B vitamin and coenzyme supplements, benefit and side effects, risks, danger with overdosing
What is the right dosage for daily use, is it one, two, three times the RDA or more?
What are the health benefits of these nutritional supplements?
June 18 2018 by
Ray Sahelian, M.D.

Benefits and medical uses, how can these natural substances help you?
Since B vitamins and their coenzymes play important metabolic roles in numerous biochemical reactions throughout the body, they can influence just about every aspect of brain and physical health. As a rule, individuals who take B vitamins notice improvements in:

Mood and energy
Alertness and mental stamina
Learning and memory
Speed of thinking
Verbal fluency
Concentration and focus
Visual clarity

The B vitamins include:
B vitamin 1 -- Thiamin Cocarboxylase, the RDA is 1.5 mg
2 -- Riboflavin Flavin Mono Nucleotide
3 -- Niacin  Nicotinamide NADH
5 -- Pantothenic acid Pantothene
6 -- Pyridoxine Pyridoxal Phosphate vitamin
Vitamin B12 -- Cyanocobalamin or Methylcobalamin or Dibencozide (B12)

MultiVit Rx - High Quality Daily Vitamins and Minerals
Manufactured by a FDA-approved and GMP-certified facility.



MultiVit Rx Supplement Facts:
Serving Size: 4 Capsules
Servings per Bottle: 30
Amount per Serving:  %DV
Vitamin A - 10,000 IU - 200%
     Beta Carotene - 7,500 IU
     Retinyl Palmitate - 2,500 IU
Vitamin C with Rose hips (ascorbic acid)
Vitamin D
Vitamin-E (mixed tocopherols)
Vitamin B-1 (thiamine hcl)
Vitamin B-2 (riboflavin)
Vitamin B-6
Folic acid
Vitamin B12
Biotin vitamin B
Pantothenic acid (d-calcium pantothenate)
Calcium (citrate)
Iodine (potassium iodine)
Magnesium (oxide)
Zinc (oxide)
Selenium (amino acid chelate)
Copper (amino acid chelate)
Manganese (carbonate)
Molybdenum (amino acid chelate)
Potassium (carbonate)
Green Tea (leaves)
PABA (para aminobenzoic acid)
Citrus Bioflavonoid Complex
Choline (bitartrate)
Betaine (HCI)
Lycopene (from tomato)
Lutein (from marigold extract)

Q. What is your opinion of Solgar, B-Complex "100", 100 Veggie Caps product?
   A. Solgar, B-Complex "100", 100 Veggie Caps has 100 mg of the B vitamins which is a too high an amount for most people.

B vitamin safety, risk, overdose, danger, side effects
Since they are water-soluble, how can one overdose? I'm wondering about the benefits of taking so called "stress" formula B vitamins which contain 250 mg B-12, 100 mg thiamine, 100 mg riboflavin, etc. Much higher than the recommended adult daily dose. Are there side effects to watch out for?
   Even though B vitamins and coenzymes are water soluble, they could still have a physiologic effect before they are excreted, and perhaps taking too much can throw off delicate body biochemistry for a while until they are excreted through the kidneys. They could alter the enzymatic processed in cells, cause rapid heart beat or even heart rhythm irregularities, overstimulation and restlessness, and perhaps insomnia. There is no evidence that taking very high amounts of B vitamins improves health. High dosages of vitamin B6 can cause nerve damage.

Are there any dangers in taking a B-100 or more specifically a B-50 complex long term / indefinitely. I am a healthy 19 y/o male with an anxiety disorder,
    Little research is available regarding the long term use of B vitamin complex in the 50 mg or 100 mg range. It is possible that tolerance could develop, heart rate disturbances could occur, or other side effects may happen that we don't know of. It is best to use lower dosages and to take breaks from use.

Cancer risk
I have been told by a physician that B vitamin supplements are not advised for patients with cancer (leukemia in the person in question). Can you offer any opinions on the role of B vitamins and cancer, specifically leukemia?
    I am not aware of prospective research studies that have looked into the role of B vitamin supplements and the incidence of cancer or leukemia or whether these B vitamin supplements influence the severity of the leukemia. Many such on the market provide several times the RDA for these vitamins and I don't think they are necessarily healthy to ingest whether one has cancer or not. At this time it may be premature to say exactly what the role of B vitamin supplements are in terms of cancer prevention or aggravation, but it may be a good idea to limit at most to 200 percent of the RDA rather than taking megadoses.

Coronary Heart Disease - FDA allows this qualified health claim
"It is known that diets low in saturated fat and cholesterol may reduce the risk of heart disease. The scientific evidence about whether folic acid (folate), vitamin B6, and vitamin B12 may also reduce the risk of heart disease and other vascular diseases is suggestive, but not conclusive. Studies in the general population have generally found that these vitamins lower homocysteine, an amino acid found in the blood. It is not known whether elevated levels of homocysteine may cause vascular disease or whether high homocysteine levels are caused by other factors. Studies that will directly evaluate whether reducing homocysteine may also reduce the risk of vascular disease are not yet complete."
"As part of a well-balanced diet that is low in saturated fat and cholesterol, Folic Acid, Vitamin B6 and Vitamin B12 may reduce the risk of vascular disease. FDA evaluated the above claim and found that, while it is known that diets low in saturated fat and cholesterol reduce the risk of heart disease and other vascular diseases, the evidence in support of the above claim is inconclusive."

Comments: I'm not convinced blood homocysteine levels need to be routinely checked since taking a cheap B vitamin complex will lower them anyway. We do so many blood tests in this country, and medical expenses are skyrocketing.

Mental function improvement
Mind Power Rx is a sophisticated cognitive formula with B vitamins and a dozen brain herbs and nutrients. It combines a delicate balance of brain circulation agents and neurotransmitter precursors with powerful natural brain chemicals that support healthy:

Mental clarity
Alertness and Focus

The herbs include: Ashwagandha, Bacopa, Fo-Ti, Ginkgo biloba, Ginseng, Gotu Kola, Mucuna pruriens, Reishi, and Rhodiola.  The nutrients and vitamins in Mind Power Rx include Acetyl-l-carnitine, Carnitine, Carnosine, Choline, DMAE, Inositol, Methylcobalamin, Pantothenic acid, Trimethylglycine, Tyrosine, and Vinpocetine.

Which Clinical Conditions are they involved in?
Because of their wide range of effects, these supplements and their coenzymes can potentially play a role in:
Depression, although other supplements such as 5-HTP, St. John's wort, and SAM-e pills are quite effective. Older adults with relatively low intakes of vitamins B6 and B12 may have a higher risk of developing depression than those who get more of the nutrients. American Journal of Clinical Nutrition, online June 2, 2010.
Age related cognitive decline
Anxiety disorders
Addiction disorders
Chronic fatigue

Alzheimer’s disease and dementia
   Advances in Nutrition, 2017. Vitamins Associated with Brain Aging, Mild Cognitive Impairment, and Alzheimer Disease: Biomarkers, Epidemiological and Experimental Evidence. Vitamins are involved as cofactors or influence the 6 key sets of pathways or pathologies associated with MCI or AD, relating to 1) 1-carbon metabolism, 2) DNA damage and repair, 3) mitochondrial function and glucose metabolism, 4) lipid and phospholipid metabolism and myelination, 5) neurotransmitter synthesis and synaptogenesis, and 6) amyloidosis and Tau protein phosphorylation. The contemporary level of evidence for each of the vitamins varies considerably, but it is notable that B vitamins are involved as cofactors in all of the core pathways or pathologies and, together with vitamins C and E, are consistently associated with a protective role against dementia.

Parkinson’s disease
Venous thrombosis reduction - J Thromb Thrombolysis 2012. Association between B-group vitamins and venous thrombosis: systematic review and meta-analysis of epidemiological studies. Reduced levels of folic acid and vitamin B12 may be independent risk factors of venous thrombosis.

Are B vitamins helpful for diabetic neuropathy?
   Perhaps, see diabetic neuropathy article that will explain other options for this condition.

Heart disease
Scientists at the University of Michigan in Ann Arbor say that people might live longer if they take daily multivitamins containing recommended doses of the B vitamins folic acid and B12.  Both nutrients help lower blood levels of homocysteine - a common substance found in the body that can harm blood vessel walls and encourage blood clotting and hardening of the arteries. Clinical trials have not yet demonstrated precisely how much benefit can be derived from lowering levels of the substance, but even a small benefit would make it worth taking vitamins. A computer analysis looked at the hypothetical balance between cost and benefit under several different scenarios, based on what is known about homocysteine and the effects of folic acid and vitamin B12. One scenario assumed that reducing homocysteine levels could reduce heart disease risk linked to the substance by 40%. The team found that in this situation about eight life-years could be saved per 1,000 men, and almost four life-years per 1,000 women. It did not matter if vitamins were given to all at-risk people, or just those with elevated homocysteine blood levels.

I should appreciate if you could comment on this NORVIT investigation: Researchers from Norway have found that treating patients who have had a heart attack with high doses of B vitamins does not lower the risk of getting another heart attack or stroke. Contrary to expectations, B vitamins may do more harm than good. NORVIT, the Norwegian Vitamin Trial, is the first trial to examine whether high doses of B vitamins prevent recurrent heart disease in patients who have had a myocardial infarction. A total of 3749 patients were assigned to take B vitamins or placebo for more than three years in addition to standard treatments after a heart attack. Professor Kaare Harald Bnaa MD, University of Troms, Norway, comments, "The results of the NORVIT trial are important because they tell doctors that prescribing high doses of B vitamins will not prevent heart disease or stroke. B vitamins should be prescribed only to patients who have deficiency diseases." The participants in the NORVIT trial were divided at random into four groups that received either 0.8 mg folic acid per day, 40 mg vitamin B-6 per day, both 0.8 mg folic acid and 40 mg vitamin B-6 per day, or a placebo capsule per day. Those who took folic acid or vitamin B-6 alone had a small increase in the risk of cardiovascular disease. However, among those who took both vitamins the risk increased by 20 percent.
   Thank you for bringing this study to our attention. I really find it strange that they would waste all this money and time on a ill-thought out study. If they are going to give the B vitamins, why pick one or two in high doses and skip the rest? I would much rather they had given one or two times the RDA for all the B vitamins rather than 40 mg of B6 which is about 20 times the RDA while not giving B1, B2, niacin, pantothenic acid, B12, biotin, etc. So, this study means little except that people should not take a high dose of one B vitamin at the expense of the others. And the researchers should go back to school and learn the basics of nutrition and biochemistry before wasting time, effort, and money on an ill-conceived study.

The Bs in the Brain Get an A
B vitamins help in energy production and deficiencies lead to fatigue and poor mental functioning. The increased consumption of refined foods has decreased the amounts of B vitamins present in our diet. However, on the positive note, small amounts of B vitamins are regularly added to some food products, such as cereals. The question of whether B vitamin supplementation is necessary in healthy individuals who have a normal diet has been debated ever since vitamins were discovered. The results of several studies over the past few years have influenced my decision in favor of low dose supplementation. There can be cognitive improvements from taking B vitamins. Back in 1995, Dr. D. Benton and colleagues, from the University College Swansea, in Great Britain, gave ten times the recommended daily allowance of nine vitamins (mostly the B vitamins) to healthy college students (Benton 1995). The study lasted for one year. The students reported improvement in mood and feeling more agreeable. There was also an improvement in cognitive functioning, especially in regards to concentration. Many of my patients consistently report that B vitamin supplementation improves their energy, concentration and mood while helping them handle everyday stress better.

For otherwise healthy individuals, supplementation with one to three times the recommended daily allowance of the B vitamins is suggested. Higher dosages may be required for individuals with medical, psychiatric, or neurological disorders.

B Vitamins and their coenzymes 
A B vitamin supplement is the cheapest, safest, and most reliable way to improve your wellbeing and overall mental abilities. I recommend the Bs to those who wish to improve their mood, mental clarity, and energy. The effects of the B vitamins are subtle, especially in the young who normally have adequate dietary intake of these nutrients. Improvements in cognitive functions from the B vitamins are particularly noticeable in middle age individuals and the elderly. Most of the B complex products contain too high doses of the B vitamins. Two to five times the RDA is sufficient for most purposes.

Coenzymated B Vitamin Complex to purchase
B Vitamin coenzyme is an activated and more powerful form of Vitamin B complex.
Supplement Facts:
Amount Per Serving
Vitamin C 9 mg
Thiamin 6 mg [Coenzymated B vitamin 1]
Riboflavin - 6 mg - 330%V                
   Coenzymated B vitamin 2
Niacin - 20 mg - 100%DV
   (from inositol 34 mg, niacinamide ascorbate 30 mg, nicotinamide adenine dinucleotide 10 mg)
Vitamin B 6 - 5 mg - 250%DV
   (from 15 mg pyridoxal -5-phosphate [Coenzymated])
Folate (as folic acid) - 200 mcg - 50%DV
Vitamin B12 - 340 mcg (from 1 mg dibencozide [Coenzymated])
Biotin vitamin 75 mcg - 25%DV
Pantothenic Acid - 13 mg 125%DV
   (as calcium D-Pantothenate)
Coenzyme Q10 (ubiquinone) - 6 mg
Inositol (inositol hexanicotinate) 4 mg

I purchased a product Vitamin B Coenzyme Complex just 3 weeks back. I am having very good results at 2 tabs/per day.The product contains NADH-5mg/tablet. the dosage for NADH in the book Mind Boosters is to take 2.5-5mg of NADH only a few times a week. whereas the the bottle indicates to take 2-3 tablets daily. (which is NADH-10/15 per day). Please let me know about the safe dosage for daily use .
   We believe 1 tablet a few times a week is sufficient for most people. However each person is different. Some need more, others less.

I took a B vitamin coenzyme complex you recommend on your site and I believe I feel a boost in energy, mental clarity, alertness and elevated mood. I went out to lunch w/ folks from the office and had quite a heavy meal: cheese burger w/ Louisiana sausage, some fries and a very heavy beer. I anticipated falling asleep at my desk after lunch, but I haven't really been dragging at all.

You mention in your book Mind Boosters about finding a B vitamin that has five to ten times the RDA amount for B vitamins. Then you mention finding another B vitamin complex that has 2 to 3 times the RDA. I have looked all over the place for a product with these amounts and have come up short. Do you have any name brands or generics that you could refer me to with these amounts. Most B-complexes on the market seem to be B-50's or B-100's or B-25's but nothing of the dose your recommending. Thanks.
   Yes, it's hard to find a B complex that's reasonable in its content. You may consider getting a multivitamin complex that has 1-5 times the RDA, or, get a B-25 and take about a quarter of a pill.

Understanding Coenzymes
In the past few years, many of the B vitamins have become available in their more activated forms known as coenzymes. For instance, the B vitamin niacin is now available in a coenzyme form known as NADH. An enzyme is basically a protein that promotes chemical changes in other substances, itself remaining unchanged in the process. A coenzyme is a substance that facilitates or is necessary for the action of an enzyme.

The brain, just like a car, needs fuel. Our primary source of fuel is through fats, proteins, and carbohydrates in the diet. After digestion in the stomach, foodstuffs are absorbed into the bloodstream and circulate to various tissues and cells where they are broken down into even smaller particles. One of these particles is a two-carbon molecule known as acetyl. Enzymes help break down these fats, proteins, and carbohydrates into acetyl and they then help extract the final energy from acetyl through a process called the Krebs cycle, named after the German biochemist who defined it. This energy is in the form of ATP (adenosine triphosphate). Enzymes also need helpers, and these helpers are called coenzymes. Most of the coenzymes in the body are partly made from vitamins, such as vitamins E, C, lipoic acid, and riboflavin (vitamin B2).

The coenzyme form of a B vitamin often has a significantly more powerful effect than a regular B vitamin. The coenzyme forms of the B vitamins are an exiting addition to the field of nutrition. It is quite possible that the elderly or certain individuals with a particular biochemical deficiency may not be able to make adequate amounts of the coenzyme forms of the B vitamins despite adequate intakes of the individual B vitamins. Hence, the coenzyme forms should be seriously considered in those who do not respond to the regular B vitamins. Some companies include most of the Bs in their coenzyme form together in one pill. I think these products deserve serious consideration, especially for their use in the middle aged and the elderly.

The Individual B Vitamins and Their Coenzymes:

Thiamin (B1) is necessary for the metabolism of carbohydrates and amino acids to adenosine triphosphate (ATP), the primary source of energy in the human body. Thiamin is found in good amounts in milk, lean pork, legumes, rice bran, and the germ of cereal grains, but is lost during food processing and cooking. The current recommended daily allowance (RDA) by government advisory panels is about 1.5 mg.

Studies indicate that supplementation with thiamin provides cognitive benefits. Dr. Benton and colleagues gave 50 mg of thiamin daily to young adult females for a period of two months (Benton 1997). The women reported being more clearheaded, composed, and energetic. The taking of thiamin had no influence on memory but reaction times were faster following supplementation. Prior to taking the thiamin, the women had normal blood levels of this vitamin.

Researchers at Princess Margaret Hospital in Christchurch, New Zealand, measured thiamin levels in elderly individuals before giving them 10 mg of the vitamin a day (Wilkinson 1997). Only the subjects with low thiamin concentrations showed benefits. They had an improvement in quality of life with more energy and deeper sleep, along with decreased blood pressure and weight.

Thiamin is now sold in its coenzyme form called cocarboxylase or thiamin pyrophosphate (TPP). Human studies giving TPP to evaluate cognitive functioning have not yet been published. See also benfotiamine a more fat soluble version.

Food sources for thiamne B vitamin % of daily need
Thiamin (vitamin B1)
Pork, lean, broiled (3 oz.) 73%
Beef liver, braised (3 oz.) 18%
Enriched corn tortilla (1) 18%
Enriched rice, cooked (1/2 cup) 18%
Whole-grain bread (1 slice) 9%

Riboflavin (B2) is a yellow-colored nutrient involved in dozens of metabolic pathways leading to energy production and the making of fatty acids and sterols. Good sources are lean meats, eggs, milk, some vegetables and enriched cereals. The recommended daily intake is about 1.5 mg. You may notice your urine turning a deeper yellow color after taking riboflavin.

Riboflavin is part of two larger activated coenzymes known as flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN). FMN is now available as a supplement. One product contains 25 mg of FMN per pill. Human studies giving FAD or FMN in order to evaluate cognitive functioning have not yet been published.

Food Sources
Riboflavin vitamin B2
Beef liver, braised (3 oz.) 318%
Yogurt, fat-free, (1 cup) 36%
Milk, fat-free (1 cup) 18%

Niacin (B3)
Also known as nicotinamide and nicotinic acid, plays essential roles in a large number of energy pathways. Perhaps as many as 200 enzymes are dependent on this nutrient. Nicotinamide is part of the coenzyme known as nicotinamide adenine dinucleotide (NADH), which is sold as a supplement. Good sources of niacin are meats, legumes, fish, and some nuts and cereals. The recommended daily intake is about 15 to 20 mg.

People with diabetes often have high cholesterol and triglyceride levels. They also have low HDL (the good cholesterol) levels. Niacin, a B vitamin, reduces concentrations of triglycerides and raises levels of HDL cholesterol. However, the use of niacin in patients with diabetes has been discouraged because high doses can sometimes worsen blood sugar control. Researchers at the University of Texas Southwestern Medical Center evaluated the use and safety of once-daily extended-release niacin in diabetic patients with triglyceride problems. During a 16-week, double-blind, placebo-controlled trial, 148 patients were randomized to placebo or 1000 mg a day of niacin. Many patients were also receiving therapy with statins. Patients taking niacin had an average increase in HDL by about 20 percent and reductions in triglyceride levels by about 20 percent compared to the placebo group. Rates of adverse event rates other than flushing were similar for the niacin and placebo groups. Four patients discontinued participation owing to flushing. No harm to the liver or muscles was observed. Blood sugar levels on average rose only minimally. The researchers conclude that niacin is a treatment option for patients with type 2 diabetes who have high triglyceride and low HDL levels.
Dr. Sahelian says: Some diabetics may get benefits with a lower dose of niacin, such as 200 to 500 mg a day, which would reduce the incidence of flushing. An extended release form of niacin seems to be a good option.

Pyridoxine (B6
Also known as pyridoxal, is widely available in most foods including vegetables, legumes, nuts, seeds, and animal products. The coenzyme form of pyridoxine is pyridoxal phosphate (PLP) and at least 100 different metabolic reactions are helped by PLP. PLP is a necessary co-enzyme in the production of brain chemicals: It helps the conversion of 5-HTP into serotonin, tyrosine into dopamine and norepinephrine, and the production of other neurotransmitters such as histamine and GABA. The recommended daily intake is about 1.5 mg. Deficiencies in B6 can lead to low mood.

Human studies with PLP in mood disorders and depression have not yet been published. PLP is available in pills ranging from 5 to 20 mg. Some individuals notice the difference between regular B6 and the coenzyme form. Joan, a 53-year old patient from Beverly Hills, California, says, "I've taken good quality B vitamins for a few years. Recently I tried the pyridoxal phosphate form of B6. It really has increased my energy, mood, and alertness."

Food Sources
Pyridoxine (vitamin B6)
Chicken, light meat, (3 oz.) 33%
Pork, loin, roasted (3 oz.) 33%

I am presently taking a prostate supplement with 50 mg of Vitamin B6. The dosage is 2 pills per day for 10 days and then I pill for the remainder of the bottle. Is 100 mg of Vitamin B6 toxic on a daily basis. I also take a vitamin B6 25 MGS In a multivitamin per day.
   We do not feel comfortable taking more than 20 mg of B6 on a long term basis but different doctors have different opinions on a safe dosage.

Today in my local paper I read that excessive doses of pyroxidine Hcl over protracted periods of time can cause serious damage to the nervous system. The paper said for a person like myself (female 31 yrs) I should be getting 1.3 mg a day.
   B6 may cause problems in doses greater than 50 or 100 mg when taken over several months, but it is unlikely that lower doses cause any immediate or significant problems.

Pantothenic acid (B5)
This nutrient is essential for biological reactions involving acetylation and energy production. This vitamin helps in the formation of acetylcholine, the metabolism of fatty acids, and the incorporation of fatty acids into cell membrane phospholipids. Pantothenic acid is also involved in making steroid hormones, vitamin A, vitamin D, and cholesterol. Good sources are egg yolk and fresh vegetables. The recommended daily intake is about 5 mg. Pantothenic acid is sold over the counter in dosages ranging from 5 to 250 mg.

Folic acid
Also known as folate, it generally functions in cooperation with vitamin B12 in many metabolic reactions, including the synthesis of DNA. Folic acid helps reduce levels of homocysteine, a substance that can increase the risk for atherosclerosis. This vitamin functions as a methyl donor. Folic acid is found in almost all foods and the recommended daily intake is about 400 micrograms. The coenzyme form of folate is called tetrahydrofolate. Folate and other B vitamins seem even more of a wonder drug than anyone suspected: Already known to prevent severe birth defects and heart attacks, they may also ward off broken bones from osteoporosis, two major studies suggest.
   Folate is a water-soluble B-vitamin and enzymatic cofactor that is necessary for the synthesis of purine and thymidine nucleotides and for the synthesis of methionine from homocysteine. Impairment of folate-mediated one-carbon metabolic pathways can result from B-vitamin deficiencies and/or single nucleotide polymorphisms, and increases risk for pathologies, including cancer and cardiovascular disease, and developmental anomalies including neural tube defects.
   New research hints that a suboptimal intake of folic acid may play a role in the development of colorectal cancer, which points to a possible role for folic acid supplementation in colorectal cancer prevention. In individuals with colorectal adenomas -- polyps that can be precursors to bowel cancer -- folic acid supplementation reverses so-called DNA hypomethylation.

Cobalamin - vitamin B12
Methylcobalamin, or cyanocobalamin, has a number of important roles in metabolism, including the synthesis of DNA. This function is particularly crucial when it comes to making new red blood cells. Hence, a deficiency of B12 leads to anemia. The formation of myelin—the white sheath surrounding nerves—is partly dependent of B12. Deficiencies in B12 intake lead to nerve damage, memory loss, poor coordination, low mood, and mental slowness. This nutrient, along with folic acid and B6, helps lower levels of homocysteine. High homocysteine levels are suspected in being one of the factors causing hardening of the arteries.

The recommended daily intake of B12 is about 3 micrograms, but much higher dosages are well tolerated. B12 is found mostly in meats and fish. Vegetarians can become deficient in this vitamin if they don’t take supplements. B12 deficiency can occur in the elderly due to malabsorption from the intestinal tract. If you have gastritis, absorption problems, autoimmune disorders, insulin dependent diabetes, certain thyroid disorders, or take antacids and other medicines that reduce stomach acid, you could have problems in maintaining adequate B12 levels. Hence, monthly B12 shots, in a dose of 1mg (1,000 micrograms), could well provide you with positive cognitive benefits. Sublingual forms of B12 are also available.

There are two coenzyme forms of B12, adenosylcobalamin and methylcobalamin. Adenosylcobalamin is sold over the counter as dibencozide, in a dose of 10,000 micrograms, which is a large dose. Human studies evaluating its role in cognitive disorders have not been published. It’s quite possible that with age, nutritional deficiencies, or enzyme deficiencies, some individuals may not be able to convert B12 into its coenzyme forms.

Vitamin B12 deficiency can often be treated with oral supplements instead of giving an injection. B12 deficiency is common in patients with reduced acid secretion because acid is required to release cobalamin from food. But these patients can absorb oral supplements because the cobalamin is in the crystalline form and not bound to food. Treatment of pernicious anemia can be done with oral B12 at 1000 mcg per day.

Oral supplements of vitamin B12 appear to correct vitamin B12 deficiencies as well as B12 injections. In order to correct a deficiency, oral doses need to contain more than 200 times the recommended daily allowance (RDA) of vitamin B12. Study author Dr. Lisette C. P. G. M. de Groot of Wageningen University in the Netherlands explained that most people develop vitamin B12 deficiencies as a result of "malabsorption," in which their bodies become unable to extract vitamin B12 from food. The deficiency typically strikes older people and takes years to develop. In some instances, people who avoid animal products -- such as vegans and followers of a macrobiotic diet -- can also develop a deficiency as a result of not eating enough B12-rich foods. A is typically treated by monthly, often painful, shots. To investigate whether an oral dose of vitamin B12 works, as well, they tested various daily doses of oral vitamin B12 supplements in 120 people aged 70 and older. They found that daily oral doses of 647 to 1032 micrograms appeared to correct the deficiency. The current RDA for vitamin B12 is 3 micrograms per day. Archives of Internal Medicine, 2005.

Food Sources for B12 B Vitamin
Salmon, cooked (3 oz.) 125%
Beef tenderloin, broiled (3 oz.) 90%
Yogurt, fat-free (1 cup) 58%
Shrimp, cooked (3 oz.) 54%
Milk (1 cup) 38%

Daily intake of 4 to 7microgram dietary vitamin B-12 is associated with steady concentrations of vitamin B-12-related biomarkers in a healthy young population.
Am J Clin Nutr. 2010.
Studies have questioned whether the current Recommended Dietary Allowance (RDA) of 2.4 mcug vitamin B-12/d is adequate. Dietary vitamin B-12 intake was estimated, and biomarkers of vitamin B-12 status were measured, in healthy men and women who were recruited from a Florida community. Plasma cobalamin, total transcobalamin, holo-transcobalamin, methylmalonic acid (MMA), total homocysteine (tHcy), and autoantibodies against intrinsic factor (IF) and Helicobacter pylori were analyzed in blood samples.Antibodies to H. pylori were detected in 12% of subjects, and negative results for IF antibodies were obtained for all subjects. The intake of vitamin B-12 correlated significantly with cobalamin, holo-transcobalamin, MMA, and tHcy. Subjects were divided into quintiles on the basis of their dietary vitamin B-12 intake, and biomarkers of vitamin B-12 status were plotted against estimated dietary vitamin B-12 intake. All biomarkers appeared to level off at a daily dietary vitamin B-12 intake between 4 and 7 mcg. In persons with normal absorption, our data indicate that an intake of 4-7 mcg vitamin B-12/d is associated with an adequate status, which suggests that the current RDA of 2.4 mcg vitamin B-12/d might be inadequate for optimal biomarker status.

Gastrectomy, loss of stomach, does oral supplementation help without intrinsic factor?
Ann Surg Oncol. 2011. Oral vitamin B12 replacement: an effective treatment for vitamin B12 deficiency after total gastrectomy in gastric cancer patients. Vitamin B12 deficiency is a common long-term sequelae after total gastrectomy. Intramuscular injection of vitamin B12 is the only known treatment. We investigated the efficacy and safety of oral vitamin B12 replacement for gastric cancer patients with vitamin B12 deficiency after total gastrectomy. We performed a single-arm, open-label, fixed-drug dosage, prospective study involving gastric cancer patients who underwent total gastrectomy. Vitamin B12-deficient (<200 pg/ml) patients received daily oral vitamin B12 (dosage: 1500 μg mecobalamin) administration for 3 months. The primary outcome measurement was serum vitamin B12. The secondary outcome measurements were improvement of neurologic symptoms and hematologic findings (serum folate, homocysteine, ferritin, iron, total iron binding capacity, transferrin, and mean corpuscular volume). For comparison, another group of vitamin B12 deficient patients received intramuscular vitamin B12 injections (dosage: 1000 μg cyanocobalamin) weekly for 5 weeks and monthly thereafter for a total of 3 months in a separate study period. In both groups, mean serum vitamin B12 increased after 30 days of treatment and was maintained up to 90 days. No adverse effects related to oral or intramuscular vitamin B12 replacements were noted. Both groups showed decreased homocysteine levels. Before treatment, 29 patients in the oral vitamin B12 group had neurologic symptoms related to vitamin B12 deficiency. After oral vitamin B12 treatment, 28 patients experienced symptom relief, and 16 patients were symptom free. Oral vitamin B12 replacement is an effective and safe treatment for vitamin B12 deficiency in gastric cancer patients after total gastrectomy.

Recommendations and review
All of the B vitamins are important and supplementation would probably benefit most everyone. For healthy individuals, taking one to three times the RDA of the Bs would be sufficient. You will find B complex supplements that say B50 or B100 on the label. This means that many of the B vitamins, such as thiamin and riboflavin, are found in dosages of 50 or 100 mg per pill. The RDA for thiamin and riboflavin is about 1.5 mg. The average, healthy person does not need to take these high dosages. However, biochemical individuality certainly does exist. Dr. David Benton, Ph.D., who researches the influence of B vitamins on cognition says, "There can be enormous differences in the needs of vitamins. It wouldn’t be unusual for some individuals requiring 20 times the amount of a particular vitamin compared to others in a similar age group."

Japanese discover first new vitamin in 55 years
Japanese scientists have discovered a new vitamin that plays an important role in fertility in mice and may have a similar function in humans, the research leader said on Thursday. A research team led by Takafumi Kato confirmed that pyrroloquinoline quinone (PQQ), a substance discovered in 1979, can be categorized as a vitamin. "There are many possible factors behind the drop in fertility," Kato said. "We need more research to find out exactly what is happening to these mice and what would be the effect on humans." PQQ is the first new vitamin to be discovered since 1948, the institute said. Vitamins are defined as organic substances needed in small quantities for health and growth. They must be obtained from food as they cannot be produced by the body. The best source of PQQ discovered so far is "natto," a pungent Japanese dish of fermented soybeans. Other foods rich in the substance include parsley, green tea, green peppers, kiwi fruit and papaya. PQQ is not generally included in multi-vitamin tablets available on the market, the release said. There are 13 other types of vitamin already known, and PQQ is believed to belong to the vitamin B group, the release said.

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Supplement Facts
Serving Size: 2 Tablets
Servings Per Container: 30
  Amount Per Serving %DV
Total Carbohydrate 1 g <1%*
Vitamin C (as niacinamide ascorbate) 17 mg 28%
Thiamin (from 20 mg cocarboxylase [Coenzymated]) 13 mg 867%
Riboflavin (from 15 mg flavin mononucleotide [Coenzymated]) 10 mg 588%
Niacin (from inositol hexanicotinate 34 mg, niacinamide ascorbate 30 mg, & nicotinamide adenine dinucleotide 10 mg [Coenzymated]) 39 mg 195%
Vitamin B-6 (from 15 mg pyridoxal-5'-phosphate [Coenzymated]) 10 mg 500%
Folate (as folic acid) 400 mcg 100%
Vitamin B-12 (from 1 mg dibencozide [Coenzymated]) 860 mcg 14,333%
Biotin 150 mcg 50%
Pantothenic Acid (as calcium D-pantothenate) 25 mg 250%
Sodium 5 mg <1%
Coenzyme Q10 12 mg
Inositol (as inositol hexanicotinate) 7 mg