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Vitamin B12
(or Cobalamin) Deficiency

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

This article (entitled: Vitamins Are Not Recommended for the Fit ) was printed on page 38 in the November 10, 2010 issue of The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

In today's environment of supplemental confusion, as a rule we don't generally recommend vitamins for the fit and healthy. Some people see it as a way of perhaps overcoming the partial guilt of not always eating right. There are some exceptions and the use of vitamin B12 is one of them.

Vitamins are trace elements that we do not require to be continually replenishing. They help our body function by enabling certain chemical reactions to occur, mostly in the manufacture and replenishment of tissue.

Vitamin B12 is also known as cobalamin, and some of us tend to slowly get deficient over time for a variety of reasons. Chiefly, it is because all of our cobalamin must come from food. We do not possess the ability to manufacture any of our own, and generally obtain our supplies by eating red meat.Cobalamin is fundamental to DNA synthesis, the blueprint of our existence, by catalyzing a reaction which produces a DNA building block called methionine from homocysteine. When there is a deficiency of cobalamin and methionine cannot be produced, there is a back-up of homocysteine and cell division in our bone marrow is prevented, resulting in large looking immature blood cells. The decrease in total red blood cells is a term called anemia.

Methionine is also a critical part of our nervous system functioning properly. Cobalamin is also involved in the production of a coenzyme.

The most common symptom of cobalamin or B12 deficiency is fatigue. In more severe states, a glossy red tongue is seen along with unusual nerve problems. At times the nerve damage can be permanent. To diagnose a deficiency in cobalamin, we start with taking a good dietary history, examining the patient for features and then performing routine blood work. Sometimes a more specialized test called a Schillings Test is required. It is a little more labor intensive and requires special booking. It measures how well our body can absorb B12 into the system.

The time tested treatment has been to use injection of B12 given every few weeks. Cobalamin requires an intrinsic factor produced by special cells in our stomachs for proper absorption into our system through the intestines.

Additionally, another secretory factor found in saliva is also needed. It binds to the B12 to prevent normal gastric degradation. In certain gastric conditions, there is little intrinsic factor produced in the stomach cells, and over time, little B12 is absorbed.

Many patients hate attending the clinic for injections on a regular basis. Others elect to be taught self-injection. There have been some reports of greater success by using large doses of B12 pills on a daily basis. With the large dose, some of the B12 is simply pushed across the intestinal wall. There is some promise in this method, but it requires regular use of the pills, and there is no substitute for the natural B12 found in our diets.

The manufactured pills are slightly different. I caution all readers against self-diagnosis and self-treatment of fatigue symptoms. It may delay the diagnosis of a more serious condition.

Related resources:

Vitamin B12 deficiency from Wikipedia, the free encyclopedia.
Vitamin B12 Deficiency by obert C. Oh, CPT, MC, USA, U.S., Army Health Clinic, Darmstadt, Germany; and David L. Brown, MAJ, MC, USA, Madigan Army Medical Center, Fort Lewis, Washington, published in American Family Physician, a peer reviewed journal of the American Academy of Family Physicians.
Dietary Supplement Fact Sheet: Vitamin B12 from Office of Dietary Supplements (ODS), National Institutes of Health (NIH). "Vitamin B12 is a water-soluble vitamin that is naturally present in some foods, added to others, and available as a dietary supplement and a prescription medication. Vitamin B12 exists in several forms and contains the mineral cobalt, so compounds with vitamin B12 activity are collectively called 'cobalamins'."
Vitamin B12 Deficiency Anemia. WebMD Medical Reference from Healthwise. Causes, Symptoms, Diagnosis, Treatment. "You need B12 to make red blood cells, which carry oxygen through your body. Not having enough B12 can lead to anemia ... This can make you feel weak and tired ... Most people get more than enough B12 from eating meat, eggs, milk, and cheese ... Vitamin B12 deficiency anemia usually happens when the digestive system is not able to absorb the vitamin."
Vitamin B12 by Hans R. Larsen MSc ChE. Summaries of the latest research. "Vitamin B12 (cobalamin) is an important water-soluble vitamin. In contrast to other water-soluble vitamins it is not excreted quickly in the urine, but rather accumulates and is stored in the liver, kidney and other body tissues. As a result, a vitamin B12 deficiency may not manifest itself until after 5 or 6 years of a diet supplying inadequate amounts."
Symptoms of Vitamin B12 Deficiency from Wrong Diagnosis.
What Causes Vitamin B12 Deficiency? By Saba Umar, eHow Contributor.
Vitamin B12 and Folate Deficiency from Lab Tests Online. Symptoms, Causes, Tests, Treatment. "B12 and folate are B complex vitamins that are necessary for normal red blood cell formation, tissue and cellular repair, and DNA synthesis. A B12 and/or folate deficiency reflects a chronic shortage of one or both of these vitamins. Since the body stores 3 to 5 years worth of B12 and several months' supply of folate in the liver, deficiencies and their associated symptoms can take months to years to manifest in adults."
How to Increase Vitamin B12 Intake by godfather25, eHow Member.

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