Today, I talk about hydrogen supplements with a twist. Specifically, I discovered that a unique combination of three products—Megahydrate, Active H2 Ultra, and pH ADJUST Alkalinizing Formula—provides surprising benefits. I put this combination, or concoction, into water to produce a hydrogen-infused drink with potent antioxidant quenching capacity that also rapidly alkalinizes the body (increasing pH levels and buffering acids), and provides the important minerals potassium and magnesium.
Combining hydrogen supplements with pH ADJUST creates a hydrogen-infused drink giving you benefits from 1) Two types of hydrogen, hydride (H-) and molecular hydrogen (H2) with antioxidant and energizing properties, 2) Increased pH levels (greater alkalinity) to balance pH levels, 3) Bicarbonates helping buffer acids and replenish bicarbonate reserves in the body, and 4) Essential minerals (potassium, magnesium) in bio-available forms.
In practical terms, this drink is energizing, anti-aging (party due to free-radical quenching effects), hydrating, and powerfully alkaline-forming! What this means for you might be a revolutionary drink that by giving your body all the antioxidant benefits of hydrogen plus increasing your pH levels turns can significantly improve multiple aspects of health.
By buffering acidity and making you alkaline, this drink can improve things like the strength of bones and teeth (via buffering and remineralization), supports kidney health (as kidneys are responsible for your bicarbonate reserves), boosts oxygenation (and thereby supports easier breathing) because alkaline cells hold more oxygen, and stops or reduces acid indigestion, acid reflux, and other acid-related problems. That could be just the beginning of the benefits you might receive because increasing your pH levels and normalizing alkaline conditions (i.e., pH 7.35–7.45) positively impacts many systems in the body.
WHY COMBINE pH ADJUST AND HYDROGEN SUPPLEMENTS?
pH Adjust, Megahydrate, and Active H2 Ultra are good supplements when used by themselves. That is, they work well as stand alone supplements. But I have found the combination of all three offers maximum antioxidant, alkalization, buffering, and mineralization benefits.
pH Adjust maximizes the effects of hydrogen supplements by boosting alkalinity and buffering capacity through the inclusion of effective, natural forms of important minerals and bicarbonates, including: potassium bicarbonate, magnesium carbonate, potassium glycinate, and sodium bicarbonate.
SYNERGY: HOW EACH PRODUCT CONTRIBUTES TO THE DRINK
There are potent synergistic effects to the combination of all three products. In particular, using both hydrogen negative ions (H-) or hydride and molecular hydrogen (H2) creates cascade effects in which hydrogen ions “recycle” themselves as antioxidants. The addition of pH Adjust brings its own set of benefits.
• MEGAHYDRATE provides hydride or hydrogen negative ions (H-), also known as anions, that act significantly as antioxidants. These hydrogen ions can last up to three weeks in water. In the body, after the H- has donated its electron, it becomes simply “H” and proceeds to pair with another hydrogen atom to form H2 (molecular hydrogen), thereby continuing to exert free-radical quenching action. This is a major benefit of consuming H- in the quantities provided by Megahydrate.
• ACTIVE H2 ULTRA provides molecular hydrogen (H2) directly into the body in significant amounts. Molecular hydrogen offers many benefits to the body, especially antioxidant benefits. Being an extremely small molecule, molecular hydrogen can enter into the smallest cellular compartments, including the nucleus of the cell, a place where most antioxidants are too large to enter) where it can exert its antioxidant capabilities. Molecular hydrogen actually provides a wide range of health benefits. (See the Molecular Hydrogen Institute (MHI) website for more information.)
• pH ADJUST Alkalinizing Formula provides effective alkalinizing and buffering functions, as well as minerals (like potassium and magnesium) and bicarbonates needed for health. It is a fluffy, white powder that mixes easily in water, teas, coffee, and other liquids. It is formulated to rapidly increase pH levels, and acts as a buffering agent to balance pH in the body.
pH Adjust was created by my father, Dr. Hank Liers, HPDI’s founder and formulator of all “Dr. Liers Original” supplements. Dr. Hank been designing effective nutritional supplements since before 1988, the year he founded HPDI.
ACID-BASE BALANCE CRITICAL FOR HEALTH
Acid-base balance is critical in the body, where a pH level of 7.35–7.45 must be maintained. Modern diets and lifestyles tend to be acidifying for the body. Diets high in animal foods that are not adequately balanced with vegetable foods lead to acidity. Other factors include overconsumption of grains, alcohol, and other acid-forming foods. Stress can also play a role due too the acidifying effects of stress hormones like cortisol.
Moreover, the aging process itself depletes bicarbonate reserves. As noted, pH Adjust contains bicarbonates that help replenish bicarbonate reserves necessary for buffering acids. Finally, a significant portion of the population has low intake of potassium and magnesium, which pH Adjust includes as part of its design.
pH Adjust also includes sodium bicarbonate (baking soda), which is a well known acidity buffer and alkalinizer. For users, advantages of pH Adjust over pure sodium bicarbonate include reduced sodium intake, improved taste, and the provision of potassium and magnesium.
POTASSIUM & MAGNESIUM FOR HEALTH
Potassium is critical in the body not only for alkalinity, but also for its role in the sodium-potassium pump which is important in the production of cellular energy (ATP) and for preventing too high levels of sodium from entering cells.
Magnesium is essential in the body and plays a role in wide range of functions, including cellular energy production, immune function, muscle and connective tissue health, and more than 400 enzyme reactions.
pH ADJUST is a highly effective buffering formula, which tends to bring pH levels (low or high) back into the optimal range (7.35-7.45). This buffering capacity means users can both avoid acidosis (high acidity) and alkalosis (high alkalinity).
MAKE THE DRINK
OPTIMIZE MEGAHYDRATE & ACTIVE H2 ULTRA BY ADDING pH ADJUST
Start with 8–16 ounces of fresh, purified water. Add 1–2 scoops of pH ADJUST, 1–2 capsules (or 1-2 scoops) of MEGAHYDRATE, and 1–2 ACTIVE H2 ULTRA tablets. Add the Active H2 Ultra tablets last, and let them effervesce completely (about 1 minute) before drinking.
This alkaline-forming, hydrogen-infused water is best taken on an empty stomach. It is ideal to drink in the morning or the afternoon (away from food). Allow at least 15–30 minutes before eating, or see what works for you. I sometimes eat light foods 10 minutes after taking this drink.
I recommend testing your pH levels (salivary and/or urinary) using pH test paper (litmus paper). pH test paper gives you a way to accurately track your pH levels. You can also use it to measure the pH of foods you consume, such as hydrogen-infused water and drinks containing pH Adjust.
Note: Many HPDI customers use pH Adjust in other drinks, including tea, coffee, and ketogenic coffee. Coffee can be acidic and acid-forming beverage, so adding pH Adjust helps buffer the acidity. Many users say pH Adjust tastes mild or good in coffee, and some say it adds a certain creaminess to it.
USE THIS ALKALINIZING HYDROGEN DRINK!
The only way you will know how beneficial hydrogen-infused water with pH Adjust can be—or how well it works for you—is to make it and use it! You will likely find yourself surprised by how energizing, alkalinizing, and mineralizing it truly is for you. And how good you feel when you drink it!
Consider testing the pH of your water first using pH test paper. Many people drink highly acidic water (pH 6 or less) without realizing it. Just because your water is filtered or purified does not necessarily mean it is alkaline. pH Adjust can “fix” this problem. Other people report that their water is highly alkaline (8.0+). Either way, pH Adjust can buffer the water to put it into the range slightly alkaline range of about 7.35–7.45. If you have extremely acidic water, you might need to use two servings of pH Adjust in 8–16 ounces of water. Play with it.
Let us know how this works out for you. We welcome your feedback and success stories!
MANY OTHER WAYS TO USE pH ADJUST
Hydrogen supplements and pH Adjust are made for each other, and create wonderfully alkalinizing hydrogen-infused water. But there are other ways to use pH Adjust. As I mentioned, you might like to read about making pH Adjust Coffee or Ketogenic Coffee using pH Adjust. Or watch my videos below. Also, did you know you can use pH Adjust in lemonade and other juices?
Today I show how to use pH ADJUST Alkalinizing Formula to make coffee alkaline. When pH Adjust is added to coffee, it rapidly changes from an acidic pH level to an alkaline pH level.
When you drink alkaline coffee, you are helping your body keep the healthy pH level of 7.34–7.45 it strives to maintain. Moreover, by changing to an alkaline state from an acidic state, you avoid health issues known to be associated with acidosis or ongoing, highly acidic pH levels.
pH ADJUST makes an already health-giving beverage into an alkaline-forming powerhouse supporting your best heath and brain performance. pH Adjust also effectively increases pH when used in water, juices, smoothies, or your favorite beverage.
pH ADJUST works by providing key minerals potassium (bicarbonate and glycinate) and magnesium (carbonate), as well as some sodium bicarbonate (baking soda) that act synergistically to boost pH levels in the body. HPDI recommends users measure pH using litmus paper to accurately test their pH levels.
Ideally your body pH is 7.35–7.45. Coffee itself is typically acidic with pH levels of about 5.0 to 6.0. pH Adjust therefore is an ideal supplement for adding into coffee to increase the pH of the coffee you drink and thereby increase your pH levels.
WHAT IS pH ADJUST?
pH ADJUST is an alkalinizing formula (powder) that is designed to increase pH levels in the body rapidly and effectively for good health.
Here is how we describe pH ADJUST on the label: “Alkalinizing Formula, 250 gm – Alkalinize with Potassium Bicarbonate, Magnesium Carbonate, Potassium Glycinate, and Sodium Bicarbonate”
pH ADJUST Features and Benefits
• Alkalinize with Potassium and Sodium Bicarbonate and Magnesium Carbonate
• Helps Counteract Overly Acidic Conditions; Increases pH Levels in the Body
• Balanced Supplemental Minerals; Unique 3:1 Potassium to Sodium Ratio Improves Taste and Reduces Salt Intake
• Tastes Good – Easy to Use Fluffy Powder
• 250 One-Gram Servings Per Container (250 grams)
• Suitable for Vegetarians & Vegans; Gluten-Free
pH ADJUST may be used to assist in overly acidic conditions in the digestive tract, blood, and kidneys; increase salivary and urinary pH to healthy levels; and to supplement the body with the minerals potassium, magnesium, and sodium.
INGREDIENTS:pH ADJUST contains (in powder form): potassium bicarbonate, magnesium carbonate, potassium glycinate, and sodium bicarbonate.
Each one gram serving (about ¼ tsp) contains about 300 mg of bicarbonate, 260 mg of carbonate, 133.4 mg of potassium ((from KHCO3 & glycinate), 99.1 mg of magnesium (from MgCO3), 48.1 mg of sodium (from NaHCO3) and 100 mg of glycine.
DIRECTIONS: As a dietary supplement, take ¼ tsp in 4–8 ounces of purified water preferably away from food, or as directed by a health care professional. For extremely acidic conditions, try 4–10 doses per day, depending on acidity level. Use pH paper to ensure pH levels remain balanced, and do not become too alkaline (alkalosis may occur above pH 8.2).
TEST pH LEVELS: The best way to test pH levels is to use litmus paper, which HPDI offers in rolls (Hydrion brand) for this purpose. You can test both salivary and urinary pH. Advantages of pH paper include rapid results, ease of use, and cost effectiveness.
MORE INFORMATION ABOUT pH ADJUST
pH ADJUST is fluffy white powder that mixes into water, juices, other liquids, and foods. It acts rapidly to raise pH levels in the body. It is easy to use, mild-tasting, and highly effective for balancing pH levels. It is gluten-free, non-GMO, vegan/vegetarian, and contains no artificial ingredients.
NUTRITIONAL CONSIDERATIONS AND APPLICATIONS
The minerals potassium, sodium, and magnesium are key substances that are involved in many important functions in the body. When combined in bicarbonates (potassium & sodium), carbonates (magnesium), and glycinate (potassium) these chemicals can help to adjust and balance pH levels that are crucial to body function.
pH ADJUST provides a 3:1 ratio of potassium to sodium. This ratio keeps potassium levels relatively high with respect to sodium. The processed food diets with a high protein and low vegetable content consumed by many people in the US and elsewhere produce conditions in the body of acidity. This in turn leads to decreased oxygenation of our cells and a greater amount of anaerobic processes in metabolism. This, in turn, leads in inadequate ATP (energy) production and the presence of unwelcome anaerobic cells and organisms.
Bicarbonate is a major element in our body. Secreted by the stomach, it is necessary for digestion. When ingested, for example, with mineral water, it helps buffer lactic acid generated during exercise and additionally reduces the acidity of dietary components. Additionally, it has a preventive effect on dental cavities. Each ¼ tsp of pH ADJUST contains about 300 mg of bicarbonate.
Bicarbonate is present in all body fluids and organs and plays a major role in the acid-base balances in the human body. The first organ where food, beverages and water stay in our body is the stomach. The mucus membrane of the human stomach has 30 million glands which produce gastric juice containing not only acids, but also bicarbonate. The flow of bicarbonate in the stomach amounts from about 24 mg/hr for a basal output to about 73 mg/hr for a maximal output.
Thus, at least half a gram of bicarbonate is secreted daily in our stomach. This rate of gastric bicarbonate secretion is 2–10% of the maximum rate of acid secretion. In the stomach, bicarbonate participates in a mucus-bicarbonate barrier regarded as the first line of the protective and repair mechanisms. On neutralization by acid, carbon dioxide is produced from bicarbonate.
One serving (about ¼ tsp) of pH ADJUST contains about 300 mg of bicarbonate.
pH ADJUST contains about 260 mg of carbonate (and 99 mg of Mg) in the form of magnesium carbonate. Magnesium carbonate is used as an antacid that gets converted to Magnesium Chloride (MgCl) and CO2 by stomach acid. MgCl is a well absorbed form of magnesium.
TRY pH ADJUST IN YOUR COFFEE
We strongly recommend trying pH Adjust in your coffee (or ketogenic coffee) to help alkalinize the body rapidly. Many people gain major benefits from drinking this simple, easy-to-use formula that is highly effective for raising pH levels. Beyond coffee, it works well in other drinks! Like water, teas, juices, or smoothies. Try pH Adjust and see how effectively it can alkalinize you.
Today I talk about my REJUVENATE!™ BERRIES & HERBS high-RNA superfood. I designed it to be a super-delicious, intensely berry flavored superfood with no greens. I put in real organic berries—BLUEBERRY, STRAWBERRY, RASPBERRY, and CRANBERRY—so it bursts with true berry flavors! I recently updated the formula, so it is is more delicious and nutritious than ever.
REJUVENATE! BERRIES & HERBS – A COMPLETE SUPERFOOD
Rejuvenate! Berries & Herbs is a delicious high-RNA (390 mg), high-protein (14.6 g) (organic pea and organic rice), high-antioxidant (ORAC value of 14,000+), high fiber (13 g) superfood with a creamy smoothness and rich berry flavor that tastes beyond great! It also boosts health with a complete multivitamin-multimineral sub-formula and important cell-protective herbs (herbal complex) that includes ginger, dandelion, burdock, turmeric, green tea extract, astragalus, and many other health-building herbs.
How to use Rejuvenate! Berries & Herbs? Just mix in water, juices, nut milks, or smoothies to create a drink with superb health benefits. Or use it creatively in foods, such as nut butters, salads, fruits, sauce/dressings, or desserts. It tastes so good, some people like to eat it by itself—or mixed in a little purified water.
HEALTHY AND HIGH-RNA BY DESIGN
Rejuvenate! Berries & Herbs is among HPDI’s premier high-RNA superfoods. That is, Rejuvenate! Berries & Herbs is one of three Rejuvenate! superfoods, which are the world’s first—and only—dedicated high-RNA superfoods. High-RNA nutrition means high in dietary nucleic acids, which Dr. Benjamin S. Frank considers to be essential nutrients, like vitamins and minerals (Dietary Nucleic Acid Nutrition & Therapy). Dr. Frank’s studies demonstrate many benefits of nucleic acids, including: greater energy, endurance, functional strength, easier breathing (anti-anoxic effect), as well as cardiovascular benefits and cosmetic benefits (smoother skin and a more youthful appearance).
• Delicious Berry Flavor Bursts with Real Organic Berries! • Powerful Organic and Wildcrafted Cell-Protective Herbs • High ORAC Value (~14,270 units)
• 390 mg Dietary Nucleic Acids (RNA/DNA) from Vegetarian Sources • Multiple Prebiotics Supporting your Microbiome • Gluten Free, Vegan/Vegetarian, No Artificial Ingredients • Mixes Well with other Rejuvenate!™ Superfoods
My updated formula (as of 12/2018) features, per serving:
– 2.6 g more protein (14.6 g total) – Very little sugar (1.2 g total) – 7.0 g more fiber (13 g total) – 100 mg of organic BiAloe® aloe vera gel powder with over 18% acemannan – 700 mcg of folate as 5-MTHF (natural, coenzyme folate) – A smooth & delicious taste (even better than before!)
Given all the upgrades I recently made to the formula, I certainly hope you will give it a try. I’m so happy with it, and I use it daily. Berries & Herbs hardly feels (or tastes!) like a nutritional supplement. But believe me, there are few superfoods anywhere that provide as much nutrition—or nutrient density!
HIGHEST QUALITY INGREDIENTS – INCLUDING ORGANIC AND WILDCRAFTED
To give you a better idea of the high-quality ingredients I put into Rejuvenate! Berries & Herbs, check out this complete list of ingredients:
Today I make a tasty smoothie with the new, improved REJUVENATE!™ BERRIES & HERBS superfood. In fact, Rejuvenate! Berries & Herbs is likely the most delicious among HPDI’s Rejuvenate! superfoods, as it contains for types of real organic berries: Blueberries, Strawberries, Raspberries, and Cranberries. This uber-berry superfood was born for smoothies.
Rejuvenate! Berries & Herbs is a uniquely healthy superfood that not only tastes amazingly good, but its high berry content gives it an ultra-high antioxidant value (ORAC) of 14,270 units per serving—an exceedingly high ORAC value compared to typical “superfood” formulas.
Rejuvenate! Berries & Herbs provides 14.6 gm of organic protein (including organic pea and organic rice). It includes a potent cell-protective herbal complex (including green tea extract, ginger, turmeric, astragalus, burdock, dandelion, and rhodiola). In addition, it contains a built-in multivitamin sub-formula including coenzyme vitamins and other highly assimilable forms of important micronutrients.
I especially love Rejuvenate! Berries & Herbs because my father Dr. Hank Liers formulated it to provide the most dietary nucleic acids per serving—390 mg (dietary RNA/DNA)—the most per serving in any Rejuvenate! superfood. Sources of dietary nucleic acids in Rejuvenate! Berries & Herbs include nutritional yeast, yeast extracts, and CGF (chlorella growth factor).
Dietary nucleic acids are proven to provide significant benefits for health. Studies by pioneering nucleic acid researcher Benjamin S. Frank, MD, PhD indicate effects such as greater endurance, easier breathing (anti-anoxic effect), increased energy (ATP production), improved functional strength, warmer body temperature (e.g., cold resistance), and other effects. Dr. Frank asserts that dietary nucleic acids are essential nutrients, not unlike vitamins and minerals (Dietary Nucleic Acid Nutrition & Therapy).
Considering all the benefits conferred by dietary nucleic acids, you really cannot go wrong by consuming more of them daily. And Rejuvenate! Berries & Herbs helps you do that by providing nearly 400 mg of dietary RNA/DNA per serving. That is a therapeutic dose which means you stand to gain all the benefits they confer. Depending on who you are and your health status, that could mean a lot in terms of helping you be healthier.
In sum, Rejuvenate! Berries & Herbs uniquely offers: 1) High RNA (dietary nucleic acids), 2) High Antioxidant Levels, 3) Herbal Sub-Formula, 4) High Protein, 5) Built-in Multivitamin, and 6) SUPER TASTE—that is super delicious in your superfood smoothies.
You just cannot get all these benefits in ANY other superfood, including other Rejuvenate! superfoods, each of which is formulated with a specific purpose. For example, Rejuvenate! PLUS is designed to provide significant levels of greens (think chlorella and spirulina), but lacks berries. Within its berry bailiwick, Rejuvenate! Berries & Herbs truly stands alone as one-of-a-kind.
REJUVENATE! BERRIES & HERBS highlights:
• Delicious Berry Flavor Bursts with Real Organic Berries (blueberries, strawberries, raspberries, cranberries)! • Powerful Organic and Wildcrafted Cell-Protective Herbs • High Antioxidant (ORAC) Value of 14,270 units per serving! • Contains Multiple Prebiotics Supporting Your Microbiome • Suitable for Vegetarians and Vegans & Gluten Free • Mixes Well with other Rejuvenate!™ superfoods (like Rejuvenate! PLUS and Rejuvenate! Original Greens) and smoothie ingredients.
New, improved REJUVENATE! Berries & Herbs features (per serving): • 14.6 g protein • Very little sugar (1.2 g total) • 7.0 g more fiber (13 g total) • 100 mg of organic BiAloe® aloe vera gel powder with over 18% acemannan • 700 mcg of folate as 5-MTHF • Smooth texture & delicious taste!
There you have it. If you’re anything like me—and you love the taste of real, organic berries—consider Rejuvenate! Berries & Herbs to be your greatest ally when it comes it to tasty and healthy superfood nutrition. Make yourself a Berries & Herbs smoothie, and start creating health naturally today! ~
I previously wrote METHYLATION CYCLE, GENETICS, B VITAMINS in which I considered in-depth how the Methylation Cycle functions, how genetics affect metabolic pathways, and how B vitamins (including vitamin B12, folate, vitamin B6, and vitamin B2) are used in Methylation Cycle pathways. In today’s article, I take an in-depth view of what you need to know about vitamin B12, including the effects of not having sufficient amounts of Vitamin B12 in the body.
Vitamin B12 is one of eight B vitamins. It is the largest and most structurally complicated vitamin. It consists of a class of chemically related compounds (vitamers), all of which show physiological activity. It contains the biochemically rare element cobalt positioned in the center of a chemical ring structure.
Vitamin B12 (also called cobalamin) is a water-soluble vitamin that is involved in the metabolism of every cell of the human body. It is a cofactor in DNA synthesis, and in both fatty acid and amino acid metabolism. It is particularly important in the normal functioning of the nervous system via its role in the synthesis of myelin and in the maturation of developing red blood cells in the bone marrow.
Vitamin B12 contains the biochemically rare element cobalt positioned in the center of a chemical ring structure.
YOUR NEED FOR VITAMIN B12
Vitamin B12 deficiency is thought to be one of the leading nutritional deficiencies in the world. An extensive 2004 study showed that deficiency is a major health concern in many parts of the world, including the North America, Central and South America, India, and certain areas in Africa. It is estimated that 40 percent of people may have low levels of vitamin B12.
Vitamin B12 affects your mood, energy level, memory, nervous system, heart, skin, hair, digestion and more. It is a key nutrient regarding adrenal fatigue and multiple metabolic functions including enzyme production, DNA synthesis, and hormonal balance.
Because of vitamin B12’s extensive roles within the body, a vitamin deficiency can show up in many different symptoms, such as chronic fatigue, mood disorders such as depression, chronic stress, and low energy.
SOURCES OF VITAMIN B12
The only organisms to produce vitamin B12 are certain bacteria and archaea. Some of these bacteria are found in the soil around the grasses that ruminants eat. They are taken into the animal, proliferate, form part of their gut flora, and continue to produce vitamin B12.
Products of animal origin such as beef (especially liver), chicken, pork, eggs, dairy, clams, and fish constitute the primary food source of vitamin B12. Older individuals and vegans are advised to use vitamin B12 fortified foods and supplements to meet their needs.
Salmon is a good source of Vitamin B12
Commercially, Vitamin B12 is prepared by bacterial fermentation. Fermentation by a variety of microorganisms yields a mixture of methylcobalamin, hydroxocobalamin, and adenosylcobalamin. Since multiple species of propionibacterium produce no exotoxins or endotoxins and have been granted GRAS status (generally regarded as safe) by the United States Food and Drug Administration, they are the preferred bacterial fermentation organisms for vitamin B12 production.
Methylcobalamin and 5-deoxyadenosylcobalamin are the forms of vitamin B12 used in the human body (called coenzyme forms). The form of cobalamin used in many some nutritional supplements and fortified foods, cyanocobalamin, is readily converted to 5-deoxyadenosylcobalamin and methylcobalamin in the body.
Hydroxocobalamin is the direct precursor of methylcobalamin and 5-deoxyadenosylcobalamin. In mammals, cobalamin is a cofactor for only two enzymes, methionine synthase (MS) and L-methylmalonyl-coenzyme A mutase (MUT).
Unlike most other vitamins, B12 is stored in substantial amounts, mainly in the liver, until it is needed by the body. If a person stops consuming the vitamin, the body’s stores of this vitamin usually take about 3 to 5 years to exhaust. Vitamin B12 is primarily stored in the liver as 5-deoxyadenosylcobalamin, but is easily converted to methylcobalamin.
ABSORPTION OF VITAMIN B12
Vitamin B12, bound to protein in food, is released by the activity of hydrochloric acid and gastric protease in the stomach. Intestinal absorption of vitamin B12 requires successively three different protein molecules: Haptocorrin, Intrinsic Factor and Transcobalamin II. If there are deficiencies in any of these factors absorption of Vitamin B12 can be seriously decreased.
When vitamin B12 is added to fortified foods and dietary supplements, it is already in free form and, thus, does not require the separation from food protein step. Free vitamin B12 then combines with intrinsic factor, a glycoprotein secreted by the stomach’s parietal cells, and the resulting complex undergoes absorption within the distal ileum by receptor-mediated endocytosis.
Approximately 56% of a 1 mcg oral dose of vitamin B12 is absorbed, but absorption decreases drastically when the capacity of intrinsic factor is exceeded (at 1–2 mcg of vitamin B12).
Vitamin B12 deficiency can be difficult to detect, especially since the symptoms of a vitamin B12 deficiency can be similar to many common symptoms, such as feeling tired or unfocused, experienced by people for a variety of reasons.
Vitamin B12 deficiency is commonly associated with chronic stomach inflammation, which may contribute to an autoimmune vitamin B12 malabsorption syndrome called pernicious anemia and to a food-bound vitamin B12 malabsorption syndrome. Poor absorption of vitamin B may be related to coeliac disease. Impairment of vitamin B12 absorption can cause megaloblastic anemia and neurologic disorders in deficient subjects. In some cases, permanent damage can be caused to the body when B12 amounts are deficient.
It is noteworthy that normal function of the digestive system required for food-bound vitamin B12 absorption is commonly impaired in individuals over 60 years of age, placing them at risk for vitamin B12 deficiency.
A diagnosis of vitamin B12 deficiency is typically based on the measurement of serum vitamin B12 levels within the blood. However, studies show that about 50 percent of patients with diseases related to vitamin B12 deficiency have normal B12 levels when tested. This can cause individuals to ignore taking in adequate levels of vitamin B12 with potential serious consequences.
FUNCTIONS AND ISSUES ASSOCIATED WITH VITAMIN B12 STATUS IN THE BODY
Vitamin B12 or cobalamin plays essential roles in folate metabolism and in the synthesis of the citric acid cycle intermediate, succinyl-CoA.
Vitamin B12 deficiency is commonly associated with chronic stomach inflammation, which may contribute to an autoimmune vitamin B12 malabsorption syndrome called pernicious anemia and to a food-bound vitamin B12 malabsorption syndrome. Impairment of vitamin B12 absorption can cause megaloblastic anemia and neurologic disorders in deficient subjects.
Normal function of the digestive system required for food-bound vitamin B12 absorption is commonly impaired in individuals over 60 years of age, placing them at risk for vitamin B12 deficiency.
Vitamin B12 and folate are important for homocysteine metabolism. Elevated homocysteine levels in blood are a risk factor for cardiovascular disease (CVD). B vitamin supplementation has been proven effective to control homocysteine levels.
The preservation of DNA integrity is dependent on folate and vitamin B12 availability. Poor vitamin B12 status has been linked to increased risk of breast cancer in some, but not all, observational studies.
Low maternal vitamin B12 status has been associated with an increased risk of neural tube defects (NTD), but it is not known whether vitamin B12 supplementation could help reduce the risk of NTD.
Vitamin B12 is essential for the preservation of the myelin sheath around neurons and for the synthesis of neurotransmitters. A severe vitamin B12 deficiency may damage nerves, causing tingling or loss of sensation in the hands and feet, muscle weakness, loss of reflexes, difficulty walking, confusion, and dementia.
While hyperhomocysteinemia may increase the risk of cognitive impairment, it is not clear whether vitamin B12 deficiency contributes to the risk of dementia in the elderly. Although B-vitamin supplementation lowers homocysteine levels in older subjects, the long-term benefit is not yet known.
Both depression and osteoporosis have been linked to diminished vitamin B12 status and high homocysteine levels.
The long-term use of certain medications, such as inhibitors of stomach acid secretion, can adversely affect vitamin B12 absorption.
Vitamin B12 is required for proper red blood cell formation, neurological function, and DNA synthesis.
MORE DETAILS ASSOCIATED WITH VITAMIN B12 STATUS IN THE BODY
1. Vitamin B12 is required for proper red blood cell formation, neurological function, and DNA synthesis. Vitamin B12 as methylcobalamin functions as a cofactor for methionine synthase. Methionine synthase (MS) catalyzes the conversion of homocysteine to methionine. Methionine along with ATP is required for the formation of S-adenosylmethionine (SAMe), a universal methyl donor for almost 100 different substrates, including DNA, RNA, hormones, proteins, and lipids.
2. Vitamin B12 as 5-deoxyadenosylcobalamin functions as a cofactor along with L-methylmalonyl-CoA mutase (MUT) to convert L-methylmalonyl-CoA to succinyl-CoA in the degradation of propionate, an essential biochemical reaction in fat and protein metabolism. Succinyl-CoA is also required for hemoglobin synthesis.
3. Vitamin B12, bound to protein in food, is released by the activity of hydrochloric acid and gastric protease in the stomach. When synthetic vitamin B12 is added to fortified foods and dietary supplements, it is already in free form and, thus, does not require this separation step. Free vitamin B12 then combines with intrinsic factor, a glycoprotein secreted by the stomach’s parietal cells, and the resulting complex undergoes absorption within the distal ileum by receptor-mediated endocytosis. Approximately 56% of a 1 mcg oral dose of vitamin B12 is absorbed, but absorption decreases drastically when the capacity of intrinsic factor is exceeded (at 1–2 mcg of vitamin B12).
4. Pernicious anemia is an autoimmune disease that affects the gastric mucosa and results in gastric atrophy. This leads to the destruction of parietal cells, achlorhydria, and failure to produce intrinsic factor, resulting in vitamin B12 malabsorption. If pernicious anemia is left untreated, it causes vitamin B12 deficiency, leading to megaloblastic anemia and neurological disorders, even in the presence of adequate dietary intake of vitamin B12.
5. Vitamin B12 status is typically assessed via serum or plasma vitamin B12 levels. Values below approximately 170–250 pg/mL (120–180 picomol/L) for adults indicate a vitamin B12 deficiency. However, evidence suggests that serum vitamin B12 concentrations might not accurately reflect intracellular concentrations. An elevated serum homocysteine level (values >13 micromol/L) might also suggest a vitamin B12 deficiency. However, this indicator has poor specificity because it is influenced by other factors, such as low vitamin B6 or folate levels. Elevated methylmalonic acid levels (values >0.4 micromol/L) might be a more reliable indicator of vitamin B12 status because they indicate a metabolic change that is highly specific to vitamin B12 deficiency.
6. Vitamin B12 deficiency is characterized by megaloblastic anemia, fatigue, weakness, constipation, loss of appetite, and weight loss. Neurological changes, such as numbness and tingling in the hands and feet, can also occur . Additional symptoms of vitamin B12 deficiency include difficulty maintaining balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue. The neurological symptoms of vitamin B12 deficiency can occur without anemia, so early diagnosis and intervention is important to avoid irreversible damage. During infancy, signs of a vitamin B12 deficiency include failure to thrive, movement disorders, developmental delays, and megaloblastic anemia. Many of these symptoms are general and can result from a variety of medical conditions other than vitamin B12 deficiency.
7. Typically, vitamin B12 deficiency is treated with vitamin B12 injections, since this method bypasses potential barriers to absorption. However, high doses of oral vitamin B12 can also be effective. The authors of a review of randomized controlled trials comparing oral with intramuscular vitamin B12 concluded that 2,000 mcg (I like 5,000 mcg) of oral vitamin B12 daily, followed by a decreased daily dose of 1,000 mcg and then 1,000 mcg weekly and finally, monthly might be as effective as intramuscular administration. Overall, an individual patient’s ability to absorb vitamin B12 is the most important factor in determining whether vitamin B12 should be administered orally or via injection. In most countries, the practice of using intramuscular vitamin B12 to treat vitamin B12 deficiency has remained unchanged.
8. Large amounts of folate can mask the damaging effects of vitamin B12 deficiency by correcting the megaloblastic anemia caused by vitamin B12 deficiency without correcting the neurological damage that also occurs. Moreover, preliminary evidence suggests that high serum folate levels might not only mask vitamin B12 deficiency, but could also exacerbate the anemia and worsen the cognitive symptoms associated with vitamin B12 deficiency. Permanent nerve damage can occur if vitamin B12 deficiency is not treated. For these reasons, folate intake from fortified food and supplements should not exceed 1,000 mcg daily in healthy adults.
Groups at Risk of Vitamin B12 Deficiency
The main causes of vitamin B12 deficiency include vitamin B12 malabsorption from food, pernicious anemia, postsurgical malabsorption, and dietary deficiency. However, in many cases, the cause of vitamin B12 deficiency is unknown. The following groups are among those most likely to be vitamin B12 deficient.
Older adults: Atrophic gastritis, a condition affecting 10%–30% of older adults, decreases secretion of hydrochloric acid in the stomach, resulting in decreased absorption of vitamin B12. Decreased hydrochloric acid levels might also increase the growth of normal intestinal bacteria that use vitamin B12, further reducing the amount of vitamin B12 available to the bodY.
Individuals with atrophic gastritis are unable to absorb the vitamin B12 that is naturally present in food. Most, however, can absorb the synthetic vitamin B12 added to fortified foods and dietary supplements. As a result, the IOM recommends that adults older than 50 years obtain most of their vitamin B12 from vitamin supplements or fortified foods. However, some elderly patients with atrophic gastritis require doses much higher than the RDA to avoid subclinical deficiency.
Individuals with pernicious anemia: Pernicious anemia, a condition that affects 1%–2% of older adults, is characterized by a lack of intrinsic factor. Individuals with pernicious anemia cannot properly absorb vitamin B12 in the gastrointestinal tract. Pernicious anemia is usually treated with intramuscular vitamin B12. However, approximately 1% of oral vitamin B12 can be absorbed passively in the absence of intrinsic factor, suggesting that high oral doses of vitamin B12 might also be an effective treatment.
Individuals with gastrointestinal disorders: Individuals with stomach and small intestine disorders, such as celiac disease and Crohn’s disease, may be unable to absorb enough vitamin B12 from food to maintain healthy body stores. Subtly reduced cognitive function resulting from early vitamin B12 deficiency might be the only initial symptom of these intestinal disorders, followed by megaloblastic anemia and dementia.
Individuals who have had gastrointestinal surgery: Surgical procedures in the gastrointestinal tract, such as weight loss surgery or surgery to remove all or part of the stomach, often result in a loss of cells that secrete hydrochloric acid and intrinsic factor. This reduces the amount of vitamin B12, particularly food-bound vitamin B12, that the body releases and absorbs. Surgical removal of the distal ileum also can result in the inability to absorb vitamin B12. Individuals undergoing these surgical procedures should be monitored preoperatively and postoperatively for several nutrient deficiencies, including vitamin B12 deficiency.
Vegetarians: Strict vegetarians and vegans are at greater risk than lacto-ovo vegetarians and non-vegetarians of developing vitamin B12 deficiency because natural food sources of vitamin B12 are limited to animal foods. Fortified breakfast cereals and fortified nutritional yeasts are some of the only sources of vitamin B12 from plants and can be used as dietary sources of vitamin B12 for strict vegetarians and vegans. Fortified foods vary in formulation, so it is important to read the Nutrition Facts labels on food products to determine the types and amounts of added nutrients they contain.
Pregnant and lactating women who follow strict vegetarian diets and their infants: Vitamin B12 crosses the placenta during pregnancy and is present in breast milk. Exclusively breastfed infants of women who consume no animal products may have very limited reserves of vitamin B12 and can develop vitamin B12 deficiency within months of birth. Undetected and untreated vitamin B12 deficiency in infants can result in severe and permanent neurological damage.
The American Dietetic Association recommends supplemental vitamin B12 for vegans and lacto-ovo vegetarians during both pregnancy and lactation to ensure that enough vitamin B12 is transferred to the fetus and infant. Pregnant and lactating women who follow strict vegetarian or vegan diets should consult with a pediatrician regarding vitamin B12 supplements for their infants and children.
Health Risks from Excessive Vitamin B12
The IOM did not establish a UL for vitamin B12 because of its low potential for toxicity. In Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, the IOM states that “no adverse effects have been associated with excess vitamin B12 intake from food and supplements in healthy individuals”.
Findings from intervention trials support these conclusions. In the NORVIT and HOPE 2 trials, vitamin B12 supplementation (in combination with folic acid and vitamin B6) did not cause any serious adverse events when administered at doses of 0.4 mg for 40 months (NORVIT trial) and 1.0 mg for 5 years (HOPE 2 trial).
Interactions with Medications
Vitamin B12 has the potential to interact with certain medications. In addition, several types of medications might adversely affect vitamin B12 levels. A few examples are provided below. Individuals taking these and other medications on a regular basis should discuss their vitamin B12 status with their healthcare providers.
Chloramphenicol: Chloramphenicol (Chloromycetin®) is a bacteriostatic antibiotic. Limited evidence from case reports indicates that chloramphenicol can interfere with the red blood cell response to supplemental vitamin B12 in some patients.
Proton pump inhibitors: Proton pump inhibitors, such as omeprazole (Prilosec®) and lansoprazole (Prevacid®), are used to treat gastroesophageal reflux disease and peptic ulcer disease. These drugs can interfere with vitamin B12 absorption from food by slowing the release of gastric acid into the stomach. However, the evidence is conflicting on whether proton pump inhibitor use affects vitamin B12 status. As a precaution, healthcare providers should monitor vitamin B12 status in patients taking proton pump inhibitors for prolonged periods.
H2 receptor antagonists: Histamine H2 receptor antagonists, used to treat peptic ulcer disease, include cimetidine (Tagamet®), famotidine (Pepcid®), and ranitidine (Zantac®). These medications can interfere with the absorption of vitamin B12 from food by slowing the release of hydrochloric acid into the stomach. Although H2 receptor antagonists have the potential to cause vitamin B12 deficiency, no evidence indicates that they promote vitamin B12 deficiency, even after long-term use. Clinically significant effects may be more likely in patients with inadequate vitamin B12 stores, especially those using H2 receptor antagonists continuously for more than 2 years.
Metformin: Metformin, a hypoglycemic agent used to treat diabetes, might reduce the absorption of vitamin B12, possibly through alterations in intestinal mobility, increased bacterial overgrowth, or alterations in the calcium-dependent uptake by ileal cells of the vitamin B12-intrinsic factor complex. Small studies and case reports suggest that 10%–30% of patients who take metformin have reduced vitamin B12 absorption. In a randomized, placebo controlled trial in patients with type 2 diabetes, metformin treatment for 4.3 years significantly decreased vitamin B12 levels by 19% and raised the risk of vitamin B12 deficiency by 7.2% compared with placebo. Some studies suggest that supplemental calcium might help improve the vitamin B12 malabsorption caused by metformin, but not all researchers agree.
Background: Low vitamin B-12 status is prevalent among the elderly, but few studies have examined the association between vitamin B-12 status and intake.Objective: We hypothesized that vitamin B-12 concentrations vary according to intake source.Design: Plasma concentrations and dietary intakes were assessed cross-sectionally for 2999 subjects in the Framingham Offspring Study. The prevalence of vitamin B-12 concentrations <148, 185, and 258 pmol/L was examined by age group (26–49, 50–64, and 65–83 y), supplement use, and the following food intake sources: fortified breakfast cereal, dairy products, and meat.Results: Thirty-nine percent of subjects had plasma vitamin B-12 concentrations <258 pmol/L, 17% had concentrations <185 pmol/L, and 9% had concentrations <148 pmol/L, with little difference between age groups. Supplement users were significantly less likely than non-supplement-users to have concentrations <185 pmol/L (8% compared with 20%, respectively). Among non-supplement-users, there were significant differences between those who consumed fortified cereal >4 times/wk (12%) and those who consumed no fortified cereal (23%) and between those in the highest and those in the lowest tertile of dairy intake (13% compared with 24%, respectively), but no significant differences by meat tertile. Regression of plasma vitamin B-12 on log of intake, by source, yielded significant slopes for each contributor adjusted for the others. For the total group, b = 40.6 for vitamin B-12 from vitamin supplements. Among non-supplement-users, b = 56.4 for dairy products, 35.2 for cereal, and 16.7 for meat. Only the meat slope differed significantly from the others.Conclusions: In contrast with previous reports, plasma vitamin B-12 concentrations were associated with vitamin B-12 intake. Use of supplements, fortified cereal, and milk appears to protect against lower concentrations. Further research is needed to investigate possible differences in bioavailability.