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Greyson, Ashley. Vitamin B12. KNH 413 – Medical Nutrition Therapy II. Miami University, Oxford, Ohio, Spring 2013. Vitamin B12 1. What is the nutrient? Vitamin B12 2. What is the RDA/DRI for the nutrient? Age Male Female Pregnancy Lactation 0-6 months .4 mcg .4 mcg 7-12 months .5 mcg .5 mcg 1-3 years .9 mcg .9 mcg 4-8 years 1.2 mcg 1.2 mcg 9-13 years 1.8 mcg 1.8 mcg 14+ years 2.4 mcg 2.4 mcg 2.6 mcg 2.8 mcg http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ 3. How is the nutrient metabolized? In contrast to other water-soluble vitamins, it is not excreted quickly in the urine, but rather accumulates and is stored in the liver, kidney and other body tissues. It is normally involved in the metabolism of every cell of the human body, especially affecting DNA synthesis and regulation, but also fatty acid synthesis and energy production. http://pureherbalextracts.com/wholesale-supplements/vitamin-b12-supplements.html 4. What are food sources of the nutrient? - Clams, Oysters and mussels - Liver - Caviar - Octopus - Fish - Crab and Lobster - Beef - Lamb - Cheese - Eggs http://www.healthaliciousness.com/articles/foods-high-in-vitamin-B12.php 5. What disease states alter the nutrients metabolism? - Pernicious Anemia condition in which the body can't make enough healthy red blood cells because it doesn't have enough vitamin B12. - Infections - Surgery - Medicines - Crohn’s disease - Short bowel syndrome - Gastrointestinal disorders http://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/printall-index.html 6. What are the tests or procedures to assess the nutrient level in the body? - Complete Blood Count (CBC) The CBC is used as a broad screening test to look for such disorders as anemia, infection, and a variety of other diseases as well. - Vitamin B12 Test to measure the level of this vitamin in the blood - Homocysteine test and Methylmalonic Acid (MMA) test MMA primarily is ordered, sometimes along with homocysteine, to help diagnose an early or mild B12 deficiency. It may be ordered as a follow-up to a vitamin B12 test for which the result is in the lower end of the normal range. Some researchers have suggested using MMA as a screening tool, especially among the elderly, who frequently have B12 deficiencies and may have few recognizable symptoms. However, the use of MMA is still controversial in the medical community and not used frequently for this purpose. http://www.bami.us/Diet/VitB12.html 7. What is the drug –nutrient interactions? Drug Proton pump inhibitors (PPIs) are used to treat gastroesophageal reflux disease (GERD) and peptic ulcer disease: Prilosec, Prevacid, Nexium, and Aciphex Potential Interaction PPI medications can interfere with vitamin B12 absorption from food by slowing the release of hydrochloric acid into the stomach. This is a concern because acid is needed to release vitamin B12 from food prior to absorption. So far, however, there is no evidence that these medications promote vitamin B12 deficiency, even after long-term use. H2 receptor antagonists are used to H2 receptor antagonists can interfere with vitamin B12 treat peptic ulcer disease. Tagamet, absorption from food by slowing the release of Pepsid, and Zantac hydrochloric acid into the stomach. This is a concern because acid is needed to release vitamin B12 from food prior to absorption. So far, however, there is no evidence that these medications promote vitamin B12 deficiency, even after long-term use. Metformin is used to treat diabetes. Metformin may interfere with calcium metabolism. This may indirectly reduce vitamin B12 absorption because vitamin B12 absorption requires calcium. Surveys suggest that from 10% to 30% of patients taking Metformin have evidence of reduced vitamin B12 absorption. http://www.bami.us/Diet/VitB12.html 8. How is the nutrient measured? Micrograms (ug) per serving (example below) Food Micrograms (μg) Percent per serving Daily Value Mollusks, clam, mixed species, cooked, 3 ounces 84.1 1400 Liver, beef, braised, 1 slice 47.9 780 Fortified breakfast cereals, (100%) fortified), ¾ cup 6.0 100 Trout, rainbow, wild, cooked, 3 ounces 5.4 90 Salmon, sockeye, cooked, 3 ounces 4.9 80 Trout, rainbow, farmed, cooked, 3 ounces 4.2 50 http://www.bami.us/Diet/VitB12.html 9. What is the Upper Tolerable Limits? None, as there is no toxicity http://www.umm.edu/patiented/articles/what_vitamins_000039_1.htm 10.What are the physical signs of deficiency? The consequences of vitamin B12 depletion -- anemia and potentially irreversible nerve damage. Easy bone fractures are a sign, along with depression, memory loss, instability, disorientation, decreased reflexes and possible hearing loss. http://www.umm.edu/patiented/articles/what_vitamins_000039_1.htm 11.What are physical signs of toxicity? No evidence of toxicity of this vitamin http://www.umm.edu/patiented/articles/what_vitamins_000039_1.htm