B12: Harmless Vitamin? or Cancer's BFF?

Leah 0:00

Megaloblastic.

Introduction

Tina 0:02

It's a fun word.

Leah 0:03

It reminds me of like mega, isn't there some sort of like an undersea creature that's a megalot something or other, Giant whale Melo. Anyways.

Tina 0:12

it sounds like a cartoon character.

Leah 0:14

Hi Tina.

Tina 0:16

Hello, Leia?

Leah 0:17

We're talking about B12 today, aren't we?

Tina 0:20

Yes.

Leah 0:21

I should sound more enthusiastic, but, uh, through my, through my research, through my falling down the rabbit hole, I realized I like B12 It's too much.

Tina 0:30

It's too much. It's too complicated.

Leah 0:32

That's too complicated.

Tina 0:34

It's definitely the most complicated B-vitamin. I think

Leah 0:37

and you know, it's one of those things where people are like, oh, just take b12. You'll just pee it out. No, don't do that. You don't just pee it out. I mean, you do pee it out.

Tina 0:48

you do pee out. It's true. But you also store it and you may use it, but here's the thing. So in the grand scheme of things, generally speaking, I think B12 has gone under the. Why not take more? There's no toxic levels idea of nutritional supplementations, but within cancer care, that may not be true.

Leah 1:06

Right, right.

Tina 1:09

That's where we run into the, ah, man. Come on. Can anything be simple?

Leah 1:13

That's why I'm just like, this is too complicated.

Tina 1:16

All right, well, let's just untangle it. If it's complicated, let's make it simple, or at least simple enough to make it useful information and.

Leah 1:22

Hopefully not confuse all the people out there

Tina 1:25

No, no, no, no. We're gonna make it simple. We're gonna have take home points if this, then that. Always never, you know, those kind of things

Leah 1:34

Oh yeah, totally. That's what we're gonna do today. All right, so today on the cancer pod, we're talking b12. What is it? Where's it come from? Why do we need it? Stay tuned.

Tina 1:45

all that and more.

Leah 1:46

Oh, that and more on this episode of the Cancer Pod.

Tina 1:52

I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

Leah 1:56

and I'm Dr Leah Sherman and on the cancer inside

Tina 2:00

And we're two naturopathic doctors who practice integrative cancer care

Leah 2:04

But we're not your doctors

Tina 2:06

This is for education entertainment and informational purposes only

Leah 2:10

do not apply any of this information without first speaking to your doctor

Tina 2:15

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

Leah 2:21

Welcome to the cancer pod

Let's Talk B12

Tina 2:30

Let's talk b12.

Leah 2:32

let's talk b12. Sorry, I didn't mean to. I was just like, on our break I'm like, should I dress my cough? And then I'm like, I had the flu. I had the flu, y'all. I caught the flu, new Year's Day at a football game indoors at Lambo. I didn't wear a mask. And it's been like, this is three weeks.

Tina 2:58

Yeah, well, yeah, it's getting there.

Leah 3:00

Oh, well almost, almost three weeks. And I have this lingering cough. So don't get the flu, y'all. It suck.

Tina 3:06

No, but that does remind me of what I said to you yesterday, which was a cough. That doesn't resolve. You need to get a chest x-ray. So if it keeps up, you gotta check it out. Make sure there's nothing deeper.

Leah 3:16

I know

Tina 3:17

All right. As long as we're clear

Leah 3:20

Yes, doctor, I'm gonna drink my

Tina 3:23

All right. Back on topic. We're gonna talk about b12.

Leah 3:27

b12. We're talking

Cobalt? In B12?

Leah 3:28

about B12 today.

Tina 3:29

Also known as Cobalamin. So I'm just gonna geek out for a moment. So at the heart of every B12 molecule, I don't care which one it is, there's all sorts of versions that people can take as a supplement. And there's a couple versions that we make in our body. If it's b12, yet the heart of it is a cobalt molecule. Like cobalt, like the stuff we use for batteries. I'm just gonna say that because I think it's a cool little factoid.

Leah 3:54

Can you hear? That's Chloe goofing. She's poof. I don't know.

Tina 3:58

I think she's, I think she's excited about my point.

Leah 4:01

I think that she is frustrated with B12 like I am what the wolf,

Tina 4:06

All right, so we're gonna talk about deficiencies. We're gonna talk about high levels. We're gonna talk about what makes people prone to having a deficiency and how they can rectify that safely.

Leah 4:17

right? Because there are medications that people take on a day-to-day basis that can lead to, um, to B12 deficiencies. and yeah, that's like outside of like the whole, I'm being treated for cancer world as well.

B12- discovered in 1940's

Leah 4:30

so in my vast research I learned that vitamin B12 was first, I guess discovered or isolated in the forties in 1948, which I thought was interesting cuz it's really not that long.

Tina 4:43

No. No. But we were discovering vitamins kind of fast and furious during the, the forties there. It's one of those vitamins that we were. Re repeating people with before we knew we were doing it. Because there was in the early 19 hundreds, and maybe probably in the 18 hundreds as well, there was observation by doctors would lead to this diagnosis of a particular type of anemia and they would give liver extract in injectable form and they would actually inject people with liver extract that was isolated from animals.

Leah 5:10

Wait, like, like in their blood inject.

Tina 5:13

Into their muscle, usually. Mm-hmm.

Leah 5:15

Oh, well, yeah. Cuz you're supposed to, yeah. B12 is only supposed to be done through.

Tina 5:19

Yeah, they had no idea that it was B12 in the liver extract that they were giving. I'm always fascinated by this kind of medical stuff that happened over, over. Time and observation. This is long before we had evidence-based medicine. We just had case series observations. Doctors would write those observations up and that's how medical information was shared. There was no established kind of, you know, double-blind placebo controlled trials going on at that time.

Leah 5:46

And the, since the liver is where. Is stored one of the places where B12 is stored. It kind of makes a lot of sense. I wonder why they started using, was it just like some random, like, oh, let's just grab some liver extract and inject. That's just so crazy that people come up with something like that.

Tina 6:04

Well, you know, it was a time when doctors would do more of the art of medicine, which involved just observation and going from there. And so my guess is it was back in the day when. if there was trouble with an organ, you would give that organ from the animal. So when people had trouble with their liver and the doctor probably said, okay, this is why I think you have trouble with your liver. Let's give you liver extract you know, someone who has trouble with their kidneys by the assessment of the doctor. And that might involve looking at their blood. It might involve looking at their skin, their hair, their nails, and taking their symptomology into effect, looking at their urine. actually smelling their urine, seeing what color it is, everything, and say, oh, there's something wrong with your kidneys. Let's give you kidney extract. And so that was uh, pretty common back in the day. So I'm guessing that's how it evolved, the liver extract. But I don't know. I have never looked at how it came about.

Leah 6:53

Well, we're gonna have to go back down that rabbit hole, aren't we?

Tina 6:55

Yeah, there are so many.

Leah 6:57

There's a lot there. There are. There are a lot with b12.

Tina 7:01

Cause it's super interesting. That's why.

Leah 7:03

Yeah. Hmm. Hmm.

Why take supplemental B12?

Leah 7:06

So just a quick review as to why somebody would use a supplement over food. I guess I really, that would be really relevant for this because people who eat vegan diets aren't really getting b12.

Tina 7:19

Yes. Although, here's the thing, in nature, every molecule has to be produced. Right. Every molecule has to be produced from the elements that we have, mostly in our soil, some in our air, but mostly our soil. And so the bacteria themselves are what create b12 bacteria puts together these molecules of cobalamine from the. Elements in the soil, and sometimes they do it together with plants. So there's a symbiosis going on there. But ultimately, bacteria are organisms, I should say, because there might be some others besides bacteria. Maybe there's some yeast that can do it. I don't know. But technically, if vegans could get enough of the bacteria that makes it. they might be able to be replete. I haven't seen any studies to that effect, but I mean, theoretically they could eat bacteria and get it in fermented foods and cultured foods if those were purposely made.

Leah 8:18

if it's the right kind. Yeah. If it was the right kind of bacteria. But um, alas, they supplement because of the problems of not having enough b12. So that would be the way to kind of prevent or treat an acute nutrient deficiency of b12, which can cause neurological issues is the big one with a B12 de.

Tina 8:42

Yeah, and it, and this is why, you know, sublingual B12 is the way to take any B12 supplement. We'll talk about forms in a little bit like the different forms of vitamin B12 or cobalamine, but sublingual. Is ideal because it bypasses any problems that could be happening in the body with absorption. So when you do it sublingual, it goes directly into the bloodstream rather than through your gastrointestinal tract.

Leah 9:08

So, um, the other reason why we use supplements in general is to prevent, delay or treat chronic nutrient deficiencies. And with B12 that could be like somebody with perishes anemia, And then the green pharmacy usage for b12. Oh, there's so many. Are you frozen?

Tina 9:26

No, I'm thinking

Leah 9:27

Oh.

Tina 9:28

I'm a deep thought.

Leah 9:29

So, I mean like I, I think the green pharmacy thing is kind of more what people take for themselves as opposed to like, what's something we would recommend for. So people, you know, you get patients coming in and they're taking B12 cuz they're tired and somebody said, oh you should be taking B12 because it gives you energy. Or um, if they have any sort of neuropathy, they might take it. You know, there are different, thoughts. Why, people would take B12 as a supple.

Tina 9:55

the O And I'm thinking about our colleagues. Um, I know that there have been times that people will do injectable b12, so it's high doses of b12, intentionally megadosing it green pharmacy style, um, as an an antiviral. Yeah.

Leah 10:12

Hmm.

Tina 10:12

Yeah, it has been used in that sense, especially when it comes to things like shingles or that herpes family of viruses.

Leah 10:20

Oh, interesting.

Tina 10:21

yeah.

Leah 10:22

Yeah. Because isn't like the, there are the B vitamins for, treating, um, post-herpetic neuralgia, I think. And uh, what's the other one? Bell's Palsy is the other one I think of. Yeah.

Tina 10:36

Yeah. that's the other time I've seen it used.

Leah 10:38

Yeah, it's been a while.

Tina 10:39

I would call that green pharmacy because you're using mega doses.

Leah 10:43

totally. Great. And I guess green pharmacy. would that be the depleting what certain medications would be depleting? No, that would be preventing delaying or treating chronic nutrient deficiency. That would be number two,

Tina 10:58

Mm-hmm.

Leah 10:59

because yeah, there are medications, that can interact with the absorption of b12, like proton pump inhibitors or H two blockers, things that people take for acid reflux or gerd, because you need stomach acid in order to break apart. the B12 that comes from food. Um, and those medications decrease your stomach acid.

Tina 11:22

Yeah. So maybe we can take a break. Let's come back and talk. Exactly how it is absorbed and who is vulnerable to B12 deficiency after the break.

Leah 11:33

a

What causes B12 deficiency?

Tina 11:43

all right, we're back. So continue on with the medications that could cause B12 deficiency.

Leah 11:49

Oh yeah. Um, Metformin I think is a really, I mean, there are others, there's like Colchicine and stuff at the, you know, people aren't taking these on a regular basis. But, Metformin is another really big one where, because of the way that it's affecting the absorption in the small.

Tina 12:06

Well, that's, that's a big one cuz Metformin is used off-label within cancer care as well as diabetes of course.

Leah 12:12

Yeah, it's, it's, it's a medication that is commonly prescribed to people with type two diabetes

Tina 12:18

And there are studies showing that people who were on metformin who had ovarian cancer specifically, I can remember a study showing that people who happened to be taking metformin had better outcomes.

Leah 12:28

and I think some people were looking at it as well with breast cancer.

Tina 12:31

Mm-hmm.

Leah 12:33

But, um, yeah, so those are some medications that I commonly think of. Mostly the proton pump inhibitors, you know, the, the acid acid blockers as the kids say. And, um, metformin, those are the big ones. And aging, I mean, just aging in itself, that's not a medication, but you know, just getting older and having, um, decreased absorption,

Tina 12:56

Mm-hmm.

Leah 12:57

you know, changes in diet from, from aging. The thing that is kind of controllable is alcohol. And one of the things that I found in my, in my vast research is that heavy consumption of alcohol for over two weeks can cause a deficiency in b12.

Tina 13:21

Interesting. So basically parting like a rockstar for a couple weeks. We'll,

Leah 13:24

Yeah, like a couple weeks of spring. I don't know. Spring break is how long? I don't know. Let's just blame it on spring break. But yeah, partying like a rockstar for, you know, two weeks plus. Not to say that you should just party for a rockstar, like limit it to one week, but I think that's pretty dramatic. when is your rockstar partying to one week at a time. Um, yeah. And so, and then. other things that could affect the absorption. We kind of touched on pernicious anemia, Um, any surgeries that would affect your, your stomach or your small intestine. Definitely, and I guess we, we should kind of point out that, well you did before, like the liver is really the main storage place for b12 and so any sort of liver disease might also affect. b12.

Tina 14:12

Yeah. My understanding is that the liver can store about six months worth of b12. If you're on a desert island and not able to get b12, you've got about six months till it tanks and you need to start eating the animals on the island.

Leah 14:28

Which may be your travel partners. No,

Tina 14:30

Hey, that's gross,

Leah 14:33

I was like, I was thinking shellfish and then somehow lost came into my head. I never saw lost, but. Gilligans Island, they never ate each.

Tina 14:44

no, there was a lot of coconuts. So the other thing is family history. So if you do have especially parents, grandparents that you know, had B12 deficiency, you do need to, you know, pursue a the workup to make sure you didn't inherit some autoimmune condition. I did have, you know, true story. I had one patient with depression and an overall lack of motivation. I mean, he powered through every day. It was his wife that. dragged him in to see me back in the day. And, um, his b12, his serum B12 was low. Now if your serum B12 is low, you're pretty tanked. so we did do an autoimmune profile and sure enough, he had antibodies that his body was making that were attacking his own parietal cells. And those are the cells in the stomach that make intrinsic factor. Intrinsic factor is necessary to absorb the b12. Yeah, It was the only case that I had of it that was autoimmune in nature. Usually we're looking at you know, deficiency due to other reasons within cancer care.

Leah 15:50

well, celiac would be another autoimmune condition that would, affect the absorption. Um, oh, and then I didn't mention like the, the big one that I'm sure that you've seen all the time. I've big smart here. Um, I didn't mention. now I'm thinking of the Natural History Museum in New York. Um, with that giant tape worm, people with a tape worm can have B12 deficiencies. Did you ever see that in New York? Did you ever see that giant tape worm that's like wrapped around the ceiling? Probably. Pretty much. It's like disgusting.

Tina 16:22

No.

Leah 16:23

Yeah, it was at the museum.

Tina 16:25

So we talked about the risk factors. So we have family history. Problems with the GI tract, whether it's post-surgical or chronic issues with the stomach or intestines, that could be celiac disease, it could be chronic gastritis. There's a lot of medications that can interfere. And then we had vegans in particular, but maybe vegetarians to an extent if they're not eating well

Symptoms of B12 deficiency

Tina 16:48

in the signs and symptoms. Look a lot like all the other anemias.

Leah 16:52

Yeah. So. The one that I always find is fascinating is that glossitis, the really smooth tongue, um, smooth, shiny kind of red tongue.

Tina 17:02

Yeah. Which is indicative of B12 and a couple other B vitamins can show up that way as well. Where the tongue is larger, redder, maybe shinier losing its pilla.

Leah 17:16

Yeah. Um, and then the other one where I've seen is, um, those kind of neurological symptoms.

Tina 17:24

Mm-hmm.

Leah 17:25

Neuropathies.

Tina 17:26

Yeah. And the reason B12 shows up with neuropathy in particular is it's necessary to, for the health and the creation of the myelin sheath around the nerves. And so the sheath around a nerve is just like the covering on an electrical wire, you know, the rubber covering around the actual metal wires. It's analogous to that. So without that, the electrons don't flow normally down the wire, so the myelin sheath has to be intact, and B12 deficiency ultimately affects the health of the re myelin sheath. And then the rest of the symptoms are pretty generic for anemia. So it's fatigue. Parlor or paleness of the skin and mucus membranes, you know, so our, our mucus membranes, you can look at your gums in that if they look pale, you look the, at the conjunctiva, which is, you know, the part just in the eye where you get conjunctivitis or pink eye. Yeah, the pink of your eye. You can look at that and if it looks pale, um, so mucus membranes will show it before your skin does.

Leah 18:28

but it's not specific. What you're saying is it's not specific two b12, it's just showing there's some sort of anemia

Tina 18:34

Correct. Anemia is a generic term for just not getting enough of the oxygen to the tissue, and there's many different types of anemia. And you use the term pernicious anemia, which is a B12 driven anemia, and it's also called megaloblastic anemia. And the reason it has the name Megaloblastic is. on your labs, there is a parameter that talks about the size of your red blood cells, and if your red blood cells are large, then they're considered megaloblastic megalot, they're large. This parameter is called M C V, so anyone who gets. Cbc, which is stands for complete blood count underneath your hemoglobin and the number of red blood cells, you'll see a bunch of other parameters. They all have to do with the health of your red blood cells and what they look like. Ultimately, what they look like under a microscope. I mean, we run it through a machines today. We're not looking at them under a microscope for the L most part, but, When they're large, that M C V stands for mean corpuscular volume. Corpuscular just means red blood cells mean volume of the red blood cells. If that's high, over a hundred. There are a few things that could be happening. B12 deficiency is one of those things. Folate deficiency is another. And the most common reason for high M C V when people are going through chemotherapy treatment. is that those are baby red blood cells. That's not a problem. It's totally normal. When red blood cells are first formed, they're called reticulocytes and they're big and round and their volume is higher than a normal mature red blood cell. So a high M C V eight outta 10 times, I would say on a lab of someone who's getting chemotherapy just means they're making new red blood cells. And it's perfectly normal normal compensation Of the body It needs to churn out new red blood cells

Baby Huey and RBC's?

Leah 20:35

I think we've mentioned before is that, when red blood cells are first made, we may have mentioned this in folate, they're really big.

Tina 20:43

Chubby.

Leah 20:43

I kind of think of the, I think of like Baby Huey. Do you remember that cartoon, baby Huey Little Giant Chicken, who was a baby? This giant, well that, so when, when pretzels are first made, they're baby Huey, they're big, and then things like folate and um, and B12 help them to mature and then they go out into the world and they're smaller. So that's how I think of it. Baby Huey. Well put a link in our show notes so people could see to baby Huey. Um, so, and I think that's a really, Way to introduce like what is B12 used for? So you mentioned myelin sheath, you mentioned formation of red blood cells. I mean there are so many different things that B12 is involved in. Um, we may have touched on it. Do we talk about it in the melatonin episode cuz of the melatonin serotonin pathway. need b12.

Tina 21:38

I think you mentioned it. Yeah,

Leah 21:40

I think I mentioned it and I said I was gonna put, a diagram and I don't think I ever supplied you with a diagram, so I don't think it ever made it. Let's see if we can make a note to do a diagram this time.

Tina 21:49

So, and I, I just wanna make sure that for signs and symptoms, because B12 is so involved in so many things, I just wanna, before we move on to the next topic, um, depression is high on the list too, because of what you're saying right now, which is, it's involved in that serotonin melatonin pathway and because it's involved in neurotransmitters, Its deficiency can cause lack of those neurotransmitters.

Leah 22:12

I worked with an integrative. Um, previously, and he would recommend both B12 and folic acid to patients to help their, um, their psych meds work better. So I thought that was kind of interesting. Oh, you know what, uh, God all over the place this episode. Um, birth control pills can also lead to, deficiencies in B vitamins such as b12,

Tina 22:38

Yes.

Leah 22:39

but don't start taking it will and ni. had to throw that in there. Okay, so I don't even know where we left off.

Tina 22:48

I dunno. Let me, let me summarize signs and symptoms though, because I do feel like we're all over the place. So we have paleness of the skin fatigue. Depression, neuropathy, general weakness, disinterest, enlarged tongue, red tongue. You can have nausea, vomiting, and you can have some. Loss of appetite for some people, but that's pretty severe. And, um, in my own experience, it goes from parlor to almost a greenish hue of the skin. Just so you know.

Leah 23:17

Oh, interesting.

Tina 23:17

Mm-hmm. Yeah. There's a hue that the skin takes on when people are deficient. That's in anemia in general. Um, anemia can give almost a, a greenish p and that's just the lack of, of the oxygen, making it to the.

How much B12 should you take?

Leah 23:32

So, um, one of the many controversial things about B12 is how much should people even be taking.

Tina 23:39

that is controversial.

Leah 23:40

because what we need or the recommended daily allowance, um, is a pretty low amount. Like it's typically in supplements as like a thousand micrograms,

Tina 23:54

Mm-hmm.

Leah 23:55

but that's not what our body needs. And then if you factor into how much of that is being absorbed, The food itself? I don't know. It's, it got very, very complicated when I was trying to find what's the recommended dose.

Tina 24:09

Yeah, it's not very much compared to what any supplement has, like you said. So, um, I don't know. I, I don't pay too much attention to the recommended dose because it's so low that it seems a little bit too low.

Leah 24:22

Yeah, I mean, like I'm comfortable with about 250 micrograms a day for somebody who's vegan, say.

Tina 24:32

Mm-hmm. And are And are you qualifying that with like a sublingual form, so you know it's making it into their system?

Leah 24:38

Yeah. Yeah. Well, like a, like a chewable or a sub lingle. Yeah. Um, but you can't really find supplements that are in that amount.

Tina 24:47

Mm-hmm. no. And because we do store it, I mean, one option is to take a higher dose, like a thousand micrograms under the tongue and do that three times a week.

Leah 24:59

Yeah, I've seen, I've seen where like on like vegan sites, they recommend doing that like once a but I guess it depends what's going on. If you're trying to replete versus supplement, you know?

Tina 25:10

Mm-hmm.

Leah 25:12

But yeah, it's not something that needs to be taken every day unless you have like a, you know, a frank deficiency or, I mean, I had patients who had their stomachs removed and they would need to get like, um, in the muscle, like they'd have to get an, you know, an injection of,

Tina 25:28

Mm-hmm.

Leah 25:29

of B12 regularly. I think it was monthly.

Tina 25:32

Yeah. I'm always interested in that because I'm wondering why the injection has to happen when sublingual should bypass the stomach. Al. but I've had that happen too, where people couldn't be repeated until they got the injection. So that doesn't add up completely. But

Leah 25:46

I don't know. You could bill insurance for the, for the shot, for the injection. That's my guess. Um, okay. So.

Tina 25:55

I wish I could say that was uh, untrue, but you're probably right.

Leah 25:59

So, um, the recommended dose based on, you know, like, you know, what, what does Linus polling website say versus,

Tina 26:09

Mm.

Leah 26:10

what you find out in the wild in the supplement world, um, that kind of, it's kind of up in the air. Do I think somebody should. 2,500 to 5,000 micrograms a day. Sublingual. No, I think that's a lot.

Tina 26:28

Yeah, I would say a thousand a day is still within my bounds of, okay. That sounds okay to me. Most people, here's the thing with compliance and myself included, doing something twice a week or three times a week is just not gonna happen if it's not an everyday thing.

Leah 26:42

Well, that's why I like the idea of, of doing like, you know, once a week, every sun, every Sunday, remember that's your day to. Take your me 12

Tina 26:53

I wish that would work in my brain. First, I have to realize that it's Sunday I could go an entire day and be like, what is today again? You know, so,

Leah 27:04

That's why we have alarms in our phones.

Tina 27:07

Yeah. Now that I could do, if I could, you know, put it in my phone to remind me, but realistically, compliance is key in our medicine, right? So like for me, when I talk

What's TookTake?

Tina 27:17

to patients, I'll tell you right now that generally speaking, throughout my career, when people do what I ask, it works better. So just speaking from experience, whenever I had someone, you know, split up their high dose vitamin D because they were taking some mega dose, like 50,000 IU they had in their capsule, I was like, no, don't do that every day. Oh my gosh, please just take that once a week. They would forget, or they'd put, you know, it'd make its way to the back of their cabinet or something. And so, uh, yeah.

Leah 27:47

This would be a perfect time. They were a sponsor. Those labels I told you about took take. Were like, there are these little stickers that you put on your pill bottles, supplements, or whatever to remind you when to take it. See, this is, I feel like this would be like when we would segue into a commercial for tuk take.

Tina 28:02

So we would do something like, and when I have a supplement, I wanna take it home just once a week. I use took, take

Leah 28:07

Exactly.

Tina 28:09

Uhhuh

Leah 28:09

Yeah.

Tina 28:12

Could do we do we do, we like deviate from our normal tone and do the.

Leah 28:16

Oh, you have to do the commercial voice.

Tina 28:18

Now a word from our sponsor.

Leah 28:21

I do like that product. I haven't used it for myself, but I love the idea of the product cuz um,

Random (but useful) factoid

Leah 28:26

yeah. Anyways,

Tina 28:28

Can I, can I throw a random? Well,

Leah 28:30

can you throw a random thing in? Sure. Cause I've been doing it.

Tina 28:34

you know, we're sitting here, we're talking about b12, we're talking about cobalamine, and I wanna just say, you're gonna read in the first sentence out there when you Google Co cobalamine or b12, that it's a co-enzyme. and I don't know how many people's brains go, er, you know, the breaks get turned on. They're like, I don't even know what coenzyme is. So I just wanna say all vitamins that we talk about, especially all these B vitamins should say all water soluble vitamins are coenzymes. They are, they are a molecule that is necessary for an enzyme to work. So it's a co-enzyme. It's not the enzyme. An enzyme is a protein. that causes a reaction to go forward. But that enzyme, that protein needs, its coen enzymes and each enzyme has its own coen enzymes. So this could be many nutrients that we talk about. In this particular case, the coenzyme is b12. So I'm saying this because I think, um, you know, the word enzyme is even confusing for some folks. I just wanted to break that down cuz it's a co-enzyme. It means that without it many enzymes in the body will not function. the ones that depend on this particular coenzyme

Different Forms of B12

Tina 29:48

b12.

Leah 29:49

I think that's a really good, um, place to also talk about what are these different forms of b12, because depending on what you read, um, cyanocobalamine is the form that you should be taking and. Others will say, no, you need to take methyl cobalamine. And there are other forms as well. And when your body takes in B12 from food, it kind of like splits it apart into the methyl cobalamine and the um, is it a dental

Tina 30:19

Dennis.

Leah 30:20

Adenal cobalamine? Um, and those are used for different things. One's used for blood formation, one's used for, you know, nerve or whatever. Um, so I think that is something else that's really confusing to people, but there's no consensus as to what is the best form to take.

Tina 30:38

no, there's not consensus and it's, it's a little bit, you know, I think about it a little bit like we think of minerals in that. Not alone. So you don't take cobalamine, like you said, you take methyl cobalamine or cyanocobalamine, and when it hits the stomach acid, it detaches from whatever it's attached to. So now you've got a methyl and a cobalamine, or you've got this ciano and then the kebo. So you've got two pieces of, of a molecule that gets broken. the question becomes not just what does the cobalamine do? Cause we know it goes on to get absorbed. As long as there's intrinsic factor and everything is normal in absorption in the gut, what happens to that other molecule? Do you need that methyl group? What is the Sino group gonna do? Do you just pee it out? Um, so it's a lot like when we talk about minerals being attached to something like magnesium, malate, magnesium.

Leah 31:32

Oxide.

Tina 31:32

Magnesium oxide, like, so what is happening to these two different molecules? You have that nutrient and then you have what it's attached to. And usually what it's attached to has to do with convenience. Um, in the case of b12, siano is the most stable. So cyanocobalamine is common, uh, over the counter and even an injectable form. it's the most shelf stable. The other forms are much more volatile, so they go bad more quickly. And I don't think there's any proof that that Siano molecule does any, that there's any detriment to it. Because we're talking about very small amounts like micrograms.

Leah 32:10

Yeah, cuz that's out there in the internet world that, oh, so Cyanocobalamine has cyanide in it, you know,

Tina 32:16

Exactly. Yeah. I think that's overblown. I don't think there's enough in there to. Amount to anything. Um, and there's also the idea that a small amount of certain things, even a smaller amount of radiation right now on the planet, we are all sitting here with a very small amount of radiation going through us. And a small amount may just be part of. Life, right? This hormesis, it's called hormesis effect, where low dose is has one effect, and super high doses have an opposite effect. So radiation, while it's necessary for life, too much of it is obviously lethal or cancer causing or whatever. So I think, I think of the siano molecule kind of along those lines. Like, eh, there's so little in there, it probably doesn't do anything. Who knows what it does? Cuz there's a little, you know, cyanide and, and other things that we put in our mouths. Um, so I don't have any problem with Cyanocobalamine as

Why B12 + Folate in Supps?

Tina 33:10

a supple.

Leah 33:11

The other important thing, I think to point out. is that for people who just start randomly taking, um, vitamin B12 as a supplement, is that a folate deficiency can also present itself very similarly. And so that is why a lot of the times you will see those two being given together as a supplement in, you know, the, the store where everyone, those often travel together because by taking. One supplement over the other. You could be masking a deficiency in the other one. But then that gets into the whole, like, do you supplement with Foley? And that we did a whole episode on that. Um, That's why I don't like b12. It's so complicated. Should we get into where it truly becomes complicated in the world of cancer? Should we take a break and then come back and talk about that? Did we have anything to cover before?

Tina 34:04

You're talking me outta even talking about it because you're saying it's complicated.

Leah 34:08

It is complicated, don't you think? And we're not even going into the whole like, you know, M T H F R, you know? Oh my gosh. That's where it really gets complicated. We're not even going there.

Tina 34:23

Yeah, so there's a, there are a few points within the realm of cancer care besides the idea of some of these deficiency syndromes where there are times you probably shouldn't be taking huge doses.

Leah 34:34

So do we break and then come back

Tina 34:37

yeah, let's take a break then we'll talk about it.

Leah 34:39

now, get our thoughts together.

Tina 34:41

Compose ourselves.

Leah 34:42

compose ourselves. we'll be back.

Tina 34:47

right after this.

B12 & Cancer

Leah 34:59

B12 in cancer, we're back. This is what the, this is what the, the folks are. You're all about?

Tina 35:08

I know, right? Sorry to, sorry to leave this to the last minute, but you know, you had to have all that other information first. In order to understand the context of this, I.

Leah 35:15

I think so. So I think a good way to ease in is that, um, in some people, a B12 deficiency can mask signs of something like polycythemia vera, if somebody takes a lot of b12, that can kind of unmask them having, polycythemia vera. So there are these conditions where, you know, B12 kind of plays a role in a way,

Tina 35:47

Yeah. I came across a paper, I think it was 2021. and it, talked about elevated B12 on labs and reasons for that besides cancer,

Leah 36:01

or besides supplement.

Tina 36:02

besides supplementation, and I think that's what you're talking about when you say masking. So if you take it and they see high b12, is that what you're saying? When you take a high B12 as a supplement and you have an underlying condition, you could be masking that condit.

Leah 36:18

Yeah, Yeah. Somebody could have a B12 deficiency due to a condition like polycythemia vera and then they start taking high doses. And then, yeah, because you need that methologic acid. If you have your lab shows high b12, which with people supplementing it often does. Um, they'll run another lab, the methologic acid, which actually shows if there is a true deficiency.

Tina 36:44

Yes, M M a

Leah 36:46

Yeah.

Tina 36:47

MMA picks up a deficiency in vitamin b12, much more, in a much more sensitive fashion than serum b12, which is a pretty gross measure.

Leah 36:55

So there have been some studies recently that talk about people who supplement with certain B vitamins, such as B12, may have an increased risk of certain cancers. Lung cancer was the big one that, um, that you know, came out.

Tina 37:12

Yeah, I don't, you know, this speaks to that whole, it was a correlation study.

Leah 37:19

right.

Tina 37:20

it was correlated. So people who took B12 were more likely to be diagnosed with lung cancer, but people diagnosed with lung cancer probably have a symptom of fatigue beforehand, or could very well have fatigue beforehand as one of their symptoms, and elect to take B12 because they feel fatigued. And that's what you.

Leah 37:41

Right, right. We talked about that. We talked about how. with these correlation studies, correlation does not imply that's the true cause, right? is it, yeah. Is it a coincidence that these people who are being diagnosed with lung cancer just happen to be taking some sort of a vitamin, um, to help them with whatever it is, energy or just, you know, overall wellness, right? Like, oh, I smoke, so I'm gonna take some vitamin. to balance out the bad effects of smoking. Yeah. So, but I still am very cautious in patients who have lung cancer or just solid tumors in general

Tina 38:20

Yeah,

Leah 38:21

with with B12 supplementation.

Tina 38:24

well that's a, I think good reason. I think that we are both cautious with solid tumors in particular because there was a couple studies that. Looked at national registries. One was in a British National Health Registry and the other was the Netherlands. Yeah, it was in the Netherlands. National Health Registry and National Health Registries for those in the United States where we don't have anything like this, they track everything people are doing within the socialized medicine system, so, If we were living in one of these countries, they would know all of our health history, including all of our diagnoses, all of our medications, what we end up dying of eventually. So these health registries have seen associations between high B12 on labs and solid tumors. Um, and in particular those tumors were pancreatic, bladder, colon, and rectum, lungs, and prostate. And so high serum B12 has been associated with those and. There was a study not long ago that looked at these two registries and actually said, okay, is there other confounding factors? Are we just picking up something that's not real? So they adjusted for other causes

Other causes of high B12 (besides cancer)

Tina 39:43

of B12 being high in the blood. So the other causes were things like, um, acute or chronic liver disease can cause high B12 in the blood. Um, chronic kidney failure can cause high B. Inflammatory conditions, including autoimmune conditions, can cause high b12 and of course, taking too much B12 supplement, um, which is easy to do, can cause high B12 on a lab, and it's also known with some blood dysplasias or blood malignancies. Um, so correcting for all of that, so saying, okay, that person had one of these things going on, so we don't

High Serum B12 as a cancer screening tool?

Tina 40:17

count that person. Even when you removed all the other causes of high B12 in the. there was still a strong correlation with the presence of solid cancers, and even more so a much higher correlation with solid tumors that had metastasized. So metastatic cancers were, were much higher, like four times more likely when the serum B12 was high.

Leah 40:44

So is high. Serum B12 outside of supplementation a marker, you know, for cancer.

Tina 40:50

Right. That's a logical question. That is exactly what is being looked at Now, there was another paper that followed this one that said, should we screen serum B12 as a. Screening tool and say, okay, if it's, you know, whatever the, whatever the cutoff would be. When they said hi, they, specifically in that national registry one that I just mentioned, in 2021, the cutoff was greater than 1000 nanograms per liter. That's was, that was the serum B12 level on the labs that they used as qualifying as a high level. So, you know, that's, that's a high level. It's not unseen. I've seen levels much higher. Of course, I work in oncology, so it's not surprising that I see high B12 in people who aren't even taking it because it does happen quite a bit with solid tumors. So yeah. Should we use that as a screening tool? Like if B12 is over a thousand and someone's not taking a supplement, do we then say, okay, we need to look for a solid tumor in this person? I mean, that, that's a really valid question. Um, I think it's being looked at right now as we.

Leah 41:53

I think a really important thing to bring up, especially if we have listeners who have undergone treatment for lung cancer, um, is there are certain medications that are given where you'll actually receive b12. you'll receive, um, folic acid in b12. Um, pemetrexed Olympia is the one that I, I think of. And so I don't want anyone to be like, wait, wait a minute, B12 and lung cancer, but my doctor is giving me this injection, You know, that's, that, that's different. That's part of the treatment. Um, because Olympia can cause, uh, folate. It's an anti folate, so it can cause a deficiency. So the B12 and FOL eight are part of that treatment.

Tina 42:39

Right. Good point.

Leah 42:41

Cause I do work with an oncologist who will take their patients off of, b12 and they also work with lung cancer patients. And so then they're giving them the Im and I'm like, how does he explaining this to them? Like, wait, okay, you can't take your B12 and I'm gonna give you b12. So I'm sure there's some explanation that goes on there, but um, I just thought I would put that out there too.

Tina 43:04

Yeah. Well, and this correlation, this serum B12 correlation with solid tumors and in particular metastatic solid tumors, um, is the reason that you and I are so conservative about giving a lot of B12 to people. What we do not know. is why this is happening. There is no great explanation to say, oh, that B12 is high in this serum because fill in the blank. We don't know what's going on. So is this something that the body is doing? As it fights the cancer, is this something the cancer is doing and it's to its advantage? Honestly, there is no good answer to this. There's speculation, but there is nothing that says whether this is actually good or bad. as far as a, a person with a cancer who's trying to fight that tumor back with their own body, right? when they did these correlations. These are health registries. So these people went on to have diagnoses of cancer. Sometimes it wasn't known at the time of the high serum b12, it predates the actual diagnosis of cancer. Um, that's the beauty of health registries.

Leah 44:12

Yeah, it was like up to a year, right? It was like a year.

Tina 44:15

Yeah. I don't remember, but you okay.

Leah 44:18

I, I thought I, I saw one of 'em. It was in England. and it, yeah, it could predate a diagnosis by up to a year.

Tina 44:25

Yeah. Why It happens. We don't know. It's, that's why we don't fool around with it. So if you have cancer, so I think you and I agree, Leia, if you have a solid tumor, you have a metastatic cancer currently, or you're at risk of recurrence, so there could be cancer in your body and you don't know it yet. Lay low on the b12. Get enough but not more than enough. Maybe go ahead and have it tested in your bloodstream once a year and make sure you have adequate levels. But don't go thinking that no dose is too high because of the big question mark in how B12 and cancer interact and whether these high levels are a good thing or a bad thing. We, we don't know.

Leah 45:08

Right, because there are a lot of patients out there, like we mentioned, who take the acid blocking medications and metformin and they have advanced cancer. And so, you know, there's, there's a balance in. and how much you can take, if you can find a lozenge that can be broken up and that way you're getting your 250 micrograms, you know, a day. If you prefer to take things daily, if you wanna take things once a week, you know. But I would highly recommend against doing the 2,500, the 5,000 micrograms daily.

Tina 45:47

Yeah. Yeah. So adequate, but not more than adequate levels is what you're looking for. And generally speaking, most people, many people can go to the doctor and say, can you just tack on a serum b12? And the doc will do it, no problem. Whether it's your oncologist or your primary care physician, do that, by all means. If you get thwarted and they say no, cuz I see no reason for it, which could happen. You know, there are places online where you can order your own labs, so there's quite a few companies online, so just look up self-testing for labs. I tend to send people to Life Extension, because they use LabCorp, a very large center.

Leah 46:25

but do they automatically reflex to a methologic acid If it's high,

Tina 46:28

Well, we don't need that for this scenario. All we need to know is if the B12 is over or under a thousand nanograms per.

Leah 46:34

yeah. But if you're supplementing daily, it's gonna be, if you're supplementing with b12,

Tina 46:39

Right. The goal is to supplement at a level that is adequate, but not More than that. So you still would wanna test it and see that you're not over a

Leah 46:47

It's so complicated.

Tina 46:50

It's nuanced. How's that?

Leah 46:52

It's nuanced. There you

Tina 46:54

I don't think it was complicated as much as it, I, I find it to be one of the more nuanced vitamins. You know, cuz it complicated, has a negative connotation in my mind. Like

Leah 47:04

It's complex there. How's that? It's complex,

Tina 47:07

makes it intriguing if you're into this kind of thing,

Leah 47:11

right?

Winding down

Leah 47:13

So if you're into this kind of thing, this discussion on supplements, you gotta stick around cuz we're gonna do one more episode. Um, on supplements for this pod. we'll do more, y'all. Don't worry. We're going to, we're gonna talk about more stuff. If you want a particular supplement addressed, just shoot us a note. you can email us at the cancer pod gmail.com. You can send us a message through Instagram. You can send us a message through Facebook. I may not see it, but you can do it.

Tina 47:45

And if you didn't know this already, this is our supplements 1 0 1 series. So go back and listen to the basics, which was episode 20. And we have already done folate, vitamin D, curcumin, vitamin C, collagen, melatonin, omega-3, fatty acids, glutamine, and mushrooms. So go. look for those episodes. Um, shoot us a line on Instagram, Facebook, or our email.

Leah 48:13

Don't do Facebook. I don't, I never. Facebook comments or

Tina 48:16

all right. Don't do Facebook then.

Leah 48:19

then and listening to the list of the things we've done. I think we, maybe doing some herbal supplements might be kind of fun for the people. Um, remember to leave us a review rating episodes. Oh my God. What is the stuff that we always say at the end?

Tina 48:35

Don't forget to rate, review,

Leah 48:37

That's it. Don't forget to rate and review. Always follow, subscribe. and buy us a coffee. We need to thank, shout out to Morgan. Thank you for buying us a coffee.

Tina 48:49

Thank you Morgan.

Leah 48:50

if you buy us a coffee, we're gonna just say hi and thank you on the air cuz we appreciate it.

Tina 48:57

She bought us three cups, so that means there's one for you, one for me, one for her.

Leah 49:00

Nice. We're having coffee together. I actually am having coffee.

Tina 49:04

We're having coffee together.

Leah 49:07

on that note. I'm Dr. Leia Sherman,

Tina 49:09

And I'm Dr. Tina Kaser,

Leah 49:11

and this is the Cancer Pod.

Tina 49:12

until next time.

49:14

Thanks for listening to the cancer pod. Remember to subscribe, review and rate us wherever you get your podcasts. Follow us on social media for updates, and as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The cancer pod is hosted by me, Dr. Lea Sherman. And by Dr. Tina Caer music is by Kevin McLeod. See you next time. LO