Vitamin B12 (WBC)
Optimal Result:
2 - 11.99 pg/MM WBC.
Vitamin B12 is an important coenzyme when in its active form of methylcobalamin. B12 facilitates the metabolism of folic acid through its primary role as a methyl donor. B12 requires intrinsic factor for absorption, which is calcium dependent. The role of vitamin B12 in the production of some neurotransmitters may also be evidenced by mood imbalance in susceptible individuals.
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What does it mean if your Vitamin B12 (WBC) result is too low?
How it gets depleted:
Age is a risk factor for deficiency of B12 due to a natural decline in intrinsic factor. Chronic use of PPIs may reduce HCl and lead to sub-clinical deficiencies. Some genetic SNPs (such as MTHFR) may lead to deficiencies in active B12 (methylcobalamin).
Clinical manifestations of depletion:
Deficiency of B12 can appear as pernicious anemia, usually due to lack of intrinsic factor. Another form of anemia associated with B12 deficiency is megoblastic anemia, when folate is in excess and insufficient B12 is present, which creates a ‘folate trap.’ Another symptom of B12 deficiency is dementia due to degeneration of myelin. In B12 deficiency, methylmalonyl CoA will be metabolized to methylmalonic acid (MMA), which is why MMA is considered the definitive marker for B12 deficiency. Achlorhydria (insufficient stomach acid) can lead to B12 deficiency because HCl is required to cleave B12 from intrinsic factor.
Food sources:
Vitamin B12 is synthesized by bacteria and exists in all animal foods. Vitamin B12 is only available from animal sources. The B12 synthesized by gut bacteria may not be a significant source for humans, as it is not absorbed in the colon.
Supplement options:
- The RDA for B12 is 6 mcg/day.
- Consider the upper limit of folate supplementation as a factor for the supplementation of B12, due to potential for folate trap.
- Vitamin B12 is extremely safe. No toxicity from high doses of vitamin B12 has ever been reported.
- Intramuscular injections are often used, particularly in the elderly to bypass intrinsic factor.
- Humans store large amounts of B12 in the liver so larger doses can be given at 6 month intervals.
- Supplementation is highly encouraged on a vegan diet. Due to high storage capacity in the liver, it may take years to deplete the body of B12 after adopting a vegan diet.
- Consider MTHFR genetic, and methyl cobalamin supplementation, particularly with hyperhomocysteinemia.
- Methylcobalamin is the recommended form of supplementation, but may be poorly absorbed in people taking antacids or those with very poor absorption (celiac, intestinal permeability, etc).
- Cyanocobalamin is not recommended for patients with MTHFR mutations.
- Hydroxocobalamin is recommended for patients with autoimmune diseases and elevated nitric oxide levels.
- Glutathione is also required for methylcobalamin to be bound for transport adequately.
- Vitamin B12 supplementation may help manage anemia, asthma, fatigue, hepatitis, dementia, epilepsy, depression, psychosis, irritability, ataxia, numbness, tingling, neuropathy, AIDS, multiple sclerosis, tinnitus, and infertility.
- Supplemental B12 is commonly given in 1000 to 5000 mcg doses.
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