in your ears called tinnitus) and the mind (depression, brain fog, mood swings, and, in rare cases, hallucinations and psychosis).<\/p>\n\n\n\n<p>In the GI tract, deficiency can cause digestive symptoms and weight loss because you\u2019re not absorbing food efficiently.<\/p>\n\n\n\n<p>Most recently, with the COVID pandemic, low B-12 was associated with increased susceptibility to the virus and is now included in most regimens for victims of \u201clong COVID\u201d.<\/p>\n\n\n\n<p>The irony is that with all these, there\u2019s usually just one predominant symptom, and making a connection to low B12 can easily be delayed, until other symptoms start to appear. For example, if your only symptom is tingling in your hands, you might undergo all sorts of diagnostic tests before your doctor thinks, \u201cMaybe we should check her B12 level.\u201d<\/p>\n\n\n\n<p>But even if you manage to get your doctor to test your B12 level, you\u2019re only halfway there because the blood test is just not very good.<\/p>\n\n\n\n<p>The normal range for B12 in the U.S. is 200 to 800 pg (picograms)\/milliliter of blood. But it\u2019s been shown that symptoms can begin as low as 400 pg\/ml, so here in the US such \u201cnormals\u201d are definitely not OK. In Europe and Japan, anything below 550 pg\/ml is considered abnormal. Therefore, if your level is, for example, 350 pg\/ml, your doctor will read a printout for you that reports \u201cnormal B12\u201d, and she won\u2019t initiate treatment. I\u2019ve had patients come in with B12 levels of 201 pg\/ml with the word \u201cnormal\u201d scribbled across it by the doctor.<\/p>\n\n\n\n<p>A far better test for early B12 deficiency is to combine serum B-12 level with your blood levels of methylmalonic acid (MMA) because this will show the very first sign that something\u2019s amiss with B12. You can have a perfectly normal B12 level, but if your MMA is elevated, B12 deficiency troubles are on the horizon. The real problem is that you\u2019ll have to ask for an MMA test without sounding like a smartass who\u2019s been spending too much time on the internet. Also, if your doctor notes that you have a megaloblastic anemia, she\u2019ll also order a folate level. Deficiencies of both are similar but if folate alone is treated, your anemia will improve but the nerve damage from low B-12 will continue unchecked.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What Causes B12 Deficiency?<\/h3>\n\n\n\n<p>The list of causes is lengthy, but by far the most common is dietary. Vegetarians who aren\u2019t paying attention to the B12 in their food choices will have downward-drifting B12 levels, and virtually all vegans not taking vitamin B12 supplements, ultimately develop deficiencies. Even vegan organizations acknowledge it\u2019s not possible to get adequate B12 while following a strictly vegan diet, and that\u2019s because the richest sources are animal products. <\/p>\n\n\n\n<p>Other causes of B12 deficiency include pernicious anemia, an uncommon (and spookily named) autoimmune disease that destroys parietal stomach cells. These cells produce a substance called intrinsic factor, necessary for B12 absorption. Also, since you need stomach acid to absorb B12, long-term use of acid-suppressing proton pump inhibitors (such as Nexium, etc.) can lead to B12 deficiency, as can chronic intestinal conditions such as Crohn\u2019s disease, celiac disease, and intestinal parasites. Up until the 1950\u2019s, Jewish grandmothers making gefilte fish would taste the partially cooked pike and carp which contained fish tapeworm (often growing to several feet long) which blocked B12 absorption. Fish inspection and thorough cooking ended this unusual source of B-12 deficiency.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The Missed Diagnosis<\/h3>\n\n\n\n<p>The main danger of missing a diagnosis of low B12 is that, while quite rare, the damage to your nerves and even brain can be permanent. Other serious consequences: your anemia can get so severe it causes heart failure and collapse. Or you could be misdiagnosed with a major depressive disorder or even psychosis and take unneeded psychiatric medications for months (or years) before someone notices you look yellowish and you\u2019re finally diagnosed with megaloblastic anemia.<\/p>\n\n\n\n<p>There are three reasons why this diagnosis is missed:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Although it\u2019s not an expensive test, B12 isn\u2019t measured during routine blood tests. Doctors generally don\u2019t order a B12 evaluation if there\u2019s no evidence of anemia (which would be picked up on a routine blood test). However, the fatigue and nervous system and GI symptoms can precede anemia by months. <strong>(We order B12\/folate routinely at WholeHealth Chicago)<\/strong><\/li>\n\n\n\n<li>Doctors rarely ask (and patients rarely volunteer) information about their eating habits. In medical school, we\u2019re taught that the US diet is plenty good enough to prevent any vitamin deficiencies. To which I now respond, \u201cHa!\u201d I agree most of us eat plenty of food (obesity levels are very much on the rise), but it\u2019s food whose nutritional value has been castrated. Also, all vegetarians and vegans should be regularly tested for possible B12 deficiency, but if your doc doesn\u2019t know your eating habits you won\u2019t be tested. <strong>(You know our intake questionnaires ask about what you\u2019re eating!)<\/strong><\/li>\n\n\n\n<li>Taking the B vitamin folic acid (folate) or eating a lot of <a href=\"https:\/\/explore.globalhealing.com\/folic-acid-foods\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">folate-containing foods<\/a> without adding B12 can actually mask the symptoms of a developing B12 deficiency. Although folate will keep your blood count normal even if your B12 is falling, the folate will not protect your brain and nervous system. You\u2019ll have no evidence of megaloblastic anemia (because of the folate), but symptoms of numbness, tingling, balance problems, and emotional issues will continue unchecked. By eating so many folate-containing green vegetables, beans, and lentils, vegetarians and vegans inadvertently mask their own slowly developing B12 deficiency <strong>(and we review your supplements)<\/strong>.<\/li>\n<\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">Treatment is Easy<\/h3>\n\n\n\n<p>It\u2019s virtually impossible to take too much B12 as any excess of this water-soluble vitamin is eliminated via urine. Nutritional guru, Alan Gaby, MD, has commented that the only way too much B12 will kill you is if you fill your bathtub with it and drown.<\/p>\n\n\n\n<p>Foods high in B12 are animal products: meat, poultry, seafood, dairy, and eggs, with eggs having the least. Because all animals store B12 in their livers, eating liver is an excellent, though not particularly popular, treatment for B12 deficiency. Your grandmother or great grandmother likely remembers a time when her doctor told someone in the family to eat more liver.<\/p>\n\n\n\n<p>Although B12 injections have been used for decades as the fastest way to raise B12 levels, the latest research is saying that well-chosen forms of oral B12 will probably work just as well. The Quicksilver Spray is a fast oral spray containing 500 mcg of methylcobalamin per pump. Taken daily, it generally restores B12 levels to a normal range in one month. However, we do have many patients with absorption difficulties and prescribe B-12 self-administration by injection, usually weekly.<\/p>\n\n\n\n<p>This brings up another confusing point. Most B12 in both injections and pills is called cyanocobalamin, which, yes indeed, does contain a totally nontoxic form of Agatha Christie\u2019s favorite murder weapon, cyanide. But what\u2019s the difference between the two? When it comes to raising your personal B12 levels, both work equally well. To be honest, the main reason for the prevalence of cyanocobalamin is cost. Totally synthetic, cyanocobalamin is cheap to make. <\/p>\n\n\n\n<p>Methylcobalamin, the natural B12 form that your body actually prefers because it doesn\u2019t have to detoxify the cyano part, is simply more expensive to manufacture.<\/p>\n\n\n\n<p>Our most popular B-12 products:<\/p>\n\n\n\n<p><a href=\"https:\/\/whcstore.vitogenix.com\/product\/quicksilver-scientific-methyl-b12-liposomal-1oz\/1451?cp=true&amp;sa=false&amp;sbp=false&amp;q=true\" target=\"_blank\" rel=\"noreferrer noopener\">Quicksilver Methylcobalamin Oral Spray 90 day supply<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/whcstore.vitogenix.com\/product\/perque-activated-b-12-guard-2000mcg-100-count\/443\" target=\"_blank\" rel=\"noreferrer noopener\">Perque Activated B-12 Guard 100 day supply<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/whcstore.vitogenix.com\/product\/integrative-therapeutics-b12-active-cherry-flavored-30-count\/935?cp=true&amp;sa=false&amp;sbp=false&amp;q=true\" target=\"_blank\" rel=\"noreferrer noopener\">Integrative Therapeutics Chewable 30 day supply<\/a><\/p>\n\n\n\n<p>If you have any questions or problems, send them along, and be sure to schedule with a <a href=\"https:\/\/wholehealthchicago.com\/our-practitioners\">WholeHealth provider <\/a>to check your levels. <\/p>\n\n\n\n<p><br>Be well,<br>David Edelberg, MD<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Over the years of writing Health Tips, I was surprised to discover that one I\u2019d written a few years ago, about vitamin B12 deficiency, had received the most comments and questions from readers. Since there have been some interesting developments in both the diagnosis and treatment of B12 deficiency, and since B12 deficiency remains so [&hellip;]<\/p>\n","protected":false},"author":4902,"featured_media":31139,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2259,195,2316,50,43],"tags":[961,1740,2534,1741,2533,2532,1848,2321,1742,2320,162,2536,2535,2530,2531,612],"class_list":["post-31136","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-depression","category-diseases","category-featured","category-healthy-lifestyle","category-nutrition-nutritional-supplements-vitamins-herbal-remedies","tag-anemia","tag-b12-deficiency","tag-blood-test","tag-cyanocobalamin","tag-diagnosis","tag-dietary-habits","tag-folate","tag-gastrointestinal-tract","tag-methylcobalamin","tag-nervous-system","tag-nutrition","tag-symptoms","tag-treatment","tag-vegan-diet","tag-vitamin-b12","tag-vitamin-supplements"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.9 - 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