VITAMIN B12 DEFICIENCY

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A Link To Anemia, Autism, Heart Disease, & Senile Dementia

by Laura Power, MS, PhD, LDN

© February, 2006

Vitamin B12 is a common deficiency across all age groups. This includes children with

developmental delays (especially regressive autism), adults with heart disease, macrocytic or

pernicious anemias, and senior citizens.  Testing can be inconclusive.  B12 is also not easily

absorbed or metabolized.  Hence food and common supplements do not always work well.  To

combat these problems we have a special test.  We also have a variety of unusual supplement

forms, including: pre-metabolized B12, sub-lingual lozenges, and a new metered nasal spray (as

a custom compound).  These tests and therapies are effective at identifying and correcting a

potentially life-threatening deficiency, as well as promoting optimum health.  Let's look at

vitamin B12 more closely.

WHO HAS SPECIAL NEEDS FOR VITAMIN B12?

People with macrocytic or pernicious anemia.

Children and adults with regressive autism.

People with multiple sclerosis.

People with short-term memory loss, senile dementia, or psychosis.

The elderly, and 30% of people over age 50.

People with digestive problems:  gastric problems (low stomach acid), celiac disease,

malabsorption, or Crohn’s disease.

People with certain kinds of liver problems, toxemia, or chemical sensitivities.

People with heart disease.

Vegetarians.

Pregnant or lactating women.

People with Addison’s disease.

Patients taking these drugs, which interfere with B12 digestion, absorption or metabolism,

including: Omeprazole (Prilosec©), Lansoprazole (Prevacid©), Tagament©, Pepsid©, Zantac©,

and Metformin©.

People taking excessive folic acid without vitamin B12.  This may cure the macrocytic

anemia, but mask an underlying neurological disease.

WHAT IS VITAMIN B12?

Vitamin B12 is part of the B-complex family of vitamins.  It is a large complex molecule with a

ring-like molecule called a porphyrin,  with the mineral cobalt at the center, and so is called a

“cobalamin”.    The common food form of B12 is cyano-cobalamin.  B12 is bound to protein in

food, and must be separated by stomach acid, then bound to intrinsic factor in the stomach,

then bound to R-protein in the intestines, then it must be metabolized in the liver to methyl-

cobalamin for use in blood and nerve cells.  It must also be metabolized to adenosyl-cobalamin

for use in mitochondria (the batteries in cells that make ATP energy).  So you can see that it is

very complex to absorb and metabolize.  Not everyone can do this effectively.  Certain groups of

people have defects of one kind or another that interfere with this.  And these people need extra

vitamin B12 in a pre-metabolized form.

FOLATE: THE COMPANION VITAMIN

In order to function properly vitamin B12 must work with folic acid (vitamin B9), which is found

in plant foods such as leafy green vegetables, grains, peanuts, avocado and oranges.  But some

people have defects in the metabolism of folic acid (also called folate).  They have difficulty

metabolizing folate to its active forms: folinic acid (5-formyl-tetrahydrofolate) and methyl folate

(5-methyl-tetrahydrofolate).  These people will need pre-metabolized forms of this vitamin as

well.  We have both forms available at the clinic, as well as combinations of pre-metabolized B12

and folate.

FUNCTION & DEFICIENCY SIGNS of B12

Vitamin B12 has several vital functions in the body:

1.

B12 helps build healthy red blood cells.  Along with folic acid it helps the red blood cells

divide.  A deficiency of B12 or folate can cause macrocytic (or megaloblastic) anemia, or

pernicious anemia (which affects the nervous system).

2.

B12 helps maintain healthy nerve cells by building the myelin sheath around the nerves.

Deficiencies have been associated with neurological symptoms: numbness and tingling in hands

and feet, poor balance and coordination, confusion, short-term memory loss, a spacey feeling,

senile dementia, regressive autism, psychosis, multiple sclerosis, and depression.

3.

B12 is also needed to help make DNA, the genetic material in all cells.

4.

B12 is needed for the metabolism of odd-chain fatty acids.

5.

B12 is a “methyl donor”, and as such is important in Phase 2 liver detoxification, which

involves folate and glutathione.

6.

Deficiencies of B12, folate, or vitamin B6 can block important pathways, causing high levels

of homocysteine, which is a 15 times greater predictor of heart disease than high cholesterol.

7.

General deficiency signs include:  fatigue, weakness, constipation, loss of appetite, weight

loss, and soreness of the mouth or tongue.

8.

Deficiency signs in infants include:  failure to thrive, movement disorders, delayed

development, and macrocytic anemia.

TESTING FOR VITAMIN B12

The first suspicion of a vitamin B12 deficiency usually comes when a high MCV (mean

corpuscular volume) is seen on a CBC (complete blood count or hematology).  But this can also

indicate a folate deficiency.  A test for serum B12 will show how much B12 is in your blood

stream, but usually reflects what you have eaten recently.  Also some of the “cobalamins”

measured are only available to bacteria, not to humans.  So the serum score should be at least

500 rather than the minimum 200.  MMA (methyl-malonic-acid) is a urine test that measures a

metabolite of B12, and can sometimes be useful.  The preferred test is Spectracell (a specialty

lab), which measures the cellular uptake of B12 into white blood cells.  It also measures folate

and all other B vitamins separately.

WHAT FOODS PROVIDE VITAMIN B12?

Vitamin B12 is made by bacteria.  It is found in animal foods, but not in plant foods.  It is

naturally found in the following foods: mollusks, clams, fish, beef, beef liver, pork, rainbow trout,

salmon, eggs, milk, cheese, yogurt, chicken and turkey.  Fortified breakfast cereals are a source

of vitamin B12 for vegetarians.

WHAT B12 SUPPLEMENTS ARE BEST?

The food form of B12 is cyano-cobalamin.  If you have no genetic defects, digestive problems, or

other special needs, then cyano-cobalamin is adequate for most people.  But many people with

deficiencies have defects in digestion, absorption or metabolism, and they need the pre-

metabolized form of B12, which is methyl-cobalamin.  [There is another form of B12 called

adenosyl-cobalamin, which is used in the mitochondria.]  Some people also need a sub-lingual

lozenge, or injections, or other novel delivery forms – such as the new metered nasal spray. [See

below]

HOW MUCH VITAMIN B12 DO YOU NEED?

The RDA for vitamin B12 is about 3 mcg / day of cyano-cobalamin.  This is sufficient for a young

person about age 20 in perfect health to prevent frank deficiency disease.  It is not, however,

enough for optimal health, nor for people with special needs.  Most adults with B12 problems

need 500 mcg to 1 mg / day.  They also need folate to go with it, in a ratio of 2 folate to 1 B12.

Children need proportionally less, based on weight and condition.

CAN VITAMIN B12 BE TOXIC?  NO.

The Institute of Medicine of the National Academy of Sciences did not establish a Tolerable Upper

Intake Level for this vitamin because Vitamin B12 has a very low potential for toxicity. The

Institute of Medicine states that "no adverse effects have been associated with excess vitamin

B12 intake from food and supplements in healthy individuals".  In fact, the Institute

recommends that adults over 50 years of age get most of their vitamin B12 from vitamin

supplements or fortified food because of the high incidence of impaired absorption of B12 from

animal foods in this age group.

THE NEW METERED NASAL SPRAY

Given the many patients who have special needs for vitamin B12 due to digestion, absorption or

metabolism problems, there is a new vitamin B12 therapy available. This is a custom

compounded methyl-cobalamin (pre-metabolized form) available in metered nasal spray.  It is

available through licensed health care providers, but is not a prescription, and therefore can be

ordered by licensed nutritionists.  It is available for children and adults to replace injections --

which children hate.  This can be compounded by certain licensed compounding pharmacies with

sterile hoods.  Dr. Power only writes nutritional prescriptions for this for her own patients.  Click

to read about compounding pharmacies.

REFERENCES

For more information and references on vitamin B12, see the National Institutes of Health web

site: http://ods.od.nih.gov/factsheets/vitaminb12.asp