Dawn (00:00):
Hello and welcome to the Gastric Health Show. My name is Dawn Boxell, Registered Dietitian, and this week’s topic is the power of Vitamin B12 deficiency symptoms and solutions. So we are going to dig into this vitamin. I know we just covered vitamin D, but I also want to include vitamin B12 because it really plays a huge role in how you feel and the energy that you have to do the things that you want to do and you know need to do.
Dawn (00:39):
If you have no energy to work out or no energy to cook a meal or meal prep, that’s a big deal and we need to address all areas and unfortunately, conventional medicine isn’t always great at looking at the nutrition indicators unless you get with a dietician, they will likely be the main one who is going to kind of investigate that as a driver or cause of why you might be feeling tired and not have the energy and motivation that you once had.
What is Vitamin B12?
Dawn (01:26):
So we’ll dig into this vitamin and kind of break down its importance and just the different aspects that truly do make a difference in your overall health. Now, vitamin B12 is really an essential nutrient that your body does not make, and this is a vitamin that has to come from food. So this is why it’s something that should be, in my opinion, it should be on your annual lab checks with your family doctor. Most typically it’s not. Occasionally I have had patients bring in blood work or show me blood work of their annual labs and vitamin D and vitamin B12 were both on
Dawn (02:14):
So to me that was impressive when that occurs. It’s just not very frequent that that happens. But vitamin B12 does contribute to many different body functions like red blood cell production, neurological development, and DNA synthesis. So besides producing red blood cells, it plays a vital role in brain function and kind of think of cognition and your ability to think clearly and we’ll get into more specifically that whole brain piece, but then also the energy production.
Dawn (02:58):
So again, it ties in with how you physically feel and your quality of life and when you feel poorly, you are not able to do the things that your doctor is asking you to do or dietician. So that’s why to me, having that awareness and being an advocate for yourself is so important and just randomly saying, Hey, I have some of these symptoms, would you be willing to test this If they’re not willing to test it, one, that’d be a really big red flag for me and I would probably be looking for a new provider, but you can always get them. They have consumer based labs that you can kind of order whatever blood work you want. So there are options that if you need this information, you want to check this data, get with it.
Dawn (03:57):
A registered dietician like myself who can help you accomplish getting the, or even just investigating the right type of blood work so that you have all the data points to investigate and say, Hey, is this contributing to how I feel in the symptoms that I’m experiencing? Because you’ll shortly learn here that there are some pretty interesting symptoms that come along with a B12 deficiency that you may be saying, Hey, this is because I’m getting older or this is because I have X, Y, Z. And blowing it off as that, even though it may be getting worse, then you aren’t maybe feeling the greatest and thinking it’s something else when it’s really, if you would fix this b12, you probably wouldn’t have that symptom anymore. So it just is something to consider if you haven’t ever investigated this level.
The Impact of Vitamin B12 on Our Body
Dawn (04:58):
It also helps promote a healthy nervous system and kind of keeps your metabolism in balance. And B12 is found in a wide range of food. B12 deficiency and insufficiency is relatively common and can lead to many different health issues. So what is b12, vitamin B12 or cobalamin is the water is soluble and really is essential for a lot of body functions and it is absorbed by the small intestines with the help of a protein called intrinsic factor. And you’ve probably heard me talk about intrinsic factor with bariatric patients because we are stapling off access to that protein that is in the stomach, the lower portion of the stomach then in a normal anatomy,
Dawn (05:56):
Anatomy then get passed through into the small intestines where absorption occurs. But intrinsic factor meets up with B12 in the lower portion of the stomach. That is not happening if you’ve had a gastric sleeve, a ruin white gastric bypass or a duodenal switch not occurring. So that means that the B12 that you’re getting from your foods, you are not converting to the absorbable form of B12 at a very, very high level at all. Very minimal in my experience. Doesn’t matter which surgery you have, you need a B12 supplement.
Dawn (06:40):
And I know many programs with sleeves don’t utilize B12 a hundred percent of the time, but in my opinion, I think you totally do need a B12 supplement to maintain adequate levels long term because of this intrinsic factor not being readily available to you as prior to the surgery. But once it’s absorbed, it is stored in the liver for future use.
Dawn (07:13):
So it starts off with as it travels through your digestive tract to get absorbed, then later B12 is stored in your liver. Again, our body cannot produce b12, so it has to come for diet from diet or supplements. The thing with B12 is it’s only found in animal products naturally. So the only other way is through some fortified foods and we’ll cover that in a little bit, but what is the impact of vitamin B12 on your body?
Red Blood Cell Production
Dawn (07:49):
And one, like we said, the red cell, red blood cell production, the synthesis of red blood cells require vitamin b12. So this is part of it. So when I’ve talked many times about the genetics and how I say there are co-factors and vitamin certain vitamins and minerals that are required for this action to be occurring because we’re basically a chemistry experiment that is going on every second of the day inside our body.
Dawn (08:25):
And when there isn’t enough of this, then that’s when problems occur because now there wasn’t enough for that process. So now we’re lacking because that was missing. Your red blood cells need b12, it works with other nutrients to ensure these oxygen carrying cells. So red blood cells is what carries the oxygen in our blood. And so this is where people will feel lo like they have a low energy because their red blood cells, they’re in, your actual red blood cells may be low.
Speaker 2 (09:12):
So your lab testing, it could show that your RBC or red blood cell is actually low. Again, this is because B12 may not be adequate. So it’s one indicator when I look at a CBC that has the red blood cells on it, I’ll also look at MCV and MCHC, which is really just telling us the volume or the size of the cell and that gives me information as well when some of those are elevated, that’s telling me more information in conjunction with the RBC.
Dawn (09:51):
So again, it’s a pattern that you look for. It is, this is the art of healthcare is really interpreting blood work and knowing what it’s telling you and putting those puzzle pieces together. So if I look at an MCV on a lab data, it could tell me about b12, b6, folate, copper, it’s and then iron. It’s telling me all a bunch of information. So that’s where I may take that basic panel that you get from a primary care doctor for relatively cheap that’s super inexpensive to draw, but then that might lead us into more testing because that’s saying,
Dawn (10:41):
hey, there’s something up with your red blood cells. But then also your ability to the size of the cells and your ability to utilize what’s available to you, something is lacking and what’s the byproduct of missing like a missing ingredient. And if you’re a person who cooks in the kitchen or bakes and say you leave out baking soda or baking powder and you make some cookies or a cake or something and they just are flat, they’re not fluffy and nice textures.
Dawn (11:22):
That’s kind of the same thing we’re talking about here. I mean you leave out B12 and you create an environment that is not conducive to a healthy body. So this is why B12 is important to the talk about and to discuss because it’s plays a bigger role than most people realize. Again, in a conventional healthcare setting, they have never prioritized nutrition, they have never put the two together that the foods you eat impact or play a role. Or I’ll say in the past there are more and more studies proving this stance.
Dawn (12:10):
So as registered dieticians, as all of us practice, I would say a lot of us get frustrated with that fact that there is, even though we do have evidence supporting the utilizing food and supplements and just focusing in on really just someone’s nutrition state and actually nourishing their body and taking it from a malnourished state to a nourish state as a priority in their health.
Dawn (12:49):
I think in time we’re going to get there. I think currently I think as a population, people are actually seeking this out because they are seeing that this lack in nutrition knowledge and nutrition connection is part of their puzzle piece of why their health is so compromised. So again, when it comes to anything vitamins, anything nutrition, a registered dietician is truly your best resource to get the information that you need.
Dawn (13:26):
We just have so much training in food and nutrients and individual food items that we really can help pair everything together so that it makes sense in then meet you where you are. And if you’re ready to make some of these changes, we have the ability to help you act on them. First of all, when it comes to the red blood cell production, I do want to say that vitamin B12 is essential for preventing megaloblastic anemia, a condition characterized by enlarged and poorly functioning red blood cells.
Neurological Health
Dawn (14:01):
So again, another sign that B12 deficiency is the cause. The next one is neurological health. So now you got to think about your nervous system and how it is dependent on b12 and it plays a role in producing myelin. B12 is think of this as one of those ingredients in making this protective sheath that surrounds nerve fibers and really even facilitates the transmission of nerve signals. So if you don’t have enough b12, guess what’s going to be compromised that protective sheath around all your nerve fibers.
Dawn (14:51):
So that is where some people can have some nerve damage from a B12 deficiency. So that is why it’s so important to make sure these are checked and looked at. Sufficient B12 levels are vital for optimal brain function cognition and the prevention of neurological disorders. One study found that vitamin B12 supplementation could enhance cognitive function in older adults.
DNA Synthesis
Dawn (15:21):
Then the next is DNA synthesis, and this vitamin is essential for DNA synthesis, which is basically saying replicating genetic material and creating new cells. So every cell in the body needs B12 for its division growth and repair. So our cells are turning over frequently, we are getting new cells, our body is making new cells and without adequate b12, that’s when it’s compromised. The gastrointestinal tract, bone marrow which have rapidly dividing cells require adequate vitamin B12 levels. So super important. The next one is energy production.
Dawn (16:09):
So this is where we think about how we feel and b12 metabolizes vitamin b12, metabolizes carbohydrates, fats and protein, converting them into usable energy and it helps break down food and extract nutrients to actually make energy so that attp, so B12 is involved in this process and when you are deficient or insufficient in your B12 level, that can contribute to just poor energy, just weak and tired, just low stamina and just kind of poor quality of life is what it comes down to.
Mood Regulation
Dawn (16:53):
The next one is mood regulation. So growing evidence suggests that B12 plays a role in your mood regulation and your mental wellbeing. It is believed to influence how neurotransmitters are synthesized and metabolically processed, including serotonin and dopamine, which are essential for mood balance. But vitamin B12 deficiency may lead to mood disorders including depression and anxiety. And I am going to share there, if you go on PubMed, you will find if you just say like B12 deficiency case study years ago,
Dawn (17:31):
I remember coming across a case study on B12 and I, again, it’s probably a few decades ago that I recall this, but it’s always stuck with me that, but they published this case study because it was so significant, so profound that B12 wasn’t checked that I think they wanted that information out that say, Hey, start simple, start with these things, these nutrients that are essential for life.
Dawn (18:02):
Start with checking those. But this individual was having a psychotic episode, we’ll call it, and they literally were have, they’re having a nervous breakdown, they were mentally unstable. And what it came down to were they were so deficient on vitamin B12 and the only thing that they needed was they gave them a B12 injection and they got better. So again, another example of do the simple things first and your body does not.
Dawn (18:45):
Of course in this scenario they were doing all kinds of things thinking it was nothing to do with their nutritional state, absolutely nothing to do with their nutritional state. And when it comes to mental health and mental wellbeing, it’s a very interesting area because for some types of mental health issues, there’s no real blood test or there’s no real thing to look at to see, hey, is this really what they’re having?
Dawn (19:23):
Is this really what’s occurring in this person? If I have a diabetic, I can look at their fasting glucose and say, oh, here’s why you are experiencing these symptoms or blood pressure. You have your blood pressure cuff when it comes to mental health. There isn’t just a black and white test that can say, Hey, here’s the problem and let’s do this approach to fix this problem. It is more complicated than that and it kind of really is the art when you are in that world that you are having to make decisions on what you think it is.
Dawn (20:08):
But I will tell you, I think it’s interesting that when I look at nutrition things, there are lots of crossovers. So someone can present with five or six symptoms in this one category, but those are the same symptoms that are in three other categories. And so it’s again that art of knowing, okay, which category are we starting with as we’re ruling out this is the problem and what is really going to fix their symptoms?
Dawn (20:43):
So when it comes to mental wellbeing, there are not, I guess just good testing ways to rule out and truly define what a person is experiencing. So next is the cardiovascular health that B12 plays a role in. And it is important to maintain a healthy cardiovascular system. B12 lowers homocysteine levels, which is associated with cardiovascular diseases. And this is why it’s so important to check your b12, but then also for prevention. So hey, I am stable in my health, but I want to be pre have a protection or prevention mindset.
What is Vitamin B12 Deficiency?
Dawn (21:33):
So annually checking that serum B12 is one thing that you can easily do and this will help you in maintaining that optimal cardiovascular function because we’re going to know that all things in that are involved in cardiac function is being reviewed and assessed. So what is vitamin B12 deficiency? And when the body becomes deficient in b12, it just means that there isn’t enough of that vitamin on board.
Dawn (22:09):
And remember, your body can’t make it so it can’t support itself in saying, oh, let’s make some more of that over here from these ingredients and muster it up. So now that person has all the energy and they feel fabulous and blah, blah, blah does not work you. If the body does not absorb enough of this nutrient or if the diet is deficient, then you can have deficiencies. People who consume a vegan or vegetarian diet do have a greater risk for B12 deficiency since you get all the B12 from animal products and they are avoiding animal products.
Dawn (22:57):
The National Institutes of Health say 1.2% of Americans aged 12 and older are B12 deficient. However, this number is likely higher. As many people with B12 deficiency do not experience any symptoms at all. You don’t necessarily have poor energy or you’re not physically feeling any of the signs and symptoms that I’m going to cover shortly. But again, I think that’s why testing is so important. You don’t know until you see the numbers because it is even just iron deficiency, although this is separate.
Symptoms of Vitamin B12 deficiency
Dawn (23:38):
I remember looking at some blood work one time and actually by the time the blood work got to the dieticians, the doctor’s office had already called the patient and because their hemoglobin was such at a critical low solo, like a four. And I remember talking to the patient after getting the blood work and I remember her saying, yeah, the doctor’s office called me and said, you have to go to the ER right now.
Dawn (24:11):
And she’s like the er. She’s like, I am shopping. Why do I have to go to the er? And they’re like, A hemoglobin of four is critical. This is like you are not getting oxygen. You need to go to the ER for a transfusion. And most of all the clinicians, so the surgeons and their healthcare staff and the dieticians, we were like, how is she shopping? How is she moving throughout the day because she shouldn’t have any energy with a hemoglobin of four. So again, kind of correlates that sometimes you just don’t it, it’s so slow.
Dawn (24:55):
And for her, she was having some blood loss that was contributing to this, but it was a slow loss that she just gradually went lower, lower, lower, and it wasn’t being monitored. I think if I remember more in the aspect of she wasn’t getting the annual blood work drawn so no one knew and she was just getting used to feeling poorly like she did.
Dawn (25:20):
And if you think about it, there are the cardiac risks that can come with having such low levels of things. So this is why. And then you throw the mental aspect with B12 complex. It’s not just oh, a b12, it, it’s really plays a physical role in your health. So again, I think you won’t always have the symptoms and just because you don’t doesn’t mean that it’s not important because again, you may be able to manage those symptoms unknowingly well, and you can be a really low level and really not even recognize it.
Fatigue and Weakness
Dawn (26:03):
So the prevalence of B12 deficiency really does increase with age with up to 20% of adults over 60 years old are deficient. So that’s pretty significant. That’s millions of people, millions of people that are in that category that may not be getting this B12 level checked. So what are the symptoms of a B12 deficiency, fatigue and weakness.
Dawn (26:34):
So this is low energy where hey, you know, kind of even just have a generalized weakness. Hey, just overall I just have no energy to do anything. You’re just kind of like, ugh, a wet noodle. You just don’t want to get up and go and do stuff. And again, this is because it plays a role in that energy production. You can also be pale or have jaundiced skin, and this is because it’s impacting the red blood cell production and can be resulting in megaloblastic anemia.
Pale or Jaundiced Skin
Dawn (27:11):
And the pale or yellow yellowish skin is one of the visible signs of anemia. The next is the neurological symptoms. So this is when your nervous system is involved, and these are things like numbness and tingling in your hands and feet, unsteady gait or balance problems, cognitive difficulties and memory loss, dizziness and lightheadedness. You can also have mouth things, and we would see this in some of our patients as well.
Glossitis and Mouth Ulcers
Dawn (27:43):
So or mouth ulcers is what it’s called. And glossitis is just an inflammation of the tongue and causing it to appear to swollen, red and smooth. And you can also have a burning sensation in your tongue. Then also pain like your tongue can just hurt. It just doesn’t hard to eat because your tongue hurts so much. And then of course you can get mouth sores or mouth ulcers really easily because of the B12 deficiency. You can also have digestive issues.
Digestive Issues:
Dawn (28:23):
So this can thing be things like nausea, vomiting, diarrhea, constipation, loss of appetite, and even weight loss in some people because they just don’t have the ability to put food in because their stomach just bothers them so much. You can also have breathing problems and heart palpitations. So this kind of goes with the example I was talking about with the he hemoglobin.
Breathing Problems and Heart Palpitations
Dawn (28:50):
Same thing with B12 deficiency. You can suffer from shortness of breath, your heart rate can be rapid, you can have heart palpitations, and this can be due to the anemia that can be connected, but it’s not uncommon for it to occur gradually and not be a parent. So again, you may one day feel fine, next week you feel completely miserable and it’s because it’s finally crossed a line and now you’re like, Ugh, I just have no ambition for life.
Who is at higher risk of vitamin B12 deficiency?
Dawn (29:30):
But let’s talk about who’s at risk, who has a higher risk of developing a B12 deficiency? One the older. So these fall into the categories of sixties and above, especially the American Journal of Clinical Nutrition. They did a study and they found it’s more prevalent as you age. Oh, this was with over 10,000 adults, and they found that B12 deficiency was 10% in people age 60 to 69, 15% in people, 70 to 79 and 20% in people 80 years and older.
Older Population
Dawn (30:16):
So again, one of those things that as you age, you’re losing that ability to convert and that intrinsic factor is not available as you age. And then you throw in, Hey, I’ve had surgery and I’ll share a few more things that make that even harder. Then yeah, you’ve got maybe two or three things against you that now you’ve really got to focus on getting adequate B12 every day so that you don’t have a deficiency. And according to the study, the B12 deficiency is more common in women than in men.
Dawn (30:58):
And this may result from women being more likely to suffer from conditions that can cause B12 deficiencies such as the A atrial V gastritis and intestinal bacterial overgrowth. Sibo like I talk about a lot. So the small intestinal bacterial overgrowth is another condition that can cause that. So again, the older population is at risk.
Gastric Surgeries
Dawn (31:24):
The next is gastric surgeries. So we know that in the world of bariatrics, we already have you supplementing for this. And again, like I mentioned, not all programs do the same formula with b12, it seems, or at least I have experienced, they don’t recommend B12 a lot of the times, but if I work with you, this is something that I check and monitor and kind of dose accordingly. But you are definitely at a higher risk of B12 deficiencies because of bariatric surgery,
Dawn (32:03):
because it does affect the absorption of b12 because of how we’ve altered your anatomy. But a recent study published in Nutrition review says that 30% of the people who have undergone gastric surgery were vitamin B12 deficient compared to 10% of non gastric surgery patients. The study also found that B12 deficiency was more common in people who had undergone gastric bypass than any of the other bariatric surgeries.
Genetic Mutations
Dawn (32:33):
So the next is genetic mutations. So this is something that most people are not even thinking about. You might be thinking, Hey, I take b12, I consume animal products, but my B12 is never normal, it’s low normal, I have a hard time keeping it in range. Maybe you might especially notice this if you’re not taking any supplementation or we haven’t dialed in the right supplement for you, but there are genetic mutations that affect the metabolism of B12 and can result in a deficiency. But there are variations in genes.
Dawn (33:18):
So many people are aware of the MTHFR. So that is one puzzle of the genetic piece. But then there are also MTRR, MTR, COMT or comt and then BHMT and NBPF3. And then the final one is TCN2 And these all can impact the body’s ability to utilize and absorb B12 effectively.
Dawn (33:47):
So again, that goes back to are you monitoring it? Are you checking these levels annually or for me, if I have somebody who’s deficient, I’m going to come up with a strategy. We’re going to apply it for at least three months, maybe six months, then we’re going to recheck it. And then annually, once we get it normal and we get the solid plan of what you do to get it there and maintain it,
Dawn (34:15):
so we’ll have our maintenance plan and then we’re going to monitor that annually to make sure that hey, you can maintain those. Because if I don’t have your genetics to evaluate, then we won’t know if this is going to last unless we continue to monitor it. And then you got to think about, hey again, life happens, things change. We age and other things contribute. So we checking annually is key.
Dawn (34:50):
One study did examine the links between polymorphisms and B12 related genes and B12 status, and they found that people with certain gene variants were more likely to have low B12 levels. So again, because you have maybe these genetic SNPs, we might need to have a higher dosing for you or maybe dialed in formula for you because you are only going to absorb a certain formula. And I have tried many different formulas with patients and have had to experiment to some degree because I find that especially in bariatrics, we have the absorption piece that is impaired.
Dawn (35:37):
And even if we have the genetic piece, we might have to utilize a different formula just to get optimal levels just to even maintain levels. So again, it’s very individualized when it comes to the genetic piece. And especially with bariatric surgery, sometimes it’s more than just say, Hey, sign me up for a B12 shot.
Dawn (36:03):
We might need to make sure that that B12 shot is compounded and it’s actually the methylcobalamin and not cyanocobalamin. So again, differences in the products used or the ingredients used because it matters because there’s different forms of cobalamin, there’s methyl b12, adenyl, hydroxy. So the form matters for certain people. And to me that’s when that genetic piece kind of helps. And then you tie in with a bariatric patient who might have some absorption issues, then we might have to do a very targeted supplement to actually get the best results.
Vegetarians and Vegans
Dawn (36:48):
The next is vegetarians and vegans. So you are definitely going to be at a higher risk for a B12 deficiency. So I’m all for more plants. I just find that a more sustainable diet includes animal products. So I’m not against vegans, I’m not against vegetarians, I just have yet to have one who does it well that they truly can support their body without supplementation.
Dawn (37:22):
So again, I think working with a dietician can truly help you accomplish that. Another person at risk is somebody who has low stomach acid. So vitamin B12 absorption depends on adequate stomach acid, like I talked about it. It all begins in the stomach. And that stomach acid is what triggers the intrinsic factor. And like we’re talking after bariatric surgery, you don’t have access to that at adequate levels. So again, now you have to consider, okay, do I need to support my low stomach acid with doing some type of digestive enzyme or
Low Stomach Acid
Dawn (38:09):
Betaine HCL or something to support the digestion and absorption of a b12? They do actually. You can purchase B12 supplements with intrinsic factor in them, and there are even prescriptions of B12 with intrinsic factor. I remember years ago we had a physician, one of the surgeons who he didn’t practice as many surgeries.
Dawn (38:35):
He was not one of our surgeons that was doing that mostly bariatric surgery. He was mostly doing other surgeries and did a few bariatric surgeries a year, and he would use a B12, prescription B12 with intrinsic factor in it. And I will say I did notice that a lot of his patients using that formula did really well with their B12 levels. But low stomach acid does play a role. And because this is, again, stomach acid is the signaler, is the trigger to everything else doing their job. When that stomach acid is not adequate, then things are not signaled to begin. The next one is GI conditions. So if you have like h pylori infection, celiac disease, inflammatory bowel disease like Crohn’s or ulcerative colitis, B12 deficiency is common.
Gastrointestinal Conditions
Dawn (39:45):
Anytime you have damage to your intestinal lining, then that can impair your body’s ability to absorb that any type of nutrients really, not just b12. Lastly is medication use. So there are certain medications that really increase your risk. One because it interferes with the absorption or blocks the absorption and really does impair your ability to get adequate from even supplementation because of these medications. Some of the medications include PPIs or proton pump inhibitors.
Medication Use
Dawn (40:25):
Another is metformin, which is used for insulin resistance and also birth control pills or oral contraceptives and then even certain antibiotics. So all of those will put you at a higher risk of developing a B12 deficiency because it’s going to impair its excretion and absorption and all of that. So if you are taking a proton pump inhibitor, then that means you are suppressing the stomach acid and it is blocking that your body’s ability to absorb B12 now.
Lab Tests for Determining Vitamin B12 Levels
Dawn (41:05):
So what lab tests should you be checking to make sure that your B12 remains an optimal status? So first, a serum b12. And this is super easy, super cheap, something you can easily ask for at a primary care visit. Your bariatric team if you’ve had bariatric surgery, should already be doing this. But again, making sure that they’re at least testing that serum B12. And then working with a dietician is what I would recommend when it comes to interpreting these, because the reference range for B12 is wide and 200-900 is the reference range.
Dawn (41:55):
And for me, I like it to be no less than 600, but definitely preferably, but definitely no less than 500. You are low if you are under 500. So again, if your primary care is looking at it, they may not be triggered or even concerned if it’s at 250, 300, 400. Whereas if you have a registered dietician look at it, they’re going to say You’re low, we’ve got to treat you.
Dawn (42:30):
So again, and then high is not good either. You don’t want to elevated above the 900 excessively. It’s not bad to go above necessarily, but there is some evidence with elevated b12. For me, I utilize it if I have, say I have somebody that has a serum B12 that’s high, and then I’m going to look at the next blood test, the methylmalonic acid or mma, I’m going to look at that. If that’s normal and it’s not elevated then and their, say their B12 is a thousand and then their MMA is normal, well, I’m going to interpret that as, okay, this is fine.
Dawn (43:12):
They probably had their B12 supplement maybe close to that blood draw, and maybe that’s a connector to it. If they chronically arrive with normal MMA but elevated serum b12 and maybe even we notice each year it kind of goes up a little bit more and more.
Serum B12
Dawn (43:32):
That’s when a red flag for me goes off with, Hey, dys, gut dysbiosis because our gut produces vitamin b12. And it could be evidence that, hey, we might need to do some work on your gut and we might need to make sure that we heal some things so that your body utilizes all of the B12 that’s available to it appropriately. So you of course you want to check a serum b12, but then a methylmalonic acid or MMA is truly the best indicator.
Methylmalonic Acid (MMA)
Dawn (44:12):
And if your physician, your bariatric team is not checking anm mma, you need to ask for it. You need to ask if this can be drawn. And when you look at an mma when it’s elevated, then that tells you that the B12 is not getting into the cells. So I can’t tell you how many labs I’ve interpreted thousands that I have had a high or normal C serum b12, so that that level is within range, but yet the MMA is elevated.
Dawn (44:53):
So it’s telling me that, hey, that it’s not getting in the cells. We need more b12 and what you’re using is maybe not the right form of B12 that my body needs. So that’s where I start thinking, okay, we might need to use those methyl forms of b12. And it could be because you have some of these genetic mutations. I mean over 50% of the population or 40% I think it is, that has the MTHFR, and there are two variants of the MTHFR. So again, to me it’s it’s information.
Dawn (45:35):
So additionally I’ve, I’ve had many patients say, okay, my doctor took me off my B12 because my serum B12 was elevated. And I said, what was your mma? And they’re like, I don’t know. It wasn’t drawn. And so I’m like, okay, get the mma. And so we get the MMA and it’s elevated and we’re like, see, if we wouldn’t have checked the mma, we would’ve never known that your B12 is really low.
Homocysteine
Dawn (46:00):
It’s not high because again, your gut plays a role in that serum level, so it’s not your best indicator in telling you the full, full information. And then lastly, homocysteine. Homocysteine can also be another indicator. I just find that a lot of docs don’t like using this in a general setting. Our bariatric docs did not like us ordering homocysteine as a general panel because it is something that is used in the cardiac world. So they do pay attention to that in other groups. And they felt like now we have information by utilizing this homocysteine,
Dawn (46:53):
now we have information that we need to send someone to a specialist to make sure that we’re not missing a cardiac related problem. So they were not fans of having a homocysteine level drawn if we didn’t have to. So again, it’s it’s data and if I needed it, they were totally cool with us ordering it and utilizing that if necessary.
Dawn (47:21):
But that was not on our annual panel to draw regularly. That was we’ve kind of vetted, we’ve got the MMA and the serum, and if we felt like, Hey, I need a little bit more information, then go ahead and order the homocysteine. So then that eliminates big red flags for no real reason. So homocysteine is really just one that can be helpful for the practitioner if B12 isn’t present. You could have the other, say you’re at your cardiologist and they are drawing your homocysteine and it is elevated, they likely will not take it further and say, let’s get your B12 and your MMA tested.
Dawn (48:05):
But you could say, PCP or bariatric team, I want my methylmalonic acid and my serum B12 tested. I need that tested to make sure high homocysteine levels can really give us information on folate. And these play together. And it also is another red flag for me, the genetic piece and that, hey, we probably had some genetic SNPs that are contributing to this and we probably need to use a more methyl formula with this person.
Complete Blood Count (CBC)
Dawn (48:47):
And then the next one is a CBC or complete blood count is what it is. But this again, and I kind of already alluded to this, I’m looking at the MCV, the MCH, the MCHC, I’m looking at the cell size for information, RDW. I want all of that information because again, it really does give me the full picture. It’s like I’ve, I’ve got all the puzzle pieces now and now I know which direction to go.
Dawn (49:17):
But just having that one serum B12 really is not accurate enough in my experience to be indicative of my only indicator to follow. So that’s where, if that’s the only thing that’s drawn, great, at least it’s drawn. But then ask for these additional tests to make sure that you’re covered and that everything is looked at correctly. So what are some solutions for B12 deficiency?
Solutions for Vitamin B12 Deficiency
Dawn (49:50):
One, dietary changes, making sure that you’re getting inadequate animal products or protein. Just think of, am I really missing my protein goals? Is that part of the problem? But beef, lamb, poultry, fish, eggs, dairy products, all of those have B12 that can help you. If you’re a vegan or vegetarian, you have to rely on fortified foods and nutritional yeast. So fortified breakfast cereals and plant milks, and then sprinkling nutritional yeast on things mixed in things all can help give you some additional b12
Dawn (50:34):
In my experience, it’s not always perfect with that. And I find that they do better if they’re taking a supplementation, most typically. But again, working with a dietician is really your best option because we can take these, this lab information and truly formulate a plan that can say, Hey, one, maybe we could increase it by getting that those protein goals met or adding some of these fortified foods as well.
Dawn (51:10):
But then maybe the right B12 formula might be needing to be adjusted. So let’s wrap this up. Vitamin B12 plays a crucial role in several body functions. The vitamin deficiency can have significant health cons, consequences. It is crucial to recognize the symptoms and understand the risk factors associated with the deficiency so that timely interventions can be made. We can maintain optimal B12 levels and support our overall health by incorporating vitamin B12 rich foods into our diet and considering appropriate supplementation when necessary and addressing any underlying factors that contribute to the deficiency.
Conclusion
Dawn (51:55):
The best way to diagnose, test and receive guidance tailored to your personal needs is to consult with a healthcare professional, professional like myself so that you can have a healthier, more vibrant life, good quality of life when your vitamin B12 is at adequate levels. So again, the gastric health membership is truly where you can get this guidance and simple ways to get input on labs you already have.
Dawn (52:30):
If you’ve had ’em in the last three months and you’re a member, I can easily give you good recommendations on what to do with that information so that it can help provide better support for your health goals. So I hope you guys have enjoyed this, and hopefully you will all get your B12 levels checked and your methylmalonic and cbc, definitely those three need to be checked and evaluated and that way you know where you stand. But that’s where I would start.
Dawn (53:07):
Get that drawn first. And then if you need a registered dietician on your team, I would love to work with you and just reach out, hit contact us, DM me on social media. I’m available to answer your questions. I do free 15 minute consultations if needed and we can get started. So you guys have a great week and we will see you next time. Bye-bye.
Listen, Learn, Enjoy…
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