Vitamin B12 is not a cofactor of Vitamin D, but it is often needed with Vitamin D
Started this page March 2018
Had been aware of B12 for years
Surfing the web finds
- B12 deficiency increases with age
- B12 appears to have no toxic upper limit
- Some people get frequent B12 injections or I.V, to restore levels
- Injection may not be needed
- Only a small portion of B12 taken orally gets into the bloodstream
- Sublingual B12 may not have that problem
- B12 is stored in the liver – half life of > 2 years - Dr. Greger says take it weekly or daily
- B12 can be supplemented via pills, sublingual, transdermal patch, injection, emulsion, and spray
- As with Vitamin D, a massive (loading) dose can restore levels quickly
Table of contents
- WARNING: High intake of B12 and B6 found to increase risk of hip fracture by 47 percent - 2019
- Here are all of the Vitamin B12 articles on VitaminDWiki
- Vitamin B12 strongly recommended in the Coimbra Protocol for Multiple Sclerois & Autoimmune
- Vitamin B12 on the web
- B12 supplemtation improved cognition (MMSE) in 3 months - Feb 2020
- 5X difference in B-12 bioavailability (emulsion best)
- B12 use both before and during Breast Cancer chemotherapy decreased survival by 1.8 X - 2019
- 11 symptoms of B12 deficiency - Jan 2019
- Brain Shrinkage 6X more likely if low B-12 - 2008
- Misconceptions about a B12 deficiency - 2017?
- Seniors needed 1000 ug of B12 tablet form (which is the least bio-available) - 2005
- B12 - a huge resource of information
- B12 infographics from the web
- A Proven Sign Of Vitamin B12 Deficiency June 2019
- Low B12 in 55% of Diabetics getting Metformin
- B12 oral seems as good as an injection, and much lower cost - Cochraine March 2018
- B12. - March 2018
- 3X as many headaches in children with low B12 - March 2018
- Singers believe B12 reduces voice tremors - Jan 2018
- Nineteen B12 genes - Feb 2018
- B12 deficiency - from Pintrest
- B12 injections increase acne
- Why Most People Need Vitamin B12 Supplementation - Mercola April 2018, 50 minute video
- B12 Mercola Nov 2018
- FDA has lowered the Daily Value for B-12 to just 2.5 mcg for adults
- Tested German pregnancies for 27 deficiencies, B-12 deficiency was found most frequently - June 2018
- B12 notes - Bill Sardi July 2018
- 80 % of those within eurological abnormalities were B12 deficient - June 2018
- Images from the web
- Evolutionary Quirk- Discover Magazine Aug 2018
- Vitamin B-12 – little extra benefit if more than 5 micrograms at a time
- How common is vitamin B-12 deficiency? - 2009
- B Vitamins at Mercola Sept 2018
- B12 Lifetime trends
- 3 out of 4 Vegans are deficient, 1 out of 4 elderly
- Very large doses do result in more getting into the blood
- Females may have less B12 if older than 12 years, especially Black females
- B-12 and Vitamin D reduce cardiovascular mortality - Dec 2018
- Oral B12 was 1.8X better than Injection - Jan 2019
- B12 needed to fight pathpgens (in roundworms) March 2019
- B12 eliminated canker sores in 74% of people - RCT 2009
- Low B12 sometimes ==> Dementia - May 2019
- B12 deficiency and clinical laboratory: Lessons revisited and clarified in seven questions - Sept 2017
Association of High Intakes of Vitamins B6 and B12 From Food and Supplements With Risk of Hip Fracture Among Postmenopausal Women in the Nurses’ Health Study - May 2019
Combination of B6 >35 mg/d and B12 >20 micrograms/d increased hip fracture risk 47%
Note: My wife had been taking Life Force supplements for decades and got a hip fracture
Recommended daily serving of 4 tablets contains 48 mg of B6 and 200 micrograms of B12
No data in the study, but perhaps this much of B6 and B12 might increase the risk of hip fracture by > 2X
Download the Study PDF from VitaminDWiki
Details on VitaminDWiki at Warning - High intake of Vitamin B12 and B6 found to increase risk of hip fracture by 47 percent - 2019
- wiki page:
- Higher vitamin D is associated with higher Folate or higher Vitamin B-12 – June 2020
- Lack of sun has caused multiple vitamin deficiencies, poor health and poor sleep - Gorminak Feb 2020
- Vitamins and Metals needed by the Immune System – Jan 2020
- My balance significantly improved at age 73 (perhaps Vitamin D, B12, or Omega-3) – Jan 2020
- High vs low Vitamin B12 levels associated with 1.7 X increased risk of death – Jan 2020
- Depression treatments: diet, exercise, bright light, Vitamin D, B12, Omega-3, Zinc, Music, etc. – May 2019
- Nasal Vitamin B12 treatment for children (perhaps nasal Vitamin D too) – Nov 2019
- Vitamin B12 treats Traumatic Brain Injury in mice – April 2019
- Warning - High intake of Vitamin B12 and B6 found to increase risk of hip fracture by 47 percent - 2019
- Cognitive decline 2X more likely if low Vitamin D or high Vitamin B12 – Feb 2019
- Vitamin B12 levels drop a lot during adolescent pregnancies – Feb 2019
- Vitamin B12 as a Treatment for Pain – review Jan 2019
- Vitamin D, Vitamin B12, etc. charts- 2004-2018
- Sleep, Vitamin D, B Vitamins, jaw, etc. Dr. Gominak transcript - 2016
- Vitamin B12-fortified toothpaste helped (Vitamin D tooth powder also helps) Jan 2019
- Interaction of drugs with Vitamin D, Magnesium, Vitamin B12, Selenium, etc – Dec 2018
- Dr. Coimbra discusses Vitamin D, Magnesium, Folic Acid, B12, Autism, Depression, etc – Sept 2018
- Vitamin B12 in addition to Foliate is needed to reduce neural tube defects – July 2018
- Autistics and Schizophrenics have 3X lower Vitamin B12 levels in the brain – Jan 2016
- ADHD associated with significantly less Vitamin B12 – Sept 2018
- Vitamin B12 best from Cheddar Cheese or from synthetic B12 (pigs) – Aug 2018
- Bulk supplementation of Vitamin D, Magnesium, Zinc, B-12, K2, Boron etc. - lower cost and easier than pills
- Vitamin B12 confusion: what test, what level, how much, which form – March 2018
- Autism treated by Vitamin B12 - several studies
- Obese women deficient in both Vitamin D and Vitamin B12 – March 2018
- Pancreatic cancer risk reduced 25 percent by just 10 micrograms of Vitamin D or Vitamin B12 – meta-analysis March 2018
- Vitamin B12 and Parkinson’s Disease
- Vitamin B12
- Drugs which create deficiencies in Vitamin D, Vitamin K, Magnesium, Zinc, Iron, etc. – Sept 2017
- Do You Believe the Myth That You Can't Prevent Alzheimer's – Mercola, Aug 2017
- Vitamin D (also B9, B12, C, E, and K) can be limited by genes – April 2017
- Autism 17 times more likely with excessive Folic Acid and B-12 (now added to bread) – May 2016
- Multiple Sclerosis and (lots of) Vitamin D - book by patient on Coimbra protocol - Feb 2016
- Hypothesis – Vitamin B-12 deficiency is associated with Vitamin D deficiency
- Results of many blood tests in Australia – deficiencies only in Vitamin D, Iodine, and Vitamin B-12 – Dec 2015
- Common deficiencies D3, Omega-3, K2, Mg, B12, E, A, Iodine, etc – Mercola Oct 2015
- Role of vitamins in gastrointestinal diseases – review May 2015
- Schizophrenia might be treated by folic acid, vitamin B12 and vitamin D – May 2014
- Sleep disorders cured by 60-80 ng of vitamin D and some B vitamins – March 2013
- Handout on Vitamin D (Hormone D) and sleep - Gominak 2012
- Video by Dr. Coimbra – 95 percent of auto-immune cured with vitamin D in high doses - April 2014
- Vitamin D is the real Multiple Sclerosis Therapy, not an alternative therapy – Coimbra July 2018
Low Vitamin B12 Levels: An Underestimated Cause Of Minimal Cognitive Impairment And Dementia
Cureus, 12 (2), e6976 2020 Feb 13, DOI: 10.7759/cureus.6976
Shazia Jatoi 1, Abdul Hafeez 2, Syeda Urooj Riaz 3, Aijaz Ali 1, Muhammad Ishaq Ghauri 3, Maham Zehra 1
Background Vitamin B12 deficiency is linked to impaired cognition and memory along with a sensation of tingling and numbness, an outcome of poor myelination. Elevated methylmalonic acid and serum homocysteine levels are markers of Vitamin B12 deficiency. Elevated homocysteine levels are also often associated with Alzheimer's disease and stroke. We conducted this study to determine the effect of vitamin B12 replacement therapy on vitamin B12-deficient patients with noted cognitive impairment.
Methods We conducted a cross-sectional, multicenter study of patients with minimal cognitive impairment (MCI) to assess for Vitamin B12 and homocysteine levels. All patients found to be deficient in vitamin B12 underwent replacement therapy and were assessed again after three months via the Mini-Mental State Examination (MMSE) and a review of symptoms.
Results A total of 202 patients were included in the study. Of those, 171 (84%) patients reported marked symptomatic improvement after vitamin B12 replacement while MMSE scores improved in 158 (78%) patients. Of the remaining 44 patients who reported no symptomatic improvement, MMSE scores improved in 26 while 18 patients showed no MMSE score improvements.
Conclusions Vitamin B12 deficiency is linked to cognition, and replacement therapy may be an option to improve patient cognition outcomes. Further studies are needed to confirm and refine the observed associations over a larger scale and to determine whether these findings will translate to a reduction in cognitive decline.
Download the PDF from VitaminDWiki
Conclusions from the end of the PDF
We found a clear association between low vitamin B12 levels and progressive cognitive
impairment; therefore, further studies are needed to confirm and refine the observed
associations over a larger scale and to determine whether this change will translate to a
reduction in cognitive decline. Moreover, we are in favor of screening for vitamin B12
deficiency, at least in the elderly population, to find and prevent the possible causes of this
deficiency state, as this can be an easily preventable cause of impending dementia before the
cognitive decline becomes irreversible.
Note: Does not appear to mention sub-lingual tablets
Download the PDF from VitaminDWiki
__MedNewsToday has detailed description
1. Tingling hands or feet
2. Trouble walking
3. Pale skin
5. Fast heart rate
6. Shortness of breath
7. Mouth pain
8. Problems thinking or reasoning
10. Nausea, vomiting, and diarrhea
11. Decreased appetite and weight loss
Vitamin B12 status and rate of brain volume loss in community-dwelling elderly.
Misconceptions about a B12 deficiency
1. Serum B12 is a conclusive test
2. A B12 deficiency always causes anemia
3. A B12 deficiency is rare and only occurs in older people
4. There is only one cause for a B12 deficiency, auto-immune pernicious anemia.
5. Serum B12 can be used to monitor treatment:
6. B12 can be toxic in high doses
- Randomized Controlled trial using 2.5, 100, 250, 500, and 1,000 µg
- “To achieve 80% to 90% of the estimated maximum reduction in the plasma methylmalonic acid concentration, daily doses of 647 to 1,032 µg of cyanocobalamin were required”
- BENEFITS. DEFICIENCY, TEST, FOOD SOURCES, SUPPLEMENTS, DOSAGES, TYPES
Anyone, at any age, can become B12 deficient. However, certain people are at an elevated risk
- that are vegetarians, vegans and people on macrobiotic diets
- aged fifty and over
- who've undergone any gastric and/or intestinal surgery, including bariatric surgery for weight loss purposes (gastric bypass)
- who regularly use proton-pump inhibitors, H2 blockers, antacids, Metformin and related diabetes drugs, or other medication which can interfere with B12 absorption
- Nitrous oxide administration or abuse
- with a history of eating disorders (anorexia or bulimia)
- with a history of alcoholism
- with a family history of pernicious anaemia
- diagnosed with anaemia (including iron deficiency anaemia, sickle cell anaemia, and thalassemia)
- with Crohn's disease, ulcerative colitis, irritable bowel syndrome, coeliac disease, or any other disease that causes malabsorption of nutrients
- with autoimmune disorders (especially thyroid disorders such as Hashimoto's thyroiditis and Graves' disease), type 1 diabetes, vitiligo, lupus, Addison's disease, ulcerative colitis, rheumatoid arthritis, acquired agammaglobulinemia, or a family history of these disorders
- with neurologic or motor symptoms
- with Downs syndrome
- with Phenylketonuria (PKU)
- with psychiatric disorders, including depression, bipolar etc
- with elevated MCV (mean corpuscular volume)
- with occlusive vascular disorders (MI, CVA, DVT, PE)
- Orthostatic hypotension / Postural hypotension
- Transient ischemic attacks (TIAs, or 'mini stroke')
- Cerebral vascular accident (CVA or 'stroke')
- Myocardial infarction ('heart attack')
- DVT - Deep vein thrombosis (blood clot to the leg or arm)
- with Gastroesophageal reflux disease (GERD)
- who've undergone neck or back surgery
- Who've undergone Chemo or radiation therapy
Women . . .
- with a history or infertility or multiple miscarriages
- with post natal depression
- Nitrous oxide administration (laughing gas)
Infants . . .
- born to and/or breast-fed by women who are symptomatic or are at risk for B12 deficiency
- Infants and children with developmental delay
- "Around one-quarter of people may have a vitamin B12 deficiency."
- "One study of Colombian children found that children deficient in vitamin B12 were at more than twice the risk of repeating a grade"
- "Deficient children were also almost twice as likely to be absent from school as those who were not" 10.1016/j.jsbmb.2018.09.005
- Vitamin B12 deficiency in diabetic subjects taking metformin: A cross sectional study in a Lebanese cohort March 2018, free PDF online
Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency 10.1002/14651858.CD004655.pub3
Adv Food Nutr Res. 2018;83:215-279. doi: 10.1016/bs.afnr.2017.11.005. Epub 2018 Feb 2.
Smith AD1, Warren MJ2, Refsum H3.
The biosynthesis of B12, involving up to 30 different enzyme-mediated steps, only occurs in bacteria. Thus, most eukaryotes require an external source of B12, and yet the vitamin appears to have only two functions in eukaryotes: as a cofactor for the enzymes methionine synthase and methylmalonylCoA mutase. These two functions are crucial for normal health in humans, and in particular, the formation of methionine is essential for providing methyl groups for over 100 methylation processes. Interference with the methionine synthase reaction not only depletes the body of methyl groups but also leads to the accumulation of homocysteine, a risk factor for many diseases. The syndrome pernicious anemia, characterized by lack of intrinsic factor, leads to a severe, sometimes fatal form of B12 deficiency.
However, there is no sharp cutoff for B12 deficiency; rather, there is a continuous inverse relationship between serum B12 and a variety of undesirable outcomes, including
- neural tube defects,
- stroke, and
The brain is particularly vulnerable; in children, inadequate B12 stunts brain and intellectual development.
Suboptimal B12 status (serum B12<300pmol/L) is very common, occurring in 30%-60% of the population, in particular in pregnant women and in less-developed countries. Thus, many tens of millions of people in the world may suffer harm from having a poor B12 status. Public health steps are urgently needed to correct this inadequacy.
KEYWORDS: Brain; Children; Cobalamin; Cognition; Elderly; Homocysteine; Memory; Methylmalonic acid; Pregnancy
PMID: 29477223 DOI: 10.1016/bs.afnr.2017.11.005
The association between serum vitamin B12 deficiency and tension-type headache in Turkish children.
24% vs 8% were < 200 pg/ml
The Singer's and the Clinician's Perspective on Vitamin B12 Treatment for Vocal Benefits
but laryngologists have not seen any studies
|5||co-factors or regulators for the transport of vitamin B12|
|3||involved in the catalysis of enzymatic reactions|
|1||involved in cell cycle regulation|
- Common Vitamin Has Been Linked to a Higher Risk of Acne
" research from the past six decades that's linked it to higher instances of the condition"
"So it looks like by intaking extra vitamin B12 (injection), we could be prompting the bacteria in our skin to slow down on their production of it, which leads to an imbalance that could heighten our risk of developing acne"
free PDF of the small 2015 study
- 40 % have marginal vitamin B12, 9 % are deficient
- "Animal foods have become a questionable source of B12 thanks to modern farming practices ,,,"
- "B12 Deficiency Mimics Many Serious Neurological Disorders and Diseases"
such as multiple sclerosis, Alzheimer’s disease and autism
- "Low B12 Implicated in Migraines"
- especially for "Adults over 50, because as you grow older, your ability to produce intrinsic factor decreases."
- also "People who have taken antibiotics, as these drugs have been shown to induce vitamin B12 deficiency.26"
- Methylcobalamin is more absorbable than the cyanocobalamin form of B12
- cyanocobalamin may have problems - GreenMed Info Dec 2018
Mercola is selling a B12 energy boost product - methylcobalamin
It apparently has better bioavailability, but the article does not appear to state by how much
but this won't be reflected on most supplement labels until 2018 or 2019
Tested German pregnancies for 27 deficiencies, B-12 deficiency was found most frequently - June 2018
High incidence of maternal vitamin B12 deficiency detected by newborn screening: first results from a study for the evaluation of 26 additional target disorders for the German newborn screening panel.
- " Up to 40% of US adults may be B12 deficient"
- "False normal B12 blood tests are common" 2012
Vitamin B12 deficiency neuropathy: A clinical and electrophysiological study
Neurophysiologie Clinique. Volume 48, Issue 3, June 2018, Page 130. https://doi.org/10.1016/j.neucli.2018.05.00
Vitamin B12 deficiency is a metabolic disorder with many causes. The neurological features of vitamin B12 deficiency are heterogeneous . Peripheral neuropathy often described , but its frequency and its type is controversial [1. The present study was conducted to describe electro-clinical presentations of peripheral neuropathy in patients with vitamin B12 deficiency.
A Retrospective review of 32 subjects with neurological abnormalities due to vitamin B12 deficiency, were subjected to a detailed motor and sensory nerve conduction studies of median, ulnar, external popliteal sciatic, internal popliteal sciatic and sural nerves. Patients that have another reason for neuropathy or another disease that can effect nerve conduction studies were excluded.
The median age of the patients was 51 (± 16.57) years old, (range 18–84 years old), sex ratio (M/F) was 1.66 (20/12).
Clinical features of neuropathy:
- ataxia and limb weakness
were present in 20 (62.5%) patients.
Electromyography showed abnormal nerve conduction in
- 25 (78.12%) patients and it was normal in 7 (21.88%) patients.
On nerve conduction study: 16 (50%) had axonal impairment, 3 (9.3%) had demyelinating neuropathy and 6 (18.75%) had mixed features. Eleven patients (34.37%) presented a pure sensory impairment and 14 (43.75%) presented mixed pattern sensory and motor impairment.
All cases underwent treatment with intramuscular hydroxocobalamin treatment (daily injection of 1000 μg cyanocobalamin for 4 weeks, followed by injections of 1000 μg each month) with marked clinical and haematological improvement.
Conclusion: We conclude that nearly 80% patients with neurologic manifestations of vitamin B12 deficiency had evidence of peripheral neuropathy which is mainly axonal with some demyelinating features.
Sensory and motor nerve conduction were affected.
Evolution is generally good if the treatment was initiated early.
The Evolutionary Quirk That Made Vitamin B12 Part of Our Diet
B12 made in the human gut is further down than it can be absorbed
- I had been taking 50,000 micrograms every couple of days – in the form of a little pill
- I just learned that the gut become far less efficient at taking in more than about 5 micrograms at a time.
- So I had been supplementing with about 1,000 X more than could be absorbed
- I have been taking many of my supplements in bulk form
This greatly reduces the cost and the number of pills I take weekly.
- Bulk Vitamin B12 costs only $18 for 500,000 micrograms Amazon
- I will be adding 5 micrograms of B-12 to my daily bulk supplements – at a cost of $0.0002 per day
Had cost $0.06/day so the bulk form will be 300 X lower cost
- I am unaware of any limitation on daily intake of Vitamin D by any form nor of Vitamin B-12 by injection
Am J Clin Nutr 2009;89(suppl):693S-6S. Printed in USA. © 2009 American Society for Nutrition
Lindsay H Allen
In considering the vitamin B-12 fortification of flour, it is important to know who is at risk of vitamin B-12 deficiency and whether those individuals would benefit from flour fortification. This article reviews current knowledge of the prevalence and causes of vitamin B-12 deficiency and considers whether fortification would improve the status of deficient subgroups of the population.
In large surveys in the United States and the United Kingdom, '6% of those aged >60 y are vitamin B-12 deficient (plasma vitamin B-12 < 148 pmol/L), with the prevalence of deficiency increasing with age.
Closer to 20% have marginal status (plasma vitamin B-12: 148-221 pmol/L) in later life.
In developing countries, deficiency is much more common, starting in early life and persisting across the life span. Inadequate intake, due to low consumption of animal-source foods, is the main cause of low serum vitamin B-12 in younger adults and likely the main cause in poor populations worldwide; in most studies, serum vitamin B-12 concentration is correlated with intake of this vitamin. In older persons, food-bound cobalamin malabsorption becomes the predominant cause of deficiency, at least in part due to gastric atrophy, but it is likely that most elderly can absorb the vitamin from fortified food. Fortification of flour with vitamin B-12 is likely to improve the status of most persons with low stores of this vitamin. However, intervention studies are still needed to assess efficacy and functional benefits of increasing intake of the amounts likely to be consumed in flour, including in elderly persons with varying degrees of gastric atrophy.
- “Although >70% of the vitamin is absorbed when intake is in the range of 0.1-0.5 ug, the ileal receptors for the vitamin B-12-intrinsic factor complex become saturated with higher intakes such that absorption falls to '50% of a 1-ug dose, 15% of a 10-ug dose, and 3% of a 25-50-ug dose”
|B Vitamin||Recommended Adult Daily Intake||Susceptibility to damage during processing and storage||Important Functions|
|Thiamine (Vitamin B1)||1.2 mg; 1.4 mg (pregnant and lactating women)||Sensitive to heat, oxygen, humidity, and light, and very sensitive to alkaline pH||Essential for metabolism of fats and carbohydrates, energy metabolism for nervous system and muscles*|
|Riboflavin (Vitamin B2)||1.3 mg; 1.6 mg (pregnant and lactating women)||Sensitive to humidity and light||Essential for growth and muscle development, eye health, and healthy skin*|
|Niacin (Vitamin B3)||16 mg; 18 mg (pregnant and lactating women)||Stable||Essential for the proper function of enzymes and a healthy nervous system, skin, nails and GI function*|
|Pantothenic Acid (Vitamin B5)||5 mg; 7 mg (pregnant and lactating women)||Sensitive to heat and humidity||A structural element of many coenzymes, plays a central role in energy metabolism and the synthesis of sex hormones*|
|Pyridoxine (Vitamin B6)||1.7 mg; 2 mg (pregnant and lactating women)||Very sensitive to heat, and sensitive to humidity, light and acid pH||Essential for the body’s utilization of protein and the synthesis of neurotransmitters*|
|Folate (Vitamin B9)||400 mcg; 600 mcg (pregnant and lactating women)||Very sensitive to heat, acid pH and light, and sensitive to humidity||Required for the production of red blood cells in bone marrow*|
|Biotin||30 mcg; 35 (pregnant and lactating women)||Sensitive to humidity and light||Supports healthy normal growth, digestion, muscle function, healthy skin and hair, and cellular health*|
|Cobalamin (Vitamin B12)||2.4 mcg; 2.8 mcg (pregnant and lactating women)||Sensitive to heat, oxygen, humidity, and contact with iron or copper||Supports protein, carbohydrate and fat metabolism, GI and nervous system health, immune function and the healthy production of red blood cells*|
Recent Insights into the Role of Vitamin B12 and Vitamin D upon Cardiovascular Mortality: A Systematic Review
Download the PDF from VitaminDWiki
Effectiveness of Vitamin B12 in Treating Recurrent Aphthous Stomatitis: A Randomized, Double-Blind, Placebo-Controlled Trial
sublingual 1000 mcg of vitamin B12 for 6 months
[https://scholar.google.com/scholar?cites=14000970951237221541&as_sdt=5,48&sciodt=0,48&hl=en||Google Scolar - 119 citations of this study as of Feb 2019]
Download the PDF from VitaminDWiki
"Reversible dementia, psychotic symptoms and epilepsy in a patient with vitamin B12 deficiency" doi: 10.1136/bcr-2018-229044
B12 deficiency and clinical laboratory: Lessons revisited and clarified in seven questions - Sept 2017
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