While most of my patients are aware of the importance of various B-vitamins for immune health – few are aware of how essential the complex of B vitamins are for cellular, nerve, cognitive, mood, immune health and resiliency!

Amid the global pandemic and subsequent social challenges there has been a significant uptick of Americans struggling with mental health. An estimated 1/3 of Americans are struggling with depression, which is a 50% increase from prior to the pandemic. The complex of B vitamins are essential for good health, including for our behavioral health, particularly vitamin B12. Vitamin B12 deficiency is a direct cause of psychological challenges, including depression and anxiety. Approximately 6% of Americans ≥ 60 years old are vitamin B12 deficient (plasma vitamin B12 < 148 pmol/ L) with close to 20% having borderline deficiencies.

Vitamin B12 Deficiency

Vitamin B12 deficiency is quite common among my patients. Many report having struggled with symptoms, like fatigue, for years with levels never having been checked previously or report having been told that their borderline low levels are unremarkable. In my experience, I have seen that it is not uncommon for patients to exhibit signs of deficiency with levels below 400 pmol/L. Common symptoms of vitamin B12 deficiency include:

• Fatigue
• Weakness
• Memory loss or forgetfulness
• Dizziness or lightheadedness
• Ringing in the ears
• Tingling in hands or feet
• Poor coordination
• Nausea
• Diarrhea
• Red and glazed appearing tongue

While it is fairly common knowledge that without adequate supplementation, vegetarian and vegan diets can lead to vitamin B12 deficiencies, a diet low in vitamin B12 isn’t the only cause of deficiency. The prevalence of deficiency increases with age, often due to the ‘tea and toast’ diets of many seniors, but also due to the fact that the acidity levels in our stomach decline with age; adequate stomach acidity is required for absorption of many B vitamins, including B12 and folate. There are many factors that influence need for B vitamins, and our genes also impact how some of us absorb our vitamin B12.

Genetic Variants

It is said that variety is the spice of life and the same holds true for our genes. There are a multitude of different genes that control processes in our bodies that are dependent on various B vitamins (and other vitamin/ nutrient cofactors) to function. The differences or variants between people can mean low, normal, or even high B vitamin levels for different patients. Medicine is ever evolving and changing, and one of the things I love about my vocation of naturopathic medicine, is that naturopathic doctors are called to stay current and adapt our practice upon new information. One such gene that affects B12 status is FUT2. There are plenty of interesting details surrounding the effect of FUT2 gene – however – the essence of whether one is a secretor of type 1-H antigens in the gut or not both affects the diversity of the gut microbiome and one’s ability to absorb vitamin B12. With non-secretors a lower risk for vitamin B12 deficiency, as well as less risk for symptomatic norovirus infection and less diversity of the gut microbiotia, while secretors have a great risk for vitamin B12 deficiency, increased risk for norovirus, but also a healthier gut micobiome. Our gut bacteria are significantly impacted by FUT2 secretor status. A multitude of other genes, the methylation genes for example, influence enzyme processes that that require various B-vitamins as cofactors to function. Several of my patients are already familiar with the MTHFR gene, however, MTHFR represent just two of over a hundred genes that influence hundreds of B-vitamin dependent enzyme processes. Considering MTHFR only, is shortsighted. Additionally, there four forms of vitamin B12 (methylcobalamine, adenosylcobalamin, hydroxycobalmin, and cyanocoblamin) and genetics impact which of each form an individual might benefit from. The whole picture must always be considered.

The Strange, Rare, and Peculiar

I often am referred patients who have not been able to get help elsewhere. Because of this I have seen patients who have with strange, rare and peculiar signs and symptoms where the root cause was related to vitamin B12 – including pernicious anemia and vitamin B12 binding deficiency. Pernicious anemia is a rare autoimmune condition that leads to malabsorption of vitamin B12 and vitamin B12 binding deficiency is a genetic condition that makes utilization of vitamin B12 extremely challenging for patients. One thing that I think is important to point out, is that in each of these conditions serum B12 levels DO NOT correspond with functional needs. Unfortunately, this is not well understood by some health care providers, which can delay appropriate care for patients who are most in need of vitamin B12. Because this is so essential to understand, I am reiterating, adequate serum vitamin B12 levels DOES NOT always reflect functional need. In other words, just because your serum levels are ‘normal’ does not mean you are not functionally deficiency or needing additional support from vitamin B12. Outside of the box healthcare is vital in these cases. Aside from serum vitamin B12 testing, intracellular tests of micronutrient levels inside of the white or red blood cells can be helpful in exploring patterns of deficiency that can point towards possible underlying causes. Vitamins deficiencies often occur synonymously, so considering a pattern of deficiencies can be quite helpful.

Part 2

Stay tuned for Part 2 of this article will discuss how other B vitamins (vitamins B1, B2, B3, B6, and B9) are essential for our immune health and resiliency. Also, I will discuss how too much of a good thing – including certain B vitamins can be problematic for some people. Because of the wide variety of factors that influence individual need for B-vitamins – including specific forms of the vitamins, I highly recommend working with a provider who is specifically trained in nutrition, including nutritional supplementation. While it may seem harmless to take an over-the-counter, generic vitamin supplement, nothing beats sage advice from a skilled provider. Naturopathic doctors are the only healthcare providers specifically trained in drug-herb and drug-nutrient interactions.

Sarah Giardenelli is a naturopathic doctor and acupuncturist with over 10 years of experience. She appreciates working with patients who have what appear to be complex health issues and exploring underlying root causes with them. She is a believer in holistic and outside of the box thinking and brings this passion to every patient in her practice at Collective Health Center.