Vitamin B12 Deficiency and Bone Health

Vitamin B12 Deficiency and Bone Health

September 15, 2014 | 61,791 views

By Dr. Mercola

Studies from the US Framingham trial show nearly two-fifths of the US population may have suboptimal blood levels of vitamin B12.1 And the criteria they use to make this assessment is 6-700 pg/ml, so it may be the majority of people who are vitamin B12 deficient.

This is important to be aware of, and correct if it applies to you, as vitamin B12 is important for the formation of red blood cells, the maintenance of your central nervous system, and plays a role in the production of DNA and RNA.

Vitamin B12 is also fittingly known as the energy vitamin, and your body requires it for a number of vital functions, including energy production. Much less is known about its role in bone health, although it's emerging as an important player.

Even though vitamin B12 is water-soluble, it doesn't exit your body quickly in your urine like other water-soluble vitamins. Instead, B12 is stored in your liver, kidneys, and other body tissues.

As a result, a deficiency may not show itself until up to seven years later, and by this time damage to your bones may have already set in…

Vitamin B12 Deficiency May Harm Your Bones

Research published in the New England Journal of Medicine (NEJM) revealed that mice deficient in vitamin B12 have growth retardation and fewer osteoblasts (cells responsible for bone formation).2

The researchers suggested that lack of vitamin B12 may interfere with growth signaling in the liver and its "downstream effect" on the osteoblasts.

Recent research also suggests low vitamin B12 status may increase the risk for bone fractures in older men.3 This risk remained even after taking into account other important factors such as smoking, vitamin D status, and calcium intake. As reported by MedicineNet:4

"Men in the group with the lowest B-12 levels were about 70 percent more likely to have suffered a fracture than others in the study. This increased risk was primarily due to fractures in the lumbar spine, where there was an up to 120 percent greater chance of fractures."

Older women with low levels of vitamin B12 (below 208 pg/ml) also experienced significantly more rapid hip bone loss – a sign of osteoporosis – than women with higher levels of B12 in a separate study.5

Elevated homocysteine levels (an amino acid) and low vitamin B12 have also been associated with deteriorated bone health,6 and this may be one avenue by which B12 influences bone health (B vitamins are known to suppress homocysteine). As explained by the Linus Pauling Institute:7

"High homocysteine levels may affect bone remodeling by increasing bone resorption (breakdown), decreasing bone formation, and reducing bone blood flow.

Another proposed mechanism involves the binding of homocysteine to the collagenous matrix of bone, which may modify collagen properties and reduce bone strength.

Since vitamin B12 is a determinant of homocysteine metabolism, it was suggested that the risk of osteoporotic fractures in older subjects might be enhanced by vitamin B12 deficiency."

Indeed, a meta-analysis found that raising vitamin B12 levels in older individuals lead to a reduction in fracture risk.8

Move Over Vitamin D and Calcium, Are You Getting Enough Vitamin B12?

Vitamin D, calcium, magnesium, and vitamin K2 are crucial for bone health, but also are among the most common supplements taken by older adults for this very reason. Vitamin B12, on the other hand, is often overlooked.

If you're a vegan who does not eat animal products, you are at high risk of deficiency, as B12 is readily bioavailable in its natural form only in animal food sources. This doesn't necessarily have to be meat -- eggs and dairy are options also. Top foods to include are:

• Wild-caught Alaskan salmon
• Raw milk
• Pastured free-range eggs

If you do consume animal products, then consider adding these foods that are even higher in vitamin B12:

• Grass-fed beef and beef liver
• Pastured organic free-range chicken

However, keep in mind that even if you do eat animal foods, a supplement can be beneficial if your body's ability to absorb the vitamin from food is compromised, which is especially prevalent as you age.

When you get older, the lining of your stomach gradually loses its ability to produce hydrochloric acid (the stomach acid suppressed by proton pump inhibitors), which releases vitamin B12 from your food. If you're over 50, it's safe to assume you are not absorbing vitamin B12 at an optimal level.

However, just because you are over 50, it doesn't mean you are deficient, it only means your risk increases. If you are eating a healthy diet, you can easily maintain healthy levels. The only way to know for sure is to get your blood tested.

Normal ranges of B12 are 200-1,100 pg/ml. Even though the lower level of normal is 200, if you are below 600, you might be suffering from B12 deficiency. There is one problem with supplementation however, and it's related to the poor absorbability of oral vitamin B12 supplements.

Vitamin B12 is the largest vitamin molecule known. Because of its large size, it is not easily absorbed passively like most supplements. This is why many, if not most, oral B12 supplements are grossly ineffective. The only effective form of B12 supplementation is IM injections or sublingual administration.

That said, B12 supplements are exceptionally safe, with virtually no known side effects. Just avoid oral B12 supplements, as they will not be readily absorbed. Injections or a sublingual (under your tongue) spray work far better, as they allow the large B12 molecule to be absorbed directly into your bloodstream.

What Else Do You Risk by Not Getting Enough Vitamin B12?

Your risk of fracture might increase, but that's not all. Some of the initial signs of B12 deficiency will often include mood changes, such as lack of motivation or feelings of apathy. Low levels can also lead to mental fogginess, memory troubles, muscle weakness, and -- one of the hallmark signs -- fatigue. Vitamin B12 also plays a role in:

Proper digestion, food absorption, iron use, and carbohydrate and fat metabolism	Healthy nervous system function	Promotion of normal nerve growth and development
Help with regulation of the formation of red blood cells	Cell formation and longevity	Proper circulation
Adrenal hormone production	Healthy immune system function	Support of female reproductive health and pregnancy
Feelings of well-being and mood regulation	Mental clarity, concentration, and memory function	Physical, emotional, and mental energy

Vitamin B12's role in brain health and mental health is particularly significant. According to a small Finnish study published in the journal Neurology, people who consume foods rich in B12 may reduce their risk of Alzheimer's in their later years.9 For each unit increase in the marker of vitamin B12 (holotranscobalamin), the risk of developing Alzheimer's was reduced by 2 percent.

Meanwhile, B group vitamins may slow brain shrinkage by as much as seven-fold in brain regions specifically known to be most impacted by Alzheimer's disease.10 Among participants taking high doses of folic acid and vitamins B6 and B12, blood levels of homocysteine were lowered, as was the associated brain shrinkage – by up to 90 percent. As discussed by Dr. Kelly Brogan, MD in the video below, vitamin B12 deficiency can even cause a range of neurological disturbances that mimic serious mental illness.

The Best 'Recipe' for Bone Health

One of the important strategies for healthy bones is to eat the right kind of foods. A diet full of processed foods will produce biochemical and metabolic conditions in your body that will decrease your bone density, so avoiding processed foods is definitely the first step in the right direction. This goes far beyond calcium, which is the first nutrient many people think of concerning their bones. Your bones are actually composed of several different minerals, and if you focus on calcium alone, you will likely weaken your bones and increase your risk of osteoporosis, as Dr. Robert Thompson explains in his book, The Calcium Lie.

Calcium, vitamins D and K2, and magnesium work synergistically together to promote strong, healthy bones, and your sodium to potassium ratio also plays an important role in maintaining your bone mass (larger amounts of potassium in relation to sodium is optimal for your bone health and your overall health). Ideally, you'd get all or most of these nutrients, including vitamin B12, from your diet (with the exception of vitamin D). This includes:

• Plant-derived calcium: Raw milk from pasture-raised cows (who eat the plants), leafy green vegetables, the pith of citrus fruits, carob, and sesame seeds
• Magnesium: Raw organic cacao and supplemental magnesium threonate if need be
• Vitamin K2: Grass-fed organic animal products (i.e. eggs, butter, and dairy), certain fermented foods such as natto, or vegetables fermented using a starter culture of vitamin K2-producing bacteria, and certain cheeses such as Brie and Gouda
• Trace minerals: Himalayan Crystal Salt, which contains all 84 elements found in your body, or other natural, unprocessed salt (NOT regular table salt!)
• Vitamin D: Ideally from appropriate sun exposure (or a safe tanning bed), as it's virtually impossible to get sufficient amounts from food. As a last resort, you could use a supplement, but if you do, you may also need to supplement with vitamin K2 to maintain ideal ratios

Remember to Exercise Regularly and Use Strength Training

Although the focus of this article is on nutrition, the other component you can't ignore if you want strong, healthy bones is weight-bearing exercises like strength training. Bone building is a dynamic process, so you want to make sure you exert enough force on your bones to stimulate the osteoblasts to build new bone. Further, bone is living tissue that requires regular physical activity in order to renew and rebuild itself, it is important to make exercise a lifelong commitment. Peak bone mass is achieved in adulthood and then begins a slow decline, but exercise can help you to maintain healthy bone mass as you get older, and should be viewed as a bone-building partner to your healthy diet.

Weight-bearing exercise is actually one of the most effective remedies against osteoporosis, because as you put more tension on your muscles it puts more pressure on your bones, which then respond by continuously creating fresh, new bone. In addition, as you build more muscle, and make the muscle that you already have stronger, you also put more constant pressure on your bones. A good weight-bearing exercise to incorporate into your routine (depending on your current level of fitness, of course) is a walking lunge, as it helps build bone density in your hips, even without any additional weights.

In addition, Acceleration Training, a.k.a. Whole Body Vibrational Training (WBVT) using a Power Plate, has also been shown to be a safe, natural way to ward off osteoporosis, and it's gentle enough even for the disabled and elderly. Research shows vibrational training may help to produce a significant increase in bone density in postmenopausal women,11 making it another valuable tool for bone health.