Assessing B12 status of our workforce
Cobalamin, that we call vitamin B12, is without any doubt one of the most important micronutrients. However, very few people, and unfortunately, also very few doctors, know this, and even when they do know, they very rarely truly appreciate the extent to which B12 deficiency can be detrimental.
Today, I will tell you why B12 is so important, what happens when there is B12 deficiency and why it is so widespread, and finally, what we can and should do about it, as individuals, but more specifically with what concerns us here, to help maintain a healthy workforce. I will do this in 10 minutes.
Before we get into it, I want to highlight that maybe the biggest difficulties we, as a society, have, but have to overcome for the benefit of the population on a large scale, is that even though many doctors have learnt that B12 deficiency can be extremely grave, they believe it is rare and that systematic testing is not necessary. This is very unfortunate, and it is this attitude that causes, on the one hand,
Why B12 is so important?
B12 is essential at three fundamental levels: cellular energy metabolism, gene transcription, and nervous system function. Cobalamin’s vital role at the cellular level is not restricted to only some tissues and organs: it is vital for every cell of every tissue and every organ. In relation to the nervous system, both for the central nervous system—our brain—and the peripheral nervous system—the spine and entire network of nerves connected to the brain and coursing through the whole body—vitamin B12 is essential in building, maintaining and repairing the myelin sheath that covers the nerves to ensure protection and proper signalling. It is, in fact, the consequences of B12 deficiency on the nervous system—an array of neurological issues—that most often betray this very serious problem.
What happens when it is deficient?
Now just ask yourself what you think would happen if the myelin sheath that covers all the nerves throughout the body were to deteriorate?
Neurological symptoms include: numbness, tingling and burning sensations in the hands, feet, extremities, or truncal areas; Parkinson-like tremors and trembling; muscles weakness, paraesthesia and paralysis; pain, fatique and debility labelled as chronic fatique syndrome; shaky legs, unsteadiness; dizziness, loss of balance; weakness of extremities, clumsiness, twitching, muscle cramps, lateral and multiple sclerosis-like symptoms; visual disturbances, partial loss of vision or blindness. But the list goes on.
Psychiatric symptoms? Confusion and disorientation, memory loss, depression, suicidal tendencies, dementia, Alzheimer’s, delirium, mania, anxiety, paranoia, irritability, restlessness, manic depression, personality changes, emotional instability, apathy, indifference, inappropriate sexual behaviour, delusions, hallucinations, violent or aggressive behaviour, hysteria, schizophrenia-like symptoms, sleep disturbances, insomnia. And here again, the list goes on.
At the cellular level, every cell becomes unable to adequately produce energy, be it from glucose or from fat. We can easily extrapolate and imagine what it would mean for the organism as a whole to have a lack of, or severe debility in the energy available to it at the cellular level, and this, for the trillions of cells of which it is made. This would have a most profound effect on everything that we do, and everything that the body does throughout the day and night.
Now consider a yet deeper level: in the nucleus of every cell, where genes are protected and cared for, a problem in the very transcription and replication of genes—these delicate operations that are necessary and vital for the continual renewal, repair and reproduction of cells—which must and do take place throughout our life, this long succession of infinitesimal instants, the perception of which is almost universally absent from consciousness, but for which the timescale is, in fact, very long at the cellular level, where movements and interactions take place at phenomenal speeds. Vitamin B12 is absolutely essential for this too. And if it’s missing? Unintended, unplanned, and unwanted genetic mutations. This means problems: very serious problems.
Why is deficiency so common?
There are two reasons for cobalamin deficiency: inadequate intake and inadequate digestion. Although the former is indeed quite important, it is the latter that causes B12 deficiency to be so common, and in fact, quasi-universal.
Cobalamin is produced in the gut of animals by specific bacteria that make part of the intestinal flora. Even if this can also be true for humans, we have relied on animals, both by eating them and products derived from them like eggs and dairy, for millions of years of evolution as hominids. In animal foods, cobalamin is always bound to protein from which it needs to be separated in order to be used. This, in turn, can only be done starting in the highly acidic environment of a well functioning stomach that secretes enough hydrochloric acid, but also enough Intrinsic Factor as well as pepsin.
Cobalamin is carried into the duodenum—the first part of the small intestine—by salivary B12 receptors that are then broken down by pancreatic protease. This allows the free B12 to attach to Intrinsic Factor, and make its way to the ileum—the very last part of the small intestine—where it penetrates the mucosal wall for absorption. Finally, the free cobalamin latches onto the plasma transporter protein transcobalamin II whose function it is to carry the B12 to the cells throughout the body. Any excess, unneeded at any given time, is carried to the liver where it is stored.
The major problem is that almost 100% of the population has dysfunctional digestion: stomachs producing neither enough hydrochloric acid nor Intrinsic Factor and pepsin; pancreases producing neither enough bicarbonate solution needed to neutralise the acidic chyme from the stomach when it goes into the small intestine, nor enough enzymes essential for breaking down nutrients; and chronically acidic intestines coated with partially undigested food, especially putrefying protein, overtaken by pathogenic yeasts like candida, and with highly compromised intestinal walls that not only cannot properly absorb nutrients, but also cannot prevent toxins from leaking back into the bloodstream and body in general. Pretty scary, isn’t it?
So, what do you think happens to the excessively delicate and precarious chain of metabolic and biochemical steps necessary for the absorption of B12 in a tiny section of the very last part of the small intestine under these pretty dismal conditions? It breaks down. And what is the result? Quasi-universal B12 deficiency in all age groups, from infants to the elderly. Naturally, because the digestive organs tends to degrade with time, the older we get, the more deficient we become. And is it a surprise that all signs and symptoms of ageing that we all deem normal and inevitable are also all symptoms of B12 deficiency? No, not in the least.
What can be done about it?
Testing B12 status should be included in every blood test for everyone everywhere. We are still very far from this situation, however. Testing B12 status can literally save your life, but at the very least, save you from mostly permanent and possibly extremely debilitating neurological damage. It is most accurately done by measuring concentrations of serum B12, plasma Homocysteine (Hcy) and urinary methyl-malonic acid (MMA), but it is usually more than adequate to measure only B12 and Hcy in order to assess B12 status.
(Both Hcy and MMA are toxic byproducts of protein metabolism that must be converted to benign and/or useable forms by the action of B6, folic acid (B9) and especially B12. And by the way, Hcy, because of its highly toxic nature and damaging effect on blood vessels, happens to be the best marker of all for risk of cerebro- and cardio-vascular disease.)
Consequently, what we must generally do is to supplement to first raise and subsequently maintain optimal B12 levels. What are optimal B12 levels? Well, it is remarkable that on most blood test result sheets we see the “normal” B12 range starting at 200 or even 180 pg/ml, given that both neurological and psychiatric symptoms appear at levels below 450 pg/ml. The consensus between B12 experts is that levels should be above 600 and optimally between 800 and 2000 pg/ml. There are no reported cases of negative consequences of hyper-cobalaminia, nor of B12 overdose while supplementing with methylcobalamin, the right choice for supplementation. (See 1 and 2—a compilation of B12-related literature.)
What should we do about it?
Even though there is ample evidence and data of various studies showing how widespread B12 deficiency actually is, it would be good to have our own data, and therefore, our own grounds for further action and recommendations. For this we should just add the B12 and Hcy tests for every staff member (and encourage contractors to do the same), and compile and analyse these data. The data will be collected anonymously by the medical service. It will include—in addition to B12, Hcy, Total Blood Count and iron (which are standard)—age, gender, weight, height and waist circumference (to calculate BMI and ABSI).
The analysis, following the prescription of the biostatistician Royall (1997), and inspired by its application in an astrophysical context by Belanger (2013), can be carried out regularly, whenever additional data is available, until it becomes conclusive enough to stop gathering data.
At that point we would know beyond any doubt if it is the case that the workforce is generally (> 50%) B12 deficient (< 450 pg/ml), what actual fraction it is, and some other useful information that can be extracted from the data. We would then be able to formulate conclusions and, depending on the results, also recommendations for other establishments, and all of this, with the very simple but noble motivation of promoting health among our colleagues, friends and family members, not just now, but for the rest of their life.
(This is the transcript of a short presentation I gave on Friday November 22, 2013. The information is from my article B12: your life depends on it. If you enjoyed reading this article, please click “Like” and share it on your social networks. This is the only way I can know you appreciated it.)