A boost of Vitamin B12

Aug 25, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Where's Eric? It's midnight!" I had been dozing on the couch since 9:30pm. I was still quite groggy. Doris said, "I told you. He's at the gym." At the gym. This wasn't computing. Did Eric have a friend named "Jim"? Not that I could think of. The last thing I remembered clearly was Doris saying she was going to pick up Eric from his shift at Norwex. That was at 10 pm. And come to think of it, the reason I was so tired is I had to drop Eric off for his shift at Husky at 7 am. My half asleep, half awake brain couldn't grasp what Doris was saying at all. All I could understand is it was midnight, Eric was missing and it had something to do with a gym.

Going to the gym helps you look after one of the major pillars of good health, exercise. Another pillar of good health is nutrition. One of the B vitamins, vitamin B12, probably doesn't get the attention it deserves.

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 containing it. 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.

Most people who eat meat get enough Vitamin B12 from their diet. But if you do need extra Vitamin B12, the supplements are inexpensive and available at every pharmacy. There are a few different forms: sublingual (or under the tongue), liquid you drink, chewables, tablets you swallow and injections. There are those who argue that the under the tongue B12 gets absorbed better than the ones you swallow. Although there is some theoretical reasons to think that might be true, it seems any time it is tested, under the tongue and swallow seem to get the same amount of B12 into a person. There is an argument that liquid and chewable B12 are absorbed better than B12 pills you swallow whole. The idea is the saliva has a carrier protein that binds to the B12 in chews and liquid and makes the B12 easier to get into the system. Again, an interesting idea, but I'm not sure it has been proven yet. And if we are sure someone isn't absorbing B12 orally, we usually go to prescription B12 injections.

Many older people will be familiar with getting a B12 shot. A B12 injection avoids all the absorption problems of getting B12 through the digestive system. And, there 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. So, not surprisingly, many people love their B12 shots and really don't like the suggestion of going off of them. But, often after we get a patient's B12 levels back up with a B12 shot for a few months, we can then go back to the much cheaper B12 pills for maintenance therapy.

Eric really was at the gym. After working eight hours at Husky, Eric came home, then worked four hours at Norwex and then he went to the gym. Just saying that sentence makes me tired. Apparently, Eric used his money to buy a gym membership. Another friend of his worked an evening shift at a fast food place that night, and three of them decided to go to the gym after work. Parents of another member of the trio drove them to the gym and back. There are definitely way worse things that teenagers could be doing at midnight than going to the gym. One of the other parents called it, "Positive peer pressure." I supposed that's true. But it is just another in the ever growing list of things I never thought I'd say as a parent. It's midnight, where's your kid? Oh Eric? He's at the gym.

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.


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