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Why Diabetics Should Check Their Vitamin B12 Levels Regularly
B12 is a strange vitamin with a unique chemical structure. Your body produces very little of it on its own and your only main source is from eating animal protein, namely meat and fish.
Yet vitamin B12 is essential for healthy cells and a healthy nervous system.
A study published in American Journal of Clinical Nutrition (AJCN) in 2009 showed that about 6% of all people aged 60 years or older in Europe and North America are deficient in vitamin B12. Studies also show that this deficiency increases as we age.
On the other hand, other studies published in the same year in Journal of the American Board of Family Medicine (JABFM) found that vitamin B12 deficiency rates among diabetics in Europe and North America averaged 22%… more than three and a half times the overall average rate.
This study at JABFM also showed that deficiency was highest among diabetic patients who used Metformin to control their blood glucose levels.
In developing countries, according to a study in the AJCN, vitamin B12 deficiency is more common and begins earlier in life. It gets worse as the patient gets older.
Low consumption of animal meat (beef and meat) is considered to be the main cause. Even in countries that practice a vegetarian diet, more than two-thirds of the population is deficient in B12.
In addition, in older people, poor absorption during digestion is considered the main cause of deficiency.
So, if you are diabetic, vegetarian or elderly, it is important to check your vitamin B12 levels regularly.
A simple blood test is successful. Your level should be between 191 and 663 pg/mL (picograms per milliliter… a picograms is one trillionth of a liter).
This measures the amount of vitamin B12 in your bloodstream, which is the amount that has been absorbed into your body after digestion.
Why is vitamin B12 important?
There are two reasons why vitamin B12 is important:
 It is important because it is needed to help folate in making DNA (deoxyribonucleic acid) and RNA (ribonucleic acid), which carry and transmit the genetic information of every living cell.
Genetic information tells the cell how to function. This information must be passed along to the new cell each time the cell divides.
 Vitamin B12 also has a function in the production of myelin, which covers and protects nerve fibers. Without enough B12, the myelin sheath does not form properly or stay healthy.
As a result, nerve transmission suffers. Eventually the nerve damage becomes irreversible.
How your body gets and uses vitamin B12
B12… aka cyanocobalamin or cobalamin… unique among vitamins.
This vitamin is water soluble and has a more complex chemical structure than all other vitamins, including B complex vitamins. And it is the only vitamin that contains an inorganic element (cobalt) as an important part of its makeup.
Only bacteria and microorganisms can make vitamin B12.
Bacteria in the gut produce some vitamin B12 but far, far less than the amount you need each day. Therefore, the only way to get enough B12 is to eat foods that contain it or take supplements.
Bacteria also work in animals to produce vitamin B12. Therefore it is found in a wide variety of foods made from animals.
Plant foods do not contain any vitamin B12 unless they have been fortified. However, vitamin B12 is added to some processed foods.
Here are the main food sources of vitamin B12:
Beef liver and shellfish… the most abundant source of B12
Fish, meat, poultry, eggs, milk and other dairy products… good sources of B12
Fermented nut products, such as tempeh… are less sources of B12
Some breakfast cereals, nutritional yeast and others have been fortified with B12.
But getting enough vitamin B12 isn’t enough to keep you healthy. Your body also needs to be able to use it.
Absorption of vitamin B12 from the food you eat is a two-step process.
First, your stomach acid has to separate B12 from the proteins attached to the food you swallow.
Then B12 needs to combine with intrinsic factorsanother protein made by the stomach, so it can be absorbed into your body.
If your body cannot produce intrinsic factor, you will not be able to absorb vitamin B12 and will end up with pernicious anemia (lack of healthy red blood cells). If this happens, your only solution is with a regular injection of B12.
How much vitamin B12 do you need?
The recommended amount of vitamin B12 you should get is 2.4 micrograms (mcg) a day for adults, 2.6mcg a day for pregnant women, and 2.8mcg for women who are breastfeeding.
The typical American and European diet supplies 7 to 30mcg of B12, well above your daily requirement.
In addition, the average well-fed person can store a supply of B12 in the liver (unlike other vitamins) that can last for five years or more.
But if you are a vegan (a strict vegetarian who does not eat eggs or drink milk) or a diabetic who follows Diet-Defeat-Diabetes… which excludes eggs and dairy products and minimizes your meat consumption… you need a daily supplement to ensure your intake is adequate.
Certain medications can interfere with your body’s ability to absorb or use vitamin B12:
Chloramphenicol (Chloromycetin®), an antibiotic used to treat certain infections
Proton pump inhibitors, such as omeprazole (Prilosec®) and lansoprazole (Prevacid®), used to treat acid reflux and peptic ulcers
Histamine H2 receptor antagonists, such as cimetidine (Tagamet®), famotidine (Pepcid®), and ranitidine (Zantac®), used to treat peptic ulcers
Metformin, used to treat type 2 diabetes
Effects of vitamin B12 deficiency
When the supply of vitamin B12 in the body is low, the production of red blood cells slows down because DNA and RNA become less available. This causes anemia. The production of cells that line the intestines is also slow.
Vitamin B12 deficiency can also seriously damage your nervous system. If the deficiency continues for a long time, the damage to the nerves can become irreversible.
Symptoms of vitamin B12 deficiency
If you are only mildly deficient in B12, you may not have any symptoms at all.
Symptoms of mild vitamin B12 deficiency include… tiredness… weakness… loss of appetite… weight loss… constipation. These symptoms can also be caused by other medical conditions and the underlying problem is not always easy to distinguish.
Very low B12 levels can lead to serious complications, such as:
Pernicious anemia means you don’t have enough healthy red blood cells. This causes your cells to lack oxygen.
According to a study at Medical Journal of Oral Pathology less than 20% of people with B12 deficiency develop pernicious anemia.
Symptoms of anemia include… fatigue… pale skin… chest pain… dizziness… headache… loss of taste… loss of smell… fast or irregular heartbeat… breathing difficulties.
Paresthesia is a burning or itching sensation on the skin, usually on the arms, hands, legs, and feet. Some people experience numbness, tingling, or prickling sensations.
Neuropathy or nerve damage can result from prolonged B12 deficiency. The symptoms are the same diabetic neuropathy (caused by long-term high blood glucose) and include pain, numbness and weakness in the legs and arms (called peripheral neuropathy).
Severe long-term B12 deficiency can cause loss of mobility, difficulty walking, memory loss, delusions and depression. It can even cause dementia.
Treatment of B12 deficiency
Treatment for deficiency involves taking supplemental vitamin B12 in the form of:
tablets that are swallowed… either as part of a multi-vitamin or stand-alone B12 tablets
sublingual tablets that dissolve under the tongue
Vitamin B12 deficiency is usually caused by your body’s inability to absorb it… not a lack of B12 in your diet.
This means that people who are deficient in B12 must take large supplemental doses. To ensure absorption they need to take more than they actually need.
This is not a problem because there are no reports of vitamin B12 causing toxicity or adverse effects even in very large amounts. In fact, it is often used as a placebo because it is non-toxic.
Indeed 1,000 mcg of B12 per day is a common recommendation, sometimes starting with 2,000 mcg per day for the first month. This large amount, several hundred times the recommended daily amount, ensures that at least some of it is absorbed, even without the intrinsic factor.
This is proven by medical studies that show that large amounts of active vitamin B12 can be absorbed, even if your body cannot create the intrinsic factor.
For example, methylcobalamin, a form of vitamin B12, can be absorbed when given in very large doses.
The accepted opinion is that sublingual administration of B12 is thought to bypass the absorption problems associated with intrinsic factors because it allows the vitamin to be absorbed directly into the venous plexus… the complex of blood vessels located in the floor of the mouth.
But there is no evidence that B12 from letting the tablet dissolve under the tongue is absorbed better than swallowing.
The effectiveness of nasal gel is also unproven.
Pernicious anemia is usually treated with injections of 50 or 100 mcg of vitamin B12 three times a week. When these go directly into your blood, they bypass the need for intrinsic factor. These injections may need to be continued for life.
which was brought home
You need to make sure that you ingest enough vitamin B12 and that your body can use it effectively:
Vitamin B12 is essential for healthy cells and a healthy nervous system.
Compared to non-diabetics, diabetics are three to four times more likely to be deficient in B12.
Diabetics and vegans should have their B12 levels checked regularly.
B12 is important because it is needed to make: DNA and RNA for new cells every time a cell divides… myelin to protect nerve fibers.
Your body makes very little B12 on its own… your main source is animal-based foods.
To be absorbed, B12 must combine with intrinsic factor, a protein made in your stomach.
If your body can’t produce intrinsic factor, you won’t be able to use the B12 you eat.
If you are European or American, you probably get a lot of B12, unless you are: a vegan… have diabetes and are taking Metformin… following Defeat-Diabetes diet… taking medications that interfere with your body’s ability to absorb or use B12
Very low B12 levels can result in… pernicious anemia (insufficient red blood cells)… paresthesia (burning or itchy skin)… neuropathy (nerve damage similar to diabetic neuropathy)… loss of mobility, loss of memory, dementia etc
Treatment consists of taking B12 as a supplement in very high doses to ensure that some of it is absorbed… you can have… tablets that are swallowed… sublingual tablets that dissolve under the skin… nasal gels. .. injection
B12 is not toxic and you cannot overdose
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