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Vitamin B12 > Uses

Nutritional Supplement

Vitamin B12

Also indexed as:B12 Vitamin, Adenosylcobalamin, Cobalamin, Cyanocobalamin, Hydroxocobalamin, Hydroxycyanocobalamin, Methylcobalamin

  • Heart and Circulatory Health

    High Homocysteine

    Vitamin B6, folic acid, and vitamin B12 all play a role in converting homocysteine to other substances within the body and have consistently lowered homocysteine levels in trials.
    High Homocysteine
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    Vitamin B6, folic acid, and vitamin B12 all play a role in converting homocysteine to other substances within the body. By so doing, they consistently lower homocysteine levels in research trials,1,2,3 a finding that is now well accepted. Several studies have used (and some doctors recommend) 400–1,000 mcg of folic acid per day, 10–50 mg of vitamin B6 per day, and 50–300 mcg of vitamin B12 per day.

    Of these three vitamins, folic acid supplementation lowers homocysteine levels the most for the average person.4,5 It also effectively lowers homocysteine in people on kidney dialysis.6 In 1996, the FDA required that all enriched flour, rice, pasta, cornmeal, and other grain products contain 140 mcg of folic acid per 3½ ounces.7 This level of fortification has led to a measurable decrease in homocysteine levels.8 However, even higher levels of food fortification with folic acid have been reported to be more effective in lowering homocysteine,9 suggesting that the FDA-mandated supplementation is inadequate to optimally protect people against high homocysteine levels. Therefore, people wishing to lower their homocysteine levels should continue to take folic acid supplements despite the FDA-mandated fortification program.

  • Blood Sugar and Diabetes Support

    Type 1 Diabetes

    Supplementing with vitamin B12 may improve symptoms of diabetic neuropathy.
    Type 1 Diabetes
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    Vitamin B12, or cobalamin, is needed for normal functioning of nerve cells and is also involved in homocysteine metabolism. People with type 1 diabetes have an increased risk of other disorders that can affect their B12 status, such as autoimmune gastritis, celiac disease, and pernicious anemia.10 Vitamin B12, taken at a dose of 1,500 micrograms per day for 24 weeks, has been found to reduce symptoms and disability due to diabetic nerve damage (neuropathy).11 In a preliminary trial that included 544 participants with diabetic neuropathy, supplementing with vitamin B12 (in the form of methylcobalamin) along with folic acid (in the form of methylfolate) and vitamin B6 (in the form of pyridoxal-5-phosphate) for 12 weeks was associated with a 35% drop in symptom scores and a 32% drop in pain scores.12 A comparison trial in 100 subjects with diabetic neuropathy found injections of B12 were more effective than the commonly used pain medication, nortriptyline, for treating symptoms of diabetic neuropathy.13 A number of other studies have shown B12, alone and in combination with other treatments such as alpha-lipoic acid and prostaglandin E1, can be beneficial in those with diabetic neuropathy.14,15 Oral vitamin B12 up to 1,500 micrograms per day is recommended by some practitioners.

  • Stress and Mood Management

    Depression and Vitamin B12 Deficiency

    Taking vitamin B12 can help counteract deficiencies related to depression.
    Depression and Vitamin B12 Deficiency
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    Deficiency of vitamin B12 can create disturbances in mood that respond to B12 supplementation.16 Significant vitamin B12 deficiency is associated with a doubled risk of severe depression, according to a study of physically disabled older women.17 Depression caused by vitamin B12 deficiency can occur even if there is no B12 deficiency-related anemia.18

    Mood has been reported to sometimes improve with high amounts of vitamin B12 (given by injection), even in the absence of a B12 deficiency.19 Supplying the body with high amounts of vitamin B12 can only be done by injection. However, in the case of overcoming a diagnosed B12 deficiency, one can follow an initial injection with oral maintenance supplementation (1 mg per day), even when the cause of the deficiency is a malabsorption problem such as pernicious anemia.

What Are Star Ratings?
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Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

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References

1. Glueck CJ, Shaw P, Land JE, et al. Evidence that homocysteine is an independent risk factor for atherosclerosis in hyperlipidemic patients. Am J Cardiol 1995;75:132-6.

2. Ubbink JB, Vermaak WJH, van der Merwe A, Becker PJ. Vitamin B12, vitamin B6, and folate nutritional status in men with hyperhomocysteinemia. Am J Clin Nutr 1993;57:47-53.

3. Ubbink JB, Vermaak WJH, ven der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927-33.

4. Dierkes J, Kroesen M, Pietrzik K. Folic acid and vitamin B6 supplementation and plasma homocysteine concentrations in healthy young women. Int J Vitam Nutr Res 1998;68:98-103.

5. Stein JH, McBride PE. Hyperhomocysteinemia and atherosclerotic vascular disease: pathophysiology, screening, and treatment. Arch Intern Med 1998;158:1301-6.

6. McGregor D, Shand B, Lynn K. A controlled trial of the effect of folate supplements on homocysteine, lipids and hemorheology in end-stage renal disease. Nephron 2000;85:215-20.

7. Food standards: amendment of standards of identity for enriched grain products to require addition of folic acid. Fed Regist 1996;61:8781-97.

8. Jacques PF, Selhub J, Bostom AG, et al. The effect of folic acid fortification on plasma folate and total homocysteine concentrations. N Engl J Med 1999;340:1449-54.

9. Malinow MR, Duell PB, Hess DL, et al. Reduction of plasma homocyst(e)ine levels by breakfast cereal fortified with folic acid in patients with coronary heart disease. N Engl J Med 1998;338:1009-15.

10. Angelousi A, Larger E. Anaemia, a common but often unrecognized risk in diabetic patients: a review. Diabetes Metab 2015;41:18–27.

11. Li S, Chen X, Li Q, et al. Effects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trial. J Diabetes Investig 2016;7:777–85.

12. Trippe B, Barrentine L, Curole M, Tipa E. Nutritional management of patients with diabetic peripheral neuropathy with L-methylfolate-methylcobalamin-pyridoxal-5-phosphate: results of a real-world patient experience trial. Curr Med Res Opin 2016;32:219–27.

13. Talaei A, Siavash M, Majidi H, Chehrei A. Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy. Int J Food Sci Nutr 2009;60:71–6.

14. Xu Q, Pan J, Yu J, et al. Meta-analysis of methylcobalamin alone and in combination with lipoic acid in patients with diabetic peripheral neuropathy. Diabetes Res Clin Pract 2013;101:99–105.

15. Jiang D, Zhao S, Li M, et al. Prostaglandin E1 plus methylcobalamin combination therapy versus prostaglandin E1 monotherapy for patients with diabetic peripheral neuropathy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018;97:e13020.

16. Lindenbaum J, Healton EB, Savage DG, et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988;318:1720-8.

17. Penninx BW, Guralnik JM, Ferrucci L, et al. Vitamin B(12) deficiency and depression in physically disabled older women: epidemiologic evidence from the Women's Health and Aging Study. Am J Psychiatry 2000;157:715-21.

18. Holmes JM. Cerebral manifestations of vitamin B12 deficiency. J Nutr Med 1991;2:89-90.

19. Ellis FR, Nasser S. A pilot study of vitamin B12 in the treatment of tiredness. Br J Nutr 1973;30:277-83.

20. Rauma AL, Torronsen R, Hanninen O, Mykkanen H. Vitamin B12 status of long term adherents of a strict uncooked vegan diet (“living food diet”) is compromised. J Nutr 1995;125:2511-5.

21. Takenaka S, Sugiyama S, Ebara S, et al. Feeding dried purple laver (nori) to vitamin B12-deficient rats significantly improves vitamin B12 status. Br J Nutr 2001;85:699-703.

22. Gaby, AR. Nutritional Medicine. Concord, NH: Fritz Perlberg Publishing, 2011.

23. Goldberg TH. Oral vitamin B12 supplementation for elderly patients with B12 deficiency. J Am Geriatr Soc 1995;43:SA73 [abstr #P258].

24. Lederle FA. Oral cobalamin for pernicious anemia. Medicine's best kept secret? JAMA 1991;265(1):94-5.

25. Kondo H. Haematological effects of oral cobalamin preparations on patients with megaloblastic anemia. Acta Haematol 1998;99:200-5.

26. Waif SO, Jansen CJ, Crabtree RE, et al. Oral vitamin B12 without intrinsic factor in the treatment of pernicious anemia. Ann Intern Med 1963;58:810-7.

27. Crosby WH. Oral cyanocobalamin without intrinsic factor for pernicious anemia. Arch Intern Med 1980;140:1582.

28. Kaufman W. The use of vitamin therapy to reverse certain concomitants of aging. J Am Geriatr Soc 1955;3:927-36.

29. Lindenbaum J, Rosenberg IH, Wilson PWF, et al. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 1994;60:2-11.

30. Verhaeverbeke I, Mets T, Mulkens K, Vandewoulde M. Normalization of low vitamin B12 serum levels in older people by oral treatment. J Am Geriatr Soc 1997;45:124-5 [letter].

31. Eussen SJ, de Groot LC, Clarke R, et al. Oral cyanocobalamin supplementation in older people with vitamin B12 deficiency: a dose-finding trial. Arch Intern Med 2005;165:1167-72.

32. Delpre G, Stark P, Niv Y. Sublingual therapy for cobalamin deficiency as an alternative to oral and parenteral cobalamin supplementation. Lancet 1999;354:740-1. [letter]

33. Snow CF. Laboratory diagnosis of vitamin B12 and folate deficiency. A Guide for the primary care physician. Arch Intern Med 1999;159:1289-98 [review].

34. Rana S, D'Amico F, Merenstein JH. Relationship of vitamin B12 deficiency with incontinence in older people. J Am Geriatr Soc 1998;46:931-2.

35. Houston DK, Johnson MA, Nozza RJ, et al. Age-related hearing loss, vitamin B-12, and folate in elderly women. Am J Clin Nutr 1999;69:564-71.

36. Kaptan K, Beyan C, Ural AU, et al. Helicobacter pylori—is it a novel causative agent in Vitamin B12 deficiency? Arch Intern Med 2000;160:1349-53.

37. Perez-Perez GI. Role of Helicobacter pylori infection in the development of pernicious anemia. Clin Infect Dis 1997;25:1020-2 [review].

38. Fong TL, Dooley CP, Dehesa M, et al. Helicobacter pylori infection in pernicious anemia: a prospective controlled study. Gastroenterology 1991;100:328-32.

39. Shemesh Z, Attias J, Ornan M, et al. Vitamin B12 deficiency in patients with chronic tinnitus and noise-induced hearing loss. Am J Otolaryngol 1993;14:94-9.

40. Remacha AF, Cadafalch J. Cobalamin deficiency in patients infected with the human immunodeficiency virus. Semin Hematol 1999;36:75-87.

41. Lindenbaum J, Healton EB, Savage DG, et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988;318:1720-8.

42. Penninx BW, Guralnik JM, Ferrucci L, et al. Vitamin B(12) deficiency and depression in physically disabled older women: epidemiologic evidence from the Women's Health and Aging Study. Am J Psychiatry 2000;157:715-21.

43. Wu K, Helzlsouer KJ, Comstock GW, et al. A prospective study on folate, B12, and pyridoxal 5'-phosphate (B6) and breast cancer. Cancer Epidemiol Biomarkers Prev 1999;8:209-17.

44. Kanazawa S, Herbert V. Total corrinoid, cobalamin (vitamin B12), and cobalamin analogue levels may be normal in serum despite cobalamin in liver depletion in patients with alcoholism. Lab Invest 1985;53:108-10.

45. Cravo ML, Camilo ME. Hyperhomocysteinemia in chronic alcoholism: relations to folic acid and vitamins B(6) and B(12) status. Nutrition 2000;16:296-302 [review].

46. Pardo J, Peled Y, Bar J, et al. Evaluation of low serum vitamin B(12) in the non-anaemic pregnant patient. Hum Reprod 2000;15:224-6.

47. Sauer SW, Keim ME. Hydroxocobalamin: improved public health readiness for cyanide disasters. Ann Emerg Med 2001;37:635-41.

48. Snowden JA, Chan-Lam D, Thomas SE, Ng JP. Oral or parenteral therapy for vitamin B12 deficiency. Lancet 1999;353:411 [letter].

49. Hovding G. Anaphylactic reaction after injection of vitamin B12. Br Med J 1968;3:102.

50. Moloney FJ, Hughes R, O'Shea D, Kirby B. Type I immediate hypersensitivity reaction to cyanocobalamin but not hydroxycobalamin. Clin Exp Dermatol 2008;33:412-4.

51. House AA, Eliasziw M, Cattran DC, et al. Effect of B-vitamin therapy on progression of diabetic nephropathy. A randomized controlled trial. JAMA 2010;303:1603-9.

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