B12 Deficiency, A Silent Epidemic – Part 2

What is vitamin B12 and why do you need it? Vitamin B12 works together with folate in the synthesis of DNA and red blood cells. It is also involved in the production of the myelin sheath around the nerves, and the conduction of nerve impulses. You can think of the brain and the nervous system as a big tangle of wires. Myelin is the insulation that protects those wires and helps them to conduct messages.

Severe vitamin B12 deficiency in conditions like pernicious anemia (an autoimmune condition where the body destroys intrinsic factor, a protein necessary for the absorption of vitamin B12) used to be fatal until scientists figured out death could be prevented by feeding patients raw liver (which contains high amounts of vitamin B12). But, anemia is the final stage of B12 deficiency. Long before anemia sets in, vitamin B12 deficiency causes several other problems, including fatigue, lethargy, weakness, memory loss and neurological and psychiatric problems.

Vitamin B12 deficiency occurs in four stages, beginning with declining blood levels of the vitamin (stage 1), progressing to low cellular concentrations of the vitamin (stage 2), an increased blood level of homocysteine and a decreased rate of DNA synthesis (stage 3), and finally, macrocytic anemia (stage 4).

Vegetarians and vegans please read: vitamin B12 is found ONLY in animal products. Vitamin B12 is the only vitamin that contains a trace element (cobalt), which is why it’s called cobalamin. Cobalamin is produced in the gut of animals. It’s the only vitamin we can’t obtain from plants or sunlight. Plants don’t need vitamin B12 so they don’t store it. A common myth amongst vegetarians and vegans is that it’s possible to get vitamin B12 from plant sources like seaweed, fermented soy, spirulina, and brewers yeast. But, plant foods said to contain vitamin B12 actually contain B12 analogs called cobamides that block intake of and increase the need for true vitamin B12. This explains why studies consistently demonstrate that up to 50% of long-term vegetarians and 80% of vegans are deficient in vitamin B12.

The effects of vitamin B12 deficiency on kids are especially alarming. Studies have shown that kids raised until age 6 on a vegan diet are still vitamin B12 deficient even years after they start eating at least some animal products.

Table 2. Some Food Sources of Vitamin B₁₂

Food	Serving	Vitamin B12 (mcg)
Clams (steamed)	3 ounces	84.1
Mussels (steamed)	3 ounces	20.4
Mackerel (Atlantic, cooked, dry-heat)	3 ounces*	16.1
Crab (Alaska king, steamed)	3 ounces	9.8
Beef (lean, plate steak, cooked, grilled)	3 ounces	6.9
Salmon (chinook, cooked, dry-heat)	3 ounces	2.4
Rockfish (cooked, dry-heat)	3 ounces	1.0
Milk (skim)	8 ounces	0.9
Turkey (cooked, roasted)	3 ounces	0.8
Brie (cheese)	1 ounce	0.5
Egg (poached)	1 large	0.4
Chicken (light meat, cooked, roasted)	3 ounces	0.3
*A three-ounce serving of meat or fish is about the size of a deck of cards.

Only bacteria can synthesize vitamin B12. Vitamin B12 is present in animal products, such as meat, poultry, fish (including shellfish), and to a lesser extent dairy products and eggs. Fresh pasteurized milk contains 0.9 mcg per cup and is an important source of vitamin B12 for some vegetarians. Those strict vegetarians who eat no animal products (vegans) need supplemental vitamin B12 to meet their requirements. Recent analyses revealed that some plant-source foods, such as certain fermented beans and vegetables and edible algae and mushrooms, contain substantial amounts of bioactive vitamin B12 (this is a point of disagreement among the experts). Together with B-vitamin fortified food and supplements, these foods may contribute, though modestly, to prevent vitamin B12 deficiency in individuals consuming vegetarian diets. Also, individuals over the age of 50 should obtain their vitamin B12 in supplements or fortified foods (e.g., fortified cereals) because of the increased likelihood of food-bound vitamin B12 malabsorption with increasing age.

If you are interested in more reading, please read this from Oregon State U and this from the U of Maryland. These are just two of the many sources I used plus talking with two doctors. I could write more, but much of it would be very technical.

B12 Deficiency, A Silent Epidemic – Part 1

This surprised the dickens out of me, I learned how serious vitamin B12 deficiency could be, and yet, many doctors just don't get it. This is just like diabetes as it is hidden and not plainly visible. Granted, I have blogged about vitamin B12 before, but this is done with several weeks of research and from several sources. In addition I have had contact with two doctors that know about the damage vitamin B12 deficiency can cause.

No, vitamin B12 deficiency is not a hidden deficiency, but a deficiency that doctors refuse to recognize and give the priority it deserves. Most doctors just tell patients to eat more meat and replenish their B12 supply. They forget about the intrinsic factor that many of the elderly loose and therefore lose the ability to absorb vitamin B12 from the meat they do consume. Those that are vegetarians and vegans have to take a vitamin B12 supplement because they do not obtain any vitamin B12 from plants.

According to one doctor, vitamin B12 deficiency is described in every medical textbook and the causes and effects are well-established in scientific literature.

First, we need to understand why vitamin B12 deficiency is very common.

The absorption of vitamin B12 is complex and involves several steps, each of which can go wrong. Causes of vitamin B12 malabsorption include:
■ intestinal dysbiosis (An unhealthy change in the normal bacterial ecology of the intestines
■ leaky gut and/or gut inflammation
■ atrophic gastritis or hypochlorhydria (low stomach acid)
■ pernicious anemia (an autoimmune condition)
■ medications (especially PPIs (Proton-pump inhibitors) and other acid- suppressing drugs)
■ alcohol
■ exposure to nitrous oxide (during surgery or recreational use)

This explains why B12 deficiency can occur even in people eating large amounts of B12-containing animal products. In fact, many patients that are vitamin B12 deficient are following a Paleo diet where they eat meat 2-3 times a day.

In general, the following groups are at greatest risk for B12 deficiency:
■ vegetarians and vegans
■ people aged 60 or over
■ people who regularly use PPIs or acid suppressing drugs
■ people on diabetes drugs like metformin
■ people with Crohn’s disease, ulcerative colitis, celiac or IBS (irritable bowel syndrome
■ women with a history of infertility

Vitamin B12 deficiency is far more common than most doctors and the general public realize. Data from the Tufts University Framingham Offspring Study suggest that 40 percent of people between the ages of 26 and 83 have plasma B12 levels in the low normal range – a range at which many experience neurological symptoms. Of these, 9 percent had outright deficiency, and 16 percent exhibited “near deficiency”. Most surprising to the researchers was the fact that low vitamin B12 levels were as common in younger people as they were in the elderly.

Vitamin B12 deficiency has been estimated to affect about 40% of people over 60 years of age. It is entirely possible that at least some of the symptoms we attribute to “normal” aging, such as memory loss, cognitive decline, decreased mobility, etc., are at least in part caused by vitamin B12 deficiency.

What do all of these diseases have in common? This is from another source.

• Alzheimer’s, dementia, cognitive decline and memory loss (collectively referred to as “aging”)
• Multiple sclerosis (MS) and other neurological disorders
• Mental illness (depression, anxiety, bipolar disorder, psychosis)
• Cardiovascular disease
• Learning or developmental disorders in kids
• Autism spectrum disorder
• Autoimmune disease and immune dysregulation
• Cancer
• Male and female infertility
  
  

Answer: they can all mimic or duplicate the signs and symptoms of vitamin B12 deficiency.

Why is vitamin B12 deficiency so under-diagnosed? Vitamin B12 deficiency is often missed for two reasons. First, it’s not routinely tested by most doctors. Second, the low end of the laboratory reference range is too low. This is why most studies underestimate true levels of deficiency. Many B12 deficient people have so-called “normal” levels of B12. Yet it is well-established in the scientific literature that people with B12 levels between 200 pg/ml and 350 pg/ml (It means picograms per milliliter (pg/ml), levels considered “normal” in the U.S., have clear B12 deficiency symptoms. Most healthy people have body stores of about 1200 mcg of vitamin B12.

Table 1. Recommended Dietary Allowance (RDA) for Vitamin B₁₂

Life Stage	Age	Males (mcg/day)	Females (mcg/day)
Infants	0-6 months	0.4 (AI)	0.4 (AI)
Infants	7-12 months	0.5 (AI)	0.5 (AI)
Children	1-3 years	0.9	0.9
Children	4-8 years	1.2	1.2
Children	9-13 years	1.8	1.8
Adolescents	14-18 years	2.4	2.4
Adults	19-50 years	2.4	2.4
Adults	51 years and older	2.4*	2.4*
Pregnancy	all ages	-	2.6
Breast-feeding	all ages	-	2.8
*Vitamin B12 intake should be from supplements or fortified foods due to the age-related increase in food-bound malabsorption.

A Diabetes Website Violating Copyright

Until September 1, I had some respect for Battle Diabetes. However, now I have none. If you follow this link, you will come to a group of blogs that originated from other bloggers. You may be fooled as I was until you try to follow the links with each blog.

The top link takes you to a poor copy of the blog lifted from a blog by the original author. The bottom link takes you to a copy of the blog summaries of the blogs lifted from the original blogger. All of the links are on Battle Diabetes and none will take you to the original blog by the owner.

To me this smells of copyright violation. I have contacted the original blogger from Australia and I believe that the other blog owners would like to know about this. Since I am not familiar with the other bloggers, I would ask any reader that might know any of the original blog owners to notify them if possible and direct them to view the blogs that have been lifted illegally from them. My best guess is that all are from outside the USA and the owner of Battle Diabetes may have thought he could bypass copyright laws.

As of the time I posted this, no changes have been made and the blogs are still on the website.

Attitudes with Type 2 Diabetes

What causes the attitudes of some people after receiving a diagnosis of type 2 diabetes? This topic came up a week ago when a few of the support group were talking about what to do for a fellow that had just been diagnosed and refused to discuss this with a couple of the group. He was even angry that we knew that he had diabetes.

This day as we were talking, he came in and noticed us and almost left, but after looking at us, went up to the counter and ordered an ice cream sundae plus a regular coke. Then he went to the opposite end of the seating area and started eating his sundae.

We were ready to leave and quietly left. After we were out of the door, he opened the door and shouted at us saying he could eat anything he chose. Allen turned and told him that he could, and when his eyesight failed, not to complain to us.

We felt this required some thought and arrived at the following:

• Often the newly diagnosed get into denial
• The newly diagnosed decide to keep their diabetes a secret for their own reason.
• Type 2 as a general thing seems to start out much more slowly than type 1. Type 2 diabetes is ambiguous and how acute it is, varies all over the map.
• People with type 2 often refuse to change their eating habits and often do not change lifestyle habits.
• Doctors of type 2 patients do not explain the seriousness of type 2 and that while a good A1c may look good, having an episode of hyperglycemia and then an episode of hypoglycemia is not to be desired.
• Many people with type 2 have guilt that they caused their diabetes and the doctors often reinforce this guilt.
• Finally, too many people with type 2 diabetes try to live in the past instead of the present.

We came up with many other possibilities and finally said enough. When it is possible to do an intervention, we will consider doing this. The rest of the time we need to keep educating people and letting them read materials that might convince them to accept their diabetes and start actively managing their diabetes.

A.J agreed and Jerry wanted to do more. We told Jerry that he could attempt more, but not to be surprised if he was ignored. Since this fellow lived alone, there was not someone else that we could appeal to for help. Jason said he is very likely in denial and it will be difficult to convince him to change. I told Jerry that it took some time to convince him and he was uncooperative for some time until he realized that he needed to change something.

A.J said that even Jack was very hard to get through to and it took a specialist and a doctor to bring him around. In that case, we had a wife to help and keep him on the right path. Jerry said he still wanted to help the fellow, but would keep what we had said in mind and be more patient in his approach. We thanked him and we went to our homes.

Tips for Diabetes Bloggers

You will have to forgive the rant, but I recently came up against several blogs that fit what I am discussing. I will list the blogs, but I may not go back to try to read them as they are being very secretive in their actions.

One tip I find useful is providing an email sign up for new posts. This is one way to make sure your readers are alerted when you post a new blog. Another way to inform your readers of a new blog is to have a RSS or other blanket feed for those that subscribe. This (email works in Google Blogger, Word Press, and several other blogging services) and helps followers know when you post a new blog or article. Others may have to pay to have this programmed.

I have encountered several excellent blogs recently that do not have this and I am occasionally lucky to check the site shortly after a new post. Some close comments after 4 or 5 days and this is discouraging when there is value that needs recognizing.

Another shortcoming of some blogs is the lack of contact information. Often I have wanted to contact the blog author and have no way to do this, as there is no comment place or contact information. Why the secrecy folks?

I know that some bloggers do not want to deal with comments and I can respect that if they don't have comment moderation available, which means the comment is not published until you approve it. Not having contact information seems like you are saying you don't care about your readers that may want to make contact. Or, if you want secrecy, why do you publish a blog for every one to read? Why not make it private for only those you want to read it?

I maintain this blog for different blog authors and like to add those that are people with type 2 diabetes that write a blog. I also include a few other sites that have valuable information for people with type 2 diabetes.

Type 2 Diabetes Website

This is a relatively recent addition to type 2 diabetes information on the Internet. It is not written by anyone with type 2 diabetes, but by a husband and wife that are interested in helping people with diabetes. The site started in October 2013 and has grown since.

Ansley and her husband are working diligently to simplify the basics of diabetes for those that are new to a diabetes diagnosis. They have both video and written material on the site. This should appeal to people with different learning styles.

While ways of accomplishing different diabetes management often differ from what I would say or the way I write about a topic, the site does have great insight into the different styles of diabetes management which is a big positive.

There are still a few areas that they have not covered or given but a small coverage. This is not a weakness, but a case that the site has not been in business long enough and there is a lot to cover. Ansley has been working in the business of diabetes for about 15 years and has a lot of experience that shows.

Please check out the website here and the Facebook page here.  Take time to explore the sites.