Are you taking the right B vitamin? This is a question I ask of all my patients. So right now I am going to walk you through 3 things so you can answer this question yourself:
- What B vitamins do
- How to test
- How to supplement
And of course, ask your doctor before initiating any new supplements, because I am not your doctor.
There are MANY types of B vitamins and they all do different things:
- B1 – Thiamine – nerves
- B2 – Riboflavin – energy, headaches
- B3 – Niacin – cholesterol
- B5 – Pantothenic acid – histamine, adrenals
- B6 – Pyridoxine – pregnancy nausea, estrogen detox
- B7 – Biotin – healthy hair
- B9 – Folate – neurological system, RBC production, influences DNA
- B12 – Cobalamin – energy, fatigue, mood disorders
I generally recommend B vitamins to people because B vitamins are used in almost every single biochemical reaction in the body – so if you are deficient in a vitamin – that means the cellular processes in your body get “stuck” and that ultimately leads to symptoms.
B vitamins help us with energy, focus, healthy red blood cell production, hormone balance, mood support, hair growth, healthy cholesterol levels, good neurological health, adrenal function, mitochondrial function, clearance of hormones and histamine, and MORE!
So if you’re not getting enough B vitamins, it’s a problem!
But first it’s important to make a distinction between TRUE deficiency and FUNCTIONAL deficiency.
In developed countries like America, rarely does someone have a true deficiency of B vitamins. Though the most common true deficiency I see is B12. This normally happens in people who are older, or people who have compromised digestion and poor absorption.
We figure out how much B vitamins you need by a couple of different tests:
- Blood tests
- Urine tests
- Or both
You can test for almost all the B vitamins in the blood. The ones that tend to be the most reliable are B12 and folate, which is B9.
Folate is measured in ng/mL and needs to be above 4.6 – your ranges may be different if you use a different lab – and the lab stops testing it at >20. For folate, I like people to be on the higher end of the range – between 10 and 20
B12 is measured in pg/mL and the range is about 230-1245. For B12 I like people to be in the functional range of 800-900.
People who are taking a B vitamin supplement often show as high levels on each, which is ok. If high levels come up and you are not taking a supplement or have not had a B vitamin injection lately, then definitely see your doctor to check things out. These tests are great, but they are not perfect. They just tell us what is floating around in the blood, and that can fluctuate depending on intake and activity levels.
I like to look also at a homocysteine marker and a CBC- complete blood count. Inside the CBC you have a marker called MCV which is mean corpuscular volume – which has to do with Red blood cell SIZE. You need healthy DNA to make healthy properly sized red blood cells, so if there are not enough folate or B12, the cells tend to become larger, because the cellular machinery doesn’t have the right tools to create the cells in the proper size, and so they get larger.
Homocysteine is a blood marker that when elevated, is linked to increase risk of cardiovascular events. If homocysteine is high, it indicates a deficiency in B2, B6, B9, or B12, or all four! Proper supplementation will bring down levels. I like to see homocysteine less than 7. Unfortunately, most labs won’t flag your result until it’s greater than 15, and that’s too high. Once homocysteine gets over 10, I get worried, and I get people on a supplement.
Urine testing is great for testing for specific byproducts in the urine that correlate with a lack of B vitamins. This is often part of a DUTCH test I run when I look at someones hormones. But you can run this many different ways, whether it’s at a traditional lab like LabCorp or whether it’s a specialty lab like an organic acids test. MMA (methylmalonic acid) is one of my favorite tests because if it’s elevated, then that indicates a B12 deficiency.
Every so often, a person will have a genetic mutation that affects their ability to use B vitamins in the body. You’ve probably heard of MTHFR – which is methylenetetrahydrafolate reductase – the enzyme that helps create active folate. Some people’s MTHFR gene doesn’t function optimally so they do not make much active folate. Active folate (5-methyltetrahydrofolate) is used by the body to convert homocysteine to methionine, and so that is why homocysteine is often high in people who are low in B vitamins. Just because you have an MTHFR gene mutation does not mean you need to supplement with large amounts of folate or B12 – so ask your doctor about what dose is needed for you. But what I can say is that people who have an affected MTHFR gene, do tend to need “methylated” B vitamins. Methylated B vitamins are vitamins that are active, and have undergone that “methylation activation” step in the lab, so the body doesn’t have to do this – which is helpful for those with MTHFR!
Now MTHFR isn’t the only gene that plays a roll, there are other types of MTHFR genes that are related, that can affect how you feel. I often see people with COMT issues. COMT is an gene that helps clear out certain neurotransmitters, including estrogen. And methylated B vitamins don’t always treat people with COMT mutations that well, because it can overstimulate them. So if you tend to feel jittery with methylated B vitamins, have your doctor test your COMT gene.
That’s all I want to say about genetics before the whole topic runs away with me.
Let’s talk about what MOST people will tolerate.
I generally recommend methylated B vitamins to everyone, and they tend to be the most tolerated overall. And I know someone is getting high quality vitamins if they are methylated.
Here are the forms you are going to look for- write this down:
- B1 – thiamine hydrochloride
- B2 – riboflavin-5-phosphate is better than riboflavin
- B3 – niacinamide
- B5 – pantothenic acid or pantothenate or calcium D-pantothenate
- B6 – pyridoxal-5-phosphate is the better than just pyridoxine
- B7 – biotin is biotin
- B9 – “methyl folate” you’ll often see this as “l-methylfolate” or “quatrefolic” – DO NOT BUY A PRODUCT THAT HAS FOLIC ACID – this product actually prevents you from making active folate
- B12 – look for adenosylcobalamin, hydroxycobalamin, and methylcobalamin – DO NOT BUY CYANOCOBALAMIN – it has a tiny molecule of cyanide inside, and it’s really cheap to make and relies on your body to convert it to be useful, so avoid this
If you are sensitive to METHYL folate or METHYL cobalamin, then you can take hydroxy- or adenosyl- cobalamin; and you can take FOLINIC acid and not folate.
My favorite B vitamin brands are OrthoMolecular, Seeking Health, Thorne, and Pure Encapsulations. Remember – get your B levels checked before you supplement, and be sure to ask your doctor which form is right for you.
And if for some reason you can’t supplement, you can EAT your B vitamins. Just follow the recommendations below.
- B1 – White rice, pork, beans, sunflower seeds
- B2 – Beef liver, oats, yogurt, mushrooms, spinach
- B3 – Beef liver, chicken, salmon, tuna, turkey, peanuts
- B5 – Beef liver, chicken, shitaake mushrooms, avocado
- B6 – Chickpeas, beef liver, tuna, turkey, salmon, sweet potato, banana
- B7 – Beef liver, eggs, almond, sweet potato
- B9 – Beef liver, lentils, spinach, asparagus, pinto beans, turnip greens
- B12 – Clams, beef liver, trout, salmon, tuna, beef, yogurt, cheese
For more information on this topic, visit my YouTube channel, and watch my B vitamin video!