B12 Deficiency: How Prevalent is It? B12 – חשוב: על ויטמין ב-12‎

Tens of articles about B12 I sent you in the past.

Below is a very good summary of the importance and under-diagnosis and treatment of vitamin B12 and the stress om methylcobalamine[methylcobalamin].

It seems to me to be a “shame” that hydroxocobalamin is not available in Israel instead of cyanocobalamine as ampules for injection.

I DO know- from experience that in most cases cyanocobalamine injections do work, but there is no reason not to prefer hydroxocobalamin injections.

See also below this article the article :

Studies on Vitamin B12 Retention Comparison of Retention Following Intramuscular Injection of Cyanocobalamin and Hydroxocobalamin

B12 Deficiency: How Prevalent is It?

by Administrator on Tuesday, 13 August 2013

by Forrest Smith MD

The consequences of B12 deficiency can be devastating yet it is often overlooked. B12 deficiency is not routinely tested for and the signs and symptoms are often missed or attributed to other causes.

As an example: a 62 year old gentleman patient presented with a feeling of numbness in his toes and a “pins and needles” sensation in his hands, had trouble walking due to poor balance, experienced severe joint pain, began turning yellow and became progressively short of breath. The cause was lack of vitamin B12 in his bloodstream, according to a case report from Harvard-affiliated Massachusetts General Hospital published in The New England Journal of Medicine. It could have been worse—a severe vitamin B12 deficiency can lead to deep depression, paranoia, memory loss, incontinence, loss of taste and smell and more.

Let’s read that last list of symptoms again—depression, delusions, memory loss, incontinence and loss of taste and smell. Does that sound like aging issues?

There is adequate evidence that vitamin B12 is epidemic among the elderly. The National Health and Nutrition Examination Survey estimated that 3.2% of adults over age 50 have a seriously low B12 level, and up to 20% may have a borderline deficiency. Vitamin B12 deficiency is also very frequent among vegans and vegetarians, and people taking acid blockers.

Vitamin B12 is necessary for the body to make red blood cells, nerves, DNA and to carry out many body functions.The amount needed is at least 2.5micrograms a day. Like all vitamins, the body cannot make B12. It must be obtained through food. There are two problems leading to deficiency: 1) many people do not consume enough to meet their needs and 2) many people cannot absorb enough, no matter how much they take in.

To illustrate how prevalent vitamin B12 deficiency is, a PubMed literature search for publications related to vitamin B12 deficiency among various groups resulted in over 14 articles. One review, which measured vitamin B12 serum levels, found that 52% of vegans and 7% of vegetariansare B12 deficient. Another review using the more sensitive marker of MMA (Methylmalonic acid) serum levels noted 83% of vegans and 68% of vegetarians. This is a huge difference indicating that conventional testing is missing 30%-60% of deficient persons. It is better to measure MMA because it is measuring B12 function rather than B12 levels alone.[ My remark: difficult to get this done in the kupot!!]

So, faulty lab testing is one reason deficiencies are overlooked. Another is that the signs and symptoms are usually slow to develop over time but the condition can appear to develop more rapidly. Given the array of symptoms it can cause, the condition can be overlooked or confused with something else.

Who is at risk of B12 deficiency?

As noted above, vegans and vegetarians are at higher risk. This is because vitamin B12 is not made by plants. B12 is the only vitamin we cannot get from plants or sunlight. The only foods that deliver it are meats, eggs, poultry, dairy and other foods from animals.

Another high-risk group is persons with low stomach acid. This includes the elderly since stomach acid production drops normally with ageing. This group also includes people taking antacids and acid blockers, especially the most potent drugs called proton pump inhibitors (Prilosec, Nexium, and others). These medications were developed to treat the rare condition of Zollinger-Ellison Syndrome in which the hydrochloric acid production is excessive resulting in severe and multiple gastric ulcers. These PPI’s are also medically indicated short-term to heal erosive esophagitis and ulcers. When properly prescribed by physicians, the appropriate education and precautions can be given to the patient. Unfortunately, due to direct-to-consumer advertising and the dangerous decision by the FDA allowing these drugs to be sold over-the-counter, millions of Americans consume these for benign heartburn and take them daily long-term.

Without appropriate stomach acid, digestion is impaired and the body cannot absorb critical minerals including calcium, magnesium and iron. This can result in osteoporosis, headaches and anaemia. Hydrochloric acid (stomach acid) is also critical for the absorption of vitamin B12 which requires acid to separate the B12 from the protein.

People who have stomach stapling or other forms of weight-loss surgery are also more likely to be low in B12 because the operation interferes with the body’s ability to extract vitamin B12 from food.

B proactive

It’s a good idea to ask your doctor about having your B12level checked (do the MMA serum test) if you:

are over 50 years old

take a proton-pump inhibitor or H2 blocker (such as Pepcid or Zantac)

take metformin (a diabetes drug)

are a strict vegetarian

have had weight-loss surgery or have a condition that interferes with the absorption of food

How to correct B12 deficiency

Cyanocobalamin is the most frequently used form of B12 supplementation in the US. But recent evidence suggests that hydroxycobalamin (frequently used in Europe) is superior to cyanocobalamin, and methylcobalamin may be superior to both – especially for neurological disease. This is probably because methylcobalamin bypasses several problems in the B12 absorption cycle and doesn’t need to be decyanated or reduced to the (+1) state (the only state that can cross the blood-brain barrier). On top of that, methylcobalamin provides the body with methyl groups that play a role in various biological processes important to overall health.

B12 can be given a number of ways. Oral tablets are adequate for many people but if there is a lack of stomach acid or intrinsic factor deficiency (called Pernicious Anemia), it may be necessary to give the injectable forms of B12. Injectables are the most reliable delivery form.

But injectables are less often necessary as the supplement industry has provided more absorbable forms of B12 as oral and sublingual. There are liquid or lozenge sublingual dosage forms. These are readily absorbed into the rich capillary beds under the tongue, thus bypassing the stomach and entering directly into the bloodstream. There are also oral tablets which have the active methylB12 along with intrinsic factor so absorption is enhanced. There is even an intranasal form of B12 but patients report this is somewhat messy. You may talk to your doctor about which form you need and prefer.[ My remark: from long experience I know that some people only get better with B12 injections especially if there are neurological-like symptoms][ In pregnancy don’t take any risk if B12 is low but ask for injections!]

Studies on Vitamin B12 Retention Comparison of Retention Following Intramuscular Injection of Cyanocobalamin and Hydroxocobalamin

Henrik Hertz M.D*

H. P. Østergaard Kristensen M.D*

E. Hoff-JØrgensen M.D*

Article first published online: 24 APR 2009

DOI: 10.1111/j.1600-0609.1964.tb00001.x

© Munksgaard 1964

Scandinavian Journal of Haematology

Volume 1, Issue 1, pages 5–15, March 1964

Additional Information(Show All)

How to CiteAuthor InformationPublication History


While according to recent investigations cyanocobalamin (CN-B12), so far the most commonly used vitamin B12 preparation, must be considered an “artificial product”, hydroxocobalamin (OH-B12) is probably one of the forms of vitamin B12 which occurs naturally in the animal organism.

The main object of the present study was to elucidate the difference in retention following intramuscular injection of CN-B12 and OH-B12, among other things with a view to the applicability of OH-B12 in the treatment of pernicious anaemia.

After i. m. injection of about 1 mg CN-B12 and OH-B12, normal subjects excreted within 24 hours about 80 per cent and about 25 per cent, respectively, in the urine. This corresponds a retention of about 20 per cent CN-B12 compared with about 75 per cent OH-B12.

The serum concentrations about 1 hour after the injection were approximately the same whether CN-B12 or OH-B12 was given. Thereafter, the concentration of CN-B12 fell far more rapidly than that of OH-B12, so that during the subsequent 48 hours the OH-B12 concentration was 3–6 times higher than the CN-B12 concentration.

Dialysis experiments showed that OH-B12 passes far more slowly through a cellophane membrane than does CN-B12, and that OH-B12is bound to the serum proteins in far greater quantities than is CN-B12. The amount of bound, i. e. non-dialysable, CN-B12 increased only slightly with increasing total concentration, while the amount of bound OH-B12 increased proportionally, making up about two-thirds of the total concentration.

These two factors – greater binding to the serum proteins and slower diffusion of non-bound OH-B12 – reduce glomerular filtration and must be considered the main explanation why far less of injected OH-B12 than of injected CN-B12 is lost in the urine.

It is concluded that owing to its excellent retention in the organism – without addition of absorption-retarding substances – hydroxocobalamin (OH-B12) must be particularly suited for the treatment of pernicious anaemia and other B12 deficiencies, all the more so as OH-B12 is presumably a physiological vitamin B12.

In maintenance therapy, 1 mg hydroxocobalamin i. m. every 3 months should be sufficient