Vitamins are essential to health and can have a huge impact on life, especially B12. A vitamin B12 deficiency is more common than many realize and the signs and symptoms can mimic certain ailments. These can include Alzheimer’s, memory loss, Multiple Sclerosis (MS), neurological disorder, autoimmune disease to name a few. Research indicates that ~40 percent of people between the ages of 26 and 83 have plasma B12 levels in the low normal range. At this low range, certain neurological symptoms can be witnessed. Many symptoms such as memory loss that are related to simply aging may be connected to a B12 deficiency.
In normal bloodwork, this vitamin isn’t really examined. There is a test to determine, but it isn’t one that is often ordered. If it is ordered, the low end of the range is too low. Many who are deficient aren’t identified. Why is this the case? It’s odd. The literature has well-established that individuals with levels between 200 pg/mL and 350 pg/mL are considered “normal” but they clearly have symptoms of deficiency. From a functional and integrative medicine standpoint, the recommendation is to treat all individuals who are symptomatic and have B12 levels less than 450 pg/mL. What’s interesting is that in Europe, the lower limit for B12 is between 500-550 pg/mL. This range, which is higher than the ranges in the United States (200-350), is connected to memory loss and dementia. Perhaps this is why the rates of Alzheimer’s and dementia are higher in the United States. Could it be related to a B12 deficiency?
Let’s look at vitamin B12. It works with folate in the synthesis of DNA and red blood cells. It’s critical in the production of the myelin sheath around the nerves. Also, it’s important in the conduction of nerve impulses. The myelin is the insulation that protects the nerves and helps messages transport. Pernicious anemia which is an autoimmune condition where the body destroys a protein necessary that is necessary for the absorption of B12 is a severe B12 deficiency. Not everyone who has a deficiency has this condition; however, there are other reasons why people aren’t absorbing B12. Some reasons may include gut inflammation, leaky gut, low stomach acid, medications or alcohol. Other factors may include people over the age of 60 or those who routinely use stomach acid suppressing drugs. Even those who take Metformin for Diabetes can be impacted. Also, individuals with the MTHRF mutation are more likely to be deficient. This is not an exhaustive list, but would also like to mention that vegetarians or vegans are at a greater risk of B12 deficiency because B12 is found only in animal products and can’t be obtained from plants or sunlight. The latest statistic is that over 50% of long-term vegetarians and ~80% of vegans are deficient in B12.
Let’s look closer at B12. Cyanocobalamin is the most frequently used form of B12 supplementation in the United States and this is the form seen in many multivitamins and B complex vitamins. It’s seen more often because it’s cheaper to produce. Not to go into too much science and physiology, but hydroxycobalamin (often used in Europe) and methylcobalamin (which you can find in individual B12 supplements in the U.S.) are the better forms and are readily absorbed by the body. Cyanocobalamin has to convert itself into methylcobalamin because it isn’t natural, but a synthetic. Those who are older or those who have conditions such as lower stomach acid production, may not be able to readily convert it to the usable form.
Please know that one of the concerns with diagnosing a B12 deficiency is that the conventional serum B12 test that most providers utilize may not be accurate. This test measures the total amount of B12 in the blood and does not rule out functional B12 deficiency. A more sensitive test is the methylmalonic acid (MMA). MMA is converted to succinic acid via an active-B12 dependent enzyme. If MMA levels are high, it suggests that active B12 is lacking. Please note that there are two ways to measure MMA – blood test or urinary. If you have intestinal bacterial overgrowth or gut dysbiosis, the urinary test would be the better choice for accuracy. There is also another test - Holotranscobalamin II (holo-TC). Holo-TC is composed of vitamin B12 attached to transcobalamin. This test is more sensitive than MMA. It represents the biologically active part of B12 that can actually be delivered to the cells and perform all of the functions of B12. In a recent study, it was revealed that conventional tests are missing those who are B12 deficient – 61% of vegetarians and 31% of vegans were not detected via serum.
If you’re exhibiting symptoms that make you suspect a deficiency, discuss with your provider. Symptoms may include fatigue, weakness, shortness of breath, memory loss, tingling and/or numbness in your hands or feet and even a sore mouth or tongue. Of course, other conditions may also have similar symptoms so it may be a process of elimination. I’ll talk about these other conditions in future articles.
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