B-12 Cyanocobalamin
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B-12: (Cyanocobalamin) also see Folate

B-12 is a worthwhile vitamin supplement for vegetarians and for senior citizens over age 55 or so.  Many of us lose the ability to extract B-12 from the food we eat as we grow older.  A high 500 mcg supplement pill each day at a cost of just 2.5 cents/day will eliminate this concern.  B-12 is necessary for the nervous system and blood cell production.

17% US Adults Over 65 B-12 Deficient: Study of 315 VA out-patients in Seattle found 17% with low serum B-12 or MMA if not on supplement and 8% if on some supplement. 46% took supplement. J Am Geriatr Soc 2002 Apr;50(4):624-30.

500 mcg/d for Elderly: Supplementation with high doses of oral B-12 is as effective as cobalamin administered by intramuscular injection to correct plasma markers of vitamin B(12) deficiency. In a DB PC study in 120 older people with mild vitamin B(12) deficiency (B(12) level of 100 to 300 pmol/L and a methylmalonic acid level of 0.26 mumol/L or greater), daily oral doses of 2.5, 100, 250, 500, and 1000 mcg of B-12 administered for 16 weeks. This resulted in mean reductions in plasma methylmalonic acid concentrations of 16%, 16%, 23%, 33%, and 33%, respectively. Daily doses of 647 to 1032 mcg of cyanocobalamin were associated with 80% to 90% of the estimated maximum reduction in the plasma methylmalonic acid concentration. The lowest dose of oral B-12 required to normalize mild deficiency is more than 200 times greater than the recommended dietary allowance, which is approximately 3 mug daily. Oral cyanocobalamin supplementation in older people with vitamin B12 deficiency: a dose-finding trial. Eussen SJ, de Groot LC, et al. Wageningen University, the Netherlands. Arch Intern Med. 2005 May 23;165(10):1167-72. Ed: The largest dose available at most drug stores is 500 mcg. or 0.5 mg. One a day is probably enough and costs only $7 a year. There is no known harm in taking more than is needed.

B-12 Helps Lower Homocysteine: Adding 400 microg/d better than intake in available multivit supplements. Increased the tHcy (total Homocysteine)-lowering potential of folic acid. Use of folic acid alone may mask B-12 deficiency which would otherwise show up as pernicious anemia. A Bronstrup, U Bonn, Am J Clin Nutr 11/98 68:1104-10.

B-12 Deficiencies Common in Toronto South Asians: Records of 988 South Asian patients found B12 results documented in 49% of charts; 46% of these showed deficiency. Patients older than 65 and vegetarians were more likely to be B12 deficient. Low serum B12 levels were positively correlated with low hemoglobin and ferritin levels and poorly correlated with low MCV levels. A vegetarian diet seems a strong risk factor. Prevalence among South Asians at a Toronto clinic. Gupta AK, Damji A, Uppaluri A. Ontario. Can Fam Physician. 2004 May;50:743-7

Folic Acid Without B-12 Dangerous in Elderly: In a study of 1,300 adults over 59, 23% had low B-12 levels. Within this group, those with the highest folic acid levels were 2.6 times as likely to show cognitive impairment as those with less as well as 3.1 times as common to have anemia. However, for those with normal B-12 levels, folic acid appeared to protect against cognitive impairment and had no relationship to anemia. Morris MS, et al. Tufts University. Amer J Clin Nutr 1/07.

B-6, B-12, Folate Not Help Stroke, Heart: In a 2 year DB PC study of 3068 stroke victims given high dose (25 mg, 0.4 mg, 2.5 mg respectively) or low dose (0.2 mg, 0.006 mg, 0.02 mg), there was no difference what so ever in strokes, heart attacks, or death during follow-up although there was a moderate decrease (2 micromol/L) in homocysteine. The study did find a more major decrease (3 micromol/L) in homocysteine was linked to decrease health risks. Lowering homocysteine in patients with ischemic stroke to prevent recurrent stroke, myocardial infarction, and death: the Vitamin Intervention for Stroke Prevention (VISP) randomized controlled trial. Toole JF, Malinow MR, Chambless LE, Spence JD, Pettigrew LC, Howard VJ, Sides EG, Wang CH, Stampfer M. JAMA. 2004 Feb 4;291(5):565-75 

B-12 Deficiency Psychosis Case: Previously healthy 52-year-old developed 3 months of acute paralysis of legs and 1 month delusions, delirium, agitation. Neurologist had earlier thought MS. Right Babinski, desquamating skin on feet, marked decrease leg strength. CBC normal but B-12 9pg/ml vs. >200 normal. Improving within 2 says IM B-12. Payinda, Am J Psychiatry 00;157:660

B-12 Helps Muscles: DB PC 4 week high dose IM showed increased compound muscle action potential. Kaji, Kyoto U, Muscle Nerv 12/98;21:1775

B-12 Helps Back Pain: In a DB PC study of 60 patients ages 18-65, treatment with IM B-12 reportedly had a large beneficial effect. U Palermo, Italy. Vitamin B12 in low back pain: a randomized, double-blind, placebo-controlled study. Mauro GL, Martorana U, Cataldo P, Brancato G, Letizia G. Eur Rev Med Pharmacol Sci 2000 May-Jun;4(3):53-8

B-12 Low Dose Not Help Sleep Phase Disorder: DB PC 50 adults 3 mg/d 4 wk no diff. Okawa, Japan, Psychiatry Clin Neurosci 10/97;51:275

B-12 10 mcg Not Enough: Cyanocobalamin supplementation of 50 microg but not 10 microg daily produced a significant increase in serum vitamin B12. Study was of 31 elderly with low or borderline B12 levels. Australia, A randomized, double-blind, placebo-controlled study of oral vitamin B12 supplementation in older patients with subnormal or borderline serum vitamin B12 concentrations. Seal EC, Metz J, Flicker L, Melny J. J Am Geriatr Soc 2002 Jan;50(1):146-51; Walmart multivit 25 microg. Walmart B-12 supplement 100 microg

B-12 High 1 mg Dose Necessary, 100 mcg Not Enough: 23 B-12 deficient elderly over age 65 were put on 6 weeks each of 25 mcg, 100 mcg, and 1000 mcg. Only highest dose normalized MMA. Response of elevated methylmalonic acid to three dose levels of oral cobalamin in older adults. Rajan S, Wallace JI, et al. J Am Geriatr Soc 2002 Nov;50(11):1789-95. (Ed: Since B-12 is stored by the body, a longer period on 100 mcg might have been enough. I recommend 500 mcg every day for over age 55.)

Mild B-12 Deficiency Common 23%: Study of elderly Dutch found 23% of free-living elderly ages 74-80 had mild deficiency. Only 1 of 25 with deficiency had inadequate intake. 31% of elderly have atropic gastritis in U.S. and Netherlands. But this explained only 25% of the deficiency cases. In US 30-40% seniors take supplements and 14% in Netherlands. Article says higher B-12 in US cereal may be reason fewer in US have high methylmalonic acid levels (MMA). Only 8% with mild deficiency had anemia. Van Asselt, Am J Clin Nutr ’98;68:328-34 and editorial.

B-12 Deficiency Very Common In India Elderly 75%: 75% of 200 adults studied had increased homocysteinemia and increase methylmalonic acid (best test for deficiency), partly due to vegetarian diets. : Am J Clin Nutr 2001 Aug;74(2):233-41

B-12 Deficiency Common in US 23%: 103 elderly adults in food program studied. 23% low B-12. This group had higher homocysteinemia and did much more poorly on cognitive testing. Hyperhomocysteinemia and vitamin B-12 deficiency in elderly using Title IIIc nutrition services. Johnson MA, Hawthorne NA, et al. Am J Clin Nutr 2003 Jan;77(1):211-20

B-12 Deficiency 17% Without Supplement, 8% With in Seattle: 315 elderly over age 65 in medical clinics were screened. Cbl deficiency (serum Cbl < or =300 pg/mL and methylmalonic acid (MMA)>271 nmol/L) was found in 13% of screened patients. 46% were taking B-12 (probably mostly low doses in multivitamins). These were significantly less likely to be Cbl deficient than persons not taking supplemental Cbl (8% vs. 17%, P =.02). J Am Geriatr Soc 2002 Apr;50(4):624-30

B-12 and Vitamin C deficiency More Common: 260 noninstitutional adults not on meds and over age 60 were studied. Those low on B-12 and/or Vit C did worse on Halstead-Reitan or Wechsler Memory Test. Low folate or B-2 worse on Halstead-R. JAMA ’83;249:2917

Seasonal Affective Disorder: B-12 Didn't Help: In a DB PC 27 patients 2 week washout and 2 weeks of treatment with 1.5 mg TID B-12 vs. placebo, researchers found no difference in depression. Oren, NIMHY, J Aff Disorder 94;32:197

Depression: B-12 Linked to Elderly, Not Folate: 3,884 Dutch elderly screened for depression. The 278 depressed and 416 controls blood tested. B-12 deficiency may play causal role in depression, but folate did not appear to do so. Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study. Tiemeier H, van Tuijl HR, Hofman A, Meijer J, Kiliaan AJ, Breteler MM. Am J Psychiatry 2002 Dec;159(12):2099-10

Depression: B-12 Levels Linked to Improvement on Meds, Not Folate Levels: In 115 young and middle aged outpatients with DSM-III-R major depressive disorder, measurements at baseline and serum of vitamin B12 level again on six-month follow-up found that higher levels at baseline and higher levels at follow-up were each related to decreases in depression. Most patients were on anti-depressant medication and most were in counseling. There was no relationship between B-12 levels initially and the level of depression. No supplements were used. Folate levels were only weakly related to response. Kuopio Univ. Finland. High vitamin B12 level and good treatment outcome may be associated in major depressive disorder. Jukka Hintikka. BMC Psychiatry 12/2003, 3:17 http://www.biomedcentral.com/1471-244X/3/17 

Depression: B-12: Studies Mentioned As Poor Evidence of Help: Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. Lindenbaum J, Healton EB, Savage DG, et al. N Engl J Med 1988;318:1720–8. Mentioned on herbal medicine site as proving that taking B-12 alone is effective in combating depression. Still older study mentioned = Ellis FR, Nasser S. A pilot study of vitamin B12 in the treatment of tiredness. Br J Nutr 1973;30:277–83. www.vitacost.com on 1/10/03 (Don't trust herbal sites!)

Depression: B-12 Lower in Elderly: Study 700 women over 65 in community. 14% mild 17% severe depression. Of depressed, 17% mild and 27% severe B-12 deficient. Found double rate severe depression in those with low B-12. Folate deficiency unrelated to depression in study. Penninx, Natl Inst Aging. Am J Psychiatry 2000;157:715

B-12: Anemia, Macrocytosis No Help in Predicting Deficiencies: Anemia and macrocytosis should not be used to predict folate or B12 deficiencies, or refractoriness to antidepressants. Measurement of folate and B12 should be considered when evaluating treatment refractoriness. 12% of 213 depressed with B12 deficiency and 19% with folate deficiency. Therefore, get vitamin blood levels in refractory. Mischoulou, MGH, J Psychosom Res 2000 Sep;49(3):183-7 

B-12 Low in Osteoporosis: Vitamin B(12) is important to DNA synthesis. In a study of bone mineral density (BMD) and B-12 levels in 2576 adults, men with plasma B(12) less than 148 pM had significantly lower BMD at the hip, and women at the spine (p < 0.05). Low Plasma Vitamin B(12) Is Associated With Lower BMD: The Framingham Osteoporosis Study. Tucker KL, Hannan MT, et al. Tufts University. J Bone Miner Res. 2005 Jan;20(1):152-8. Ed: B-12 500 mcg every day is on my list of recommended vitamins for adults over age 45.  It's very cheap.