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Supplements of antioxidant vitamins do not reduce the risk of gastrointestinal cancers, and some may be associated with an increased risk of death, concluded a systematic review published last week.
A group at high risk of diabetes benefited from taking vitamin E supplements. People with insulin resistance are more likely than average to develop diabetes. Previous research has suggested that vitamin E can hold off diabetes.
Newswise — Recent nutrition research published in The Lancet confirms what dietitians already know: the best way to protect yourself from digestive cancers is by eating right, not taking a pill.
LAFAYETTE — Lafayette is courting national health-food chain Vitamin Cottage to occupy the newly constructed Eckerd drug store space, which has been vacant since this summer.
Elderly people who get supplemental vitamin D in their diets have stronger muscles than those who don't, based on evidence from studies funded by the Agricultural Research Service.
SEATTLE, WA -- October 4, 2004 -- More than half of women currently treated for osteoporosis have suboptimal levels of vitamin D, according to new research presented today at the American Society for Bone and Mineral Research (ASBMR) meeting in Seattle.
Folic acid, also known as folate, is a B vitamin that's found in some enriched foods and vitamin pills. If women get enough of it before and during pregnancy, it can decrease the risk for neural tube birth defects.
* Latest News
* Vitamin D Low in Females with Osteoporosis (10/04/2004, United Press International)
* Vitamin Pills Don't Cut Stomach Cancer Risk (10/01/2004, Reuters Health)
* Lycopene, Vitamin E Reduce Prostate Tumors in Mice (09/30/2004, Reuters Health)
* More News on Vitamins and Minerals
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* Vitamin and Mineral Supplements: Use with Care (Mayo Foundation for Medical Education and Research)
* Vitamins (Harvard School of Public Health)
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* ClinicalTrials.gov: Micronutrients (National Institutes of Health)
* ClinicalTrials.gov: Vitamins (National Institutes of Health)
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* Copper: Reducing It in Your Diet (Mayo Foundation for Medical Education and Research)
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* Iron (National Institutes of Health, Office of Dietary Supplements)
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* NCCAM Consumer Advisory on Coral Calcium (National Center for Complementary and Alternative Medicine)
* Potassium: Am I Getting Enough? (Mayo Foundation for Medical Education and Research)
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* Taking Vitamin Supplements to Prevent Cardiovascular Disease and Cancer: Recommendations from the U.S. Preventive Services Task Force (American College of Physicians)
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* Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Trial (National Cancer Institute)
* How Vitamin C Is Administered Affects How Much Reaches the Bloodstream and May Affect the Results of Studies of Its Potential Effect on Cancer (American College of Physicians)
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Vitamin and mineral supplements: Use with care
By Mayo Clinic staff
With added amino acids, antioxidants, enzymes and herbs, it might seem like dietary supplements could easily replace food as your source of nutrients. But this isn't the case. Whole foods — such as fruits, vegetables and whole grains — provide a complex combination of vitamins, minerals, fiber and other substances that promote health.
Though vitamin and mineral supplements can't copy all of the nutrients and benefits of whole foods, they can complement your diet. If you have trouble getting enough nutrients, you may benefit from taking a vitamin or mineral supplement. To use supplements safely, weigh your nutritional needs, scrutinize the merits of taking a supplement, and understand how to choose and use dietary supplements.
Vitamin and mineral ABCs
Vitamins and minerals are substances your body needs in small but steady amounts for normal growth, function and health. Together, vitamins and minerals are called micronutrients. Your body can't make most micronutrients, so you must get them from the foods you eat or, in some cases, from supplements.
Vitamins: Partners in regulating body functions
Vitamins are needed for a variety of biologic processes, among them growth, digestion, mental alertness and resistance to infection. They also enable your body to use carbohydrates, fats and proteins, and they act as catalysts — initiating or speeding up chemical reactions. Though vitamins are involved in converting food into energy, they supply no calories.
Vitamins can be either water-soluble or fat-soluble.
* Water-soluble vitamins. Vitamin C, biotin and the seven B vitamins — thiamin (B-1), riboflavin (B-2), niacin (B-3), pantothenic acid (B-5), pyridoxine (B-6), folic acid (B-9) and cobalamin (B-12) — dissolve in water (water-soluble) and aren't stored in your body in any significant amounts. Surplus water-soluble vitamins are simply excreted in your urine.
* Fat-soluble vitamins. Any extra vitamin A, D, E or K not used by your body right after ingestion is stored in your body fat and liver. Excess fat-soluble vitamins can accumulate in your body and become toxic. You're especially sensitive to excess amounts of vitamins A and D. Because vitamins E and K affect blood clotting, talk with your doctor before taking a supplement that contains either of these vitamins if you're taking a blood thinner, such as warfarin (Coumadin).
Minerals: Building blocks for your body
Minerals are the main components in your teeth and bones, and they serve as building blocks for other cells and enzymes. Minerals also help regulate the balance of fluids in your body and control the movement of nerve impulses. Some minerals also help deliver oxygen to cells and help carry away carbon dioxide.
Minerals have two categories:
* Major minerals. Calcium, phosphorus, magnesium, sodium, potassium, sulfur and chloride are considered major minerals because adults need them in larger amounts — more than 250 milligrams (mg) a day.
* Trace minerals. Chromium, copper, fluoride, iodine, iron, manganese, molybdenum, selenium and zinc are considered trace minerals because your body needs them in smaller amounts — fewer than 20 mg a day. Whole foods: Your best source of micronutrients
Whole foods are your best sources of vitamins and minerals. They offer three main benefits over supplements:
* Whole foods are complex. They contain a variety of the micronutrients your body needs — not just one. An orange, for example, provides vitamin C but also beta carotene, calcium and other nutrients. A vitamin C supplement lacks these other micronutrients.
* Whole foods provide dietary fiber. Fiber is important for digestion and can help prevent certain diseases such as cancer, diabetes and heart disease. Adequate fiber intake can also help prevent constipation.
* Whole foods contain other substances that appear to be important for good health. Fruits and vegetables, for example, contain naturally occurring food substances called phytochemicals, which may help protect you against cancer, heart disease, diabetes and high blood pressure. Many are also good sources of antioxidants — substances that slow down oxidation, a natural process that leads to cell and tissue damage. If you depend on supplements rather than eating a variety of whole foods, you miss the potential benefits of these substances.
Who needs vitamin and mineral supplements?
Many people don't receive all of the nutrients they need from their diet because they either can't or don't eat enough, or they can't or don't eat a variety of healthy foods. For some people, including those on restrictive diets, multivitamin-mineral supplements can provide vitamins and minerals that their diets often don't. Pregnant women and older adults have altered nutrient needs and may also benefit from a supplement.
Choosing and using supplements
Supplements, as the term suggests, can complement your regular diet, but they aren't food substitutes. They can't replace the hundreds of nutrients found in whole foods. But if you do decide to take a vitamin or mineral supplement, consider these factors:
* Check the supplement label. Read labels carefully. Product labels can tell you what the active ingredient or ingredients are, which nutrients are included, the serving size — for example, capsule, packet or teaspoonful — and the amount of nutrients in each serving. The label also provides directions for safe use and tips for storage along with the name and address of the manufacturer, packer or distributor where you can write if you need more information on a particular product.
* Avoid supplements that provide "megadoses." In general, choose a multivitamin-mineral supplement — for example, Centrum, One A Day, others — that provides about 100 Percent Daily Value (%DV) of all the vitamins and minerals instead of one that supplies, for example, 500%DV of one vitamin and only 20%DV of another. The exception to this is calcium. You may notice that calcium-containing supplements don't provide 100%DV. If they did, the tablets would be too large to swallow. Most cases of nutrient toxicity stem from high-dose supplements.
* Percent daily value: What does it mean?
* Look for “USP” on the label. This ensures that the supplement meets the standards for strength, purity, disintegration and dissolution established by the testing organization, U.S. Pharmacopeia (USP).
* Beware of gimmicks. Synthetic vitamins are usually the same as so-called "natural" vitamins, but "natural" vitamins usually cost more. And don't give in to the temptation of added herbs, enzymes or amino acids — they add mostly cost.
* Look for expiration dates. Supplements can lose potency over time, especially in hot and humid climates. If a supplement doesn't have an expiration date, don't buy it. If your supplements have expired, discard them.
* Store all vitamin and mineral supplements safely. Store supplements in a dry, cool place. Avoid hot, humid storage locations, such as the bathroom. Also, store supplements out of sight and away from children. Put supplements in a locked cabinet or other secure location. Don't leave them on the counter or rely on child-resistant packaging. Be especially careful with any supplements containing iron. Iron overdose is a leading cause of poisoning deaths among children.
* Play it safe. Before taking anything other than a standard multivitamin-mineral supplement of 100%DV or less, check with your doctor, pharmacist or a registered dietitian. High doses of some vitamins or minerals may cause health problems. For example, high doses of vitamin B-3 (niacin) can result in or worsen liver problems, and too much vitamin A over time may cause liver problems or weaken bones in women. In addition, supplements may interfere with your medications. For instance, vitamin E isn't recommended if you're taking blood-thinning medications (anticoagulants) because it can complicate the proper control of blood thinning. If you're already taking an individual vitamin or mineral supplement and haven't told your doctor, discuss it at your next checkup.
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The term vitamin is derived from the words vital and amine, because vitamins are required for life and were originally thought to be amines. Although not all vitamins are amines, they are organic compounds required by humans in small amounts from the diet. An organic compound is considered a vitamin if a lack of that compound in the diet results in overt symptoms of deficiency.
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Minerals are elements that originate in the Earth and cannot be made by living systems. Plants obtain minerals from the soil, and most of the minerals in our diets come from directly from plants or indirectly from animal sources. Minerals may also be present in the water we drink, but this varies with geographic locale. Minerals from plant sources may also vary from place to place, because soil mineral content varies geographically.
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Some nutrients may be synthesized by the body in addition to being consumed in the diet. Choline is considered an essential nutrient because even healthy individuals cannot synthesize enough to maintain health. Other nutrients can be synthesized in adequate amounts by healthy individuals but may be required from the diet under conditions of stress or illness. Aging and chronic diseases may also increase the need for dietary intake of these conditionally essential nutrients.
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D -vitamin förekommer i sin vanligaste form såsom kolekalcifenol-D3. Den vanligast spridda kunskapen om ämnet ifråga förtäljer om huruledes solbestrålning av huden stimulerar kroppen att själv syntetisera vitaminet. Utgångsmaterialet för denna syntes är 7-hydrokolesterol, vilket är en intermediär i kolesterolsyntesen. Den som är noggrann med bruket av definitioner bör betrakta D3 som ett prohormon, alldenstund ämnet konverteras till en metabolit med streroidliknande egenskaper. D3 hydrolyseras tvåfaldigt, först i levern till 25-hydroxivitamin D, därpå ytterligare i njurarna, bildande 1,25-dihydroxivitamin D3 (kalcitriol). Såsmåningom är kalcitriolet omsatt till den hormonellt aktiva formen av D-vitamin; 1,25-(OH)2D3, för vilket receptorer har anfunnits i bukspottskörtel och flera andra inälvor, i de monukleära cellerna, i de aktiverade T-lyfocyterna, i skinnet, och hos kvinnor i äggstockar och bröst.
D -vitamin spelar en central roll då kroppens omsättning av kalcium och fosfor skall regleras. Dess betydelse härvid förmärkes också genom dess giftverkan vid överdrivna doser. Koncentrationen av fosfor och kalcium i blodet ökar då markant, med skadliga inflytanden på framför allt njurarna som följd. De toxiska effekterna av vitamin D förtjänar extra försiktighet som dessa verkningar i motsats till andra potentiellt toxiska vitaminers, inte går tillbaka bara i och med att tillförseln avbrytes. Gränsen för toxiskt intag ligger kring ca: 80 mikrogram vid kontinuerlig tillförsel under flera månader. Gränsen för akut toxiskt intag kan ligga kring 5 mg. Symtom på förgiftning är t.ex törst, klåda, illamående, urinträngning och diarré. D-vitamin är enligt vad som nämnts tidigare nödvändigt för kroppens tillgodogörande av kalcium och fosfor. Ämnet är således av vital betydelse för tand och benbildningen. Vitaminet medverkar vid regleringen av blodkoagulationen, samt i diverse funktioner som rör nerver, inälvor och cellmembraner. Produktionen av ämnet tyroxin avhänger därav. D-vitamin inverkar på citonsyraomsättningen, vilken effekt i själva verket är primär, medan mineralomsättningen är sekundär.
D et tydligaste utslaget av bristande intag utgöres av rakitis, ett tillstånd vilket också går under benämningen "engelska sjukan". Det uppträder hos växande barn och yttrar sig såsom en uppmjukning av skelettbenen, vilka typiskt kommer att uppvisa diverse anormala krökar och böjar. Bröstben, kotpelare, rörben och bäcken företer ofta tydliga deformationer, vilka i svårare fall består tämligen oförändrade in i vuxen ålder. Benbildningen sker nyckfullt, bitvis försvårat, annorstädes i ett uppdrivet tempo med tornar och knölar som resultat. Hos vuxna resulterar vitamin -D- brist i kramper, demineralisering av skelettet, nervositet, samt känslor av smärtor och stickningar.
A -vitamin är ett fettlösligt vitamin, tillika en omättad alkohol. Vitamin A förekommer i tvenne olika kemiska former, dels enkelt såsom retinol, dels i form av karoten. Vitaminet spelar en nyckelroll för det mänskliga ögats förmåga till mörkerseende. Processen härför tillgår i det att trans-retinol i ögats näthinna vid påverkan från ljus inledningsvis undergår isomeration och dehydrogenation, dymedelst bildande 11-cis-retinal. Härpå bildas det starkt ljusabsorberande ämnet rhodopsin. A-vitamin förekommer särskilt rikligt i vissa animaliska produkter, såsom fiskleverolja, mjölkprodukter och äggula. Från växtriket inhämtas vitaminet bäst i proform såsom karoten, känt för och benämnt efter sin förekomst morötter. Karoten finns också i tomater och paprika. A-vitamin-brist yttrar sig i torra hornhinnor och slemhinnor, något som, slående mot urin och luftvägarna leder till nedsatt motståndskraft visavi infektioner, och då ögonen drabbas i förlängningen kan leda till blindhet. Den primära effekten på ögat är dock vikande mörkerseende. Härvid är näthinnan och inte hornhinnan säte för de skönjbara förändringarna. A-vitamin förstöres lätt om bärande animalievaror stekes på hög värme. Genom sin fettlöslighet inbjuder vitaminet till upplagring och ansamling i fetthaltiga kroppsorgan, företrädelsevis levern och njurarna. Effekter av överdosering kan vara illamående, håravfall, fjällande hud och leverförstoring. Dessa yttringar erfordrar dock dagliga intag på bortemot 50 mg under flera månader. Vad som är att märka är den fosterskadande effekten av höga doser. Karotener förefaller generellt vara ofarligare än rent vitamin, även om en i och för sig harmlös gulfärgning av huden kan uppstå vid stora intag. Retinol absorberas mer än dubbelt så bra som betakaroten av kroppen.
S å kallade antioxidanter tjänar den fysiska hälsan, antingen genom att oskadliggöra i kroppen förekommande syreradikaler, eller genom kemisk reduktion och därigenom återställande av ämnen i kroppen vilka genom skadliga influenser har blivit oxiderade. Kungen av alla antioxidanter är C-vitamin. Det är ett lättoxiderat ämne, varför det är sårbart för förstöring i händelse av inadekvat förvaring eller tillagning. Det förstöres snabbt vid förhöjda temperaturer (över 30 grader C), såväl i lösning som i fri form. Höga pH- nivåer samt metaller som järn och koppar påskyndar förstöringen av vitaminet under förvaring.
C -vitamin skyddar genom att själv oxideras. Då det en gång oxiderats är det förbrukat och därmed otjänligt som antioxidant. Således är dess öde att förr eller senare i någon mening förstöras. Därest kroppen exponeras för stora mängder oxiderande ämnen och radikaler, så ökar behovet av antioxidanter, och enkannerligen C-vitamin, i propotion härtill. En rökare förstör med varje cigarett 25- 100 mg C-vitamin. Den typiske rökaren har en rynkig hud utan spänst. Elasticiteten har gått förlorad till följd av oxidation av de i huden ingående tvärbindningarna och fetterna. På motsvarande sätt påverkas hos rökare, ett flertal i kroppen ingående substanser. Likaledes uppstår ett komplex av skador i åtföljd på kolmonooxidförgiftning. Sammantaget är detta skador som endast delvis kan motverkar genom C-vitamin- intag. Generella faktorer som förorsakar ökat behov vitamin-C är graviditet och infektion, samt osund livsföring och exponering för gifter och manipulerad föda i största allmänhet. Risken för C -vitamin- brist är hög hos bantare och äldre människor. Ytterligare faktorer som påkallar ökat intag är temperaturvariationer i miljön, därvid kyla eller värme, och till sist, icke minst viktigt, intag av p-piller.
D en grundläggande information som tillhandahålles envar är att 60 mg vitamin C om dagen motverkar uppkomsten av skörbjugg. Skörbjugg är i och för sig ett mycket allvarligt tillstånd och av högsta angelägenhetsgrad att undvika. Innan arkorbinsyrans roll för att förebygga avitaminosen ifråga, var känd, föll många människor offer för skörbjugg. Inledningsvis uppstår en allmän svaghet, parad med huvudvärk och illamående. Härpå inträder en fas av tilltagande symtom, jämväl blödningar i mun, slemhinnor, i musklerna och i ledernas senhinnor. Sjukdomsyttringarna ledsagas av starka smärtor i de drabbade vävnaderna, allt i grader ända intill invaliditet. Blodbrist, utmärgling och slutligen död följer i förlängningen. I dag förekommer utvecklad skörbjugg endast sporadiskt. De kemiska jämvikter, varunder patogena förändringar inträffar och återställes, är emellertid merendels graduella företeelser. En hög tillgänglighet av antioxidant i kroppen verkar uppbyggande för hälsan, och ju högre tillgänglighet, desto större uppbygglighet, dock naturligtvis endast till en viss gräns. Men kroppen kan svåreligen skadas av C-vitamin. Överdriven dosering förorsakar främst diarré samt ökad utsöndring av kalcium, järn och mangan i urinen. Denna tålighet tillåter ett intag för att med god marginal även åtse skyddet mot effekter av syrebrist i hjärnan och åstadkomma förbättrad motståndskraft mot cancer. Terapeutiskt kan C-vitamin även motverka anemi, artrit, krampbenägenhet, manodepressivitet och schizofreni. Den största verkan har C-vitamin på nervvävnaden. Hjärnan har ett stort behov av skydd mot radikaler och menliga inflytanden i samband med syrebrist. Vitaminet ifråga stimulerar ett flertal former av läkning, exempelvis vid sår, benbrott och efter hjärtinfarkt.
v
itaminet B1 är det först upptäckta av B-vitaminerna och går under benämningen tiamin, så ity att det innehåller en svavelgrupp och en amingrupp. Vitaminet är stukturellt komplext, men reagerar medels enkel fosforylering till dess koenzymform, tiaminpyrofosfat. Detta ämne innehar vissa exklusiva funktioner, exempelvis är det nödvändigt vid all alfa-keto-dekarboxylation. Det utgör en länk mellan citronsyracykeln och kolhydratomsättningen, vilket är av vikt för cellernas energiförsörjning.
B1 upptages till relativt stor andel i tarmen, och ännu bättre vid närvaro av allicin, som förefinnes i lökväxter. Kroppens förmåga att lagra vitaminet är emellertid liten. Det är ett temperaturkänsligt vitamin och förfares vid upphettning. Annan förstöring kan uppkomma i kroppen genom intag av koffein, alkohol och sulfamediciner. Också överdriven sockerkonsumtion påfordrar en reglering av vitaminintaget som kompensation.
Brist på tiamin yttrar sig i depression, abnorm trötthet, förvirring, försämrad minnesretention och ängslan. I sin mest välmanifesterade form utvecklas beri-beri som resultat av långvarigt underintag. Ordet "beri-beri" är singalesiska och betyder "stor svaghet". Till sin natur är beri-beri en inflammation i de perifera nerverna. Tillståndet är vanligt i delar av världen varest ensidig risdiet utgör förhärskande kost. Speciellt s.k polerat ris, varifrån skalet är avlägsnat, tillåter uppkomst av avitaminosen ifråga. Den drabbade utvecklar förlamningskomplex, begynnande i den nedre delen av kroppen och fortskridande uppåt. På förlamningarna följer muskelförtvining och ödem. Svullnad kan även förekomma i mer eller mindre oberoende förlopp. Döden inträder i regel till följd av hjärtförlamning med en mortalitet på mellan 10- 25 %.
Vitaminet B1 innehar antioxidativa effekter. Det stimulerar tillväxt och matsmältningsfunktionerna. Det verkar gynnsamt för ett balanserat känsloliv, normal nervfunktion, smärtlindring, och för hjärtats vidkommande. I samverkan med kompletterande antioxidantia motverkar B1 uppkomsten av fria radikaler i cellerna, samt verkar understödjande på nedbrytningen av i kroppen uppkommen acetaldehyd. Vitaminet verkar för minskat upptag och avgiftning vid blyexposition.
Det kan tillföras för att terapeutiskt verka understödjande vid behandling av ångest, neuroser, ansiktsförlamning och vissa anemier, för att lindra smärtor, samt vid vid bältros. B1 verkar synergistiskt med övriga B-vitaminer. Det är i det närmaste ofarligt, även i stora doser. Dock skall diabetes föranleda viss försiktighet med dess överdrivna bruk.
kroppen deriverar tvenne olika koenzymer från riboflavin, dels flavin adenin dinukleotid (FAD), dels flavin mononukleotid (FMN). Dessa är inblandande i diverse elektrontransferreaktioner, på vad sätt B2 kan sägas verka som antioxidantia. B2 ingår i det s.k gula andningsfermentet och låter kroppen tillgodogöra sig luftens syre. Det understödjer omvandlingen av tryptofan till niacin. Ämnet bör liksom många andra vitaminer intagas i samband med måltid. Doserna B2 kan med fördel anpassas efter B6- intaget, därvid i förhållandet 1:1.
Riboflavin nedbrytes under inverkan från ljus, framför allt i alkalisk miljö. Däremot är det förhållandevis värmebeständigt. Mer svårartad B2 brist är sällsynt i de industrialiserade delarna av världen, men lättare bristtillstånd kan vara allmännare. Bl.a förmärkes då ökande benägenhet till munsår och sprickor i mungiporna, inflammationer i munnen och seborroiskt exsem på härför disponerade hudpartier på kroppen. I kombination med annan B-vitamin-brist uppstår benäget även ljuskänslighet och kliande slemhinnor, samt diverse mentala orostillstånd. Matsmältningsrubbningar och viktförlust, acne, samt håravfall kan vara andra bristeffekter.
Förutom betydelsen för kroppens framställning av B3 så medverkar även riboflavin då fettsyror, noradrenalin, histamin, serotonin och acetylkolin skall syntetiseras. Ämnet utövar gynnsamma inflytanden på tillväxten och reproduktionen och kan mildra lindriga synstörningar. Kvinnor som är havande, ammar eller äter p-piller bör överväga ökad tillförsel av riboflavin. Allmänt är ökade dagsdoser lämpliga vid stress, hård motion, bantning, feber och diabetes.
B2 kan knappast intagas i toxiska doser. Den normalt rekommenderade dagskonsumtionen ligger i intervallet 1,2- 1,7 mg/ dag.
Detta vitamin förekommer knappast i vegetabiliska födoämnen, men däremot i animalisk föda som t.ex lever. Vid upptag ur den vanliga födan svarar den i tarmen förevarande bakteriefloran för kobalaminets tillgänglighet, och medverkar ävenledes delvis till produktionen därav. Den in vivo ovanligt förekommande metallen kobolt är i molekylen koordinerad med ett tetrapyrrolringsystem. B12 omsättes i kroppen, bildande ett koenzym, vilket är av betydelse då kol-kolbindningar skall brytas. Dock förändras själva enheten som sådan inte under genomgången metabolism, utan kvarstår i en identifikativt giltig form, för att såsmåningom lämna kroppen via tarmen såsom just kobalamin. Vitaminet ifråga uppbär delfunktioner som är viktiga för celldelningen.
Blodbrist av en typ, erinrande om perniciös anemi, kan försåvitt B12 -vitamin- brist föreligger, iakttagas. Antingen har bristtillståndet sitt upphov i otillräckligt vitamininnehåll i födan, eller så är, vanligare, tarmresorptionen inskränkt på ett eller annat sätt. En av magslemhinnan producerad faktor, vilken under vitaminets passage genom magtarmkanalen synes förena sig därmed, är nödvändigt för upptaget. Nämnda faktor saknas vid tillstånd av perniciös anemi, vilket förklarar den härvidlag parallella iakttagelsen. Kost, innehållande ringa mängder B1 men stora mängder folsyra, kan giva upphov till brist, liksom vikande sköldkörtelfunktion. Binnikemask förorsakar långtgående inskränkningar i tillgången på vitaminet, sannolikt huvudsakligen i det att parasiten agerar konsument. Abnorm tarmflora och genomgångna, operativa ingrepp, varunder delar av digestionssystemet avlägsnats, spelar självfallet stor roll för tillgängligheten.
Emellertid lagras vitaminet trots sin vattenlöslighet effektivt i kroppen och enär minimibehovet är verkligt litet kan symtomen låta vänta på sig i flera år efter avbruten tillförsel. Halveringstiden är ca: ett år för i levern inmängt B12. Symtombilden avseende B12- brist kan innefatta störningar i koncentrationen, minnet och balansen, koordinationsrubbningar, depressioner, irritation och allvarligare demens och irreversibla förändringar i ryggmärgen.
I likhet med flera andra B-vitaminer är B12 inblandat i kolhydratomsättningen, samt delaktigt i blodbildningen. Det medverkar även i fett- och proteinmetabolismen.
En rekommendabel minimidos ligger kring 3 mikrogram/ dygn, men ytterligare tillförsel är, trots kroppens initiala benägenhet att anlagra eller behålla vitaminet, praktiskt taget riskfri också vid megadosering.
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