Methyl-B12: Part Two
Why Vegans Need To Supplement With B12
Advocates of vegan and vegetarian diets often maintain that these people do not need to supplement with vitamin B12 because it is found in certain vegetable foods (spirulina and tempeh being the most common examples), and their intestinal flora will produce it for them, even if they are not eating it.
However, the fact is vitamin B12 is found only in animal foods (meat, fish, eggs, cheese, etc), and while it may look like it is contained in spirulina and tempeh, that form is in fact only an analog. Which means it may look like B12 under a microscope, but in fact will not act as such within the human body. (More on the subject can be found here: Vitamin B12 Analogues.)
Furthermore, there are no studies showing that vegans and vegetarians produce enough B12 from intestinal flora alone to meet their biological requirements. Indeed, studies on the subject reveal that the majority of strict vegetarian and vegan populations show levels of B12 well below normal, concluding that: “…with few exceptions, the reviewed studies documented relatively high deficiency prevalence among vegetarians. Vegans who do not ingest vitamin B12 supplements were found to be at especially high risk. Vegetarians, especially vegans, should give strong consideration to the use of vitamin B12 supplements to ensure adequate vitamin B12 intake.” (Eur J Clin Nutr. 2014 May;68(5):541-8; “The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature.”)
A recent study that analyzed two specific groups of vegans (“living-food” vegans and Natural Hygiene vegans), concluded that: “…in agreement with the average of all of the other studies, about 50% of vegans, measured cross-sectional, have below-normal B12 status. The mounting evidence points toward the need for all vegans to supplement their diets with B12 or to monitor their vitamin B12 status.”
The authors of this study pointed out that it takes many years for obvious symptoms of B12 deficiency to show up, but more subtle metabolic testing (urinary MMA assay) shows evidence of insufficiency within a year or two after ceasing the intake of B12 from animal foods, or supplements.
Although the stores of B12 in the liver may not yet be depleted, the metabolism is beginning to be unfavorably altered at the cellular level due to the lack of newly ingested B12. They suggest that: “Early detection and supplementation among pure vegetarians is the best way to circumvent permanent neurological damage and disorders.”
(“Metabolic Vitamin B12 Status on a Mostly Raw Vegan Diet with Follow-Up Using Tablets, Nutritional Yeast, or Probiotic Supplements”; Michael S. Donaldson; Hallelujah Acres Foundation, Shelby, N.C., USA)
Other Causes of B12 Deficiency
Vitamin B12 deficiency can also result from other conditions such as: atrophic gastritis, in which the stomach lining has thinned; pernicious anemia, which makes it hard to absorb vitamin B12; surgery that removed part of your stomach, or small intestine (including weight loss surgery); conditions that affect the small intestine, such as Crohn’s disease, celiac disease, or parasites; alcoholism; immune system disorders, such as Graves’ disease or lupus; long term use of drugs that suppress stomach acid.
The Quick B12 Solution
NutriStart’s Quick B12 is a sublingual version of the active form of vitamin B12 (methylcobalamin). It comes in a good tasting, glycerin-based liquid, with 0.5ml (15 drops) providing 1,000 mcg of B12. Our product contains no gluten, animal products, sweeteners, yeast, dairy, or artificial coloring. Sublingual B12 tablets that dissolve easily under the tongue are made with a base of lactose (not suitable for vegans and the lactose-intolerant), other tablets that are slower to dissolve are usually made with a base of sorbitol (a sugar alcohol which can cause gastrointestinal distress in some people). These are fine if one has no allergies to them. Quick B12 uses vegetable glycerine, which is naturally mildly sweet while having no impact on blood sugar, and which most people can tolerate without side effects.
Vitamin B12 requires “intrinsic factor”, a glycoprotein produced by the cells of the stomach, to be properly absorbed. Aging, poor digestive function, and other health factors can affect production of intrinsic factor. Because of this tendency towards mal-absorption, doctors often use injections to provide patients with a guaranteed amount of B12. (However, all doctor-provided injections, in Canada at least, are in the form of cyanocobalamin. I did find one pharmacy in the vicinity of Victoria – Island Pharmacy – which did sell injectable methylcobalamin, though they required one to provide a recommendation from a health professional in order to purchase.)
Another way to bypass the need for intrinsic factor is to take the supplement under the tongue (sublingually), which allows it to enter the bloodstream through the mucous membranes. Less painful than an injection, and just as effective, except in extreme cases (e.g. Chronic Fatigue Syndrome, Lupus, Fibromyalgia, neurological diseases), this simple method can be used without the need to see a doctor.
Why Methylcobalamin?
The last generation of supplemental vitamin B12, known as cyanocobalamin, works okay for building red blood cells, but does not do much more than that. Since this form of B12 is an inactive form, it requires conversion by the body into the methyl form in order to perform the other functions required by the methylation cycle, including its neuro-protective effects.
Quick B12 contains methylcobalamin, because it is the active form of B12, immediately available for use by the body, and with a broader range of benefits than cyanocobalamin.
If you have a simple vitamin B12 deficiency or want a cost-effective way to maintain B12 levels, cyanocobalamin is a good option. “On the other hand, if you’re targeting neurological health or desire the direct bioavailability of B12, methylcobalamin may be more fitting. While both forms of vitamin B12 are effective in treating deficiencies, methylcobalamin is often favored for its immediate bioavailability, neurological support, and longer retention in the body, making it a preferred choice for those with specific health needs.” (Source)
Psychiatric Symptoms of B12 Deficiency
While doctors may still think of vitamin B12 mostly for its role in producing red blood cells (deficiency leading to pernicious anemia, resulting in fatigue), B12 also has a role in psychiatric symptoms, including anxiety, depression, and even various states of psychosis. (Acta Psychiatr Scand. 2003 Aug;108(2):156-9. “Catatonia and other psychiatric symptoms with vitamin B12 deficiency.” Berry N, et al.)
The body requires B12 to make the protective coating surrounding the nerves, known as myelin, so inadequate B12 can expose nerves to damage. Symptoms of such nerve damage can manifest as dementia, multiple sclerosis, neuropathy, and balance or walking disturbances.
Sufficient B12 is also required for the production of SAMe (S-adenosylmethionine), a “methyl donor” required for producing and metabolizing neurotransmitters, among other functions. Therefore, a deficiency in SAMe, induced by B12 deficiency, can lead to a variety of psychiatric ailments.
Over the past few decades psychiatric symptoms attributed to B12 deficiency have included: acute psychotic states; confusion; delirium (including with hallucinations); delusions; loss of memory; manic and schizophrenic states. (J Am Geriatr Soc. 1988 Dec;36(12):1105-12; “What are the psychiatric manifestations of vitamin B12 deficiency?” Hector M, et al.)
Now, these are all serious conditions, often horribly disrupting people’s lives, and usually resulting in people being put on a variety of potentially dangerous pharmaceutical drugs. The fact that many of these psychiatric conditions could be helped by something as simple, safe, and affordable as vitamin B12, deserves further exploration by a doctor before resorting to medications.
Why B12 Lab Results May be Useless
Let’s say you think you may have a B12 deficiency, maybe because you have some of the symptoms listed below, maybe because you are just fatigued all of the time, or maybe just because you have mental fog too often. Your doctor tells you your lab results indicate that your B12 levels are fine, and you rest easy in the knowledge that at least that base is covered, and you can forget about B12 being an issue. Don’t rest too easy: that test is flawed, mostly because the bar is set too low, and there are other more accurate tests that could be done to truly confirm your B12 status.
It is becoming obvious that B12 deficiency is commonly under-diagnosed, and missed by many medical professionals. This is due to two reasons: it is not a routine test used by most doctors, and the laboratory reference range bar is set too low. So even if you are tested, and the test comes back with “normal” levels of B12, we still cannot rule out a B12 deficiency.
I’ll throw some numbers around here, just in case any of you have a chance to actually look at your own test results, and to see how there are different standards in different parts of the world.
In the U.S. a normal reading for B12 is between 200 pg/mL and 350 pg/mL. However, two American experts in the diagnosis and treatment of B12 deficiency (S. Pacholok R.N. and J. Stewart D.O.) consider a B12 deficiency to exist when readings are below 450 pg/mL. And, even if the readings are above 450 pg/mL, but there are symptoms that may be associated with B12 deficiency, these experts will look at other markers that can indicate a B12 deficiency more complicated in nature than the common B12 test will reveal.
They will therefore use B12 treatment therapeutically for patients who show normal B12 levels, but also have elevated levels of urinary “methylmalonic acid” (uMMA), homocysteine, and/or holotranscobalamin.
In Europe and Japan the acceptable “normal” level of B12 in the blood is above 550 pg/mL, and anything lower than that is considered to be associated with symptoms such as cognitive decline, dementia, and memory problems.
It has been theorized that one reason for the lower rates of Alzheimer’s disease and dementia in Japan, is their willingness to prescribe B12 to people who, in the U.S., would be considered to have adequate levels of B12. This wider, therapeutic use of a simple, affordable, medical intervention may be saving them from dealing with a much more expensive and disruptive condition, as their population ages.
In Part 3 we will look at more obscure symptoms of B12 deficiency, recommended dosages, and the warnings that accompany too much B12.
(Author: All newsletters and blogs are written by Ken Peters who has worked as a nutritional consultant for the last 30 years, and as product designer for NutriStart for the last 25 years. He has also authored two books – Health Secrets Vol. 1&2. He may be reached at: kenpetersconsulting@gmail.com)