Vitamin B12 (Cobalamin)

Routine annual

also

What it isB12 is a cobalt-containing vitamin made by bacteria and obtained almost exclusively from animal foods. It requires intrinsic factor from the stomach for absorption in the ileum.

DoesActs as a cofactor in DNA synthesis, red blood cell production, fatty acid metabolism, and myelin formation around nerves.

GoodHigh-normal B12 supports red cell production, methylation, mood, and cognitive.

BadLow B12 causes megaloblastic anemia, peripheral neuropathy, cognitive impairment that mimics dementia, and elevated homocysteine. Common in vegans, older adults, and those on metformin or acid-suppressing drugs.

Standard
200–900 pg/mL.
Optimal
600–900 pg/mL (higher is good)
Modifiers
Falls with age, vegan diet, metformin, proton pump inhibitors, gastric bypass.

How to optimize

Lifestyle
Diet
Animal foods — fish, meat, eggs, dairy; nutritional yeast for vegans.
Supplements
Methylcobalamin or hydroxocobalamin (1000µg/day sublingual); injections for malabsorption.
Peptides
Drugs
Cyanocobalamin injections for severe deficiency or malabsorption.