Cobalamin, or vitamin B12, is a critical part of a safe and effective alcohol withdrawal regimen. Cobalamin is a coenzyme molecule important in the many biochemical reactions required for the production of DNA, RNA, neurotransmitters, neuron cell myelin, and cell division. Many types of enzymes rely on vitamin B12 to function normally.
Cobalmin exists in four forms, but only two are biologically active. All forms contain the rare element cobalt and the manufactured form, cyanocobalamin, contains a cyanide molecule bound to the cobalt. Vitamin B12 is produced by bacteria and archaea and most animals must either ingest the vitamin in their diet or ingest cobalt that their gut flora can utilize to produce the vitamin. Human colonic flora can produce cobalamin, but it cannot be absorbed, and thus, humans must obtain the vitamin by eating food sources high in cobalamin such as meats or grains fortified with the vitamin. The human liver can store large quantities of vitamin B12 and a dietary deficiency can take three to five years before signs show up.
Vitamin B12 deficiencies can occur from poor dietary intake or malabsorption of the vitamin by the gastrointestinal tract. Malabsorption can be due to a variety of causes such as gastric bypass surgery, low gastric acidity, or autoimmune disease causing a lack of the binding protein intrinsic factor.
The most common presentation of vitamin B12 deficiency is pernicious anemia which includes a triad of symptoms including megaloblastic anemia, gastrointestinal symptoms (diarrhea, loss of motility), and neurological symptoms such as motor and sensory loss, spinal cord degeneration, and psychosis.
In alcoholism, people not only develop vitamin B12 deficiency from poor dietary intake, but alcohol also causes a functional deficiency of the vitamin. Alcoholics diagnosed with pernicious anemia often have normal serum levels of vitamin B12 suggesting that the function of the vitamin is being inhibited.
At TelePsychiatry Associates, all individuals are started on vitamin B12 at the proper doses and frequency before alcohol detox begins to prevent the consequences of vitamin B12 deficiency.