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.
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©,
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
FUNCTION & DEFICIENCY SIGNS of B12
Vitamin B12 has several vital functions in the body:
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).
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.
B12 is also needed to help make DNA, the genetic material in all cells.
B12 is needed for the metabolism of odd-chain fatty acids.
B12 is a “methyl donor”, and as such is important in Phase 2 liver detoxification, which
involves folate and glutathione.
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.
General deficiency signs include: fatigue, weakness, constipation, loss of appetite, weight
loss, and soreness of the mouth or tongue.
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
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.
For more information and references on vitamin B12, see the National Institutes of Health web