Updated: Nov 16, 2021
Vitamin B12 is an essential vitamin, necessary for the production of red blood cells and ultimately, optimal human function. Our red blood cells carry our oxygen to every cell in our body. Without sufficient supply, you may feel #fatigue, numbness or tingling, insomnia, weakness, nausea, decreased appetite, weight loss, fast heart rate, smooth or tender tongue, brain fog, #irritability, depression, headache, dizziness, and a plethora of additional dis-ease.
Certainly the best sources of B12 will be food you eat, but some people need more for a variety of reasons. Supplementation may improve these symptoms and for some, this is necessary to maintain optimal supply to feel well, even when their lab reports demonstrate "normal levels."
The brain, nerves, blood cells and so much more are dependent upon vitamin B12 and while we can find this naturally in our diets, from meat, fish, an dairy products, some individuals eliminate these foods from their diet for health or ethical reasons (vegetarians and vegans), while others have metabolism or #methylation challenges which keep them from sustaining optimal levels.
Gastric bypass patients and those with pernicious anemia, megaloblastic macrocytic anemia, leukopenia, thrombocytopenia, macrocytosis (enlarged red blood cells), or gluten sensitivity, for example, are often deficient in B12 and require injection or infusion supplementation. Diabetics who have taken metformin, those utilizing proton pump inhibitors (Prilosec, Prevacid), histamine 2-receptor antagonists (Tagamet, Zantac) or individuals with any sort of inflammatory bowel disease may also have a B12 deficiency.
Vitamin B12 has been utilized to support those with infertility, body weight concerns, osteoporosis, vitiligo, premature aging of hair, burning feet, insomnia, paranoia, memory loss, violent behavior, and even in little ones with developmental delay or autistic behavior. Interestingly, there has been improvement in reports of loss of positional sense (awareness of body position in space), diminished sense of touch or pain, clumsiness, and incontinence, and tremors. Vision changes, cerebral and ischemic attacks, even myocardial infarction, orthostatic hypotension, and palpitations are additional reasons cited in either the literature for potential benefits of vitamin B12 nutritional therapy or anecdotal improvements shared by clients.
Access to sufficient nutrients may be the challenge, but so might utilization. Vitamin B12 relies almost entirely on gut health, which so few people can maintain these days. Our diets, stress, and rounds of antibiotics destroy our gut flora creating dysbiosis and a plethora of consequence. Your stomach acid must break down the protein required to get the B12 from your foods, and then you must have sufficient intrinsic factor on the gut lining to bring B12 into circulation, as well as sufficient transcobalamin proteins to move it around the body, and finally, sufficient pancreatic enzymes for absorption. While some individuals may require short-term supplement, others do require it more long term so understanding your options can be helpful.
There are currently four different kinds of B12, including: cyanocobalamin, hydroxocobalamin, methylcobalamin, and adenosylcobalamin. Keep in mind, there are a number of B vitamins, but here we are talking specifically about B12 because it is special; it augments all the other's functions while also working to enhance metabolic activity. Not only does B12 support red blood cell formation, neurologic function, and DNA synthesis, but it is critical to the production of ATP (the energy process). If you've been a vegetarian, or especially vegan, for more than a little while, you really might be deficient.
Cyanocobalamin is the inactive form of vitamin B12 that is ironically FDA-approved for the deficiency of vitamin B12-deficiency, but it is considered the poorest form and therefore, the cheapest version of vitamin B12. This product is created in a laboratory and although it is quite stable, it has poor bioavailability with poor conversion rates and more importantly, is made with cyanide. The energy required just to detoxify cyanocobalamin could deplete glutathione reserves, a compound necessary for detoxification, and even kidney failure.
Hydroxocobalamin, compared to cyanocobalamin, has a higher affinity to plasma protein and a longer half-life, so it lasts longer in the bloodstream ultimately meaning the client doesn't need as many injections. This formulation is not FDA-approved, but hydroxocobalamin is recommended worldwide by the World Health Organization as the drug of choice for treatment of vitamin B12 deficiency. Nasal absorption of hydroxocobalamin is also high so weekly application may prove a viable alternative to monthly injections. Interestingly, hydroxocobalamin is an approved and effective treatment for cyanide poisoning, as it binds with the cyanide molecule and converts it into cyanocobalamin and excretes it via the kidneys.
Methylcobalamin (MeB12 and MeCbl) is the active form of vitamin B12 and is considered one of the best forms for maximum bioavailability as it doesn't need any extra step for conversion and is directly used by the body. It also helps reduce homocysteine concentration by converting homocysteine to methionine through a methylation process. This makes this version of B12 particularly useful for autistic children. This is the only the cobalamin compound which regulates the sleep and wake cycle, improving the overall quality of sleep and helps in developing nerve cells by maintaining the circadian rhythm. Studies have found an individual deficient in methylcobalamin suffers from agitation, anxiety, restlessness, and distress. Cognitive decline and cardiovascular diseases have also demonstrated improvement with methylcobalamin.
Adenosylcobalamin is the mitochondrial form of vitamin B12 found in cellular tissues. This form interacts with an enzyme called methylmalonyl CoA mutase, a metabolic enzyme, and may be useful for those with impaired energy production. Interestingly, although naturally occurring, it is the least stable of the four, outside the human body, and does not translate well into a tablet-based supplement. This one is available in a liquid.
Orally, the ideal form of vitamin B12 is the methylcobalamin form, although a combination of methylcobalamin and adenosylcobalamin is more effective according to the NIH. Knowing your various genetic SNPs however can help identify which variation of vitamin B12 is best for you. Injection and infusions are additional options with Eden Family Practice.
Controversy with Laboratory Testing
Most of us have a pretty healthy store in our livers, up to several years' worth, or so we believe. The controversy is that our laboratory reference ranges, for what is normal, may not be optimal. This is true for so many areas of health within conventional medicine, because health isn't entirely the goal. Rather, the ranges are based on levels upon which overt disease is evident. We want more for you! What is normal physiology? Where are we at our optimal performance levels? What level of vitamin B12 offers us lifelong vitality? The Japanese for example, say that 500 umol/L is ideal and Australians are comfortable with a level as low as 150 umol/L, as are many American clinicians. Dr. Layne might argue that 500 umol/L is the minimum expectation.
Consider that we begin to show symptoms of vitamin B12 deficiency at much higher levels than these however. Deficiencies begin to appear in our cerebrospinal fluid, for example, when levels fall below 550 umol/L. Further, the serum vitamin B12 test measures the total amount of B12 in the blood, which doesn't distinguish between active and inactive forms of B12. The inactive component may represent as much as 80 percent of your total vitamin B12 so your level will measure as normal, but your body doesn't have easy access to these forms. Our current testing methodology doesn't record what is happening at the cellular level.
Brain and nervous system health and prevention of disease in older adults may even require levels closer to 1,000 pg/mL. When you have a B12 deficiency, the myelin sheath around your nerves is being stripped off and neurological damage can result. The real tragedy appears to be those who have symptoms, are tested by their providers, and are told their levels are normal so aren't treated, but because they are 200-to-500-ish, they ultimately suffer neurological injury before more attention is offered, although the underlying cause may still be missed.
There are a few non-conventional methods for testing vitamin B12, such as the methylmalonic acid (urinary MMA) which is particularly helpful for identifying those with neurological damage (caution with kidney and thyroid disease or SIBO). The holotranscobalamin (HoloTC) is another useful test for evaluating vitamin B12 deficiency as it only evaluates the active forms of B12. It really should be a first-line test for diagnosing vitamin B12 deficiency as low levels would indicate deficiency at the cellular level.
Homocysteine is yet another (tHcy) helpful test, as methyl-B12 is needed as a cofactor for converting #homocysteine back into methionine. If you have normal B12 values, but high homocysteine levels, this may indicate a deficiency or issue utilizing your methyl-B12. High homocysteine levels can also be the result of low B6, folate, renal failure, and hypothyroidism. It is a test we routinely evaluate in our wellness clients, particularly those with MTHFR gene SNPs. Folate (vitamin B9), ferritin (iron storage), and a complete blood count are also important to evaluate.
Folate and MTHFR
Vitamin B12 is the most important nutrient for assisting your body in absorbing folate, so if you do not have sufficient B12, you can not optimally metabolize your methylfolate. If you're a real nerd like me, you might be quite familiar with the kreb cycle, but if not, know that about half the population has a genetic inability or at least suboptimal ability to break down glucose into energy at the level of your mitochondria. This has enormous impacts on your health and wellness, from low performance to significant birth defects.
History of IV Nutritional Therapy
Dr. John Myers introduced the option of offering vitamins in a sort of cocktail as far back as the 1960s. Vitamin B12 injections were frequently utilized during this time, but today, there is a bit more regulation to protect consumers from inappropriate use, dosage, or administration. Access to vitamin B12 has since become an issue for some consumers, or even just the awareness of the issue. If third party payers don't see the value in vitamin B12 therapy, then clinicians aren't going to offer it. Keep in mind, we have a system of sickcare, not actual healthcare.
The point is that in the event of any discordance between clinical findings of vitamin B12 deficiency and a normal B12 laboratory results, then treatment should not be delayed. Clinical findings are significant, valuable, and sufficient evidence to support treatment particularly because the high range of normal is exceptionally high, with levels even higher than what is thought to be optimal demonstrating little to no risk to the client. Certainly, levels should be evaluated with ongoing treatment, but overdose is just not an issue and the risk of deficiency is real.
Why Vitamin B12 Infusion?
Vitamin B12 can be offered intramuscularly or intravenously and the real difference here is the intramuscular injection is absorbed slower over a longer time frame. Because B12 can be stored, offering it into the muscle means it can be released slowly over a month's time; however, the intravenous option allows for a quicker result, but it doesn't last as long. The intramuscular route does pose some risk for local infection, hematoma, or abscess formation at the site, but this is quite rare. When offered intravenously, here at Eden Family Practice, Dr. Layne can create a cocktail of vitamins specific to your needs in effort to boost the immune system and support skin health. Vitamin C can also be utilized independently or glutathione, NAC, or vitamin D3. Jump into one of our Meet the Doctor sessions if you have further questions, or book your first appointment so Dr. Layne can work with you individually.