B12 Deficiency Risk From Taking Metformin or Being a Vegetarian

Vitamin B12 is one of those micronutrients that our bodies require in order to live and thrive. Vitamin B12 also goes by the name cyanocobalamin. (No wonder we’ve shortened it to B12!) We need vitamin B12 to:[1]

• Produce red blood cells
• Create new DNA
• Build proteins, hormones, and lipids
• Release energy – without vitamin B12 your body cannot produce the energy it needs[2]

In short, we can’t live without vitamin B12!

Fortunately, most American children and adults obtain adequate amounts of vitamin B12 through the foods we eat. However, vitamin B12 deficiency continues to be a concern in the US. Those most susceptible to vitamin B12 deficiency include: the elderly, pregnant or lactating women, strict vegetarians, those with low levels of stomach acidity, hyperthyroidism, those who have undergone gastric bypass surgery, and people suffering with pernicious anemia.[3]

Approximately one-third of adults over 50 suffer from atrophic gastritis. This is a thinning of the stomach lining that hinders vitamin B12 absorption. As a result, about 3.2 percent of those over 50 are deficient in vitamin B12.[4]

Remarkably, the human body stores enough vitamin B12 in the liver to last several years. So a deficiency in vitamin B12 intake may not show up for a while.[5] As a result, its deficiency can also appear rather suddenly and without warning, or gradually intensifying over time.[6] A blood test is required to confirm vitamin B12 deficiency. The recommended daily allowance for adults is 2.4 micrograms per day.

Symptoms of vitamin B12 deficiency may include:[7]  

• Anemia
• Fatigue/Loss of energy
• Weakness
• Constipation
• Loss of appetite
• Weight loss
• Neurological changes
• Balance issues
• Depression
• Confusion
• Dementia
• Poor memory

Sources of Vitamin B12

For most people, the best and most natural way to get vitamin B12 comes from the foods we eat. These sources of vitamin B12 are limited to animal products: meats, eggs, fish, and dairy. Otherwise, vitamin B12 is not found in plants, hence the reason strict vegetarians may experience a vitamin B12 deficiency. However, nutritional yeast offers vegetarians a good source of vitamin B12.

Foods with the highest amounts of vitamin B12 include:[8]

• Clams and other shellfish
• Beef liver
• Wild trout, salmon, sardines and tuna
• Beef
• Organic milk, cheese, and yogurt
• Eggs

Reasons for Vitamin B12 Deficiency

Sometimes the reason for vitamin B12 deficiency is not due to lack of intake, but can be traced back to the body’s inability to absorb this crucial vitamin. In a healthy person, the stomach secretes hydrochloric acid and a glycoprotein called intrinsic factor, both of which are required for the absorption of vitamin B12 when food enters the digestive tract.

For this reason, prolonged use of proton pump inhibitors and other antacids can also cause vitamin B12 deficiency.[9] With the prevalence of acid reflux and GERD in our society today, people think nothing of taking a daily dose of an antacid, not realizing the complications that long-term use can bring on. Vitamin B12 deficiency can cause irreversible neurological damage.

Other medications that may lead to vitamin B12 deficiency include antibiotics, and Metformin (a common drug prescribed for high blood sugar). Also, heavy use of alcohol or nicotine can also cause a deficiency in this vital micronutrient.[10]

In addition to the above, a number of physical conditions and diseases also impair vitamin B12 absorption. Pernicious anemia, celiac disease, inflammatory bowel disease, Crohn’s disease, ulcerative colitis, bacterial overgrowth or parasites, and chronic pancreatitis are examples of such conditions.[11]

Supplementing with Vitamin B12

For those with a vitamin B12 deficiency, vitamin B12 supplements are available in a variety of forms including:

• Injection
• Intravenous
• Oral
• Nasal gel and spray
• And sublingual tablets (placed under the tongue)

Injections, intravenous, nasal applications and sublingual supplements bypass the digestive system in the event that there’s a lack of stomach acid or intrinsic factor present. For those with a healthy gut, but who simply don’t get enough vitamin B12 in their diet oral supplements are available.

Vitamin B12 injections work quickly, but the shots can be very painful and costly, often requiring the administration of a healthcare professional. Intravenous supplementation is also expensive and even more burdensome. Oral supplementation with vitamin B12 can be effective, but one has to take fairly high doses due to the fact that only about 2 percent of the ingested supplement can be absorbed by healthy people.[12]

Many vitamin B12 supplement distributors claim all kinds of health benefits for increasing one’s intake of vitamin B12. Some of these include: enhanced athletic performance, relieving depression, as a sleep aid, and as prevention for osteoporosis, high blood sugar, cardiovascular disease, and stroke. However, there is no science to demonstrate these claims in healthy people with good levels of vitamin B12.[13]

Advantages of Sublingual Vitamin B12 Supplements

Some manufacturers claim that sublingual vitamin B12 tablets are better absorbed and more effective than other forms of supplementation, but the research does not bear this out either.[14] However, sublingual tablets may have at least two real advantages.

First, for those with low stomach acid or intrinsic factor, sublingual tablets enable the absorption of the B12 vitamin without having to go through the digestive tract.

Second, for those who need to supplement with vitamin B12, sublingual tablets are much less expensive and less burdensome than receiving injections or intravenous supplementation.

So if your body is unable to metabolize vitamin B12 through your food intake, supplementing with sublingual tablets may be a good choice for you.

B Proactive

Our bodies are intricately designed with specific nutritional requirements. Vitamin B12 is one of those micronutrients we cannot live without. Make sure that you eat foods that contain vitamin B12 and supplement with this essential vitamin if you find yourself lacking.

 

 

Sources:
[1] Lauren Cox, “Vitamin B12: Deficiency & Supplements,” Live Science, August 15, 2014, http://www.livescience.com/47398-vitamin-b12-deficiency-supplements.html.
[2] WebMD, “Ways to Improve Your Energy,” July 9, 2015, http://www.webmd.com/a-to-z-guides/prevention-15/vitamins/energy-boosting-supplements?page=1.
[3] National Institutes of Health.
[4] Dr. Andrew Weil, MD, “Facts About Vitamin B12,” October 29, 2012, http://www.drweil.com/drw/u/ART02810/facts-about-vitamin-b.
[5] Lab Tests Online, “Vitamin B12 and Folate Deficiencies,” nd, https://labtestsonline.org/understanding/conditions/vitaminb12/start/2.
[6] Patrick J. Skerrett, “Vitamin B12 Deficiency Can Be Sneaky, Harmful,” Harvard Health Blog, January 10, 2013, http://www.health.harvard.edu/blog/vitamin-b12-deficiency-can-be-sneaky-harmful-201301105780.
[7] National Institutes of Health, “Vitamin B12 Dietary Supplement Fact Sheet,” https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/.
[8] National Institutes of Health.
[9] Dr. Joseph Mercola, MD, “Long-Term Use of Proton Pump Inhibitors and Other Antacids Can Cause Vitamin B12 Deficiency,” February 5, 2014, http://articles.mercola.com/sites/articles/archive/2014/02/05/antacids-vitamin-b12-deficiency.aspx.
[10] Dr. Andrew Weil, MD.
[11] Lab Tests Online.
[12] Andrew French, “The Advantages of Sublingual Vitamin B-12,” SF Gate, nd, http://healthyeating.sfgate.com/advantages-sublingual-vitamin-b12-9022.html.
[13] Dr. Andrew Weil, MD.
[14] Andrew French