What Vitamin B12 actually is/does (PODCAST E68)

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[JorenVaes]

Adam, as much as I appreciate the need for you to have sponsors, there are a number of finance/investment youtubers that have gone into Masterworks and pointed out that a lot of their claims are dubious at best and downright wrong at worst.

[everestjarvik]

A couple years ago, I was going through a hard time and not eating well and over the course of a few days, I began to lose feeling in my feet and legs. When I went to the hospital I learned that I was completely out of B12 for a while and starting to experience nerve damage. They gave me injectable B12 but it takes a while to kick in and the symptoms kept getting worse for about a month, spreading to almost my whole body. It took me 8 months to fully recover but I did, thankfully

Please remember to get enough B12 y’all, it’s not even funny what happens if you don’t

[eliseleonard]

Doc here: the banana bag is a life saver for some chronic alcoholics with what is called Wernicke’s encephalopathy. It’s mainly the thiamine that reverses some acute neurological problems like balance problems, hypothermia, and delirium. It has to be given over about 3 days, but the effect is dramatic when thiamine deficiency is the problem. We saw this first hand in our dad, and the episode led to him cutting down to a beer a day which, yes, is bizarre, but it worked for him.

[rdbeef]

Dietitian here. It's important to note that B12 is the ONLY vitamin with no upper limit. Even the other water soluble vitamin have acute toxicities (what happens when you take a megadose all at once vs taking too much over years), and B6 does have chronic toxicity with potential nerve damage.

Also, this is pedantic, but I wanted to point out that acid blockers don't reduce how much B12 is extracted from your food or how well your food is digested, but rather interrupt your body's ability to absorb B12. Your stomach produces Intrinsic Factor which binds to B12 in the acidic environment in the stomach, which helps the B12 become absorbed in the intestines. The acid blocker raise the pH and reduces how well B12 binds to IF. This is also why bariatric surgery patients might be instructed to take B12 shots for the rest of their lives, since their stomach might be reduced/bypassed and therefore the B12 they eat does not bind to IF. (edit for correction)

[malemd]

Internist here. B12 is quite large by molecular standards and requires Intrinsic Factor (IF) a glycoprotein secreted in the upper part of the stomach by gastric parietal cells. Without IF the absorption is minimal by diffusion maybe around 1 to 2 percent because of its large size. The extraction of B12 from its carrier molecules in our diet is facilitated by an optimal amount of acidity, namely a pH level of around 2. This b12-IF complex is then washed down all the way to the last part of the small intestine (normally a length of around 15 feet) called the terminal ileum. Here the b12 is finally absorbed by an ACTIVE process. Hence, when it comes to b12 absorption there's many a slip 'twixt the cup and the lip causing a deficiency state namely:
1. Imbibing a vegan diet extremely low in available b12
2. Taking a medication suppressing acid production like famotidine or omeprazole which RAISES (not lowers) stomach pH
3. Certain autoimmune diseases where the body destroys its own gastric parietal cells or by aging
4. Having part of one's stomach stapled or removed hence removing the source of IF
5. Rarely, having bacterial overgrowth in one's gut from older phased out surgeries leaving behind 'blind loops' where gut bacteria over-proliferate and consume all available b12 before it can be absorbed

Dissolvable sublingual tablet and spray b12 is directly absorbed by diffusion and can prove effective. I use the dissolvable tablets myself. I like to keep my blood b12 level above 500. It's a critically important vitamin for blood cells and neurobiological proper function.

[purplegill]

This is absolutely mindblowing to me. I've had severe dietary issues due to my chronic condition and one medication I'm on, one of the many medications I'm on, is an acid blocker. I'm actually gonna ask my doctor about b12 now because this could be huge in explaining how bad my lethargy has been.

[stellaz]

My grandfather - and his sister - both died of pernicious anemia in the 1920's when they didn't know what caused it. He was 55 years old. His sister was 40! B12 has a purpose!

[Im_Ryan]

The greenhouse set it fantastic. Makes me want to get myself some more plants. Maybe I should try getting some hyrdponics or something so I can grow fresh herbs in my student apartment...

[StinkFinger]

In 1980, I had taken way way too much real windowpane LSD, and for the first time in several hundred LSD trips, I actually began to have REAL hallucinations... instead of the peak building over the course of an hour or two, my 'peak' continued escalating for FOUR DAYS... The visual hallucinations continued, as the upward echelon into LSD overdose meandered forward.

For the first time in my life, I was actually scared of the amount of LSD I had ingested.

I had my brother drive me to St Joseph's Hospital in Atlanta, I told the emergency room physician I had overdosed on LSD...

I thought I was going to be in trouble, because I was just 17 years old...

The doctor was very cool... Very calmly and casually, he told the nurse to give me so many cc's of B12...

THE LSD TRIP LITERALLY VANISHED!!!

I had been awake for days, on an ever-escalating LSD "Peak", but literally within milliseconds of getting the B12 injections, I could feel the LSD trip vanish like a deflating balloon

[ataready]

I think B vitamins are really important, because at a time when I wasn't eating that well, and felt pretty bad, I started eating nutritional yeast and felt like I had a lot more energy. It has vitamin b3, b6, b1, b2, b12, and b9. So I resolved to eating that every day.

[daniele]

I (53m) was diagnosed with acid reflux and lactose intolerance a couple years ago. The meds kind of helped. One day I decided to stop eating after 6pm to lose weight. All my stomach aches stopped. I still get bloated from dairy, but there's no pain anymore. It's worth a try, it's free.

[MoarCowbell]

I had really low B12 last year. Medically, dangerously low. I slept ten to twelve hours a day and was still tired. Didn't have strength and stamina to do workouts at the gym. And caused severe depression...where went from beautiful twelve inches of hair to cutting, buzzing, then shaving it all off. And had feeling of my legs falling asleep often. I'm in a much better place since I got my B12 shots and take B12 vitamins daily now. I'm NOT vegan and have a healthy diet. No fast food, above average protein consumption, some months I don't even drink a single beer. And when I drink, it's like one or two cans at most. I'm glad my doctor tested for B12 when I had my yearly check up.

[drband]

I actually watched to the end. I have been diagnosed with slight anemia (again) and have been on acid blockers for several years. This is good info to discuss with my Dr.
He’s suspicious of the connection I think, and has already ordered a B12 screening blood test.
Thanks for the discussion—helpful.

[wrw]

Adam, I too have had terrible gastritis. It was 100% eliminated by taking a Zinc, Zinc-L-Carnosine complex. I won't mention the brand but the supplement is called PepZincGI. 2 very small capsules on an empty stomach. I also take Bromelain as a digestive aid. I tried taking the bile salt Tudca but it actually caused gastritis, so everybody's different. Maybe you could do a show on Ox bile and other bile salts. As you know, there are problems with those acid blockers and they do not get at the cause of the inflammation of the lining of the stomach that is gastritis. Love the show!

[CreeperKiller]

My mom (who is not vegan, pregnant, etc.) recently found out that she's B-12 deficient and has been for probably about half a decade. It was a real wakeup call to me and my wife (who are vegan!) to start supplementing before we deplete our liver stores!

[thecomputersurgeon]

Interesting podcast. I think you would enjoy looking into "refeeding syndrome" perhaps as part of a larger topic.

That's another indication for the banana bag you mentioned. We use a similar (also yellow) IV preparation of B vitamins and glucose called Pabrinex over here. It's very useful because people withdrawing from alcohol may not have eaten for days/are vomiting, making the IV route convenient. Once they're eating again they can have oral thiamine and "vitamin B co strong". The thiamine content in pabrinex is high which can help in those at risk of Wernicke/Korsakoff (alcoholic brain damage due to thiamine deficiency)

We don't get a lot of nutrition teaching in med school which is frankly trash. We all know how important it is but no one cares. There's no money in promoting healthy eating and exercise. And nutritional research is very hard to prove causations.

Another great listen. Thanks Adam!

[shesh]

My Doctor told me to stop taking B12 preparations because i was in the upper range in my blood test, but offered no reason why and now I regret not asking if it really was an issue

[vincentharrison]

Watching this on Youtube, I would have LOVED to have seen the chemical compound images overlayed as you were naming them.

[StartCodonUST]

What a fantastic topic for a podcast! I feel like I could listen to an entire series on all the different vitamins. I was a chemistry major and spent a lot of time in the biochemical side, so a lot of this is perfectly intelligible information but which is still remarkably unfamiliar to me. Also, what a startlingly comprehensive explanation for why a healthy diet is so important for lifelong health!

[eatonr]

You are a complete goof for detail, connections and the amazing things that just seemed to happen. You did a great video thank you so much.