Vitamin B12- A Most Important Vitamin

Author: S. Bledsoe, M.D.

Pop quiz!  Which vitamin increases energy levels, reduces depression and stress, protects against heart disease and certain cancers, promotes healthy skin and hair, and is essential for a host of body systems including the digestive, circulatory, and nervous systems?  If you said Vitamin B12, you would be correct.  This vitamin is absolutely essential for your well-being, and you are at risk for being deficient in B12 after certain weight loss procedures.


Weight loss procedures such as the roux-en-Y gastric bypass (RYGB), the biliopancreatic diversion (BPD), and the sleeve gastrectomy (SG) can all contribute to low levels of vitamin B12.  In fact, vitamin B12 levels are monitored carefully and supplements are provided for those at high risk for deficiencies.


In the unaltered anatomy, the stomach makes a substance known as Intrinsic Factor (IF).  When Vitamin B12 is ingested, it combines with IF.  This complex of vitamin B12-IF is readily absorbed in the small intestine near where it joins to the colon.  Anything that interrupts any step in this process can result in low levels of vitamin B12.  In patients who have had weight loss surgery, either the IF and vitamin B12 don’t have a chance to combine or the part of the stomach that makes IF is removed.


In larger studies, B12 deficiencies are found in 12-33% of gastric bypass patients.  Since the body has large stores of vitamin B12, it usually takes a year or longer for a deficiency to develop.  In some cases, it has taken up to 9 years for a deficiency to reveal itself.  This is why routine screening in post-operative patients is absolutely critical.


Traditionally, supplementation of vitamin B12 is done by one of three means: an injection, an intranasal spray or an under-the-tongue (sublingual) tablet.  Higher oral doses are also felt to allow for some absorption, but this is felt to be an inefficient means of obtaining B12.  Doses vary based on the route of administration.


While the method of supplementation is a personal choice, many people avoid the discomfort of the injection and the expense of the intranasal sprays.  For many people, the sublingual route is the best choice.  The usual dose for this is 300-500 micrograms per day although higher doses are considered safe.  Be sure to choose a manufacturer that uses high quality products such as the vitamin B12 found at Bariatric Fuel.

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