Vitamin B12 Deficiency: What are the consequences?

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The Role of Vitamin B12 in coronary and vascular Health 

Two thirds of stroke deaths in the world occur in developing countries. The incidence of stroke and other vascular diseases has been shown to be due to elevated levels of homocysteine in the blood. Whilst is in not known exactly how elevated homocysteine contributes to stroke and coronary heart disease, it is thought that elevated homocysteine is responsible for atherogenesis and thrombogenesis due to endothelial damage, focal vascular smooth muscle proliferation probably causing irregular vascular contraction, and coagulation abnormalities. Vitamin B12 and folate are essential vitamins in regulating homocysteine levels, with deficiency, particularly in vitamin B12 being directly correlated with increases in homocysteine. Thus, in developing countries, where nutritional status is poor, or where there is primarily a vegetarian or vegan diet, serum levels of vitamin B12 are low, with a resultant increase in cardovascular disease.. Studies have shown that homocysteine levels begin to rise as the vitamin B12 levels in serum drop below 300 pmol/L. It should be noted that this level of vitamin B12 is considerably higher than the levels quoted by most pathology labs as being low.

Topical Vitamin B12 

Continuing reduction in homocysteine levels requires continual treatment with high doses of Vitamin B12 to raise serum vitamin B12 levels and lower homocysteine. Such treatments cannot readily be achieved using oral vitamin B12 supplements due to the limited uptake capacity for vitamin B12 in the intestine. For this reason, vitamin B12 deficiency or  inflammatory conditions such as fibromyalgia are normally treated with vitamin B12 injections. Recently a  topical form of vitamin B12 has been developed which is a specially formulated preparation that is an easy to apply, needle-free delivery system to the skin of the patient. This pain-free form of delivery greatly increases the patient comfort experienced during the administration of the medication and allows for self-medication without the need for medical staff or any special training. Oral supplementation with vitamin B12 does not provide enough vitamin B12 to overcome vitamin B12 deficiency due to the limited uptake capacity of the intestine for vitamin B12, hence there is a requirement for higher initial doses of vitamin B12 to be supplied either by injection or via the topical vitamin B12 formulation.  In addition, the topical formulation is particularly suited to patients with chronic inflammatory diseases who may have gastro-intestinal problems, such as gastric ulcers, atrophic gastritis, Crohn’s Disease and Ulcerative Colitis, or who are on MetforminÔ medication, which can often lead to vitamin B12 deficiency. 

Further Information on the relationship between elevated Homocysteine levels and CVD

See the following web-sites:-

Some references on homocsysteine and CVD are listed below:

  1. Israelsson B, Brattström LE, Hultberg BL. Homocysteine and myocardial infarction. Atherosclerosis. 1988 Jun;71(2-3):227-33

  2. Brattström L, Lindgren A, Israelsson B, Malinow MR, Norrving B, Upson B, Hamfelt A. Hyperhomocysteinaemia in stroke: prevalence, cause, and relationships to type of stroke and stroke risk factors. Eur J Clin Invest. 1992 Mar;22(3):214-21.

  3. Graham IM. Homocysteine as a risk factor for cardiovascular disease. Trends Cardiovasc Med. 1991 Sep;1(6):244-9.

  4. Brattstrom LE, Hardebo JE, Hultberg BL. Moderate homocysteinemia--a possible risk factor for arteriosclerotic cerebrovascular disease. Stroke. 1984 Nov-Dec;15(6):1012-6.

  5. Dennis VW, Robinson K. Homocysteinemia and vascular disease in end-stage renal disease. Kidney Int Suppl. 1996 Dec;57:S11-7. Review.

  6. Lolin YI, Sanderson JE, Cheng SK, Chan CF, Pang CP, Woo KS, Masarei JR. Hyperhomocysteinaemia and premature coronary artery disease in the Chinese.Heart. 1996 Aug;76(2):117-22

  7. van den Berg M, Stehouwer CD, Bierdrager E, Rauwerda JA. Plasma homocysteine and severity of atherosclerosis in young patients with lower-limb atherosclerotic disease. Arterioscler Thromb Vasc Biol. 1996 Jan;16(1):165-71

  8. Ubbink JB, Vermaak WJ, Delport R, van der Merwe A, Becker PJ, Potgieter H. Effective homocysteine metabolism may protect South African blacks against coronary heart disease. Am J Clin Nutr. 1995 Oct;62(4):802-8

  9. Dalery K, Lussier-Cacan S, Selhub J, Davignon J, Latour Y, Genest J Jr. Homocysteine and coronary artery disease in French Canadian subjects: relation with vitamins B12, B6, pyridoxal phosphate, and folate. Am J Cardiol. 1995 Jun 1;75(16):1107-11

  10. Furie KL, Kelly PJ. Homocyst(e)ine and stroke. Semin Neurol. 2006 Feb;26(1):24-32. Review