The Essential Vitamin B12
Also known as : Cobalamin; Folic Acid
Cobalamin is a nutrient, which humans naturally acquire from their diets.
One man’s story : “I was feeling sluggish, had to lie down a couple of times a day, found it difficult to work evenings and to exercise for long periods. I was taking general vitamins and eating healthy foods, all to no avail. Even nutritional yeast which is for B12 deficiency, but this did nothing. Then I came across a B12 article. 
“The effect was almost immediate and remarkable. I have been taking them almost every day now and my stamina and energy levels are back up; I feel middle-aged again instead of a tired old man.
What are vitamin B12 and folate deficiencies?
B12 and folate are B complex vitamins that are necessary for normal healthy red blood cell formation, tissue and cellular repair, and DNA synthesis.
B12 and/or folate deficiency reflects a chronic shortage of one or both of these vitamins. Since the body stores 3 to 6 years worth of B12 and about a 3 months’ supply of folate in the liver, deficiencies and their associated symptoms can take months to years to manifest in adults.
Infants and children will show signs of deficiency more rapidly because they have not yet established extensive reserves.
During a study of 86 children with intestinal
parasitic infections, showed that B12 levels, which plays a key role in promoting cell immunity, increased after 3 months of anti-parasitic treatment. It just proves how the intestine plays such a crucial roll in the health and absorption of nutrients to the body.
It was noted that the B12 status is low in Crohn’s disease
Vitamin B12 is a cobalt-containing porphyrin called cobalamin,
In the diet, it is bound to protein and gastric acid is required to separate the vitamin from its attached protein. Intrinsic factor, produced by the parietal cells of the stomach mucosa, is then required for its active transport in the small intestine.
Symptoms of vitamin B12 deficiency can include
- fatigue,
- shortness of breath,
- tingling sensations,
- difficulty walking,
- diarrhoea.
Vitamin B12 deficiency is most commonly caused by failure of intrinsic factor secretion.
Other causes of vitamin deficiency include
- dietary insufficiency,
- vegetarian diets,
- hypochlorhydria
- gastritis
Hypochlorhydria and gastritis may be associated with food
intolerance.
It is not surprising, given the relationship between poor digestion and vitamin B12 deficiency, that patients receiving losec (omeprazole), ranitidine or cimetidine which is treatment to reduce gastric acid secretion in heartburn or peptic ulcer would have decreased vitamin B12 absorption.
Nervous System Vitamin B12 deficiency is associated with mood changes. In older women with B12 deficiency this is more pronounced. Vitamin B12 is essential to regenerate methionine the precursor for (SAMe). SAMe plays a pivotal role in the nervous system.
Multiple sclerosis patients have low vitamin B12 levels and supplementation may improve their neurologic and fatigue
symptoms
Tinnitus B12 deficiency may affect the auditory pathway leading to
increased incidence of tinnitus.
Alzheimer’s disease Some patients diagnosed with Alzheimer’s disease or senile dementia may have an unrecognised B12 deficiency
inflammatory bowel disease is due to reduced absorption of nutrients and B12 deficiency which is also common in celiac disease and may be the presenting manifestation.
Vitamin B12 deficiency in elderly is relatively common,
often as a result of decreased absorption from dietary sources. Low stomach acid may contribute to this deficiency. In view of the complications of vitamin B12 deficiency, such as the neurological effects described above, and the potential of folate to mask clinical signs such
as macrocytic anaemia, B12 status is an important consideration in elderly patients.
Low levels of vitamin B12 have been found in patients with
chronic idiopathic urticaria. (Chronic idiopathic urticaria (CIU), defined as the occurrence of daily, or almost daily, wheals and itching for at least 6 weeks, with no obvious cause.)
Rheumatoid Arthritis Patients receiving methotrexate therapy for rheumatoid arthritis may also be receiving folate to reduce the toxic effects of methotrexate. Folate can mask or hide the symptoms of B12 deficiency, and even exacerbate or make more obvious, the effects of vitamin B12 deficiency which has been associated with rheumatoid arthritis.
In most severe cases, in which anaemia is developed, the patient can notice that he or she is much more vulnerable to infections and other ailments, a sore mouth and sporadic diarrhoea while losing kilos without specific reason
Sufficient levels of vitamin B12 are essential to maintaining normal cognitive, neurological, and cardiovascular health, appropriate bone formation and reducing the risk 
PERNICIOUS ANAEMIA
The most common causes of vitamin b12 deficiency are an autoimmune condition known as :
pernicious anaemia and food bound vitamin b12 malabsorption.
Although both causes become more common with increasing age they are separate conditions.
Pernicious anaemia has been estimated to be present in approximately 2% of individuals over 60. Although anaemia is often a symptom,
the condition is actually the end stage of an autoimmune inflammation of the stomach, resulting in destruction of stomach cells by ones own antibodies.
Progressive destruction of the cells that line the stomach causes decreased secretion of acid and enzymes required to release food-bound vitamin b12.
Antibodies are an intrinsic factor to bind to IF preventing formation of the IF-b12 complex from further inhibiting vitamin b12 absorption. If the body vitamin b12 stores are adequate prior to the onset of pernicious anaemia it may take years for symptoms of deficiency to develop. (Receptors on the surface of the small intestine take up the IF-b12 complex only in the presence of calcium, which is supplied by the pancreas.)
Myths
B12 is generally found in all animal foods (except honey).
Contrary to rumors, there are no reliable, unfortified plant sources of vitamin B12, including tempeh, seaweeds, and organic produce.
The overwhelming consensus in the mainstream nutrition community, as well as among vegan health professionals, is that plant foods are not a reliable source of vitamin B12, and fortified foods or supplements are necessary for the optimal health of vegans, and even vegetarians in many cases. Luckily, vitamin B12 is made by bacterial fermentation such that it does not need to be obtained from animal products.
Despite this, some vegan advocates still believe that “plant foods provide all the nutrients necessary for optimal health,” and do not address vitamin B12
Other advocates acknowledge the need for B12, but only as an after thought. And still others emphasize that humans need only small amounts of B12 and that it can be stored in the body for years.
While true that, at the time they become vegan, some people have enough B12 stored in their liver to prevent overt B12 deficiency for many years, people often misinterpret this to mean that you only need to consume a tiny amount once every few years.
Actually, to build up such stores, it takes years of consuming B12 beyond one’s daily needs (unless you are using supplements which can build up stores more quickly). Some people do not have large enough stores of B12 to be relied upon even for short periods.
Overt B12 Deficiency B12 protects the nervous system. Without it, permanent damage can result (e.g., blindness, deafness, dementia). Fatigue, and tingling in the hands or feet, can be early signs of deficiency.
Vitamin B12, like folate (aka folic acid), is needed to help red blood cells divide. In some cases, vegans may get so much folate that even with B12 deficiency, their blood cells continue to divide properly. In other cases, their blood cells will fail to divide properly and they will become fatigued and suffer from macrocytic (aka megaloblastic) anemia.
Mild B12 Deficiency Homocysteine is a by-product of protein metabolism. Elevated homocysteine levels are linked with increased risks of heart disease and stroke.
From 1999 to 2003, there were many studies comparing the homocysteine levels of vegans and vegetarians who do not supplement their diet with vitamin B12 to those of non-vegetarians. In every study,the vegans or vegetarians had higher homocysteine levels than the meat-eaters and in the range associated with heart disease and stroke.
If you have been a typical meat eater for most of your life, your body should have stored enough B12 to prevent overt deficiency for a number of years. However, B12 stores cannot be relied on to keep homocysteine levels in check for very long.
Due to the anaemia, those affected may be weak, light-headed, and short of breath. A deficiency in B12 can also result in varying degrees of neuropathy or nerve damage that can cause tingling and numbness in the person’s hands and feet. In severe cases, mental changes that range from confusion and irritability to dementia may occur.
Pregnant women need increased amounts of folate for proper foetal development.
Because of the added stress of rapidly growing cells (the foetus), increased amounts of folate are required.
If a woman has a folate deficiency prior to pregnancy, it will be intensified during gestation and may lead to premature birth and neural tube birth defects, such as spina bifida, in the child.
The number of neural tube defect cases decreased by 36% in the U.S. since focusing on folate supplements during pregnancy. Restless leg syndrome during pregnancy is another neurologic symptom associated with decreased folate.
Maternal homocysteine levels predict foetal homocysteine levels and so optimal vitamin B12 status is important to prevent pregnancy complications. Low plasma B12 is an independent risk factor for neural tube defects including spina bifida and supplementation with both 
As discussed above, vitamin B12 deficiency symptoms can be aggravated with administration of folic acid, which is routine for women during peri-conception and pregnancy. Therefore it seems prudent to consider B12 status in these women. Routine co-supplementation of B12 is probably advisable when folate is administered. This is, of course, especially pertinent for vegetarian women.
Vitamin B12 status
Complementary considerations – Folic acid is synergistic with vitamin B12,
and supplementation of folic acid should always be accompanied by vitamin B12 supplementation to avoid masking a vitamin B12 deficiency and worsening its deleterious effects e.g. aggravating neurologic symptoms.
Sublingual vitamin B12 tablets are a convenient and effective form of vitamin B12 supplementation, which rapidly raises serum cobalamin levels. Main Actions
- Reduction of hyperhomocysteinaemia – is found in 5-7% of the population and correlates with atherosclerosis and venous thrombosis.
- Supplementation of vegetarian diets
- Support of haemopoiesis – stem and progenitor cells, 1. Bone marrow stroma, 3. Stem cell plasticity, 4. The regulation of haemopoiesis,
Supplementation in malabsorption syndromes Active Ingredients
Each tablet contains:
Cyanocobalamin (Vitamin B12)
* Contains lactose – however this amount will
not cause the symptoms of lactose intolerance.
This product can also be safely consumed by
persons with allergy to dairy proteins (caseins).
1 mg*
Supplementation with 1000 mcg of vitamin B12 twice daily raises serum vitamin B12 levels 4-fold to therapeutic values within 7-12 days. Treatment needs to continue at high doses to maintain high serum vitamin B12. Your Health Practitioner will advise
Recommended Dosage
Adults and children over 12 years:
Dissolve one tablet under the tongue once daily or as directed by your health care professional.
Children 6 to 12 years: dissolve half a tablet under the tongue once daily or as directed by your health care professional.
The active ingredients in the Nutrition Care formulations, when professionally prescribed by Sirius Health, may assist patients suffering from specific conditions.
This statement does not imply or make a claim for a cure for disorders treated with any Nutrition Care products and their use should be based on published and relevant scientific and clinical data.
Sublingual vitamin B12 as a viable alternative to parenteral and oral cobalamin supplementation.
