Only bacterial cells retain the capacity to synthesize B12, but almost all organisms, except plants and fungi, require B12. In humans, the absorption of B12 from food is a highly complicated process, and is frequently compromised with aging, such that about a quarter of community-living elderly are B12-deficient. For nursing home residents, the proportion is 46%1<\/a><\/sup>.<\/p>\n\n\n\n\n In the wild, the consequences of B12 deficiency, which include anemia, lower extremity weakness, loss of postural balance, and dementia2<\/a><\/sup>, would quickly result in death. This suggests that the high likelihood for B12 deficiency in elderly has been \u201cbuilt in\u201d by evolution as a mechanism to kill off the eldest generation.<\/p>\n\n\n\n\n What is the connection between vitamin B12 and inflammation? A B12 deficiency leads to high levels of homocysteine; this compound causes inflammation leading to osteoporosis3<\/a><\/sup>, vascular disease4<\/a><\/sup>, and retinal and brain disease5<\/a><\/sup>, just to mention a few.<\/p>\n\n\n\n\n In 1998, Health Canada together with the U.S. Institute of Medicine, recommended \u201cBecause 10 to 30 percent of older people may malabsorb food-bound vitamin B12, it is advisable for those older than 50 years to meet the RDA mainly by consuming foods fortified with vitamin B12 or a supplement containing vitamin B12\u201d(see Table 3, Footnote d)<\/a>. In Canada, as no B12 fortified foods are available, supplements are the only avenue to get synthetic B12. Unfortunately, it appears the vast majority of Canadians, including physicians and other health care providers, are unaware of this recommendation.<\/p>\n\n\n\n\n As animal-based foods are the only sources of food B12, a vegan or quasi-vegan diet such as the methionine and protein restricted diets suggested in earlier instalments is already likely to result in B12 deficiency, including in younger people and in children, unless supplements are taken.<\/p>\n\n\n\n\n Up until recently, no bad effects of excessive B12 supplementation had been identified6<\/a><\/sup>; the exception may be cancer patients receiving chemotherapy7<\/a><\/sup>. <\/p>\n\n\n\n\n How much B12 should be taken? It depends on whether someone has symptoms that are likely to be due to B12 deficiency. In such cases, I would prescribe intramuscular or subcutaneous injections of 1000 micrograms (mcg) daily for a week, then once weekly for 4 weeks, and then monthly, for life. <\/p>\n\n\n\n\n Unfortunately, in individuals who have pernicious anemia, even this large dose may be insufficient. In these cases, weekly injections of 1000 mcg B12 may be necessary, again for life. In Canada, a doctor\u2019s prescription is not necessary to obtain B12 for injection from a pharmacy.<\/p>\n\n\n\n\n For individuals over 50 without symptoms, I recommend sublingual methylcobalamin, eg 1000 mcg every other day. This preparation has been shown to be well absorbed (at least in children)8<\/a><\/sup>. For people who do have symptoms which could be caused by a B12 deficiency, taking 2500 mcg sublingually every day is possibly as effective as taking a weekly injection.<\/p>\n\n\n\n\n At the beginning of the COVID-19 pandemic, residents of nursing homes were most likely to have severe illness and to die from infection. Near the end of 2020, I wrote an article suggesting that B12 deficiency could be a cause of this excess severity and mortality, and might also impair vaccine effectiveness in vulnerable nursing home residents. Unfortunately, I was unable to get my medical colleagues, regional health administrators, or the provincial government to take this seriously. Click here to access the article<\/a>.<\/p>\n\n\n\n\n I\u2019m going to end instalment 7 here, with a couple of additional comments. These days, in western societies, pretty well all of the classic vitamin deficiencies such as scurvy (vitamin C deficiency), rickets (vitamin D deficiency), pellagra (niacin deficiency) or beriberi (thiamine deficiency) are essentially non-existent. Even neural tube defects caused by folate deficiency have diminished greatly. The exception is vitamin B12 deficiency, extremely common in seniors, and likely a very important cause of people being admitted to nursing homes when they suffer from falls, incontinence, or dementia caused by a lack of B12. <\/p>\n\n\n\n\n This would be simple to fix, but governments and doctors seem uninterested in doing so. Is this because the geriatric industry is so important to our economy?<\/p>\n\n\n\n\n I admit that I\u2019m quite fixated on vitamin B12. My mother suffered from pernicious anemia (PA), and it is likely I do also, as PA is at least partially hereditary. I first looked at PA in detail in my second year in medical school – click here to download my essay<\/a>. My website<\/a> has a number of other articles; type B12 (followed by Enter or Return) into the search box in the upper right-hand corner.<\/p>\n\n\n\n\n Instalment 8<\/a> will look at some other dietary supplements which might be part of your approach to reduce inflammation.<\/p>\n\n\n\n\n While I discourage the use of most dietary supplements, there are exceptions. One is Vitamin B12 (cobalamin). Read this instalment to find out why.<\/p>\n","protected":false},"author":1,"featured_media":1968,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[535],"tags":[12,563,490,116,560,561,367,562,559],"class_list":["post-1785","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-diy-inflammation","tag-b12","tag-cobalamin","tag-covid-19","tag-diet","tag-health-canada","tag-homocysteine","tag-inflammation","tag-methylcobalamin","tag-supplements"],"_links":{"self":[{"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/1785","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1785"}],"version-history":[{"count":4,"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/1785\/revisions"}],"predecessor-version":[{"id":1969,"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/1785\/revisions\/1969"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=\/wp\/v2\/media\/1968"}],"wp:attachment":[{"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1785"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1785"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/henry.olders.ca\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1785"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n\t