Don’t be like Winnie the Pooh and eat sensibly for vital vitamin

I WAS down an internet rabbit hole recently when I stumbled across a list of amusing research paper titles.

Among several that caught my eye, two of my favourites were “Fantastic yeasts and where to find them: the hidden diversity of dimorphic fungal pathogens” and “The mouth, the anus and the blastopore – open questions about questionable openings”.

As good as these were, it was another title that really caught my eye – “Does Winnie the Pooh have a vitamin B12 deficiency?”

Upon further investigation, I discovered that this is a real paper, albeit a very short one and firmly tongue-in-cheek. I recommend reading it as it is really quite amusing.

The authors pose the question based on Pooh’s almost exclusive diet of honey, which contains no vitamin B12 whatsoever.

Vitamins are organic molecules that are made by plants or animals and are required by an organism at certain levels to allow for proper function within the body.

There are 13 essential vitamins in total without which we cannot live.

Vitamin B12 is one of these and, rather inconveniently, is not something we can produce ourselves.

Rather it is produced by bacteria in the gut of certain animals but, critically, not in plants. This means humans must rely either on their diet for a source of this vital vitamin or on an industrially produced equivalent made by a fermentation process.

Animal-based foods such as meat, fish, eggs and dairy products are the only way to access it through the normal diet.

This is not good news for those with an exclusively vegan diet nor, for that matter, a honey-eating bear.

Why is vitamin B12 so essential? Well, it has a number of different roles within the body.

Firstly, it is heavily involved (along with folate, another B vitamin) in the maturation of red blood cells, which takes place within the bone marrow before they are released into the bloodstream.

If levels are low, younger and larger red blood cells are released too early and this can lead to anaemia (low haemoglobin). This aspect of B12’s role was how it was discovered in the first place. A condition known as pernicious anaemia had been known of since the 1800s and had been given its dubious moniker because of its lack of treatment and often deadly outcome.

While it was known that levels of haemoglobin were low, causing fatigue, pale skin, muscle weakness and breathing difficulty, the underlying process driving this was not.

Then in the Twenties, a team of Harvard physicians discovered that when sufferers ate half a pound of liver every day their conditions improved.

This led to the discovery of vitamin B12 or, to give it its other name, cobalamin (because it contains the element cobalt).

Its value doesn’t stop there. It is also involved in the synthesis of DNA and of the protein sheaths around nerves called myelin.

Thus a lack of B12 can also result in a variety of neurological issues such as memory lapses, cognitive decline, numbness or tingling in the limbs (legs and feet more often than hands and arms) and poor co-ordination.

Sufferers may also experience soreness and redness of the tongue, yellowing of the skin and even visual problems in the case of severe deficiency.

While a diet lacking in animal-derived foods can result in vitamin B12 deficiency it may still occur even in a meat eater.

In order to be absorbed into our bloodstream, B12 needs to be bound to something called intrinsic factor, which is released from cells within our stomachs.

Once bound, it is taken up via receptors on the walls of the small intestine. If there is a gut condition that affects this absorption, such as inflammatory bowel disease or coeliac disease, this process may be interrupted.

Likewise, if the cells that produce intrinsic factor in the stomach are attacked by the body’s own immune system, this is likely to have the same outcome.

Thus it is always worth checking for antibodies against these stomach cells if a person is found to have a B12 deficiency as they will always struggle to get it even with a change of diet. In the latter scenario, a B12 deficiency means it must be replaced at regular intervals indefinitely.

Due to the lack of absorption, giving oral B12 tablets is not much use so injections that bypass this are the preferred option. These are given intramuscularly, most commonly into gluteal muscle on the bottom.

Generally speaking, someone commencing on B12 replacement via this method will be advised to have a loading dose, which means an injection every other day for a couple of weeks and thereafter a top-up every three months.

It is always worth considering whether certain medications may be hampering the uptake of B12. Tablets as common as metformin and omeprazole are known potentially to increase the risk of B12 deficiency.

But for those simply lacking B12 in their diets, there are tablets and supplements available, although simply ensuring you are eating enough B12-rich foods is the best option.

For vegans, supplements can be important but it is also worth sourcing foods that are fortified with B12, such as many breakfast cereals. Something as vital as B12 will inevitably become a marketable health target. While it is important to visit your GP if you have and of the symptoms I have mentioned (which could also be related to all sorts of different things), something as vital as B12 will inevitably become a marketable health target. Therefore it is important not to jump to the conclusion that everything is related to low B12 and spend loads of money on trying to correct it.

There are all sorts of B12 related treatments out there, offering various supplements and even infusions.

If you trawl online forums, you will probably hear about those who recommend B12 replacement even in those with levels well within the normal range.

In reality, any excess B12 supplementation is likely to travel straight through. Similarly, it is sometimes advertised as something to take in to improve athletic performance or endurance. There is no robust science of which I am aware to back any of this up.

It’s best to simply ensure you are eating the right foods to prevent the deficiency from occurring in the first place.

If you recognise in yourself any of the symptoms that the authors of the Winnie the Pooh study noticed in their subject — such as a forgetfulness that means he “frequently forgets levels of honey reserves”, a yellowing of the skin or “restricted gait” and an “apparent preferred bipedalism” suggestive of “limited lower joint movement” — then it might be worth checking your B12 levels.