Vitamin B12 - What you Don't Know Could Cost You

To start, a few questions.

Did you know that not all B12 supplements are the same?

Did you know that there are THREE different forms of B12 available for supplements?

Did you know that the most common blood test used to determine Vitamin B12 levels in the body has limitations?

Did you know that there is a difference between using B12 supplements to correct a deficiency and using B12 supplements to optimize wellness?

If you said no to most of the questions, do not worry. Very few health care consumers are privy to this information.

The supplemental industry is a BILLION dollar business. Health Canada does its best to ensure that the products on the shelf are SAFE, but the marketing of a product does not always tell you how EFFECTIVE it will be for you. This can make choosing a product difficult for the average consumer.

It is crucial to be a critical consumer of your health. If you are not sure about the safety or efficacy of a health food product, then seek the advice of a qualified health care practitioner. You can ask a Naturopathic Doctor or an Integrative Medical Doctor for advice before purchasing any products.

So, back to Vitamin B12.

There are three available forms of Vitamin B12 on the market. If you look at your supplements, you may see Cyanocobalamin, Hydroxycobalamin, or Methylcobalamin written on the label. The COBALAMIN part of that complex word represents the Vitamin B12. The first part of that word is what makes all the difference.

Cyanocobalamin is the least expensive form, and is the one most commonly used in supplements and in Vitamin B12 injections. This form is considered the least bioavailable. This means that more of it may be excreted before your body is able to use it.

Hydroxycobalamin is the next in line when it comes to cost. It may stay in your blood stream longer.

Methylcobalamin is the most expensive form of Vitamin B12. This form may be well absorbed, and may offer benefits beyond increasing Vitamin B12 levels. Some practitioners use it as part of care for neurological complaints, and it may also support sleep. This form may also be used as part of a broader plan for hormonal imbalances or environmental toxicity.

You can get all of these forms in an injectable solution. If you are getting B12 injections, you can ask your prescriber which form is being used.

So how do you know if you NEED Vitamin B12 supplementation?

The first step is to test your blood levels. Currently there are three tests readily available. The most common test is serum vitamin B12. This provides measure of how much B12 there is floating around in the blood, but this does not give any indication of your body’s absorption and storage of Vitamin B12. An interesting fact is that every laboratory provides a different reference range of “normal” for serum Vitamin B12 testing. Some have an upper limit of 400 ng/L while others up to 900 ng/L. Currently, there is no data to support this upper limit of normal. So it is important to work with a qualified health care provider to manage your supplemented dose.

Two other tests, when done simultaneously, can help determine how much B12 our body needs, and how much it is using. These tests are Homocysteine and Methylmalonic acid. These last two tests are more costly, and can help show how our body is using Vitamin B12.

** special note: there are NO other reliable measures of vitamin B12 levels in the body at this time. Be skeptical of any practitioner who claims otherwise.

Who should get their Vitamin B12 levels checked?

Anyone who is experiencing symptoms that could be due to a Vitamin B12 deficiency may wish to ask about testing. Symptoms of a deficiency include fatigue, constipation, dizziness, headaches, irritability, swollen tongue, moodiness, shortness of breath, numbness, palpitations, anxiety, and psychosis.

Patients who are taking birth control, medications to treat heartburn, anti-seizure medications, or medications to manage blood sugar may wish to discuss screening, as these medications have been associated with lower Vitamin B12 levels. Additionally, patients who have absorption issues as a result of a bowel disease or surgery may want to keep tabs on their levels. Older adults may also wish to be screened, as absorption of Vitamin B12 naturally decreases with age. Those who abide by a vegetarian or vegan diet may also be at risk of deficiency, and may wish to be monitored.

Can B12 supplementation help even if I am not deficient?

The short answer - it depends. Some research has looked at using higher doses of Vitamin B12 (in methyl and hydroxyl forms) for a variety of health care concerns, including mood and sleep. Current research is mixed, so talk to your practitioner about whether supplementation is appropriate for you.

Remember, be a conscious consumer of your health!

In health,

Dr. Tara ND

References

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