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Vitamino B12 trūkumas ir kaip jo išvengti  (5)

Vitamino B12, dar kitaip žinomo kaip kobalaminas/cobalamin, trūkumas yra karšta tema, ypač tarp vegetarų ir veganų. Vieni teigia, kad atsisakius mėsos reikia vartoti papildus, kiti mano, kad nebūtina, nes žarnyno flora gali pagaminti reikiamą kiekį šio vitamino. Tad kaip yra iš tikrųjų?

Taip, žarnyno flora gali pagaminti B12 vitamino, bet, deja, šiandieną daugelio žmonių (net ir veganų ar vegetarų) žarnyno flora ir virškinimas yra ne geriausios būkles. Kartais rašoma, kad vitamino B12 trūkumas nėra didelė problema, deja, yra priešingai – nemažai daliai žmonių trūksta vitamino B12 arba jo lygis yra mažesnis nei optimalus, ypač vyresnių žmonių tarpe. Vienas JAV atliktas tyrimas parodė, kad net 39% žmonių turėjo mažesnį nei optimalų B12 lygį.

B12 trūkumas siejamas su padidėjusia Alzheimerio ligos rizika, taip pat B12 trūkumas gali sukelti megaloblastinę anemiją (raudonųjų kraujo kūnelių kiekis

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sumažėja, bet jie pasidaro didesni nei įprastai). Per paskutinius dešimt metų kai kuriose šalyse į įvairius produktus buvo pradėta dėti folinės rūgšties, taip pat žmonės vartoja papildus. Folinė rūgštis gali užmaskuoti B12 trūkumą, ir mažakraujystė nepasireikš, bet po to b12 trūkumas gali progresuoti iki nervų degeneracijos. B12 trūkumas gali sukelti atminties sutrikimus, nuovargį, depresiją, tad jei jus kamuoja šie simptomai būtinai reiktų pasidaryti B12 testą. Padidėjęs homocisteino lygis kraujyje taip pat gali būti B12 trūkumo ženklas. Padidėjęs homcisteino lygis yra širdies ir kraujagyslių ligų rizikos veiksnys. B12 reikalingas homocisteinui metabolizuoti, jei trūksta B12 padidėja homocisteinas.

B12 pasisavinimas yra sudėtingas

Čia priminsiu, kad B12 pasisavinimo mechanizmas yra gana sudėtingas.

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Beje, tai pats didžiausias vitaminas pagal molekulinį svorį, ir tai yra viena iš priežasčių, kodėl jis sunkiau pasisavinamas. Kad pasisavintų B12, skrandis turi pagaminti pats gaminti vidinį faktorių (intrinsic factor). Taip pat, maiste B12 būna prisijungęs prie baltymų, ir kad jis būtų pasisavinamas, reikia, kad jis būtų ‘atlaisvintas nuo baltymų. Tam reikią virškinimo fermentų ir skrandžio rūgšties, kurios vėlgi ne vienas, ypač vyresnio amžiaus žmogus, stokoja. Taip pat, šiandieną vis daugiau žmonių, net ir vaikų, naudoja skrandžio rūgštį mažinančius vaistus. Ir beje, skrandžio refliuksas ir skrandžio rūgštingumas gali būti du skirtingi dalykai, bet apie tai kitą kartą. Atlaisvintas B12 po to dvylikapirštėje žarnoje jungiasi su vidiniu faktoriumi ir po to tas kompleksas pasisavinamas paskutinėje plonojo žarnyno dalyje. Jei skrandis dėl vienokių ar kitokių priežasčių negamina vidinio faktoriaus (autoimuninės

ligos – piktybinė anemija; atrofinis gastritas) ar gamina mažiau, tai pasisavinama tik apie 1-3%, čia pasisavinama visai per kitą mechanizmą – pasyvią difuziją. Tad jei jūsų skrandis negamina arba gamina nepakankamai skrandžio rūgšties arba vidinio faktoriaus , tai kad būtų pasiekta dienos norma, reikia 100 kartų daugiau B12, o su maistu to pasiekti neįmanoma. Paros B12 norma suaugusiems yra 2.4 mikrogramų (1 miligramas = 1000 mkg, 1 gramas = 1000 000 mkg), gali truputi skirtis priklausomai nuo šalies. Bet kaip sakiau, jei pasisavinimas sutrikęs, reikia 100 kartų daugiau – 240 mkg/d. Iš papildų, jei faktorius gaminamas, tai iš mažos dozės (1 mkg) pasisavinama apie 50%, vartojant dideles dozes arba jei negaminama pakankamai vidinio faktoriaus pasisavinimas sumažėja – pasisavinama tik 1-3%.

Vartoti B12 papildus ar ne?

Mano nuomone, esant veganu ar vegetaru geriau nerizikuoti ir laikas nuo laiko geriau panaudoti B12 papildus. Jei jau nenorima naudoti papildų, tai reiktų bent kasmet pasidaryti B12 tyrimą. Paprasčiausias yra kraujo B12 testas, dar gerai kartu pasidaryti ir homocisteiną. Bet bene geriausiai B12 trūkumą parodo methyl maloninės rūgšties (MMA) testas. Yra MMA kraujo testas, bet taip pat gali būti testuojamas šlapimas. Jei MMA yra padidėjęs reiškia trūksta B12, arba bent jau jo yra mažiau nei optimalus lygis. Beje, dažnai kraujo B12 gali būti normoje, bet MMA vis tiek padidėjęs. Tai

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būna todėl, kad kraujo B12 ne visada atspindi jo lygi ląstelėse.

Cyano kobalamin B12 papildai

Dauguma papildų naudojama pigi cyano kobalamin forma, kai prie B12 (kobalimino molekulės) prijungiama cianido molekulė. Net jei cianido toksiškumas ir perdėtas geriau naudoti kitas B12 formas: methyl methyl, adenosylcobalamin arba hydroxy cobalamin. Geriau naudoti sublingual papildus, kurie pasisavinamas per po liežuviu esančią liauką, taip aplenkimas sudėtingas B12 pasisavinimo mechanizmas. Bet ir iš šitų papildų pasisavinimas nėra aukštas. Jei su papildais nepavyksta pakelti B12 lygio, tai tada reikia daryti injekcijas į raumenis.

Kiek naudoti?

Jei nenorite daryti testo, tai būtų patartina naudoti 0.5-1 mg (miligramą) per dieną, keletą kartų per savaitę. Perdozavimo rizikos beveik nėra ir šis vitaminas neturi pašalinių efektų.

Diabetikams rizika didesnė

Daugelis diabetikų naudoja vaistą – Metformin, kuris sumažina B12 pasisavinimą. Tad jei jūs naudojate šį vaistą, tai būtų labai patartina naudoti B12. Antibiotikai, kurie naikina žarnyno flora, taip pat gali būti viena iš B12 trūkumo priežasčių.

Straipsnis parentas pagal:

Vitamin B12. National Institute of Health

Tucker et al. (2000) Plasma vitamin B-12 concentrations relate to intake source in the Framingham Offspring study. Am J Clin Nutr.71(2):514-22.

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Komentarai (5:)

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