“I think I’m anemic.” Well, not me, but it’s a common phrase uttered in a doctor’s office.

Patient comes in pale, fatigued, sheer exhausted. Clearly, something’s not right. On a basic blood panel, you see that her hemoglobin is low, that her RBC count is low. It’s anemia, that’s clear – but which kind?

If you read this post, you may have thought, obviously she should  take some iron. And I’m here to warn you: Don’t! Thanks to science, we can measure several markers for Iron (including other pieces you would see on a basic blood panel). So I’d do that first. But I’m not here to diagnose anemia. I’m mostly here to ramble on with my discoveries.

Also, I’m here to remind you that there are several types of anemia (just like fatigue). This is the magic & frustration of medicine. Same end result (anemia) from umpteen different causes.

Let’s turn our attention to just one cause: Vitamin B12 .

First of all let’s get one thing clear. There is no such thing as Vitamin B.

B, is the catch all term for 12 different vitamins, 5 of which we don’t talk about, or have been renamed. When you take Vitamin B, it could be any, all or one of the 12 [1].

Vitamin B12 is a big circular vitamin required in small amounts and constantly recycled in the liver (sound familiar?) [1,2,3,4]

Cobalamin is the common name for B12. Cobalt (as in Cobalt blue), is a rare mineral found in soil. The Cobalt Vitamin (Cobal -amin, get it?) is made when bacteria combine Cobalt, Nitrogen & other chemicals [5].

The only natural source of B12 is from bacteria in soil[5]. Animals, plants, fungi & yeast do not have the enzyme to create it [5].

Animals get B12 from eating soil or food that contains B12 as by-products of bacterial-plant reactions, or through fortified foods. B12 is not an animal product, but once made by bacteria and consumed, it is attached to animal proteins [1,5].

Tempeh is not a vegan source of B12. Soybean ferments via fungus, not bacteria, and therefore no B12 is present[6]. The bacteria present in fermentation of plants are not the same as the cobalamin producing bacteria in soil, & therefore are not a source of B12 [5,6].

Animal products are the most reliable source of B12, outside of unwashed/unpasteurized vegetables [7](which carry their own risk of other contaminants).

Human gut flora, can symbiotically create B12 in the colon – BUT we don’t absorb the B12 we make, as it is too far down the intestinal tract. It is a form that gets passed (eventually) to soil & water through our stool. What goes around comes around [8,9].

So, If we can’t make it, and other animals can’t make it, and heck other plants, yeast and fungi can’t make it, then we better take care of our soil. Well nourished soil & bacteria are essential to the production of vitamins in our food. No cobalt, no cobalamin. 

Your body can store B12 in the liver for years (average of 7 years)[1] . We only need a tiny bit every day, and this storage is helpful for filling in for diet, when B12 is scarce. Our bodies are amazing! But… because the symptoms of depleting stores can seem vague, they can be overlooked. It is important to assess  B12 status, as the damage from insufficient B12 can be irreversible, severe and appear quickly.

How much you need [1,2,3]:

Minimal Daily Intake

0.4 – 2 mcg/day

2.4 mcg/day

2.6 mcg/day

2.8 mcg/day

100-6000 mcg/day

Stage 

Infancy – Teen years 

Adults

Pregnancy

Lactating

Adult short-term supplementation

Cobalamin is essential for DNA synthesis, Energy Production, Fat & Protein metabolism, Nerve pulse transmission, Red Blood Cell Production, Immune system function[1,3].

The different forms of B12:

Hydroxy-Cobalamin is the first form created by bacteria from Cobalt, Nitrogen, Carbon & Hydrogen – our enzymes can convert hydroxycobalamin into useful forms [1]:

• Adenosyl-Cobalamin – this is the main storage form, found in the liver. It is also crucial for creating a part of what is called The Krebs Cycle – the basis of energy production [1].

• Methyl-Cobalamin is the methyl donor form of B12. It is vital for nerve & cognitive functions [1,5].
• Cyano-Cobalamin is not produced naturally, but is the most common form for adding to products and supplements. This commercial form offers you the Cobalamin, but is not useful until converted to Hydroxycobalamin using Glutathione from your liver [1].
• Pseudo-Cobalamin is created by algae (Spirulina & other seaweeds). This form is not useful in the human body, and competes with the B12 that is available [10,11,12,13].

Stage of B12 Digestion: Digest it!

Body Requirement #1: Healthy levels of stomach acid Normal pH = 0.8-2.0

Are you at risk? Reduced in alcoholism, antacid use, regular aspirin use, aging [14] 

Body Requirement #2: Intrinsic Factor release from healthy parietal cells (aka stomach cells).

Are you at risk? Reduced in elderly, certain autoimmune conditions, atrophic gastritis [1,4,14].

Stage of B12 Digestion: Metabolize it!

Body Requirement #3: A healthy & alkaline duodenum (beginning of your small intestine) Normal pH = 7

Are you at risk? Duodenal ulcers, cancers & operations can make this area dysfunctional [1,2,3,4,13].

Stage of B12 Digestion: Absorb it!

Body Requirement #4: A healthy ileum (end of your small intestine) has receptors that pick up B12

Are you at risk? IBD, Metformin use, Alcoholism, Celiac Disease, Parasites & Surgery can inhibit B12 absorption [14,15].

Common signs of B12 deficiency:

Numbness/tingling/burning, Fatigue/Weakness, Anemia, Decreased immunity, Swollen, inflamed tongue, difficult thinking or memory, balance problems, hallucinations

 

Now: Questions I have about Vitamin B12. Because, you can't be a scientist without questions.

1. Could we extract the cobalt from the vitamin, and still address the body’s needs?

2. Is it possible that we can do cellular/DNA damage with high-dose methyl? As overload and toxicity (I think) has been assessed with the other forms.

3. How can we encourage Cobalt turnover in soil, without supplementing it (as is done on animal farms)?

References

1. Gropper, S.S., Smith, J.L., Groff, J.L. (2005). Advanced Nutrition and Human Metabolism 4th Ed. Toronto:Wadsworth

2. Mahan, K., Escott-Stump, S. (2004). Krause’s Food Nutrition and Diet Therapy 11th Ed. Philadelphia: Elsevier

3. Linus Pauling Institute (2007). Vitamin B12.  http://lpi.oregonstate.edu/infocenter/vitamins/vitaminB12/

4.  Xu, Z. (2002). Vitamins, Minerals and Health (Draft). FNH 351 Class notes. University of British Columbia

5. Trufanov, V.A. (1959). Vitamin B12 (Cobalamin). Problems of Nutrition (Russian -trans by NIH) Clin Chem 5(4); 335-348.

6. Katz, Sandor (2012). The Art of Fermentation. White River Jct, Vermont: Chelsea Green Publishing p. 24.

7. Marz, R.B. (1999). Medical Nutrition from Marz 2nd Ed. Portland: OmniPress

8. Location of B12 synthesis – Albert, MJ, Mahan, VI, Baker, SJ (1980). Vitamin B12 synthesis by human small intestinal bacteria. Nature. Feb 21;283(5749):781-2.

9. Singh, V. V. Singh, Toskes, P. P. (2003) Small Bowel Bacterial Overgrowth: Presentation, Diagnosis, and Treatment.Current Gastroenterology Reports. 5:365–372

10. Taga, M.E., Walker, G.C. (2008). Pseudo-B12 Joins the Cofactor Family. Journal of Bacteriology. Feb. p. 1157-1159.

11. Hufham, J.B,,Burgus, R.C.,Ing, S.Y.I., Pfiffner, J. (1968). Reduction of Hydroxocobalamin by Cell-free Particles from Pseudomonas rubescens. Journal of Bacteriology Mar:947-951.

12. Watanabe, F., Katsura, H., Takenaka, S., Fujita, T., Abe, K., Tamura, Y., Nakatsuka, T., Nakano, Y. (1999). Pseudovitamin B(12) is the predominant cobamide of an algal health food, spirulina tablets. Journal of Agricultural and Food Chemistry. Nov; 47(11) 4736-41 http://www.ncbi.nlm.nih.gov/pubmed/10552882?dopt=Abstract

13. Hoffbrand, A.V., Catovsky, D., Tuddenham, E.G.D. (Eds). (2005). Postgraduate Haemotology 5th Edition. Massachesetts:Blackwell Publishing. p 68.

14. BC Ministry of Health (2012) – Cobalamin Deficiency – Investigation and Management. Clinical Practice Guidelines.

15. Location of Metformin inhibition – Bell, David S.H. (2010). Metformin-induced Vitamin B12 Deficiency Presenting as a Peripheral Neuropathy. South Med Journal;103(3):265-267. http://www.medscape.com/viewarticle/719043_3