It leads to mood disorders and cognitive impairment
Friday – 25 Shaaban 1444 AH – 17 March 2023 AD Issue Number [16180]
Riyadh: Dr. Abeer Mubarak
A study by researchers from San Cecilio University Hospital and Virgen de las Nieves University Hospital, Granada, Spain, raised the issue of the importance of vitamin B12, the causes of its deficiency in the body, and ways to treat it.
“B12”
The study was published in the last February issue of the Spanish medical journal Revista Clínica Española, titled “Vitamin (B12) is more than just a cure for anemia.” And the Spanish researchers reported in their scientific review, saying: “In recent years, many studies have found a significant association between low levels of vitamin B12 (Cobalamin) in the blood and mood disorders, depression, and cognitive impairment in both the elderly and the young. Cobalamin deficiency is known to cause brain damage, with the removal of the myelin sheath from neurons and decreased neurotransmitter synthesis in the central nervous system.”
Vitamins, by medical definition, are chemical compounds that are necessary to complete a number of tasks in the body, but the body cannot manufacture them. There is no “natural” way for a person to obtain vitamins, except through food.
Vitamin B12, or cobalamin, belongs to a group of water-soluble vitamins. Remarkably, according to what the Spanish researchers said: “In nature, vitamin B12 is synthesized exclusively by bacteria. Because our gut microbiota (in the colon) are not sufficient to produce the amounts of vitamin B12 necessary to meet the daily needs of the body, this vitamin is obtained through eating animal-derived foods, such as eggs, milk, dairy products, red meat, and poultry. And liver (mainly beef liver), fish and seafood.
Clinical nutrition sources indicate that the recommended daily intake of vitamin B12 is 2.4 micrograms/day for adults, and 2.8 micrograms/day during pregnancy and breastfeeding. This vitamin plays an essential role in the formation of the myelin sheath covering of nerve cells (which facilitates very rapid communication between nerve cells), in the completion of the maturation of red blood cells, and in the synthesis of DNA.
The two main reasons for the decrease in vitamin B12 in the body are the lack of daily food intake and the low absorption in the intestine. There are many reasons for that. The digestive system dealing with the types of foods containing vitamin B12 passes through 3 stages, which are:
The first stage, which takes place in the stomach to release and release vitamin B12 from those foods.
The second stage, which also takes place in the stomach, to protect vitamin B12 until it reaches its absorption area at the end of the small intestine.
– The third stage, the stage of the actual absorption process in the last parts of the small intestine.
absorption process
The Spanish researchers explained in their scientific review that “in order for vitamin (B12) to be absorbed during digestion, there must be (in the stomach) sufficient amounts of hydrochloric acid and the protein Pepsin, in order for the proteins in food to be broken down and fragmented, and thus obtain The release and liberation of vitamin B12. And they added that this process also needs in the stomach a “protein called intrinsic factor IF, which binds to the released vitamin (B12), forming the IF B12 union complex.” This (binding with the intrinsic factor protein) protects the vitamin until it reaches the ileum (the last part of the small intestine).”
When the IF B12 conjugate complex reaches the ileum, this conjugate binds to specific receptors on the surface of cells in that remote region of the small intestine. These receptors are called Cubam receptors. After this link, the cells of the small intestine there begin to absorb vitamin B12 alone through the active transport process, then this vitamin moves from the absorption cells in that remote area of the small intestine, to enter the blood vessels that transport it to the liver. It is known that the liver is the first organ in the body to receive all the nutrients that are absorbed from the intestine, following digesting the foods we eat.
In the liver, dietary vitamin B12 is converted into active compounds, part of which is stored in the liver as a reserve for consumption when necessary, and the rest is distributed to areas of the body that most need it. Especially the nervous system, the places where red blood cells are produced in the body, and the cells of the body.
The researchers explained that the liver reserves of vitamin B12 stores allow delaying the appearance of symptoms and signs of its deficiency in the body for years. That is, when eating foods rich in it is low, or there are any pathological disorders that prevent its complete absorption in the intestines.
They also explained that the remaining amount of vitamin B12, which was not stored and distributed in the body, reaches the tissues of the body to take its daily need from it, and the excess (regarding 50 percent of the daily intake) is excreted with the stool.
abundance factors
From the overall sequence of these complex processes in the method of digestion, the factors necessary for them, the need to protect vitamin B12, the location and mechanism of its absorption, and the method of distribution and storage, it is clear that there are 8 factors that are necessary for the availability of the necessary quantities of this vitamin in the body, namely:
Eating foods of animal origin, so limiting yourself to plant foods requires caution.
These animal foods should be rich in vitamin B12.
– That the stomach produces acids, and any reason for the lack of stomach production of acids may result in a problem in the availability of vitamin B12.
The stomach should have the ability to produce pepsin, which is necessary to complete the process of digesting and breaking down animal proteins.
The stomach should be able to produce the “intrinsic factor” protein. Any reason for the lack of stomach production for this may result in a problem in the availability of vitamin B12.
– That the process of combining vitamin B12 (which was released from foods) with the intrinsic factor protein. Any reason that hinders the occurrence of this union between the two compounds may result in a problem in the availability of vitamin B12.
– That the cells absorbing nutrients in the last part of the small intestine have the ability to receive vitamin B12, and to complete the stages of active transport for the absorption of this vitamin.
This last part should be free from chronic diseases, such as autoimmune infections, tuberculosis infection, and others.
Pharmacological compensation for the treatment of vitamin B12 deficiency.
> When it is proven that there is a case of vitamin B12 deficiency in the body, and to alleviate or remove symptoms and signs of disease resulting from that condition, vitamin B12 is given as a medicine. It can then be received either orally or by injection into a muscle, depending on the cause of the deficiency and the patient’s preference.
Initially, patients with severe cobalamin deficiency are usually treated with intramuscular injections. If the deficiency is less severe, the oral formulation is also useful. Cobalamin injections are given at a rate of one milligram per day for the first week of treatment, then once a week for the following month, then every other month.
If cobalamin deficiency is caused by a strict vegetarian diet, the oral formulation (high dose 1-2 milligrams) is sufficient if the patient refuses to take the injection.
Because of cobalamin sensitivity, a subcutaneous test is necessary prior to any parenteral treatment. Because of the potential for causing anaphylaxis, cobalamin should not be given intravenously.
6 satisfactory causes of vitamin B12 deficiency
> Vitamin B12 deficiency may occur as a result of one of the “pathological” causes, that is, other than low food intake, which requires compensatory treatment, according to what the US Food and Drug Administration (FDA) indicates. They include:
Pernicious anemia: In this case, the cause is the lack or low availability of the “internal factor” due to the formation of autoantibodies, which attack and damage parietal cells in the lining of the stomach. It is known that these cells in the lining of the stomach are tasked with secreting this “internal factor.” The result is decreased absorption of vitamin B12 at the end of the small intestine, the ileum.
– Atrophic Gastritis: As a result of certain autoimmune disorders, groups of stomach lining cells are damaged (not just parietal cells as in cases of pernicious anemia), and thus the stomach secretion of acids, pepsin and intrinsic factor decreases. All are important factors in preparing vitamin B12 for later absorption in the intestine.
Total or partial gastrectomy: This may reduce the level of intrinsic factor and other stomach factors, which are needed to prepare vitamin B12 for later absorption in the intestine.
Overgrowth of small intestine bacteria: types of bacteria are not usually found in the small intestine (other than the large intestine), and an abnormal increase in the total number of bacteria occurs there for pathological reasons (eg surgeries) related to the slow passage of food through them, which creates a suitable environment for the growth of bacteria . This excess bacteria causes vitamin B12 to be consumed instead of absorbed by the intestine.
– Microbial infections in the gastrointestinal tract: either in the intestine (Diphyllobothrium latum) or in the stomach (H. pylori), or tuberculosis in the intestine.
Pancreatic Insufficiency: It is noted clinically that vitamin B12 deficiency occurs in the body in regarding 30 percent of patients with pancreatic insufficiency due to the secretion of its juices.
6 drugs that impede the absorption of vitamin B12
> The types of medications one takes often have side effects and adverse interactions. And there is a group of medications that he took that may be the reason for hindering the absorption of vitamin B12 by the intestine, which may eventually cause its deficiency and the appearance of symptoms and signs of disease. Such as:
Medications to reduce gastric acid production (PPI): Chronic intake of this type of medication, especially the strong-acting ones, such as commonly used proton pump inhibitors (of the types omeprazole or lansoprazole), reduces acid secretion, and thus the “internal factor” cannot bind to the vitamin. B12 »in the foods eaten, and eventually its absorption decreases, despite the patient’s keenness to eat foods rich in it.
– Metformin (used to control blood sugar) in the long term: There are several mechanisms for the effect of this drug on the lack of absorption of vitamin B12, including causing a decrease and slow bowel movement, or an overgrowth of intestinal bacteria that compete with vitamin B 12”, which reduces the chances of its absorption.
– Aminosalicyclic Acid: It is one of the drugs that may be used in a combination of a group of drugs to treat tuberculosis, or to treat Crohn’s disease in the intestine, or for arthritis. It may hinder the body’s ability to absorb vitamin B12.
Colchicine: Taking this anti-inflammatory drug used to prevent and treat gout attacks, or inflammatory conditions in the joints and others, may reduce the body’s ability to absorb vitamin B12.
Vitamin C pills: Taking vitamin C pills or effervescent tablets while taking vitamin B12 pills may reduce its intestinal absorption. To avoid this interaction, vitamin C should be taken two hours or more following taking vitamin B12 supplements.
Anticonvulsants: These are medications that may be used to treat epilepsy or bipolar disorder. It is medically believed that patients who frequently use anticonvulsants have a deficiency in vitamin B12, which requires checking its blood level.
* Consultant in internal medicine
