Pharmacist Blog: To B or Not to B Active

When I discovered I was pregnant with my first son, one of my primary focuses was finding a prenatal vitamin that would provide the necessary vitamins for my baby’s development. One of these essential vitamins is folate or vitamin B9. Folate is integral for healthy brain and spinal cord development and should be supplemented pre-pregnancy, during pregnancy, and while breastfeeding due to increased needs. Furthermore, up to 40% of the world’s population have some degree of mutation which inhibits the body’s ability to change folic acid to its active form, 5-methyltetrahydrofolate (5-MTHF).

The fact that this vitamin is so crucial during early pregnancy coupled with the possibility that I could be part of the population that cannot metabolize folic acid to its active form, led me to choose a prenatal vitamin that contained 5-MTHF instead of folic acid. Folate not only plays an important role in pregnancy, but it’s also essential in the process of making and repairing DNA and the maturing of red blood cells. Deficiency can cause fatigue, headache, swollen or painful tongue, and irritability. Folate is found as folic acid in fortified foods, most prenatal vitamins, many B-Complex vitamins, and as a stand-alone folic acid supplement.  

Vitamin B12

Another B Vitamin that is available in an inactive and active form that I personally supplement with is Vitamin B12. Vitamin B12 is available over the counter as cyanocobalamin, a synthetic form of B12, and methylcobalamin, an active form of B12. Cyanocobalamin is more common due to its lower cost and longer shelf-life. When ingested, your body must convert cyanocobalamin to methylcobalamin and adenosylcobalamin for this nutrient to perform its important role in the formation of red blood cells and, the formation of DNA and contribute to the healthy function of brain and nerve cells. Symptoms of B12 deficiency can include feeling tired or weak, a sore mouth or tongue, numbness or tingling in your hands and feet, confusion, depressed mood, and irritability.

The best way to intake B12 is through diet (mostly animal products), but I frequently recommend supplementing vitamin B12 because deficiency is common, and this nutrient is essential for everyone. In addition, most individuals over 65 years of age and individuals who take certain medications need supplementation. For example, metformin (a common diabetic medication) and proton pump inhibitors (common medications for acid reflux) both interfere with the absorption of B12, which can lead to deficiency.  

Choosing Vitamin B Supplements

When deciding on these B vitamins, what product should be chosen to achieve the best results? B vitamins are water-soluble, which means they don’t stick around the body and can quickly get excreted by the kidneys. If you take an active form, you give your body more time to absorb and use the nutrient since it does not need to be converted to something else. If you are going to make the effort to take vitamins, you might as well make sure your body can use them, which is why I will always recommend the active form of the vitamin over a precursor.