Health Benefits of B Vitamins

B vitamins help avoid hospitalizations related to Coronary Heart Disease (CHD)

Use of specific dietary supplements can have a positive effect on health care costs through avoided hospitalizations related to Coronary Heart Disease (CHD), according to a new article published in the Journal of Dietary Supplements(1). The article, "From Science to Finance—A Tool for Deriving Economic Implications from the Results of Dietary Supplement Clinical Studies," published by Christopher Shanahan and Robert de Lorimier, Ph.D., explores a potential cost-benefit analysis tool that, when applied to a high-risk population (U.S. adults over 55 with CHD) who take dietary supplements, specifically omega-3 fatty acid or B vitamin dietary supplements, can result in the reduction of the individuals' odds of experiencing a costly medical event.

Hospitalizations for all U.S. adults over the age of 55 with CHD cost the United States over $64 billion in 2012(2), and the amount spent on the treatment of CHD, rather than the prevention, is burdensome on both the societal and individual levels—and only expected to increase, according to the article. "One way to control the burden of CHD costs is to minimize the number of costly inpatient procedures," the authors said. "Many dietary supplement products are available in the market today that have been shown to have positive effects on heart health through associated clinical studies...Thus, the potential decrease of total health care expenditures in the United States is a strong argument for the daily use of dietary supplements."

According to the authors' analysis of all U.S. adults over the age of 55 diagnosed with CHD:

If every high-risk person in the target population were to take B vitamins at preventive intake levels daily, there would be an average of $1.5 billion in avoided expenditures per year and a cumulative of $12.1 billion in avoided expenditures between 2013 – 2020

"This is a relatively low-technology, yet smart, approach that can be used by consumers, physicians, employers, and policymakers as a means to reduce personal and societal health care costs," the authors concluded.

Vitamin B3 Reduces Risk for Further Skin Cancer

An inexpensive vitamin B₃ product, widely available over the counter, has been shown to reduce significantly the risk of developing further skin cancers in patients who have already been diagnosed with nonmelanoma skin cancer. The product is nicotinamide, taken orally 500 mg twice daily.

Nonmelanoma skin cancer is the most common cancer worldwide, she said. In Australia, it is four times more common than any other cancer, and it affects more than half the population during their lifetime.

The finding, from the Australian ONTRAC (Oral Nicotinamide to Reduce Actinic Cancer) study, was presented during a press briefing held in advance of the American Society of Clinical Oncology (ASCO) 2015 Annual Meeting.

The results released today show that patients who took nicotinamide 500 mg twice daily for 1 year showed a 23% reduction in new diagnoses of nonmelanoma skin cancer, compared with those who took placebo (P = .02). Specifically, new diagnoses of basal cell carcinoma were reduced by 20%, squamous cell carcinoma by 30%, and actinic keratoses by 13%.

ASCO President Peter Yu, MD, director of cancer research at the Palo Alto Medical Foundation, described this research as a "major advance" in prevention.

In the United States, about 5 million people each year are diagnosed with nonmelanoma skin cancer.

Low vitamin B12 levels increase the risk of fractures in older men

Older men who have low levels of vitamin B12 have a higher risk of having fractures. These are the findings of researchers at the Sahlgrenska Academy as a part of an international study of a total of 1000 older men.

Osteoporosis is one of the world's most widespread diseases, and intensive research is under way worldwide to identify its causes and to be able to prevent fractures.

In an extensive study, researchers at the Sahlgrenska Academy at the University of Gothenburg can now show that low levels of vitamin B12 in the blood increases the risk of fractures in older men.

International research project

This study is a part of an international research project initiated by the National Institutes of Health (NIH) in the US and comprises 11,000 men in total. In their part of the study, the Gothenburg researchers studied 1,000 Swedish men, MrOS Sweden, with an average age of 75, and used various methods to analyze the blood concentrations of the B vitamins B12 and folate, which are found in our food naturally.

Higher fracture risk

The results show that the risk of suffering a fracture six years later was higher among men who had low B12 levels at the beginning of the study than men with normal B12 levels. In the quartile with the lowest B12 content, the risk was elevated by approximately 70 percent compared with the others. The risk increase pertained primarily to fractures in the lumbar region, where the risk increase was up to 120 percent.

"The higher risk also remains when we take other risk factors for fractures into consideration, such as age, smoking, BMI, BMD (bone mineral density), previous fractures, physical activity, the D-vitamin content in the blood and calcium intake," says Catharina Lewerin, researcher at the Sahlgrenska Academy.

Does this mean that older men can prevent fractures by eating more vitamin B12?

"It has not been scientifically established, but such studies are under way, including one large Dutch study where older individuals over the age of 65 are treated with both vitamin B12, folic acid and vitamin D to investigate the occurrence of fractures.

"Right now, there is no reason to eat more vitamin B12, but rather treatment shall only be applied in confirmed cases of deficiencies and in some cases to prevent deficiencies. For anyone who wants to strengthen their bones and prevent fractures, physical activity 30 minutes a day and quitting smoking is good self care," says Catharina Lewerin.

New method

In this study, the researchers used a relatively new method called holotranscobalamin, which measures the amount of vitamin that is taken up in the cells, which is considered to be a more sensitive test for B12 deficiency.

The article was published online December 2013 in Osteoporosis International.

Acid-Reflux Drugs Tied to Lower Levels of Vitamin B-12

People who take certain acid-reflux medications might have an increased risk of vitamin B-12 deficiency, according to new research.

Taking proton pump inhibitors (PPIs) to ease the symptoms of excess stomach acid for more than two years was linked to a 65 percent increase in the risk of vitamin B-12 deficiency. Commonly used PPI brands include Prilosec, Nexium and Prevacid.

Researchers also found that using acid-suppressing drugs called histamine-2 receptor antagonists -- also known as H2 blockers -- for two years was associated with a 25 percent increase in the risk of B-12 deficiency. Common brands include Tagamet, Pepcid and Zantac.

"This study raises the question of whether or not people who are on long-term acid suppression need to be tested for vitamin B-12 deficiency," said study author Dr. Douglas Corley, a research scientist and gastroenterologist at Kaiser Permanente's division of research in Oakland, Calif.

Corley said, however, that these findings should be confirmed by another study. "It's hard to make a general clinical recommendation based on one study, even if it is a large study," he said.

Vitamin B-12 is an important nutrient that helps keep blood and nerve cells healthy, according to the U.S. Office of Dietary Supplements (ODS). It can be found naturally in meat, fish, poultry, eggs, milk and other dairy products. According to the ODS, between 1.5 percent and 15 percent of Americans are deficient in B-12.

Although most people get enough B-12 from their diet, some have trouble absorbing the vitamin efficiently. A deficiency of B-12 can cause tiredness, weakness, constipation and a loss of appetite. A more serious deficiency can cause balance problems, memory difficulties and nerve problems, such as numbness and tingling in the hands or feet.

Stomach acid is helpful in the absorption of B-12, Corley said, so it makes sense that taking medications that reduce the amount of stomach acid would decrease vitamin B-12 absorption.

More than 150 million prescriptions were written for PPIs in 2012, according to background information included in the study. Both types of medications also are available in lower doses over the counter.

Corley and his colleagues reviewed data on nearly 26,000 people who had been diagnosed with a vitamin B-12 deficiency and compared them to almost 185,000 people who didn't have a deficiency.

While 12 percent of people with a vitamin B-12 deficiency had taken PPIs for more than two years, 7.2 percent of those without a deficiency had taken the medications long-term.

Of those with a deficiency, 4.2 percent took an H2 blocker for two years or longer, while 3.2 percent of those without a deficiency took the drugs for two years or more.

The risk of developing a vitamin B-12 deficiency was 65 percent higher for the long-term PPI users and 25 percent higher for those taking H2 blockers, according to the study.

People who took higher doses were more likely to develop a vitamin B-12 deficiency. People who took an average of 1.5 PPI pills per day had almost double the risk of developing a deficiency compared to those who averaged 0.75 pills per day, the study found.

Women had a greater risk of deficiency than men, and people younger than 30 taking these medications had a greater risk of developing a deficiency than older people, according to the study.

The risk of vitamin B-12 deficiency decreases when you stop taking the medications, but doesn't disappear completely, Corley said.

The study's findings were published in the Dec. 11, 2013 issue of the Journal of the American Medical Association. Although the study found an association between taking acid-reflux drugs long-term and having a higher risk of a B-12 deficiency, it didn't establish a cause-and-effect relationship.

If you're taking acid-suppressing medications, Corley said, "our study doesn't recommend stopping those medications, but you should take them at the lowest effective dose." And people shouldn't start taking vitamin B-12 supplements on their own, but should discuss it with their doctor, he said.

One expert had concerns about how frequently acid-suppressing drugs are used.

"This study found an adverse effect associated with taking these drugs," said Victoria Richards, an associate professor of medical sciences at the Frank H. Netter M.D. School of Medicine at Quinnipiac University, in Hamden, Conn. "It's also concerning that these drugs are used at such a high rate. Why do so many people have the need to suppress acid so much?"

The bottom line, Richards said, is that if you are having any symptoms of vitamin B-12 deficiency and you've been taking these medications, talk to your doctor about whether you should be tested for a deficiency. Tell your doctor if you've been taking over-the-counter acid-suppressing medications, so your doctor can properly evaluate your risk.

Low Vitamin B12 Levels May Lead to Brain Shrinkage, Cognitive Problems

Older people with low levels of vitamin B12 in their blood may be more likely to lose brain cells and develop problems with their thinking skills, according to a study published in the September 27, 2011, print issue of Neurology®, the medical journal of the American Academy of Neurology. Foods that come from animals, including fish, meat, especially liver, milk, eggs and poultry, are usually sources of vitamin B12.

The study involved 121 people age 65 and older living on the south side of Chicago. Their blood was drawn to measure levels of vitamin B12 and B12-related metabolites that can indicate a B12 deficiency. The participants also took tests measuring their memory and other cognitive skills. An average of four-and-a-half years later, MRI scans of the participants’ brains were taken to measure total brain volume and look for other signs of brain damage.

Having high levels of four of five markers for vitamin B12 deficiency was associated with having lower scores on the cognitive tests and smaller total brain volume.

“Our findings definitely deserve further examination,” said study author Christine C. Tangney, PhD, of Rush University Medical Center in Chicago. “It’s too early to say whether increasing vitamin B12 levels in older people through diet or supplements could prevent these problems, but it is an interesting question to explore. Findings from a British trial with B vitamin supplementation are also supportive of these outcomes.”

On the cognitive tests, the scores ranged from -2.18 to 1.42, with an average of 0.23. For each increase of one micromole per liter of homocysteine—one of the markers of B12—the cognitive scores decreased by 0.03 standardized units or points.

Study: Vitamin B May Not Reduce Risk of Memory Loss

vitamin B12 and folic acid supplements may not reduce the risk of memory and thinking problems after all, according to a new study published in the November 12, 2014, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study is one of the largest to date to test long-term use of supplements and thinking and memory skills.

The study involved people with high blood levels of homocysteine, an amino acid. High levels of homocysteine have been linked to memory loss and Alzheimer’s disease.

“Since homocysteine levels can be lowered with folic acid and vitamin B12 supplements, the hope has been that taking these vitamins could also reduce the risk of memory loss and Alzheimer’s disease,” said study author Rosalie Dhonukshe-Rutten, PhD, of Wageningen University in Wageningen, the Netherlands.

Early observational studies showed there may be some benefit to thinking and memory skills in taking folic acid and vitamin B12, but the results of later randomized, controlled trials were less convincing.

For the current study, 2,919 people with an average age of 74 took either a tablet with 400 μg of folic acid and 500 μg of vitamin B12 or a placebo every day for two years. Tests of memory and thinking skills were performed at the beginning and end of the study. All of the participants had high blood levels of homocysteine.

“While the homocysteine levels decreased by more in the group taking the B vitamins than in the group taking the placebo, unfortunately there was no difference between the two groups in the scores on the thinking and memory tests,” said Dhonukshe-Rutten.

Higher levels of vitamin B6, common amino acid associated with lower risk of lung cancer

An analysis that included nearly 400,000 participants finds that those with higher blood levels of vitamin B6 and the essential amino acid methionine (found in most protein) had an associated lower risk of lung cancer, including participants who were current or former smokers, according to a study in the June 16, 2010 issue of JAMA.

Previous research has suggested that deficiencies in B vitamins may increase the probability of DNA damage and subse quent gene mutations. "Given their involvement in maintaining DNA integrity and gene ex pression, these nutrients have a potentially important role in inhibiting cancer devel opment, and offer the possibility of modi fying cancer risk through dietary changes," the authors write. They add that deficiencies in nutrient levels of B vitamins have been shown to be high in many western populations.

Paul Brennan, Ph.D., of the International Agency for Re search on Cancer, Lyon, France, and colleagues conducted an investigation of B vitamins and me thionine status based on serum samples from the European Prospective Inves tigation into Cancer and Nutrition (EPIC) cohort study, which recruited 519,978 participants from 10 European countries between 1992 and 2000, of whom 385,747 donated blood. By 2006, 899 lung cancer cases were identified and 1,770 control participants were individually matched by country, sex, date of birth, and date of blood collection.

After an analysis of the incidence rate of lung can cer within the entire EPIC cohort and adjusting for various factors, the researchers found a lower risk for lung cancer among participants with increasing levels of B6 (comparing the fourth vs. first quartile of B6 levels). A lower risk was also seen for increasing methionine levels. "Similar and consistent decreases in risk were observed in never, former, and current smokers, indicating that results were not due to confounding [factors that can influence outcomes] by smoking. The magnitude of risk was also constant with increasing length of follow-up, indicating that the associations were not explained by preclinical disease," the researchers write.

When participants were classified by median (midpoint) levels of serum methionine and B6, having above-median levels of both was associated with a lower lung cancer risk overall. A mod erate lower risk was observed for increasing serum folate levels, although this association was restricted to former and current smokers, and was not apparent in never smokers.

"Our results suggest that above-median se rum measures of both B6 and methionine, assessed on average 5 years prior to disease onset, are associated with a reduction of at least 50 percent on the risk of developing lung cancer. An additional association for se rum levels of folate was present, that when combined with B6 and methionine, was associated with a two-thirds lower risk of lung cancer," the authors write.

The researchers add that if their observations regarding serum methionine, B6, or both are shown to be causal, identifying optimum levels for reducing future cancer risk would appear to be appropriate.

"Lung cancer remains the most com mon cause of cancer death in the world today and is likely to remain so for the near future. It is essential that for lung cancer prevention, any additional evidence about causality does not detract from the importance of reducing the numbers of individuals who smoke tobacco. With this in mind, it is important to recognize that a large proportion of lung cancer cases occur among former smokers, making up the majority in countries where tobacco campaigns have been particularly successful, and a non-trivial number of lung cancer cases oc cur also among never smokers, particu larly among women in parts of Asia. Clarifying the role of B vitamins and re ated metabolites in lung cancer risk is likely therefore to be particularly relevant for former smokers and never smokers," the authors conclude.

Diet high in B-vitamins lowers heart risks

Eating more foods containing the B-vitamins folate and B-6 lowers the risk of death from stroke and heart disease for women and may reduce the risk of heart failure in men, according to Japanese research reported in Stroke: Journal of the American Heart Association.

“Japanese people need more dietary intake of folate and vitamin B-6, which may lead to the prevention of heart disease,” said Hiroyasu Iso, M.D., professor of public health at Osaka University.

The findings on the value of B vitamins were consistent with studies in Europe and North America, although the dietary consumption of vitamin B-6 is generally lower in Japan than in the United States.

Researchers analyzed data from 23,119 men and 35,611 women (ages 40–79) who completed food frequency questionnaires as part of the large Japan Collaborative Cohort (JACC) Study. During a median 14 years of follow-up, 986 died from stroke, 424 from heart disease and 2,087 from all diseases related to the cardiovascular system.

Investigators divided participants into five groups based on their intake of folate, vitamin B-6 and vitamin B-12. Comparing those with the diets lowest and highest for each nutrient, they found that higher consumption of folate and vitamin B-6 was associated with significantly fewer deaths from heart failure in men, and significantly fewer deaths from stroke, heart disease and total cardiovascular diseases in women. Vitamin B-12 intake was not associated with reduced mortality risk.

The protective effects of folate and vitamin B-6 didn’t change when researchers adjusted for the presence of cardiovascular risk factors, nor when they eliminated supplement users from the analysis.

Folate and vitamin B-6 may help guard against cardiovascular disease by lowering homocysteine levels, the investigators said. Homocysteine is an amino acid in the blood that’s affected by diet and heredity. Folic acid and other B vitamins help break down homocysteine in the body.

A direct causal link hasn’t been established, but evidence has shown that too much homocysteine may damage the inner lining of arteries and promote the formation of blood clots.

Sources of folate include vegetables and fruits, whole or enriched grains, fortified cereals, beans and legumes. Sources of vitamin B-6 include vegetables, fish, liver, meats, whole grains and fortified cereals.

Folic Acid, B6, B12 Helps Prevent Stroke

As reported in the New England Journal of Medicine in 2006, the Heart Outcomes Prevention Evaluation (HOPE) 2 trial, which included 5,522 patients older than 54 years with vascular disease or diabetes, found that daily treatment with 2.5 mg folic acid, 50 mg vitamin B6, and 1 mg vitamin B12 for an average of 5 years reduced homocysteine levels and the risk of stroke.