Vitamin B12 supplement injections: Myths and reality


Vitamin B12 supplement injections: Myths and reality

Vitamin B12, vitamin B12 or vitamin B-12, also called cobalamin, is a water-soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins. It is normally involved in the metabolism of every cell of the human body, especially affecting DNA synthesis and regulation, but also fatty acid synthesis and energy production. Neither fungi, plants, nor animals are capable of producing vitamin B12. Only bacteria and archaea have the enzymes required for its synthesis, although many foods are a natural source of B12 because of bacterial symbiosis. The vitamin is the largest and most structurally complicated vitamin and can be produced industrially only through bacterial fermentation-synthesis.

Vitamin B12 consists of a class of chemically related compounds (vitamers), all of which have vitamin activity. It contains the biochemically rare element cobalt. Biosynthesis of the basic structure of the vitamin is accomplished only by bacteria (which usually produce hydroxocobalamin), but conversion between different forms of the vitamin can be accomplished in the human body. A common semi-synthetic form of the vitamin, cyanocobalamin, does not occur in nature, but is produced from bacterial hydroxocobalamin and then used in many pharmaceuticals and supplements, and as a food additive, because of its stability and lower production cost. In the body it is converted to the human physiological forms methylcobalamin and adenosylcobalamin, leaving behind the cyanide, albeit in minimal concentration. More recently, hydroxocobalamin, methylcobalamin, and adenosylcobalamin can be found in more expensive pharmacological products and food supplements. The extra utility of these is currently debated.

Vitamin B12 was discovered from its relationship to the disease pernicious anemia, which is an autoimmune disease in which parietal cells of the stomach responsible for secreting intrinsic factor are destroyed. Intrinsic factor is crucial for the normal absorption of B12, so a lack of intrinsic factor, as seen in pernicious anemia, causes a vitamin B12 deficiency. Many other subtler kinds of vitamin B12 deficiency and their biochemical effects have since been elucidated.

Vitamin B12 is used to treat vitamin B12 deficiency, cyanide poisoning, and hereditary deficiency of transcobalamin II. It is given as part of the Schilling test for detecting pernicious anemia. For cyanide poisoning, a large amount may be given intravenously and sometimes in combination with sodium thiosulfate. The mechanism of action is straightforward: the hydroxycobalamin hydroxide ligand is displaced by the toxic cyanide ion, and the resulting harmless B12 complex is excreted in urine. In the United States, the Food and Drug Administration approved (in 2006) the use of hydroxocobalamin for acute treatment of cyanide poisoning.

High vitamin B12 level in elderly individuals may protect against brain atrophy or shrinkage associated with Alzheimer's disease and impaired cognitive function. High-dose administration of Vitamin B12 has been additionally validated to stimulate the activity of the body's TH1 suppressor T-Cells, which then down-regulates the over-production of the allergen antibody IgE in allergic individuals.

The dietary reference intake for an adult ranges from 2 to 3 �g per day (USA), and 1.5 �g per day (UK). Vitamin B12 is believed to be safe when used orally in amounts that do not exceed the recommended dietary allowance (RDA). There have been studies that showed no adverse consequences of doses above the RDA. The RDA for vitamin B12 in pregnant women is 2.6 �g per day and 2.8 �g during lactation periods. There is insufficient reliable information available about the safety of consuming greater amounts of vitamin B12 during pregnancy. The Institute of Medicine states that because 10 to 30% of older people may be unable to absorb naturally occurring vitamin B12 in foods, it is advisable for those 51 years old and older to consume B12-fortified foods or B12 supplements to meet the recommended intake.

The UK Vegan Society, the Vegetarian Resource Group, and the Physicians Committee for Responsible Medicine, among others, recommend that vegans either consistently eat B12-fortified foods or take a daily or weekly B12 supplement to meet the recommended intake. It is important for vegans, whose food provides few sources of B12, and anyone else wishing to obtain B12 from food sources other than animals, to consume foods that contain little or no pseudovitamin-B12 and are high in biologically active B12. However, there have been no significant human trials of sufficient size to demonstrate enzymatic activity of B12 from nonbacterial sources, such as Chlorella and edible sea algae (seaweeds, such as lavers), although chemically some of these sources have been reported to contain B12 that seems chemically identical to active vitamin. However, among these sources, only fresh sea algae such as Susabi-nori (Porphyra yezoensis) have been reported to demonstrate vitamin B12 activity in B12 deficient rats. This has yet to be demonstrated for Chlorella, and no study in rats of any algal B12 source has yet to be confirmed by a second independent study. The possibility of algae-derived active forms of B12 presently remains an active topic of research, with no results that have yet reached consensus in the nutritional community.

Vitamin B12 deficiency can potentially cause severe and irreversible damage, especially to the brain and nervous system. At levels only slightly lower than normal, a range of symptoms such as fatigue, depression, and poor memory may be experienced. Vitamin B12 deficiency can also cause symptoms of mania and psychosis.

Vitamin B12 is provided as a supplement in many processed foods, and is also available in vitamin pill form, including multi-vitamins. Vitamin B12 can be supplemented in healthy subjects also by liquid, transdermal patch, nasal spray, or injection and is available singly or in combination with other supplements. It is a common ingredient in energy drinks and energy shots, usually at several times the minimum recommended daily allowance of B12. Vitamin B12 supplements are effective for preventing deficiencies, especially in vegetarians, and are often marketed as weight loss supplements. However, no scientific studies have shown that B12 is effective for weight loss.

Vitamin B12 supplement injections: Myths and realityCyanocobalamin is converted to its active forms, first hydroxocobalamin and then methylcobalamin and adenosylcobalamin in the liver. The sublingual route, in which B12 is presumably or supposedly absorbed more directly under the tongue, has not proven to be necessary or helpful, even though a number of lozenges, pills, and even a lollipop designed for sublingual absorption, are being marketed. A 2003 study found no significant difference in absorption for serum levels from oral vs. sublingual delivery of 0.5 mg of cobalamin. Sublingual methods of replacement are effective only because of the typically high doses (0.5 mg), which are swallowed, not because of placement of the tablet. As noted below, such very high doses of oral B12 may be effective as treatments, even if gastro-intestinal tract absorption is impaired by gastric atrophy (pernicious anemia).


Injection and patches are sometimes used if digestive absorption is impaired, but there is evidence that this course of action may not be necessary with modern high potency oral supplements (such as 0.5 to 1 mg or more). Even pernicious anemia can be treated entirely by the oral route. These supplements carry such large doses of the vitamin that 1% to 5% of high oral doses of free crystalline B12 is absorbed along the entire intestine by passive diffusion.

However, if the patient has inborn errors in the methyltransfer pathway (cobalamin C disease, combined methylmalonic aciduria and homocystinuria), treatment with intravenous, intramuscular hydroxocobalamin or transdermal B12 is needed. Non-cyano forms as supplements. Recently sublingual methylcobalamin has become available in 1 mg tablets. Such tablets have higher bioavailability than the older cyanocobalamin. No cyanide is released with methylcobolamin, although the amount of cyanide (2% of the weight, or 20 micrograms cyanide in a 1 mg cyanocobalamin tab) is far less than ingested in many natural foods. Although the safety of cyanocobalamin has not been seriously questioned, the safety of the other types is also well established.

Vitamin B12 supplement injections side effects

There are quite a few side effects that patients may experience from injections of vitamin B12. The more common side effects include: mild diarrhea; upset stomach; nausea; a feeling of pain and a warm sensation at the site of the injection; a feeling, or a sense, of being swollen over the entire body; Headaches; and Joint pain. If any of these side effects become severe or troublesome, make your doctor aware. I personally have been taking injectable B12 for over a month and have none of these side effects or the one�s listed below. I also have many colleagues that take B12 injections and also have no problems with side effects. But it is important to make the that you as the consumer know of all possibilities.

Vitamin B12 injections can result in serious side effects. Although this is a relatively rare occurrence, anyone taking vitamin B12 injections should be aware of the possibility. Call your doctor immediately if you experience any of the following side effects; a rapid heartbeat; heart palpitations; chest pain; a feeling of tightness in the chest; rapid weight gain; muscle weakness; muscle pain; muscle cramps; a feeling of extreme thirst; frequent urination; leg pain; a sense of confusion; numbness; dizziness; a tingling sensation; difficulty breathing; difficulty swallowing; shortness of breath with mild exertion or when lying down; unusual coughing; unusual wheezing; a feeling of extreme tiredness or fatigue; swelling of the extremities including hands, arms, lower legs, feet or ankles; redness, pain or a feeling of warmth in one leg; tenderness or swelling in one leg; a red skin color on the face; a red skin color anywhere on the body; hives; itching and any kind of a skin rash. Again, if any of these side effects become severe or troublesome, make your doctor aware immediately.

So, as it mentions above B-12 injection side effects are very rare but it is good to know all the information pertaining to what you are putting in your body. I know for me, I have been happier, healthier and stronger due to injecting B12 two times per week. I would never go back. However, it is you decision to weight the pros and cons.

A study funded by the Canadian Institutes of Health Research (CIHR), the Swiss National Science Foundation, and the Deutsche Forschungsgemeinschaft may have uncovered one of the causes of a vitamin b12 deficiency.

Vitamin B12 supplement injections: Myths and realityMillions of people around the world suffer from a deficiency of vitamin b12, most of the time the causes are simply a lack of b12 in the diet, other times it is a result of alcoholism or other conditions like Chron�s disease. The only way to treat a b12 deficiency is either to treat the underlying condition, changing of the diet to include more b12 rich foods or to take vitamin b12 shots.

Researches recently discovered that there is another potential cause for a b12 deficiency, a mutation of the transport protein now known as ABCD4. Researchers found that there was a protein involved in the uptake of available b12 within the cells. If ABCD4 is mutated it affects the ability for the body to process and use the vitamin.

One researcher, Matthias Baumgartner of Zurich�s University Children�s Hospital, says �We were also able to compensate for the genetic mutation by adding an intact ABCD4 protein to the patients� cells, thus allowing the vitamin to be properly integrated into the cells.�

What this means is that potentially there could be an effective treatment for those that are suffering from b12 absorption issues which leads to a deficiency by adding the fully functioning protein to the patient.

Vitamin b12 is a water soluble vitamin that is primarily available in meat products. Those on strict vegan or vegetarian diets may suffer from a lack of the vitamin. B12 is a powerful anti-oxidant that supports the neurological process, the formation of red blood cells and is known to increase metabolism. People who suffer from a b12 deficiency may find themselves at risk of stroke, anemia, lack of energy, depression, dementia and psychosis.

Vitamin B12 is a large complex vitamin that requires �intrinsic factor� be present in the small intestine, just above the colon, in order for it to be utilized. It is found in many foods such as; eggs, cheeses like mozzarella, Parmesan, and Swiss, shellfish like clams and mussels, caviar, fish, crabs, lobster, milk and beef. It is critical in the formation of red blood cells. There is also no risk of overdose of this vitamin; it has no upper limit in dosing.

A deficiency of this vitamin can mimic some symptoms of alzheimers disease, causing memory loss, dementia, irritability, depression and dizziness. Deficiencies can cause mood swings, impaired brain function, tingling, and numbness. Anemia can also result from a deficiency in vitamin B12.

 

Now, to answer the initial question�. Who should be adding vitamin B12 to their diet? Anyone who has a risk factor of Alzheimers, Dementia, Anemia, Diabetes, Fatigue, Fibromyalgia, Heart disease, or Pernicious anemia. Another group of people who should be adding vitamin B12 is Vegans. Those who are on Vegan diets limit dairy and beef from they�re diet. (A main source of vitamin B12.) Also, the elderly population may find need in b12. As an aging person, over 50 there is a reduction of stomach acids which are necessary to allow B12 to break free from proteins that they bind too and be ready to be absorbed by the body. Low levels of b12 can create neurological issues. People also take B12 for the �energy� that they feel from taking it. This is due to the production of red blood cells. Basically, Vitamin B12 is a good supplement for everyone to add to their supplement regimen. Of course, you should have your levels checked by your physician and then come up with an appropriate treatment plan for you.

As always, get 6-8hours of quality sleep, drink plenty of water and try to get quality foods in your diet. When choosing meats, go for the trimmer cuts and remove the excess fats before cooking. Be consistent with your supplements.

There's no solid evidence that vitamin B-12 injections aid weight loss. Proponents of vitamin B-12 injections say the shots give you more energy and boost your metabolism, helping you shed unwanted pounds. But unless you have a vitamin B-12 deficiency, vitamin B-12 injections aren't likely to give you an energy boost.

Vitamin B12 injections versus oral supplements: A research

Vitamin B12 supplement injections: Myths and realityTo estimate savings, using a third-party payer perspective, if all elderly patients currently receiving vitamin B12 (cobalamin) injections were switched to high-dose oral therapy. DESIGN: We modeled high-dose oral B12 supplement costs to include drugs, pharmacists' fees, and one-time conversion costs consisting of two physician visits and laboratory monitoring. The number of vitamin-injection visits avoided by switching to oral therapy was predicted using a multivariate model that considered covariates for overall patient illness. SETTING: Ontario family physicians' and internists' practices. PARTICIPANTS: Population-based administrative databases for Ontario were used to identify all people between 65 and 100 years who received parenteral vitamin B12 during 1995 and 1996. MAIN OUTCOME MEASURES: The cost of parenteral vitamin B12 for each patient, including drugs, injections, pharmacists' fees, and injection-associated physician visits, was measured directly from the databases. RESULTS: The annual cost of parenteral vitamin B12 therapy averaged $145.88 per person and totaled a maximum $25 million over 5 years. Converting all patients to high-dose oral B12 and treating them for 5 years would cost $7.4 million. Depending on how many vitamin-injection visits are avoided by switching to oral therapy, between $2.9 million and $17.6 million would be saved. Switching to oral B12 administration saved costs as long as 16.3% of injection-associated visits were avoided. CONCLUSION: Switching all patients from B12 injections to oral cobalamin therapy could result in substantial savings.

Ultimately, animals must obtain vitamin B12 directly or indirectly from bacteria, and these bacteria may inhabit a section of the gut which is distal to the section where B12 is absorbed. Thus, herbivorous animals must either obtain B12 from bacteria in their rumens, or (if fermenting plant material in the hindgut) by reingestion of cecotrope feces.


Vitamin B12 is found in most animal derived foods, including fish and shellfish, meat (especially liver), poultry, eggs, milk, and milk products. However, the binding capacity of egg yolks and egg whites is markedly diminished after heat treatment. An NIH Fact Sheet lists a variety of animal food sources of B12.

Besides certain fermented foods, there are currently only a few non-animal food sources of biologically active B12 suggested, and none of these have been subjected to human trials.

Certain makers of kombucha cultured tea, such as GT's Kombucha, list vitamin B12 as naturally present in their product. One brand purports to contain 20% of the daily value of B12 in a single bottle, making kombucha a potential "high" food source of B12. Because kombucha is produced by a symbiosis between yeast and bacteria, the possibility that kombucha contains B12 does not contradict current knowledge. But no scientific studies have yet been published confirming the fact, nor whether the B12 in kombucha is the biologically active B12.

A Japanese fermented black tea known as Batabata-cha has been found to contain biologically active B12. Unlike kombucha which is made by fermenting already prepared tea, Batabata-cha is fermented while still in the tea leaf state.


Vitamin B12 supplement injections: Myths and realityChlorella, a fresh-water single cell green algae has been suggested as a vitamin B12 source but not proven by any live animal assay. Algae are thought to acquire B12 through a symbiotic relationship with heterotrophic bacteria, in which the bacteria supply B12 in exchange for fixed carbon. Spirulina and dried Asakusa-nori (Porphyra tenera) have been found to contain mostly pseudovitamin-B12 (see Terminology) instead of biologically active B12. While Asakusa-nori (Porphyra tenera) contains mostly pseudovitamin-B12 in the dry state, it has been reported to contain mostly biologically active B12 in the fresh state, but even its fresh state vitamin activity has not been verified by animal enzyme assay.
One group of researchers has reported that the purple laver seaweed known as Susabi-nori (Porphyra yezoensis).

In its fresh state contains B12 activity in the rat model, which implies that source would be active in humans. These results have not been confirmed. Foods fortified with B12 are also sources of the vitamin although they cannot be regarded as true food sources of B12 since the vitamin is added in supplement form, from commercial bacterial production sources, such as cyanocobalamin. Examples of B12-fortified foods include fortified breakfast cereals, fortified soy products, fortified energy bars, and fortified nutritional yeast. The UK Vegan Society, the Vegetarian Resource Group, and the Physicians Committee for Responsible Medicine, among others, deny that non-animal food sources of vitamin B12 are reliable and recommend that every vegan who is not supplementing consume B12-fortified foods. Not all of these may contain labeled amounts of vitamin activity. Supplemental B12 added to beverages in one study was found to degrade to contain varying levels of pseudovitamin-B12. One report has found B12 analogues present in varying amounts in some multivitamins.

Unconventional natural sources of B12 also exist, but their utility as food sources of B12 are doubtful. For example, plants pulled from the ground and not washed scrupulously may contain remnants of B12 from the bacteria present in the surrounding soil. B12 is also found in lakes if the water has not been sanitized. Certain insects such as termites contain B12 produced by their gut bacteria, in a way analogous to ruminant animals. The human intestinal tract itself may contain B12 producing bacteria in the small intestine, but it is unclear whether sufficient amounts of the vitamin could be produced to meet nutritional needs.

 

Dated 30 September 2013

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