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However, when used in combination with vitamin B12 the predictive value for determining vitamin B12 deficiency is improved [ 10 ]. Absorption Vitamin B12 is bound to protein in food and is available for absorption after it has been cleaved from protein by the hydrochloric acid produced by the gastric mucosa.

The released cobalamin then attaches to R protein and passes into the duodenum where the R protein is removed and free cobalamin binds to Intrinsic Factor IF.

The IF-cobalamin complex is absorbed by the distal ileum and requires calcium [ 2 ]. Vitamin B12 enters the circulation about 3—4 hours later bound to TC.

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Vitamin B12 is secreted in bile and reabsorbed via the enterohepatic circulation by ileal receptors which require IF, thus the development of vitamin B12 deficiency is likely to be more rapid in patients with pernicious anaemia as IF is lacking [ 3 ].

Vitamin B12 is excreted via the faeces, which is composed of unabsorbed biliary vitamin B12, gastrointestinal cells and secretions, and vitamin B12 synthesised by bacteria in the colon. It is estimated that daily vitamin B12 losses are in proportion to body stores with approximately 0. Excessive vitamin B12 in the circulation, e. Historically, vitamin B12 absorption has been measured by a number of methods including whole body counting of radiolabeled vitamin B12, metabolic balance studies [ 1 ] or controlled feeding studies in vitamin Bdepleted individuals [ 12 ].

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It is known that the total amount of vitamin B12 that is absorbed increases with vitamin B12 intake but that the percentage absorption decreases with increasing doses [ 13 ]. The absorption capacity is thought to recover to baseline levels within hours allowing for efficient absorption of the next dose [ 11 ]. The Schilling test was the classical procedure for assessing the absorption of vitamin B12 but is now rarely used. As there has been no replacement a number of individual tests must be used to diagnose the cause of vitamin B12 deficiency.

Tests that diagnose atrophic gastritis, a common cause of vitamin B12 malabsorption, include gastroscopy or serum gastrin and pepsinogen levels.

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Specific tests for pernicious anaemia include IF antibodies and serum gastrin estimation. MMA and tHcy are better markers of vitamin B12 status, although they are not appropriate for testing absorption [ 16 ]. An overview of the medical management of vitamin B12 deficiency can be found in a recent article by Ralph Carmel [ 17 ].

Food Sources and Bioavailability of Vitamin B12 Vitamin B12 is synthesised by certain bacteria in the gastrointestinal tract of animals and is then absorbed by the host animal. Vitamin B12 is concentrated in animal tissues, hence, vitamin B12 is found only in foods of animal origin [ 11 ]. There are no naturally occurring bioactive forms of vitamin B12 from plant sources.

Some plant foods contain added vitamin B12 and others e.

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Some foods that are contaminated or fermented by bacteria e. A number of methods have been used to determine the vitamin B12 content of foods. Microbiological assays using vitamin B12 requiring bacteria were used, however, they are no longer the reference method as measurement uncertainty is high. Radio isotope dilution assays with labeled vitamin B12 and hog IF are used [ 20 ].

Further advances are expected with the development of more specific monoclonal antibodies tests using specific binding proteins [ 21 ]. As outlined previously, vitamin B12 absorption is complex and there are adverse changes with age.

In view of the technical challenges and biological factors, there is little data on the bioavailability of dietary vitamin B12 in humans. It is thought that 1. In normal humans the absorption of vitamin B12 from foods has been shown to vary depending on the quantity and type of protein consumed [ 19 ].

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Vitamin B12 from foods appear to have different absorption rates with better absorption from chicken and beef as compared to eggs. Studies assessing absorption of food bound vitamin B12 from whole foods are described in Table 1. However, the US and Australian Nutrient Reference Values suggest that older adults with atrophic gastritis may require higher intakes of vitamin Brich foods, vitamin B12 fortified foods or supplements [ 322 ].

The story underscores an obvious and painful truth as, 47 years later, we are still fighting for equal pay and promotion, which is the mere tip of what seems to be a minutely melting iceberg. A recent NPR article revealed that in Boston, women are still only earning 77 cents for every dollar a male brings in. That is being 23 percent less able to pay off student debt, save, buy property, pay for kids, and retire without the assistance of someone else.

This discrepancy ignores the facts that women are generally more engaged, are better at engaging their reports Gallupcan significantly add to top-line growth Credit Suisseand reduce a variety of risks Morgan Stanley. If anything, given the relative supply of mid- to upper-level female managers, per the laws of supply and demand, women at these levels should be paid more, not less, than their male equivalents.

It can take a LOT of time, generations it seems, for societal change to be realized and reinforced by all necessary stakeholders. In this case, like most cases, the ultimate stakeholders are men, who by their very chromosomes, are privileged.

They are privileged by a set of social, governmental, legal, religious, economic, and business rules and norms created by their predecessors, for their benefit and control. This system will merrily enforce and defend practices of blatantly questionable morality, sometimes with conscious vehemence. Of course, this privilege is also available to any woman who wants to play along, which many Caucasian women, per the recent elections, seem to have agreed to do.

It could be argued the privileges of being an attractive white woman, particularly prized in the eyes of the global patriarchy, can boost this allegiance.