B12 or Not B12

     That is the question!  It is common, for some people, to self diagnose after reading a short list of symptoms.  To those individuals, knowing that weakness, fatigue, constipation and loss of appetite were symptoms of B12 deficiency would have them consuming mass quantities of the supplement.      However, there are many causes for these symptoms of which B12 deficiency is only one.  We should look at symptoms as mere guideposts on the journey to an accurate diagnosis.  Other possible causes could be; hyperparathyroidism, hypopituitarism and Addison's disease.  The mere sound of these names may strike fear in the heart of the self diagnostician, therefore, one may be inclined to treat with B12 in the hope that a subsequent reduction in symptoms would preclude the more scary diagnosis.

     So let's venture further down the symptom trail in an effort to support a diagnosis of B12 deficiency.  In addition to the above symptoms one would also expect to see, numbness in the hands and feet, loss of balance, memory issues, depression, confusion, and soreness of the oral cavity.  This list, for the most part, is just as subjective as the first, so anyone looking to convince themselves of a deficiency has a little more work to do.

     To make an objective diagnosis we should look for more objective measures.  One tell tale sign of  later stage B12 deficiency is the development of megaloblastic enemia, a condition of enlarged red blood cells.  However, most individuals would like to know before it gets to that point.  Earlier detection can be determined by measuring for elevated homocysteine or methylmalonic acid in the blood which rise with  B12 deficiency.  This method is even more accurate than measuring blood B12 concentrations itself, due to the fact that intracellular B12 can be much higher than blood levels.

     So let's now assume we have run the tests and we know for certain that B12 levels are low.  Does this mean that we can merely increase the intake though diet and supplementation.  In order for B12 to be absorbed into the body it must first be removed from the protein that caries it in our food.  This process is carried out by the hydrochloric acid in the stomach.  Then it must attach to a different protein, excreted from the stomach lining, called intrinsic factor which will facilitate it's absorption in the intestines.  If either of these steps is compromised then the amount of B12 absorption will be limited.

     For individuals, who self medicate with antacids for digestive issues such as ulcers, heart burn or indigestion, there is a reduction in stomach acid that does not allow the initial protein to be removed so  the B12 is not available for binding to the intrinsic factor.  Additionally, people with pernicious anemia lack the ability to produce intrinsic factor  thereby eliminating the handle that facilitates  absorption.  Even with normal intrinsic factor production, there is a finite amount of it produced and therefore a natural limit to the amount of  B12 that may be absorbed.  It is for these reasons that if one is severely deficient in B12 the best course of treatment is intravenous B12 injections.

     There has been some indicators that B12 can be absorbed through mucous membranes such as those located in the oral cavity.  To facilitate absorption it is said that placing a B12 tablet under the tongue until it dissolves will increase the amount absorbed.

     Ultimately, this is one case where verifying a need can save money in the long run.

Image courtesy of artemisphoto / FreeDigitalPhotos.net

For more information about Dr White and Action Chiropractic go to: www.DanburyActionChiropractic.com