Hi. This is Dr. Toni Harrison with Incredible Health. I wanted to talk to you today about vitamin B12, Folate, and energy. What do vitamin B12 and folate have to do with feeling fatigued and your energy levels? So vitamin B12 is Cobalamin, and vitamin B9 is folate. Cobalamin can be replaced with methyl-cobalamin, hydroxocobalamin or cyanocobalamin. We don’t use cyanocobalamin here at Incredible Health. I don’t see any reason to give a cyanide molecule to the human body, so I tend to use more methyl-cobalamin than I do hydroxocobalamin. Folate, we tend to use the methyl form also. Some people have that MTHFR SNP, which means that they have a change in their DNA, and they have difficulty methylating those vitamins and making them active, so we just use the methyl form, just go straight to it.
So, why do we tend to have these deficiencies in our population now? Number one, we have difficulty choosing the right foods for us to eat. We’re all busy. We all choose convenience foods at times. Very few of us are getting our seven servings of fruits and vegetables in a day. Even when we are able to choose enough fruits and vegetables in our day, our fruits and vegetables don’t have the same vitamin and mineral content in them that they used to have. So, for a lot of us we’re ending up with having B12 and folate deficiency, along with other vitamin deficiencies.
Other populations also have troubles with B12 and folate deficiencies. Anybody who’s got any issues with malnutrition, anybody with malabsorption issues like IBS, anybody who’s got any kind of gut disturbance going on. Alcoholics have a problem. Our elderly people have a difficult time getting a full meal, for instance. A little old lady will choose a slice of toast for breakfast instead of eating a good solid breakfast. But, even in our elderly population when they do eat a good meal they don’t absorb the nutrients like they did when they were 30 or 40 years old, so elderly people, in particular, have a problem. Strict vegans have a problem and definitely need to get their B12 replaced. Vegans that are breast feeding will certainly want to get B12 replaced because it the B12 deficiency can be aggravated in the breast feeding newborn. Let me see if I left out any populations. The only population I left out is people who have had weight loss surgery. They may need to get some replacement done.
So, how would one figure out whether they have a B12 or folate deficiency? There are some clues on the CBC, the complete blood count. There is a value on a CBC called the MCV, the mean corpuscular volume. What that is that’s kind of the size of your red blood cell. When you have an MCV greater than 100 that is a megaloblastic cell, meaning that red blood cell is too big. B12 and folate deficiency can be one cause of anemia, and if those cells are too big that’s called a megaloblastic anemia. Anemia just means that you don’t have enough red blood cells running around in your blood volume. Megaloblastic anemia, the most common cause is B12 and folate deficiency. It is possible to have a normocytic anemia, which means the red blood cells are the correct size, there’s just not enough of them. A normocytic anemia can the seen in somebody who has B12 and folate deficiency along with iron deficiency, which does happen in people that are malnourished.
It is possible to have a B12 and folate deficiency and have a normal CBC. So, in one study they had people who had confirmed B12 deficiency and 29% of them were anemic, which means that 71% of them were not anemic, and only 36% of them had an MCV greater than 100. So, if your MCV is greater than 80 you should probably get your B12 and your folate replenished. Being anemic is certainly one cause of being fatigued. You just don’t have enough red blood cells to deliver the oxygen to your tissues that is required. Like I said, getting a B12 or folate replacement is easy enough to … Kind of do your own experiment and see if that’s part of your problem.
Another way that B12 and folate contribute to feelings of fatigue is through the nervous system. So, if you have B12 and folate deficiency you can have dementia, weakness, and paresthesia’s. Paresthesia’s are the funny tingling feelings that you feel in your extremities. For instance, when you hit your funny bone you have that weird shooting kind of sensation, that’s a paresthesia. Some people will interpret weakness as lack of energy. B12 and folate deficiency is one cause of a reversible dementia. So, if you have somebody that’s showing signs of dementia, or cognitive decline, it might be worthwhile to get a B12 and folate replacement and see if that helps them out.
Also, on your lab work if you have a physician that has drawn a methylmalonate or homocysteine level that can be a sign of B12 and folate deficiency. So, if you have elevated levels of homocysteine you’re definitely going to want to get your B12 deficiency corrected. Another way that B12 and folate deficiency contributes to fatigue is with the mitochondria. Your mitochondria are an organelle within your cell that’s solely responsible for producing energy. They require B12 and folate, along with other vitamins, to do their job, to make all of those chemical reactions happen that are required in order to produce energy in your cell. If your cells don’t have energy, then your whole body is not going have energy. So, for your mitochondrial health you need B12 and folate [deficiency 00:07:24].
Those are the three ways that B12 and folate contribute to a lack of energy. Your red blood cell production, your nervous system, and your mitochondrial health. Now, how would one go about replacing B12 and folate? Folate can be replaced by mouth. Even if you have problems with malnutrition or malabsorption you would absorb the folate by mouth. Your typical multivitamin may have around 400 mcg of folate in it. If you are folate deficiency we may need to increase that from 1-5 mg per day for a while until we’ve replaced the folate that we need to. Again, that would be by mouth.
You always want to replace B12 and folate together. You would never just replace one of them. I don’t necessarily mean together right at the same moment, but throughout the course of your day, your week you’re going to want to make sure that you’re getting both of them replaced. B12 you can replace either by mouth or by injection. A lot of people really prefer the injection because they know 100% of the B12 is getting into their system. When you take B12 by mouth you don’t necessarily know exactly how much of it is getting into your system, and people can appreciably tell that the B12 is making a difference. So, that would be a quick and easy way to kind of do your own experiment, get a B12 shot and see if it makes a difference, see if it makes you feel any better. We do those shots here at Incredible Health. So, with the shot you would give 1 gm every week for a while until you feel like you’ve been replenished.
With some vitamins you have to worry about toxicity or overdosing, overdoing it. With B12 and folate you don’t have to worry about that, because they’re water-soluble vitamins and if you get too much your kidneys will just filter it out and you’ll get rid of it in your urine, so that’s not a concern with B12 and folate deficiencies.
It is possible to measure the B12 and folate directly. So, if you wanted to test and see if you have a B12 deficiency that’s a serum B12 level that you want to get drawn. Your physician can order that for you. If you want to look at folate and see if you have a folate deficiency, it’s possible to measure a serum folate level, but it really doesn’t give you much information, because for folate that’s a snapshot in time. It will tell you that you were deficient at noon, but it may not tell you that you had a folate deficiency at 7 p.m. that night, because one meal can change your serum folate level, so you need a more long-term snapshot. The way to do that would be to order an RBC folate and that gives you more of a picture of, generally speaking do you tend to have a folate deficiency than just this particular moment in time.
Another thing to consider with folate deficiency is that that can contribute to cancer development. You need folate in order to produce your DNA normally. Folate deficiency contributes to problems with DNA synthesis, so when your cells divide and make a new cell, if they can’t methylate the DNA correctly they have problems creating an exact replica of the DNA, the chromosome, and that can lead to cancer development. Anyway, I think I covered everything that I wanted to go over with you today.
One thing that I left out is that as people tend to be gluten free, we’re trying to be more gluten free, they’re losing a source of folate in their diet. Typically people get the majority of their folate from enriched flour, which would be your breads and your pastas, and if we’re trying to be gluten free, which is a good thing to do, then we tend to lose out on our folate intake also. If you’re somebody that’s trying to be gluten free that’s something to keep in mind. I think I nailed everything else that I wanted to go over with you. Feel free to come by the clinic here at Incredible Health if you want to get a B12 shot, or if you would like for me to order those lab tests for you so that you can see if that’s part of your energy problems.