Full Transcript Introduction to Vitamin B12 0:00 Hey everybody, welcome back. 0:01 I'm Dr. 0:01 Mark Stengler, and if you've been following this channel for a while, you know I am always trying to bridge the gap between conventional medicine and what 0:08 the research actually shows. 0:10 Today we're going to do a deep dive on one of the most important and most misunderstood nutrients in the human body, vitamin B12. 0:18 So whether you're vegan or the age of 50, dealing with fatigue, or just curious about your labs, this video is for you. 0:25 We're gonna cover what B-12 actually does, what's the best human research tells us, which forms work and which ones don't and exactly how to take it. 0:34 Let's get into it! 0:35 Welcome to Health Breakthroughs with Dr. 0:36 Stengler. 0:37 I'm Dr Mark Stegler and each episode we cut through the noise to bring you practical, science-backed insights for more energy, 0:45 better health and a life that feels like yours again. 0:51 Vitamin B12, also called cobalamin, is a water soluble vitamin that your body cannot make on its own. 0:57 You have to get it from food or supplementation. 1:01 It's structurally the most complex of all the vitamins and it contains cobalt, which is actually where the name cobulmin comes from. 1:08 Now here's something most people don't know. 1:10 B12 in food is bound to protein. 1:13 When you eat it, stomach acid and a digestive enzyme called pepsin have to free it first.
How B12 Is Absorbed and Why Deficiency Happens 1:18 Then it binds to something called intrinsic factor, a protein made in the stomach, and that complex gets absorbed into the final part of your small intestine, 1:29 This is why B12 deficiency isn't always about diet, it's often about absorption, and several things interfere with that process. 1:37 For example, metformin, one of the most commonly prescribed diabetes drugs, blocks B-12 absorption. 1:44 Studies show up to 30% of long-term users become deficient in B 12. Then you have the common proton pump inhibitors like omeprazole taken by tens of millions 1:54 of people which reduces stomach acid and impairs B12 release from food. 1:59 Then there's the H pylori or helicobacter pilari infection of the stomach which can affect B12 absorption or conditions like Crohn's disease, 2:07 which naturally causes absorption problems. 2:10 But here's the scary part. 2:11 B-12 is stored in the liver and it can take years for a deficiency to show up in symptoms or blood work. 2:17 So by the time you fill it, the deficit could be quite significant. 2:21 B12 is involved in some of the most fundamental processes in human biology. 2:26 You have first, DNA synthesis. 2:28 B 12 is essential for making new cells. 2:31 Every single time your body divides a cell, which is happening billions of times a day, second, B-12's involved myelin production. 2:38 This one is huge. 2:39 Myelin is the protective sheath around your nerve fibers. 2:42 Think of it like the insulation around an electrical wire. 2:45 B12 deficiency leads to demyelination, which causes the neurological symptoms we see, like tingling of the hands and feet, 2:53 balance problems, cognitive decline, and in severe cases, something called subacute combined degeneration of spinal cord. 3:01 Third, the methylation cycle. 3:03 B12 works alongside folate and B6 in the methylation pathway.
What B12 Does in the Body 3:08 This is how your body controls gene expression, produces neurotransmitters like serotonin and dopamine, processes homocysteine, 3:16 and is involved in detoxification. 3:18 Elevated homocistine is a well-established independent risk factor for cardiovascular conditions, such as stroke. 3:25 It's also a risk-factor for dementia. 3:27 Number four, energy metabolism. 3:29 B12 is a cofactor in what's called the Krebs cycle, and this is your cellular energy engine. 3:35 When B 12 is low, this pathway backs up and you actually get elevated methylmalonic acid, one of the most sensitive markers of functional B-12 deficiency. 3:46 The bottom line is that fatigue, brain fog, depression, peripheral neuropathy, anemia, elevated homocysteine are all on the table when B12 is low. 3:55 So let's go over what the human research shows. 3:57 Let's over some of the highlights from clinical research because this is where things get really interesting. 4:03 Let's talk about cognition and dementia. 4:06 A landmark study published in neurology followed elderly individuals and found that those with low B12 status had significantly more brain volume loss 4:15 over time. 4:16 Separately, the Vitacog trial out of Oxford showed that high-dose B vitamins, including B-12, slowed brain atrophy in people with mild cognitive impairment 4:27 by up to 53% compared to placebo. 4:29 This is a remarkable finding. 4:32 You've done everything you were told to do and something still feels off. 4:36 Health Breakthroughs with Dr. 4:37 Stengler, we go beyond symptom management to explore integrative, science-backed approaches to the issues that medicine too often overlooks. 4:45 Chronic fatigue, brain fog, gut dysfunction, inflammation, hormone imbalance, and healthy aging. 4:50 If you're ready for real answers and practical tools to support your health naturally, follow Health breakthroughs of Dr Stegler on Doctor Talks or wherever 4:59 you listen to podcasts.
Research on B12 Benefits 5:01 Then there's also cardiovascular risk. 5:03 Multiple studies confirm that B12 supplementation lowers homocysteine. 5:08 Whether that directly translates to reduce cardiac events is still debated. 5:12 The HOPE-2 trial showed homocysine reduction but did not show that it moved the needle on hard outcomes. 5:19 Most researchers believe the intervention may need to happen earlier before vascular damage is established. 5:25 Nevertheless, reducing homocysteines levels is important. 5:28 Then there's depression, a 2020 meta-analysis in the journal Nutrients found in an association between low B12 and depression. 5:36 And some intervention studies show B-12 supplementation improves the response to antidepressants, especially in older adults. 5:43 The mechanism likely involves neurotransmitter synthesis through the methylation pathway. 5:49 Then we have Neuropathy. 5:50 Studies in diabetic patients show that correcting B12 deficiency, especially in metformin users, improves nerve conduction velocity and reduces neuropathic symptoms. 6:01 Pregnancy. 6:01 B-12 is critical in the first trimester alongside folate. 6:05 Low maternal B12 is associated with neural tube defects, preterm birth, and low birth weight. 6:12 The research here is strong and consistent. 6:14 So what are the best forms of B-12? 6:17 This is where I really want you to pay attention because not all B 12 is created equal. 6:21 There are four main forms of B12. 6:23 First there's cyanocobalamin. 6:25 This is the cheap synthetic form you'll find in most commercial supplements and fortified foods. 6:31 It contains a small cyanide molecule that your body has to detach and excrete. 6:36 In healthy people this isn't dangerous but requires conversion steps. 6:40 And people with certain genetic variants, particularly the MTHFR and some other genes, may not convert it efficiently. 6:47 I don't recommend this form really for anybody. 6:50 Methylcobalamin, this is the active, neurologically active form of B12 found in human tissue. 6:57 It's used directly in the methylation cycle and in myelin synthesis.
Best Forms of B12 7:01 This is my first line recommendation for most patients, especially those with neurological symptoms, cognitive concerns, 7:08 or known MTHFR variants. 7:11 Then there's another form called adenosyl cobalamin. 7:14 The other active form, primarily used in the mitochondria for energy metabolism, it works synergistically with methylcobalamin. 7:22 Some high-quality supplements contain both of these types of B12. 7:26 Then there's hydroxylcobilamin, a natural form found in food that converts to both active forms. 7:32 It has a longer half-life in a body and can be a great form to use in injectable B-12, especially in cases of severe deficiency or pernicious anemia. 7:41 So my clinical recommendation for most people is that methylcobalamin is the best starting point, especially if you have severe deficiency or malabsorption. 7:49 If you're sensitive to methyl cobalamin, which a small percent of people are, then you could use some of the other forms that I described earlier. 7:57 How to use B12. 7:58 Let's talk about delivery, because this matters as much as which form you choose. 8:03 Our supplementation works for the majority of people, but only at high enough doses. 8:07 At low doses, B-12 absorption depends entirely on intrinsic factor. 8:12 But at very high doses, around a thousand micrograms and above, about 1% gets absorbed through passive diffusion, bypassing intrinsic factor entirely. 8:21 This is why many supplements are dosed in the hundreds to thousands of micro grams, even though daily needs are only about 2.4 micro-gram. 8:29 It seems counter-intuitive, but it's by design. 8:33 Then we have sublingual, which is absorption under the tongue.
How to Take B12 and Typical Dosing 8:36 Tablets or liquids dissolved under tongue may offer better absorption than swallowing in a capsule, as some B12 can be absorbed through the oral mucosa. 8:45 The evidence here is modest but the logic is sound. 8:49 and I often recommend this option for people with absorption problems. 8:52 There's also nasal sprays, usually available by prescription, and that's another route to get around the gut, but they're less commonly used and tend to 9:00 be more expensive. 9:02 Then you have intramuscular injection, which is the gold standard. 9:05 The gold is standard for the people who have pernicious anemia, severe malabsorption, neurological deficiency, or when we need rapid repletion. 9:13 Hydroxyl cobalamin is a good form, so is methyl covalamin for injection form. 9:18 In my practice, I've seen patients with long standing neurological symptoms turn around with a course of intramuscular or subcutaneous B12 injections, 9:28 especially those who do not respond to oral supplementation. 9:32 Hey everybody, I want to take just a quick moment and invite you to my website, drstengler.com. 9:37 Here we have the supplements that we've been using with our patients for many, many years. 9:42 High quality and high potency supplements, very pure. 9:45 So, if you're looking for high quality supplements where you can notice a difference, both in how you feel and on your lab tests, 9:51 go to our website at dr.stegler dot com. 9:54 But for a typical dosing protocol for healthy adults as a maintenance dosage, usually it's 500 to 1000 micrograms of methylcobalamin daily orally or sublingually. 10:05 If you have a known deficiency, we like to up that 1000 to 5000 micro grams daily for one to three months and then reassess. 10:13 You have severe deficiency or pernicious anemia, then use the injectable form. 10:17 Usually do that weekly for few months, and once monthly after that. 10:22 You can ask your doctor for both serum B12 and methylmalonic acid as tests. 10:27 Serum B-12 can look normal while functional deficiency exists, and that's why the methyl malonic can be a great functional marker. 10:35 So here's the takeaway. 10:36 B12 deficiency is far more common than most conventional doctors are checking for. 10:41 It can silently affect your brain, nerves, energy and cardiovascular system for years. 10:47 And most people can correct it safely and effectively with the right form, right dose and right delivery method.
Key Takeaways and Testing Advice 10:52 If you're on metformin or a PPI medication for blocking stomach acid, or if you are vegetarian or vegan, Or if your over the age of 50, if we have any 11:01 of these symptoms we talked about, get your levels checked. 11:05 Ask for the methylmalonic acid not just CRB12. 11:09 If You found this helpful please give it a like and share it with someone who might need it. 11:13 Drop your questions in the comments, I'll read them and try to respond. 11:17 And subscribe if you're not already, because we go deep on evidence-based integrative medicine every week. 11:22 I will see you in next one. 11:24 Take care of yourself. 11:26 Thanks for listening to Health Breakthroughs with Dr. 11:28 Stengler. 11:29 If today's episode resonated with you, please follow the show, share it with someone who needs it, and leave a review. 11:36 It helps more people find us. 11:37 For more resources and wellness support, visit DrStenglar.com.
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