Vitamin B12 and Folate play a vital role in keeping us healthy. Both are involved in the repair of DNA. In this way, Vitamin B12 and Folate help to maintain the integrity of our genome. In particular, B12 and Folate are important for the health of the brain, nerves, blood cells, intestines, and heart. That’s why there are so many benefits of B12 and folate.

Unfortunately, many individuals suffer from Vitamin B12 and folate deficiency. For example, most vegans and vegetarians have vitamin B12 deficiency as plant-based food barely contains any B12. A common case scenario of folate deficiency is an individual who consumes alcohol excessively (and many do and remain in denial). If such a person becomes pregnant, there is an increased risk of neurologic defects in the newborn.

In addition, many other individuals are at risk of B12 and folate  deficiency as described later in this article.

Note: Folate and folic acid are interchangeable terms. Folic acid is also called vitamin B9.

Various Types Of Vitamin B12 Supplements

B12 is technically called cobalamin. Many cheap B12 supplements contain Cyano-cobalamin, which obviously contains Cyanide and may not be the optimal form of vitamin B12 supplement. On the other hand, Methyl Cobalamin is the best form of vitamin B12 supplement. Why? Because it is a natural form of vitamin B12. We also call it active B12 as it is ready to be taken up by the cells.

ZARY – A Premium Vitamin B12 and Folate Supplement

I formulated ZARY, more than fifteen years ago.  It not only contains Vitamin B12 (Methyl Cobalamin) but also Folate (Methyl Folate). Why this combination? Because Vitamin B12 and Folate have synergistic actions. Therefore, it makes sense to put them together in a supplement.

In ZARY, vitamin B12 and folate are present as the Active Form, which means these two vitamins are ready to be utilized by the body without the need for the complex changes that the dietary Vitamin B12 and folate have to go through before these become available to the cells. Many individuals cannot convert their dietary vitamin B12 and Folate into the active form. These individuals also have elevated Homocysteine level.

Homocysteine is an amino-acid. High levels of homocysteine is a known risk factor for heart disease, stroke, and dementia. Thus, lowering homocysteine level with supplements may lower cardiovascular risk.¹

Why Take Vitamin B12 and Folate Together?

Because low vitamin B12 and low folate usually cause similar symptoms such as anemia. Now if you take vitamin B12 alone, then anemia may correct but deficiency of folate would continue with serious health consequences such as low white cell count or neural tube defects in the newborn.
Similarly, if you take folate alone for anemia, then anemia may resolve but vitamin B12 deficiency would persist. And a person may develop severe neurologic complications.
That’s why it is advisable to take both vitamin B12 and folate together. ZARY is a good combination of Vitamin B12 and Folate, in one lozenge.

What Are Symptoms of Vitamin B12 Deficiency?

• Lack of energy
• Anemia (low red blood cell count). However, size of the red blood cells is larger than normal. Technically it is called megaloblastic anemia.
• Burning of the tongue
• Poor appetite
• Tingling and numbness in the feet and hands due to peripheral neuropathy
• Muscle weakness
• Memory loss
• Depression
• Abnormal gait and lack of balance
• Constipation alternating with diarrhea
• Vague abdominal pain
• Increase in the level of Homocysteine which is a risk factor for heart disease, stroke, and dementia. (Low folic acid is the other contributory factor for elevated Homocysteine level.)

Symptoms of Folate Deficiency

• Lack of energy
• Anemia (low red blood cell count). However, size of the red blood cells is larger than normal. Technically it is called megaloblastic anemia.
• Low white cell count
• Low platelet count
• Neural tube defects in the newborn
• poor growth in children
• Irritability
• Diarrhea
• Tender tongue

What Causes B12 Deficiency?

• Vegan and vegetarian diet
• Metformin (a diabetic drug)
• Stomach-Acid Suppressing medicines such as Prilosec (omeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), Aciphex (rabeprazole), Pepcid (famotidine), Zantac (ranitidine), Tagamet (cimetidine) etc.
• Antibiotics
• Stomach surgery
• Gastrointestinal disorders such as atrophic gastritis, small intestinal resection or bypass, gluten enteropathy, Crohn’s disease, chronic pancreatitis, and malignancy.
• Pernicious Anemia, which is an autoimmune disorder in which there is interference with the absorption of vitamin B12 in your food.

What Causes Folate Deficiency?

• Fast food diet
• Inadequate amounts of fruits and vegetables in diet
• Overcooked vegetables. Cooking destroys folate in the diet
• Excessive alcohol intake
• Medicines such as phenytoin, sulfasalazine, Bactrim
• Malabsorption diseases such as Celiac disease, Crohn’s disease
• Kidney Dialysis

How Do I know If I’m Low in B12 and/or Folate?

B 12 and Folate deficiencies can be diagnosed by blood tests.

A vitamin B12 blood level less than 400 pg/ml indicates deficiency. You can add a blood test of MMA (Methyl Malonyl Acid) which is elevated if you have B12 deficiency.

The normal range for Folic acid is 2.7 to 17.0 nanograms per milliliter (ng/mL) or 6.12 to 38.52 nanomoles per liter (nmol/L). A level below the normal range may indicate Folic acid anemia. 

Another blood test, Homocysteine level, is elevated if you have B12 deficiency.

What Is Subtle B12 Deficiency?

Subtle B12 deficiency may be present even if the blood tests are in the normal range.

A practical – and inexpensive – approach is to take a B12 supplement for one week if you have any of the symptoms of B12 deficiency. If your symptoms improve, you probably have B12 deficiency.

In my clinical experience, patients do much better when their B12 level is close to 1000 pg/ml. (Normal range is 400 -1000 pg/ml).

Diagnosis of B12 Deficiency Is Often Missed. Sad but True!

B12 deficiency often remains undiagnosed simply because physicians don’t think of it as a possibility.

For example, when a diabetic patient complains of tingling in their feet, physicians do all the work-up to diagnose diabetic peripheral neuropathy. Then, they start the patient on a drug treatment without even checking the B12 level, even if you are on metformin. Peripheral neuropathy in diabetic patients on metformin is often due to two factors: diabetes itself and B12 deficiency.

Similarly, if you complain of “tiredness,” many healthcare providers (especially in a HMO setting) will not check your Vitamin B12 level.

Along the same lines, if you complain of memory loss, your physician will likely order an expensive diagnostic work-up including MRI of the brain. Your physician may even diagnose you with Alzheimer’s dementia – and place you on drugs – without even checking your B12 level. Sad but true!

Is There A Danger of Vitamin B12 Overdose?

No, because B12 is water-soluble. Therefore, any excess amount of B12 gets excreted through the urine.

What If Vitamin B12 Level is High?

High B12 level may occur if you take high doses of B12 supplements. This is not a problem. You simply reduce the dose of your B12 supplement. However, if your Vitamin B12 level is high – and you are not taking any B12 supplement – your physician needs to check for any underlying health issues. For example, high Vitamin B12 level may be present in liver disease, kidney disease and leukemias.²  Paradoxically, you may experience symptoms of B12 deficiency which happens because you develop relative deficiency of vitamin B12 at the tissue level. This is also called functional Vitamin B12 deficiency.³

Can Vitamin B12 and Folate Lower Homocysteine Level?

B12 in high doses along with active form of Folate and Vitamin B6 helps to lower homocysteine level.

High levels of homocysteine is a known risk factor for heart disease, stroke, and dementia. Lowering homocysteine level with supplements may lower cardiovascular risk.³

Treatment Of Vitamin B12 And Folate Deficiency

It is important to find out the root cause of low B12 or folate. Sometimes, the root cause is relatively easy to eliminate such as discontinuing the stomach acid-suppressing drugs in case of B12 deficiency or switching from Phenytoin to some other ant-seizure drug in case of folate deficiency.

But in general, people are not willing to change their lifestyle if that is the root cause of B12 deficiency. For example, many vegans do not want to include Vitamin B12 foods in their diet. In addition, many of the diseases that cause B12 deficiency are either permanent (such as stomach surgery) or difficult to treat.

Similarly, many alcoholics do not want to get rid of their drinking habits.

Therefore, Vitamin B12 and Folate supplements are the mainstay treatment of B12 and Folate deficiencies. However, it is helpful if one can include Vitamin B12 and Folate-rich foods in their diet.

What Are Vitamin B12-Rich Foods?

Animal products are the main natural sources of Vitamin B12. Plant derived food is devoid of B12.

Good dietary sources include egg yolk, salmon, crabs, oysters, clams, sardines, liver, brain and kidney.

Smaller amounts of B12 are also found in beef, lamb, chicken, pork, milk and cheese.

What Are Folic Acid-Rich Foods?

Leafy vegetables such as spinach, asparagus, and broccoli as well as fresh fruits especially citrus fruits, are an excellent source of folic acid.

Other foods rich in folic acid include whole grains, beans, legumes, mushrooms, chicken, shellfish, and liver.

What Are Different Forms of Vitamin B12 And folate Supplements?

B12 supplements are readily available as oral pills and lozenges.

It is also available in the form of an injection, for which you need a prescription from a physician.

I prefer the lozenges because the absorption from the oral cavity is excellent, better than from the stomach and intestines if you take pills. Furthermore, you avoid the hassle, cost, and pain of the injections.

I have formulated a combination of Vitamin B12 and Folate – ZARY – in one lozenge that makes it very easy to take these two vitamins regularly.

Benefits Of Vitamin B12 And Folate Supplements

There are numerous health benefits of B12 and folate as these vitamins are involved in the health of the DNA. Scientific studies and clinical practice show that B12 and Folate supplement may provide the following benefits:

• Energy
• Relief from pins and needle sensation in the feet and hands
• Stronger muscle
• Resolution of sore tongue
• Improvement in appetite
• Better balance and gait
• Improved memory
• Lowering of Homocysteine levels when vitamin B12 is given in combination with Folic acid and Vitamin B6, which may translate into reduced risk of heart disease and stroke.

Can You Take Vitamin B12 And Vitamin D Together?

Yes. Remember Vitamin B12 is water-soluble, and Vitamin D is fat-soluble. Therefore, there is no interference with the absorption if you take these two vitamins together.

In Summary

B12 deficiency is quite common. Unfortunately, it often remains undiagnosed. Symptoms of B12 deficiency are non-specific. It is important to find out the root cause of B12 deficiency symptoms. B12 supplements are the practical way to treat B12 deficiency. It’s so rewarding to see the benefits of Vitamin B12 in a person with B12 deficiency. Fortunately, B12 toxicity is unheard of because it is a water soluble vitamin and any excess amount gets washed out in the urine.