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Vitamin B12 cobalamin

Vitamin: B12, cobalamin

Daily Value: 6.0 mcg

Hazardous level: 100 mcg

Average intake in US diet: 7.84 mcg

Function: Aids metabolism of fats, carbohydrates, and proteins; facilitates blood cell

formation; maintains healthy nervous system and skin

SENIOR DOSAGE RATIONALE:150% of USRDA is desirable, adjusted for weight and intake

KEY NOTES AND REFERENCES:

Herzlich, B.C., et al , "Relationship among homocyst(e)ine, vitamin B-12 and cardiac disease in the

elderly: association between vitamin B-12 deficiency and decreased left ventricular ejection fraction", J

Nutr. 126: 1249S-53S (1996)

"We evaluated the association of moderate hyperhomocyst(e)inemia and vitamin B-12 status with

coronary artery disease (CAD) and left ventricular ejection fraction in 367 elderly patients... In

conclusion, vitamin B-12-deficient patients had significantly lower left ventricular ejection fractions

than nonvitamin B-12-deficient patients."

Koehler, K.M., et al, "Vitamin supplementation and other variables affecting serum homocysteine and

methylmalonic acid concentrations in elderly men and women, J Am Coll Nutr. 15: 364-76 (1996)

"An elevated serum concentration of the metabolite, homocysteine (Hcys): 1) can indicate folate or

vitamin B12 deficiency, 2) is an independent risk factor for vascular disease. .. to determine the

effect of self-selected vitamin supplementation and other variables ... for elderly volunteers, age

68-96 years, and compared for those consuming (26 men, 25 women) and not consuming (24 men,

25 women) self-selected vitamin supplements. RESULTS: Compared with the nonsupplemented

group, the supplemented group had lower mean serum MMA (208 +/- 162 vs. 241 +/- 98 nmol/L [+/-

SD]) and Hcys (9.5 +/- 2.6 vs. 11.2 +/- 2.7 mumol/L); and higher serum vitamin B12 (391 +/- 174

vs 292 +/- 107 pmol/L), and serum folate (46 +/- 15 vs. 24 +/- 10 nmol/L) p < 0.05... Clinicians

should be aware of the risk of vitamin B12 deficiency in older people... These elderly volunteers had

generally good folate status; nevertheless, some subjects seemed likely to benefit from an

improvement in folate status that would reduce their serum Hcys within the normal range."

Piyathilake, C.J., et al, "Cigarette smoking, intracellular vitamin deficiency, and occurrence of micronuclei

in epithelial cells of the buccal mucosa", Cancer Epidemiol Biomarkers Prev. 4: 751-8 (1995)

"The study focuses on the assessment of chromosomal damage associated with folate and vitamin

B12 deficiency.... The presence of vitamin B12 in the immediate environment (saliva) and vitamin

C and E in the plasma, however, appear to be marginally protective against chromosomal damage

in buccal mucosal cells."

Fata, F.T., Herzlich, B.C., Schiffman, G., and Ast, A.L., "Impaired antibody responses to pneumococcal

polysaccharide in elderly patients with low serum vitamin B12 levels", Ann Intern Med. 124: 299-304

(1996)

"To determine whether immunocompetent elderly patients with low serum vitamin B12 levels have

impaired serum antibody responses to the 23-polyvalent pneumococcal polysaccharide vaccine. ..:

Patients with low vitamin B12 levels had impaired antibody responses to pneumococcal vaccine."

Mayer, G., Krîger, M., and Meier-Ewert, K. , "Effects of vitamin B12 on performance and circadian rhythm

in normal subjects", Neuropsychopharmacology 15: 456-64 (1996)

"This preliminary study investigates effects of methyl- and cyanocobalamin on circadian rhythms,

well-being, alertness, and concentration in healthy subjects... the change in the visual analogue scales

items "sleep quality", "concentration", and "feeling refreshed" between pretreatment and the first

week of treatment showed significant correlations with vitamin B12 plasma levels."

Quinn, K. and Basu, T.K. , "Folate and vitamin B12 status of the elderly", Eur J Clin Nutr. 50: 340-2

(1996)

" The present study was undertaken to investigate the relationship between estimated folate and

vitamin B12 intakes and their biochemical status in elderly persons. SUBJECTS: Twenty-eight

males and 30 females ( > 65 years)...CONCLUSIONS: The folate status appears to be a greater

concern than the vitamin B12 status for the elderly population. It seems that although mean values

of dietary intake and plasma concentrations of folate may indicate nutritional adequacy, a proportion

of the older population may still be at nutritional risks."

WHITE PAPER REFERENCES FOR SENIOR FORMULATION

Ellis, FR and Nasser, S, "A pilot study of vitamin B12 in the treatment of tiredness", Br. J. Nutr

30:277-84 (1973)

28 people, 5mg twice weekly, "The response achieved statistical significance in respect of

general well-being"- 5 mg B12 twice weekly for two weeks improved energy (median

age=41)

Mayer, G, Kroger, M, and Maier-Ewert, K,"Effects of vitamin B12 on performance and circadian

rhythm in normal subjects," Neuropsychopharmacology 15: 456-64 (1996)

"'sleep quality', 'concentration', and 'feeling refreshed' ...showed significant correlations

with vitamin B12 plasma levels." [study of 20 people, 3 mg B12 per day, 2 weeks]- 20

35-yr olds, 3 mg B12 at 7 am for 2 weeks, felt refreshed and needed less sleep. "Only

methylcobalamin has a positive psychotropic alerting effect with a distribution of the

sleep-wake cycle toward sleep reduction."

Naurath, HJ, et al, "Effects of vitamin B12, folate, and vitamin B6 supplements in elderly people

with normal serum vitamin concentrations", Lancet 346: 85-89 (1995)

"supplement containing 1mg vitamin B12, 1.1 mg folate, and 5 mg vitamin B6" "Vitamin

supplements significantly reduced all four metabolite concentrations [related to high

homocysteine]... The response rate to vitamin supplements supports the notion that

metabolic evidence of vitamin deficiency is common in the elderly, even in the presence

of normal serum vitamin levels." - 1 mg B12 8x IM over 2 weeks reduces homocystiene

in elderly

Selhub, J. et al, "Association between plasma homocysteine concentrations and extracranial

carotid-artery stenosis", NEJM 332: 286-92 (1995)

study of 1041 elderly subjects ages 67-96; "High plasma homocysteine concentrations

and low concentrations of folate and vitamin B6...are associated with an increased risk of

extracranial carotid-artery stenosis in the elderly." - vit B12 in elderly reduces risk of

extracranial carotid-artery stenosis (atherosclerosis)

Baker, H., et al, "Vitamin Profiles in elderly persons living at home or in nursing homes, versus

profile in healthy young subjects," J Am Ger Soc 27:444-50 (1979)

"473 elderly persons...The circulating levels of biotin, pantothenate, riboflavin, vitamins

A, B6, B12, C, E, folate, Thiamine, nicotinate, and carotenes were determined in all

groups." "Thiamine, vitamin C and vitamin B12 levels were strikingly depressed in the

non-institutional elderly... Over 30% of the institutional elderly had vitamin B6 and

nicotinate hypovitaminemia...Both the institutional and the non-institutional elderly

showed depressed levels of folate and vitamin B12...Vitamin supplementation reduced

the percentage of folate and B12 deficits."- 24% of elderly deficient in B12

Cole, MG, and Prchal, JF, "Low serum vitamin B12 in Alzheimer-type dementia", Age and

Ageing 13: 101-105 (1984)

"Serum B12 levels were significantly lower...in [20 subjects aged 65 years and over] with

Alzheimer-type dementia"- B12 lower in Alzheimer patients

Shimikawa, T. et al, "Vitamin intake: a possible determinant of plasma homocysteine among

middle-aged adults", Ann Epidemiol 7: 285-93 (1997)

"Plasma homocysteine among users of vitamin supplement products was 1.5 micromol/L

lower than among nonusers."

Wieland, R. G., "Vitamin B12 Deficiency in the Nonanemic Elderly", J Am Geriatric Soc 34:

690 (1985)

"B12 deficiency in the apparently healthy elderly is a major problem" - 86 people mean

age 87; 5 of 81 had low values, even in apparently healthy people; deficiency in healthy

elderly is a major problem

Matchar, D.B., et al, "Significance of low serum vitamin B12 levels in the elderly", J Am

Geriatric Soc 34: 692-3 (1985)

"The proportion of patients with low serum B12 levels increased with age:...14.8% older

than or equal to 65 years." "We conclude that...most patients with low B12 levels have

normal B12 absorption" - elderly with low B12 have normal absorption

WHITE PAPER REFERENCES FOR STAY WELL FORMULATIONS

Mayer, G, Kroger, M, and Maier-Ewert, K,"Effects of vitamin B12 on performance and circadian rhythm

in normal subjects," Neuropsychopharmacology 15: 456-64 (1996)

"'sleep quality', 'concentration', and 'feeling refreshed' ...showed significant correlations with

vitamin B12 plasma levels." [study of 20 people, 3 mg B12 per day, 2 weeks]

Ellis, FR and Nasser, S, "A pilot study of vitamin B12 in the treatment of tiredness", Br. J. Nutr

30:277-84 (1973)

28 people, 5mg twice weekly, "The response achieved statistical significance in respect of

general well-being"

Chandra, R. K., "Effect of vitamin and trace-element supplementation on immune responses and

infection in elderly subjects", Lancet 340: 1124-27 (1992)

study of 96 people, had 23 vs. 48 days of illness, recipe 400 iu retinol, 16 mg beta-

carotene, 2.2 mg thiamin, 1.5 mg riboflavin, 16 mg niacin, 3 mg B6, 400 mcg folate, 4

mcg B12, 80 mg C, 4 mcg D, 44 mg E, 16 mg Iron, 200 mg Ca, 100 mg Mg