“Hey, Doc, I’ve been dragging lately. How about a shot of B12?” asked a patient of Consumer Reports’ chief medical adviser, Marvin M. Lipman. “My mother-in-law had one, and it put her on top of the world.”
According to Lipman, primary-care practitioners have been fielding such requests about this reputedly potent fatigue-fighter for at least half a century. So you would think the revitalizing properties of Vitamin B12 for healthy individuals would be well established by now. Think again. And you might also be surprised by how many people truly are B12-deficient.
The oversize reputation of B12 probably stems from long-ago research that established the vitamin’s importance in relieving the fatigue associated with pernicious anemia, a disease that impairs the absorption of B12 from food.
The injectable red liquid quickly gained a reputation as a magic antidote for everyday fatigue in otherwise healthy people with normal B12 blood levels. This belief has persisted despite the lack of good scientific evidence for its use as an all-purpose energizer. In 1985, the National Ambulatory Medical Care Survey recorded about 2.5 million B12 injections, of which fewer than 400,000 were for diagnoses compatible with B12 deficiency disorders.
It wasn’t until 1973 that the first randomized controlled clinical trial of the vitamin — involving 29 subjects and lasting only six weeks — took place. The participants, all with normal B12 blood levels, were given either a twice-weekly dose of the vitamin or a placebo for two weeks, followed by a rest period of two weeks and a final two-week phase in which the vitamin and placebo recipients were secretly switched. The study was flawed because only the group that received the vitamin first was analyzed. No statistical differences were noted in appetite, sleep patterns and fatigue, but those initially given B12 were “happier” and “felt better.”
In another small study from 1989, 15 people with chronic fatigue syndrome were given either a placebo or a mixture of liver extract, folic acid and B12 at different phases of the month-long study. Their fatigue levels were the same regardless of which phase they were in.
The role of B12 has been much better established as replacement therapy for people who are deficient in the vitamin, which is essential for DNA synthesis, red blood cell development, peripheral nerve integrity and cognitive function. B12 is not made in our bodies and can be obtained only from animal proteins or artificially fortified grains. Once it’s ingested, stomach acid is necessary to pry it from food, after which the vitamin combines with intrinsic factor, a substance made in the stomach, before eventually being absorbed in the small intestine.
According to the 2001-2004 National Health and Nutrition Examination Survey, 3.2 percent of those over the age of 50 have true B12 deficiency. More in that age group are at risk: Up to 30 percent lack sufficient stomach acid to extract B12 from food.
Even greater decreases in stomach acid can occur in patients using proton pump inhibitors, such as omeprazole (Prilosec and generic) and esomeprazole (Nexium), and H2 blockers, such as famotidine (Pepcid and generic) and ranitidine (Zantac and generic).
Another medication associated with B12 deficiency is the diabetes drug metformin (Glucophage and generic). Strict vegetarians should consume extra B12 from fortified food or supplements. Malabsorption due to inflammatory bowel disease (Crohn’s and regional ileitis) can also cause a deficiency.
There are no guidelines on screening for B12 deficiency in people without symptoms. Still, it seems reasonable to check high-risk individuals, especially since oral Vitamin B12 has been shown to be as effective as injected B12, and in any event supplementation is not harmful.
Ask your physician to check your Vitamin B12 level if you:
●are older than 50;
●take a PPI or an H2 blocker
●are a strict vegetarian
●have inflammatory bowel disease.