Vitamin B. It's more than just B-12, and it's not all created equal

[smg 471]

So prior to surgery I was informed by my GP to "make sure I watch my Vitamin B levels after surgery", and I heard it again from doing research online, and then I heard it again from my Nutritionist in my pre-op class. Obviously, all Vitamins are important, but Vitamin B is what I heard the most, and that made me concerned, but also curious as to why.

What is Vitamin B and why do we need it?

Why are bariatric patients prone to Vitamin B deficiencies?

What are good food sources that are high in Vitamin B?

I did a lot of research, confirmed my findings with my Nutritionist and surgeon, and thought that I would share them here for those still in the research phase pre-op, or even those that have concerns post-op about Vitamin B.

**DISCLAIMER**

I am not a Doctor, Nutritionist, or Medical Professional. Please consult your Doctor before starting or changing any recommended supplements. This is simple research that can be found on the Internet and should NOT be taken as medical advice!!!

WHAT IS VITAMIN B AND WHY DO WE NEED IT?

First off, let me clear up one common misconception. "Vitamin B" is not actually a singular vitamin. It's a class of vitamins. It's 8 vitamins overall that make up the Vitamin B family, they each play an important role in our bodies, and they are often classified under various names aside from "Vitamin B-1, Vitamin B-2, etc".

The biggest role B-Vitamins play in our bodies is maintaining cell health, as well as keeping us energized. Each B-Vitamin plays its part, and each come from various sources. Foods or supplements that contain all 8 B-vitamins are known as Vitamin-B Complex. Knowing where each comes from and what it does is important for everyone, especially those of us who have had bariatric surgery as we are at greater risk for deficiencies in these important vitamins. Other factors contributing to a higher risk of deficiency are; older age, pregnant women, people with Crohn's disease or Celiac disease to name a few.

Below is a brief summary of each of the B-Vitamins, what they do, and what foods they're in.

Vitamin B-1 (THIAMINE)

Description: In short, Vitamin B-1 helps convert food into energy. It is a coenzyme in the catabolism of sugars and amino acids.

Deficiency: Symptoms of Deficiency in Vitamin B-1 can include emotional disturbances, encephalopathy, weakness or pain in extremities, irregular heartbeat, edema, heart failure.

Food Sources: Whole Grain Wheat, oatmeal, Flax, Sunflower Seeds, Brown Rice, Whole Grain Rye, Asparagus, Kale, Cauliflower, Potatoes, Oranges, eggs, Liver (Beef, pork and chicken). Many additional foods are fortified with Vitamin B-1 in the United States.

Vitamin B-2 (Riboflavin)

Description: Vitamin B-2 is an essential requirement for enzymes to perform various actions including the catabolism of fatty acids, but it is also important for maintaining good eyesight.

Deficiency: Symptoms can include cracked lips, sensitivity to sunlight, sore throat, edema, tongue swelling, dermatitis, hyperemia.

Food Sources: Milk, cheese, Eggs, Dark Green Vegetables, Leafy Vegetables, legumes, mushrooms, almonds, liver, kidneys. Many additional foods are fortified with Vitamin B-2 in the United States.

Vitamin B-3 (Niacin)

Description: Vitamin B-3 is needed for many metabolic processes. It helps convert food into energy and also aids in proper digestion and appetite.

Deficiency: Symptoms can include digestive issues, nausea, cramps, aggression, dermatitis, insomnia, weakness, mental confusion, diarrhea, dementia

Food Sources: Liver, chicken Breast, Beef, Fish, Eggs, Venison, Avocados, Peanuts, Leafy Greens, Broccoli, Asparagus, Dates, Tomatoes, Carrots, Sweet Potatoes, Nuts, Legumes, Seeds, Mushrooms, Peanut Butter, Tofu

Vitamin B-5 (Pantothenic Acid)

Description: Vitamin B-5 aids oxidation of fatty acids and carbohydrates, and used in the synthesis of Coenzyme A (CoA), which is important in energy metabolism.

Deficiency: Deficiency is rare but symptoms can include acne and parasthesia.

Food Sources: Whole Grains (not refined), meat, Avocados, Broccoli, Alfalfa, Fish, Mushrooms, Brown Rice, Yeast.

Vitamin B-6 (Pyridoxine)

Description: Vitamin B-6 helps convert food into energy. It also helps the immune system fight off infection. It also helps women who are pregnant or breastfeeding to help babies brains develop normally.

Deficiency: Symptoms can include dermatitis, pink-eye, epilepsy, neurological issues, anemia, depression, confusion, nausea, rashes

Food Sources: tuna, Salmon, Chickpeas (Garbanzo Beans), Whole Grains, Beef Liver, Ground Beef, Chicken Breast, Watermelon, Potatoes, Spinach

Vitamin B-7 (Biotin)

Description: Vitamin B-7 is necessary for cell growth. It also plays a key role in the production of fatty acids, and the metabolism of fats and amino acids. It also assists in various metabolic reactions involving the transfer of CO2. It may also be helpful in maintaining a stable blood sugar level. It's often recommended as a supplement to promote strong hair and nails, but the scientific data supporting these claims are weak and heavily scrutinized.

Deficiency: Deficiency does not typically cause symptoms in adults, but can impair growth and cause neurological defects in infants.

Food Sources: Peanuts, Swiss Chard, Leafy Greens, Egg Yolk, Liver, Saskatoon Berries

Vitamin B-9 (Folic Acid)

Description: Vitamin B-9 helps with the growth of red blood cells. Folic Acid helps reduce birth defects. Folic Acid is also used by the body to make and repair DNA, as well as methylate DNA. It's especially important in aiding rapid cell division and growth during infancy and pregnancy.

Deficiency: Symptoms can include anemia, diarrhea, and deficiencies in pregnant women can cause birth defects.

Food Sources: Whole Grains, Leafy Greens, Beets, Meat, Fish, Legumes, Liver, Citrus. Many additional foods are fortified with Vitamin B-9 in the United States (cereal).

Vitamin B-12 (Cobalamin)

Description: Vitamin B-12 helps regulate the nervous system. It also plays a key role in red blood cell growth, the production of bone marrow, and the cellular metabolism of carbohydrates, Proteins and lipids.

Deficiency: Symptoms can include anemia, confusion, fatigue, weakness, irritability, depression, tingling in extremities

Food Sources: Vitamin B-12 is found primarily in animal based foods, and those on a strict vegan diet can be at more risk than others. Eggs, Cheese, Milk, Fish, Shellfish, Liver, Kidney, Beef, Red Meat

WHY ARE BARIATRIC PATIENTS AT RISK FOR B-12 DEFICIENCIES?

Vitamin B-12 relies on proteins for successful intestinal absorption in the human body:

Haptocorrin (transcobalamin) secreted by the salivary glands is essential in protecting Vitamin B-12 while traveling through the acid of the stomach.

Intrinsic Factor: This is a glycoprotein that is produced by the cells of the stomach. It is essential for the absorption of Vitamin B-12 in the small intestine.

Because bariatric patients of certain procedures have up to 85% of their stomachs removed, the majority of the cells that produced intrinsic factor are also removed. Simply adding a Vitamin B-12 supplement may not be enough in these patients as some supplements still require intrinsic factor to be properly absorbed. There are two major types of Vitamin B-12 found in supplements:

Cyanocobalamin: A synthetic form of Vitamin B-12, This is the more common form of B-12 found on the market, because it is the easiest to make, not because it's the best (certainly not for bariatric patients). This form is made with a cyanide element that is excreted. The presence of cyanide in this amount is nothing to be alarmed about (although I gasped the first time I saw it). The problem with cyanocobalamin is that it needs to be methylated before the body can absorb it properly. To do this it requires intrinsic factor, which is reduced in bariatric patients. Basically your body needs to convert Cyanocobalamin into Methylcobalamin before it can be used by your body.

Methylcobalamin: Vitamin B-12 in this form remains in your body for longer periods, and at higher levels than cyanocobalamin, making it available to your body for a longer period of time. Because this form of Vitamin does NOT need intrinsic factor to be absorbed by the body, it is far more available for use by your body as a bariatric patient, and you are not restricted to oral use. sublingual (under the tongue), melts, Patches, sprays, and creams are alternative ways to use this form of Vitamin B-12 and make it available immediately.

When researching supplements and vitamins, make sure to look at the label. The label should read: "Vitamin B-12 (as Methylcobalamin)". Be sure to look. As I mentioned previously, Cyanocobalamin is more common because it is cheaper and easier to make.

I hope this helps someone during their research and those who have questions about the B-Vitamin family. If I missed anything, please add it below and I'll edit this post.

Best of luck!

[Djmohr 6,965]

This was very interesting. At my 6 month labs I was determined to be slightly Vitamin B1 deficient. I have been on a B1 Vitamin ever since.

My levels have been normal since I began taking them.

Thanks for sharing this!

[NeedaBreak4Me 1,755]

You should always try to take the methylated form in Vitamins, they are more readily absorbed into your system.

I use the following multi, it has all the correct methylated Vitamins in excellent quanitities.

I have not had any nutritional issues since my surgery so far.

http://www.lifeextension.com/vitamins-supplements/item02001/one-per-day-tablets

[missdeeAus 69]

Are u only able to buy this product online? I must say I was told to buy centurim by my dietician. Perhaps when the jar runs out.

Sent from my iPhone using the BariatricPal App

[smg 471]

@@missdeeAus There are many products that use the Metthylcobalamin form of B-12. I don't know if Centrum is one of them or not. The Multivitamin that I use has most of the B-Vitamins including methylcobalamin B-12, but I also take a B-Complex Vitamin where the B-12 is methylcobalamin.

The Multivitamin I take: http://www.opurity.com/products/opurityr-complete-capsules-for-gastric-sleeve-gastric-bypass-and-gastric-band-360-capsules.html

The B-Complex Vitamin I take: http://www.orthomolecularproducts.com/ortho-b-complex/

I get the opurity Multi from the above link. The B-Complex vitamin I get from my surgeon/NUT but they also sell them online at Amazon -- http://amzn.to/2bp3pYd

[smg 471]

You should always try to take the methylated form in Vitamins, they are more readily absorbed into your system.

I use the following multi, it has all the correct methylated Vitamins in excellent quanitities.

I have not had any nutritional issues since my surgery so far.

http://www.lifeextension.com/vitamins-supplements/item02001/one-per-day-tablets

I like LifeExtension products. They consistently rate high in various tests on labdoor. I use their Magnesium product. I don't use the "Natural Vitality Calm" stuff that's pretty popular as it's known to have super-high levels of arsenic in it. Love the LifeExtension Magnesium as an alternative.

For my multi, however, I choose a "bariatric formulated" version that I know to be clean, simply because it includes higher amounts of vitamins that are easy to become deficient in, but that's just me and based on recommendations from my surgeon/NUT. Thanks for sharing!

Edited August 18, 2016 by smg

[Christinamo7 4,041]

I drink the Vitamin Water zero - I have to limit myself to 2 per day because my b Vitamins were too high at my last appointment. curious to see where they will be tomorrow at my six month check.

I have no idea what kind of B is in there - but clearly it is working for me.

[smg 471]

I drink the Vitamin Water zero - I have to limit myself to 2 per day because my b Vitamins were too high at my last appointment. curious to see where they will be tomorrow at my six month check.

I have no idea what kind of B is in there - but clearly it is working for me.

Vitamin Water Zero contains Vitamin B3, B5 and B12 from cyanocobalamin. I'm assuming you also take a Multi-Vitamin? There are also a lot of foods that are fortified with B Vitamins in the United States. Which B-Vitamins were you high in out of curiosity? The one most bariatric patients are prone to deficiencies in is B-12 because of the absorption issues due to a reduced amount of intrinsic factor being produced. As far as B-12 in foods, there is plenty in most meat/dairy products, and if your stomach is producing enough intrinsic factor to methlyate it you would certainly get enough.

It is possible that your stomach, though smaller from the sleeve, is still producing enough intrinsic factor to methylate the cyanocobalamin and B-12 from foods and synthetic cyanocobalamin sources. Since your body can't use B-12 until it becomes methylcobalamin, then either your other supplements include this form or your body is producing enough of the intrinsic factor Protein to absorb it....either way it's a good thing

If you look at most supplements, the amounts of B-Vitamins they include are FAR BEYOND the recommended daily amounts because most of us can't absorb all of it. B-12 can be added in some supplements as high as 16,000% of the daily amounts to make sure you get enough, so having high readings is not out of the question.

For most people, "too much B-vitamins" won't be an issue, although for some it may be. Too much B6 or B3 *could* be an issue for some, but the amounts needed for symptoms in most people are astronomical and won't be a concern for most if the sources of B-vitamins are coming from supplements (at the directed dosage) and food.

Some people who take cholesterol meds may want to check if their meds contain high levels of Vitamin B-3 (Niacin), though.

[Christinamo7 4,041]

12 and 6 were seriously high. I use the garden of life womens once daily. all of my other labs were normal. so, we'll see how things are tomorrow and if any changes need to be made. I will say I do eat chicken breast, red meat, eggs, almonds, green veg. but I'd hardly say I eat a lot of anything - a lot less than I ever used to, that's for sure.

[smg 471]

12 and 6 were seriously high. I use the garden of life womens once daily. all of my other labs were normal. so, we'll see how things are tomorrow and if any changes need to be made. I will say I do eat chicken breast, red meat, eggs, almonds, green veg. but I'd hardly say I eat a lot of anything - a lot less than I ever used to, that's for sure.

Garden of Life is another good brand. I use Probiotics from them and really like them. Good to hear that you're Vitamins and diet are working...nothing better than leaving the doc with a thumbs up and good labs

[linah 92]

Thanks for sharing this! Lots of useful info :-)

Sent from my SM-G900FD using the BariatricPal App

[NeedaBreak4Me 1,755]

Are u only able to buy this product online? I must say I was told to buy centurim by my dietician. Perhaps when the jar runs out.

Sent from my iPhone using the BariatricPal App

We do not have methylated Vitamins in Australia, i don't know why...

But i buy them from iherb, they normally arrive in around 3 days.