Skip to main content
SpringerLink
Log in

Why Food Fortification with Vitamin B12 Is Needed?

  • Chapter
  • First Online:
Handbook of Food Fortification and Health

Part of the book series: Nutrition and Health ((NH))

Abstract

There are many articles indicating the increasing prevalence of low vitamin B12 (also called cobalamin) status in different segments of the general population [1–7]. The early detection of vitamin B12 deficiency is essential in order to prescribe opportune treatments, and there is evidence that such deficiencies are more common than would be expected. Vitamin B12 deficiency frequently occurs in individuals with dietary patterns that exclude animal food products and patients who are unable to absorb vitamin B12. Vitamin B12 deficiency has many causes, and pernicious anemia has been described as a widespread cause of this. Recent studies on vitamin B12, including the description of novel etiologies of vitamin B12 deficiency, have added to our understanding of this essential dietary component. For example, vitamin B12 deficiency can arise not only from insufficient dietary intake [8] but also from food-cobalamin malabsorption syndrome [9]. The latter is characterized by the failure to release vitamin B12 from food or a deficiency of intestinal vitamin B12 transport proteins or both, due to chronic overgrowth of Helicobacter pylori [10] and intestinal microbial proliferation. Changes in gut flora can arise from antibiotic treatment, long-term ingestion of biguanides (metformin) [11, 12], and antacids, including H2-receptor antagonists and proton-pump inhibitors [13] (mainly among patients with Zollinger–Ellison syndrome [14]). There are also genetic vitamin B12 metabolism diseases as Imerslund–Grasbeck syndrome which is a selective vitamin B12 malabsorption with proteinuria [15]. Chronic alcoholism, surgery (e.g., bypass surgery for obesity), and partial pancreatic exocrine failure can also contribute to vitamin B12 deficiency. Overall, this demonstrates that new approaches to the identification and treatment of subjects with vitamin B12 deficiency may be needed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

MRI:

Magnetic resonance imaging

RAS:

Recurrent aphthous stomatitis

References

  1. Masalha R, Rudoy I, Volkov I, Yusuf N, Wirguin I, Herishana Y. Symptomatic dietary vitamin B12 deficiency in a nonvegetarian population. Am J Med. 2002;112:413–6.

    Article  PubMed  Google Scholar 

  2. Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299–326.

    Article  PubMed  CAS  Google Scholar 

  3. Savage D, Gangaidzo I, Lindenbaum J, Kiire C, Mukiibi JM, Moyo A, et al. Vitamin B12 deficiency is the primary cause of megaloblastic anaemia in Zimbabwe. Br J Haematol. 1994;86(4):844–50.

    Article  PubMed  CAS  Google Scholar 

  4. Allen LH. Folate and vitamin B12 status in the Americas. Nutr Rev. 2004;62(6 Pt 2):S29–33.

    Article  PubMed  Google Scholar 

  5. Fora MA, Mohammad MA. High frequency of suboptimal serum vitamin B12 level in adults in Jordan. Saudi Med J. 2005;26(10):1591–5.

    PubMed  Google Scholar 

  6. Dagnelie PC. Nutrition and health-potential health benefits and risks of vegetarianism and limited consumption of meat in the Netherlands. Ned Tijdschr Geneeskd. 2003;147(27):1308–13.

    PubMed  CAS  Google Scholar 

  7. Volkov I, Rudoy I, Machagna M, Glezer I, Ganel U, Orenshtein A, et al. Modern society and prospects of low vitamin B12 intake. Ann Nutr Metab. 2007;51:468–70.

    Article  PubMed  CAS  Google Scholar 

  8. Narayanan MN, Dawson DW, Lewis MJ. Dietary deficiency of vitamin B12 is associated with low serum cobalamin levels in non-vegetarians. Eur J Haematol. 1991;47(2):115–8.

    Article  PubMed  CAS  Google Scholar 

  9. Andres E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ. 2004;171(3):251–9. Review.

    PubMed  Google Scholar 

  10. Kaptan K, Beyan C, Ural AU, Cetin T, Avcu F, Gulsen M, et al. Helicobacter pylori—is it a novel causative agent in vitamin B12 deficiency? Arch Intern Med. 2000;160:1349–53.

    Article  PubMed  CAS  Google Scholar 

  11. Bauman WA, Shaw S, Javatilleke E, Spungen AM, Herbert V. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care. 2000;23:1227–31.

    Article  PubMed  CAS  Google Scholar 

  12. Andrès E, Noel E, Goichot B. Metformin-associated vitamin B12 deficiency. Arch Intern Med. 2002;162:2251–2.

    Article  PubMed  Google Scholar 

  13. Howden CW. Vitamin B12 levels during prolonged treatment with proton pump inhibitors. J Clin Gastroenterol. 2000;30:29–33.

    Article  PubMed  CAS  Google Scholar 

  14. Termanini B, Gibril F, Sutliff VE, Yu F, Venzon DJ, Jensen RT. Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with Zollinger–Ellison syndrome. Am J Med. 1998;104:422–30.

    Article  PubMed  CAS  Google Scholar 

  15. Grasbeck R. Imerslund-Grasbeck syndrome (selective vitamin B12 malabsorption with proteinuria). Orphanet J Rare Dis. 2006;1:17.

    Article  PubMed  Google Scholar 

  16. Smolka V, Bekarek V, Hlidkova E, et al. Metabolic complications and neurologic manifestations of vitamin B12 deficiency in children of vegetarian mothers. Cas Lek Cesk. 2001;140(23):732–5.

    PubMed  CAS  Google Scholar 

  17. Muthayya S, Dwarkanath P, Mhaskar M, Mhaskar R, Thomas A, Duggan C, et al. The relationship of neonatal serum vitamin B12 status with birth weight. Asia Pac J Clin Nutr. 2006;15(4):538–43.

    PubMed  CAS  Google Scholar 

  18. Brasseur D. Excessive dietetic restrictions in children. Rev Med Brux. 2000;21(4):A367–70.

    PubMed  CAS  Google Scholar 

  19. Healton EB, Savage DG, Brust JC, Carett TJ, Lindenbaum J. Neurologic aspects of cobalamin deficiency. Medicine (Baltimore). 1991;70(4):229–45.

    PubMed  CAS  Google Scholar 

  20. Miller A, Korem M, Almog R, Galboiz Y. Vitamin B12, demyelination, remyelination and repair in multiple sclerosis. J Neurol Sci. 2005;233(1–2):93–7. Review.

    Article  PubMed  CAS  Google Scholar 

  21. Wolters M, Strohle A, Hahn A. Cobalamin: a critical vitamin in the elderly. Prev Med. 2004;39:1256–66.

    Article  PubMed  CAS  Google Scholar 

  22. Masalha R, Chudakov B, Muhamad M, Rudoy I, Volkov I, Wirguin I. Cobalamin-responsive psychosis as the sole manifestation of vitamin B12 deficiency. Isr Med Assoc J. 2001;3:701–3.

    PubMed  CAS  Google Scholar 

  23. Sachdev PS. Homocysteine and brain atrophy. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29(7):1152–61. Review.

    Article  PubMed  CAS  Google Scholar 

  24. Corder EH, Beaumont H. Susceptibility groups for Alzheimer’s disease (OPTIMA cohort): integration of gene variants and biochemical factors. Mech Ageing Dev. 2006;128(1):76–82.

    Article  PubMed  Google Scholar 

  25. Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol. 2006;5(11):949–60. Review.

    Article  PubMed  CAS  Google Scholar 

  26. Homocysteine Studies Collaboration. Homocysteine and risk of ischemic heart disease and stroke. JAMA. 2002;288:2015–22.

    Article  Google Scholar 

  27. Del Ser T, Barba R, Herranz AS, Seijas V, López-Manglano C, Domingo J, et al. Hyperhomocyst(e)inemia is a risk factor of secondary vascular events in stroke patients. Cerebrovasc Dis. 2001;12:91–8.

    Article  PubMed  Google Scholar 

  28. Boysen G, Brander T, Christensen H, Gideon R, Truelsen T. Homocysteine and risk of recurrent stroke. Stroke. 2003;34(5):1258–61.

    Article  PubMed  CAS  Google Scholar 

  29. Stanger O, Herrmann W, Pietrzik K, Fowler B, Geisel J, Dierkes J, et al. DACH-LIGA homocystein (German, Austrian and Swiss Homocysteine Society): consensus paper on the rational clinical use of homocysteine, folic acid and B-vitamins in cardiovascular and thrombotic diseases: guidelines and recommendations. Clin Chem Lab Med. 2003;41:1392–403.

    PubMed  CAS  Google Scholar 

  30. Lonn E, Yusuf S, Arnold MJ, Sheridan P, Pogue J, Micks M, et al. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med. 2006;355(7):746. Erratum in: N Engl J Med. 2006;355(7):746.

    Article  Google Scholar 

  31. Bonaa KH, Njolstad I, Ueland PM, Schirmer H, Tverdal A, Steigen T, et al. Homocysteine lowering and cardiovascular events after acute myocardial infarction. N Engl J Med. 2006;354(15):1578–88.

    Article  PubMed  CAS  Google Scholar 

  32. Bazzano LA, Reynolds K, Holder KN, He J. Effect of folic acid supplementation on risk of cardiovascular diseases: a meta-analysis of randomized controlled trials. JAMA. 2006;296(22):2720–6.

    Article  PubMed  CAS  Google Scholar 

  33. Kira J, Tobimatsu S, Goto I. Vitamin B12 metabolism and massive-dose methyl vitamin B12 therapy in Japanese patients with multiple sclerosis. Intern Med. 1994;33(2):82–6.

    Article  PubMed  CAS  Google Scholar 

  34. Wheatley C. A scarlet pimpernel for the resolution of inflammation? The role of supra-therapeutic doses of cobalamin, in the treatment of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic or traumatic shock. Med Hypotheses. 2006;67(1):124–42.

    Article  PubMed  CAS  Google Scholar 

  35. Broderick KE, Feala J, McCulloch A, Paternostro G, Sharma VS, Pilz RB, et al. The nitric oxide scavenger cobinamide profoundly improves survival in Drosophila melanogaster model of bacterial sepsis. FASEB J. 2006;20(11):1865–73.

    Article  PubMed  CAS  Google Scholar 

  36. Diamond AL. Vitamin B12-associated neurological diseases. Review, eMedicine Website. Last updated Nov.2004.

    Google Scholar 

  37. Solomon LR. Cobalamin-responsive disorders in the ambulatory care setting: unreliability of cobalamin, methylmalonic acid, and homocysteine testing. Blood. 2005;105:978–85.

    Article  PubMed  CAS  Google Scholar 

  38. Hash RB, Sargent MA, Katner H. Anemia secondary to combined deficiencies of iron and cobalamin. Arch Fam Med. 1996;5:585–8.

    Article  PubMed  CAS  Google Scholar 

  39. Carmel R. Prevalence of undiagnosed pernicious anemia in the elderly. Arch Intern Med. 1996;156:1097–100.

    Article  PubMed  CAS  Google Scholar 

  40. Herrmann W, Obeid R, Schorr H, Geisel J. Functional vitamin B12 deficiency and determination of holotranscobalamin in populations at risk. Clin Chem Lab Med. 2003;41(11):1478–88.

    PubMed  CAS  Google Scholar 

  41. Volkov I, Rudoy I, Freud T, Sardal G, Naimer S, Peleg R, et al. Effectiveness of vitamin B12 in treating recurrent aphthous stomatitis: a randomized double blind placebo controlled trial. J Am Board Fam Med. 2009;22:9–16.

    Article  PubMed  Google Scholar 

  42. Kumamoto Y, Maruta H, Ishigami J, Kamidono S, Orikasa S, Kimura M, et al. Clinical efficacy of mecobalamin in the treatment of oligozoospermia—results of double-blind comparative clinical study. Hinyokika Kiyo. 1988;34(6):1109–32.

    PubMed  CAS  Google Scholar 

  43. Bennett M. Vitamin B12 deficiency, infertility and recurrent fetal loss. J Reprod Med. 2001;46(3):209–12.

    PubMed  CAS  Google Scholar 

  44. Chatterjee S, Chowdhury RG, Khan B. Medical management of male infertility. J Indian Med Assoc. 2006;104(2):74, 76–7.

    Google Scholar 

  45. Reznikoff-Etievant MF, Zittoun J, Vaylet C, Pernet P, Milliez J. Low vitamin B(12) level as a risk factor for very early recurrent abortion. Eur J Obstet Gynecol Reprod Biol. 2002;104(2):156–9.

    Article  PubMed  CAS  Google Scholar 

  46. Herrmann M, Widmann T, Herrmann W. Homocysteine—a newly recognised risk factor for osteoporosis. Clin Chem Lab Med. 2005;43(10):1111–7. Review.

    PubMed  CAS  Google Scholar 

  47. Bloom DE. 7 Billion and counting. Science. 2011;333:560–2.

    Article  Google Scholar 

  48. Sipponen P, Laxén F, Huotari K, Härkönen M. Prevalence of low vitamin B12 and high homocysteine in serum in an elderly male population: association with atrophic gastritis and Helicobacter pylori infection. Scand J Gastroenterol. 2003;38(12):1209–16.

    Article  PubMed  CAS  Google Scholar 

  49. Andersen CB, Madsen M, Storm T, Moestrup SK, Andersen GR. Structural basis for receptor recognition of vitamin-B(12)-intrinsic factor complexes. Nature. 2010;464(7287):445–8.

    Article  PubMed  Google Scholar 

  50. Wang YH, Yan F, Zhang WB, Ye G, Zheng YY, Zhang XH, et al. An investigation of vitamin B12 deficiency in elderly inpatients in neurology department. Neurosci Bull. 2009;25(4):209–15.

    Article  PubMed  CAS  Google Scholar 

  51. Bozoglu E, Isik AT, Doruk H, Kilic S. The effects of early vitamin B12 replacement therapy on the cognitive and functional status of elderly subjects. Bull Clin Psychopharmacol. 2010;20:120–4.

    CAS  Google Scholar 

  52. Watanabe F. Vitamin B12 sources and bioavailability. Exp Biol Med (Maywood). 2007;232(10):1266–74.

    Article  CAS  Google Scholar 

  53. Dangour AD, Allen E, Clarke R, Elbourne D, Fasey N, Fletcher AE, et al. A randomised controlled trial investigating the effect of vitamin B12 supplementation on neurological function in healthy older people: the Older People and Enhanced Neurological function (OPEN) study protocol [ISRCTN54195799]. Nutr J. 2011;10:22.

    Article  PubMed  CAS  Google Scholar 

  54. Lin YT, Lin MH, Lai HY, Chen LK, Hwang SJ, Lan CF. Regular vitamin B12 supplementation among older Chinese men in a veterans care home in Taiwan. Arch Gerontol Geriatr. 2009;49(1):186–9.

    Article  PubMed  CAS  Google Scholar 

  55. Selhub J, Paul L. Folic acid fortification: why not vitamin B12 also? Biofactors. 2011;37(4):269–71. doi:10.1002/biof.173.

    Article  PubMed  CAS  Google Scholar 

  56. Recommended Dietary Allowances: 10th edn. Nap.edu. http://www.nap.edu/openbook.php?record_id=1349&page=253. Retrieved 30 March 2011.

  57. Bor MV, Lydeking-Olsen E, Moller J, Nexo E. A daily intake of approximately 6 micrograms of vitamin B-12 appears to saturate all the vitamin B-12-related variables in Danish postmenopausal women. Am J Clin Nutr. 2006;83:52–8.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Ben-Gurion University of the Negev Beer-Sheva, Hogla Street, 6, Lehavim, 85338, Israel

    Ilia Volkov MD

  2. Department of Nutrition and Dietetics, Diabetes and Nutritional Sciences, School of Medicine, King’s College London, Franklin Wilkins Buildings, 150 Stamford Street, London, SE1 9NU, UK

    Victor R. Preedy PhD

Authors
  1. Ilia Volkov MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Victor R. Preedy PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Victor R. Preedy PhD .

Editor information

Editors and Affiliations

  1. Diabetes and Nutritional Sciences, School of Medicine, King's College London, 150 Stamford Street, London, SE1 9NH, United Kingdom

    Victor R. Preedy

  2. University Hospital Lewisham, Department of Gastroenterology, Department of Gastroenterology, Kings College Hospital, London, SM68SU, United Kingdom

    Rajaventhan Srirajaskanthan

  3. Department of Biomedical Sciences, School of Life Sciences, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, United Kingdom

    Vinood B. Patel

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Volkov, I., Preedy, V.R. (2013). Why Food Fortification with Vitamin B12 Is Needed?. In: Preedy, V., Srirajaskanthan, R., Patel, V. (eds) Handbook of Food Fortification and Health. Nutrition and Health. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4614-7110-3_19

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-7110-3_19

  • Published:

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4614-7109-7

  • Online ISBN: 978-1-4614-7110-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation