Wednesday, January 19, 2011

Liver Disease and Vitamin B 12

Liver Disease and Vitamin B 12

Vitamin B 12 and folate are both crucial to the formation of red blood cells. Therefore, a deficiency of these vitamins often leads to anemia and associated fatigue. This explains why individuals with liver disease who suffer from excessive fatigue, often ask about vitamin B12 injections. However, their expectation that such an injection will provide an “extra boost ” of energy is misguided. Since vitamin B12 is commonly found in animal food products such as meat, fish, milk and eggs, a vitamin B12 deficiency is a very uncommon cause of fatigue in individuals with liver disease. A few exceptions must be made to this statement. One exception applies to individuals with alcoholic liver disease for whom the bulk of nutrients are obtained from alcohol. A vitamin B12 deficiency may develop among these individuals. Furthermore, since alcohol interferes with the absorption of vitamin B12, a vitamin B12 deficiency may develop if a person consumes an excessive amount of alcohol even if he or she maintains a well-balanced diet. A vitamin B 12 deficiency may also occur in individuals with chronic liver disease who maintain a strict vegetarian diet for a long period of time, such as is the case for those suffering with chronic encephalopathy. Finally, the older a person is, the more likely a B12 deficiency is to develop. This is because stomach acid is needed to absorb this vitamin from food, and, as a person ages, the amount of acid in the stomach diminishes. Therefore, individuals with liver disease who are over the age of sixty, or individuals with liver disease who are chronically on medications that block stomach acid - such as H2 blockers (for example Pepcid, Axid, Tagamet, and Zantac) or proton-pump inhibitors (for example, Prilosec, Nexium, Prevacid, Aciphex and Protonix) should be checked for a vitamin B 12 deficiency. As with vitamin B12, a folate deficiency can also produce anemia. In fact, vitamin B 12 must be present in order to activate folate, which accounts for the fact that a deficiency of one tends to simultaneously cause a deficiency of the other.

Vitamin B12

B12 is important to every cell and system, including the blood and nervous system. Low levels of vitamin B12 (as well as folate and vitamin B6) are associated with high levels of homocysteine, an amino acid that, at elevated levels, is associated with an increased risk of heart disease and stroke and may also play a role in age-related mental decline and dementia. B12 is found naturally only in foods of animal origin; many other foods are fortified with it. The body can store large amounts.

Claims, purported benefits: B12 prevents confusion and memory loss in older people, protects the heart, peps you up, especially when given as injections. Treats canker sores.

Bottom line: Many people over age 50 don’t produce enough stomach acid to adequately absorb B12. A poor diet and heavy drinking can also contribute to a deficiency. Vegans (who eat no animal products) and people with intestinal diseases can also be at risk. Severe B12 deficiency can cause confusion, memory loss, tingling and weakness in the limbs, hallucinations, and listlessness. A much rarer but more serious type of B12 deficiency that can occur at any age is pernicious anemia, in which the stomach nearly stops producing acid and a protein also needed for absorption (intrinsic factor), so that virtually no B12 from food is absorbed. Initially this causes anemia, but eventually, when B12 stores are depleted, there can be irreversible damage to the nervous system. Blood tests can diagnose a B12 deficiency; high doses of B12 can correct it. Older people need 6 to 15 micrograms of B12 daily (the RDA is just 2.4 micrograms), easily obtained from food or a multivitamin. Most multis marketed for seniors have 25 or 30 micrograms. Unless you have been diagnosed as deficient you don’t need additional supplementation.

1 comment:

  1. I recently heard about a new oral prescription alternative to the injections called Eligen B12. I recently read that it works even if you don't have intrinsic factor (so even if you don't have normal gut absorption). Apparently it came out a month or two ago. Has anyone heard of it or tried it??