Vitamin: B12, cobalamin.
RDA, Hazardous level
men 51+. 6 mcg none
women 51+ 6 mcg none
Average intake in US diet: 7.84 mcg
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