Many common drugs and dietary supplements can interfere with the absorption of B-12. These include: Alcohol, antibiotics, some antibiotics, Pepcid, Zantac, Prilosec, (and other anti-acid medications), Metformin, nicotine, Dilantin, HIV medications, folic acid, and potassium supplements
B-12 deficiency may present as the following symptoms:
Anemia, GI symptoms, neurological symptoms, change in mental status, confusion, depression, constipation, fatigue, muscle weakness, numbness and tingling in the hands and feet, shortness of breath, or sore mouth and tongue
A severe deficiency may cause irreversible nerve damage. Large doses of folic acid will correct the anemia of B-12 deficiency but not prevent or correct the nerve damage caused by the deficiency and should not be used to treat anemia until the cause is known. A deficiency not corrected by food may need to be treated with oral supplementation or injections. If minimal or no response noted, a medical evaluation should be conducted.
B-12 deficiency may be caused by Celiac and Crohn’s diseases (or other malabsorption syndromes), damage to the liver, pancreas or stomach, diet, medications, or parasites, as well as other situations.
Many research studies are looking at connections between B-12 deficiency and heart disease, breast cancer, Alzheimer’s disease and depression.
No toxicity levels have ever been reported and there are no known cases of toxic amounts being consumed. Allergic reactions can occur with injections. Vitamin B-12 is preserved with most cooking methods when the vitamin is derived from animal/fish sources.
Foods highest in Vitamin B-12:
- Liver – since this is where the vitamin is stored, it is the highest source. Animals with the highest concentrations include lamb, beef, veal, moose, turkey, duck and goose.
- Fish – along with Omega-3 fatty acids and low cholesterol. Mackerel provides the most, followed by snapper, salmon, tuna, cod, sardines, halibut, trout and bluefish.
- Beef - the amount of B-12 depends on the cut, with chuck having the most, followed by sirloin, rib-eye and ribs.
- Lamb – common in Middle East and Mediterranean dishes.
- Clams, oysters, mussels and scallops – clams have the highest amount.
- Crab, lobster and shrimp – crab has the most.
- Cheese – Swiss is the highest, followed by Parmesan and Feta.
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