Vitamin B12  Cobalamin

Vitamin B12 is a water-soluble vitamin. Water-soluble vitamins dissolve in water and therefore the leftovers are disposed through urine. However, of all the B vitamins, B12 is the only one that the body can store and it can be stored in the liver for up to a year.

B12 is regularly used in combination with other B vitamins in a B complex formulation. Vitamin B12 is bound to the proteins in food and it requires stomach acid during digestion to release the B12 from the proteins. After release, it combines with a substance named intrinsic factor so that it can be absorbed into the bloodstream.

Low or decreased levels of vitamin B12 can be found in elderly people, vegans, vegetarians, and people with HIV infection. Other people with low levels requiring supplementation are those with the inability to absorb B12 properly from their intestinal tract and suffer from pernicious anemia. People that have had gastrointestinal surgeries, Crohn’s and celiac disease, also have the potential for low levels of B12 because they have difficulties absorbing B12 naturally.

Those with Lupus or Grave’s disease and other immune system disorders are more likely to be B12 deficient. A condition named atrophic gastritis that causes a person’s stomach lining to thin is another ailment that can lead to B12 deficiency, additionally, small intestine issues such as bacterial growth or parasites.

Vitamin B12 deficiency can surface with a variety of signs and symptoms. Notably constant fatigue, low stamina and energy, nervousness, numbness in fingers and toes, diarrhea, nausea and constipation, bleeding gums or mouth sores and difficulty thinking clearly.

Where do humans get B12?

B12 is found naturally in a myriad of animal proteins but it is not found in plant foods unless they are fortified. Organ meats such as beef liver, shellfish, poultry, milk, eggs and other dairy foods as well as some breakfast cereals and yeast contain vitamin B12.

Foods high in vitamin B12 include shellfish, fish, crab and liver, red meat, low fat dairy, cheese, eggs and fortified cereals.

Ready to eat high-level B12 cereals such as Kellogg’s Product 19 and fortified soy products (soymilk and tofu), legumes and legume products such as Loma Linda’s vegie-burger or vegie sausage and Silk Brand plain soymilk.

Fin fish and shellfish products such as mollusks, oysters, octopus, mussels, king mackerel and Alaskan king crab, poultry products such as goose (liver), duck, turkey, chicken and emu. Beef products such as chuck, shoulder and round steak as well as by-Products like liver, brain, pancreas, spleen and lung.

Most pork products and by-products like the liver, spleen, lungs, brain and pancreas. Some Dairy and egg products like duck and chicken eggs, milk and plain yogurt, and ethnic Foods such as wild Alaskan moose, trout, salmon and caribou.

Who needs it?

Everyone needs B12. Vitamin B12 does many things for your body. It helps make your DNA and your red blood cells, convert food to fuel, increase muscle mass, nourish your nervous system by protecting nerves, helps red blood cells, protects the heart and bones, protect your brain and keeps you looking and feeling young.

What are its uses?

Vitamin B12 is used to treat all B12 deficiencies and megaloblastic anemia.

Other diseases treated with B12 that still have unclear evidence for effectiveness are Alzheimer's disease, angioplasty, breast cancer, canker sores, cardiovascular disease, preventing cervical cancer, depression, diabetic neuropathy, fatigue, facial spasms, high cholesterol, joint pain, mental performance, sickle cell disease damage, and sleep disorders.

What are the interaction precautions of B12?

Always tell your healthcare professional before you begin supplementing and tell them all herbal and pharmaceutical drugs you are currently taking.

Vitamin B12 can interact or interfere with medicines; some can lower vitamin B12 levels in the body.

These medicines interact or alter B12 levels.

• Chloramphenicol (Chloromycetin®) antibiotic.
• Proton pump inhibitors, such as omeprazole (Prilosec®) and lansoprazole (Prevacid®), that are used to treat acid reflux and peptic ulcer disease.
• Histamine H2 receptor antagonists, such as cimetidine (Tagamet®), famotidine (Pepcid®), and ranitidine (Zantac®).
• Metformin for treating diabetes.

Other agents with the potential for interactions include agents for bone loss, cancer, gout, high blood pressure, medicines for intestinal disorders, nervous system, alcohol, aspirin, bile acid, birth control pills, nicotine, nitrous oxide, chloramphenicol, metformin, and zidovudine.

Herbs and Dietary Supplement Interactions

Vitamin B12 can interact with supplements and herbs. These include those used for high blood pressure, gout, bone loss, cancer, stomach and intestinal disorders, tobacco, stimulants, folic acid, antibacterials, and cardiovascular herbs. Other herbs and supplements might have the potential to interact and may not be known or of significance for concern.

Safety

Allergies

Vitamin B12 should be avoided by any people sensitive or allergic to any other ingredient in the supplement, cobalt, and vitamin B12.

Side Effects and Warning

No upper limit of vitamin B12 has been established. However, those with heart issues that have had stents placed should make their health professional aware of their intention to supplement.

People with high blood pressure being administered intravenous Hydroxocobalamin.

Use cautiously if you have skin disorders, gastrointestinal concerns, blood disorders, low serum levels of potassium, megaloblastic anemia, gout, and elevated uric acid levels.

Pregnancy and Breastfeeding

Vitamin B12 is safe when taken according to the recommended (RDA) amounts. No sufficient data is available on the safety of larger amounts of B12 during pregnancy.

Low vitamin B12 levels during pregnancy have negative effects on the mental function in infants.

Infants who breastfeed from a B12 deficient mother are at sever risk of developmental disorders, growth failure and anemia.

Dosage

Dosage by MayoClinic.org

Adults (18 years and older)

Recommended dietary amounts (RDAs) are 2.4 micrograms daily for ages 14 years and older, 2.6 micrograms daily for pregnant females, and 2.8 micrograms daily for breastfeeding females. Those over 50 years of age should meet the RDA by eating foods reinforced with B12 or by taking a vitamin B12 supplement. Supplementation of 25-100 micrograms daily has been used to maintain vitamin B12 levels in older people. A doctor and a pharmacist should be consulted for use in other indications.

For canker sores, sublingual (under the tongue) vitamin B12 has been given daily for six months.

For claudication, a total daily dose of 1.5 milligrams of vitamin B12 was taken by mouth in divided doses of 0.5 milligrams three times daily for six months.

For vitamin B12 deficiency, 125-2,000 micrograms of cyanocobalamin has been taken by mouth daily for up to 2.5 years or longer. Five hundred micrograms of sublingual (under the tongue) vitamin B12 has been used daily for up to four weeks.

The following doses have been given intravenously (through the veins): 1,000 micrograms of intramuscular cobalamin once daily for 10 days (after 10 days, the dose was changed to once weekly for four weeks, followed by once monthly for life); 1,000 micrograms of intramuscular cyanocobalamin given on days 1, 3, 7, 10, 14, 21, 30, 60, and 90 of treatment. For vitamin B12 deficiency caused by long-term PPI therapy, cyanocobalamin nasal spray has been used for eight weeks. The exact dosage is unclear. One study tested intranasal vitamin B12 replacement therapy (500 micrograms weekly).

For prevention of anemia, the following doses have been taken by mouth: 2-10 micrograms of vitamin B12 daily combined with iron and/or folic acid for up to 16 weeks; 100 micrograms of vitamin B12 every other week plus daily folic acid and/or iron for up to 12 weeks.

For mental performance, the following doses have been taken by mouth: 0.05-1 milligram vitamin B12 taken daily for four weeks to 5.4 years; 10 micrograms or 50 micrograms of cyanocobalamin daily for one month; and one milligram of cyanocobalamin weekly for four weeks. One 1,000 microgram vitamin B12 injection has been used daily for five days, followed by one 1,000 microgram injection monthly for five months. Additionally, 1000 microgram injections have been used weekly for four weeks or monthly for six months.

For cyanide poisoning, an intravenous (IV) infusion of five grams of Hydroxocobalamin (up to 20 grams) has been used.

For depression, one milligram of cyanocobalamin, through intramuscular injections, was used weekly for four weeks.

For hereditary sideroblastic anemia, 100 micrograms of intramuscular vitamin B12 has been used monthly, with or without daily folic acid, for up to four months.

Children (under 18 years old)

Recommended dietary amounts (RDAs) are missing for all age groups, instead adequate intake (AI) levels have been used in place of RDA’s.

The RDAs and AI levels of vitamin B12 are as follows:

Infants 0-6 months old, 0.4 micrograms (AI)

Infants 7-12 months old, 0.5 micrograms (AI)

Children 1-3 years old, 0.9 micrograms

Children 4-8 years old, 1.2 micrograms

Children 9-13 years old, 1.8 micrograms

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Do not refrigerate. Keep from freezing.

Store the dietary supplement in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Storing injectable B12 instructions

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