Calcium-D-glucarate helps fight Gilbert’s Syndrome symptoms

Studies show that Calcium-D-glucarate may help fight Gilbert’s Syndrome symptoms. Here I unpack what it is and what it could do for people with Gilbert’s Syndrome.

What is Calcium-D-glucarate?

Calcium-D-glucarate is naturally found in fruits and vegetables. It’s a combination of calcium with glucaric acid, and is similar to glucaric acid which is found in the body. It is commonly used as a dietary supplement due to its potential health benefits.

What does Calcium-D-glucarate do and why does it help fight Gilbert’s Syndrome symptoms?

Some studies show that Calcium-D-glucarate may have a positive effect on liver health and bile metabolism. It is believed that Calcium-D-glucarate may improve the detoxification process in the liver by increasing the excretion of certain toxins. Importantly for people with Gilbert’s Syndrome this includes bilirubin.

How does Calcium-D-glucarate help fight Gilbert’s Syndrome symptoms?

It’s thought that Calcium-D-glucarate stops an enzyme called beta-glucuronidase. This enzyme is responsible for breaking the bond between glucuronic acid and toxins. This lets them be reabsorbed into the body instead of being eliminated. This means that by stopping beta-glucuronidase from working as well, Calcium-D-glucarate may help prevent the reabsorption of bilirubin and other toxins.

Here’s what happens in your body in medical terms:

Beta-glucuronidase is an enzyme that plays a role in the breakdown of bilirubin in the intestines. It acts by deconjugating bilirubin, converting it back into its unconjugated form, which is less water-soluble. Normally, bilirubin that has been conjugated by UGT1A1 in the liver is excreted into the intestines, where it is further metabolised and eliminated from the body. However, in individuals with Gilbert’s syndrome, the reduced UGT1A1 activity leads to impaired bilirubin conjugation. The presence of beta-glucuronidase in the intestines can cause an increased release of unconjugated bilirubin.

The increased activity of beta-glucuronidase can contribute to higher levels of unconjugated bilirubin. This makes the symptoms of Gilbert’s syndrome worse.

Here’s what this means in ordinary words-

Calcium-D-glucurate gets in the way of chemicals that increase bilirubin and so you can deal with it more easily, if you have Gilbert’s Syndrome.

Be cautious!

It is always important to note that the available research on Calcium-D-glucarate’s effect on bilirubin is limited. More studies are needed to establish how well it works in reducing Gilbert’s Syndrome symptoms.

Is it the right supplement for you?

Don’t forget – everyone responds differently to supplements too. You might have other conditions that mean that Calcium-D-glucarate isn’t right for you. It does other things, such as affect estrogen levels and some suggest its use for hormone related conditions :https://drbrighten.com/benefits-of-calcium-d-glucarate/. Make sure you check with your Doctor before taking it as it could affect other medications.

You can increase your levels of the glucaric acid element by eating more apples, oranges, broccoli, cauliflower and cabbage.

You can also decrease the beta-glucuronidase that may be worsening your symptoms by eating a healthy low fat diet, that includes plenty of fresh fruit and veg. Reducing smoking, alcohol and sugar may also help. Want to find out more about how your diet can help you live a happier life with Gilbert’s Syndrome? Check out this post https://gilbertssyndrome.org.uk/the-liver-diet/ You can find out more about food and nutrition to help with Gilbert’s Syndrome in the Posts ‘diet’ category here https://gilbertssyndrome.org.uk/category/diet/

If you decide you want to get a supplement, try this one. It has good reviews, although badged as for women due to its impact on hormones – you don’t have to be a woman to take it of course.

Want more help?

You can work with me as a health coach to support you in managing your Gilbert’s Syndrome symptoms and improving your wellbeing. Find out more here https://wellandgoodlife.co.uk/

You can also take the Gilbert’s Syndrome Essentials course which gives you all the basics on Gilbert’s Syndrome and how to manage the top symptoms. Find out more here https://wellandgoodlife.co.uk/uncategorized/essentials-of-gilberts-syndrome-course/

So, it sounds like Calcium-D-glucarate just might have a positive impact on bilirubin levels by potentially enhancing the liver’s detoxification processes. However, further research is needed to fully understand its effects, and it is advisable to consult a healthcare professional for personalised advice if you plan to take a supplement.

You can find out more here

https://www.webmd.com/vitamins/ai/ingredientmono-136/calcium-d-glucarate

April 21, 2023April 21, 2023

Banish your Gilbert’s Syndrome Brain Fog

Here you’ll find out what brain fog is and its causes. Why is brain fog a Gilbert’s Syndrome symptom? How you can banish brain fog with short, medium and long term tactics. I’ll also signpost you to more help if you need it. Read on!

What is brain fog

‘Brain fog’ describes a collection of different sensations that you feel in your head. Feeling fuzzy or that your thinking is unclear; inability to collect your words and express yourself clearly and concisely; losing the thread of your thoughts; forgetting something a moment after having thought it; disorientation or even dizziness; being easily distracted; a feeling of fatigue or tiredness that isn’t in your muscles.

There are many reasons you might have brain fog

Common causes of brain fog

Vitamin deficiency such as Vitamin D or B12, or lacking iron.
Hormonal changes such as during puberty, the menstrual cycle, pregnancy or menopause.
Low blood pressure.
Long term poor sleep quality.
Long term stress or depression.
Mental health conditions or neurodiversities such as schizophrenia or ADHD
Caffeine withdrawal.
Alcohol dependency
Medication, including antihistamines or other over the counter meds such as cold remedies, as well as prescribed medications or medical treatments such as for pain or cancer.
Medical conditions such as hypermobility, chronic fatigue, diabetes, multiple sclerosis, thyroid problems, Gilbert’s Syndrome and many more.
Shift work.
Allergies or sensitivities to particular foods.
Environmental toxins and chemicals.
Trauma.

Why would Gilbert’s Syndrome in particular cause brain fog?

There’s no definite reason we have brain fog with Gilbert’s Syndrome, but it is a recognised symptom. Let’s take a look at some pieces of scientific research examining bilirubin as a neurotoxin and its ability to pass through the blood brain barrier.

Jaundice and brain fog – Is bilirubin toxic to the brain?

If you have Gilbert’s Syndrome then you produce too much unconjugated bilirubin from time to time. And, yes, this bilirubin is a neurotoxin. But in adults this should cause little problem unless there are excessive levels of bilirubin that are life threatening. Excessive levels of bilirubin are not a part of Gilbert’s Syndrome. Gilbert’s Syndrome produces mild to moderate rises in bilirubin levels.

The science stuff:

Babies can have high levels of bilirubin just after birth, and their brains are not developed to process it the way adults are. This is why bilirubin can be dangerous to newborns. Adult brains have ways to deal with the bilirubin that prevent it from causing damage. This is noted in the extract from a piece of research below.

https://pubmed.ncbi.nlm.nih.gov/11001835/

However, because bilirubin is neurotoxic, hyperbilirubinemia in the newborn may exceptionally result in death in the neonatal period, or survival with severe neurological sequelae (kernicterus). Bilirubin enters the brain through an intact blood-brain barrier. Clearance of bilirubin from brain partly involves retro-transfer through the blood-brain barrier, and possibly also through the brain-CSF barrier into CSF. Work in our lab during the past 5 years has substantiated earlier work which had suggested that bilirubin may also be metabolized in brain. The responsible enzyme is found on the inner mitochondrial membrane, and oxidizes bilirubin at a rate of 100-300 pmol bilirubin/mg protein/minute. The enzyme activity is lower in the newborn compared with the mature animal, and is also lower in neurons compared with glia.

https://www.sciencedirect.com/science/article/abs/pii/S0188440914002641

This article notes some of the effects of Uncojugated Bilirubin (UCB) on the barrier of the brain. The tests are in an artificial environment not actual people. They do note that long term exposure to high levels can cause neurological damage. However, in Gilbert’s Syndrome the levels wouldn’t be high enough for long enough:

In spite of the increased awareness of UCB effects to brain cells (Brites and Brito, 2012), knowledge about its passage across the endothelial monolayer, the rate in which this passage is achieved, and its effects on the integrity of the brain endothelial barrier is scarce …

In conclusion, our data demonstrate that UCB impairs barrier function in an in vitro model of the human BBB. Interestingly, this interaction involves dual effects that depend on the time of incubation, with early transcytosis and late paracellular pathways facilitating UCB entrance into the brain (Figure 8). Collectively, these results underscore the need of prompt clinical intervention in cases of lasting hyperbilirubinemia to prevent BIND and related irreversible CNS damage.

https://www.frontiersin.org/articles/10.3389/fncel.2012.00022/full

As this piece notes, there are other enzymes in the adult brain that protect the brain from neurotoxic effects:

Owing to its lipid soluble nature, bilirubin may cross the blood-brain barrier and thus enter the brain. Its clearance from the brain is ensured by the presence of an enzyme on the inner mitochondrial membrane, which aids in the oxidation of bilirubin, thus protecting against its neurotoxic effects. The mechanism of toxicity is yet obscure, but bilirubin has a higher affinity to settle in glia and neurons.

https://www.ncbi.nlm.nih.gov/books/NBK544252/

The question is – does the effect of higher bilirubin result in sensations of brain fog, although it doesn’t appear to cause long term damage? The studies don’t appear to answer that explicitly. Bilirubin might be a factor. If you manage your Gilbert’s Syndrome and have fewer episodes of raised bilirubin this should hopefully lead to less brain fog.

Solutions

If you’ve been experiencing a long term episode of brain fog it’s a good idea to go to see your health professional. I experienced brain fog and disorientation which I thought was Gilbert’s Syndrome at first. After a couple of weeks I went to see my Doctor. It turned out to be a vitamin deficiency and I got better after a week or two of treatment.

If you are experiencing a symptom flare up, or regular episodes, then you could try a number of things that might help relieve the symptoms. (Please do always consult your Doctor if your symptoms are unusual. I’m not a medical Doctor and I am not qualified to provide medical advice. )

Quick(er) fixes

Hydration! Ok, so it’s really true that a lot of people just don’t drink enough and this directly affects your ability to think. If you are feeling sluggish a glass of water could be the simple answer.

Nutrition – I have already mentioned that some deficiencies can cause problems. If you’ve had a long episode of brain fog that isn’t going away then do see your Doctor. This is particularly important if you take medication that can prevent you absorbing vitamins.

There are lots of foods that can optimise your health and brain health especially. I talk more about specific foods below. A balanced plant predominant wholefood diet is the best for overall health. This reduces junk highly processed foods that can cause you to feel generally unwell over time.

Alcohol, sugar and caffeine can all mess with energy levels and cause issues if you have Gilbert’s Syndrome. Of course as noted below and elsewhere, caffeine can help some people.

Exercise – Encouraging blood flow to your brain through exercise is an easy fix, short, long and medium term. It helps your brain stay healthy for longer. Just don’t embark on sudden vigorous exercise if you have Gilbert’s Syndrome – or your symptoms may be triggered. Even standing and moving about the room on a regular basis can help.

Sleep quality is really important. There are many reasons you could experience poor sleep and brain fog can result. Improving sleep quality may resolve the issue. Sometimes life gets in the way of sleep! In which case you could try other tactics such as stress reduction, pacing or supplements to help bolster your energy.

Stress reduction or managing response to stress eg meditation, hypnotherapy, counselling, cbt, can help you deal with stressful or anxious thinking that are preventing you from thinking clearly.

These are all lifestyle interventions that can reduce your Gilbert’s Syndrome symptoms overall. Other posts talk about some of these in relation to managing Gilbert’s Syndrome symptoms. Here are links to some:

https://gilbertssyndrome.org.uk/how-to-stop-feeling-exhausted/

https://gilbertssyndrome.org.uk/gilberts-syndrome-and-caffeine/

https://gilbertssyndrome.org.uk/hack-your-liver-to-improve-your-mental-health/

https://gilbertssyndrome.org.uk/the-liver-diet/

I have produced a Gilbert’s Syndrome Essentials course that can help you with the main Gilbert’s Syndrome symptoms. The course has additional advice and resources to help you get started on your journey to a happier and healthier life with Gilbert’s Syndrome. Read more

To develop a personalised programme you might want to work with a health coach who can help you get a plan to improve your wellbeing based on your individual circumstances. They can help you track and manage symptoms together with you. https://wellandgoodlife.co.uk/plans-for-health-and-wellbeing/

Tracking and managing symptoms

If you’ve tried a few things and they haven’t worked, then maybe you need to take a more detailed look at what’s happening and when.

Can you pinpoint episodes? Is there something that happens beforehand. Try a symptom tracker. It may be something that happens the day before or a couple of days before that is the trigger. You might then be able to avoid the problem or adjust your lifestyle to reduce exposure or experience the symptoms when they’ll have less impact.

For example, I had a once weekly commute to a distant city which was an eight hour round trip on top of a day of long meetings. The next day I would feel absolutely drained, and overwhelmed by brain fog. I made sure that was my final working day of the week or adjusted my hours to ensure a short working day afterwards with no complex tasks.

Pacing

A similar kind of symptom management is ‘pacing’. If you find that after certain activities or an active period you experience brain fog or fatigue, then balancing your activities might mean you have fewer episodes. If you have a chronic health condition then pushing through is not usually the best method of living better with your condition. Pacing, a practice tested and developed with people who have chronic fatigue conditions, has been shown to work well in managing symptoms including brain fog.

The organisation for people with Ehlers Danlos and other hypermobility conditions has a guide that is useful: https://www.ehlers-danlos.org/information/managing-fatigue-sleeping-problems-and-brain-fog/

Action for ME have a useful booklet on pacing that sets it out in great detail if you want to have a go https://www.actionforme.org.uk/uploads/pdfs/Pacing-for-people-with-me-booklet-Feb-2020.pdf

How pacing works: First you would analyse when your activities are triggering your brain fog. Then limit those activities by initially reducing considerably or down to within a minimum. Only increase activity if that doesn’t result in symptoms. It takes time and planning, but it can get you off a treadmill of repeated brain fog and fatigue episodes. Sometimes you may blow your activity budget for a special occasion. At least you know what to expect and can set time aside, or practice self care to recover more quickly.

If you have ensured you are deficiency free, don’t have other health issues that aren’t treated, are eating well, reducing your exposure to caffeine, sugar and alcohol, sleeping well and are managing stress, plus there are no specific triggers to avoid then you are likely to have fewer episodes. There are plenty of posts to help with some of those aspects of living better with Gilbert’s Syndrome. You can also take the Gilbert’s Syndrome Essentials course for a grounding in dealing with some of the key symptoms.

Long term brain health

You can support your brain function for the long term too.

Adding berries into your breakfast could increase concentration and focus. This may be because the antioxidants reduce inflammation and support blood flow. They also support brain plasticity, enabling it to organise itself better See this study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192974/

And in this study, blueberry juice was found to help brain function https://www.labnews.co.uk/article/2025588/berry_aids_brain_function_improvement

Nut intake has also been linked to better capability to pass cognitive tests in later life for women in this study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105147/

Caffeine can have short and long term benefits if you can tolerate it. It may protect against Alzheimer’s but this is thought to be because of the antioxidants. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554764/ https://pubmed.ncbi.nlm.nih.gov/26677204/ Although caffeine has its benefits, it can potentially work against you if you are trying to balance your energy levels and issues such as brain fog. Becoming reliant on a psychoactive stimulant can make it harder to manage your fluctuating fuzzy head symptoms. Here’s my post on Gilbert’s Syndrome and caffeine

Supplements

You can add supplements into your healthy living plan or toolkit. Or, you may just need an extra boost during an episode. Here are some you might try.

Ashwagandha https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573577/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252722/ and

Rhodiola https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9228580/ are adaptogens that help balance stress and energy levels, enabling great energy stability. They don’t work overnight, but can provide a general foundation for balancing energy and improving sleep.

Add in Gotu Kola if you need a gentle lift more immediately. I find it acts like caffeine, but without the agitation, rapid heart beat and discomfort that I experience with coffee due to my sensitivity. I use it if I have a demanding task and I’ve perhaps had a poor night’s sleep or have a flare up of fatigue for another reason. Studies show its use in a wide range of conditions. It is thought to protect the brain, support brain health, help mood and even work as a painkiller https://examine.com/supplements/gotu-kola/research/#ref-71

If you are experiencing an overall increase in your Gilbert’s Syndrome symptoms and feeling hungover, perhaps jaundiced, nauseous etc, you might want to add in supplements such as zinc sulphate to reduce bilirubin levels. Some people also take NAC. Read more about how they impact bilirubin here: https://gilbertssyndrome.org.uk/what-is-gilberts-syndrome/bilirubin/

Some people take calcium d glucarate to help with the glucuronidation (detox pathways in the liver), and dandelion root is also thought to help https://mastcell360.com/wp-content/uploads/2019/11/Glucuronidation-Assist.pdf

More help and info

I hope I’ve given you lots of ideas to try to help banish brain fog. If you would like more support to develop a lifestyle that supports a healthier and happier life with Gilbert’s Syndrome, you can find the Gilbert’s Syndrome Essentials Course and plans for personal support and coaching to help you here. https://wellandgoodlife.co.uk/plans-for-health-and-wellbeing/

Get regular updates on the latest help for Gilbert’s Syndrome on twitter https://twitter.com/GilbertsSyndrom and instagram https://www.instagram.com/gilbertssyndrome.org.uk/

Do let me know if you experience brain fog and if anything has helped you by sharing your comments below.

March 10, 2023March 13, 2023

Beware B12 vitamin deficiency when you have Gilbert’s Syndrome

Tell me more about B12
Cases and research showing impact of B12 deficiency on Gilbert’s Syndrome.
Why is understanding B12 vitamin deficiency even more important when I have Gilbert’s Syndrome?
Important things to take away from the research about B12 vitamin deficiency and Gilbert’s Syndrome.
What could cause B12 deficiency?
What are the symptoms of B12 deficiency – and why you should know about them if you have Gilbert’s Syndrome symptoms.
What range is normal for B12?
How should I make sure I am not B12 vitamin deficient?
How much B12 should I take?
Final thoughts on staying well

Tell me more about B12…

B vitamins are vital for energy and to manage stress. Vitamin B12 is a superhero that helps support your red blood cells, nerves and is essential to your DNA, as well as many other processes in your body.

https://uncw.edu/csurf/explorations/documents/volume%209%202014/flood.pdf

Why is understanding B12 vitamin deficiency even more important when I have Gilbert’s Syndrome?

For people with Gilbert’s Syndrome it’s particularly important to get enough of this vitamin because B12 deficiency can result in hyperbilirubinemia (the buildup of bilirubin in your body). Combined with Gilbert’s Syndrome this can be acute. But this symptom could also be dismissed because you have Gilbert’s Syndrome. It’s vital to know you have Gilbert’s Syndrome, and its symptoms, so you can include that knowledge when in a medical situation. But it’s also important not to dismiss symptoms as JUST Gilbert’s Syndrome, when they could be something else.

Having a B12 deficiency could give you similar symptoms to a Gilbert’s Syndrome flare up – so do not dismiss it when you feel unwell for longer than usual.

If you don’t have enough B12 your ability to produce S-adenosyl-L-methionine (SAMe) is affected, which has been shown to help process bilirubin in people with Gilbert’s Syndrome.

Low on energy? Known as “The Energy Vitamin”, Vitamin B12 is essential for the production of red blood cells and also helps maintain a healthy heart. A deficiency in B12 can cause you to feel tired and fatigued, affect your nervous system and can also cause anaemia. Click to learn more and for your discount!
From Dr Vegan

Cases and research showing impact of B12 deficiency on Gilbert’s Syndrome.

Case reports and research:

You might be interested to read about this case, where a woman with vitamin B12 deficiency also had Gilbert’s Syndrome. Treatment with vitamin B12 led to much improved symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703004/

This article on ‘food fadism’ and GS increasing jaundice is also interesting.

https://www.jcdr.net/articles/PDF/16536/53243_CE[Nik]_F(SHU)_PF1(AG_KM)_PFA(AG_KM)_PN(KM).pdf

(In my opinion, the headline is misleading. Many people will be eating a predominantly plant diet for a variety of reasons which may be economic, cultural or religious – not just a ‘fad’). It may be worth noting that in this study all but one of the patients are male, and this is in an Indian cohort – which has a different UGT1a1 string (the Gilbert’s Syndrome gene) to other populations. However the case report I also link to above is for a caucasian woman, and it does corroborate the findings. This means these findings are relevant across different biological variations of Gilbert’s Syndrome.

The research illustrates the need to ensure your diet has the right nutrition, whatever foods you eat.

Many people may be below optimum ranges for B12. This study : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540890/ shows that in India 47% of people may be deficient in B12 . Studies indicate that B12 deficiency may be at rates between 6% and 20% in the UK and US, 40% in South American countries, and up to 70% in countries on the continent of Africa. http://frankhollis.com/temp/BMJ%20B12%20deficiency%20review.pdf This is from a 2014 paper, and more recent studies

Important things to take away from the research about B12 vitamin deficiency and Gilbert’s Syndrome.

What’s important to note is that there are two main implications

You may have jaundice for a reason that is not directly due to Gilbert’s Syndrome, even if you have Gilbert’s Syndrome
B12 deficiency will likely make your jaundice and other symptoms WORSE:

‘aggravating pre-existing indirect hyperbilirubinemia in Gilbert’s syndrome patients’

If you have jaundice that is not clearing up, or prolonged fatigue, brain fog etc – then it is always worth checking if there are other causes. If B12 deficiency is the cause then simple supplementation will have a considerable positive effect. Which is worth knowing!

What could cause B12 deficiency?

Causes of B12 deficiency are usually one of the following:

Age: As we get older our stomach acid reduces which means we don’t break down the B12 into forms that can be absorbed easily by our body.
Medical conditions: such as Celiac or Crohn’s disease will prevent the stomach from absorbing B12 properly, as will gastric bypasses or stomach parasites. You may also have a condition called pernicious anaemia, which results in B12 deficiency.
Some medications: such as metformin (used to support people with diabetes) and proton pump inhibitors (stomach acid suppressants) will interfere with how B12 is broken down and absorbed.
Diet: if you aren’t careful to ensure that you are regularly eating food that contains B12, then you may become deficient over time. Modern industrial farming methods have depleted natural sources of B12 in our food.
https://www.nutranews.org/en–vitamins–is-everyone-lacking-in-vitamin-b12-why-is-there-such-widespread-deficiency-what-are-the-consequences–1481

What are the symptoms of B12 deficiency – and why you should know about them if you have Gilbert’s Syndrome symptoms.

For milder deficiency you may feel tired, be pale or jaundiced if you have Gilbert’s Syndrome. You may get dizzy and feel weak, your heart may beat too quickly. A sore tongue and loss of appetite, plus other digestive disturbances might occur.

https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/symptoms/

Longer term, more serious deficiencies can have very serious impacts. You may become clumsy as you lose nerve control and there is neurological damage. It may feel like you have dementia as your memory is impaired. You may even experience hallucinations and psychosis. Heart conditions and infertility can also result.

What range is normal for B12?

The normal range for vitamin B12 can vary slightly depending on the lab. But a normal level of vitamin B12 in your bloodstream is generally between 190 and 950 picograms per milliliter (pg/mL). Between 200 to 300 pg/mL is considered borderline and your doctor may do more testing. Below 200 pg/mL is low and more testing is needed.

https://www.webmd.com/a-to-z-guides/vitamin-b12-test#:~:text=Understanding%20the%20Results,-The%20normal%20range&text=But%20a%20normal%20level%20of,and%20more%20testing%20is%20needed.

How should I make sure I am not B12 vitamin deficient?

In the past we absorbed it from the soil that produced our food. Modern farming and intensive production have exhausted our soil and sanitised our food. Now, sources of food that have B12 have to be fortified. You can get B12 from eating animals, but that’s because they’ve been given supplements themselves. You can cut out the middle by going straight to the supplement. https://www.veganfoodandliving.com/vegan-diet/the-truth-about-b12-and-where-to-get-it-on-a-vegan-diet/

https://www.healthline.com/nutrition/vitamin-b12-dosage#importance-of-b-12

Taking a supplement is an easy way to get around a deficiency. It’s thought to be safe to take in any volume, as it is water soluble and so too much will be passed out of the body. Only a small amount of the supplement version is absorbed. This fact sheet gives different B12 amounts based on source, and the percentage absorption of separate supplements.

https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

You may need more if you are older or breastfeeding, for example. If you are already deficient then extra may be taken for a while ahead of reducing to a maintenance supplement.

If you have a condition that affects the stomach or bowel, such as Crohn’s, you may need injections rather than an oral supplement.

How much B12 should I take?

In the US the National Institute of Health recommends 2.4mcg for an adult, more for a pregnant person. In the UK the NHS recommends 1.5mcg.

Dietary supplements

Vitamin B12 is available in multivitamin/mineral supplements, in supplements containing other B-complex vitamins, and in supplements containing only vitamin B12.

Multivitamin/mineral supplements typically contain vitamin B12 at doses ranging from 5 to 25 mcg (https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional). Vitamin B12 levels are higher, generally 50–500 mcg, in supplements containing vitamin B12 with other B-complex vitamins and even higher, typically 500–1,000 mcg, in supplements containing only vitamin B12.

The most common form of vitamin B12 in dietary supplements is cyanocobalamin. Other forms of vitamin B12 in supplements are adenosylcobalamin, methylcobalamin, and hydroxycobalamin .

No evidence indicates that absorption rates of vitamin B12 in supplements vary by form of the vitamin.

Basically – you can take a little extra in the form of a multivitamin, or you can focus on your B vitamins or B12 in particular, in which case you’ll get a larger dose. However, the type of B12 and massively increasing the dose to above 1,000mcg isn’t going to substantially increase your level of B12 absorbed.

This supplement from Drvegan is high quality and dedicated to keeping your B12 topped up!

Final thoughts on staying well

The great news is that it’s easy to treat deficiency with supplementation and mild symptoms will quickly improve. More importantly, many people could have less than optimal B12 levels, which shows how important balanced nutrition is.

A plant based diet is great for health and yeast extract and yeast flakes can be an important addition. Or – cereal, bread, multivitamins may all include your essential B12.

Not everyone has the resources to afford food that has the best nutrition, or age, illness or other factors may mean that their food isn’t providing what is needed for good health.

In the UK we are fortunate that our NHS Doctors will usually seek a blood test when symptoms mentioned present themselves. This would quickly highlight any concerns. The solution is then simple and cost effective.

With increasingly poor diet quality and depletion of soil quality, it is important to be aware that your food intake may need to be addressed to ensure you get the best from it. Simple adjustments can balance out any gaps. You could address issues that are making you feel much worse than you need to, and are exacerbating your Gilbert’s Syndrome!