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Little Things That Do A lot

By: Clifford M. Sonnie, M.D.

Have you ever noticed how the smallest thing in our lives could have the biggest impact on it? Well a good example of this is vitamin B12. It is one of those vitamins that we often don’t think about and in fact it is often ignored. Well that little thing may be responsible for an entire array of preventable age-related diseases.

Interestingly enough, it has been shown that 40% of Americans have a low level of B12 and 20% of Americans over the age of 65 have a severely low level of B12. So, let’s talk about (you guessed it) B12.

B12 is something called an “essential vitamin” (remember essential amino acids?). This is a vitamin your body doesn’t make. You have to get it from your diet. It is found in great abundance in meat, eggs, and milk. I won’t go into the exact chemistry of B12( yeah, you say) but I will tell you that it is vital in the formation of myelin which is the insulation around every nerve, the synthesis of red blood cells, the synthesis of DNA, and the breaking down of homocystine. As a result B12 deficiency has been strongly related to depression, age related dementia, heart disease, stroke, and rheumatoid arthritis and recent literature has even linked it to Alzheimer’s. Why don’t we suspect it earlier? For the most part, B12 deficiency is a very slowly progressing problem, whose symptoms literally take years to surface. Some will rear their ugly heads earlier than others, but this is not an overnight event.

Before we get into the symptoms, (you guessed it) a little science! There is something in our bodies called an intrinsic factor. It is found in our intestinal tract and is responsible for the absorption and function of many GI processes, one of which is the absorption of vitamin B12. The intrinsic factor tends to decrease over time; therefore the body’s ability to absorb B12 diminishes. It is not eliminated, just decreased. Secondly, the use of those nasty “proton inhibitors” can also be linked to B12 deficiency. You know these as Prilosec and Nexium to name a few, but they all work the same way. Basically, these medications decrease the amount of gastric acid. The less acid available for digestion, the less B12 is released from food. The less acid, the higher the possibility of bacteria overgrowing in the intestine. Overgrowth of bacteria and the decreased gastric acid will decrease the absorption of B12.

So, like I said before, B12 deficiency sneaks up on you. What are you looking for? The symptomology is confusion, vision changes and memory loss. As I said before too, it can be associated with rheumatoid arthritis, heart disease, and should be measured with the suspicion of any neurological condition. Every patient with unexplained anemia or any neurological condition; and patients with long standing intestinal problems likes Crohn’s disease, should be evaluated for B12 deficiency. Depression is another condition that should be evaluated for B12 deficiency. Here is where I disagree with some of the recent testing. I believe the lower limit of the so called “Normal Level” for B12 is too low. Many times it is indeed measured, but because it is in the normal range, therapy is not begun.

So, how do we fix it? The replacement of B12 can be done in any of these three ways; orally, sublingually or by injection. I don’t know of anyone, myself included, with perfectly operating intestinal systems. So my concern is the oral and sublingual absorption of B12 may not be the most efficient way to replace it. Unfortunately, the only other way to give it is by injection. They don’t have to be done by a physician, but they do have to be initiated by a physician, who writes a prescription for the injection, and the patient can then give it to themselves. Levels should be monitored by a simple routine blood test. B12 injections are generally given frequently at first to “fill up the tank” and then they can be routinely done as often as every couple of weeks or every month depending on what is necessary for that patient to maintain their levels.

As you can see B12 is very important to many aspects of our health. But it is usually not monitored early. In my opinion, routine blood tests should include not only the “usual suspects”, but B12 as well. Before we all go scurrying to our MD’s, demanding to be injected with B12, or buying up all the B12 at your health food store, please have the levels checked first. So make that appointment with your family M.D. or D.O. or call us at the Balance of Life Clinic and we’ll do the appropriate testing and start you on your way to good health. As always, a smart healthcare consumer is informed and aware.

Clifford M. Sonnie is the medical director at the Balance of Life Clinic.