An estimated 10-30% of adults over the age of 50 have difficulty absorbing vitamin B12 from food. A much more common cause of B12 deficiency, especially in older people, is a lack of stomach acid, because stomach acid is needed to liberate vitamin B12 from food.
A Cochrane review on folic acid supplements and cognition, with or without vitamin B12, did not find a significant effect of the supplements vs. Similar to cardiovascular disease, although the research has shown that vitamin B12 supplementation reduces homocysteine blood levels, this has not translated into reduced rates of cognitive decline. High homocysteine levels are linked with a higher incidence of Alzheimer’s disease, dementia, and cognitive decline. However, some evidence suggests that supplements of 25 mcg per day or higher may increase the risk of bone fractures. No upper limit has been set for vitamin B12, as there is no established toxic level. UL: A Tolerable Upper Intake Level (UL) is the maximum daily dose unlikely to cause adverse side effects in the general population. For pregnancy and lactation, the amount increases to 2.6 mcg and 2.8 mcg daily, respectively. RDA: The Recommended Dietary Allowance for men and women ages 14 years and older is 2.4 micrograms (mcg) daily. In cases of severe vitamin B12 deficiency due to inadequate intrinsic factor (pernicious anemia), doctors may prescribe B12 injections in the muscle. Vitamin B12 tablets are available in high dosages far above the recommended dietary allowance, but these high amounts are not necessarily the amount that will be absorbed because an adequate amount of intrinsic factor is also needed. Although there are claims that certain forms-like sublingual tablets or liquids placed under the tongue to be absorbed through the tissues of the mouth-have better absorption than traditional tablets, studies have not shown an important difference. There is a variety of vitamin B12 supplements available.
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Supplements and fortified foods contain B12 in its free form, so they may be more easily absorbed. From there, vitamin B12 combines with a protein called intrinsic factor so that it can be absorbed further down in the small intestine. In the stomach, hydrochloric acid and enzymes unbind vitamin B12 into its free form. Vitamin B12 binds to the protein in the foods we eat. It is also a key player in the function and development of brain and nerve cells. Vitamin B12 is needed to form red blood cells and DNA. It can also be added to foods or supplements. Vitamin B12, or cobalamin, is naturally found in animal foods.