Vitamin Week Continues with Vitamin B-12 aka Cobalamin

Today I will discuss Vitamin B-12. This is a very important vitamin to know about because many of us will need supplementation after age 65!

Vitamin B-12 exists in many different forms and contains the mineral cobalt, which is why it is also known as "cobalamin."  Vitamin B-12 plays a very important role in the development and maintenance of our nervous system, red blood cell formation, and the synthesis of DNA.

B-12 is found in all animal products, dairy products, and fortified cereals. Cooked clams and liver are known to have the highest amounts of B-12.

According to the NIH - recommended intake of B-12 is the following:

Table 1: Recommended Dietary Allowances (RDAs) for Vitamin B12

Age	Male	Female	Pregnancy	Lactation
0–6 months*	0.4 mcg	0.4 mcg
7–12 months*	0.5 mcg	0.5 mcg
1–3 years	0.9 mcg	0.9 mcg
4–8 years	1.2 mcg	1.2 mcg
9–13 years	1.8 mcg	1.8 mcg
14+ years	2.4 mcg	2.4 mcg	2.6 mcg	2.8 mcg

* Adequate Intake

 In a well-balanced diet, a person obtains approximately 5 to 15 mcg of vitamin B12 daily, which is much more than the recommended dietary allowance noted above. This is why it takes years to develop true B-12 deficiency! For a healthy, young, individual - it takes anywhere between 3 to 5 years to develop B-12 deficiency since we have a huge reserve of B-12 stored in the liver.

Symptoms of B-12 Deficiency

Symptoms of B-12 deficiency can be divided into different categories as B-12 plays an important role in the formation of red blood cells and the functioning of our nervous system (nerves and brain).

The clinical manifestations of B-12 deficiency on the blood include anemia leading to feeling tired, weak, and/or short of breath. 

The clinical manifestations of B-12 deficiency on the nerves include:
-feeling numbness or "pins and needles" in your hands and/or feet
-loss of sensation in the hands and/or feet
-inability to walk
-inability to sense ones feet on the ground

The clinical manifestations of B-12 deficiency on the brain include:
-confusion
-change in mental status
-personality changes
-difficulty with memory
-depression

Who is at Risk for B-12 Defiency?

1) The malnourished

Those with limited access to foods containing B-12 (vegetarians) or who do not follow a well-balanced diet (such as the elderly or alcoholics) or at risk or B-12 deficiency. 

2) Those with diseases effecting intrisic factor production in the stomach such as pernicious anemia 

3) Those with decreased acid production in the stomach due to:
- medications for GERD/Acid Reflux (like "H-2 blockers" (i.e. Zantac) or "Proton Pump Inhibitors" (i.e. Nexium, Protonix, Prilosec))
-surgical resection of parts of the stomach (such as weight loss surgeries) 

Acid in the stomach helps to breakdown B-12 so that it can bind to intrinsic factor and be absorbed. If there is less acid in the stomach due to the conditions above, one might develop B-12 deficiency.

4) Older individuals

Older individuals are at risk for B-12 deficiency due to limited nutritional intake of B-12 and development of atrophic gastritis. Many elderly patients are predisposed to atrophic gastritis, since acid production decreases with age as the stomach lining begins to thin. 

5) Individuals with diseases effecting absorption of nutrients in the intestines such as celiac disease, inflammatory bowel disease, and those who have undergone intestinal surgeries

6) Those taking medications such as: Metformin, cephalosporins, aminoglycosides, etc.

Who Needs To Be Taking B-12 Supplements?

I would recommend having your B-12 levels checked if:

-you are experiencing any of the symptoms that I have mentioned above

-you consider yourself in one of the groups outlined above who are "at risk" for B-12 deficiency

-you are older than 65 years of age

Treatment of B-12 deficiency is quite common and curable, so be sure to ask your doctor if you need further supplementation! 

Please continue to email your questions/comments to DoctorDeenaMD@gmail.com


**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**