Vitamin B12 (Cobalamin) is one of the most important components of the nervous system. It participates in the production of the substance that insulates nerve tissues, which is called myelin. It also is involved in many critical biochemical processes that help maintain the normal function of the brain, spinal cord, and peripheral nerves. Deficiency of Vitamin B12 leads to symptoms:
- Memory loss and forgetfulness.
- Mood swings and short temper.
- Imbalance and vertigo.
- Tremors, shakiness and incoordination.
- Difficulty walking, eventually leading to falls.
- Burning pain or numbness in the limbs.
- Fatigue, tiredness and listlessness.
Vitamin B12 deficiency results in:
- Depression and anxiety.
- Neuropathy (nerve damage).
- Migraine headache.
- Blood vessel damage and strokes.
Conditions associated with or causing vitamin B12 deficiency include the following:
- Thinning of the stomach lining with aging (gastric atrophy).
- Gastric bypass surgery.
- Malabsorption syndromes
- Inflammatory bowel disease (eg. Crohn’s disease, ulcerative colitis).
- Stomach acid blocking medications.
- Parasitic tapeworm infections.
- Alcohol and nitrous oxide abuse
- Autoimmune conditions:
- Anti-parietal cell antibody syndrome.
- Addison’s disease.
- Celiac disease.
In the days before folic acid was added to many foods, people with vitamin B12 deficiency would develop a condition called “Pernicious Anemia.” It was called pernicious because it would happen gradually, and many people would not discover the deficiency until widespread damage had been done to the nervous system. These days, we rarely see pernicious anemia, because folic acid supplementation prevents many of the changes that lead to such anemia. But because so many people have difficulty absorbing vitamin B12, it is still very common for us to encounter patients suffering with nervous system malfunction, just without the anemia.
Common pitfalls with managing Vitamin B12:
- It is not a routine thing to have your vitamin B12 level checked during a routine checkup with your doctor.
- Even if your level is checked, your doctor might report the result back to you as normal, when it is not. Much research has shown that symptoms of deficiency can occur when levels are below 400 pg/mL, but most labs have not caught up with the research and will not consider you deficient until your level falls below around 180 pg/mL. Your doctor might not be aware of this and make the mistake of agreeing with the lab, erroneously calling your levels normal.
- If you are taking oral supplements, you might not be absorbing vitamin B12, particularly if it is in the form of Cyanocobalamin. So you might have a false sense of security that you are OK when in fact your supplement may be passing right through you.
What can I do to help myself?
- If you are experiencing symptoms of vitamin B12 deficiency, ask your doctor to check your vitamin B12 level.
- If your level is less than 400, consider replacement. Even if it’s right around 400, it can’t hurt to bump your levels up somewhat to give yourself some leeway. How do I replace vitamin B12?
- Many people who are younger or who are vegetarians may be able to get their levels back up to normal simply by adding a multivitamin or taking Cyanocobalamin 500 mcg by mouth daily.
- However, many people will not absorb this and will need an alternative:
- Cyanocobalamin intramuscular 1,000 mcg daily for seven days, then weekly or monthly, depending on what repeat levels show.
- Methylcobalamin 2,000-5,000 mcg daily. Methylcobalamin is highly absorbable from the gut, even in people who normally can’t absorb its cousin, Cyanocobalamin.
- If you have vitamin B12 deficiency, it is smart to recheck levels within a few weeks of starting supplementation to make sure that you’re getting enough on board.
- If your levels become normal, but you still have symptoms, it may be smart to check other labs (total serum homocysteine level and methymalonic acid level) to make sure that you’re getting enough. Some people have genetic malabsorption conditions that require higher doses of Vitamin B12.