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Do You Need Vitamin B12 To Utilize Folate

Do You Need Vitamin B12 To Utilize Folate


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Just wondering if Vitamin B12 is necessary for the body to utitlize folate. My husband is on Methotrexate for rheumatoid arthritis, a medicine which is known to destroy folate. The doctors therefore prescribe high dose folic acid. He also, however, has a geographic tongue which is supposedly due to B12 defiency. If he is deficient in B12, and yet if B12 is necessary for folate absorption, the extra folic acid is presumably doing no good. Whether the two vitamins are essential co-factors is interesting to know because I've just read that folic acid deficiency gives people a 69% higher risk of heart disease. And he's just had a massive heart attack.

I can't seem to find the answer on standard search engines, would be grateful to know whether B12 is needed to utilize folate. Many thanks.


B12 is not necessary to utilize folate but it is necessary to replace B12 before repleting folate as otherwise you can induce subacute combined degeneration of the cord. There are multiple mechanisms of folate absorption from the small bowel and large bowel which don't require B12.

Geographic tongue is not caused by B12 deficiency, and the actual cause is not known. It does cause raw beef tongue.

You don't normally need to prescribe mega doses of folic acid with methotrexate. Common doses are 5 mg per week, and 0.8 mg daily, though some physicians don't bother using folic acid at all. Although folic acid was commonly prescribed because it was believed that methotrexate works by virtue of its ability to antagonize folic acid, it is now known that this is not true. It works as an adenosine antagonist, and so you can take the folic acid on the same day as the methotrexate if you wish.


Vitamin B12

Infants need vitamin B12 for supporting brain development and producing healthy red blood cells. Infants who do not get adequate vitamin B12 can become deficient. If left untreated, vitamin B12 deficiency in infants can lead to permanent brain damage. Vitamin B12 is found in foods from animals, primarily meat, fish, milk and milk products, and eggs therefore infants of mothers who consume a vegetarian or vegan diet may be at risk for vitamin B12 deficiency.

Do infants get enough B12 from breast milk?

Usually. Vitamin B12 is transferred through the placenta to the fetus during pregnancy and through breast milk after birth. Infants who drink breast milk from a mother who consumes adequate amounts of vitamin B12 or infants who drink infant formula, will receive enough vitamin B12. However, if a breastfeeding mother is deficient in vitamin B12, her infant may also become deficient.

Vitamin B12 is most commonly found in foods from animals therefore, infants who only receive breast milk from mothers who consume no animal products are at greater risk for developing vitamin B12 deficiency shortly after birth. Breastfeeding mothers on a strict vegetarian or vegan diet should consult their healthcare provider about taking a supplement that contains the appropriate amount of vitamin B12. Mothers can learn more about why vitamin B12 is important, how much is needed, and what foods are high in vitamin B12. external icon

Breastfeeding mothers who have had a malabsorptive bariatric procedure (such as gastric bypass surgery), who have pernicious anemia (low number of red blood cells caused by a deficiency of vitamin B12), or who have certain gastrointestinal disorders, may not be able to absorb various vitamins and minerals, such as vitamin B12, folic acid (vitamin B9), iron, and calcium. Healthcare providers should monitor these mothers for nutrient deficiencies, including vitamin B12 deficiency.


Don’t Worry, Be Happy & Be Healthy with Vitamin B12

When it comes to managing some of our most common chronic conditions and quickly improving a persons’ overall sense of wellbeing, few things compare to B Vitamins and in particular, Vitamin B12. Safe, quick to administer, and fast-acting, B12 injections can make a profound difference in the lives of people with low energy, chronic fatigue, anxiety, hepatic (liver) disorders, infertility, arthritis/joint pain, and a host of other common conditions.

In Naturopathic Medicine, we are trained to treat the gut and the liver – it was always drilled into us that “You can’t ever go wrong by treating the liver”. In line with this, I’ve also learned that you can never go wrong by looking for and treating B vitamin deficiencies (because this impacts your liver!) and so let’s talk about Vitamin B12.

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What is B12 Deficiency?

Research conducted by Tufts University indicates that up to 40 percent of Americans may be suffering from low B12 levels. This includes people with all diets, from meat-eaters to flexitarians to vegans.

Symptoms of B12 deficiency—also known as pernicious anemia—can include fatigue, heart palpitations, memory loss, numbness or tingling in hands and feet, and poor coordination. It can also cause tongue discomfort and discoloration.

There are a few factors in B12 deficiency. Impaired digestion from low stomach acid, lack of calcium, and age can all lead to reduced absorption. The rate at which humans can absorb B12 naturally decreases as we get older, diagnosing and treating deficiency as soon as possible is preferable.

Folic acid also contributes to the healthy absorption of B12. Folate, which is found in leafy green vegetables, is another B complex vitamin that the body cannot produce and must ingest. It is also essential in the creation and maintenance of healthy cells and DNA.

In addition to dietary factors, there are also genetic factors in B12 deficiency which can impact absorption and retention rates. A blood test from your doctor or physician can reveal your B12 and folate levels, and they can advise you if supplementation is required.

Fortified nutritional yeast is extremely high in B12.


Best supplements for anaemia: Do you need vitamin B12, folic acid or iron?

Red blood cells are produced in the bone marrow, with vast quantities created every single day. Nutrients from food, such as iron, vitamin B12 and folate ensure the bone marrow is healthy.

Too little of these nutrients will lead to some type of anaemia, which all share general symptoms.

According to Nursing Times, there are seven warning signs of anaemia to be aware of. These are:

  • Fatigue
  • Breathlessness (dyspnoea)
  • Faintness
  • Irregular heart beats (palpitations)
  • Headache
  • Ringing in your ears (tinnitus)
  • Loss of appetite

This is an autoimmune disease that attacks the stomach’s cells that are responsible for producing intrinsic factor – a protein that binds to B12.

Normally, intrinsic factor binds with vitamin B12 so that the nutrient can be re-absorbed into the body.

When a person had pernicious anaemia, this doesn’t happen, causing a deficiency in the long term.

The body usually stores enough vitamin B12 to last up to four years, but pernicious anaemia begins in most people over the age of 60.

Other causes of a vitamin B12 deficiency can be caused by a vegan diet, an unhealthy diet or Crohn’s disease.

Meanwhile, folate can only be stored for roughly four months inside of the body.

The water-soluble vitamin is needed in a daily diet, said the Nursing Times.

An unhealthy, unbalanced diet is a likely cause, or irritable bowel syndrome which can cause absorption issues.

Furthermore, excessive urination can cause a folate deficiency, which may be due to congestive heart failure.

The body may be more demanding for folate for any of these possible reasons:

  • Are pregnant
  • Have cancer
  • Sickle cell anaemia
  • Inflammation in the body

As for an iron deficiency, the NHS explained heavy periods, pregnancy and internal bleeding are likely culprits.

Any of these deficiencies can be identified by a blood test arranged by your GP.

Thankfully, all of these deficiencies can be corrected by taking supplements.

  • Iron deficiency – take iron supplements
  • B12 deficiency – take B12 supplements
  • Folate deficiency – take folic acid supplements

Your GP may advise you to take supplements for a specified duration if a deficiency is identified.

You will likely have a repeat blood test at a later date to check if the deficiency has been remedied.


What Are Your Optimal/Functional Ranges of B12 and Folate (how to read your blood test)?

If you learn one thing from this article, know this: low-normal B12 and folate levels will not cut it if you’re interested in preventative health and optimizing your well-being long-term.

If you want vibrant energy, a sharp mind, good muscle tone, efficient detoxification and a healthy nervous system, you want to come out on the high end of normal for these markers…not the low end.

Optimal/functional ranges of serum B12 range are likely:

Optimal/functional ranges of red blood cell (RBC) folate range are likely:

If you’re working with your own doctor or healthcare provider, keep in mind that different labs have different reference ranges, particularly for the folate.


Complications of vitamin B12 or folate deficiency anaemia

Although it's uncommon, vitamin B12 or folate deficiency (with or without anaemia) can lead to complications, particularly if you've been deficient in vitamin B12 or folate for some time.

Potential complications can include:

  • problems with the nervous system
  • temporary infertility
  • heart conditions
  • pregnancy complications and birth defects

Adults with severe anaemia are also at risk of developing heart failure.

Some complications improve with appropriate treatment, but others – such as problems with the nervous system – can be permanent.

Read about the complications of vitamin B12 or folate deficiency anaemia .

What are the symptoms of vitamin B12 or folate deficiency?

Vitamin B12 or folate deficiency anaemia can cause a wide range of symptoms. These usually develop gradually but can worsen if the condition goes untreated.

Anaemia is where you have fewer red blood cells than normal or you have an abnormally low amount of a substance called haemoglobin in each red blood cell. General symptoms of anaemia may include:

  • extreme tiredness (fatigue)
  • lack of energy (lethargy)
  • breathlessness
  • feeling faint
  • headaches
  • pale skin
  • noticeable heartbeats (palpitations)
  • hearing sounds coming from inside the body, rather than from an outside source ( tinnitus )
  • loss of appetite and weight loss

Which foods have a high vitamin B12 content?

As mentioned above, vitamin B12 is only found in sufficiently high quantities in animal products. If you eat meat, fish, eggs, offal and (non-pasteurized) dairy products, it is generally quite easy to cover your daily requirements. Most plant-based foods do not contain vitamin B12. There are some exceptions, such as fermented foods like sauerkraut, kimchi, pickled vegetables, and beer, and foods contaminated by bacteria (e.g. tuber and root vegetables), which may contain traces of various types of B12. Under certain circumstances, however, these compounds are present in a form that our body is unable to process ( &ldquovitamin B12 analogues&rdquo) and whose presence may even impede the utilization of useful forms of vitamin B12.


Everything you need to know about vitamin B-12

Vitamin B-12 is a crucial B vitamin. It is needed for nerve tissue health, brain function, and the production of red blood cells. Cobalamin is another name for vitamin B-12.

Deficiency can result when levels of vitamin B-12 are too low. This can lead to irreversible neurological symptoms. In the United States (U.S.), between 1.5 and 15 percent of the population are currently diagnosed with vitamin B-12 deficiency.

This article will explore the functions of vitamin B-12, how a person would know they are not consuming enough vitamin B-12, and where to source more.

Share on Pinterest Vitamin B-12 is vital for red blood cell production and mental processes.

Vitamin B-12 is a water-soluble vitamin, like all other B-vitamins.

This means it can dissolve in water and travel through the bloodstream. The human body can store vitamin B-12 for up to four years. Any excess or unwanted vitamin B-12 is excreted in the urine.

Vitamin B-12 is the largest and most structurally complicated vitamin. It occurs naturally in meat products and can only be industrially produced through bacterial fermentation synthesis.

Vitamin B-12 can be found naturally in animal products, such as fish, meat, eggs, and dairy products. It does not typically occur in plant foods.

Good dietary sources of vitamin B-12 include:

  • beef
  • pork
  • ham
  • poultry
  • lamb
  • fish, especially haddock and tuna
  • dairy products, such as milk, cheese, and yogurt
  • some nutritional yeast products
  • eggs

Some types of soya milk and breakfast cereals are fortified with vitamin B-12.

It is always better to maintain a balanced diet and receive healthful amounts of nutrients before active treatment is required. The symptoms of deficiency are easily avoided with a healthful diet.

Vitamin B-12 is crucial to the normal function of the brain and the nervous system. It is also involved in the formation of red blood cells and helps to create and regulate DNA.

The metabolism of every cell in the body depends on vitamin B-12, as it plays a part in the synthesis of fatty acids and energy production. Vitamin B-12 enables the release of energy by helping the human body absorb folic acid.

The human body produces millions of red blood cells every minute. These cells cannot multiply properly without vitamin B-12. The production of red blood cells reduces if vitamin B-12 levels are too low. Anemia can occur if the red blood cell count drops.

Intake requirements

In the U.S., the National Institutes of Health (NIH) recommend that teens and adults over the age of 14 years should consume 2.4 micrograms (mcg) of vitamin B-12 a day. Pregnant women should be sure to consume 2.6 mcg, and lactating women 2.8 mcg.

Excessive intake of vitamin B-12 has not demonstrated toxic or harmful qualities. However, people are always advised to speak with their physician before starting to take supplements.

Some medications may interact with vitamin B-12. These include metformin, proton pump inhibitors, and h2 receptor agonists, often used for peptic ulcer disease. All of these drugs may interfere with vitamin B-12 absorption. The antibiotic chloramphenicol, or chloromycetin, may also interfere with red blood cell production in people taking supplements.

Vitamin B-12 deficiency occurs when the body does not receive enough vitamin B-12.

It can result in irreversible and potentially severe damage, especially to the nervous system and brain.

Even slightly lower-than-normal levels of vitamin B-12 can trigger deficiency symptoms, such as depression, confusion, memory problems, and fatigue. However, these symptoms alone are not specific enough to diagnose vitamin B-12 deficiency.

Other symptoms of vitamin B-12 deficiency include constipation, loss of appetite, and weight loss.

Once symptoms escalate, they can include neurological changes, such as numbness and tingling in the hands and feet. Some people may have difficulty maintaining balance.

Infants who lack vitamin B-12 may demonstrate unusual movements, such as face tremors, as well as reflex problems, feeding difficulties, irritation, and eventual growth problems if the deficiency is left untreated.

Vitamin B-12 deficiency carries a serious risk of permanent nerve and brain damage. Some people with insufficient vitamin B-12 have a higher risk of developing psychosis, mania, and dementia.

Insufficient vitamin B-12 can also lead to anemia. The most common symptoms of anemia are fatigue, shortness of breath, and an irregular heartbeat. People with anemia might also experience:

  • a sore mouth or tongue
  • weight loss
  • pale or yellowing skin
  • menstrual problems

Vitamin B-12 deficiency also leaves people more susceptible to the effects of infections.

Who is at risk?

Vegans face a risk of vitamin B-12 deficiency, as their diet excludes animal-sourced food products. Pregnancy and lactation can worsen deficiency in vegans. Plant-sourced foods do not have enough cobalamin to guarantee long-term health.

People with pernicious anemia may lack vitamin B-12. Pernicious anemia is an autoimmune disease that affects the blood. Patients with this disorder do not have enough intrinsic factor (IF), a protein in the stomach that allows the body to absorb vitamin B-12.

Other at-risk groups include people with small intestine problems, for example, an individual whose small intestine has been surgically shortened. They may not be able to absorb cobalamin properly. People with Crohn’s disease are said to be at risk, but researchers maintain that there is a lack of evidence to confirm this.

Gastritis, celiac disease, and inflammatory bowel disease may lead to a deficiency because these conditions cause the absorption of nutrients to be reduced.

People with chronic alcoholism may lack vitamin B-12 , as their bodies are also not able to absorb nutrients efficiently.

Individuals treating diabetes with metformin are advised to monitor their levels of vitamin B-12. Metformin might reduce the absorption of vitamin B-12.

Treatment includes vitamin B-12 injections. A vitamin B-12 injection must be administered to people that have problems with nutrient absorption.


B Vitamins Can Be Easy

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B vitamins are important to just about every system in your body. They’re protective against common and potentially lethal chronic diseases. And, they’re important for a healthy pregnancy, hormone production, and for your hair, skin, and nails. While all of the B vitamins are in whole foods, there are a few that some people may struggle to get enough of. However avoiding deficiency is relatively easy with testing when indicated, and the addition of appropriate supplements. Hopefully, this article has helped you to B pro-active with your well-being!