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From: sbharris@ix.netcom.com (Steven B. Harris )
Subject: Re: Pernicious anemia - what is it please???
Date: 07 Oct 1995
Newsgroups: sci.med

In <456gqp$a1o@ixnews3.ix.netcom.com> simon17@ix.netcom.com (Carl
Mueller) writes:

>I am interested in learning all I can about this disease.
>Unforunately, I haven't been able to find much using the netscape
>search engine.  Can anyone help me out?
>
>Thank you....
>Carl


  An autoimmune disease where the cells in your stomach that produce
acid and intrinsic factor (IF) die.  So you don't make acid.  The job
of IF is to bind B12 that you eat (and also that comes out of your
liver in bile) so it can be (re)absorbed at the end of your small
intestine.  If no IF, the B12 just goes through the tube and you don't
get it.

   Your liver stores enough B12 to last a year or so with this kind of
double loss, but eventually your B12 blood levels fall.  You need B12
to make the myelin sheaths of nerves, and also to regenerate folic
acid, which is used to make DNA for cell division.  "Pernicious anemia"
was the disease where people's bone marrows failed for lack of cell
division, due to not enough folate, due to not enough B12, due to the
loss of IF. The anemia can be fixed with enough folate, but you still
get nerve damage from direct lack of B12, even if you take lots of
folate.   This causes numbness in the feet, and eventually even
dementia and psych problems.  These clear if treated early, but since
nerves have limited ability to regenerate, not if treated late.

  Treatment of this problem is basically B12 shots.  It can be treated
with big (1000 mcg) doses of B12 orally, which bypass IF for
absorption, and they are even fairly cheap at places like Trader Joes,
But no doctor really trusts such small doses as get across into the
blood this way, for such a nasty disease (which used to be as fatal as
leukemia).  So shots are what you get.  (the B12 nasal gels and
sublingual tabs are pure ripoff products).  Because B12 is stored so
well by the liver, one shot a month is enough.  You can learn to give
them youself, just like insulin (and you can use the same insulin
syringes easily, and store the B12 in your fridge).  But you must do it
**for life** either way.  If those stomach cells are gone, they're
gone.


                                           Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Vegetarians and vitamin B12
Date: Thu, 18 Dec 1997
Newsgroups: sci.med.nutrition

In <67a266$4le@newsops.execpc.com> rreid@earth.execpc.com (Rodney Reid)
writes:
>
>: Most B-12 supplements are made from bacteria.  Note that
>: some of the other ingredients in a supplement, such as
>: gelatin, may come from animals.
>
>	I hadn't heard this before (about B-12).  Wouldn't it be easier
to synthesize it?


    As the most complicated vitamin, B-12 is a nightmare to synthesize.
It took the world's greatest organic chemist of the day, Robert
Woodward, in a monumental coordinated effort, working with
intermediates prepared by dozens of teams across the world, to report
total synthesis of bit of the stuff in 1972.  By contrast, the proper
bacteria make the stuff out of a couple of minerals, inorganic
nitrogen, and glucose, in about 10 seconds.

   Needless to say, the commercial source is bacteria only.

                                      Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition,sci.life-extension,sci.pharmacy,
	misc.health.alternative
Subject: Folate and B12 tox (was: Vitamin C , 500mg, harmful !!!!)
Date: 15 Apr 1998 04:30:28 GMT

In <1693.408T225T13053433@escape.ca> "Syd Baumel" <sgb@escape.ca>
writes:

>>Yes, and if the experts are that concerned about protecting people
from the devastating neurologic and psychiatric damage that B12
deficiency can wreak, they won't rely on anemia as a screen for any
patient (few still do, I think), because it's well-documented that in
some people serious neurologic and/or psychiatric pathology due to B12
deficiency can progress for months or years in the absence of any
anemia whatsoever.<<


Comment:

   Absolutely.  Usually in salad fiends <g>.  But your point is well
taken, and doctors shouldn't be relying on CBC screens anyway for this
stuff.  Not that Medicare is paying for any screens of any kind these
days.  They've decided that a pound of cure is cheaper in geriatrics.
Particularly when the cure is spelled H-O-S-P-I-C-E, as it increasingly
is.  <Insert cynical look of disgust here.>

   Low B12s are a serious problem in geriatrics, due to the problems of
poor absorption of B12 in food (but not pills) with low stomach acid
(even with perfectly fine intrinsic factor production).  Worse, the
normal lab limits for B12 are probably too low.  I treat everybody
these days below 350, though the lab says 200.  Oral replacement really
is cheap and efficient enough for just about everybody with marginal
levels and no symptoms.  You can get 1000 mcg pills at Trader Joe's for
6 cents each.   And for that matter, you can get 400 mcg folate tabs at
Trader Joe's for $1.49 a bottle of 100 (!).  So 1.5 cents each, and 3
cents a day for the good 800 ug dose.  At those prices, every man over
40 and every woman over 50 ought to be on couple of extra folates and a
"mega" B12 (which is a tiny little red nothing of a pill).  Why not?
Just add them to your regular multivit, which should have at least 25
mg of B6 in it (and of course 400 mcg more folate).

    I know it isn't worth much to talk about the results of unpublished
studies, but for what it's worth I'll mention one I did a few years ago
at UCLA, and will one day get around to publishing.  It was a mouse
life span study I once did with folate, thinking that it might inhibit
carcinogenesis.  I fed 80% folate powder to mice in the diet at 1 part
per THOUSAND by weight of folate in the dry diet, for a life time.
That's equivalent to about 750 mg to a GRAM (1000 mg) a day for a
human.  A thousand times highest RDA vitamin doses.  It had no effect
at all on life span, which averaged about 3 years in our long lived
hybrid strain.  Or on tumor incidence, either, drat.  Very
disappointing, but it pretty much removed all residual fear I might
have had of folate being like B6 and harboring some hidden toxicity.
Like B12, folate is probably about as near to being nontoxic as any
vitamin gets.  There is something in the literature about kindling
effects for people with seizure disorders on very large doses of
folate, but otherwise I see no reason why everybody couldn't take
several milligrams of both B12 and folate every day, if they wanted.
I certainly do.

                                     Steve Harris, M.D.



From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition,sci.life-extension,sci.pharmacy,
	misc.health.alternative
Subject: Re: Folate and B12 tox (was: Vitamin C , 500mg, harmful !!!!)
Date: 17 Apr 1998 23:47:19 GMT

In <35380E60.EF9@netcom.ca> Tom Matthews <tmatth@netcom.ca> writes:

>Steven B. Harris wrote:
>
>> In <09CZ.1958$a93.3175541@news.giganews.com> Bryan Shelton
>> <bryan@shell.c-com.net> writes:
>
>> >But do you know of any way (besides injections)
>> >to get LARGE amounts of B-12 absorbed and into the bloodstream?
>
>>     No.
>
>What about sublingual and nasal? It seems to me I recall from a previous
>discussion that you (Steve) didn't think too much of these, but we
>brought forth some reasonable evidence. Here is one:


   And as I recall, we said this evidence didn't mean anything, because
there was no oral control.  I'm not saying nasal doesn't work at 1500
mcg a day.  I'm questioning whether it works any better than oral at
the same dose.  ONCE AGAIN, there's nothing special about your nasal
and sublingual tissues, as compared with your gut.  Except the MUCH
smaller surface area.  These routes are used to bypass the stomach acid
and the liver metabolism for some meds, but this is an irrelevent issue
for B12, which isn't hurt by acid, and which you WANT to go to the
liver (any which doesn't bind there being excreted in the urine).


                                          Steve



From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition
Subject: Re: B-12 ..1000mcg per day - Anybody doing this amount?
Date: 29 Apr 1998 00:52:49 GMT

In <893765067.752010@mnementh.southern.co.nz> Brian Sandle
<bsandle@southern.co.nz> writes:

>> Comment:
>>    It's perfectly fine if it's true. Absorption of B12 is such that
>>you cannot poison yourself on it. I stand ready eat it like mashed
>>potatoes, if you'll buy it.
>
>So you do not disagree with Ron that you shouldn't *inject* too much.


    Oh, I'd disagree with him even there, but the problem is that I
really don't want to give myself a big IV to prove it.  However, the IV
toxicity of B12 has been looked at.  It is SO low that hydroxycobalamin
has been seriously suggested (and tried out in animals) as a CYANIDE
POISONING antidote.  We're talking injections of many grams of the
hydroxo form of the vitamin, mainline.  No known major toxicity
problems, at least with that form.

    Well, some of the rats DID ask if they could have Ron as their
researcher, instead.  They settled for Xanax.

                                         Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition
Subject: Re: B-12 dosage (Pernicious Anemia)
Date: 9 May 1998 05:03:19 GMT

In <35576a67.21909967@nntp.ix.netcom.com> seesig@Do-Not-Spam-Me.com
(MaryS) writes:

>Well, here's my question:
>
>Is there a "normal" amount of B-12 that is "customary" to be given (by
>injection) for pernicious anemia?  If so how much?


Generally, you give 1 cc (1000 mcg) every week for a couple of months
to replete liver stores.  Then that much every month.  I use a full
U-100 insulin syringe worth, and teach patients to give their own.

The body retains about 10% of this dose, and less of each one as time
goes one.  100 ug (0.1 cc) if given by injection would work just as
well, I'm sure, although to replete the body you might have to give it
a little longer.  There's no evidence, BTW, that have to replete the
liver to maximally treat the disease.  It's just done for safety
reasons.  All you really need to make sure of is that the blood levels
stay in the high normal range.  Ask for a blood level to be drawn just
before your next dose, if you're worried about that.  There is NO
reason you should have to worry, and any good doc should be GLAD to
draw such a level, to satify you on that score.

BTW-- I rarely tell my patients something is working mostly by placebo
effect, even if I think so.  I've learned...

Not that this is necessarily true for you.  If you really have a
positive Shilling's test and had low B12, you could have just about any
residual mental problems from it for quite some time.


                                        Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition
Subject: Re: B-12 dosage (Pernicious Anemia)
Date: 9 May 1998 07:28:01 GMT

In <2837.433T305T902969@escape.ca> "Syd Baumel" <sgb@escape.ca> writes:

>  I know of only two controlled trials
>that have attempted to test this hypothesis, and both actually
>found that B12 shots were better than placebo shots.


    HA.  I've seen one of those papers-- didn't know that by now there
were TWO.  Leaving them aside, B12 is a WONDERFUL placebo.  Pretty ruby
color (heap powerful color), inoccuous, not terribly expensive.  But
mildly painful to administer (that's important-- you need SOME kind of
a price shamanistically to expect a reward).  Has powerful and subtle
vitamin effects.  And now, not one, but two positive papers.  And of
course, more in the psych literature for people with low or even lowish
levels.  So the doc who's giving it more than half believes it's doing
good things he can't prove.  Geez, I should reprint the papers on B12
for tiredness to give to my patients that I'm treating for chronic
fatigue with B12.  Tell me why not?

   Er, you wouldn't happen to have the refs so I could find them again?
One was in Lancet or BMJ, if I remember, and was a study of B12 for
basically chronic fatigue...


>Again, because ultra-high doses can, it seems, be given with such
>impunity, the logical method, used by at least some
>nutritionally-oriented
>doctors, is simply to give the patient as much as s/he needs to feel
>better.  At some point, a lowest necessary dosage can be found; but
>for starters, "put the pedal to the metal."

Well, the liver is totally saturated for several days after one shot,
which means ALL of it goes into the urine.  So more than a couple of
shots a week doesn't make much sense in terms of repleting liver
stores.  But that's not to say it might not make sense for other
reasons.  Bottom line is we just don't know.


>I'm writing this as a back seat doctor.  Hopefully some of the real
>doctors here will pipe in with their observations.


  Here's one: the placebo effect works much better if you have to go to
your doctor's office for the shot <g>.  Giving it to yourself out of
the vial from your refrigerator, isn't as good.

   On the other hand, your insurance is surely not going to pay for
doctor's office shots unless your blood levels are down.  There's
controversy over how far down is "down."  Most labs say 200.  You're at
risk for deficiencies by various gold standard tests (methionine load,
bone marrow growth assay tests) below 300.  I treat anybody with levels
below 300 and ANY neuro signs or mental ANYTHING, with a round of shots
(which they give themselves).  Everybody else with lowish levels but
nothing I could call a possible symptom, gets oral replacement.  If
they're not taking a vitamin, most of these people are just low acid
types who do fine on multivitamin amounts of B12 (which, because free
of protein, are well absorbed).  If they're ALREADY taking a vitamin
and have low B12s, odds go up that they really do have pernicious
anemia (with or without the anemia-- I mean intrinsic factor loss), and
will need at least 1000 mcg a day by mouth to get better levels.

   I don't know if these people all need to have a Shilling test.  We
know they need to be treated anyway, so what's the point?  I suppose so
that if we find their loss is due to bacterial overgrowth and not IF
loss, we can give them antibiotics.  In any case, the Shilling test can
be done at any time (and in fact, has to be done later if there's
significant folate/anemia/gut atrophy), and you start B12 treatment on
people the moment you draw the second confirmatory B12 level (if the
second level comes back normal, all you did is waste one cheap shot).


                                        Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition
Subject: Re: Alzheimers & vitamins B-12 and Folic Acid Deficiencies
Date: 27 May 1998 01:20:42 GMT

In <01bd8901$911e5a20$6443dcc8@lcscm.unisys.com.br> "no spam"
<lcscm@nospamunisys.com.br> writes:

>> >Yep.  All vegetarian non-ruminants are forced into "reflection," as
>> >this process is called, to get enough B12.
>
>Why are we not forced into it to get enough vit. K?


   We get enough from our diet, because a little is in most foods, and
our need for it is extremely low (on the order of 1 mcg a day or less).


>Eating one's own feces to get proper nutrition simply does not make
>sense.  Liz

    It may not be appetizing, but I have no idea what you mean by it
not making sense.  If it works, it makes sense.

   It can get worse than vitamins, you know-- when termites molt they
lose all their gut flora, which they need to digest cellulose.  If they
didn't eat some feces quick to get reinfected, they'd starve to death
in the midst of plenty.  And now you know one reason the little buggers
are colonial and social.

                                         Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: B12 deficiency
Date: 20 Jun 1998 02:05:23 GMT

In <cas9-1906980902340001@128.253.33.82> cas9@cornell.edu (Claudia
Sutton) writes:

>I was diagnosed with pernicious anemia after a routine blood panel,
>re-tested for B12 and folate levels, and found to be B12 deficient. Fine,
>I am taking B12 monthly IM now. My question is whether there should be
>any followup to determine that 1) pernicious anemia has resolved,and 2)
>B12 blood levels are within normal range. Additionally, is it useful (for
>other than my own interest) to do more tests to determine the reason that
>I became B12 deficient ?


  You can't really diagnose "pernicious anemia" (intrinsic factor
deficiency) from a blood test.  All you can diagnose is B12 deficiency!
For which there are many possible reasons.

   If you want to see if you really have the atrophy of the stomach
which causes B12 deficiency, and which is the "pernicious anemia"
disease, you can have your doctor order the Shilling test for you.
This (in the simplest form) uses 2 types of B12, each labeled with a
different radio-isotope of cobalt (these are differentiable in tests
because they give off different spectra of radiation).  One of them is
administered bound to intrinsic factor. After a shot of B12 to make
sure you don't absorb any of the radioactive B12 into your liver, you
take the two radio-B12's in a capsule.  After a while, these show up in
your urine, depending on how well you absorbed them (you do a 24 hour
collection, usually).

   If you have pernicious anemia, you will absorb only the Co isotope
bound to the intrinsic factor, and not the other.  If there's something
wrong with your gut or you have bacteria or parasites eating your B12,
you won't get absorption of either isotope.  Vegans and people who are
short of B12, but with normal intrinsic factor production (people with
no acid to digest the B12 bound in proteins), will absorb both forms of
B12 in Shilling test very well.

   You can take the Shilling test any time, since it's likely that the
problem which caused your initial B12 problem is still present.  The
shots haven't changed it.  Indeed, it's good that you've been on the
shots for a while, since they are necessary to make sure that any
secondary changes in gut nutrient absorption caused by B12 deficiency
itself, are corrected BEFORE you see why you didn't absorb B12 in the
FIRST place.


                                                 Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: B12 deficiency
Date: 25 Jun 1998 03:37:55 GMT

In <sbelknap-2406981851590001@dbts102.uicomp.uic.edu> sbelknap@uic.edu
(Steven Belknap) writes:

>Finally a comment on treatment of cobolamin deficiency: it is not
>necessary to give cobolamin by injection. Just give a bigger dose orally.
>There is a parallel ileal uptake mechanism for cobolamin which does not
>require intrinsic factor. See Lederle FA Oral cobalamin for pernicious
>anemia. Medicine's best kept secret? JAMA (United States), Jan 2 1991,
>265(1) p94-5.


   Comment: but I think most clinicians would try to get at least one
shot in (preferably hydroxycobalamin, which is better retained), if the
patient has neurological symptoms.  You need to replete stores (which
are several THOUSAND micrograms) and get blood levels up as soon as you
can.  It's been shown that oral cobalamin at > 1,000 mcg/day (which
gets a few micrograms a day into the body, at most) is quite effective
at releaving the anemia of B12 deficiency.  But that's a secondary
problem of folate metabolism in which a little B12 causes a BIG effect,
due to the amplification factor.  Oral B12 hasn't yet proven to be
equal in reversing the myelination defect in PA patients with nerve
damage.  Until it has, I would suggest prudence on the side of
conservative treatment.  A shot of hydroxycobalamin is cheap, almost
painless, and just about without risk.  It would really take some nutty
people all around to avoid one in a bad case of PA.

                                     Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: rec.food.veg,sci.med.nutrition
Subject: Re: B12 supplements, fortified, natural sources
Date: 14 Oct 1998 13:07:40 GMT

In <3623DDA7.3C71C934@puc.edu> EJ <ejarschke@puc.edu> writes:

>My daughter got a vit. 12 shot a few years ago, and the doctor told her
>that the body needs such a minimal amount. A shot would supply her body
>with vit. 12 for many years.


    Not true.  You can go a few years if your liver is completely
loaded with B12 (several thousand micrograms) and you produce intrinsic
factor so that minimal B12 escaping in your bile does not make it out
in your stool.  However, a shot only supplies 1000 micrograms, of which
perhaps 100 is retained.  That's  only about 2 months worth for an
adult, and maybe a couple more for a child.  In children with B12
absorption problems, less than that.  Which, of course, is why shots
are given once a month to people who need them.

                                       Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition
Subject: Re: Is there any scientific studies confirming foodcombining?
Date: 14 Oct 1998 13:23:01 GMT

In <36249294.81522716@kumc.edu> Pete Beyer <pbeyer@kumc.edu> writes:

>  (sarcasm not meant to be et the expense of the original
>poster but I had a graduate student review the food combining book for
>flaws in science and he had us rollin' on the floor).
>  Pete


   Yeah, there's some funny stuff in Fit For Laughs_.  I loved the part
where the Diamonds inform us that we don't need animal products for B12
because vegetarian animals get along fine without them.  No mention of
the fact that they need several stomachs or a penchant for eating their
own feces to do it.  Hmmm.  If you eat your feces, is that a
carbohydrate or a protein food?



From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.pharmacy
Subject: Re: Anti-acids hinder B-12 absorption ?
Date: 25 Nov 1998 22:25:28 GMT

In <365C1B7E.7E4F@enterprise.bidmc.harvard.edu> David Rind
<rind@enterprise.bidmc.harvard.edu> writes:

>Steven B. Harris wrote:
>>The only people who need to worry how MUCH B12 is in their vitamins are
>>people with NO stomach acid, not as a result of medication, but due to
>>the gastric atrophy caused by achlorhydria (which can cause pernicious
>>anemia).
>
>Do you have the causality correct here?  My recollection (quite
>possibly incorrect) is that it is loss of parietal cells that causes
>both achlorhydria and lack of intrinsic factor, not that achlorhydria
>causes loss of parietal cells.
>
>--
>David Rind
>rind@enterprise.bidmc.harvard.edu


   I never said to imply that achlorhydria caused loss of parietal
cells.  I'm was (no doubt unwisely) using "achlorhydria" as the name of
a pathology, not the name of a condition.  My apologies, but I don't
know what the better term is.  I'm reluctant to call low B12 due to
autoimmune parietal cell dysplasia "pernicious anemia" without the
anemia.  But I mean total loss of intrinsic factor production due to
autoimmune gastric atrophy and nearly total loss of parietal cells.
I'm quit willing to admit that this may be but one end of a spectrum of
some of the loss of parietal dsyfunction that occurs in aging  (though
of course complete autoimmune parietal dysplasia also occurs in younger
people, most notably middled aged women with many other autoimmune
problems, such as thyroid disease).


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative,sci.med
Subject: Re: B12 deficiency anemia
Date: 14 Feb 1999 07:55:22 GMT

In <36C645B6.69AEAB6B@servtech.com> Ed Mathes <emathes@servtech.com>
writes:

> There is an intranasal gel available called NASOBAN or something like
>that. Supposed to be as efficaceous as an injection.


   It's something like 7 bucks a sniff, and goes down in my book as the
most overpriced and overdone and silly pharmaceutical product in recent
history.  And the FDA's simultaneous ban on nasal B12 OTC is enough to
confirm some of what the alternatives are always saying about the FDA's
main role being to protect the pharmaceutical industry from cheap and
effective competition.  A use-patent on nasal B12?  Please.  There is a
such a thing as prior art and previous general and common use.

    Oral B12 in pharmacologic doses (>1000 mcg) works just fine for
pernicious anemia.  It's been proven in direct trials head to head
against injection, and several reviews (all scratching heads about why
it's not employed more often) have been written.  Somehow, doctors
trust patients to take horribly difficult drugs like coumadin and
digoxin and cyclosporin, but cannot quite bring themselves to believe
they are capable of swallowing a pink vitamin pill every day.  I can
only conclude that we're up against the power of myth, placebo, and
magic, here.  Yea, even fashion.  Yes, even in your dear old Scientific
Medicine.

    I've seen this before.  As an intern, I used to ask why all those
COPD people ("chonic lung-ers"), and asthmatics admitted to hospital
were being given expensive solumedrol after the first injection, when
instead they could just be getting plain old oral cheap
corticosteroids. The answers were never satisfying.  And that was
because they were BS.  Today, in cost managed care, after the first IV
dose, they're starting to jolly well get oral prednisone.

                                 Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative
Subject: Re: B12 deficiency anemia
Date: 17 Feb 1999 03:34:21 GMT

In <7ac4kq$s7i$1@nnrp1.dejanews.com> native_texan@my-dejanews.com
writes:

>In article <7ab3a3$bk$1@nnrp1.dejanews.com>,
>  celeste_a@my-dejanews.com wrote:
>
>>I lived off of B-12 shots for a couple of years, I spent the first year
>>driving to have someone give the injection before I got brave enough to
>>give it to myself, I got such relief from my CFS it is so worth the
>>effort.
>>
>> In article <7a52co$j9t$1@news-2.news.gte.net>,
>>   "Lisa M Mill" <lisa.mill@gte.net> wrote:
>> > I was recently (last week) diagnosed with vitamin B12 deficiency
>> > anemia and don't know much about it yet except what I've dug up on
>> > the web (which didn't amount to much). Does anyone know if there are
>> > any alternatives to the intramuscular shot? I'm not too keen on being
>> > tied to a needle for the rest of my life.
>
>I doubt if anything taken by mouth however will work as well as an
>injection. If you try B12 tablets use only sublinguals which absorb into
>the bloodstream into the capillaries under the tongue. A swallowed B12
>tablet does little good unless it is interic coated because stomach acids
>apparently destroy B12 to a high degree.

   Nonsense.   Swallowed B12 tablets work perfectly well, so long as
the dose is properly large (in which cases there's so much that just
mass diffusion gives you enough).  This stuff about B12 being destroyed
by stomach acid is malarky.  If you're not absorbing B12 you probably
don't HAVE any stomach acid.


>Many people swear by Liquid Liver extracts which also
>contain heme iron, the most biovailable form.


    Which has nothing to do with B12 deficiency.  Althought this was
indeed the way B12 was discovered, quite by accident and serendipity.
Some scientists had found that liver caused bled dogs to regenerate
blood most rapidly.  It was the absorbable iron in large amounts, but
they decided to try the extract on pernicious anemia (and not under the
tongue, either).  By sheer dumb luck, they happened to hit on the organ
that stores the vitamin whose lack is the cause of the disease, which
doesn't have anything to do with the anemia of dogs who've been bled.
That's the way it goes in science.

                                    Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative
Subject: Re: B12 deficiency anemia
Date: 18 Feb 1999 02:18:10 GMT

In <7afkf8$vqt$1@nnrp1.dejanews.com> native_texan@my-dejanews.com
writes:

>>Nonsense. Swallowed B12 tablets work perfectly well, so long as the dose
>>is properly large (in which cases there's so much that just mass
>>diffusion gives you enough). This stuff about B12 being destroyed by
>>stomach acid is malarky. If you're not absorbing B12 you probably don't
>>HAVE any stomach acid.
>
>If the problem for pernicious anemia is malabsorption of B12 in the gut
>why do you recommend going through that same delivery pathway by
>megadoses of B12 by pill?


    Because it works (though you might not have predicted that it
would).   That's been proven in many studies.  And it's cheap.   It's a
purely pragmatic suggestion.



>It doesn't make sense to me that you would try to argue to keep using
>a pill when you could accomplish the same thing and bypassing a
>stomach malabsorption problem through a nasal gel or a sublingual.


    Nobody has succeeded in proving that nasal gels or sublinguals
"bypass" the stomach malabsorption problem (actually, the terminal
ileum malabsorption problem) by any other means than just delivering
that same huge dose of B12 to the stomach (which is what happens
eventually to things you put up your nose or under your tongue).  All
it does is increase expense.  Since we know every well that the amount
of B12 in gels and sublinguals works perfectly well if you just SWALLOW
it as a pill, and is a LOT cheaper, then why not just swallow it?


>Seems like you're
>trying to do it the hard way and also the method that probably causes
>the problem in the first place.


    Seems like you're trying to do it the hard way.  A pill is easy and
cheap.  And I don't care if you don't believe for some theoretical
reason of your own that a 1000 or 2000 mcg pill doesn't work.  The
proven fact is that it does work.   Facts trump theories.   If you
don't want to believe it, be my guest.


>The heme iron has nothing to do with pernicious anemia but liquid
>liver extract is a good food source of B12 which was the actual point
>of mentioning liver extract.

    Look, you're not making sense, now, even in terms of your own
arguments.  Are you suggesting putting that liver extract under your
tongue?  Putting it up your nose?   THINK, man.  The only reason liver
extract was historically useful for oral treatment of B12 anemia, is
that the dose of B12 was so large that it acted like taking a mega-B12
pill (if nauseatingly large quanities was eaten). That is all.  There's
nothing special about liver, other than it contains a very high
concentration of B12.  The only stuff that is comparable in content is
feces.  Which is not as palatable, but is used by some animals.

> Animal products are the only good source of B12. Vegetable
>sources are very poor to nonexistent.

    All B12 is made by bacteria, period.  That's where the stuff in
pills was made, and it's where the stuff in liver was made (the liver
concentrates it from the diet, or from bacteria in the stomach, in
ruminants).  Animal sources are high in B12 because many ruminant
animals harbor stomach bacteria that make B12, which the animals then
absorb.  Cows and deer make it in their stomachs, and can thus absorb
it in their intestines, and it's passed to their flesh and milk.
Animals like rabbits and chickens don't, and so they must eat their own
feces, since B12 is not absorbed from the colon.  Humans could obtain
it by eating feces also, but usually prefer not to.   Eating cows or
rabbits or chickens or their products like milk and eggs, is easier.
But has little to do with this discussion.

                                         Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative,sci.med.nutrition,sci.med
Subject: Re: B12 deficiency anemia
Date: 18 Feb 1999 04:21:08 GMT

>In <7aev41$bi6$1@nnrp1.dejanews.com> best_of_show@yahoo.com writes:


Harris
>>    Nonsense.   Swallowed B12 tablets work perfectly well, so long as
>> the dose is properly large (in which cases there's so much that just
>> mass diffusion gives you enough).  This stuff about B12 being
>> destroyed by stomach acid is malarky.  If you're not absorbing B12
>> you probably don't HAVE any stomach acid.

>You don't have a clue what you're talking about.


Comment:

   Okay, I decided to post the abstracts anyway.  Read them, and read
the papers and their references if you need to.  And when you've
educated yourself on the subject, get back with us.


Baillieres Clin Haematol 1995 Sep;8(3):679-97
Cobalamin and folate deficiency in the elderly.
Matthews JH

Department of Medicine, Queens University, Kingston, Ontario,
Canada.

Elderly persons are more likely to have low values for serum and
erythrocyte folate, and for serum cobalamin. Many of those with
low vitamin levels have biochemical abnormalities consistent with
true deficiency, including increased formiminoglutamic acid
excretion, abnormal marrow deoxyuridine suppression, and
raised serum levels of methylmalonic acid and homocysteine.
Therapy with the appropriate vitamin reverses the biochemical
defect. Despite this, the clinical consequences for most elderly
persons are remarkably few. True megaloblastic anaemia is rare,
and the small number of therapeutic trials to date have not
improved the levels of haemoglobin in the treated subjects,
although the mean corpuscular volume has decreased significantly.
There has been recent concern that these low blood vitamin levels
might be important causes of nervous system damage, but studies
specifically of the elderly have not demonstrated overall
improvements in neurological function following therapy. Vascular
damage from high blood homocysteine levels secondary to cobalamin
or folate deficiency remains a potential hazard. Dietary insuf-
ficiency, malabsorption of protein-bound vitamin B12 secondary to
atrophic gastritis, and defective absorption of folyl polyglut-
amates seem the likeliest possible causes. Pernicious anaemia,
although a common cause of severe megaloblastic anaemia in
the elderly, is an infrequent cause for the low cobalamin levels
in population studies. Although the benefits are uncertain, the
balance of the evidence suggests that one should treat elderly
persons with low values of cobalamin or folate. Crystalline
vitamin B12 and folic acid are absorbed normally and are
therefore suitable for replacement therapy, provided that
pernicious anaemia is excluded.

----------


[Note: this refers only to B12 as normal present in
multivitamins.  Crystalline B12 in large doses orally can
certainly be used to treat pernicious anemia, as noted in several
abstracts below.]


Far from destroying B12, stomach acid is necessary to liberate
B12 from normal food.  Food B12 absorption problems are common in
the elderly who make less acid, and people on antacid therapy.
This is not pernicious anemia.  B12 in vitamins, already
liberated, presents no difficulty for these people, and is enough
for them even when given in small amounts, such as are present in
multivitamins.



J Am Coll Nutr 1994 Dec;13(6):584-91

Effect of hypochlorhydria due to omeprazole treatment or atrophic
gastritis on protein-bound vitamin B12 absorption.

Saltzman JR, Kemp JA, Golner BB, Pedrosa MC, Dallal GE, Russell
RM

USDA Human Nutrition Research Center on Aging, Tufts University,
Boston, MA.

OBJECTIVE: To investigate the effects of hypochlorhydria and
acidic drink ingestion on protein-bound vitamin B12 absorption in
elderly subjects. METHODS: Absorption of protein-bound vitamin
B12 was examined in elderly normal subjects (n = 8), and in
hypochlorhydric subjects due to omeprazole treatment (n = 8) or
with atrophic gastritis (n = 3). Subjects underwent absorption
tests of protein-bound vitamin B12 ingested with water, cranberry
juice and 0.1 N hydrochloric acid. RESULTS: Protein-bound vitamin
B12 absorption was lower in the omeprazole-treated group (0.50%)
compared to the normal group (1.21%; p < 0.001). With cranberry
juice ingestion, the omeprazole-treated group showed an
increase in absorbed protein-bound vitamin B12 (p = 0.025). With
dilute hydrochloric acid ingestion, there was a further increase
in vitamin B12 absorption (p < 0.001). CONCLUSION: Omeprazole
causes protein-bound vitamin B12 malabsorption, and ingestion of
an acidic drink improves protein-bound vitamin B12 absorption.

Publication Types:
  Clinical trial
  Randomized controlled trial


Comments:
  Comment in: J Am Coll Nutr 1994 Dec;13(6):544-5


PMID: 7706591, UI: 95221751

----------

Ann Pharmacother 1992 Oct;26(10):1283-6


Effect of histamine H2-receptor antagonists on vitamin B12
absorption.

Force RW, Nahata MC

College of Pharmacy, Ohio State University, Columbus 43210.

OBJECTIVE: To discuss the potential of histamine H2-receptor
antagonists (H2RAs) to cause malabsorption of vitamin B12
(cyanocobalamin). DATA SOURCES: Pertinent literature was identif-
ied via a MEDLINE search. Journals and references cited in
published articles also were used as data sources. STUDY
SELECTION: Studies evaluating the effect of H2RAs on vitamin B12
absorption were reviewed. DATA SYNTHESIS: H2RAs decrease acid
secretion by the gastric parietal cells. Gastric acid and pepsin
produced by these cells are required for the cleavage of vitamin
B12 from dietary sources. Intrinsic factor (IF), also produced by
gastric parietal cells, is required for vitamin B12 absorption
from the gastrointestinal tract. Although H2RAs have not conclus-
ively been shown to decrease IF secretion, studies have demons-
trated a significant reduction in food-bound vitamin B12 absorpt-
ion secondary to decreased acid secretion in patients taking
these drugs. CONCLUSIONS: H2RAs have the potential to cause
vitamin B12 deficiency. This may be important in patients with
inadequate stores of vitamin B12 (e.g., poor diet), particularly
those receiving H2RA therapy continuously for more than two
years. Healthcare providers should be aware of this potential
adverse effect.

PMID: 1358279, UI: 93043703





J Am Geriatr Soc 1998 Sep;46(9):1125-7
Oral cobalamin for pernicious anemia: back from the verge of
extinction.

Lederle FA

Department of Medicine, Minneapolis Veterans Affairs Medical
Center, MN 55417,USA.

BACKGROUND: High dose oral cobalamin therapy was shown to be
effective for pernicious anemia and other cobalamin deficiency
states 30 years ago, and physicians and patients state that they
would find oral therapy useful, but a survey conducted in 1989
found that physicians were generally unaware of it. OBJECTIVE: To
assess physician awareness and use of oral cobalamin since 1989.
DESIGN, SETTING, AND PARTICIPANTS: Minneapolis area internists
not listed as having subspecialties or academic business address-
es were surveyed in 1989 and in 1996. MEASUREMENTS AND RESULTS:
There were 245 responses to the 1989 survey and 223 responses to
the 1996 survey for response rates of 68% and 69%, respectively.
The percentage of internists who ever used oral cobalamin to
treat pernicious anemia increased from 0 in 1989 to 19% in 1996
(P < .001). The percentage who were aware of an effective oral
cobalamin preparation for treating cobalamin deficiency states
also increased significantly from 4 to 29% (P < .001). The
percentage of internists who agreed with the incorrect view
that sufficient quantities of cobalamin cannot be absorbed when
given orally declined from 91% in 1989 to 71% in 1996 (P < .001).
CONCLUSION: Minneapolis internists' awareness and use of oral
cobalamin treatment for pernicious anemia increased substantially
between 1989 and 1996, but the majority of internists remained
unaware of this treatment option.

PMID: 9736106, UI: 98405513

----------

JAMA 1991 Jan 2;265(1):94-5

Oral cobalamin for pernicious anemia. Medicine's best kept
secret?

Lederle FA

Department of Medicine, Minneapolis Veterans Affairs Medical
Center, Minneapolis 55417.

Publication Types:
  Review
  Review, tutorial
Comments:
  Comment in: JAMA 1991 Jan 2;265(1):96-7
  Comment in: JAMA 1991 May 1;265(17):2190


PMID: 2064638, UI: 91073621

----------

Acta Med Scand 1978;204(1-2):81-4


Vitamin B12 body stores during oral and parenteral treatment of
pernicious anaemia.

Berlin R, Berlin H, Brante G, Pilbrant A

Oral treatment of pernicious anaemia patients with 1 mg
cyanocobalamin daily has been shown before to be as effective as
conventional injection therapy. The result of this study indicat-
es that oral treatment also keeps the vitamin B12 body stores
adequately filled, a confirmation of earlier results obtained in
another way.

PMID: 685735, UI: 78253590

----------











From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative
Subject: Re: B12 deficiency anemia
Date: 19 Feb 1999 11:23:35 GMT

In <7ahroj$tma$1@nnrp1.dejanews.com> alt_health@my-dejanews.com writes:

>> >The heme iron has nothing to do with pernicious anemia but liquid
>> >liver extract is a good food source of B12 which was the actual point
>> >of mentioning liver extract.
>>
>>     Look, you're not making sense, now, even in terms of your own
>> arguments.  Are you suggesting putting that liver extract under your
>> tongue?  Putting it up your nose?   T
>
>It IS A PILL!! Sorry next time I will say explicitly LIQUID LIVER EXTRACT
>FORM - PILL!!!


<irrelevent comments about extracts snipped>


    It's easier and cheaper to take a B12 pill.  And there's more B12
in a 2000 mcg B12 pill than any liver extract preparation which obtains
the B12 solely from liver (I've seen some spiked with commercial B12
from bacteria-- as you can tell from the "cyano"cobalamin on the label.


>> Humans could obtain
>> it by eating feces also, but usually prefer not to.   Eating cows or
>> rabbits or chickens or their products like milk and eggs, is easier.
>> But has little to do with this discussion.
>
>Sure it does. Just not to you. It was offered as an alternative to
>injections to the original post as a high B12 source as an alternative to
>try. No more complicated than that.


     It was offered after you suggested that I didn't know what I was
talking about when I suggested B12 pills as an alternative to
injections.  Now you're offering liver extract instead.  More money,
bigger pills, probably raw and full of prions (you never know where
that liver has been), and absolutely no reason in the world to believe
it's any more effective.




>Animal food is the only source of food based B12 in the human diet. I
>rarely eat a bowl of bacteria. You already said liver was source of B12
>so what are you arguing about.


    Price and convenience.  In the old days, people had to treat
pernicious anemia with ounces of raw liver juice a day.  I've dubious
about getting enough B12 from liver into a few pills.  But I'm willing
to be convinced.  Just find me a liver pill with 1000 mcg of B12 and no
cyanocobalamin added, and I'll admit it's still possible to do it that
way.  Dumb and expensive, but possible.




>I don't recall going into a long discussion or a discussion at all
>arguing HOW B12 arrived in the animal in the first place. I don't doubt
>you are a fine chemist and know this information already. But this isn't
>a physicians/chemists forum, some who read posts in this forum may not
>know that. I don't care how the animal manufactured it and placed it in
>his flesh originally, the point is it is there.



    If you don't care how it got there, why not just bypass the middle
man, and get it straight from the bacteria?  You may not eat a bowl of
bacteria, but you can certainly take a pill with a milligram of B12
purified from a bacterial culture.  Cost will be about 5 or 10 cents.




From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative,sci.med.nutrition,sci.med
Subject: Re: B12 deficiency anemia
Date: 19 Feb 1999 11:34:13 GMT

In <7ailkl$khl$1@nnrp1.dejanews.com> alt_health@my-dejanews.com writes:

>
>
>>
>> PMID: 1358279, UI: 93043703
>>
>> J Am Geriatr Soc 1998 Sep;46(9):1125-7
>> Oral cobalamin for pernicious anemia: back from the verge of
>> extinction.
>>
>> Lederle FA
>>
>> Department of Medicine, Minneapolis Veterans Affairs Medical
>> Center, MN 55417,USA.
>
>> The
>> percentage of internists who agreed with the incorrect view
>> that sufficient quantities of cobalamin cannot be absorbed when
>> given orally declined from 91% in 1989 to 71% in 1996 (P < .001).
>> CONCLUSION: Minneapolis internists' awareness and use of oral
>> cobalamin treatment for pernicious anemia increased substantially
>> between 1989 and 1996, but the majority of internists remained
>> unaware of this treatment option.
>>
>> PMID: 9736106, UI: 98405513
>>
>> ----------
>
>So then I guess I'm with the 70% of internists (as of 1996 and in
>Minneapolis) who believe standard oral B12 tablets are not well absorbed.
>Very discomfiting thought..I'm apparently with the majority view of a
>group of internists.



    A group of nutritionally out of date internists.  Yep.  When you
really truly actually get the full irony of this, it will be most
amusing.

     To be fair, if you read internal medicine texts, they don't really
come out and say that not enough can be given orally.  They often fudge
and say that oral megadoses are possible, but expensive.  And that used
to be true 20 years ago.  But B12 has come down a lot in price.  While
the money you pay for an office injection has kept going up.






From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative
Subject: Re: B12 deficiency anemia
Date: 19 Feb 1999 11:42:29 GMT

In <7aivjd$4fj$1@news-1.news.gte.net> "Lisa M Mill" <lisa.mill@gte.net>
writes:

>Steve, thank you so much for your good advice and good science.
>Everything I have learned about this deficiency in the past couple of
>weeks (via my own intensive research and through my physician) has been
>exactly what you have been offering here.

   You are welcome.

>The doctors still haven't figured out exactly WHY I can't absorb B12, but
>we're well on our way. One more Schilling's test to go.... Thanks again,
>Lisa.



    At Harbor/UCLA where I trained at one time, we had a neat version
of the two stage Shilling test, which did both states simultaneously.
It used one radioisotope of cobalt bound to free B12, and a different
radioisotope of cobalt bound to B12 and intrinsic factor.  The isotopes
gave off different gamma spectra, and could be told apart in a gamma
counter.  So you only took ONE capsule (with both isotopes) after ONE
"cold"  B12 shot, and collected urine only once.  And that gave all the
answers in one fell swoop.

    Guess, the FDA thought it was too elegant.

                                     Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative
Subject: Re: B12 deficiency anemia
Date: 22 Feb 1999 02:43:56 GMT

In <7ajuf8$m9h$1@nnrp1.dejanews.com> alt_health@my-dejanews.com writes:

>Based on some of the studies you provided and some investigation on my
>own it looks like B12 IS absorbed orally in a regular tablet (I am
>willing to change my mind but not without a good reason) but as you say
>it takes a HELL OF A LOT to have any effect when the person has a
>malabsorption already. It probably DOESN'T work for anywhere close to
>everybody who tries it either.

    Actually, it works on almost everyone.  I've yet to see a failure.
Somebody wrote me the other day that they'd had a personal failure, and
this is the first case I've heard of.  Naturally, it's prudent to check
followup B12s in people who go the oral route.  Complete waste of money
to do this for people getting injections, of course.

> I couldn't get many people to use the megadose B12 2,000mcg or
>5,000mcg because they were expensive

   Cheaper than shots or the equivalent amount from liver.  I promise.

> and their physicians said no way, too much potency.

   Ignorant physicians.  But you're arging that you have to deal with
ignorant physicans in any case with the liver stuff, so why not argue
with them over something that's cheaper?  And by the way, the oral
studies have almost all been done with 1000 mcg non sublingual tabs.
Very cheap. To get 2000, just take two.

>We didn't carry non-sublinguals in high doses because no one wanted
>them and companies have begun to phase out non-sublinguals and that
>was just the reality.


   You don't need sublingual.  And everybody has a a 500 mcg or 1000
mcg B12 tab.  Take two and don't call me in the morning.

                                   Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative
Subject: Re: B12 deficiency anemia
Date: 22 Feb 1999 03:15:19 GMT

In <7ameua$ph2$1@nnrp1.dejanews.com> silverfern@my-dejanews.com writes:


>In article <7ajhq0$sm2@dfw-ixnews9.ix.netcom.com>,
>  sbharris@ix.netcom.com(Steven B. Harris) wrote
>
>>     Even so, the point remains.   Why not just take a B12 pill for a
>> lot less money?
>>
>>      I'll bet you $5 you can't find a liquid liver extract capsule
>> which has enough B12 in it to help pernicious anemia at a dose less
>> than 10 a day.   Unless it's been spiked with commercial
>> cyanocobalamin.  In which case, what's the point of paying for the raw
>> liver?  Yuck.
>>
>
>Except thaat liver also contains appreciable amounts of folate, the
>synergyst of b12. However high the b12 supplements if folate is low the
>effect will be reduced--unless you also supplement with folate?


   Most people do.  Do you know anybody using liver pills who's not
also taking at least a one-a-multivit?  They all have at least 400 mcg
of folate, which is (along with a couple of hundred you get in even a
poor diet) quite a lot.  And quite sufficienct.  I'm even aware of a
study showing that more than 600 mcg of folate or so has no additional
effect on homocysteine levels.


>And don't forget that in spite of your "yuck" liver extracts and
>desiccated liver have been used for many years to combat low b12 levels
>successfully.


    Most B12 deficiency is not due to pernicious anemia, but a lack of
stomach acid to free B12 from protein.  Dry liver has enough B12 in it
to get around that, but not enough to treat pernicious anemia, unless
taken at a dose of ounces a day.  Which NOBODY does in pill form.  That
would be-- what--- 30 pills a day of desicated raw liver?  60?  And for
what?   It's just stupidity, and the cost is astronomical for
supplements taken in those doses.  If you get mad cow disease, not to
mention high cholesterol, you deserve it.

                                       Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition,rec.food.veg
Subject: Re: B12 in mushrooms?
Date: 28 Feb 1999 12:28:34 GMT

In <36D6FFEE.36CC@netcom.ca> "Michael H." <zoltron@netcom.ca> writes:

>Incidentally, has there ever been a documented case of a dietary B12
>deficiency? I thought that it is purely hypothetical, based on observing
>people with a certain medical condition (can't recall the name) in which
>they can't metabolize B12. I don't think it is possible to have a dietary
>B12 deficiency, and would like to see evidence that there has ever been
>even one person diagnosed with it.


   You can think what you like.  But if you go to medline there are
plenty of articles about vegens being short of B12.  It's particularly
tough on their kids.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: URGENT HELP on thalassemia
Date: 2 Mar 1999 07:45:31 GMT

In <36DB68ED.EE03345C@emory.edu> Andrew Chung <achung@emory.edu>
writes:

>Daphne Le Duck wrote:
>
>> Hi,
>>
>> I have a friend who has alpha thalassemia minor and vitamins b12
>> deficiency. From what I have found out so far, alpha thalasemia minor
>> usually goes without any symptoms. However, this friend of mine
>> suffers tiredness, shortness of breath and numbness feeling in his
>> fringers. He has been taking vitamins b12 supplements for the past
>> month and still no improvement in his breathing problems.
>>
>> Does anyone know how to improve his breathing ? Please mail me ASAP.
>
>Sounds like he may still be anemic despite the oral B12 supplements
>(pernicious anemia). Have him see his doctor about B12 shots.


    Or get a B12 blood test.  These things are a waste of time and
money if you're getting regular shots (since they never fail to go back
to normal), but they're always useful in people who it's been decided
to treat with B12 by mouth (including people with pernicious anemia,
who can be treated with megadoses of B12 by mouth also).  If B12 levels
are well into the normal range ( >400 ng/dl), then B12 is not the
problem-- period.  People with thalassemia of any kind have to make
blood cells faster, and may run a worse risk of being folate
deficienct, even if they have enough B12.  You can test for this (red
cell folate) although it's more expensive.  Or, you can just supplement
it at several 400 mcg tabs a day.  They're cheap.

   You'd also like to know if your friend is more or less anemic.  B12
or folate deficiency don't usually cause tiredness or shortness of
breath independent of worse anemia (so if the anemia is not worse, or
if it's better, then B12 deficiency is unlikely to be the problem).
And if B12 deficiency causes numbness without anemia (which it can with
enough folate in the diet), it's invariably worse in the feet than the
hands.

                                  Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition,rec.food.veg
Subject: Re: B12 in mushrooms?
Date: 2 Mar 1999 08:22:46 GMT

In <7bf7rc$t73$1@metro.ucc.usyd.edu.au> jones_j@alf.chem.usyd.edu.au
(Jeff Jones) writes:

>Steven B. Harris (sbharris@ix.netcom.com) wrote:
>
>:    If the mushrooms are grown on manure, yes, they can contain B12.
>: But it's just a complicated way of eating a little manure.
>
>:     Take a B12 pill and forget it.
>
>Don't worry, I do. I'm still trying to find the reason why I don't absorb
>it well though (it's taken a while - ruled out celiac disease, pernicious
>anemia and ileal Crohns disease). Maybe it's just a combination of me
>being an athlete + irritable bowel syndrome. Iron is a problem as well.
>Back to the GI doc this Friday (not the radiologist who asked me about
>mushrooms).


   How much B12 are you taking, and how do you know you're not
absorbing it?  Are you on more than 1000 a day and still have low blood
levels after a month?  This is not impossible, but would certainly
suggest a problem like sprue.

    That being said, there is a certain problem with B12, and that is
that if very low, it may need to be jump started.  The cells in your
intestine need folate (which must be regenerated by B12 unless you eat
large amounts of folate) to grow and work and absorb well, just as
those in your bone marrow do.  The effects of deficiency of these
vitamins (needed to make DNA) are a bit like those of chemotherapy--
bone marrow and intestinal lining are hardest hit because they divide
the fastest of any cells in your body.  If you've been severely short
of B12 or folate for a while, you get folate and B12 malabsorption from
simply being short of folate and B12.  A vicious cycle.

   For this reason many docs start people off with a shot or two of B12
just as a jump-start, with some folate supplents, even if they intend
to eventually go the oral B12 megadose route.  And you probably have to
do this for a month to get an acurate Schilling's test, also (there's
no problem in giving B12 long before a Schilling's test, which you can
do any time you like after B12 is repleted; in fact B12 has to be
given during the test in any case to prevent the liver from absorbing
radioactive B12.  But this dose of B12 is given at close to the same
time as the oral B12, so it's ineffective at regenerating mucosa in
time, if it's the first replacement shot the patient has ever had).

   To put it another way: if you're severely B12 deficient as a result
of lack of intrinsic factor, you can't absorb B12 even when given WITH
intrinsic factor, unless you get B12 levels (or at least folate levels)
up in your blood for some weeks.  Fail to do this, and your Schilling
test results may make it look like you have sprue or general intestinal
malabsorption, when you really only have garden variety "pernicious
anemia" type malabsorption, which is a much less serious thing (since
only a small part of the gut, and a couple of nutrients, are affected
by the latter).

                                       Steve Harris, M.D.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition,rec.food.veg
Subject: Re: B12 in mushrooms?
Date: 3 Mar 1999 12:42:16 GMT

>Michael H. <zoltron@netcom.ca> wrote:

>> North Americans are dropping dead
>> everywhere from heart disease because of high meat consumption,
>> but I do not see people dropping dead from B12 deficiencies.


    How would you know if if you saw it?  Minor B12 deficencies just
raise homocysteine levels.   Which contribute to athererosclerosis.
Which makes people drop dead from heart attacks.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: blood question
Date: 27 Mar 1999 13:45:47 GMT

In <clw-2603990825420001@i48-10-38.pdx.du.teleport.com>
clw@teleport.com writes:

>> And on a related note, I've always wondered why Vitamin B-12 isn't
>> highly toxic.  Considering that its chemical structure is a
>> cobalamin porphyrin ring, coordinated to a cyanide ligand, I'm
>> suprised that the cyanide isn't released into the body.
>
>If the molecule was metabolized to release cyanide, it would be toxic.


  Wrong.  The molecule is indeed metabolized to release cyanide.  It's
not toxic because there's very little cyanide, and because the
metabolism is slow.  If you inject someone with 1000 micrograms of B12
in the cyano form, that's roughly 5 micrograms of CN-.   It takes 1000
times more to be very toxic, and 10 times that to kill.

  Hydroxocobalamin actually has quite an affinity for CN-, and has been
used for CN- poisoning.  If you're going to be poisoned with CN-, you
can't have it bound to something that likes it as well or better, as
the cytochromes which have to take up the CN- for you to be poisoned!


>That doesn't happen.  Also, the heme molelcule contains the CN group
>but is not toxic.

   Wrong again (two for two).  There are no -CN groups in heme.  Though
heme breakdown by heme oxygenase does release CO.



From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.physics,sci.med
Subject: Re: Theory, observation, science and belief.
Date: 9 May 1999 10:37:36 GMT

In <19990508180204.25114.00001368@ng-fp1.aol.com> orfnugen6@aol.com
(ORFNUGEN6) writes:

>Most great scientists had wrong beliefs on something or other.
>I don't know if you are trying to express a tautology here.
>Certainly, a scientist who believes in and pursues a wrong theory
>is at a pretty good disadvantage when it comes to arriving at new
>knowledge.


   You would be surprised.  Wrong but fruitful theories in science have
been nearly as useful as "correct" theories, and have inspired people
to try things they would not otherwise have rationally tried, thereby
causing them to discover that which they hadn't even dreamed of.  All
that is necessary is that somebody watching has a mind plastic enough
to change, and prepared enough to profit from serendipity.  It's sort
of like the restrictions of a sonnet form causing people to come up
with rhymes and throughts they would not have otherwise entertained,
and finding that a few of them are quite striking.

   Take some of the Nobel prizes in medicine.  The guys who identified
and isolated B12 (Minot and Murphy) were feeding dogs which had been
bled various foods to see which encouraged formation of blood.  Liver
turned out to be especially powerful, so they tried raw liver juice on
people with pernicious anemia (PA), and it worked.  That led to
isolation of the anti-PA factor, which turned out to be B12.  Alas,
along the way it was found that B-12 in liver wasn't what was helping
the dogs--- that was mundane liver iron.  Liver cure of PA was a
complete coincidence.  Wups.  Bad theory but inspirational all the
same.

   Once upon a time there was an Canadian WW I orthopedic surgeon named
Banting who knew that pancreatectomy caused diabetes, and had the
bright idea that one could tie off the pancreatic duct of a dog, let
the gland degenerate and self-digest, after which the putative
anti-diabetes factor could be isolated from it.  He went back home to
Canada, where a physiologist named McLeod in Toronto told him that
digestion of insulin seemed to be a barrier to isolation from the
pancreas, and that perhaps duct ligation could make the dignestive
enzymes go away but not the insulin in the pancreatic islet cells.
So Banting got a small lab, and with an assistant (Best) went to work
preparing extracts.  He soon found that extracts from dogs with duct
previously tied off where eratic, and another young researcher named
Colip helped figure out that washing the pancreas immediatedly with
cold acidic alcohol could disolve the active factor and inhibit
breakdown.  Banting decided to try this on fetal pancreas (reasoning
there would be less digestive enzyme) and it worked, even without tying
off the duct.  Collip soon realized it worked fine on adult pancreas,
too, also even without the duct tie, and began obtaining it from
slaughterhouses.  Banting's ideas were wrong-- his method doesn't help
insulin concentration at all and is horribly expensive and inhumane.
Wups.  But it led to the correct research trail to interest Lilly, and
also to 50 years worth of profitable commercial extraction from animal
pancreas, by Lilly Co., of beef and pork insulin (before genetically
engineer products became abvailable from bacteria and yeast).   Many
lives were saved.  And Banting shared the Nobel, while Colip did not.
Wups again.


From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: Iron: removal effective for hepatitis, unneeded supplements 
	harmful
Date: 16 May 1999 19:39:22 GMT

In <373D8648.F2F35381@Mindspring.com> Jim <JDBarron@Mindspring.com>


>B-12 deficiency can cause serious damage when it is misdiagnosed and
>treated inappropriately with folic acid. This is because folic acid
>*masks the symptoms* without addressing the real problem allowing serious
>damage to occur without warning symptoms. (It is for this reason that
>folic acid supplements also include B-12)


   Actually, folic acid therapy does address most (the GI and
hematological) problems which occur with B12 deficiency (which are
actually due to secondary folic acid deficiency). It just doesn't
address the myelination step which really does require B12, so
neurological damage continues.

   Not that B12 deficiency is ever misdiagnosed as folate deficiency
(an urban myth, that).  That's just ridiculously unlikely in this day
and age.  Any doctor who did that would have to be perversely looking
for zebras, and deliberately ignoring a key piece of knowledge which
anyone knowing enough to think of folate deficiency would certainly
know in the first place.


From: "Steve Harris" <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: vegetarian friend ate beef. -- lost headaches.
Date: Thu, 17 May 2001 17:04:59 -0700

DRCEEPHD wrote in message <20010517023015.10912.00000072@ng-mc1.aol.com>...

>We have a symbiotic relationship with our intestinal bacteria.  We cannot
>survive without them.


Nonsense.  Rats and mice raised in a completely sterile environment, with
completely sterile guts, do just fine. This wouldn't work for a cow or a
termite, but it would work fine for you.




From: steveharrismd@aol.com (SteveHarrisMD)
Newsgroups: sci.med.nutrition
Date: 17 Jul 2001 09:26:40 GMT
Subject: Re: B12 in nori

<< Subject: Re: B12 in nori
From: geowcherry@aol.com  (GeoWCherry)
Date: Mon, Jul 16, 2001 8:01 PM
Message-id: <20010716230154.27383.00001925@ng-ck1.aol.com>

A Google search of "synthetic vitamin B-12" produced 26 hits. Perhaps your
definition of synthetic and their definition is different.



===================

Don't strain your brain. So Google just turned up a loose use of language-- a
bunch of cases of people using the term "synthetic" to describe industrially
produced stuff which doesn't come naturally in your foods, but is made by
fermentation, by bacteria. It's about as synthetic as the alcohol in your beer.

The only sythetic part is the cyano group, which is put on as the bacterial
paste is cleaned up with activated charcoal. The rest is made by the bacteria.

SBH



From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.life-extension,sci.med,sci.med.nutrition
Subject: Re: Highish homocysteine levels in Taiwanese vegatarians
Date: Wed, 13 Feb 2002 18:24:17 -0700
Message-ID: <a4f3pi$39l$1@nntp9.atl.mindspring.net>

"Matti Narkia" <mnng@surfeu.fi> wrote in message
news:3ocj6u81d53j3s7vkcmnm4v0epujjagora@4ax.com...
> Tue, 12 Feb 2002 16:25:19 -0700 in article
> <a4c8e0$h5a$1@nntp9.atl.mindspring.net> "Steve Harris"
> <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:
>
> >"Peter H. Proctor" <pproctor@neosoft.com> wrote in message
> >news:23271826C5E840E3.C08BDBEC30F38F8A.DD8493C95DE34490@lp.airnews.net...
> >>
> >> Rather, the Lancet paper indicates that If you have enough folate,
> >> B12 becomes the limiting factor for homocysteine levels..

> The full text of the article is available at the url
>

http://www.thelancet.com/journal/vol359/iss9302/full/llan.359.9302.original_resear


Comment: you're right, and I'm embarrassed to be out of date. Folate
supplementation apparently does put a load on the next rate limiting step
for homocysteine metabolism, which is a B12-dependent methyl transferase.

Besides the neurological risk involved in giving folate to somebody who
might be B12 deficient (folate covers the anemia of pernicious anemia,
allowing the CNS symptoms to progress without diagnosis), this homocysteine
metabolic chain is yet more reason to make sure anybody you're giving oral
folate to, also gets their 1000 mcg/day of oral B12. It's cheap.

Bottom line: use folate and B12 always together, as though they were one
vitamin. Make sure the B12 is in appropriate amounts (500 mcg a day at
least) that it doesn't matter if the patient doesn't absorb it well.

SBH




From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.life-extension,sci.med,sci.med.nutrition
Subject: Re: Highish homocysteine levels in Taiwanese vegatarians
Date: Wed, 13 Feb 2002 18:42:09 -0700
Message-ID: <a4f4qv$doa$1@slb7.atl.mindspring.net>

"Martin Banschbach" <mbansch314@aol.com> wrote in message
news:cba7fed1.0202121939.218ad000@posting.google.com...
> I have not looked at the abstract.  It's not a new function of B12 and
> it's not an error.  I say this based on what my understanding of what
> B12 does in humans.  This means that your understanding is not correct
> (not a good way to start I know).

But you're correct. There are some B12 dependent enzymes lately discovered I
didn't know if. Some medline reading has corrected by error. Thanks.


> Only two enzymes in the human body are known to reguire B12 (have it
> bound to the enzyme as a cofactor).  The intestinal peptidase that
> allows the digestion of dietary folate and the mutase that handles
> branched chain amino acids (and also odd chain fatty acids).

Not so, there are many others. I've posted a review below. There are many
methyl transferases, such as methionine synthase, which require B12.
Methionine synthase is not a mutase.


> The demyelination that is seen in a severe B12 deficiency is coming from
> the buildup of odd chain fatty metablites and branched chain amino acid
> metabolites in both the CNS and peripheral myelinated axons.  B12 is not
> needed for myelin formation (from what I know about it) but it will
> cause existing myelin to breakdowwn when a severe deficiency is present.


Myelin basic protein is methylated by a B12 dependent enzyme, though there
is some question about whether or not this is what causes the myelopathy.
Where are you getting your information about what does cause the myelopathy?


> Adenosylcobalamin is the active form that works where odd chain fatty
> acids or branched chain amino acids have to be handled (nerve cells
> have a very high
> rate of branched chain amino acid metabolism).

Correct. Carbon-centered radicals formed when adenosyl is cleaved from
cobalt in B12, are the active groups here.

> In the gut, its cobalamin that binds to the protease.
>
> In methionine salvage, it's methylcobalamin that is used.

Yes, but by another enzyme, as noted.

Abstract:


Coenzyme B12 (cobalamin)-dependent enzymes.

Marsh EN.

Department of Chemistry, University of Michigan, Ann Arbor 48109-1055, USA.

The B12 or cobalamin coenzymes are complex macrocycles whose reactivity is
associated with a unique cobalt-carbon bond. The two biologically active
forms are MeCbl and AdoCbl and their closely related cobamide forms. MeCbl
participates as the intermediate carrier of activated methyl groups. During
the catalytic cycle the coenzyme shuttles between MeCbl and the highly
nucleophilic cob(I)alamin form. Examples of MeCbl-dependent enzymes include
methionine synthase and Me-H4-MPT: coenzyme M methyl transferase. AdoCbl
functions as a source of carbon-based free radicals that are unmasked by
homolysis of the coenzyme's cobalt-carbon bond. The free radicals are
subsequently used to remove non-acid hydrogen atoms from substrates to
facilitate a variety of reactions involving cleavage of carbon-carbon,
carbon-oxygen and carbon-nitrogen bonds. Most reactions involve 1,2
migrations of hydroxy-, amino- and carbon-containing groups, but there is
also one class of ribonucleotide reductases that uses AdoCbl. The structures
of two cobalamin-dependent enzymes, methionine synthase and
methylmalonyl-CoA mutase, have been solved. In both cases the cobalt is
co-ordinated by a histidine ligand from the protein. The significance of
this binding motif is presently unclear since in other cobalamin-dependent
enzymes spectroscopic evidence suggests that the coenzyme's nucleotide
'tail' remains co-ordinated to cobalt when bound to the protein.


From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.life-extension,sci.med,sci.med.nutrition
Subject: Re: Highish homocysteine levels in Taiwanese vegatarians
Date: Thu, 14 Feb 2002 13:54:31 -0700
Message-ID: <a4h8m1$8en$1@slb3.atl.mindspring.net>

"Martin Banschbach" <mbansch314@aol.com> wrote in message
news:cba7fed1.0202132259.7ae6c873@posting.google.com...

I don't know exactly what the mechanism is for myelin damage in B12
deficiency. From a medline search, I suspect it isn't completely worked out.


> Even our newest biochemistry textbook only covers the intestinal
> peptidase and the mutase for enzymes known to need B12.  I have always
> thought that the only thing left to discover was molecular biology
> (regulation of human gene expression).  Finding new enzymes that need
> B12 was a shock to me.


To me also. A reminder to us both to be humble. But it makes sense that
there are two major CLASSES of B12-cofactor dependent enzymes: the
methylators which need methyl-cobalamine, and the mutases and things that
mess with carbon-carbon bonds which need the radical generated by scission
of the adenosyl-cobalamin. But I suspect that the number of individual
enzymes and isozymes will be high. Methylation and C-C bond breaking are
very basic and important reactions, and that probably explains why B12 is a
cofactor used by probably all living organisms (though only prokaryotes make
it, with eukaryotes dependent on them as source).

> Since B6 affects so many enzymes and B12 only affected a few it was
> always amazing to me that the impact of a B12 deficiency was so much
> worse than the impact of a B6 deficiency.

That's partly due to the fact that a lot of B12 deficiency is folate
deficiency, which screws up DNA synthesis and general cell growth and
repair. As for the rest, I suspect like you that there are a number of
directly B12 requiring reactions we haven't discovered yet. Perhaps some of
these, like the homocysteine salvage system, only impact chronic problems
like clotting and atherosclerosis, and are quite hard to find as obvious
deficiencies. It's somewhat of an irony that Linus Pauling argued all those
years that stroke and heart attack were due to a sort of hidden vitamin
deficiency. He was partly right, it seems-- but the vitamins are B12 and
folate, not C!

> We both ended up learning something new.  Thanks Steve.

Yep. Thanks to you also.



From: "Steve Harris" <SBHarris123@ix.netcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: Vit. B12 In Plant Foods
Date: Thu, 21 Feb 2002 02:05:03 -0700
Message-ID: <a52e9h$60j$1@slb1.atl.mindspring.net>

"DRCEEPHD" <drceephd@aol.com> wrote in message
news:20020221032809.24899.00001787@mb-fj.aol.com...
> >Your teachers were didn't know what they were talking about, then.  There
> >are many studies of B12 malnurished vegan children in the scientific
> >literature. There is more than enough cobalt in fruits and vegetables to
> >make the few micrograms of B12 you need every day, if you could make it
> >in your stomach or small intestine as a cow or deer can. You can't.
> >Bacteria do make it in your colon, but you can't absorb it.  Sort of
> >like you cannot seem to absorb these ideas, which have been presented
> >to you before on sci.med.nutrtion.

> Reread your medical physiology text ( assuming you ever read it the
> first time.) You should discover that B-12 absorption occurs in the
> ileum and not the colon.

Yes, when did I say otherwise? And your point is what? Bacteria make it in
your colon but you can't absorb it, because you ileum comes before your
colon, and there's an ileocecal valve which prevents feces from going the
wrong way.

> >> Correct dietary, intrinsic factor from the stomach, healthy gut flora
> >> and a working gut wall, and voila...no B-12 shortage.
> >
> >Nonsense. If you think having colonic flora growing in your small
> >intestine is "healthy gut flora," you've one too many vigorous
> >colonics. They filled you up way too high.
>
> Shit normally floats downstream.  Only you would consider that colonic
> bateria would swim upstream into the small intestine.

I never considered it. You're the one claiming that there are bacteria in
your ileum making B12. If they don't come from the colon, where do they come
from? What bacteria are these, again?

> >No. Combined generation of the myelin from B12 deficiency is rather
> >hard to miss.
>
> Really?

Really. Spinal cords look like hell. Do you think nobody's ever looked at
the spinal tracts of such cows?

> >Nobody has ever described a B12 deficient cow.
>
> Wouldn't be too good for business would it?

It wouldn't hurt business. God, you're so damn ignorant. Vets and farmers
would simply go around injecting cows with B12 the way they inject pigs and
lambs with vitamin E, if it did much good. The way they put cobalt pellets
into cow stomachs now, if they need to. Again, it's not exactly like the ag
industry wouldn't tolerate vitmain injections-- there are already many
places where they are routine. FYI, injectable vitamin B12 is already used
in the ag industry-- go to any farm supply store and look in the vitamin
section, and you'll see industrial sized bottles of B12 for injection.  It's
just rarely used in cows. Mostly it's for lambs, who develop a
characteristic white liver disease when fed in cobalt deficiency pasture or
feedlot grain. Cattle usually get cobalt pellets. This works on lambs too,
but they seem to be more sensitive to cobalt deficiency than cattle.

> >Besides, if you fed a
> >cow enough antibiotics to kill her gut flora, she wouldn't be able to
> >process cellulose and would start to starve from lack of calories in the
> >conventional way, long before she had time to develop B12 deficiency.
>
> Maybe, and maybe not.  I still think it is worth checking out.

It's been checked out. Read a book.

> >Think about it. You're suggesting they've been feeding cows enough
> >antibiotics to kill the flora that makes it possible for them to grow
> >and give milk, and nobody noticed until they got B12 deficient?
>
> And here I thought that antibiotics were selective, killing only certain
> types of bacteria, and that some bacteria could mutate to survive.
> Silly me.

Silly you. For the same goes for the many bacteria that make B12.

> >Not your brightest idea, is
> >it?
>
> Maybe not, but at least I am thinking.  How about you?

I'm doing better than thinking. I also read, and I also go out into the
world to see how things are done. I see no evidence that you do ether one.
For example, if you knew fact one about nutrition in animals, if you'd ever
read a vet text, and if you'd ever actually been in a real farm supply store
and paid attention, you wouldn't be here making such an fool of yourself
with your idiot theories on animal disease.


From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: rec.food.veg,sci.med.nutrition
Subject: Re: B-12
Date: Thu, 21 Mar 2002 10:19:25 -0800
Message-ID: <a7d859$7d$1@slb3.atl.mindspring.net>

Ross Clement wrote in message <3c99a798$1@isls-news.wmin.ac.uk>...
>nemo (nemo@naughtylass.wet) wrote:

>I can't see anyone challenging the original ignoramus about his claim
>that B12 is an animal byproduct. If he actually bothered to check his
>facts, he'd find that B12 is synthesied by bacteria.



It is indeed, but I know of no plant product which contains enough to keep
from becoming deficient (unless you're into plants pulled out of sewage or
manure- treated fields without much cleanup). No yeast produces B12-- that's
a misconception caused by some old and bad immuno-assays which counted
B-12-like corins produced by some eukaryotes.  Animals concentrate the B12
they get from bacteria (in their guts, or from feces they eat), and that's
why animals and animal products are the main dietary source for those people
who don't like eating feces directly. Or eating vitamin pills.

I agree with Marty's B12 post with the single exception is that it as been
proven that you can treat pernicious anemia from day one just as effectively
(ie, blood picture improves just as fast) with oral B-12 in doses larger
than 1000 mcg, as with shots.  A car which is nearly out of gas runs just as
well if only the fuel line contains fuel, as it does if the whole tank is
full.  Doctors usually start with B12 shots just to start filling the tank
up again (being so low makes them nervous, as with a car), and because oral
high dose treatment hasn't formally been proven to reverse the neurological
symptoms (should there be any) as fast as shots. And the neuro symptoms can
be so subtle that you can't ever tell if you might not be getting them (who
doesn't have a little depression and stress?).

SBH

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.





From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: rec.food.veg,sci.med.nutrition
Subject: Re: B-12
Date: Fri, 22 Mar 2002 10:06:01 -0800
Message-ID: <a7fro6$bkp$1@slb6.atl.mindspring.net>

Ross Clement wrote in message <3c9afde7$1@isls-news.wmin.ac.uk>...

>But, you are wrong in suggesting (more or less) that it's a choice between
>animals and animal products or vitamin pills. Many vegan food products have
>bacteria synthesised B12 added during manufacture, and hence are a good
>vegan source that requires neither animals nor vitamin pills--

Yep, I should have added "vitamin fortified foods" to my list. I think of
them as basically no different from vitamin pills, but if you love to have
your industrial vitamins ground up and pre-sprinkled on, or mixed with, your
food--- fine by me.  Vegans who eat Total cereal or King Vitaman (two
popular fortified cereals in the US) should do fine.

SBH

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.





From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.animals.ethics.vegetarian,alt.food.vegan,rec.food.veg,
	sci.med.nutrition
Subject: Re: B-12 from the scientific community
Date: Sat, 23 Mar 2002 12:37:59 -0800
Message-ID: <a7ip12$hgl$1@slb2.atl.mindspring.net>

Lotus wrote in message <3C9C841F.7FB5797B@esatclear.ie>...
>"nemo" wrote;
>
>> Sorry. The daily requirement is 3 micro-grams. The absorbency is about
>> 10%, therefore 30micro-grams would be OK. 1mg a day might certainly
>> make you feel good though. In large doses B12 lifts depression
>> somewhat. (Source - lecture on B12 at Vegan Society London by a London
>> University professor about 20 years ago.)
>
>
>Nemo, you wrote above, that the daily requirement is 3 micro-grams.
>In all the literature that I have seen, the RDA- recommended daily
>allowance,- not requirement, is up to 3.0 mcg.
>Absorbency being about 10% would fit in with what others have said
>about the RDR (requirement) being about 1/10 of the RDA (allowance).


These things all take into account absorbency (bioavailability).


>The B12 from flesh foods is 'cyanocobalamin', is it not,


No, it is not. B12 obtained from bacterial culture (probably the hydroxyl)
which is then purified by filtering it through activated charcoal is
cyanocobalamin (it picks up cyanide from the charcoal). This is a man-made
derivative used most often in vitamins because it is stable.  B12 in meat is
either the methyl or the adenosyl version. There is no B12 in plants, except
as they happen to be contaminated with bacteria, and then it would be the
hydroxyl form.


> but isn't
>the form obtained from plant foods 'hydroxycobalamin'- a form
>of B12 that has far superior bio availability?

No, there is nothing superior about the bacterial product (which may be
contaminating plants) as compared with that available from meat. The cyano
compound in many (not all) commercial vitamins is an exception: it's
absorbed well, but smokers with a lot of cyanide in their systems may have
difficulty converting cyanocobalamin to more usable forms (this is a purely
equilibrium process, like converting CO-hemoglobin to the O2 form, and
depends on cyanide levels being low).  This is of practical importance only
for people with tobacco amblyopia, a very rare form of B12 neuropathy in
smokers caused (so goes the theory) by cyano conversion and destruction of
all usable B12 in the body from CN- in cigarette smoke.


SBH
--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.





From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.animals.ethics.vegetarian,alt.food.vegan,rec.food.veg,
	sci.med.nutrition
Subject: Re: B-12 from the scientific community
Date: Sat, 23 Mar 2002 16:29:56 -0800
Message-ID: <a7j6ju$98d$1@nntp9.atl.mindspring.net>

hilite wrote in message ...
>It has been reported that cyanocobalamin can create serious allergic
>reactions in some individuals, which requires immediate
>hospitalization. So why take it? Natural B12 is cheap and non-toxic.
>This seems like a no-brainer.


It's all natural B12. I doubt very much that the B12 allergic reactions are
due to the cyano group, and there's certainly no direct evidence for it.
Possibly they are related to some bacterial antigen which hasn't been
purified out (but that would cause problems with any B12, because it all
comes from there). There's literature reference claiming that somebody who'd
had B12 allergy from shots was re-triggered from eating marmite (!).  That
means it certainly was not the cyano per se causing the problem, since there
would be no cyanocobalamin in marmite. There's another reference reporting
successful reintroduction of B12 to two patients who'd had shot allergies--
that suggests the problem is not the B12 per se.  Overall, this is a very
murky area.

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.





From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: b12 injection
Date: Thu, 15 Aug 2002 17:41:49 -0700
Message-ID: <ajhhpe$39s$1@slb6.atl.mindspring.net>

john wrote in message <3D5BDDE3.7129C972@electronmail.com>...
>For b12 injections, how much do they normally inject?


One cc.  That's a pretty standard injection of anything <g>.

For B12 that one cc can contain 100 mcg of vitamin or 1000 mcg. There isn't
much difference so far as your body is concerned because you keep the same
amount either way, and waste the rest.

SBH

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.





From: "Steve Harris" <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Nutrition Scam (The Silly Shilling Test)
Date: Sun, 19 Jan 2003 14:30:03 -0800
Message-ID: <b0f994$gd7$1@slb5.atl.mindspring.net>

Denis Marier wrote in message ...
>The situation is that your body produces B12 but cannot keep it.  It
>urinated it all .
>The way the schilling tests are done is your are administered B12
>intramuscularly.
>A nuclear pill is then given to you.  Your have to collect all your urine
>for the next 24 hours.
>Then the container is brought to the laboratory and analyzed.  The Doctor
>reads the report and if not satisfactory the tests are done again.  Only
>then you know if your system cannot retain enough B12 for normal living. In
>my case I produce B12 but my system destroys/use it quicker than the average
>person.   As for vegans, their diet does not include enough B12 and in
>certain case they may require their diet to be supplemented by B12.
>Tons of B12 oral tablets are sold but the human system cannot absorb the
>vitamin by the mouth.  It has to be administered intramuscularly.  Many
>manufacturers and re-sellers will tell you that this is not true that their
>tablet is the real things.  Without costly shilling tests you cannot know
>your B12 requirement nor can you validate the merit of the use of tablets to
>supplement a vegan's diet.  FWIW





Complete nonsense. The Shilling test (please note the spelling) is a waste
of money, since the treatment is the same for B12 deficiency (diagnosed by
blood test), no matter what the mechanism. A simple, cheap, megadose pill
containing from 1 to 5 mg B12 is given every day. After a few months of
this, another blood test confirms the efficacy, and that's the end of it.
You take the pill daily for the rest of your life, but they're about nickel
apiece. The money you save not doing ONE Shilling test will buy you a
lifetime (40 year) supply of B12 pills.

The pills work in anyone short of B12 who has a terminal ileum (if you're
missing that piece of your gut, you're pretty likely to know about it, since
it will have been cut out of you at some point). For these few people
missing that piece of small bowel, B12 shots are necessary, but not doing a
Shilling test STILL pays for a lifetime of shots, and provides no
therapeutic information. So there's STILL no point in doing it. It's a relic
of a bygone age when B12 was expensive. Nobody but a few academic fossils
does the test anymore, and even they woudn't do it, if they had to pay for
it.

I wish them all a package of radioactive cobalt for Christmas.

SBH




From: "Steve Harris" <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Nutrition Scam
Date: Sun, 19 Jan 2003 14:14:39 -0800
Message-ID: <b0f8bu$o52$1@slb6.atl.mindspring.net>

John De Hoog wrote in message ...
>Eric Bohlman wrote...
>
>> Actually it's pretty much correct but a little sloppy.  People who need
>> B12
>> injections generally have a condition called pernicious anemia in which
>> their immune system attacks the stomach cells that produce a protein,
>> called "intrinsic factor," that's necessary for the absorption of B12. So
>> the statement "the body cannot absorb it" *is* correct *if* the body in
>> question has pernicious anemia.  Someone who lacks intrinsic factor can
>> take tons of B12 orally and it won't get into the bloodstream.  That's why
>> they need injections



Wrong. They don't need injections-- that's urban myth.  As for "tons",
you're off by a factor of about a billion. A milligram a day of B12 orally
will provide somebody with pernicious anemia with all they need. Sometimes
they are given a few shots to load them up after initial diagnosis, but
nobody has proven formally that these have a better recovery than patients
treated with oral megadoses alone.

SBH




From: "Steve Harris" <sbharris@ix.netcom.com>
Newsgroups: sci.med,sci.med.nutrition
Subject: Re: Nutrition Scam
Date: Mon, 20 Jan 2003 19:25:20 -0800
Message-ID: <b0iehq$5ek$1@slb2.atl.mindspring.net>

Gym Bob wrote in message ...
>I understand that sublingual B12 is the best form for absorption.


There's no good evidence for this that know of, and I've looked. The
sublingual route of oral absorption for drug like nitroglycerine has gotten
a lot of press because in your mouth and your anus is mucosa which is
drained by veins which bypass the liver, and thus things you absorb by mouth
or per rectum bypass liver metabolism. This is totally irrelevent to B12,
which you want to go to your liver anyway. Not that I think the surface area
of your mouth compares with your gut when it comes to mass-action
diffusional B12 absorption, of the type we're discussing here.

Sublingual B12 was invented by marketing geniuses, and it's bought by the
nutritionally clueless. Sort of the same way as with B12 nasal gel. Not
quite that silly, but getting there.

SBH




From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Pernicious Anemia - Progressive?
Date: Sun, 3 Aug 2003 20:48:08 -0700
Message-ID: <bgkl5f$3la$1@slb5.atl.mindspring.net>

"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:bgjs93$2t1$1@reader1.panix.com...

> No, the standard doses of vitamin B12 given in people with pernicious
> anemia are much higher than someone would require even if they
> could absorb no B12 from their regular diet.

Well, not really. If you get a shot once a month, you retain
maybe 30 mcg of B12 from that single shot, whether you get
100 mcg or 1000 mcg in the shot (makes no difference).
That's a *little* more than you need for a month, but not a
*huge* amount more. The closeness of the figures is one
reason why clinicians treating initial presentation of
pernicious anemia sometimes give a few shots, less than
month apart, to begin to build up liver stores again. That's
done whether you continue with shots or oral megadosing for
maintenance.

Of course this isn't necessary with a totally compliant
patient who never misses a monthly shot, or their daily oral
megadose. They'll build up their total 3000 to 5000 mcg
store eventually over the years, and in the meantime are
fine. But totally compliant patients are rare.

SBH




From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: Pernicious Anemia - Progressive?
Date: Mon, 04 Aug 2003 07:19:01 -0400
Message-ID: <bglffc$g4g$1@reader1.panix.com>

Steve Harris wrote:
> Well, not really. If you get a shot once a month, you retain
> maybe 30 mcg of B12 from that single shot, whether you get
> 100 mcg or 1000 mcg in the shot (makes no difference).
> That's a *little* more than you need for a month, but not a
> *huge* amount more. The closeness of the figures is one
> reason why clinicians treating initial presentation of
> pernicious anemia sometimes give a few shots, less than
> month apart, to begin to build up liver stores again. That's
> done whether you continue with shots or oral megadosing for
> maintenance.
>
> Of course this isn't necessary with a totally compliant
> patient who never misses a monthly shot, or their daily oral
> megadose. They'll build up their total 3000 to 5000 mcg
> store eventually over the years, and in the meantime are
> fine. But totally compliant patients are rare.
>
> SBH

Do you have a reference on that? I had thought that patients
who were very deficient in B12 held onto more of the 1000 mcg
injection than patients who were only mildly deficient, so
I'm interested in the data if you have it.

(It shouldn't need to be said, but since this is Usenet: this
is a completely serious request. Dr. Harris was the first person
I can recall pointing out that oral B12 could be used for PA. It
seemed like a strange idea until I reviewed the RCTs and found that
he was completely correct. I would now treat with oral B12 in
anyone willing to take the daily dose.)

--
David Rind
drind@caregroup.harvard.edu



From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Pernicious Anemia - Progressive?
Date: Mon, 4 Aug 2003 12:28:35 -0700
Message-ID: <bgmc8q$ob7$1@slb5.atl.mindspring.net>

"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:bglffc$g4g$1@reader1.panix.com...

> Do you have a reference on that? I had thought that patients
> who were very deficient in B12 held onto more of the 1000 mcg
> injection than patients who were only mildly deficient, so
> I'm interested in the data if you have it.


Was afraid you'd ask. I read this in some family practice
review which made the point that there's no effective
difference between 100 mcg/mL cyanocobalamin preps and 1000
mcg/mL preps, but that info doesn't appear to show up in
anything abstractable on medline. Probably because it comes
from early 1960's research from before medline or somewhere
in the next decade before abstracting was common. Or it was
looked at in the process of testing out one of the newer
injectables (hydroxy or methyl cobalamin) with the old
cyano- as control, and I can't find it.

Might look to see what it says in your Heme text if you have
access to one. I'm at work.

I do remember the comparison was in patients with actual
pernicious anemia, so they were all maximally deficiency
with no body stores and transcobalamins completely
unsaturated. I've no doubt that patients with partially
saturated transcobalamins manage to retain less of a
standard parenteral dose.

SBH




From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: Pernicious Anemia - Progressive?
Date: Mon, 04 Aug 2003 21:11:12 -0400
Message-ID: <bgn07n$3k9$1@reader1.panix.com>

Steve Harris wrote:
> Was afraid you'd ask. I read this in some family practice
> review which made the point that there's no effective
> difference between 100 mcg/mL cyanocobalamin preps and 1000
> mcg/mL preps, but that info doesn't appear to show up in
> anything abstractable on medline. Probably because it comes
> from early 1960's research from before medline or somewhere
> in the next decade before abstracting was common. Or it was
> looked at in the process of testing out one of the newer
> injectables (hydroxy or methyl cobalamin) with the old
> cyano- as control, and I can't find it.
>
> Might look to see what it says in your Heme text if you have
> access to one. I'm at work.
>
> I do remember the comparison was in patients with actual
> pernicious anemia, so they were all maximally deficiency
> with no body stores and transcobalamins completely
> unsaturated. I've no doubt that patients with partially
> saturated transcobalamins manage to retain less of a
> standard parenteral dose.
>
> SBH

Well part of what I'd read even before my first post was the
following from UpToDate:

"Pernicious anemia (PA) is typically treated with parenteral (ie,
intramuscular) Cbl, in a dose of 1000 µg (1 mg) every day for one week,
followed by 1 mg every week for four weeks and then, if the underlying
disorder persists, as in PA, 1 mg every month for the remainder of the
patient's life.

While doses lower than those noted above have been recommended (ie, 100
µg in place of 1,000 µg), there are no adverse consequences of this
potential "overtreatment", as parenteral vitamin B12 is inexpensive,
nontoxic, and amounts given in excess of need are excreted harmlessly in
the urine. Conversely, use of the lower dose could result in a slower
response, which might be critical when irreversible neurologic damage is
a concern."

This is unreferenced, but is from Stanley Schrier, and the last
sentence at least suggests that he thinks more B12 can potentially
be absorbed from a 1000 mcg injection than a 100 mcg injection....

--
David Rind
drind@caregroup.harvard.edu



From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: Pernicious Anemia - Progressive?
Date: Tue, 05 Aug 2003 06:48:54 -0400
Message-ID: <bgo22u$clh$1@reader1.panix.com>

Steve Harris wrote:
> "David Rind" <drind@caregroup.harvard.edu> wrote in message
> news:bgn07n$3k9$1@reader1.panix.com...
>
>>This is unreferenced, but is from Stanley Schrier, and the last
>>sentence at least suggests that he thinks more B12 can potentially
>>be absorbed from a 1000 mcg injection than a 100 mcg injection....
>
> As did I. It's a common belief.

Okay, I'm confused now. I had thought you were saying that
no matter what dose injection is given, people can only
absorb about 30 mcg per injection. Is the actual point you're
making that people will absorb a little more with a 1000 mcg
than a 100 mcg injection but that the 1000 mcg injection gets
you nowhere near an additional benefit of 900 mcg so while
there's a little bit of an extra buffer with 1000 mcg, it isn't
nearly so large as might be imagined?

--
David Rind
drind@caregroup.harvard.edu



From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Pernicious Anemia - Progressive?
Date: Tue, 5 Aug 2003 11:29:58 -0700
Message-ID: <bgot36$qpg$1@slb9.atl.mindspring.net>

"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:bgo22u$clh$1@reader1.panix.com...
> Okay, I'm confused now. I had thought you were saying that
> no matter what dose injection is given, people can only
> absorb about 30 mcg per injection.


That is more or less the case, though I cannot find the
reference at this moment.



>Is the actual point you're
> making that people will absorb a little more with a 1000 mcg
> than a 100 mcg injection but that the 1000 mcg injection gets
> you nowhere near an additional benefit of 900 mcg so while
> there's a little bit of an extra buffer with 1000 mcg, it isn't
> nearly so large as might be imagined?


No, in the study I recall, they couldn't find any difference
in amount regained from a 100 mcg vs 1000 shot.  Your
retention mechanisms are HIGLY dependent on specific
proteins for this water soluble vitamin which goes off in
the urine otherwise. They are totally saturated with either
dose.  Which is not surprising.




From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition
Subject: Re: No B-12 in Plant Food. No Problem.
Date: 30 Aug 2005 21:40:10 -0700
Message-ID: <1125463210.412546.34020@g14g2000cwa.googlegroups.com>

Visual Purple wrote:
> Along with just about every other nutrient on the planet, there is B-12
> in Spirulina.
>
> http://www.onlinefitnesstrainer.com/herbs/Spirulina.htm


COMMENT:

But not as much as you might think, since 5/6ths of the B-12 in
spirullina is pseudo-B12 which shows up colormetrically but not on
bioassay (so it's not active). And it doesn't usually say which assay
is used on the label. It's actually not a suitable vegan source.

A far better vegetarian source of B12, if you must have a whole food,
is chlorella algae.

Though I don't know why it all matters, since all B12 on the commercial
supplement market is made in bacteria, anyway-- just like the stuff you
get from animal products ultimately was. It's animal-source free. B-12
has been made synthetically by chemists, but at hugh cost, and only as
a demo. It's WAY too complicated to synthesize artificially for any
purpose it's used for.

SBH


J Agric Food Chem. 1999 Nov;47(11):4736-41.

Pseudovitamin B(12) is the predominant cobamide of an algal health food,
spirulina tablets.

Watanabe F, Katsura H, Takenaka S, Fujita T, Abe K, Tamura Y, Nakatsuka T,
Nakano Y.

Department of Health Science, Kochi Women's University, Kochi 780-8515,
Japan. watanabe@cc.kochi-wu.ac.jp

The vitamin B(12) concentration of an algal health food, spirulina
(Spirulina sp.) tablets, was determined by both Lactobacillus
leichmannii ATCC 7830 microbiological and intrinsic factor
chemiluminescence methods. The values determined with the
microbiological method were approximately 6-9-fold greater in the
spirulina tablets than the values determined with the chemiluminescence
method. Although most of the vitamin B(12) determined with the
microbiological method was derived from various vitamin B(12)
substitutive compounds and/or inactive vitamin B(12) analogues, the
spirulina contained a small amount of vitamin B(12) active in the
binding of the intrinsic factor. Two intrinsic factor active vitamin
B(12) analogues (major and minor) were purified from the
spirulina tablets and partially characterized. The major (83%) and
minor (17%) analogues were identified as pseudovitamin B(12) and vitamin B(12),
respectively, as judged from data of TLC, reversed-phase HPLC, (1)H NMR
spectroscopy, ultraviolet-visible spectroscopy, and biological activity
using L. leichmannii as a test organism and the binding of vitamin
B(12) to the intrinsic factor.

PMID: 10552882 [PubMed - indexed for MEDLINE]



=====================

J Nutr Sci Vitaminol (Tokyo). 2002 Oct;48(5):325-31.

Characterization and bioavailability of vitamin B12-compounds from
edible algae.

Watanabe F, Takenaka S, Kittaka-Katsura H, Ebara S, Miyamoto E.

Department of Health Science, Kochi Women's University, Kochi 780-8515,
Japan. watanabe@cc.kochi-wu.ac.jp

Substantial amounts of vitamin B12 were found in some edible algae (green
and purple lavers) and algal health food (chlorella and spirulina ablets)
using the Lactobacillus delbrueckii subsp. lactis ATCC7830
microbiological assay method. Corrinoid-compounds were purified and
characterized from these algae to clarify the chemical properties and
bioavailability of the algal vitamin B12. True vitamin B12 is the
predominate cobamide of green and purple lavers and chlorella tablets.
Feeding the purple laver to vitamin B12-deficient rats significantly
improved the vitamin B12 status. The results suggest that algal vitamin
B12 is a bioavailable source for mammals. Pseudovitamin B12 (an inactive
corrinoid) predominated in the spirulina tablets, which are not suitable
for use as a vitamin B12 source, especially for vegetarians.

algal health food, bioavailability, cobalamin, edible algae, vitamin
B12

Publication Types:
    Review
    Review, Tutorial

PMID: 12656203 [PubMed - indexed for MEDLINE]



From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.nutrition,misc.health.diabetes
Subject: Re: Methylcobalamimin and Diabetic Neuropathy
Date: 23 Sep 2005 17:23:06 -0700
Message-ID: <1127521386.511617.202030@z14g2000cwz.googlegroups.com>

Kamalakar Pasupuleti wrote:
> I understand Methylcobalamin is good for diabetic peripheral
> neuropathy . The product is available in health food /vitamin
> stores only for reasons not known to me .


The reason is COST. In theory the methyl form is the best, since it is
the active form in the body already, and doesn't have to be made from
the artificial cyano form (which is the cheap one).


>    I welcome feedback from it's users . I wish to try for my
> tingling of soles .
>
> Regards ,
> Kam


Evidence is modest for effect, but does exist. If you're sure your
symptoms are from diabetes, it's worth a try, **after** you've done
everything else to get the diabetes under control.

Since you're taking very high levels of methylcobalamin over what can
be absorbed, the most economical thing to do is buy 4000 mcg
methylcobalamin tabs and quarter them, taking a quarter pill a day.
It's very unlikly that oral doses over 1000 mcg will do anything extra.

Acta Neurol Taiwan. 2005 Jun;14(2):48-54.

Effectiveness of vitamin B12 on diabetic neuropathy: systematic review
of clinical controlled trials.

Sun Y, Lai MS, Lu CJ.

Department of Neurology, En Chu Kong Hospital, No. 399, Fuhsin Road,
San-shia, Taipei, Taiwan. sunyu@ms4.hinet.net

The clinical effectiveness of vitamin B12 and its active coenzyme form
on diabetic neuropathy is uncertain. Therefore, we searched the
English- and non-English-language literature on this topic by using
MEDLINE (Ovid, PubMed), the Cochrane Controlled Trials Register, and
related papers. We identified seven randomized controlled trials from
June 1954 to July 2004 and reviewed them for the clinical ffectiveness
of vitamin B12 according to the following parameters: Measurement
scales of somatic and autonomic symptoms or signs; vibrometer-detected
thresholds of vibration perception; and, electrophysiologic measures
such as nerve conduction velocities and evoked potentials. Three
atudies involved the use of vitamin B complex (including B12) as the
active drug, and four used methylcobalamin. Two studies were of fairly
good quality (Jadad score = 3/5), and five were of poor quality (Jadad
score < or = 2/5). Both the vitamin B12 combination and pure
methylcobalamin had beneficial effects on somatic symptoms, such as
pain and paresthesia. In three studies, methylcobalamin therapy
improved autonomic symptoms. Effects on vibration perception and
electrophysiological measures were not consistent. With both the
vitamin B12 combination and pure methylcobalamin, symptomatic relief
was greater than changes in electrophysiological results. However, more
high-quality, double-blind randomized controlled trials are needed to
confirm the effects of vitamin B12 on diabetic neuropathy.

Publication Types:
    Review

PMID: 16008162 [PubMed - indexed for MEDLINE]


 

































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































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