Are you getting enough Vitamin B?

Oct 4, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

The furious hunter prowled through his territory. His eyes darted from side to side scanning for movement. A gust of wind swirled. His prey took flight. A deft leap! And a victorious kill! Sheldon's trophy dangled from his mouth as he proudly trotted back. Sheldon loves the fall. The cool crisp air just seems to get his little engine running. And, of course, there are leaves. Leaves everywhere. Sheldon loves hunting leaves. Sometimes, when the breeze is right, there are almost too many leaves for one dog to chase.

The CBC headline seemed to be chasing a health care crisis. "Too many seniors are getting Vitamin B12 shots!" Well that is kinda true. However, it is not really the whole story.

What is Vitamin B12? Vitamin B12 or cobalamin is a substance your body needs to do a variety of physiologic processes. It also can't be made by the body. To get Vitamin B12 we have to eat foods with Vitamin B12. The most common dietary sources of B12 are meat, fish, dairy and eggs. This is why vegetarians and vegans often need to take a Vitamin B12 supplement. After the food hits the stomach, stomach acid cleaves the B12 from the food. Enzymes in the small intestine cleave the B12 from a carrier protein that brings it down from the stomach. Then the B12 is bound to something call intrinsic factor which helps it get absorbed out of the intestine into the blood stream. Then it is stored in the liver. Because the liver does such a good job of storing B12, it can be 5-10 years between the start of a B12 deficiency and when a person gets symptoms

A person can experience real problems if they don't get enough B12 in their diet. Vitamin B12 is used in red blood cell production, DNA synthesis and in nerve function. When I think of Vitamin B12 deficiency, the first problem that comes to mind is red blood cell dysfunction. Vitamin B12 is required to make succinyl-Co-A. Succinyl-Co-A is needed to make red blood cells. Not enough B12 can lead to not enough red blood cells or red blood cells that don't work properly. That's why severe B12 deficiency is can lead to megaloblastic anemia. Nerves don't work well without B12 either. Not enough Vitamin B12 can effect the myelin sheaths around certain nerve fibers. This can lead to weakness, unsteady walking, and lack of feeling in the fingers and toes. The person can also feel fatigue, lack of appetite, depression, and unusual things like loss of taste.

People can get B12 deficiency from lack of meat in their diet, a lack of intrinsic factor which leads to a condition called pernicious anemia, conditions that decrease stomach acid, conditions that effect the intestine like Crohn's disease and from chronic alcoholism. Medications can decrease a person's B12. Metformin, and stomach acid blockers like proton pump inhibitors can reduce B12. Finally as we age, we seem to absorb Vitamin B12 less well.

The study on CBC about seniors getting too many B12 shots was done by Silverstein et. al. They looked at the patient records of 146,850 residents of Ontario aged 65 or over who were prescribed regular vitamin B12 shot between January 2011 and October 2015. They found that 93,615 patients or 64% either had tests confirm they already had normal B12 levels, or they weren't tested at all. So basically 2/3 of the people they looked at didn't really need a B12 shot.

My question is, so what? Are they saying two thirds of the seniors in the studies were harmed by the B12 shot? No. Are they saying the doctors did something wrong? Not really. The main point of this study was money. The researchers figured that by the time you paid for doctor's time and the shot it cost the health care system about $45 per shot. That means a year of monthly shots was about $540. A year's worth of over the counter Vitamin B12 tablets probably costs less that the $45 shot. So it is not that the study isn't important, but it wasn't really about patient's health. It was about saving the health care system money.

The is a powerful placebo effect of going to the doctor and getting a B12 shot once a month. People feel better. People feel like they have more energy. In fact, the B12 shot happens to be bright red! If you were trying to pick the best color for a "powerful" placebo shot, it is hard to do better than red. However, the researchers are trying to show the if people just bought their OTC B12 tablets at a pharmacy and took them daily, it would cost the health care system less.

I miss summer. I miss the long stretches of day-light. I miss the warm nights. Yes fall leaves are pretty, but give me summer green any day. Not Sheldon. He starts running laps around the house to warm up before fall walks. Then he starts barking because you aren't putting on your shoes fast enough. He knows the cool fall air is just on the other side of that door. He knows there are leaves dancing out there just taunting him. It is fall and it is time for the furious leaf warrior to hunt.

As always if you have any questions or concerns about these products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

CBC article about Vitamin B12 over-prescribing - https://www.cbc.ca/news/health/unnecessary-vitaminb12-shots-1.5291960

Jama article on Vit B12 over-prescribing in Ontario - https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2737914

 


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