Rather than worrying about the dose of B12 first it's important to know the type of B12 a person is using. There are four types and one of them is synthetic and contains cyanide it's a small dose of cyanide and usually leaves our body after it's played its role in the steps to level eight the synthetic version into the active form that the body needs as B12. The synthetic version is cheaper and used the most. The other three forms are natural require less steps to convert and safer for a person who has trouble metabolizing medication or has kidney or liver impairment that delays detoxification of the harmful agents. When looking at this as a scientific approach rather than a medical practice you'll see through research as it goes deeper which form of B12 is right for you I personally use methylcobalamine
I suffer from on-going Tinnitus. (A constant ringing or humming in the ears). As I age, it is getting worse and I have tried most every suggestion out there. Vitamin B12 is recommended in the literature to help relieve the ringing and I have yet to try it.
I am wondering if anyone out there has truly found relief from this. Not getting much help from the medical community. All I am told is that there is currently no cure.
@Diane Just saw your post & I hope you see this reply someday. Tinnitus is just awful and I've yet to find a real solution. A brown noise sound machine, in addition to a TENS Unit helps. Recently started B12 drops but it's too soon to tell. Good luck to you!
What has not been mentioned here is the form of b12 that may be causing problems.
Methylated b vitamins are more easily absorbed and do not build up in the blood.
The synthetic forms, are cheap , ubiquitous, and toxic to many
This is an irresponsible article. Disclaimmers at the end of an article don't count for much, not everyone stays until the curtains come down. The subjects of the study were NOT taking supplements.
I stumbled across this researching for a close friend whose B12 level was well above the normal limit, which is mostly just a number taken from bell curves. Completely asymptomatic and his new primary care doctor overreacts to everything and orders more tests for every little thing. Could study my friend as a case study as to why our health care costs are out of control with no attendant benefit to our statistics on longevity or QOL compared to other saner countries labelled socialist by our very serious greed over people folks.
This article doesn't cover one other B12 issue: those of us who are mildly allergic to B12 supplements, especially these mega doses of sublingual tablets. After about 7 weeks of taking 1000 - 2000 a day -- I'm a vegetarian -- I developed a blush like dermatitis, particularly on one side, starting on an arm. It was odd, as it felt like seasonal dry skin beginning early. As if showers were too hot. But it later appeared on both knees and my torso. It's mild but annoying. I did some on-line research and learned than some people have a histamine reaction to cobalt-derivative material, and all oral B12 supplements are cobalt-based. Being water soluble and easily eliminated in urine doesn't make a substance safe for those with an immune response. Anyone else know more about this?
They do not facto in autoimmune pernicious anemia which is an under diagnosed and gravely misunderstood disease that can lead to severe B12 deficiency, but w/ above normal serological B12 levels due to malabsorption issues. Pernicious anemia is a fatal disease if left untreated and greatly diminishes longevity.
Undiagnosed pernicious anemia also raises homocysteine, affecting health and life expectancy.
If this was not factored in, which it wasn't, this article and the scientists are missing a crucial element in how high B12 can be linked to autoimmune PA and therefore lower life expectancy.
5
Attention grabbing article - read the last paragraph “ “Excessive levels of B12, he said, “might change the gut microbiota in ways that could be harmful — no one really knows.”
Still, Dr. Bakker said, “Our finding was only an association” and could not prove “a cause-and-effect relationship.”
Association means nothing - it means they had no results indicating High B12 levels lead to early death ..They didn’t control the variables -
Agree with others could be non functioning organs causing b12 to accumulate . There’s many reasons why the microbiome in the stomache would change - but doubtful it would create absorption issue as gut disregulation of bacteria usually relates in ability to absorb nutrients.. there is no upper reference range listed in science because no studies have proven high B12 causes death .
Many studies however have been done on high carbohydrate intake and not enough animal protein causing high folate that mask B12 . Think author would serve society better if he focused on increasing B12 through diet to escape the effects of b12 deficiency which is prevalent in the world ..
for all mostly plant based people - please do not stop supplementing B12!!! It may already be supplemented in some vegan products .I cannot absorb B12 from food due autoimmune disease and trust me you don’t want to develop a deficiency - eventually leads to paralysis if untreated
8
I began life as a vegan in 2006. I consumed maybe 500 ml of fortified plant milk per day. The brand I used meant that I was receiving maybe 300% of my recommended daily allowance of B12. But the complex of other B vitamins (required for synthesis) were not present in the brand. I experienced psychosis. This psychosis returned when I was breastfeeding and snacking on fortified cereal and plant milk. It particularly happened after my last bowl of cereal at night! Symptoms stopped after I now drink unfortified milk, and don’t snack on cereal so often. And since I am no longer vegan. My kidneys are healthy but according to a doctor ‘a little on the small side’. I don’t know about my liver but I have no history of obvious liver disease, eg jaundice. I am possibly slightly on the autism spectrum.
2
What would it possible mean if someone who’s b 12 was elevated (1200 or 1300) but their CBC, comprehensive panel, hemoglobin a1c, magnesium, tsh, and vitamin test came back normal?
1
@Kara
. . . Poor intracellular uptake. There are variants of Transcobalamine II receptor that transfers B12 from the serum to the intracellular space that do not work well. This means that the cell can be low in B12 while the blood labs imply the opposite. This is why many doctors trying to sort through this issue will look to intracellular B12 levels, as well as haptocorrin levels, MMA, Homocysteine and functional nutrient tests like that offered by Spectracell.
There is also the issue of cyanocobalamin being inactive as a species of B12 and is a form people often supplement with. This will make blood levels will look normal or high but can induce a relative deficiency or insufficiency. Smokers also have high CN-B12 because there is co much cyanide in tobacco smoke. This is important in older research looking at risk of supplementation because almost all B12 offered for oral delivery was this from a decade ago. Thus research before this is compromised by not know what the B12 form is in the serum they are measuring.
1
Proper kidney and liver function are required to rid the body of excess vitamins including B12. What this study indicates loosely is liver and kidney dysfunction suggested by elevated b12 levels have a higher mortality rates than better functioning endocrine organs. If your kidneys or liver are failing you will be less likely to rid the body of toxins including excess vitamins.
The author either has poor reading comprehension or is angling for sensationalism.
4
This study has more value in the number of questions it raises, rather than as a stand alone study.
Since none of the participants was supplementing, does that mean they were getting B12 from animal foods, like meat, dairy and eggs? Tons of other potential risk factors for higher mortality to consider if that's the case.
If they were vegan, what did they eat to maintain such high levels?
Side note: it is pretty well established that supplementation of most vitamins and minerals in general can carry high risk for higher mortality and health complications - even at "recommended" doses. Folic acid is one example.
But most research suggests that B12 toxicity from even very high levels oral supplementation nearly impossible.
4
I'm writing a report, and I'm trying to figure out what are the side effects of taking to much B12? What will happen?
Liver disease, kidney disease, and other life threatening conditions can cause elevated B-12. Excessive B-12 is normally eliminated in the urine.
7
very easy to test b-12 levels, this should take the guesswork out
2
I took additional b12 because I'm vegatarian, but thanks for the article! Now I know, that I shouldn't overtake it.
3
Someday, somewhere in the near or distant future, a science writer will pen an article talking about what deficiencies in certain vitamins means to good health.
Most articles, like this one, warn about the dangers of taking too many specific vitamins. Who pays for this negative research? A group that wants us to not spend money on health-based products like vitamins and spend it on junk food? When will we see expensively researched articles on the dangers of certain foods and their contributions to obesity and early death?
Articles on the dangers of vitamins are prevalent and have become a joke.
7
@Richard J. Noyes they're all over the place. Have you looked?
2
If the study didn't control for diet, in particular adherents of vegan and vegetarianism then it missed a segment of the population requiring a B12 supplement.
5
OK, this article raised a lot more questions than it answered.
10
ONE IMPORTANT CLINICAL CONUNDRUM I HAVE PERSONALLY OBSERVED IN PATIENTS WITH SYMPTOMS OF B12 DEFICIENCY BUT WITH MID-TO-HIGH NORMAL B12 BLOOD LEVELS, IS THE B12 ASSAY IS NOT ALWAYS RELIABLE. THE PHYSICIAN WHO SUSPECTS THE PATIENT IS B12 DEFICIENT MUST ALSO OBTAIN METHYLMALONIC ACID AND HOMOCYSTEINE BLOOD LEVELS. IF THOSE ARE ELEVATED DESPITE A NORMAL B12 ASSAY IN A SYMPTOMATIC PATIENT, THE DEFICIENCY IS SUBSTANTIATED (VERY GOOD REFERENCE: STABLER, SP. VITAMIN B12 DEFICIENCY, NEW ENGLAND JOURNAL OF MEDICINE, 2013;368:149-160).
13
@Robert F. Saul, MD Thank you, your comment and info is greatly appreciated !
2
Here in the states the average suggested level is 300 to 1200 though people in the300’s are more likely to have neurological symptoms. Japan says the lower level should be 500. I’ve heard a study said a higher than average level may decrease The chance of getting Alzheimer’s disease. A low level can result in neuropathies - loss of feeling in the feet and lower legs. What is the ideal level. I don’t know - food would probably be the best source if your body absorbs it. Best of health to everyone .
3
"Very high blood levels of vitamin B12 were tied to an increased risk of early death."
No, not even tied.
It's an association, not even a correlation, or maybe docs in the Netherlands use it to mean correlation. Who knows? I don't think it should be used to describe the results of any scientific study. The headline is sensationalism, though, certainly not the factual news headline I expect from the Times.
27
I am a 62 year old vegan I take B12 every day should I have my blood checked to make sure I’m not taking to much ?
15
@Esther it is mostly likely fine as a vegetarian to supplement with B12. But yes your doctor should be ordering bloodwork panels for you at your yearly physical, this should include testing for B12 levels.
I have always been slightly low in B12 and then suddenly plunged into deficiency. I’ve been on 2000mcg since and will return for a follow up visit to see how the levels are looking now. I am a vegetarian/ mostly vegan.
1
Is the correlation of high B-12 levels with higher mortality also correlated with source of B-12, eg. red meats?
14
@Ruffy Very good question. I wonder of the study factored that in.
4
Zipfizz energy drink powder has 41,677% of your recommend daily allowance of B12. That never seemed like a good idea to me.
6
What are the risks for vegetarians who do take a supplement?
8
Scientists, and science journalists, often proclaim that association (and correlation) are not causation; but they never say what IS causation! Maybe because they don't know?
2
@Frank Williams
Actually, scientists do say when they identify a cause. And people ignore the science. Or worse, they quibble about irrelevancies. In the last century, statisticians proved that smoking tobacco causes cancer. Today, 50 percent of all smokers still die from smoking-caused illnesses: cancer, heart disease, stroke and more. Yet addicted people keep smoking. Like Rush Limbaugh, my father daily denied the cause, smoking until age 69 when diagnosed with - you guessed it - fatal lung cancer.
5
Correlation does not equate causation, very irresponsible article. It is the equivalent of saying that the color red is deadly due to a higher percentage of people dying in red vehicles. Even the end of the article states no "a cause-and-effect relationship.” So why title like B12 is even a remote chance of being deadly, basically clickbait, for shame NYT, for shame, not ethical to have this as a NYT article.
39
If none of the study participants were taking supplements might the elevated levels of B12 in some participants be linked to increased consumption of animal sourced foods? It is not clear from the article what the dietary habits of the subjects were and whether or not elevated B12 correlated with consumption levels of mear, eggs, and dairy.
This information would be useful to have since in the absence of supplementation the only dietary source of B12 is animal sourced foods, which have known adverse effects on health and all cause mortality.
24
So what are the 'normal' level for 60+ age, vegetarians?
30
If they weren’t taking supplements why were their vitamin B levels so high? Is that simply natural variation?
10
@Godzilla De Tukwila
Presumably, yes, it's normal variation. The "high" group was greater than 455 pg/ml. The "normal range" for B-12 (from LabCorp) is 232-1245.
So I guess the researchers are saying that anyone in the top half of the normal range is at increased risk for mortality. Not sure what they'd propose doing about this since the body (i.e. liver) stores 6-7 years-worth of B-12. Even if you could cut the blood levels, your liver would just reinstate the B-12 levels to what it regarded as normal.
7
"Researchers in the Netherlands measured B12 levels in 5,571 generally healthy men and women whose average age was 54. None were taking supplements. They followed them for an average of eight years."
None were taking supplements.
9
@dlb
The authors are clearly suggesting that oral B-12 supplementation is a potential problem, even though none of the participants were supplementing.
From the Introduction:
"Furthermore, it has been found that combined supplementation of folic acid, vitamin B6, and vitamin B12 results in more rapid decline of renal function and an increase in occurrence of vascular events in patients with diabetic nephropathy. Taken together, these findings underscore the importance of further exploration of a possible role of chronic kidney disease (CKD) in the association of plasma concentrations of vitamin B12 with all-cause mortality."
From the Conclusion:
"The results of this study could also be clinically interpreted in the context of oral vitamin supplementation. Concern about the excess intake of vitamins, particularly vitamin B12, has gained attention. A 2010 study by Løland et al reported that vitamin B supplementation had no beneficial effect on the progression of coronary artery disease, as had been hypothesized previously. Moreover,in a prospective study with 75 864 women, vitamin B12 supplementation was associated with an increased risk of hip fracture. In that sense, our results may also suggest that caution should be taken when considering vitamin B12 supplementation in the absence of vitamin B12 deficiency."
7
“Our finding was only an association” and could not prove “a cause-and-effect relationship.”
6
Vitamin supplementation will be decried...until big pharma controls it all.
7
Not all B12 supplements are the same. I would only take a high quality METHYL cobalamine supplement as opposed to CYANO cobalamine...I had extreme anemia which could have killed me and I take a special gel cap w selenium, zinc, etc w the Methyl B12
13
@V How about MECOBALAMIN (sublingual)? Are they equally good?
4
This column doesn’t mention the differences between the synthetic form of b12 and the natural form. The synthetic form cyanocobalamin has a cyanide group(which can’t be good) but the natural form has a methyl group and thus is named methylcobalamin.
High blood levels could mean poor metabolism of the synthetic form.
Making an association like this is meaningless without more data.
13
@ANash The study was of people who were not taking supplements.
2
This is sort of a puzzling, useless study. For one thing, B-12 levels are typically not measured by doctors. If anything, elderly people are probably suffering from B-12 levels that are too low, just as they are most likely suffering from other elements of malnutrition as they age.
More important, however, is the assumption that oral supplementation can create B-12 "overdosing." In fact, the body absorbs only very small amounts of B-12 from food or vitamins. See the quotes below from the NIH fact sheet.
So you can eat a 1,000 mcg pill and most of that goes right through your system and down the drain.
Years ago, I had a B-12 deficiency and they put me on monthly shots because oral supplementation is so ineffective. After an injection my levels would rise to about 1200, then my system eliminated what it didn't need and I'd get down to my historical normal of around 450.
Bottom line: I doubt someone could "overdose" on B-12 without doing multiple shots/month.
NIH B-12 factsheet:
"Approximately 56% of a 1 mcg oral dose of vitamin B12 is absorbed, but absorption decreases drastically when the capacity of intrinsic factor is exceeded (at 1–2 mcg of vitamin B12.)
"... However the body’s ability to absorb vitamin B12 from dietary supplements is largely limited by the capacity of intrinsic factor. For example, only about 10 mcg of a 500 mcg oral supplement is actually absorbed in healthy people."
https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
19
@Paul B
By the way, I should probably add that if you experience a precipitous drop in B-12, you will definitely know it because muscles don't work very well without enough B-12. You may experience trouble walking, issues with your digestive tract, etc. Not sure about slowly dropping levels but I imagine they'd produce increasing fatigue, forgetfulness, confusion, etc (sound kind of like what you'd see in an elderly person, right? Probably not a coincidence.)
If you're concerned and can't get your doc to authorize a B-12 test, just do it yourself at a site like the one below. Also, don't let people tell you that because your number is technically in the "normal range" it's OK. Mine had dropped 60-70% in a relatively short period of time but hadn't quite dropped below the minimum of 211. (The real question in any issue involving labs is what's normal, or not, for you. You only know that by knowing your numbers.)
https://www.lifeextension.com/lab-testing/itemlc100002/b12-status-panel-blood-test
10
@Paul B
Ahhhh......I was waiting for someone to mention intrinsic factor. For those who don't know, intrinsic factor is made in the stomach lining and helps one absorb B12. As we age, we make less and less of it and that's why B12 is administered as a shot rather than a pill. Yes, older folks are more likely to suffer from this deficiency. But let's not overdo it. one shot per month is adequate.
5
Symptoms of lack of vitamin B12 can cause serious anemia, nerve damage and degeneration of the spinal cord. ... A lack of B12 damages the myelin sheath that surrounds and protect nerves. (symptoms associated with Fibromyalgia) Without this protection, nerves cease to function properly and conditions such as peripheral neuropathy occur.
That's why I supplement b12 & b1 with Lipoic acid.
Good article
6
Very interesting. Question is, is it a "real" excess, where the cells have an excess and therefore the blood has an excess, or is there an excess in the blood becuse it can't be used by the cells?
Interesting whether if there is a genetic marker that's common in the folks with higher B12 levels. Or if people who feel worse tend to OTC supplement B12...
5
This is not easy to understand all the detail on the topic of b12 Deficiency and how it is so unusual that the knowlege of the active B12 and testing for this is so unknown by gp ... If there is any risk to a taking b12 supplements.... Is it possible to concider depending on what the person's health condition and genetic back grown and the lack of information that's provided by health care... The effects and B12 and what B12 is being used as treatment would be vary diffrent to for instance a person who has auto-amune disease are going to be diffrent then some one who's using supplements for diet...there is four types of cobolumin (B12) and not all the b12 supplements are the right ones needed..and if public are not having to self educate in order to attempt getting quality of life back. The public heath care system has no signs of any plan or interest for researching this..That's is major part the Harmful risk and effects of b12 to people... Especially in Canada!
lucky,I had chance to learn about this on my own, most cases are not identified, they have been limited, most suffer there entire lives with out knowing that B12 Deficiency are in relation to the illnesses that are being misdiagnosed and treated as fibro or muscular sclerosis and mental health problems autism, and ADHD bipolor disorder.... It would be nice to know that the B12 that's in most supplements r not the ones people lack and need to make healthy blood cells
2
Moral of story: Don't take supplements (any supplements) unless you suffer from a deficiency.
7
@Rupert
We all suffer from massive deficiencies.
Our soil has been continually depleted of nutrients since the 1930's with the advent of mechanized agriculture. If you look at a graph of soil nutrients there is a 45 degree downward slope from 1930 to today with down bumps from pesticides, soil erosion, declining seed quality, fertilizers, and GMO crops, and every other "advance." The advances increase crop yield and Big Ag profit, but decrease nutrient quality and human health.
17
@Fourteen14
Unlike minerals, soil nutrient content is not particularly relevant for vitamins.
Almost all of them (B12 excepted) are synthesized in plants, not absorbed from the soil. They are also almost exclusively composed of very common elements, readily obtained from air and water (C, H, O), and chemical fertilizers (primarily N).
If people are suffering from deficiencies, it's probably from a lack of whole foods in the diet (especially fruits and vegetables), not the agricultural practices used to grow those foods.
7
@DS I disagree...soil microbes which have traditionally added to our health are being microwaved into oblivion.
2
Although the author is rightfully cautious in drawing conclusions about B12 cause-and-effect, over the counter dosages are typically extreme. My local stores only stock enormous doses 1000 mcg and up. Unless someone has a diagnosed deficiency, such huge daily doses seem potentially dangerous long term. Instead, I special order more reasonable doses of 100 mcg, the smallest I can get (background: mostly vegan, age 73).
8
@ghsalb,
Vegans do need to take supplements, since plant foods don’t contain vitamin B12.
But, many older people lose the ability to actively transport B12 across the intestine; in that case, they need to take large amounts to allow for passive diffusion of small amounts of B12 into the bloodstream. About 1 in 3 older people are deficient in B12, and presumably unable to actively take it up. But interestingly, so are about 1 in 6 animal product eaters.
Many doctors don’t test for B12 levels, which seems crazy to me, given how many people are deficient in it, and what the symptoms of B12 can be (which includes peripheral neuropathy and dementia). I think a blood test for B12 levels would be a place to start, to help determine how much B12 a vegan should take.
11
@Dr. J
Of course, while you're at it, one should mention all the other deadly vegan and vegetarian deficiencies: calcium, heme iron, iodine, carnitine, carnosine, creatine, trace minerals, omega-3s, DHA, zinc, D3, retinol, magnesium, and higher quality protein.
B-12 is the tip of the iceberg. All those missing nutrients are found in meat and are far more bioavailable, too.
Note that vegetarians do not live longer than meat eaters as vegetarians love to say. The studies were not exactly comparing meat eaters with vegetarians - they compared vegetarians with those who ate burgers, plus fries, shakes, sodas, and other processed foods. Lots of confounders.
And not that it shows the opposite, but Hong Kongers eat the most meat and live the longest lives.
6
@Fourteen14,
Most of the evidence does not support what you state.
Moreover, eating animal products is not sustainable — raising animals to eat requires far more resources in terms of land, water, petroleum products (fertilizers, biocides, fossil fuel) than does raising crops for human consumption — it is environmentally degrading, releases far more greenhouse gasses, is cruel to animals and workers in the environment, and contributes far more to the development of antibiotic resistance.
And, evidence shows that eating whole plant foods is far healthier than eating animal products and processed foods.
9
B12 is consumed only by eating animal products. Vegans are advised to supplement with B12 to avoid neurological damage.
16
@William But does too much B12 cause other issues? My father had high B6, which was considered a bad thing.
2
The article suggests it does.
1
You say “None were taking supplements,” but in the article they explain that they are referring to prescribed B12 injections, and had no access to information about over the counter supplements. Correct me if I’m wrong: I’m not very good at reading scientific studies.
10
@Peter Silverman : They were able to independently confirm that the study participants were not receiving B12 injections because they had access to pharmacy records. But they weren't able to independently confirm that participants weren't taking over-the-counter supplements, i.e., they had to take the participants' word for it.
9
First, it would seem so basic that they must have compensated for diet - they didn't or couldn't - but B-12 is highest in foods that are have often been implicated in heart disease, variants of beef, eggs, and cheese, as well as some foods touted for health benefits, salmon.
Second, this was a post hoc analysis as part of a larger study on the prevention of renal and vascular disease, and the criteria and selection process for the study participants might have skewed the population.
Third, plasma concentrations say nothing about consumption, nor about supplementation. Like many similar findings, of a correlation between a plasma value and some nutrients, there is often no, and often an inverse, relationship between the supplementation and its presumed effect; think calcium, vitamin D, Vitamin E, etc.
Fourth, the flaw in much reporting and in many people's thinking is that the study is true on its own, but it needs to be interpreted as a part of a collection of studies. After many studies of heart disease, one finds general findings for the effects of exercise and/or medications, but there are often studies that show a null effect and some that will show the opposite result. One needs to judge studies as a whole collection or as part of a meta-analysis to verify the meaning.
65
@James Igoe Excellent analysis!
7
@Joseph Something else to consider. Diabetics taking Metformin over a long period are prone to B12 deficiency. Which causes Diarrhea.
2