Over the 20 plus years I havB12Facebooke practiced medicine, I have had patients ask countless different questions about a multitude of health issues. Although I discuss a large variety of topics with patients, I do get some similar types of questions. One of the topics that patients frequently ask me about is Vitamin B12.

I usually hear a lot of the same concerns from one patient to the next. These are some of the questions I might get from a  hypothetical patient, cleverly named John.  John is a normal 40 year old who has come in for his annual checkup.

Dr. Rybicki: Good morning John. How’s it going?

Patient: Good doc, I’m coming in for my annual check-up, but I wanted to talk to about this fatigue I’ve been having. I know I work a lot, I still exercise two to three times a week, but it seems like I am just getting more tired than usual.

Dr. Rybicki: Do you get any chest pain or shortness of breath?

Patient: No, just worn out. I have been reading up on fatigue and I wonder if I am deficient in vitamin B, or something else. What’s the deal with vitamin B?

Dr. Rybicki: When you talk about vitamin B you are actually referring to a group of vitamins, sometimes called the vitamin B complex. For example B12 is one that you think of when it comes to energy. Some of the other B vitamins that you may have heard of areB1, also known as thiamine,  and ,B3, known as niacin.

Patient: So if I’m low in B12, this can be causing my fatigue, right? What exactly does B12 do in the body?

Dr. Rybicki: Correct, B12 deficiency can cause a number of problems, including fatigue. B12 in the body is an important “co-enzyme” that is needed to metabolize carbohydrates and fats. This is important for energy production. It is also very important for the production of red blood cells and for the development of normal nerve structures.

Patient: I know that my grandfather has a low B12 level and he needs monthly shots of B12. I know he was real tired, got very anemic and had a lot of tingling in his feet.  Do you think I need shots?

Dr. Rybicki: He probably has pernicious anemia. This is caused by a very low B12 level. This is a result of not being able to absorb B12 through the stomach. Several things cause this, one being age, and the stomach lacks what’s called “intrinsic factor” which is needed for the stomach to be able to absorb vitamin B12. Since B12 in not absorbed by eating, it then needs to be given by a shot. Some doctors will actually prescribe very high oral B12 in these cases instead of shots. For you, we will check a simple blood test to see what your B12 levels are.

Patient: Sometimes I’ll drink an energy shot or take an energy drink. I know that there is a lot of B12 in these. Are these OK?

Dr. Rybicki: I wouldn’t rely on any of these because they contain many other ingredients. Some are high in sugar,  some are high in caffeine. The best way to get B12 is by diet and possibly vitamin supplements.

Patient: What foods can I eat to get enough B12?

Dr. Rybicki: Foods such as beef, liver, salmon, eggs, cheese all have some B12 in them.

Patient: What if I want to eat a vegan diet?

Dr. Rybicki: There are specialized formulas of nutritional yeast that can be added to foods. These contain a lot of B12

Patient: What about vitamin supplements. What are the best kinds and how much should  I take?

Dr. Rybicki: B12 is available in tablets, sublingual (under the tongue) tablets, oral sprays, nasal gels and patches. B12 absorption in the stomach of even normal people is still pretty low. That is why some experts recommend the sublingual, nasal gels and patches because these do not require absorption in the stomach. Still most research shows that you can get a good boost in your vitamin B levels with tablet supplements.

Patient: Can I just take  a general multivitamin, or should I take extra B12?

Dr. Rybicki: Most general multivitamins have small amounts of B12, but if you really want to boost your levels you can take a B complex or just vitamin B12. You can take anywhere from 250 to 1000 micrograms of extra B12 per day.

Patient: OK, I guess let’s get everything checked up and then we can decide if I need to take extra B12 vitamins

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