Q: I have been taking a multivitamin because senior citizens need more vitamin B12 than younger people. I heard that I should take B12 separately, because the multivitamin doesn’t contain enough. I find that hard to believe —- the amount of B12 meets USRDA standards.

— E.T., Schenectady, N.Y.

A: B12, also called cobalamin, is safe even at very high doses. Did you know it contains the mineral cobalt? You can get B12 from your diet by eating fish, dairy products, eggs, beef, pork and organ meats such as liver.

Vegetarians will need supplementation to stay healthy. The USRDA (recommended daily allowance) isn’t enough to advance optimal health or replenish you if you are deficient.

Seniors don’t absorb B12 from their GI tract as well as younger folks do. A B12 deficiency may cause fatigue, pale skin, diarrhea, weight loss, numbness or tingling in the hands and feet, loss of balance, confusion, memory loss, sores in the mouth, depression and mood swings.

The scary part is that a B12 deficiency can “look” like any number of psychiatric and neurological conditions, so it’s important to rule out a deficiency before you wind up on all sorts of drugs or have multiple surgeries.

Also, B12 is important in preventing heart disease, because it (along with folic acid) helps reduce inflammatory chemicals like homocysteine. See why I like it so much?

Your physician’s office can run a blood test to determine deficiency, but blood levels of B12 don’t always reflect the levels of B12 in your nerve tissue.

The type of B12 matters and, yes, taking it separately in larger doses is better. The amount contained in multivitamins is too low to protect you from heart disease and way too low if you have central nervous system damage of any sort. It’s your nerve nutrient. Let’s talk about that, since some of my readers are in disabling pain.

If you have multiple sclerosis, spinal cord lesions, peripheral neuropathy, trigeminal neuralgia, ALS, Alzheimer’s, Parkinson’s, muscular dystrophy or any condition that causes aberrant nerve misfiring or demyelination (unraveling) of the nerve sheath, these conditions may be improved by injecting a special, active form of B12 called methylcobalamin.

(You should take approximately 5,000 mcg daily for a week and then once weekly for a few weeks.)

Methylcobalamin helps insulate damaged nerve fibers and regenerate healthier neurons. Any physician can call a compounding pharmacy to order it. It’s different from the cyanocobalamin vials you get by prescription from pharmacies. That type doesn’t work as well for brain or spinal-cord problems.

Please be aware that whenever you take B12 in high dosages, you should take a full range of B-complex vitamins to maintain balance. Anyone with nerve damage should also consider DHA (essential fatty acids) to nourish and protect against more nerve damage.

If you take antibiotics, metformin for diabetes, seizure medications like phenytoin or Phenobarbital, or pretty much any acid-reducer or ulcer medication, you could become deficient in B12.

Did you know?

You can buy potent oral and sublingual forms of methylcobalamin at most health-food stores and pharmacies, as well as online.

Suzy Cohen is a registered pharmacist. This information is not intended to treat, cure or diagnose your condition. Always consult your physician. To contact her, go to http://www.dear pharmacist.com.

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