In children B12 affects normal growth and the central nervous system development (brain) and bone marrow maintenance, and formation.

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1 Increased Flow Chelsey Fiteni 31 Bandiera St, Birkdale, QLD increasedflow.com.au VITAMIN B12 Vitamin B12, also called cobalamin, is one of the 8 B vitamins. Vitamin B12 has the largest and most complex chemical structure of all the vitamins. Vitamin B12 is essential for the development and maintenance of a healthy brain and nervous system. It is essential for the preservation of the myelin sheath around nerves, and for the synthesis of brain neurotransmitters. B12 regulates your sleep wake cycle and improves sleep quality (circadian rhythms), thereby improving concentration and alertness. Nervous system conditions such as depression and Multiple Sclerosis have been linked to diminished vitamin B 12 status, as B12 crosses the blood brain barrier and protect neurons. B12 is fundamental to the formation of healthy red blood cell production; and like all B vitamins Vitamin B12 is required for the manufacture of the nucleic acids that make up genes, the body's genetic material. B12 is important for the body to regulate factors that influence cardio-vascular/heart health, such as Homocysteine levels in your body. It does this by influencing methylation reactions that occur in every cell and tissue, and is needed for detoxification (Glutathione production). B12 can assist the folate cycle where there are changes to the MTHFR gene. Your practitioner may discuss this if it is relevant to you. In children B12 affects normal growth and the central nervous system development (brain) and bone marrow maintenance, and formation. All B Vitamins, including B12 are water soluble, meaning the body does not store them, and you need to consume them daily. However the body has the potential to store Vitamin B12 in the liver for many years. B12, B9 and B6 work together Vitamin B12 and vitamin B9 (folate or folic acid) work closely together to help make red blood cells and to help iron work better in the body. Folate and B12 work together to detoxify the body and to produce a compound called SAMe, which is involved in immune function and mood. Vitamins B12, B6, and folates work together to control blood levels of the amino acid homocysteine. High levels of homocysteine may be associated with an increased risk of cardiovascular disease. High homocysteine may also be an indicator that someone already has heart disease. B12 Deficiency A deficiency of B12 is often missed and low levels of B12 at any age can cause a range of symptoms including: Fatigue, weakness Pale complexion Shortness of breath, labored breathing Anemia Diarrhea Nervousness, irritability, temper outbursts, paranoia Numbness- symmetrical numbness hands and feet Tingling sensation in the fingers and toes, burning feet Mood changes/swings & nervous system conditions such as depression Cognitive changes such as memory loss or dementia Visual disturbances Disturbed sugar metabolism Tongue-inflamed, pale, sore, smooth, ulcers Members of the population who are at risk of B12 deficiency include:

2 Vegans and vegetarians who do not eat dairy or eggs, since vitamin B12 is found only in animal products Those with nutrient absorption issues due to Crohn disease, Pancreatic disease, Ulcerative colitis, Coeliac disease, laxative abuse, weight loss surgery The elderly - It is not uncommon for older people to be mildly deficient in B12. This may be because their diets are not as nutritious, or because they have less stomach acid, which the body needs to absorb B12. People with diabetes, especially those taking Metformin medication People who are infected with Helicobacter pylori. H. pylori damages stomach cells that make intrinsic factor, a substance the body needs to absorb B12 People taking antacid medications called PPIs(proton pump inhibitors)-see further for more information Patients with an eating disorder People with HIV People with bacterial overgrowth in the gut People with hyperthyroidism, thyrotoxicosis People with Multiple Sclerosis Pregnant and lactating women It is important to note, Folic acid (vitamin B9), especially when taken in high doses, can mask the symptoms of a vitamin B12 deficiency. The danger is that without symptoms, someone with a vitamin B12 deficiency may not know it and could run the risk of developing nerve damage. You should talk to your health practitioner if you plan to take more than 800 mcg of Folic acid (per day), to make sure you do not have a B12 deficiency. NOTE: Folic acid food fortification interferes with accurate B12 deficiency diagnosis, and diagnosis if often missed. Drug induced B12 deficiency Vitamin B12 can be decreased in the body by: Oral contraceptives/ Pill Antivirals (Nucleoside Reverse Transcriptase Inhibitors)-e.g. Tamiflu Antibiotics -can reduce the gut synthesis of B12 Anti-Diabetic-Biguanides e.g. Metformin Proton pump inhibitors-for reflux, stomach ulcers H2 Receptor antagonists- for reflux, stomach ulcers Bile Acid sequestrants- some lipid lowering medications (not statins) Anti-seizure medications Methotrexate and Chemotherapy Medications (Osiecki, 2016, p51). Patients are given additional folate to reduce the toxic effects of methotrexate, however this can mask and even exacerbate the effects of B12 deficiency. Your healthcare practitioner can look up the drug medications and see if the drug you are on does affect your B12 levels. B12: Beneficial Effects and Therapeutic Uses Alzheimers Disease (AD) There is a direct relationship between vitamin B 12 status and the severity of cognitive impairment in AD. Vitamin B12 has been shown to improve day time vigilance of patients with AD. If elevated homocysteine levels, B vitamins, including B12 have shown to be of benefit when accompanied by omega-3 supplementation. Pernicious anaemia Pernicious anemia is a type of anemia that happens when stomach cells are not able to make intrinsic factor. Without intrinsic factor, your body cannot absorb vitamin B12. Symptoms as listed above. Pernicious anemia can be a dangerous condition and should always be treated by a practitioner. Vitamin B12 supplements in high doses, either given as injections or orally, can be prescribed to treat pernicious anemia. The diagnosis of pernicious anaemia can be confirmed by testing for intrinsic factor antibodies, parietal cell antibodies and fasting gastrin. Heart disease Many studies suggest that people with high levels of the amino acid homocysteine are almost two times more likely to develop coronary artery disease and 2.5 times more likely to have a stroke than those with normal levels. B9, B6, and B12, help lower homocysteine levels. However, researchers do not know whether high homocysteine levels actually cause heart disease. Patients who are

3 concerned about heart disease should try to get enough B vitamins from healthy foods. However, in some cases practitioners will also prescribe B vitamins to lower homocysteine levels. Age-related macular degeneration (AMD) One large study found that women who took 1,000 mcg of vitamin B12, along with 2500 mcg of folic acid and 500 mg of vitamin B6 daily, reduced the risk of developing AMD, an eye disease that can cause loss of vision. Diabetic Neuropathy 500mg of B12, 3 times daily for 4 months reduced burning sensations, numbness, muscle cramps and pain sensitivity. Nerve Degeneration B12 deficiency gives rise to nerve and spinal cord degeneration. Breast cancer The preservation of DNA integrity is dependent on folate and vitamin B12 availability. Population studies have shown that women who get more folate in their diet have lower risk of breast cancer. Another preliminary study suggested that postmenopausal women who had the lowest amounts of B12 in their diet had an increased risk for breast cancer. Shingles B12 assists nerve recovery post shingle infection. Bells Palsy B12 assists recovery of nerve function in Bells Palsy. Osteoporosis B12 is key for bone marrow maintenance and formation and is therefore key for healthy, strong bones. Testing Blood B12 levels: A simple blood test can tell you what your serum level of B12 is. Ideally it should be mcg/L. However, these are not the best measures to determine a deficiency. Methylmalonic acid (MMA): is a protein breakdown product of B12 and is a more sensitive and accurate measure of B12 activity. If the level is high there is a deficiency of Vitamin B12. It can also be measured in a spot urine test. Homocysteine: High homocysteine readings on a blood test can also indicate the need for more vitamin B12. It is also a good idea to test blood folate levels in conjunction with a B12 blood test as an excess of folate (B9) can mask a B12 deficiency. If there is a blood result of high Homocysteine and high MMA, it may indicate Folate deficiency too. Available Forms Vitamin B12 can be found in supplemental forms, including B complex vitamins, individual supplements. Vitamin B12 is available in oral tablets or capsule, sublingual lozenges and buccal (inside cheek) sprays which don t require stomach absorption ( the network of blood vessels under your tongue directly absorbs what is placed there).oral absorption is preferable, as it avoids the need for intestinal absorption. Cyanocobalamin Sublingual Synthetic form of B12 is of low biological activity. It needs to be converted in the liver to the more active form. Methylcobalamin Methylcobalamin (Co-Methylcobalamin). This form is the most biologically active form of B12, and

4 is absorbed very efficiently. It is the main form of B12 found in your blood. It does not need to be converted to be active, unlike other forms. This form is recommended in people who are heterozygous or homozygous for the C677T MTHFR gene mutation. Hydroxycobalamin Hydroxycobalamin is easily converted to active B12 forms, does not depend on intestinal absorption. Why Hydroxy over Methyl? Hydroxocobalamin is relatively stable compared to Methyl cobalamin (which readily oxidises back to Hydroxocobalamin (after losing its methyl group in the mouth).whenever there is either little effect, poor resolution of B12 deficiency, or even a worsening of symptoms after taking methyl cobalamin, Hydroxocobalamin can be a better tolerated form of vitamin B12 in many individuals. It provides a stable and naturally-occurring form of vitamin B12. It is readily absorbed, even when digestion is compromised. It converts to methyl B12 in the body, without introducing external methyl groups. It supports the methylation cycle without over-stimulation, and supports health homocysteine levels and cardiovascular function. B12 Injections/subcutaneous Cyanocobalamin-comes as a solution (liquid) to be injected into a muscle or just under the skin. It is usually injected by a medical healthcare provider. These injections will supply you with enough B12 only as long as you received the injections regularly. You may receive Cyanocobalamin injections monthly for the rest of your life, keep all appointments to receive injections even if you feel well. Discuss any questions with your Medical health professional. Other forms new to the market include liposomal B12 and nano technology forms, which also have superior absorption. Practitioner Notes: (none) NOTE: It should be recognised that many, but not all the symptoms of B12 deficiency listed above, such as depression and memory, tend to improve with B12 injections. The treatment outcome usually depends on how long the patient has been ill, age, and other aspects of health. Food Sources of B12 Meat, particularly organ meats such as liver and kidney (liverwurst) ranges from approx mcg per serving size Egg yolk, milk, swisse cheese and other dairy products ranges from approx mcg per serving size Seafood such as salmon, oysters, herring, sardines and clams ranges from approx mcg per serving size Recommended Daily Intake-B12 Infants 0-6mths 0.4ug/day 7-12 mths 0.5ug/day Children and Adolescents 1-8yrs 0.9ug/day Boys/Girls 9-13yrs 1.8ug/day 14-18yrs 2.4ug/day Adults-all ages Men 2.4ug/day Women 2.4ug/day Pregnancy (all ages) and lactation B12 is critical in the first 2 years of life, and so pregnant women and young babies need to be

5 routinely screened. RDI 2.8ug/day [Nutrient Reference Values for Australia and New Zealand (NHMRC 2006)] B12 Overdose and Toxicity A B12 overdose is very unlikely as it is a water soluble vitamin and any excess is generally excreted from your body in urine. In rare cases excessive supplementation may result in tingling or numbness of the arms, hands and face. There have also been rare, reported cases of polycythemia, where there is an abnormally increased concentration of haemoglobin in the blood, generally due to an increase in red cell numbers Practitioner Notes (none) REFERENCES Cobalamin 2016, viewed 14th Sept 2016, University of Maryland Medical Center, Institute of Medicine-National Academy Press, 1999, Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline, viewed 19th September 2016 Nutrient Reference Values for Australia and New Zealand-Vitamin B12, Australian Govt, National Health and Medical Research Council, 2006 Oregan State University-Linus Pauling Institute 2016, Vitamin B12, viewed 13th September 2016, Osiecki H, The Nutrient Bible-9th Edition, Bioconcepts Publishing, Eagle Farm, QLD, 2016 Three of the B Vitamins: Folate, Vitamin B6, and Vitamin B12, 2016, Harvard TC Chan, School of Public Health, viewed 13 September, 2016, Upfal, J, 2016, Australian Drug Guide-9th Edition, Black Inc, Carlton, Australia United States Department of Agriculture: National Agricultural Library website. Cobalamin (Vitamin B12). Viewed 12 October Australian Government: National Health and Medical Research Council website. Nutrient Reference Values for Australian and New Zealand. Viewed 12 October Medline Plus, Cyanocobalamin Injection, viewed on 14th October Jernerén F, et.al. Brain atrophy in cognitively impaired elderly: The importance of long-chain ω-3 fatty acids and B vitamin status in a randomised controlled trial. Am J Clin Nutr July; 102(1): Douaud G, et.al. Preventing Alzheimer s disease related grey matter atrophy by B vitamin treatment. Proceedings of the National Academy of Sciences of the United States of America. 2013;110(23): Content on this handout is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your registered health professional. Content has been prepared for Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All readers are urged to always seek advice from a registered health care professional for diagnosis and answers to their health questions. Natural Business Tools 2016