B12 - What You Should Know

When I got an email from Twin Lab's formulator, Gene Bruno's publicist I jumped at the opportunity to pick his brain about his B12 supplements and the knowledge he has around the subject. I have been thinking a lot about this subject lately, probably because I'm pregnant. 

As you may or may not know, a lot of people {vegans and vegetarians in particular} are deficient in B12 and it's a very serious medical condition. Iron and B12 go hand in hand so an Iron deficiency can mean a B12 deficiency and visa-versa!

If you're interested in the subject, below is an informative Q+A with Gene Bruno that covers most of the iron and B12 myths and facts {from his perspective}. As you probably know, I love interviews and gathering varying information/opinions from all sorts of professionals on the subjects of food, health and wellness. Read below for his thoughts...

1) How do b-12 and Iron work together? If you supplement with iron is it pointless if you are low in b-12?

Iron is necessary for the formation of hemoglobin, the proteins in red blood cells involved in the transport and storage of oxygen. Vitamin B12 is required for the synthesis of hemoglobin. Also, a deficiency of either nutrient can cause anemia. If you have a B12-deficiency anemia (pernicious anemia), supplementation with iron will not cure it.

--- What about calcium? 

Calcium is required for healthy bone formation and maintenance. Vitamin B12 helps keep homocysteine levels in check, which is important since high homocysteine levels may affect bone remodeling by increasing bone resorption (breakdown), decreasing bone formation, and reducing bone blood flow.

--- Are they all related? Should you supplement with both together?

The relationship is as described above. It is not necessary to supplement with the nutrients together in order to benefit from the individual nutrients. However, all of them are needed for good health.

2) Where else can you get b-12 but in animal products? Is b-12 only in meat or is it also in dairy?  

Plants do not require B12, so they don’t make B12. Only animals and humans make B12 (which is made by the microflora in their guts), which is why it can only be found in animal food sources. Besides meat, this includes eggs (1 large egg contains 44 mcg) and milk (1 cup whole milk or reduced fat milk contains about 1 mcg). 

3) Any tips on pregnancy or thoughts? 

The Daily Value for vitamin B12 increases slightly during pregnancy (from 6 mcg to 8 mcg). However, given digestion and absorption issues, I would recommend a B12 lozenge.

4) If we don't eat meat or dairy, where can we get B12 and Iron?

Are you vegan, or do you consume milk and eggs? If the latter, you are getting some B12. Also, assuming your intestinal flora (friendly bacteria) is in good shape, it will manufacture some B-12 for you.

Regarding the iron, it is possible that you are consuming other good vegetarian sources (e.g., spinach).

If you take supplements, that is another way that you may be getting B12 and iron.

Gene's thoughts and some research to back it up...

The vegan diet has many benefits to offer. In some cases, it can help diabetic patients lower their daily insulin requirement.[i] Furthermore, long-term consumption of a low-calorie low-protein vegan diet is associated with low cardiovascular disease risk. This includes lower body mass index (BMI), lower plasma concentrations of lipids, lipoproteins, glucose, insulin, and C-reactive protein, as well as lower blood pressure (both systolic and diastolic), and thickness of the internal diameter of the carotid (a measure of heart disease risk).[ii] Other research study indicates that consumption of a strict raw food diet lowers plasma total cholesterol and triglyceride concentrations.[iii] Long-term benefits were also seen in a 17-year observational study of vegetarians and other health conscious people. Results demonstrated that daily consumption of fresh fruit was associated with significantly reduced mortality from ischaemic heart disease, cerebrovascular disease, and for all causes combined.[iv] Overall the individuals in the study had a mortality about half that of the general population.  In addition, in a 12-week study on individuals following a raw food vegetarian diet experienced improvements in measures of mental and emotional quality of life.[v]

5) So how a vegan or vegetarian ANIMAL would get B12. 

The intestinal flora (friendly bacteria) of herbivores (vegan animals) manufacture vitamin B12.

6) I wanted to know if we manufacture our own b12?

Yes. Like animals, the intestinal flora (friendly bacteria) of human beings are also capable of manufacturing vitamin B12. 

7) So then WHY are people so deficient? Is it poor gut flora or diet? Maybe because nutrients work together, people are just low in MOST vital nutrients? Or do we need more fermented foods in our diets? Because I heard that you can take an entire BOTTLE of b12 if you aren't methylating it {I think that's the right word} and still only absorb a little. So there is a bigger picture. It's not black and white - like EAT MEAT and you'll be fine. Lots of people are iron deficient in pregnancy and not in pregnancy and eat meat all the time. 

Dietary B12 is bound to protein in food, from which it is released by the action of pepsin and gastric acids.  Gastric acid secretion, however, reduces with age.  This normally begins at about 40. This can seriously reduce the potential absorption of this nutrient since the intestinal absorption of B12 is dependent upon its binding with the glycoprotein known as intrinsic factor, secreted from the parietal cells of the stomach.  If the gastric juices of a person lacks intrinsic factor, then there is little uptake of the vitamin; although if amounts about a thousand times the normal dosage are given B12 may pass through the intestinal wall by diffusion.  Even so as little as 1.2% is absorbed of dietary B12 may be absorbed.[vi] This is why B12 lozenges (dots) are a preferred supplementation form since it is absorbed in the mouth and bypasses the whole problem with intrinsic factor.

Vitamin B12 must be converted into its coenzyme forms, methylcobalamin and 5-deoxyadenosylcobalamin. These are the forms of vitamin B12 used in the human body.[vii] Methylcobalamin is the predominant B12 coenzyme found in blood plasma and certain other body fluids such as breast milk; in cells methylcobalamin is found in the intracellular fluid (or cytoplasmic matrix).[viii] This conversion takes place via a process called methylation. Vitamin B12 absorption is not dependent upon methylation of B12 into methylcobalamin. Rather, it is necessary for the ultimate use of this nutrient by the body.


My {Juli's} story:

This subject is so interesting to me because overall health is not just about one nutrient; yet a deficiency in just one nutrient can offset the whole system. For example, low energy isn't just due to low iron; just like bone strength isn't due to how much calcium you ingest; nutrients work together and have a symbiotic relationship. Silica ingestion can help calcium absorption and low B12 can affect your iron levels and so on. I was iron deficient when I was pregnant with my other two kids but I'm NOT this time around, in fact my iron is at crazy high levels. I eat less fish and dairy than ever before. So, how could this be? I'm still not sure and either are my midwives or doc, but I do eat a TON of nutritional yeast, I drink spinach green drinks everyday and ingest way more fermented foods than ever. In the past 5 years I have worked on my gut health {no gluten has helped me} and it is healing and my flora must be getting better at manufacturing my own B12. But everybody is different. And I highly recommend you get a simple blood test to see what your levels are. B12 deficiency can cause mental health issues like depression and low energy.

You can also get a hair analysis done which can be beneficial for many reasons - you can see your mercury levels and arsenic levels as well as calcium, magnesium and other minerals - which allows you to supplement correctly for your body's needs instead of blindly or by guessing or assuming {that's a waste of money}. No matter what diet you follow, you can be deficient in many vital nutrients and/or high in ones you shouldn't be consuming. You can't always get everything you need from food - especially if you aren't in perfect health and aren't absorbing things correctly. 

Remember, this is food for thought - to get us thinking and to help us all be more proactive. This is not medical advice. Afterall, I have friends who thrive on a plant-based diet and others that don't. Some product B12 and absorb it better than others; it's all personal and individualized. So ask your health care provider about iron and b12. New "scientific" studies are conducted all the time and everybody has a different opinion and study to prove their theories. This is just two people's take on the subject. And if you need more info, I suggest you ask your doctor, read a few books on it and maybe try finding some more studies online. Kind, constructive comments are welcome and diet opinions as well. Feel free to share your stories or ask questions. 


[i] Douglass JM. Raw diet and insulin requirements. Ann Intern Med 1975 Jan;82(1):61-2.

[ii] Fontana L, Meyer TE, Klein S, Holloszy JO. Long-term low-calorie low-protein vegan diet and endurance exercise are associated with low cardiometabolic risk. Rejuvenation Res 2007;10(2):225-34.

[iii] Koebnick C, Garcia AL, Dagnelie PC, Strassner C, Lindemans J, Katz N, Leitzmann C, Hoffmann I. Long-term consumption of a raw food diet is associated with favorable serum LDL cholesterol and triglycerides but also with elevated plasma homocysteine and low serum HDL cholesterol in humans. J Nutr 2005;135(10):2372-8.

[iv] Key TJ, Thorogood M, Appleby PN, Burr ML. Dietary habits and mortality in 11,000 vegetarians and health conscious people: results of a 17 year follow up. BMJ 1996;313(7060):775-9.

[v] Link LB, Hussaini NS, Jacobson JS. Change in quality of life and immune markers after a stay at a raw vegan institute: a pilot study. Complement Ther Med 2008;16(3):124-30.

[vi] Whitney EN, Cataldo CB, Rolfes SR: Understanding Normal and Clinical Nutrition. BelmontCAWadsworth/Thompson Learning; 2002.

[vii] Brody T.  Nutritional Biochemistry. 2nd edSan Diego: Academic Press; 1999.

[viii] Linnell JC, Bhatt HR. Inherited errors of cobalamin metabolism and their management. Baillieres Clin Haematol1995;8(3):567-601.