Vitamin B12 News

January 26, 2011 Written by JP       [Font too small?]

In years past, nutritionally oriented physicians would often administer Vitamin B12 injections to patients with fatigue of unknown origin. There were spoken and unspoken justifications for doing so. The official use of intramuscular B12 was to address an underlying deficiency which could manifest itself as a number of symptoms associated with poor vitality: cognitive impairment, lack of energy, mood changes and sensory disturbances. The unofficial reason for providing B12 during office visits is that it serves as an excellent placebo. For one thing, it’s a rather dramatic procedure. Having a bright red liquid pumped into your bloodstream by a doctor or nurse gets your attention! In addition, it’s well established that B12 is relatively non-toxic even when given in therapeutic dosages. (1,2,3,4,5)

It’s sometimes surprising to note how many symptoms present themselves without a definitive diagnosis. Chronic coughing is but one example of a troublesome symptom that doesn’t necessarily indicate a serious health threat. According to a recent review in the British Journal of Pharmacology “despite the clinical significance of cough, research efforts aimed at improving diagnostic capabilities and developing more effective therapeutic agents have been, to date, disappointing in their limited scope and outcomes”. However, a new discovery may revolutionize the way some cases of unexplained chronic cough are managed. The January 2011 issue of the American Journal of Clinical Nutrition evaluated the possible role of Vitamin B12 deficiency in adults with chronic cough. The basis for doing so is that a lack of B12 can cause automonic nervous system dysfunction, central and peripheral nervous system damage and sensory neuropathy – which may exhibit itself in recurrent coughing. An examination of 42 patients revealed that B12 deficiency or Cbl-D likely contributed to their cough via a form of sensory neuropathy referred to as laryngeal hyperresponsiveness. The conclusion of the researchers involved states that, “Cbl-D should be considered among factors that sustain chronic cough, particularly when cough triggers cannot be identified”. (6,7,8)

There are more antidepressant medications on the market than ever before. An enormous amount of money and time has been devoted to developing more effective and safer drugs that promote a healthier mood. But the fact remains that some patients simply don’t respond to even the best and brightest pharmaceuticals that physicians have to offer. However, ensuring optimal Vitamin B12 levels may help improve the odds of success – especially in cases where a deficiency is established or suspected. A small smattering of older and recent papers in the scientific literature suggest this connection. Here are a few quotes that summarize the conclusions of psychiatrists throughout the world:

  • “Subjects with depression who do not respond to conventional antidepressants should be evaluated for nutritional factors” (9)
  • “Vitamin B12 level and the probability of recovery from major depression may be positively associated” (10)
  • “These findings offer preliminary support for further investigation of B complex vitamin augmentation in the treatment of geriatric depression” (11)

The Anti-Diabetic Medication, Metformin, Lowers Plasma Vitamin B12

Source: BMJ 2010; 340:c2181 (link)

One of the studies referenced above is based on case studies involving vegetarians – a group that is more likely to exhibit B12 deficiencies. However, other populations are also vulnerable to B12 inadequacies and all that accompanies them. Various medications, including those used to manage diabetes, epilepsy and GERD or heartburn can predispose one to sub-par B12 concentrations. Appropriate blood tests (B12, complete blood count, homocysteine and methylonic acid) can help establish overt and subclinical cases of Cbl-D. (12,13,14,15,16)

The downsides of going to your doctor to receive a B12 booster is the cost, inconvenience and the prick of the needle. But fortunately, there’s some good news to report on the B12 front. The most current research indicates that using oral forms of this essential nutrient is probably sufficient to address most deficiencies. This is especially true if B12 supplements are used consistently and over the long term. The most common dosage used to address Cbl-D and diseases related to a lack of B12, such as pernicious anemia, is 1,000 mcg daily. However, dosages as low as 10 mcg/day may provide enough B12 to impact health markers such as elevated homocysteine. This an amount that is often found in mass-market brand multivitamins. Given all of this, perhaps there’s a new role that modern day physicians should adopt with regard to B12: to help patients modify B12 supplementation as indicated by the results of pertinent tests. (17,18,19,20,21)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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16 Comments & Updates to “Vitamin B12 News”

  1. anne h Says:

    Our old friend B12!
    How little we know about the “intrinsic factor!”
    How vital it is to ….. everything!

  2. JP Says:

    Indeed, Anne. Always more to learn! :)

    Be well!

    JP

  3. Laurence Says:

    I thought this excerpt was interesting:

    “Subjects with depression who do not respond to conventional antidepressants should be evaluated for nutritional factors”

    I’ve taken anti-depressants before and they don’t seem to work. What did seem to work was eating properly. That means no processed foods, no soda ect. I adopted a vegan diet and made sure I was eating my healthy fats from nuts and the like. I exercised 60 minutes a day (that releases endorphins) and guess what, I’m not depressed!

    Answer this question for me: If someone is eating a raw food diet with fresh fruits and vegetables, nuts and salmon… and exercising 60 minutes a day… do you really think it’s possible that they’re going to be depressed? I don’t think so. If you’ve ever watched the documentary called Food Inc. there’s a clip where one of the nutritionists talks about how niacin has been used to treat depression at high levels. I tried this and it works for me. Here’s the video: http://nutritionisthesolution.com/natural-treatment-for-depression-explained-niacin-b3
    I’d suggest trying it. It’s difficult to get enough vitamins and they are extremely safe compared to antidepressants which can cause suicidal thoughts. I think everyone should take a vitamin b12 supplement, 1 because its a good idea 2) it will help combat depression. Anyone nice post loved it!
    Best,
    Laurence

  4. JP Says:

    Thank you, Laurence.

    Great job on overcoming your depression naturally!

    Be well!

    JP

  5. Bob C. Says:

    My B12 level is very low and I have not had any success getting it up with a 1mg dose of cyanocobalamin. I recently switched to a 5mg dose of methylcobalamin but have not had it tested yet. Is there any evidence to suggest that one particular type is better absorbed than another? My B12 levels actually dropped while I was on the 1mg dose.

    I just discovered your excellent site while searching for krill oil info and have found it very helpful. I have been dealing with an agressive prostate cancer and have found alternative and complimentary medicine with regard to diet, nutrition and exercise very helpful.

  6. JP Says:

    Hi Bob,

    It will be interesting to see what your upcoming lab results show based on the high dosage methylcobalamin therapy. Are you taking the B12 orally (swallowing it whole) or sublingually. Has your doctor offered any theory about why your B12 level is so low? Is it treatment related?

    A few things to consider: 1) Methylcobalamin should be well absorbed regardless of how it’s administered. Having said that, if there’s reason to believe that your digestive absorption is compromised, taking it sublingually may be helpful. 2) Taking aloe with Vitamin B12 may enhance it’s assimilation. 3) One study suggests that methylcobalamin may hasten recovery from prostate surgery.

    I should also note that some, but certainly not all, studies have linked higher plasma B12 to an increased risk of prostate cancer. To be clear, the studies are mostly population evaluations which aren’t the best source of evidence. Also, the findings have varied – some studies have found an apparent association, others have not.

    If you don’t find success with the most common over-the-counter Vitamin B12 supplements, there are a few options including prescription B12 (injectables or nasal sprays). There are also a few Vitamin B12 creams on the market which may be useful.

    Overview of potential causes of Vitamin B12 deficiency and proposed solutions:

    http://www.altmedrev.com/publications/3/6/461.pdf (review article)

    http://www.ncbi.nlm.nih.gov/pubmed/22435613 (aloe)

    http://www.ncbi.nlm.nih.gov/pubmed/19198223 (prostate specific)

    Links re: Vitamin B12 and Prostate Cancer

    Association: http://www.sciencedirect.com/science/article/pii/S0959804996003735

    http://onlinelibrary.wiley.com/doi/10.1002/ijc.20646/full

    No Association: http://www.hindawi.com/journals/jce/2012/957467/

    http://cebp.aacrjournals.org/content/12/11/1271.long

    Other B12 Sources:

    http://www.nlm.nih.gov/medlineplus/druginfo/meds/a605007.html

    http://www.nascobal.com/

    http://www.iherb.com/Life-Flo-Health-Vitamin-B-12-Cream-4-oz-113-4-g/46861

    Be well!

    JP

  7. Bob C. Says:

    Thank you very much for your quick reply. I have been using the sublingual tablets on my doctor’s suggestion. We don’t know why the B12 is low but it could be the minimal red meat in my diet. I had a prostatectomy and radiotherapy cancer treatment several years ago. Since then my WBC, RBC and B12 have been low. The low B12 may be the cause of my peripheral neuropathy and may be contributing to the low RBC.

    I was aware of the possible B12 link to higher cancer risk but the article I read implied that folic acid was riskier that the B12. For now I’ll side with the paper that suggests B12 will hasten recovery. Given the known issues with peripheral neuropathy and cognitive function, I will stay with the B12 for the present.

    Again, thank you very much for your help and the very informative links.

    Bob C.

  8. JP Says:

    Update on which form (and form of administration) is best:

    http://www.nature.com/ejcn/journal/vaop/ncurrent/abs/ejcn2014165a.html

    Treatment of vitamin B12 deficiency–Methylcobalamine? Cyancobalamine? Hydroxocobalamin?—clearing the confusion

    K Thakkar1,3 and G Billa1,2,3

    Advance online publication 13 August 2014

    Vitamin B12 (cyancobalamin, Cbl) has two active co-enzyme forms, methylcobalamin (MeCbl) and adenosylcobalamin (AdCbl). There has been a paradigm shift in the treatment of vitamin B12 deficiency such that MeCbl is being extensively used and promoted. This is despite the fact that both MeCbl and AdCbl are essential and have distinct metabolic fates and functions. MeCbl is primarily involved along with folate in hematopiesis and development of the brain during childhood. Whereas deficiency of AdCbl disturbs the carbohydrate, fat and amino-acid metabolism, and hence interferes with the formation of myelin. Thereby, it is important to treat vitamin B12 deficiency with a combination of MeCbl and AdCbl or hydroxocobalamin or Cbl. Regarding the route, it has been proved that the oral route is comparable to the intramuscular route for rectifying vitamin B12 deficiency.

    Be well!

    JP

  9. JP Says:

    Update: Vitamin B12 deficiency is common in seniors for a variety of reasons …

    http://www.ncbi.nlm.nih.gov/pubmed/25651452

    J Nutr Health Aging. 2015;19(2):234-239.

    Cobalamin Deficiency in the Elderly: Aetiology and Management: A Study of 125 Patients in a Geriatric Hospital.

    Introduction: Cobalamin deficiency is frequent in elderly patients and the main aetiologies are food-cobalamin malabsorption and pernicious anaemia. The aim of our retrospective study was to identify the causes and methods of management of cobalamin deficiency at Nice geriatric university hospital.

    Methods: A retrospective monocentric study was conducted over 14 months at Nice geriatric hospital, which included patients with cobalamin deficiency having received supplementation. The clinical and paraclinical data, etiological diagnosis, treatment and follow-up modalities were analyzed retrospectively.

    Results: We studied 125 elderly patients whose median age was 85.5 ± 7 years. The etiological diagnosis was food-cobalamin malabsorption for 72 patients (57.6 %), nutritional cobalamin deficiency for 15 patients (12 %), pernicious anaemia for 12 patients (9.6 %) and there was no etiological diagnosis for 26 patients (20.8 %). Concerning cobalamin therapy, 111 patients (88.8 %) received oral therapy and 14 (11.2 %) intramuscular therapy. Vitamin B12 levels increased significantly after supplementation (p<0.001) but cobalamin administration varied according to the diagnoses (p<0.001) and was less effective in patients with dementia (p=0.04) and food-cobalamin malabsorption.

    Conclusion: Our study showed the importance of food-cobalamin malabsorption in etiological diagnosis in accordance with the literature, but also the non-negligible share of nutritional cobalamin deficiency. Mainly oral cobalamin supplementation was used in our study with a significant increase in vitamin B12 levels. An oral cobalamin regimen is proposed for elderly patients with cobalamin deficiency but with no severe neurological signs.

    Be well!

    JP

  10. JP Says:

    Updated 08/20/15:

    http://www.ncbi.nlm.nih.gov/pubmed/26288227

    PLoS One. 2015 Aug 19;10(8):e0135268.

    Lower Circulating B12 Is Associated with Higher Obesity and Insulin Resistance during Pregnancy in a Non-Diabetic White British Population.

    OBJECTIVE: Vitamin B12 and folate are critical micronutrients needed to support the increased metabolic demands of pregnancy. Recent studies from India have suggested that low vitamin B12 and folate concentrations in pregnancy are associated with increased obesity; however differences in diet, antenatal vitamin supplementation, and socioeconomic status may limit the generalisability of these findings. We aimed to explore the cross-sectional relationship of circulating serum vitamin B12 and folate at 28 weeks’ gestation with maternal adiposity and related biochemical markers in a white non diabetic UK obstetric cohort.

    METHODS: Anthropometry and biochemistry data was available on 995 women recruited at 28 weeks gestation to the Exeter Family Study of Childhood Health. Associations between B12 and folate with maternal BMI and other obesity-related biochemical factors (HOMA-R, fasting glucose, triglycerides, HDL and AST) were explored using regression analysis, adjusting for potential confounders (socioeconomic status, vegetarian diet, vitamin supplementation, parity, haemodilution (haematocrit)).

    RESULTS: Higher 28 week BMI was associated with lower circulating vitamin B12 (r = -0.25; P<0.001) and folate (r = -0.15; P<0.001). In multiple regression analysis higher 28 week BMI remained an independent predictor of lower circulating B12 (β (95% CI) = -0.59 (-0.74, -0.44) i.e. for every 1% increase in BMI there was a 0.6% decrease in circulating B12). Other markers of adiposity/body fat metabolism (HOMA-R, triglycerides and AST) were also independently associated with circulating B12. In a similar multiple regression AST was the only independent obesity-related marker associated with serum folate (β (95% CI) = 0.16 (0.21, 0.51)).

    CONCLUSION: In conclusion, our study has replicated the previous Indian findings of associations between lower serum B12 and higher obesity and insulin resistance during pregnancy in a non-diabetic White British population. These findings may have important implications for fetal and maternal health in obese pregnancies.

  11. JP Says:

    Updated 03/30/16:

    http://www.nature.com/ejcn/journal/vaop/ncurrent/abs/ejcn201633a.html

    European Journal of Clinical Nutrition advance online publication 23 March 2016

    Low serum levels of vitamin B12 in older adults with normal nutritional status by mini nutritional assessment

    Undernutrition as well as low levels of vitamin B12 and folic acid are common problems among older adults. However, recommended routine nutritional status assessment tools may result in inadequate vitamin serum levels to go unnoticed. Therefore, the aim of this study is to evaluate the inadequacy of serum levels of vitamin B12 and folic acid within Mini Nutritional Assessment (MNA) classification categories among older adults. A cross-sectional study was conducted with 97 older adults residing in care homes in Portugal. Undernutrition was identified through the MNA, and serum levels of vitamin B12 and folic acid were measured using chemiluminescence. Cognitive function, depressive symptoms and functional characteristics were also assessed using the Abbreviated Mental Test Score, the Epidemiologic Studies Depression Scale and the Barthel Index, respectively. The mean age of older adults was 82.2 (6.3) years; 3.1% were undernourished and 26.8% were at undernutrition risk. In the MNA normal nutritional status group, 11.8% presented vitamin B12 deficiency (<200 pg/ml), 32.4% had low serum levels (200–400 pg/ml) and 4.4% had folic acid deficiency (<3 ng/ml). A high proportion of older adults with low serum levels of vitamin B12 presenting normal nutritional status by MNA was identified. This finding emphasizes the need to evaluate serum vitamin B12 levels, independently of the MNA results.

    Be well!

    JP

  12. JP Says:

    Updated 07/26/16:

    http://onlinelibrary.wiley.com/doi/10.1111/fcp.12220/abstract

    Fundam Clin Pharmacol. 2016 Jul 14.

    Hibiscus sabdariffa increases hydroxocobalamin oral bioavailability and clinical efficacy in vitamin B12 deficiency with neurological symptoms.

    The aim of the study was to evaluate the bioavailability and clinical benefits of oral new formulation (HB12 ) of Hydroxocobalamin (Hdrx) with Hibiscus sabdariffa (HS). First, in an observational study, a cohort of 30 vitamin B12 deficient patients (vit B12 < 200 pg/ml), with neurologic symptoms received oral fixed-dose of Hdrx containing 15 mg Hdrx daily for 10 days followed by 15 mg monthly. Clinical benefits were evaluated on haematological and biochemical parameters, and neurological improvement at days 10 and 90 compared to day 0. In order to understand the mechanism, intestinal mucosa from mice were mounted in vitro in Ussing chambers to measure Hdrx Fluxes. In the clinical study, serum vitamin B12 level increased from 55.1 ± 36.9 to 1330 ± 335.5 pg/mL at day 10 and 431.0 ± 24.27 pg/mL at day 90, without overt adverse effects. In mice ileum, a) intestinal bioavailability of Hdrx increased in dose-dependent manner with HB12 . The apparent permeability of Hdrx, was Papp = 34.9 ± 4.6 x 10-6 cm.s-1 in presence of 3 mg/mL (HB12 B) compared to the control Papp = 6.2 ± 0.7 x 10-6 cm.s-1 . b). Total transepithelial electrical conductance (Gt ) increased in dose-dependent manner with HB12 , Gt = 161.5 ± 10.8 mS/cm² with HB12 B (Hdrx 1mg + HS 3 mg) compared to the control Hdrx, Gt = 28.7± 4.0 mS/cm². In conclusion, the clinical study suggests that injections are not required when Hdrx is given orally. Intestinal bioavailability of Hdrx increased in vitro when it was used concomitantly with HS.

    Be well!

    JP

  13. JP Says:

    Updated 09/11/16:

    http://www.mdpi.com/2072-6643/8/9/460/htm

    Nutrients 2016, 8(9), 460

    Association of Vitamin B12 with Pro-Inflammatory Cytokines and Biochemical Markers Related to Cardiometabolic Risk in Saudi Subjects

    Background: This study aimed to examine the relationship between changes in systemic vitamin B12 concentrations with pro-inflammatory cytokines, anthropometric factors and biochemical markers of cardiometabolic risk in a Saudi population. Methods: A total of 364 subjects (224 children, age: 12.99 ± 2.73 (mean ± SD) years; BMI: 20.07 ± 4.92 kg/m2 and 140 adults, age: 41.87 ± 8.82 years; BMI: 31.65 ± 5.77 kg/m2) were studied. Fasting blood, anthropometric and biochemical data were collected. Serum cytokines were quantified using multiplex assay kits and B12 concentrations were measured using immunoassay analyzer. Results: Vitamin B12 was negatively associated with TNF-α (r = −0.14, p < 0.05), insulin (r = −0.230, p < 0.01) and HOMA-IR (r = −0.252, p < 0.01) in all subjects. In children, vitamin B12 was negatively associated with serum resistin (r = −0.160, p < 0.01), insulin (r = −0.248, p < 0.01), HOMA-IR (r = −0.261, p < 0.01). In adults, vitamin B12 was negatively associated with TNF-α (r = −0.242, p < 0.01) while positively associated with resistin (r = 0.248, p < 0.01). Serum resistin was the most significant predictor for circulating vitamin B12 in all subjects (r2 = −0.17, p < 0.05) and in children (r2 = −0.167, p < 0.01) while HDL-cholesterol was the predictor of B12 in adults (r2 = −0.78, p < 0.05). Conclusions: Serum vitamin B12 concentrations were associated with pro-inflammatory cytokines and biochemical markers of cardiometabolic risks in adults. Maintaining adequate vitamin B12 concentrations may lower inflammation-induced cardiometabolic risk in the Saudi adult population.

    Be well!

    JP

  14. JP Says:

    Updated 12/15/16:

    https://www.ncbi.nlm.nih.gov/pubmed/27958255

    Niger J Clin Pract. 2017 Jan;20(1):99-105.

    Evaluation of serum Vitamin B12 level and related nutritional status among apparently healthy obese female individuals.

    OBJECTIVE: Obesity is a major public health problem and great risk for not only cardiovascular diseases but also cancer, musculoskeletal, and gynecological diseases. This study was aimed to investigate the association between serum Vitamin B12 (vitB12), body mass index (BMI), and nutritional status among obese women.

    METHODS: This cross-sectional study enrolled consecutive female subjects. The consumptions of red meat, fish, bovine liver, egg, and mushroom were recorded. According to the Dietary Reference Intakes, the patients were categorized as insufficiency and sufficiency. Three cutoff points were defined for vitB12 status: (1) Deficiency if vitB12 is <200 pg/mL; (2) insufficiency if vitB12 is 250-350 pg/mL, and (3) sufficient if vitB12 is ≥350 pg/mL. According to BMI, the patients were assigned to nonobese and obese groups. BMI, serum vitB12 level, consumptions of red meat, fish, bovine liver, egg, and mushroom were evaluated and compared between two groups.

    RESULTS: Mean level of vitB12 was 247.8 ± 10.4 pg/mL and significantly associated with consumption of egg (P = 0.031), bovine liver (P = 0.004), mushroom (P = 0.040), and red meat (P = 0.003). VitB12 was significantly higher in nonobese than obese group (282.5 ± 106.8 vs. 242.5 ± 107.5 pg/mL, P = 0.001). The ratio of vitB12 deficiency was significantly higher in obese than nonobese group (37.6% vs. 24.7%; P = 0.019). VitB12 level was negatively correlated with BMI (r = -0.155; P< 0.001), but not insulin resistance (r = -0.172; P = 0.062).

    CONCLUSION: Obesity was associated with low level of vitB12 in obese women, and more likely to be vitB12 deficient. Consumption of certain types of food contributes to increase vitB12 level.

    Be well!

    JP

  15. JP Says:

    Updated 03/20/17:

    http://www.mdpi.com/2072-6643/9/3/308/htm

    Nutrients 2017, 9(3), 308

    Oral Cyanocobalamin is Effective in the Treatment of Vitamin B12 Deficiency in Crohn’s Disease

    Cobalamin deficiency is common in patients with Crohn’s disease (CD). Intramuscular cobalamin continues to be the standard therapy for the deficiency and maintenance treatment in these patients, although oral route has been demonstrated to be effective in other pathologies with impaired absorption. Our aims were to evaluate the efficacy of oral therapy in the treatment of cobalamin deficiency and in long-term maintenance in patients with Crohn’s disease. We performed a multicenter retrospective cohort study that included 94 patients with Crohn’s disease and cobalamin deficiency. Seventy-six patients had B12 deficiency and 94.7% of them normalized their cobalamin levels with oral treatment. The most used dose was 1 mg/day, but there were no significant differences in treatment effectiveness depending on the dose used (≥1 mg/24 h vs. <1 mg/24 h). Eighty-two patients had previous documented B12 deficiency and were treated with oral B12 to maintain their correct cobalamin levels. After a mean follow-up of 3 years, the oral route was effective as maintenance treatment in 81.7% of patients. A lack of treatment adherence was admitted by 46.6% of patients in who the oral route failed. In conclusion, our study shows that oral cyanocobalamin provides effective acute and maintenance treatment for vitamin B12 deficiency caused by CD with or without ileum resection.

    Be well!

    JP

  16. JP Says:

    Updated 02/13/19:

    https://e-cnr.org/DOIx.php?id=10.7762/cnr.2019.8.1.36

    Clin Nutr Res. 2019 Jan 25;8(1):36-45.

    The Effect of Vitamin B12 and Folic Acid Supplementation on Serum Homocysteine, Anemia Status and Quality of Life of Patients with Multiple Sclerosis.

    Plasma homocysteine level and megaloblastic anemia status are two factors that can affect the quality of life of patients with multiple sclerosis (MS). We conducted this study to determine the effect of vitamin B12 and folic acid supplementation on serum homocysteine, megaloblastic anemia status and quality of life of patients with MS. A total of 50 patients with relapsing remitting multiple sclerosis (RRMS) included in this study which divided into 2 groups. The vitamin group received 5 mg folic acid tablet daily and 3 doses of vitamin B12 (1,000 mcg) injection and the other group received placebo and normal saline injection (same doses). The quality of life was measured by using Multiple Sclerosis Quality of Life-54 questionnaire (MSQOL-54). Fully automated fluorescence polarization immunoassay was used to measure serum homocysteine, vitamin B12 and folate. Complete blood count blood test was conducted to determine the anemia status. The mean homocysteine level reduced by 2.49 ± 0.39 µmol/L (p = 0.001), hemoglobin increased from 11.24 ± 1.54 to 13.12 ± 1.05 g/dL (p = 0.001), and mean corpuscular volume decreased from 95.50 ± 6.65 to 89.64 ± 4.24 in the vitamin group (p = 0.001). There was a significant improvement in the mental field of life quality in the placebo group (37.46 ± 19.01 to 50.98 ± 21.64; p = 0.001), whereas both physical and mental fields of quality of life were improved significantly in the vitamin group (40.38 ± 15.07 to 59.21 ± 12.32 and 29.58 ± 15.99 to 51.68 ± 18.22, respectively; p = 0.001). Serum homocysteine level decrease and anemia status improvement with vitamin B12 and folic acid supplementation reveal the potential role of these two vitamins in improving the life quality of MS patients.

    Be well!

    JP

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