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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.
 Cyanocobalamin 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.
 Millions 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
 To 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.
 Chlorella, 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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