Doctor's Note

This is the first of a five-part video series on B12, similar to my series on vitamin D, where I delved into the derivation of my recommendations, found for B12 in Vitamin B12: how much, how often? and in general in Optimum Nutrition Recommendations. For more context, check out Vegan B12 Deficiency: Putting It into Perspective and The Safest Source of B12.

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Comment Etiquette

73 Responses to “Vitamin B12 Recommendation Change”

  1. Michael Greger M.D.

    This is the first of a five-part video series on B12, similar to the series I did on vitamin D where I delve into the derivation of my recommendations, found here for B12 and here in general. To put vitamin B12 in context, please check out Vegan B12 Deficiency: Putting It into Perspective. Tomorrow I’ll identify the safest sources of B12. If you can’t wait until tomorrow for your NutritionFacts.org video-of-the-day fix, please feel free to check out videos on 1000+ other topics.Report

    Reply
  5. Elvin

    Dr Greger: I hope you will say something about cyanocobalamin vs. methylcobalamin. In some places (the country where I live is one) the only oral B12 available is methylcobalamin, coming in capsules of 500mcg a hit. And then on the packages it recommends taking (over the course of a day) 1500mcg. Now, is methylcobalamin especially hard to absorb, or what? I only take 500 or 1000mcg a day. Enough?Report

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    • Michael Greger M.D.

      re: cyanocobalamin (the inexpensive form) vs. methylcobalamin. Vitamin B12 supplements are so cheap to produce that supplement manufacturers try to come with all sorts of fancy ways to “add value” to products so they can make more money. The coral calcium scam is the classic example–how else can you charge $20 for a bottle of chalk? Likewise, unless you’re a smoker, have kidney failure, or base your diet around cassava root, cyanocobalamin should be fine. If it’s unavailable, then I would shoot for about 2,000 mcg a day of methylcobalamin.Report

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      • BPCveg

        Sorry, maybe I missed something … what if you are a smoker, have kidney failure or base your diet around cassava root — why do these factors affect which form of vitamin B12 you should take?Report

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      • MacSmiley

        2000 mcg daily? Are you saying that methylcobalamin is inferior? that it’s less bioavailable, not just more costly than cyanocobalamin?

        Dr Fuhrman’s Gentle Care Formula MVM has only 30 mcg. Do you mean it’s time for him to reformulate?Report

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      • Strix

         I’m totally confused now :? So, since I’ve been taking the Methylcobalamin for years now, I should either start taking the cyanocobalmin or take 2,000 — thousand!! — per DAY of the Methylcobalamin??

        I take a 1000 mcg of Methylcobalamin about twice a week.

        Wow. Please advise! Report

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      • JD Mumma

        My research indicates that the reason cyanocobalamin costs less is because it requires less processing than methylcobalamin. As well cyanocobalamin is more stable when exposed to heat and/or light which may also may also lower production and distribution cost.

        “Vitamin B12 is produced industrially by microbial fermentation, using almost exclusively Pseudomonas denitrificans and Propionibacterium species as described in Japanese Patent 03244376, then converting the natural vitamin B12 into the
        cyanocobalamin form by chemical processes including cyanidization followed by extraction and purification steps using organic solvents (as reviewed by Spalla et al., 1989 “Microbial production of vitamin B12″, E.J. Vandamme ed., Elsevier, London, New York, pp. 257-284; Schliwa et al., Proc. Natl. Acad. Sci. USA, 1981, 78, pp. 4329-4333). The chemical conversion step and any subsequent purification steps cause this production process to be expensive, unsafe to the operators and environmentally unfriendly.” Hendrik Louis Bijl http://www.google.com/patents/EP0824152B1Report

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      • barbarabrussels

        2,000 mcg a day of methylcobalamin? Could you please do yet another video on B12, particularly on this methylcobalamin type? I’m confused, I also have been taking 1000 mcg twice a week like the other commenter Strix has, based on your recommendations. This is insufficient for this type of B12? Almost all the supplements for sale contain this type, so lmaybe it’s worth clarifying. Thanks doc.Report

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        • David Johnson

          Now I am wondering too. Dr. Fuhrman’s current multivitamin for men contains only 100mcg per day. It would seem this is greatly deficient, and that is alarming.

          Why is so much methylcobalamin required? Does Dr. Gregor explain this anywhere? it would be a great help if he would (or know where he has).Report

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            • mbglife

              Hi Joseph
              Could you please help clarify all these questions on why the difference in recommended daily amounts of methl vs cyno complained? I have the same questions.

              Thanks,
              Mark G.Report

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                • mbglife

                  No, sorry. What I want to know is
                  (a) what is the preferred form of B12 and why?
                  (b) why is there a difference in the recommended levels?

                  Also, I notice on the same page in response to a comment you posted, there was this post and I don’t know what it means. Is it saying that methyl is better or not? (Maybe just answering the above questions is the bottom line and all that’s needed.)

                  William Hiatt’s reply to Joseph Gonzales R.D.
                  a month ago
                  “our methy ls groups are already being taxed to failure due toxins in food, environmental toxins, depleted glutathione levels, why pile on more work for the methylation groups, and this is not even addressing those with SNPs- Methylcobalamin is as cheap and in the form of transdermal applications higher in efficacy without the risk of dosage dumping. The other area Jack does not address is the Lock and Key fitting of synthetic vitamins. Methyl is the bioavailble form. By supplementing with transdermal nano patches you do not have to be concerned with problems in binding with IF (Intrinsic Factor) Many medications as well as PPI interfere with this so even if you are eating foods high in B-12 you still may suffer from malabsorption”Report

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                • mbglife

                  I also found this reply by Laloofah on a different page. Is what she shares correct?

                  Laloofah
                  (4 months ago)
                  I’m about to re-stock my Vitamin B-12 stash and wanted to learn more about the cyanocobalamin vs methylcobalamin issue first. Since every one of Dr. Greger’s informative B-12 videos and articles seem to contain at least one question about the differences, efficacy, safety, etc, of the two types, I thought I’d share this except from an article on B-12 by Dustin Rudolph (the “Plant-Based Pharmacist”) that I found very helpful (the original article cites sources & includes links to additional info, which are not included here):

                  “Cyanocobalamin is a synthetic version of vitamin B12. After ingestion, cyanocobalamin is broken down into the two active forms of B12 known as methylcobalamin and 5-deoxyadenosylcobalamin. The active form methylcobalamin is an essential co-factor in the production of healthy red blood cells. The other active form, adenosylcobalamin, is an essential co-factor in the maintenance of healthy nerve cells and healthy red blood cells. Because cyanocobalamin is broken down into both active forms of B12, it is the preferred supplement for use in healthy individuals.

                  There have been concerns brought up by some individuals that during the metabolic breakdown of cyanocobalamin, cyanide is released as a byproduct. Cyanide can be toxic to the human body in large amounts. However, the amount of cyanide contained in a B12 supplement is not physiologically toxic to the human body. The only possible theoretical exception might be in patients who have kidney disease. Keyword emphasis on the word might. These patients have an impaired ability to clear cyanide, which could lead to elevated cyanide levels over time. A better option for those with kidney disease may be methylcobalamin due to this.”Report

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  6. bsmithson

    There are 2 items I am seeing called for in cookbooks, and I’d like to know if they are harmless. One is baking seitan in aluminum foil. Is there any transfer of aluminum into the food? And the other is liquid smoke. I had heard that this was mutogenic. Is that true? If so, could you please give me some idea of the risk? I think it is an ingredient not just in recipes, but also in vegan bacon and ham.Report

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  7. Lindsey

    I’m a vegan of 4 years (I supplement B12), and I just had my B12 serum levels checked, and they were at 1900 (don’t know the units) where the max end of the normal range is 900. Do you think it is necessary to get my homocysteine and MMA levels checked as well? Or since my serum level is so high, am I probably OK?Report

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  8. BPCveg

    Dr. Greger: Like you, I was also surprised to learn that the RDA for vitamin B12 is based on an obsolete study. I think that a great future addition to nutritionfacts.org would be a section which provides the latest on RDA recommendations together with sources on which they are based. It would be useful to users of your website to be able to look up any nutrient/supplement (e.g. calcium, vitamin D, etc.) and find the corresponding source information that describes how the RDA was determined. When new studies are published that challenge the RDA, you could then indicate the updates directly on that section. I think that this addition would be a great enhancement to your website.Report

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      • Thea

        Yes, a great idea!

        I’ll add my twist: I want a link at the top of the page, right next to “videos, blog, about, …” that takes us directly to Dr. Greger’s latest recommendations (which may or may not relate to RDA) – with links on where those recommendations come from. Right now, if we want a summary of Dr. Greger’s recommendations, we have to hunt for the blog post on it, and I don’t think that post gets updated at these new findings come out.Report

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  9. Thea

    Dr. Greger: I have been following your advice about vitamin B-12 by taking a weekly sublinguil (sp?) pill. While the vitamin B12 daily recommendations have changed, have the weekly recommendations also changed?Report

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  10. Elvin

    Dr Greger: Since then, for one reason or another (non-availibility of cyanocobalamin being one them), there are those that have no choice but to take methylcobalamin, would you be so good from now on as to include methylcobalamin dosage in your Optimum Nutrition Recommendations?Report

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  11. Yaron

    Thanks for the video!

    If I’m not mistaken Vitamin B12 was first discovered 60-90 years ago. One can say it is relatively recent. What if there are more vitamins that we are not yet aware of?

    Is it possible that there is another vitamin, call it Vitamin X, that we still haven’t discovered and vegans might need to supplement their diet with? How can we be certain that this is not the case and that we don’t actually harm ourselves somehow following a vegan diet?

    I’m a vegan and actually not worried about it at all. There were many vegans who reached old age. I am asking the question out of curiosity alone…Report

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  12. albert

    Dr. Greger can you please do some videos on homocysteine lowering. Seems like an important stuff yet couldn’t find much info here. I’d really like to know what your advice would be (yeah, “eat greens, avoid animal foods” ;)), but wouldn’t mind some details esp which food in particular was proven helpfulReport

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  14. Michael Lanfield

    I am confused Michael. In this video you said the excess B12 we pee out, but everywhere else I heard B12 stays in our bodies for a long time, like some 20 or 30 years. What is the verdict? Thanks! btw I love your work…Report

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  16. NotYetAVegan

    Twinlab brewers yeast has a single ingredient, debittered brewers yeast. Each single tablespoon has 33% of the daily value of B12 (2mcg) according to the package. The package claims that it is also naturally occurring. Would taking 3 to 4 tablespoons of this throughout the day satisfy the B12 needs of a vegan? Or is this B12 not useful, like the type that comes from algae?Report

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  17. Scott

    Dr. Fuhrman pointed out to me (via his forum) that the recommendation of 4 to 7 mcg / d of B-12 in the 2010 study is INTAKE, not ABSORBTION (my emphases).

    So, on what basis is Dr. Greger building a case for 4 to 7 mcg / d absorbtion?Report

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  18. lea

    I am new ( 5yrs ) to being a vegetarian and Is there any truth that the B12 shots are better as it goes straight to the blood stream rather than the tables because those are water soluble and we pee most of it out? This is what a cardiologist told my friend after coming in for heart palpitations and was very deficient in B12Report

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  19. Antonio Sal

    Hi Mr. Greger, thanks for your advices. I wonder if B12 excess is bad: the graphs shown in the video show that above 7 mcg the levels of MMA and homocysteine start to rise. Does the body know to “stop absorving” when it’s fed up of B12?Report

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  21. Sara

    Hi Dr Greger. Can you please advise us or make a video on when to start supplementing b12 in babies and children and how often to supplement per age and dose. Can you also please make a video on plant based diets for babies and children.Report

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      • Sara

        Thanks for the info. Once the babies don’t want breastmilk anymore, how do you supplement B12? I am still feeding my twins at 11 months old 3-4x daily and 1-2x during the night. I really hope Dr Greger makes a video on this topic as I want to know if what I am doing is correct.Report

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        • Joseph Gonzales R.D.

          We’ll see if he can do a video on this thank for the suggestion! In the meantime, check with your doctor about B12 supplements for babies. Note this is super duper important and I cannot say enough for B12 for those who follow a vegan diet. Children 1-3 yrs old need 0.9 micrograms of B12 per day, and kids 4-8 yrs old 1.2 micrograms per day. That is easy to obtain just assure they start supplementing post breastfeeding, and that you are good B12 stores and are supplementing as well :)Report

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  22. Brux

    I gotta say … I am looking for information about B12, what to take, how to take it, how much, and in what form … and it is frustrating to have to go through all these videos to find a little bit of information here, and then some more over here … why not just have a B12 video that you update with all the B12 information in it in one place! Please?????Report

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  23. OrielAd

    Hi !
    There is a mistake in the interpretation of this study : http://ajcn.nutrition.org/content/91/3/571.full
    The study shows that a daily intake of 4 to 7 mcg of vitamin B12 is optimal for an “omnivore”, not the absobtion of 4 to 7 mcg per day. 4 to 7 mcg / day is the intake, not the amount of the vitamin that is absorbed.
    Therefore, what amount of vitamin B12 is it necessary to take ? Are 10 mcg per day enough ?Report

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  24. Dominick LoBraico

    Hey Dr Greger: I’m a practicing Ob, and came across this link (below) regarding excess folate and B12 levels in women , and a possible link to higher incidence of autism. What intrigues me about the study (not as yet published), is that the only patients we supplement with b12 are those on a WFPBD, while, as you know, all women are supplemented with folic acid because most are on the SAD, and don’t get enough in their meals. I am very interested in seeing the study when it is publised- I think we may be seeing B12 really as a marker for a high animal protein /dairy based diet, and therefore, as a marker for animal protein, and it’s hormones, antibiotics, and other contaminants. Would love to hear your thoughts…thanks.

    http://www.medscape.com/viewarticle/863216?nlid=104597_2581&src=WNL_mdplsnews_160513_mscpedit_obgy&uac=18963ET&spon=16&impID=1095314&faf=1Report

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  27. naomitriana

    Hello! So I recently got my b 12 levels checked and they show that I am at 462 and the ‘healthy range’ of b 12 my doctor used is 193-986 pg/mL. The weird thing is that I don’t take any supplements and I got the test recently because I have been experiencing really low energy even though I am eating, sleeping and moving the same. Are my levels normal? Or are they low and could that be why I am experiencing low energy? My doctor won’t prescribe b 12 injections(and I am trying to find a place that will, because injections seem more direct than tablets). Also I have been vegan for 3 years now.Report

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    • Jim Felder

      The serum B-12 doesn’t test for how effect the B-12 you have is being used. If you can I would ask for a methylmalonic acid and homosystine level blood tests. B-12 is central to the breakdown of these two substances, and so high blood levels would indicate that from a functional perspective you are B-12 deficient. There is also a methylmalonic acid urine test that I would assume would be cheaper, but I don’t know the relative accuracy of it compared to the blood test.

      And of course, you could just start taking a 1000 mcg B-12 a day and just see what happens. You need at least 4 mcg of B-12 a day. Given that amounts over about 1.5 mcg per meal are only absobed at a rate of about 1% by indirect diffusion through the gut a 1000 mcg tablet would result in 11.5 mcg being absorbed or only about 2-3 times the recommend amount.

      Any extra B-12 is quickly and easily eliminated by the kidneys, so no worries about getting too much.Report

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  30. Bianka Takaoka

    I’m giving a talk next week refuting a paper that argues against veganism. My question regards one of the author’s empirical arguments against veganism. After citing the ADAs statement that well planned vegan and vegetarian diets are suitable for people of all ages, the author then cites another report by W.J. Craig that reports that “eliminating all animal products from the diet increases the risk of certain nutritional deficiencies. Micronutrients of special concern for the vegan include vitamin B12 and D, calcium, and long-chain n-3 (omega-3 fatty acids. Unless vegans regularly consume foods that are fortified with these nutrients, appropriate supplements should be consumed. In some cases, iron and zinc status of vegans may also be of concern because of the limited bioavalability of these materials.” The author (a philosopher) then notes that women are more susceptible to this kind of nutrient deficiency. Is this true? Are vegans, especially female vegans, at special risk of not getting these micronutrients? I was under the impression that vegans needed to get B12 and that all people, no matter their diet, need to make sure to get these micro nutrients.Report

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  31. Phil Jacques

    Once a week of 2500 cyanocobalamin is good enough. Methylcobalamin doesn’t stay in the system long and should be taken once a day but at lower dose. That’s what I heard from Dr. Greger on his live chat.Report

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  32. mk029

    I’m obviously coming into this discussion late, but I’m confused as to how much (and what source) vit B12 to give my 4 and 7 year old girls? They take a multivitamin (includes vit B12 5mcg) and vit D drops, hubby and I take a sublingual B12 twice a week @ 1000mcg. I’d appreciate some better direction. Thanks!Report

    Reply
    • joanlarryd@gmail.com

      As one of the moderators for NF.org, I’m glad you are aware of the need for Vit B12. One of our other moderators fashioned a good response to Vit B12 questions which I’ll post below with encouragement to review the mentioned NF videos.
      Best of health to your entire family! Joan-Nurse-Educator

      Joseph Gonzales R.D. NF Moderator Jeff and Karen Hay • a year ago
      Aloha Jeff and Karen! Thanks for reposting. B12 is super important. Adults needs roughly 2.4 micrograms per day. In supplement form it comes in higher doses. Taking in excess doesn’t appear to pose a threat, as there is no upper limit. Any brand should be fine and you can find cheap sources. Dr. Greger talks about exactly what B12 is in this video. You are right it’s a soil bacteria. Many people believe we can obtain some from dirt but there is no strong proof of this, if any. From dietitian Jack Norris’s post: “Vitamin B12 is a complicated vitamin with a unique absorption mechanism and a number of inactive analogues (molecules that appear to be active B12, but actually are not) that possibly interfere with its function. Vitamin B12 is generally found in all animal foods (except honey). Contrary to the many rumors, there are no reliable, unfortified plant sources of vitamin B12, including tempeh, seaweeds, and organic produce.”

      We have tons of videos on B12, including the safest source where it mentions how we actually do produce B12 it’s just too far downstream to be absorbed.

      Check out more of Dr. Greger’s Optimal Nutrition Recommendations. Let us know when you have more questions! So many folks here have solid answers and suggestions.

      Thanks,
      JosephReport

      Reply
  33. Arthur C

    Hello,
    I cite the study (http://www.ajcn.org/content/91/3/571.full.pdf+html) :
    “In conclusion, this study provides evidence that, for healthy adults between the ages of 18 and 50 y, a dietary vitamin B-12 intake of 4–7 lg/d is associated with normal vitamin B-12 status as judged from measurements of cobalamin, holo-transcobalamin, tHcy, and MMA.”
    “Conclusion: In persons with normal absorption, our data indicate that an intake of 4–7 lg vitamin B-12/d is associated with an ade- quate vitamin B-12 status, which suggests that the current RDA of 2.4 lg vitamin B-12/d might be inadequate for optimal bio- marker status even in a healthy population between 18 and 50 y of age.”

    Dr Greger, you seem to have mistakingly understood “absorption” instead of “intake”. The study does not back up your recommandation to take 250 µg daily, or maybe you could cite the passage of the study that goes in this direction ?Report

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    • Arthur C

      “a dietary vitamin B-12 intake of 4–7 lg/d is associated with normal vitamin B-12 status”
      Obviously, it was 4-7 µg/d. The pdf document’s copy didn’t work well.Report

      Reply

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