Clinical Pearl Wednesday #155

Foods containing vitamin B 12

Many patients take B12 supplements, but it’s estimated that about half of the population are unable to use cyanocobalamin, the most common form of b12 on the market today.  MTHFR variants are estimated to impact 40-50% of the population, making cyanocobalamin ineffective, since these patients cannot break apart the cyan molecule from the B12 molecule – this methylation defect is becoming more and more common, and we should be able to help patients understand this, especially the ones who are looking to optimize their health.

Educating patients to use a methylated form of B12 can help patients with improved energy, iron metabolism, and just an overall better sense of wellbeing.  However, keep in mind that B12 is less effective ALONE, and more effective when taken in a COMPLEX, or group of B vitamins. I take a B-Complex every day and I swear it helps keep my energy levels consistent (but be aware: it will make your urine bright yellow/green!).

The majority of people CAN use methylcobalamin, but there is a smaller group of people with COMT genetic variants who cannot even use this type of B12; for these people, hydroxycobalamin is a great choice. 

Two main takeways: 

1.  Recommend methylated B12 over cyanocobalamin and

2.  Recommend a B complex over individual B12.

3.  Recommend taking B vitamins early in the day to avoid sleep impairments.

4.  Stop B vitamins/biotin a week prior to ALL blood tests

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