As an NTP, it is very important that I consider cofactors. Deficiencies are not just caused by an inadaquete amount of a particular nutrient. Many people are aware that vegans and vegetarians are at greater risk for B12 deficiency, but what they don't know is that even if a sufficient amount of animal products are being consumed, one may still be deficient due to inadaquete cofactors such as intrensic factor and hydrochloric acid.
The common picture of a B12 deficient patient is an elderly person with pernicious anemia. But B12 deficiency may be caused instead by food-B12 malabsorption.
Food-B12 malabsorption is the inability to release B12 from food or its binding proteins. Unlike pernicious anemia, it’s more likely to be associated with mild, preclinical B12 deficiency.
B12 deficiency is common in elderly patients. One study revealed a prevalence of 12 percent among elderly people. Other studies, focusing on those who are in institutions or who are sick and malnourished, have suggested a higher prevalence of 30 percent to 40 percent. Unfortunately, B12 deficiency is often unrecognized because the clinical manifestations can be very subtle. In fact, one of its manifestations -- mild memory loss -- can mimic the early stages of dementia.
Food-B12 malabsorption is caused primarily by atrophic gastritis. More than 40 percent of patients older than 80 years have gastric atrophy that can be related to h. pylori infection. vitamin B12 deficiency is a pervasive and growing health crisis in the U.S. and other countries around the globe.
There are a wide range of symptoms of vitamin B12 deficiency, from mild to severe, which can affect your body, mind and mood.
In general, look for signs of:
Fatigue, lack of energy, muscle weakness, tingling in your extremities
Mental fogginess or problems with your memory, trouble sleeping
Mood swings, especially feelings of apathy or lack of motivation
Even though vitamin B12 is water-soluble, it doesn’t exit your body quickly like other water-soluble vitamins. B12 is stored in your liver, kidneys and other body tissues, and as a result, a deficiency may not show itself for a number of years.
This time lag is a serious concern, because after about seven years of B12 deficiency, irreversible brain damage can result.
Other symptoms of long-term, chronic B12 deficiency can include:
dementia and Alzheimer's
neurological and neuropsychiatric conditions
female fertility and childbearing problems
heart disease and cancer
Why Vitamin B12 is Essential
Vitamin B12 fuels many of your body’s most important functions, literally from your head to your feet. Among them:
proper food digestion and absorption
healthy nervous system function
formation of red blood cells
healthy immune system function
mental clarity, concentration, memory function
Your body was simply not built to function without a sufficient supply of vitamin B12 throughout its lifetime. I can’t overemphasize the importance of insuring you are getting adequate B12.
Since vitamin B12 is present in natural form only in animal sources of food, strict vegetarians and vegans are very high on the list of those who can expect to be B12 deficient.
Other sources of vitamin B12 deficiency include:
Inadequate production of stomach acid -- The older you are, the less able your stomach is to produce the hydrochloric acid necessary to release B12 from the food you eat.
Long-term use of antacid/antiulcer drugs -- Since hydrochloric acid is a requirement for the absorption of vitamin B12, it follows that if you’re taking an antacid, your stomach won’t be able to digest B12 out of your food. This class of drugs includes H2-receptor antagonists like Zantac and Tagamet, and proton pump inhibitors like Nexium and Prilosec.
Use of the drug metformin for Type 2 diabetes -- Use of metformin (brand names include Glucophage, Glucophage XR, Fortamet, Riomet, and Glumetza) may inhibit your B12 absorption, especially at higher doses. Infection with H. pylori bacteria -- If you suffer from a chronic Helicobacter pylori infection, you might be B12 deficient.
Coffee consumption -- Four or more cups of coffee a day can reduce your B vitamin stores by as much as 15 percent.
Gastric bypass surgery
Exposure to nitrous oxide (laughing gas)
And the LEADING cause of vitamin B12 deficiency: food-cobalamin malabsorption syndrome -- This condition results when your stomach lining loses its ability to produce intrinsic factor, a protein that binds to vitamin B12 and allows your body to absorb it into your bloodstream at the end of your small intestine.
The Role of Intrinsic Factor in B12 Absorption
The reason your body needs intrinsic factor is because vitamin B12 is a very large molecule. It is actually the largest vitamin we know of, and the way it gets absorbed into your body is complex.
Intrinsic factor is a molecule protein made by your stomach. It grabs onto the B12 molecule and together they move through your stomach to your small intestine. When they reach the end of your small intestine, the intrinsic factor is absorbed first, pulling the B12 with it into the cells of your large intestine, where they are absorbed for use by the rest of your body.
If your body doesn’t produce enough stomach acid, then you’re not producing enough intrinsic factor either. Since the only way vitamin B12 can be absorbed into your system is through bonding with intrinsic factor molecules, it’s easy to understand why so many people are not getting adequate B12 into their bodies.