From: email@example.com (Steven B. Harris ) Subject: Re: Pernicious anemia - what is it please??? Date: 07 Oct 1995 Newsgroups: sci.med In <firstname.lastname@example.org> email@example.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: firstname.lastname@example.org(Steven B. Harris) Subject: Re: Vegetarians and vitamin B12 Date: Thu, 18 Dec 1997 Newsgroups: sci.med.nutrition In <email@example.com> firstname.lastname@example.org (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: email@example.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" <firstname.lastname@example.org> 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: email@example.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 <firstname.lastname@example.org> writes: >Steven B. Harris wrote: > >> In <09CZ.email@example.com> Bryan Shelton >> <firstname.lastname@example.org> 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: email@example.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 <firstname.lastname@example.org> Brian Sandle <email@example.com> 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: firstname.lastname@example.org(Steven B. Harris) Newsgroups: sci.med.nutrition Subject: Re: B-12 dosage (Pernicious Anemia) Date: 9 May 1998 05:03:19 GMT In <email@example.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: firstname.lastname@example.org(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" <email@example.com> 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: firstname.lastname@example.org(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 <email@example.com> "no spam" <firstname.lastname@example.org> 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: email@example.com(Steven B. Harris) Newsgroups: sci.med Subject: Re: B12 deficiency Date: 20 Jun 1998 02:05:23 GMT In <firstname.lastname@example.org> email@example.com (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: firstname.lastname@example.org(Steven B. Harris) Newsgroups: sci.med Subject: Re: B12 deficiency Date: 25 Jun 1998 03:37:55 GMT In <email@example.com> firstname.lastname@example.org (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: email@example.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 <firstname.lastname@example.org> 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: email@example.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 <firstname.lastname@example.org> Pete Beyer <email@example.com> 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: firstname.lastname@example.org(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 <email@example.com> 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 >firstname.lastname@example.org 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: email@example.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 <firstname.lastname@example.org> 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: email@example.com(Steven B. Harris) Newsgroups: misc.health.alternative Subject: Re: B12 deficiency anemia Date: 17 Feb 1999 03:34:21 GMT In <firstname.lastname@example.org> email@example.com writes: >In article <firstname.lastname@example.org>, > email@example.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 <firstname.lastname@example.org>, >> "Lisa M Mill" <email@example.com> 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: firstname.lastname@example.org(Steven B. Harris) Newsgroups: misc.health.alternative Subject: Re: B12 deficiency anemia Date: 18 Feb 1999 02:18:10 GMT In <email@example.com> firstname.lastname@example.org 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: email@example.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 <firstname.lastname@example.org> email@example.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: firstname.lastname@example.org(Steven B. Harris) Newsgroups: misc.health.alternative Subject: Re: B12 deficiency anemia Date: 19 Feb 1999 11:23:35 GMT In <email@example.com> firstname.lastname@example.org 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: email@example.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 <firstname.lastname@example.org> email@example.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: firstname.lastname@example.org(Steven B. Harris) Newsgroups: misc.health.alternative Subject: Re: B12 deficiency anemia Date: 19 Feb 1999 11:42:29 GMT In <email@example.com> "Lisa M Mill" <firstname.lastname@example.org> 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: email@example.com(Steven B. Harris) Newsgroups: misc.health.alternative Subject: Re: B12 deficiency anemia Date: 22 Feb 1999 02:43:56 GMT In <firstname.lastname@example.org> email@example.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: firstname.lastname@example.org(Steven B. Harris) Newsgroups: misc.health.alternative Subject: Re: B12 deficiency anemia Date: 22 Feb 1999 03:15:19 GMT In <email@example.com> firstname.lastname@example.org writes: >In article <email@example.com>, > firstname.lastname@example.org(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: email@example.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." <firstname.lastname@example.org> 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: email@example.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 <firstname.lastname@example.org> 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: email@example.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 <firstname.lastname@example.org> email@example.com (Jeff Jones) writes: >Steven B. Harris (firstname.lastname@example.org) 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: email@example.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. <firstname.lastname@example.org> 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: email@example.com(Steven B. Harris) Newsgroups: sci.med Subject: Re: blood question Date: 27 Mar 1999 13:45:47 GMT In <firstname.lastname@example.org> email@example.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: firstname.lastname@example.org(Steven B. Harris) Newsgroups: sci.physics,sci.med Subject: Re: Theory, observation, science and belief. Date: 9 May 1999 10:37:36 GMT In <email@example.com> firstname.lastname@example.org (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: email@example.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" <firstname.lastname@example.org> 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 <email@example.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: firstname.lastname@example.org (SteveHarrisMD) Newsgroups: sci.med.nutrition Date: 17 Jul 2001 09:26:40 GMT Subject: Re: B12 in nori << Subject: Re: B12 in nori From: email@example.com (GeoWCherry) Date: Mon, Jul 16, 2001 8:01 PM Message-id: <firstname.lastname@example.org> 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: <email@example.com> "Matti Narkia" <firstname.lastname@example.org> wrote in message news:email@example.com... > Tue, 12 Feb 2002 16:25:19 -0700 in article > <firstname.lastname@example.org> "Steve Harris" > <sbharris@ix.RETICULATEDOBJECTcom.com> wrote: > > >"Peter H. Proctor" <email@example.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: <firstname.lastname@example.org> "Martin Banschbach" <email@example.com> wrote in message news:firstname.lastname@example.org... > 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: <email@example.com> "Martin Banschbach" <firstname.lastname@example.org> wrote in message news:email@example.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: <firstname.lastname@example.org> "DRCEEPHD" <email@example.com> wrote in message news:firstname.lastname@example.org... > >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: <email@example.com> Ross Clement wrote in message <firstname.lastname@example.org>... >nemo (email@example.com) 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: <firstname.lastname@example.org> Ross Clement wrote in message <email@example.com>... >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: <firstname.lastname@example.org> 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: <email@example.com> 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: <firstname.lastname@example.org> 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" <email@example.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: <firstname.lastname@example.org> 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" <email@example.com> Newsgroups: sci.med,sci.med.nutrition Subject: Re: Nutrition Scam Date: Sun, 19 Jan 2003 14:14:39 -0800 Message-ID: <firstname.lastname@example.org> 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" <email@example.com> Newsgroups: sci.med,sci.med.nutrition Subject: Re: Nutrition Scam Date: Mon, 20 Jan 2003 19:25:20 -0800 Message-ID: <firstname.lastname@example.org> 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: <email@example.com> "David Rind" <firstname.lastname@example.org> wrote in message news:email@example.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 <firstname.lastname@example.org> Newsgroups: sci.med Subject: Re: Pernicious Anemia - Progressive? Date: Mon, 04 Aug 2003 07:19:01 -0400 Message-ID: <email@example.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 firstname.lastname@example.org
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: <email@example.com> "David Rind" <firstname.lastname@example.org> wrote in message news:email@example.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 <firstname.lastname@example.org> Newsgroups: sci.med Subject: Re: Pernicious Anemia - Progressive? Date: Mon, 04 Aug 2003 21:11:12 -0400 Message-ID: <email@example.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 firstname.lastname@example.org
From: David Rind <email@example.com> Newsgroups: sci.med Subject: Re: Pernicious Anemia - Progressive? Date: Tue, 05 Aug 2003 06:48:54 -0400 Message-ID: <firstname.lastname@example.org> Steve Harris wrote: > "David Rind" <email@example.com> wrote in message > news:firstname.lastname@example.org... > >>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 email@example.com
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: <firstname.lastname@example.org> "David Rind" <email@example.com> wrote in message news:firstname.lastname@example.org... > 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 <email@example.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: <firstname.lastname@example.org> 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. email@example.com 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. firstname.lastname@example.org 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 <email@example.com> Newsgroups: sci.med.nutrition,misc.health.diabetes Subject: Re: Methylcobalamimin and Diabetic Neuropathy Date: 23 Sep 2005 17:23:06 -0700 Message-ID: <firstname.lastname@example.org> 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. email@example.com 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]