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Vitamin B12: Deficiencies, Benefits, Side Effects, Sources, Facts

Vitamin b12 aka Cobalamin

What is Cobalamin

Cobalamin, also known as Vitamin B12, is a water-soluble vitamin created only by bacteria and is essential for cell metabolism. Vitamin B12 has multiple forms and contains the mineral cobalt, where the name Cobalamin comes from. One of eight essential B vitamins; it plays a role in the brain, nervous system, and red blood cell formation. All B vitamins convert food into energy for the body, as well as help the body use fats and proteins. Vitamin B12 found in food sources is bound to protein, where stomach acid releases the vitamin during digestion. Once the vitamin is released, it combines with Intrinsic Factor and is then absorbed into the blood for use in the body’s many vital processes. Supplements of Vitamin B12 do not go through this process and are ready to use immediately, which is why they are recommended for those with stomach problems, who have difficulty separating the vitamin from food.

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Cobalamin Molecular Structure

Why is Cobalamin Essential

  • Vitamin B12 is needed for the development and function of the brain and nervous system. It maintains the myelin sheath, which is made to protect the neurons as well as creating neurotransmitters that transfer signals from the neurons to the body. Some of the created neurotransmitters act as an antidepressant, improving overall mood and reducing depression.
  • Cobalamin helps create DNA and RNA also known as the genetic material for the body. It also is responsible for synthesizing proteins that the body can then use for various processes. Alongside Folate, Cobalamin can reduce the risk for certain types of cancers.
  • It works closely with Folic Acid to make properly formed red blood cells and facilitate iron transport in the blood.
  • Folic Acid and Cobalamin create a compound called S-adenosylmethionine that assists in immune function and mood.
  • Cobalamin acts as a coenzyme: It is needed for enzyme-catalyzed reactions in the body.

Cobalamin Deficiency

When there is a Cobalamin deficiency, it results in the decline of enzymes that use Vitamin B12. This in turn, elevates homocysteine levels, which can lead to decreased cognitive function and heart problems. The body can store Vitamin B12 in the liver for many years, meaning that deficiency in healthy individuals is rare. Genetic defects with absorption, the elderly, those whose diets may not get enough Cobalamin to store in the body are most at risk of deficiency.

The most at risk for developing a Vitamin B12 deficiency include:

  • Vegans

Since Vitamin B12 is found in animal products, those that do not eat any animal products like dairy, cheese, or eggs are at risk for deficiency. Vegans and vegetarians who do not eat those products should take a Cobalamin supplement as well as consider eating fortified foods like cereal. Pregnant and Breastfeeding vegan mothers can pass on a Vitamin B12 deficiency to their children because it gets passed through the placenta and breast milk.

  • Gastrointestinal Surgery

Those who have had weight loss surgery or portions of the stomach removed end up losing some ability to secrete stomach acid and intrinsic factor. This decreases the stomach’s ability to unbind Vitamin B12 from protein in food.

  • Elderly

As people age, the ability to absorb nutrients decline, leaving them susceptible to developing a nutrient deficiency. This can be due to the lack of healthy diet or less stomach acid to absorb Vitamin B12. Supplements can still be absorbed properly because it is not bound to protein and doesn’t need to be released by the stomach acid.

  • Diseases affecting absorption

Crohn’s disease and  pancreatic disease affect absorption of nutrients including the absorption of Vitamin B12. Weight loss surgery, HIV, diabetes, and certain medications can also affect the ability of the body to absorb nutrients. Diseases of the pancreas can also lead to malabsorption because it provides enzymes needed for Vitamin B12 absorption in the body.

  • Inherited disorders affecting Vitamin B12 absorption

Imerslund-Grasbeck, congenital pernicious anemia and mutations affecting Cobalamin transport have been discovered to affect absorption.

  • Those with eating disorders

People that have eating disorders have difficulty eating enough food or eating the right balance of foods and retaining it in their body to be absorbed.

Causes:

  • Low dietary intake and vegan diets
  • Malabsorption
  • Intestinal Disorders & gastrointestinal surgery
  • Lack of binding proteins
  • Use of medications that lower absorption
  • Elderly with lower absorption capacity

Deficiency can cause the following symptoms:

  • Damage to the brain and nervous system: Without Vitamin B12, the body lacks the ability to protect the nerve cells and lower homocysteine, which can lead to dementia and Alzheimer’s. Deficiency leads to damage of the myelin sheath, which is the protective covering on the nerves throughout the body. This can present itself in numbness and tingling in the hands and feet, also known as paresthesia.
  • Depression: Depression is linked with Cobalamin deficiency potentially due to lower amounts of neurotransmitters created and higher homocysteine levels in the blood.
  • Constipation
  • Chronic stomach inflammation
  • Poor memory
  • Incontinence
  • Stiff or rigid muscles
  • Hypotension (low blood pressure)
  • Vision problem
  • Loss of appetite
  • Fatigue
  • Mania/Psychosis
  • Pernicious Anemia: This serious type of autoimmune anemia is found mostly in the elderly and affects the cells in the stomach. This is caused by inflammation of the stomach, destruction of the stomach cells by the body’s antibodies. When stomach cells are destroyed or impaired they cannot  make intrinsic factor and in turn, cannot absorb Vitamin B12 in the gastrointestinal tract. High doses of supplemental Cobalamin may be needed to compensate for this. Symptoms include:
    • Pale skin
    • Shortness of breath
    • Diarrhea
    • Weakness and Fatigue
    • Fever
    • Weight Loss
    • Numbness and tingling in hands and feet
    • Loss of Balance and difficulty walking
    • Confusion
    • Memory Loss
    • Moodiness

Top 10 Health Benefits of Vitamin B12

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  1. Helps the Body Produce Energy

Cobalamin turns carbohydrates from food into glucose that the body then uses for energy production, decreasing fatigue and weakness in the body.

  1. Cellular Processes

Vitamin B12 is needed to make DNA, which is the body’s genetic material, as well as synthesizing proteins that the body uses for various processes.

  1. Mental Health

Some neurotransmitters created by Cobalamin act as antidepressants to increase mood and prevent depression.

  1. Essential for Healthy Blood Cells

Alongside Folic Acid, Cobalamin works to create healthy red blood cells and facilitates the transport of iron in the body through the bloodstream.

  1. Promotes Healthy Skin, Hair, and Nails

Vitamin B12 renews cells in the body and can increase cell turnover for the skin reducing dryness, inflammation, and blemishes. It can strengthen nails and reduce hair breakage.

  1. Cancer prevention

Since Folate is required for the creation of DNA, Vitamin B12 is needed to turn Folate into a usable form. Without adequate Vitamin B12, Folate cannot make DNA, leading to more DNA damage and altered methylation leading to cancer. Vitamin B12 alongside Folate reduces the risk of breast, cervical, colorectal, and lung cancer.

  1. Nervous System Health

Vitamin B12 is essential for creating myelin to protect nerve cells and producing neurotransmitters, which are chemicals that help the brain signal communications. Folic Acid and Cobalamin improve memory and reduce brain atrophy. Vitamin B12 deficiency is associated with the development of Alzheimer’s disease and dementia due to high levels of homocysteine in the blood.

  1. Heart Disease Prevention

Vitamins B9, B6, and B12 lower homocysteine levels. High homocysteine levels are associated with higher heart disease and stroke risk.

  1. Decreased risk of developing age-related blindness

Taking Vitamin B12, Folic Acid, and Vitamin B6 daily can reduce the risk of developing Age-Related Macular Degeneration, a cause of blindness related to aging.

  1. Male Fertility

Vitamin B12 has shown to improve sperm count and sperm motility leading to increased fertility in men.

Top 10 Food sources of Vitamin B12

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Vitamin B12 is found in most animal products such as meat, fish, and dairy, as well as in supplements and fortified foods. Breakfast cereal, energy bars, and soy products are commonly fortified with Cobalamin. In foods, Vitamin B12 is bound to the protein and is released by stomach acid. Supplements are already ready to be absorbed by the body so they are perfect for those with stomach issues.

The following foods are great sources of natural Vitamin B12:

  1. Clams
  2. Beef Liver
  3. Rainbow Trout
  4. Salmon
  5. Tuna
  6. Crab
  7. Salmon
  8. Milk
  9. Swiss Cheese
  10. Egg

Daily Recommended Values

The body can store up to 2,500 micrograms at a time in the liver, so Cobalamin deficiency from dietary intake is rare. These are the recommended values for the following groups:

  • Infants
    • 0 to 6 months: 0.4 micrograms
    • 6 months to 1 year: 0.5 micrograms
  • Children
    • 1 to 3 years: 0.9 micrograms
    • 4 to 8 years: 1.2 micrograms
    • 9 to 13 years: 1.8 micrograms
  • Teens
    • 14 to 18 years: 2.4 micrograms
  • Adults
    • 19 years and older: 2.4 micrograms
    • Over 50 years: 100 to 400 micrograms
    • Pregnant Women: 2.6 micrograms
    • Breastfeeding Women: 2.8 micrograms

Side Effects & Dangers

Studies have shown that this water soluble vitamin is relatively safe and nontoxic as excess will be excreted in urine and not stored in the body like fat soluble vitamins. Although, taking one version of the B vitamins for an extended period of time can imbalance the other B vitamins. It is normally recommended to take Folic Acid supplements with Cobalamin or to take a B complex vitamin. Because Folic Acid and Cobalamin work closely together in the body, high doses of Folic Acid can hide symptoms of a Vitamin B12 deficiency, leading to nervous system damage if left undetected.

The following conditions should not take Vitamin B12:

  • Leber’s Disease: This hereditary eye disease when combined with Vitamin B12 can harm the optic nerve, leading to blindness.
  • Post-Surgical Stent: Those with heart conditions or heart stent placement should avoid Vitamin B12, Folate, and Vitamin B6 because it can cause blood vessels to narrow.
  • Allergies to Vitamin B12, Cobalt, or any other ingredient found in the supplements.

Special Caution for those with the following regarding Vitamin B12:

  • High Blood pressure
  • History of Cancer
  • Skin Disorders: Skin discoloration, rash, itching, and burning have been reported in those with skin disorders when using Vitamin B12.
  • Blood disorders: Vitamin B12 can increase blood volume and the amount of red blood cells in the blood.
  • History of Gout: Taking Vitamin B12 can start a gout attack in those that are susceptible with a previous history.
  • Low Potassium Levels: Those with low amounts of potassium in the blood taking Vitamin B12 can develop fatally low potassium levels.
  • Urinary problems: Urinary discoloration has been seen as a side effect in those with urinary problems.
  • Gastrointestinal problems: Nausea, difficulty with swallowing, and diarrhea have been noted as side effects in those with gastrointestinal problems.

How to Get Enough Cobalamin?

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  1. Eat foods naturally rich in Vitamin B12 like milk, poultry, fish, shellfish, and meat.
  2. Eat foods artificially fortified with Vitamin B12 like cereal, energy bars, soy products and yeast to increase intake of Cobalamin.
  3. If you are a vegan or worried about a deficiency, consider a supplement that has Vitamin B12 but first check with your doctor for dosage.
  4. Cobalamin is found in multi-vitamin, cyanocobalamin, and methylcobalamin in oral supplement form.
  5. The elderly are also advised to take a supplement because the ability to absorb Cobalamin declines as you age.

 

Medicine Interactions: What other drugs will affect Cobalamin?

Always check with a medical health professional before starting any supplements. The following medications are known to drastically affect Vitamin B12:

  • H-Receptor Antagonists

Medications that reduce stomach acid and pepsin produced by H2 blockers interfere with the absorption of Vitamin B12. Cobalamin levels should be monitored in those taking high dosages of H2 blockers for extended periods of time.

  • Metformin

This medication can reduce Cobalamin levels in the blood and extended use can lead to a B12 deficiency. Supplementation of Cobalamin can avoid this risk for deficiency.

  • Proton Pump Inhibitors

These GERD medications reduce the amount of stomach acid and pepsin produced and affects absorption of dietary Vitamin B12. Stomach acid is needed to release Cobalamin from proteins in food so the body can absorb them.

  • Nitrous Oxide

This anesthetic inactivates Cobalamin and can produce symptoms of a deficiency.

The following medications interfere with this particular vitamin absorption from food:

  • Anti-Seizure Medication
  • Chemotherapy Medications
  • Colchicine
  • Bile Acid Sequestrants
  • Tetracycline, Chloramphenicol, and Neomycin Antibiotics
  • Cholestyramine

Sources:

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