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What and when should they be supplemented?

Vitamin B12, or cobalamin, is a water-soluble vitamin and, as the term suggests, is soluble in water; it is only partially accumulated in the body. Therefore, it must be regularly ingested through food.

And those who follow or would like to follow a vegan or vegetarian diet may have already heard of this, as this type of diet may often require specific supplements.

With Dr Martina Anderson, nutritionist at H. Medical Care, we find out what B12 is for and where to find it.

• B12:

What is it for?

Vitamin B12 is involved in various roles, which are fundamental for ensuring perfect body functioning. In particular, it is necessary for the metabolism of amino acids and nucleic acids – together with folic acid, it assists in synthesising DNA and RNA – and fatty acids. It is also essential in the production of red cells and the formation of bone marrow. And, it also promotes the transformation of nutrients into energy and reduces stress by increasing good mood.

The nutrition

B12 is present in foods of animal origin, where it is found in enzymatic form, therefore linked to proteins, and is made available thanks to some gastric enzymes. We find it in particular in:

• meat;
• fish;
• liver;
• milk;
• egg;

The amount of B12 absorbed compared to that present in foods is 60% for meat and milk, 30-40% for fish products and, according to some studies, less than 10% for eggs. Furthermore, about a third of the vitamin is lost during cooking.

The daily requirement for adults corresponds to approximately 2-2.4 mcg, generally taken following a normal diet. However, pregnant or breastfeeding women must take a larger quantity to provide the right amount to the fetus.

What does it cause?

It is difficult for those who follow a varied and balanced diet to register a deficiency; this type can occur in subjects who follow a vegan diet or when the absorption mechanism does not work well in the intestine.

In the case of malabsorption, the causes can be inflammatory diseases, malabsorption diseases (e.g. celiac disease), proliferation of bacteria, drugs, decrease in gastric acidity, especially in the elderly or absence of the intrinsic factor; the latter is, in fact, responsible for the absorption.

In the case of vegan diets, the deficiency is linked to the lack of foods of animal origin that contain it.

The main consequence of deficiency is a form of anaemia defined as “pernicious“, resulting from poor production of blood cells, which can cause paleness, weakness, tingling in the limbs and fatigue. In more serious cases, there can also be consequences for the nervous system.

The diagnosis is made through tests: if a deficiency is suspected, the level of B12 in the blood is evaluated, and the size of the red cells is checked to ensure it is not too high.

Deficiency should be avoided in pregnant women to avoid harmful consequences on the unborn child.

Vegan Diets

For the moment, there are no processed plant foods that could satisfy human vitamin B12 needs.

Some algae, brewer’s yeast, and some foods of oriental origin such as tempeh (derived from soybeans) and Kombucha (Chinese tea) contain vitamin B12 but in tiny proportions, useless for human needs since they are not assimilable from our organism.

For this reason, those who eat only plant-based foods need to take this vitamin through specific supplements. Consuming fortified foods, i.e., those added with B12, can also be helpful. Even in newborns of vegan mothers, it is important to start treatment with supplements immediately after birth to prevent deficiency.

What is the relationship with protein?

B12, folates, and the vitamin C complex are fundamental as they support and help our body produce proteins. Furthermore, consider that when our body absorbs B12, it does so using stomach acid, which separates B12 from the proteins associated with foods and binds it to another molecule, facilitating its absorption.

B12 plays a very important role in the metabolic process. Promoting the production of red cells and facilitating protein metabolism protects the nervous system’s integrity.

 What are the symptoms and causes? 

Deficiency depends on poor or inadequate absorption and storage capacity. This deficiency could be avoided in vegan subjects by taking food supplements that compensate for its level.

The diagnosis is usually made by examining the results of tests following the appearance of symptoms such as:

• Anaemia;
• Sense of respiratory weakness and muscle fatigue;
• Tingling in the hands and feet;
• Pallor;
• Feeling dizzy;
• Confusion;
• Walking difficulties

What are the causes and symptoms of excesses?

When B12 is high, the cause can frequently be attributed to various pathologies that are very serious for our health:

• Liver diseases;
• Myeloproliferative disorders;
• Solid neoplasms;
• Kidney failure;
• Alcoholism

It is important to remember that the presence of high B12 levels does not inevitably mean the presence of these diseases. Furthermore, an excess brings with it several symptoms of its own:

• Tremor;
• Swellings;
• Excessive nervousness;
• Rapid heartbeat;
• Kidney problems

Many patients with these symptoms wonder how to lower B12 when is so high, but it is important to remember that none of these disorders tends to last long, given that the quantity of this excess is eliminated thanks to urine.

What are the main problems linked to excess?

Nutritionists recommend a daily intake of 2.4 micrograms per adult. If we take a greater quantity of vitamin B12, our body will not be able to dispose of the excess properly, and we risk incurring the following side effects:

Heart failure: Too much B12 in our body can lead to the heart not pumping blood properly, causing episodes of heart failure. For this reason, patients with heart problems must refrain from taking excessive doses of B12 (especially in the form of injections), especially if not under close medical supervision.

Hepatic and renal failure. Both liver and kidney cells can be damaged by excess intake of this type, causing significant damage to these two organs.

Formation of clots.

Another negative effect of excess vitamin B12 is that it facilitates the formation of blood clots, which can become very dangerous because they impede normal blood flow. Therefore, people who are familiar with clots or stroke should also avoid further intake of B12.

Vision problems. It is also possible to suffer from blurred vision due to excessive accumulation in the body.

How to lower the levels?

An excess can lead to some contraindications. For this reason, it is important to know how to lower it by paying attention to your diet.

To counteract B12 hypervitaminosis, it is advisable to give up some foods of animal origin, such as:

• Egg;
• Milk and derivatives;
• Meat;
• Fish

It is important to reduce the consumption of legumes, soy, wheat germ and other products of plant origin that contain this.

Another key factor in correcting B12 levels is physical activity, which promotes its disposal through sweat. Drinking plenty of water to facilitate its elimination through urine is also recommended.