Bottom Line/HEALTH: One of the most common complaints that we all hear and we all say is how tired we are. Well, is B-12 the answer? Let’s find out.
I’m Sarah Hiner, president of Bottom Line Publications, and this is our Conversation With the Experts, where we get the answers to your tough questions from our leading experts.
Today I’m speaking to Dr. Andrew Rubman, a leading naturopathic physician and the medical director of the Southbury Clinic in Southbury, Connecticut. Dr. Rubman is also a long-time contributing medical editor to Bottom Line. So welcome, Andy. It’s always great to see you.
Dr. Rubman: Hi, Sarah.
Bottom Line: All right, B-12. Is that the magic silver bullet to the utter fatigue? Besides the fact that we all need to sleep more. But is B-12 really one of the magic secrets to being able to fight fatigue?
Dr. Rubman: In many cases, it really is. It is the master vitamin for the liver…it’s the master vitamin for the central nervous system. You can think of it as being the CEO of a small company where it really directs the functions of many, many other things under it.
And it’s responsible for one’s energy, for the amount of hormones and modulatory substances that are created to manage energy, and also the sensitivity of the receptors to those substances. So it does work on the creation side and it does work on the sensitivity side.
Bottom Line: So it’s the conductor of the band.
Dr. Rubman: Absolutely.
Bottom Line: In some ways.
Dr. Rubman: Oh yeah.
Bottom Line: Does it work in isolation, or do you need the family of Bs with it?
Dr. Rubman: It really does. It is conserved to a great degree so that the body can actually store up to about three years’ worth of B-12 in the liver, just to make sure it doesn’t run out. But unlike being conserved the way that B-12 is, B-6, its go-to vitamin, is consumed and needs to be taken probably twice a day. B-6 goes to B-3, B-3 goes to B-1 and B-2, and then the story enlarges out to wrap its friends and relations.
Bottom Line: If I don’t have enough of the other Bs, will B-12 be able to be effective on its own?
Dr. Rubman: Not really, but B-12 will be able to leverage a certain amount of the B vitamin activity present in a good diet. But oftentimes, we introduce complexity by supplementing single B vitamins. It’s been all the rage to take niacin by itself to limit cholesterol. People get into trouble doing that. Giving high doses of thiamine to help people get over hangovers, that can be problematic over time.
Bottom Line: All these people that are getting vitamin B-12 shots, are those effective without taking additional Bs?
Dr. Rubman: Not particularly, and truth be told, most of them don’t need to be taking it in a shot form. But it does drive one into an office visit for the physician.
Bottom Line: How do you know that you need B-12?
Dr. Rubman: There are blood tests that are fairly good at estimating whether one has particularly low B-12. The problem with relying just on those is that the normal range looks at one’s adequacy of vitamin B-12 in protecting from pernicious anemia, not really for optimal function. So if you said to me, “All right, what level should I be looking for for an optimal level for vitamin B-12?” it would be over the top of the reference range, and probably from 1,200 to 1,400.
Bottom Line: How does somebody know if they need to be getting a B-12 shot or taking supplemental Bs? Is it just that they’re tired?
Dr. Rubman: They’re tired, they are vulnerable to colds, they’re vulnerable to viruses, they feel that their mood and temperament is inadequately balanced. They tend to have digestive problems, they tend to hold water weight. Those are some of the big ones, but the list is very long because of its central function in the liver and in the central nervous system.
Bottom Line: If somebody’s having a bunch of neurological issues, what do those look like or feel like?
Dr. Rubman: The classic one is peripheral circulatory issues.
Bottom Line: That tingling?
Dr. Rubman: Tingling in the fingertips. Raynaud’s phenomenon. You go to pick up a frozen rib roast in the market and your fingers start turning colors. Your energy is bad, and the doctor says you have a type of anemia called pernicious anemia. That’s related to B-12 deficiency. But you really have to be low to get that.
Bottom Line: If they’re just having some fingertip issues or things like that, or if they seem to be getting sick quite frequently, you said that—can they just start supplementing Bs, or do they need to go to their doctor for a measure?
Dr. Rubman: They probably can supplement the B vitamins. However, it shouldn’t be an excuse not to go to the doctor if you continue to feel sick, because self-diagnosis is very difficult.
Bottom Line: Of course. Can you eat your Bs?
Dr. Rubman: Yes. The question is, do you have adequate stomach acid in order to process them properly and uptake them from the system? As we age, as we take more medications, or particularly if we’re taking acid-suppressant medication, it becomes more difficult to conduct that.
Bottom Line: So let’s talk about supplementing Bs, then. Who should do it?
Dr. Rubman: We find it in the multivitamins. I prescribe it to almost everyone who comes through my office; almost everyone that I treat seems to benefit from it. So just about everyone should be able to benefit from B supplementation taken at least twice a day.
Bottom Line: B supplements—and I just jumped actually between B-12s and the family of Bs, because in fact they work together.
Dr. Rubman: They do, yeah.
Bottom Line: So if somebody needs to be supplementing or wants to be supplementing Bs, they take a B multi twice a day, and then how about for B-12? What would be—because that’s not necessarily in the B multi, is that correct?
Dr. Rubman: It should be, but the amount may be less than the person really needs in order to kick it into gear. You can take additional supplemental B-12, but you have to be a little bit judicious. You might be able to take 1,000 micrograms (mcgs) or 1 milligram, a day for a period of about a month or six weeks, but then go in and have the simple blood test taken to see what you’re doing.
There is a propensity for the mineral which is in B-12, which is cobalt, to be in excess in the body and to promote symptoms if one takes too much B-12 over a period of time.
Bottom Line: If somebody wants to supplement with B-12 in addition, there’s a certain type that’s the most recommended type of B-12 that we usually recommend. What’s that?
Dr. Rubman: Right. For the most recommended one that you can take the lowest amount and get the best results from, that would be methylcobalamin. The type given in the shot in the caboose and that you can take by mouth is called cyanocobalamin. It’s relatively cheap, and so most of my patients will actually end up taking more of the cyanocobalamin and get the same effect rather than spending the extra money on the methyl.
Bottom Line: Let me just reiterate. Taking the multi Bs on your own, not an issue, but there is some risk if you’re going to supplement B-12. That really should be with professional oversight and monitoring.
Dr. Rubman: Yeah, after a period of time, you’ll want to see what the impact on your system has been of the amount that you’re taking. And the B-12 supplementation is usually in a form which is sublingual or transbuccal —transbuccal meaning through the lining of the mouth. You take a small purple pill, you park it on the side of your mouth…five minutes later, it’s gone and you go about your business.
Bottom Line: Thank you. The bottom line on B-12? It really is the conductor of your entire orchestra, so if you’re feeling fatigued, if you’re having some tingling in your fingers, then you really might want to talk about supplementing some B vitamins.
If you’re going to try supplementing Bs, go for the full family of Bs first, because they work together with B-12. Be sure to always take your Bs twice a day, because they don’t last that long. And if you’re going to supplement B-12, talk to your doctor and have it monitored, because you really can take too much. This is Sarah Hiner with Bottom Line.