VITAMIN B12

KIMBERLY SMITH

WHAT IS VITAMIN B12?

It is one of eight B vitamins.
Vitamin B12 is a water-soluble vitamin.
Vitamin B12 exists in several forms and contains the mineral cobalt,

so compounds with vitamin B12 activity are collectively called

cobalamins.
Its key role is in the normal functioning of thebrainandnervous
system, and the formation of red blood cells.
Vitamin B12 is structurally the most complicated vitamin, it is also
the largest.

WHY IS IT IMPORTANT
It is involved in the metabolismof everycellof the human body, especially

affectingDNAsynthesis,fatty acidandamino acid metabolism.

It is an especially important vitamin for maintaining healthy nerve cells,
and it helps in the production of DNA and RNA, the body's genetic material.
It works closely with vitamin B9, also called folate or folic acid, to help
make red blood cells and to help iron work better in the body.
Folate and B12 work together to produce S-adenosylmethionine (SAMe), a
compound involved in immune function and mood.
Vitamins B12, B6, and B9 work together to control blood levels of the
amino acid homocysteine. High levels of homocysteine are associated with
heart disease.

SOURCES
Food
Clams, cooked, 3 ounces
Liver, beef, cooked, 3 ounces
Breakfast cereals, fortified with 100% of the
DV for vitamin B12, 1 serving
Trout, rainbow, wild, cooked, 3 ounces
Salmon, sockeye, cooked, 3 ounces
Trout, rainbow, farmed, cooked, 3 ounces
Tuna fish, light, canned in water, 3 ounces
Cheeseburger, double patty and bun, 1
sandwich
Haddock, cooked, 3 ounces

Micrograms
(mcg)
per serving
84.1

Percent DV*
1,402

70.7

1,178

6.0

100

5.4

90

4.8

80

3.5

58

2.5

42

2.1

35

1.8

30

SOURCES
Food
Breakfast cereals, fortified with
25% of the DV for vitamin B12, 1
serving
Beef, top sirloin, broiled, 3
ounces
Milk, low-fat, 1 cup
Yogurt, fruit, low-fat, 8 ounces
Cheese, Swiss, 1 ounce
Ham, cured, roasted, 3 ounces
Egg, whole, hard boiled, 1 large
Chicken, breast meat, roasted, 3
ounces

Micrograms (mcg)
per serving
1.5

Percent DV*
25

1.4

23

1.2
1.1
0.9
0.6
0.6
0.3

18
18
15
10
10
5

SOURCES
B12 can also be supplied by dietary supplements.
In dietary supplements, vitamin B12 is usually present as cyanocobalamin, a form that the

body readily converts to the active forms methylcobalamin and 5deoxyadenosylcobalamin.

However, the bodys ability to absorb vitamin B12 from dietary supplements is largely

limited by the capacity of intrinsic factor.

In addition to oral dietary supplements, vitamin B12 is available in sublingual preparations

as tablets or lozenges.
Vitamin B12 is also available as a prescription medication in a gel formulation applied

intranasally, a product marketed as an alternative to vitamin B12 injections that some

patients might prefer .

RECOMMENDED INTAKE
Recommended Dietary Allowances (RDAs) for Vitamin B12

Age
06 months*

Male
0.4 mcg

Female
0.4 mcg

Pregnancy

Lactation

712 months*

0.5 mcg

0.5 mcg

13 years

0.9 mcg

0.9 mcg

48 years

1.2 mcg

1.2 mcg

913 years

1.8 mcg

1.8 mcg

14+ years

2.4 mcg

2.4 mcg

2.6 mcg

2.8 mcg

ABSORPTION MECHANISM
Dietary vitamin B12 is normally bound to proteins in food and is provided by food

products of animal origin.

Pepsin and acid in the stomach will degrade these food proteins and release
vitamin B12.
The vitamin B12 that is now free then binds to one of the three vitamin B12
binding proteins, called haptocorrin, which is produced by the salivary glands and
the parietal cells in the stomach.
In the duodenum the pH is now less acidic and this allows pancreatic proteases to
degrade the haptocorrin, and vitamin B12 (both newly ingested and from the bile
duct) is released again and binds tightly to Intrinsic Factor produced by parietal
cells.
In the mucosal cells of the distal ileum, the vitamin B12-Intrinsic Factor complex is
recognized by special receptors.

ABSORPTION
Vitamin B12 then enters the blood bound to another binding

protein, transcobalamin, the complex is known as

holotranscobalamin (Active B12).
The majority of vitamin B12(70-80%) in blood is bound to
haptocorrin and only a minor proportion (20-30%) is bound to
transcobalamin.
Holotranscobalamin (Active B12) is the biologically active fraction of
vitamin B12 in the blood as it is in only this form that vitamin B12 is
delivered to all the cells of the body.
Vitamin B12 absorbed in the intestine then gets transported to the
liver via the portal system.
There is extensive enterohepatic circulation of vitamin B12 and it is
transported from the liver, via the bile duct, to the duodenum.

INTRINSIC FACTOR
Intrinsic factor is one of the most important glycoprotein in the

human body.
It has only one primary function that is essential for good health.
Produced by the parietal cells of the stomach as well as the salivary
glands, intrinsic factor has a brief, but very important life.
Intrinsic factor is key for supporting energy,metabolism, and mental
health by working with one nutrient; vitamin B12.
Intrinsic factor binds to B12 when it reaches the stomach following
exposure to gastric juices.
The absence of intrinsic factor leads to a condition called pernicious
anemia, or the inability to initiate intrinsic factor and B12
absorption.

PERNICIOUS ANEMIA

MALABSORPTION
A common cause of B12 deficiency is malabsorption due to a number of gastrointestinal
conditions:
Atrophic gastritis, which increases with age, impairs the production of acid and

enzymes needed to break down food and also the production of intrinsic factor.
Malabsorption would also occur withpancreatic insufficiencyand any surgery which

removed part of the stomach or ileumwould increase risk.

Intestinal diseasessuch asCrohns, andcoeliac diseasecan cause complications.
Long-term use ofacid suppressants (proton pump inhibitors, H2 antagonists)is a

potential risk factor, and these are some of the most widely prescribed and used drugs in
the elderly population.
Finally, in truepernicious anemiawhere there is an autoimmune component, there are

three different types of antibodies that could be the cause. Those which bind to the
intrinsic factor-vitamin B12 complex preventing uptake, antibodies which bind to intrinsic
factor itself preventing binding with vitamin B12, and antibodies to gastric parietal cells
preventing the production of intrinsic factor.

DEFICIENCY
The human body stores several years' worth of vitamin B12 in the liver, so low

levels in the body are rare.

Causes:
Vegetarianism/Veganism
Medication
Malabsorption

Decreases in vitamin B12 levels are more common in the elderly, HIV-infected

persons, and vegetarians/vegans.

A diet that does not include food products of animal origin, or where meat is

avoided, would lead to a higher risk of vitamin B12 deficiency.

Pernicious Anemia is caused by B12 deficiency.

SIGNS OF DEFICIENCY ARE:

extreme tiredness
a lack of energy
Pins and needles (paraesthesia)
a sore and red tongue
mouth ulcers
muscle weakness
disturbed vision
psychological problems, which may include depression andconfusion
problems withmemory, understanding and judgement

PEOPLE AT RISK OF B12 DEFICIENCY

The elderly
Alcoholics
Individuals with atrophic gastritis
People with pernicious anemia
People with gastrointestinal disorders
People who have had gastrointestinal surgery
Vegetarians, Vegans
Infants with Vegetarian/Vegan mothers

DRUG INTERACTION

Chloramphenicol- it can interfere with the RBCs interaction with b12

Proton pump Inhibitors(omeprazole and lansoprazole)- interferes with absorption by

decreasing the release of gastric acid in the stomach.

H2 Receptor antagonists( e.g. cimetidine)- interferes with absorption by slowing the

release of HCL in the stomach.

Antibiotics- An increased bacterial load can bind significant amounts of vitamin B 12in the

gut, preventing its absorption. In people with bacterial overgrowth of the small bowel,
antibiotics such asmetronidazole(Flagyl) can actually improve vitamin B 12status.