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If there ever was a heart-mind vitamin, then B12 is it. Synthesizing neurotransmitters that govern mood, energy, sleep, appetite, and motivation all the while supporting heart and circulatory health, B12 is a brilliant multi-tasker and not a vitamin to ignore.
Learn how one amazing vitamin can help support your heart and mind, where to get it, how to absorb it, and how to make sure you’re getting the most active form.
The Current Level for Diagnosed B12 Deficiency is Too Low
Current research suggests that the accepted blood serum level for a diagnosis of B12 deficiency is just too low. (1,2) It is currently anything less than 200 picograms per milliliter (pg/mL). (3) However, many people experience symptoms of deficiency at much higher levels.
Many health organizations, including the National Institute of Health, are now recognizing that patients with B12 blood serum levels between 200-350 pg/ml are “low-normal” and would benefit from B12 supplementation (4, 5), but even this is probably too low.
Current research shows that those with blood serum levels less than 678 pg/ml, especially older individuals, may receive clinical benefits from B12 supplementation and that physicians should consider supplementation in all patients with levels below 407 pg/mL. (1)
Vitamin B12 Deficiency in the US
While many researchers focus on testing and treating B12 deficiency in the developing world, there still hasn’t been a major population study in the United States to measure this critical deficiency since the Framingham Offspring study conducted by Tufts University in the year 2000. Researchers there found that at least 40% of the population tested “low-normal” or deficient for vitamin B12, but the latest research shows that the 40% of folks at 350 pg/mL or lower should really be considered to be deficient. (6)
Vegetarians, the elderly, those who have had gastric bypass surgery, and those on long-term use of certain medications are at much higher risk for deficiency. This is due to reduced absorption and intake of B12 from food sources. (2,7-9)
B12 Supports Mind and Mood
The main function of B12 is to support the nervous system while maintaining healthy brain chemistry and synthesizing neurotransmitters like dopamine, serotonin and epinephrine. These govern mood, energy, sleep, appetite, drive, motivation, movement, cognition and numerous other brain functions.
Studies have shown that people with certain mood issues and cognitive concerns respond well to B12 supplementation, especially older individuals. There is a strong correlation between low B12 levels and cognitive issues associated with aging. One study reported that 50% of the subjects with mood issues were also deficient in vitamin B12. (10-13)
B12 Supports a Healthy Heart
Low levels of B12 are linked to elevated levels of the amino acid, homocysteine, which can negatively affect multiple systems of the body. The relationship between B12 and homocysteine is so strong that measuring homocysteine levels is considered one of the tests to measure B12 levels. (14)
Perhaps B12’s most valuable function concerns the heart. Chronically high levels of homocysteine are linked to multiple heart health concerns. (15-17) The most active form of B12, called methylcobalamine, is essential for converting homocysteine into methionine (a naturally occurring amino acid) through a process called methylation. Folate is required for this conversion and they work in concert to lower homocysteine levels. New studies reveal that high homocysteine levels are also correlated with the presence of certain mood imbalances and cognitive concerns. (18-20)
Why Are We Deficient?
It is difficult to detect a B12 deficiency, because the related health issues may not appear for some 5-6 years. (3, 5) Another problem is that of the several biomarkers regularly used for measuring B12 levels, none are entirely accurate and all of them have their benefits and drawbacks. Even measuring B12 blood serum levels may not provide an accurate picture of how much is available to the body on the cellular level. (21, 22)
When you combine the facts that many people have stopped eating red meat (which is high in B12), that B12 is a large, bulky and hard-to-absorb vitamin, and that as we age the digestive strength necessary to break down B12 can diminish (23), you can start to understand why this is such a prevalent national health issue.
Food Sources of B12
Some of the foods richest in B12 are fish, meat, eggs and dairy, which is why vegetarians and vegans are at such great risk for B12 deficiency. Vegetarian sources do exist, but there are not many of them and they generally are not a significant source unless fortified during food production. (24)
Weak Digestion Makes For Poor Absorption of B12
Dietary B12 is released from certain foods in the stomach by hydrochloric acid (HCl). If the digestive acids are low, then B12 absorption is also low. When HCl levels are optimal, the production and secretion of pepsin (the enzyme responsible for unbinding B12 from ingested foods) is also held in balance. This allows the free B12 to bind to another protein, called the intrinsic factor, which carries it to the distal part of the small intestine for processing, and eventually to the liver where it is stored.
As we age, digestive strength typically weakens and the production of pepsin can be decreased by up to 40% independent of any other factors, resulting in significantly reduced absorption and bioavailability of B12. While I don’t believe this necessarily has to happen to everyone, seniors are at significant risk for this reason. (25-27)
The more likely cause of this, rather than just aging, is the insidious congestion of the bile and pancreatic enzyme ducts due to the ingestion of processed foods. For more on this, check out my articles on digestion, bile and gallbladder health.
What Type of B12 is Best?
Perhaps the most common form on the market today is cyanocobalamin. While it is the most inexpensive form, it is not the most active. Cyanocobalamin must be converted to methylcobalamin, which is the most active and more effective form of B12.
We RecommendBest Way to Take Vitamin B12
For years, B12 injections were trendy for boosting energy. It was believed that absorption of B12 orally in the cobalamin form was low. New research is showing that oral supplementation with methylcobalamin is just as effective and carries the added benefits of lower cost and ease of administration. (28, 29) Hooray!!! No more shots!
In addition, adequate amounts of folate and a mood supportive chemical, called SAMe, are all needed to convert (or methylate) the cyanocobalamin into methylcobalamin. Using the methylcobalamin form orally, this cumbersome process of activating the B12 is already accomplished. B12 and folate support healthy methylation through their roles in the synthesis of methionine from homocysteine and the synthesis of S-adenosylmethionine (SAMe) – a naturally-occurring compound found in almost every tissue and fluid in the body and well-known mood support supplement. (30,31)
The Best Folate: 5-MTHF (5-methyltetrahydrofolate)
5-MTHF is the most biologically active form of folate. Folic acid is a synthetic form of folate and while not harmful, it is not as effective as folate or 5-MTHF. It is the predominant type of folate present in food and the form into which the body must convert all other forms of folate. Along with vitamin B12, folate serves as a donor of methyl groups in many nervous system and metabolic processes, including the conversion of homocysteine to methionine, the synthesis of monoamine neurotransmitters, the production of melatonin, and the synthesis of DNA. (32, 33) In addition, red blood cells require vitamin B12 and folate for proliferation and manufacturing. (34) B12 is also essential for neurological health, and chronic insufficiency can affect the spinal cord, peripheral nerves, the optic nerve and the brain. (35)
B12 Dosage Recommendations
The best way to take B12 is in a sublingual form. Be sure it is a combination of methylcobalamin and folate in the 5-MTHF form. About 2500mcg of B12 is an effective clinical dose. It is best taken in the morning for a B12 boost all day.