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Vitamin B12 - What you Don't Know Could Cost You



To start, a few questions.

 
Did you know that not all B12 supplements are the same? 


Did you know that there are THREE different forms of B12 available for supplements?   


Did you know that the most common blood test used to determine Vitamin B12 levels in the body is inaccurate?


Did you know that there is a difference between using B12 supplements to correct a deficiency and using B12 supplements to optimize wellness?


            If you said no to most of the questions, do not worry.   Very few health care consumers are privy to this information.

            The supplemental industry is a BILLION dollar business, with minimal regulation.    Health Canada does its best to ensure that the products on the shelf are SAFE, but does little to control the marketing of how EFFECTIVE each product is.   This means that each company can slap on whatever claim they want to sell their product.   This also means that every health food-store owner who has little to no medical training can promote whatever product provides the most profit.    This is a serious problem for the average consumer.

            It is crucial to be a critical consumer of your health.   If you are not sure about the safety or efficacy of a health food product, then seek the advice of an EDUCATED health care practitioner.   Your medical doctor has little to no training in nutrition or nutritional supplementation, unless they have taken a personal interest and have reviewed the literature outside of their medical curriculum.    Employees at a health food store are not trained in human physiology as robustly as your medical doctor.   So where is the middle ground? You can rely on a Naturopathic Doctor or an Integrative Medical Doctor for reliable advice before purchasing any products. 


So, back to Vitamin B12.   

            There are three available forms of Vitamin B12 on the market.    If you look at your supplements, you may see Cyanocobalamin, Hydroxycobalamin, or Methylcobalamin written on the label.     The COBALAMIN part of that complex word represents the Vitamin B12.    The first part of that word is what makes all the difference.     

            Cyanocobalamin is cheap and is most commonly used in supplements (because it is cheap) and in the Vitamin B12 injections prescribed by most medical doctors.     You get what you pay for with this form, because it is the least bioavailable.    This means that you will excrete most of this before it is able to do any good in your body.     After you take this form in, 80% is immediately excreted by the kidneys.   There is also a very small subsection of the general public that could be poisoned by the cyanide component in this supplement.   Hardly seems worth it, doesn’t it? 

            Hydroxycobalamin is the next in line when it comes to cost, but provides much more bang for your buck.  Approximately 5% is almost immediately excreted by the kidneys.      This means that it sticks around longer in your blood stream, leading to better absorption.    

            Methylcobalamin is the most expensive form of Vitamin B12, but is by far the most superior.    Not only is this form highly absorbed, it provides additional benefits to increasing Vitamin B12 levels.   The Methyl part is best for neurological complaints such as Shingles, Multiple Sclerosis, ALS, Dementia, and can also improve sleep by indirectly increasing Melatonin levels.  This form is also part of a comprehensive treatment protocol to treat hormonal imbalances or environmental toxicity. 

            You can get all of these forms in an injectable solution.   If you are getting B12 injections prescribed by your medical doctor, request a methylcobalamin form.  


So how do you know if you NEED Vitamin B12 supplementation?     

            The first step is to test your blood levels.   Currently there are three tests readily available.   The most common test is serum vitamin B12.  This provides measure of how much B12 there is floating around in the blood, but this does not give any indication of your body’s absorption and storage of Vitamin B12.  An interesting fact is that every laboratory provides a difference reference range of “normal” for serum Vitamin B12 testing.    Some have an upper limit of 400 ng/L while others up to 900 ng/L.    Currently, there is no data to support this upper limit of normal.   So you need to trust an educated health care provider to correctly manage your supplemented dose.      

            Two other tests, when done simultaneously, best determine how much B12 our body needs, and how much it is using.   These tests are Homocysteine and Methylmalonic acid.   These last two tests are more costly, but provide the best measure of how our body is using Vitamin B12.  

** special note: there are NO other reliable measures of vitamin B12 levels in the body at this time.  Be skeptical of any practitioner who claims otherwise. 

Who should get their Vitamin B12 levels checked?

            Anyone who is experiencing symptoms that could be due to a Vitamin B12 deficiency should get tested.   Symptoms of a deficiency include fatigue, constipation, dizziness, headaches, irritability, swollen tongue, moodiness, shortness of breath, numbness, palpitations, anxiety, and psychosis.   

            All patients who are taking birth control, medications to treat heartburn, anti-seizure medications, or medications to manage blood sugar requiring screening, as they are documented to cause deficiency of Vitamin B12.  Additionally, any patients who have absorption issues as a result of a bowel disease or surgery need to keep tabs on their levels. The elderly should be screened regularly, as absorption of Vitamin B12 naturally decreases with age.   Those who abide by a vegetarian or vegan diet are commonly deficient as well, and need to be monitored. 

Can B12 supplementation help even if I am not deficient?

            The short answer - it depends.    There is a growing body of evidence that supports using higher doses of Vitamin B12 (in methyl and hydroxyl forms) to combat a variety of health care concerns.    The majority of this research has supported the benefit of using higher doses in patients suffering from dementia, mood or sleep disorders.   This is promising as more and more psychiatrists are recommending nutritional supplements prior to prescribing more aggressive psychiatric medications.   

Remember, be a conscious consumer of your health!  

In health, 

Dr. Tara ND
 
References

1. Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009 Feb;89(2):693S-6S
2. Bailey RL, Durazo-Arvizu RA, Carmel R, Green R, Pfeiffer CM, Sempos CT, Carriquiry A, Yetley EA. Modeling a methylmalonic acid-derived change point for serum vitamin B-12 for adults in NHANES. Am J Clin Nutr. 2013 Aug;98(2):460-7.
3. Herrmann W, Obeid R. Utility and limitations of biochemical markers of vitamin B12 deficiency. Eur J Clin Invest. 2013 Mar;43(3):231-7.
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8. Methylcobalamin. Altern Med Rev. 1998; 3: 461-463.
9. Sohler A, Pfeiffer CC, Kowalski T. Effectiveness and route of administration of Vitamin B12. Int Clin Nut Rev. 1989; 9:64-65.  
10. Prousky, J. Understanding the serum Vitamin b12 level and its implications in treating neuropsychiatric conditions: an orthomolecular perspective.  Journal of Orthomolecular Medicine.  2010; 25(2): 77-88.