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LetterLetters

Response to letters about vitamin B12

Michael R. Kolber and Sherilyn K.D. Houle
Canadian Family Physician June 2014, 60 (6) 522;
Michael R. Kolber
Edmonton, Alta
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Sherilyn K.D. Houle
Edmonton, Alta
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We thank Drs Rosenberg and Vitou for their letters1,2 pertaining to our article, “Oral vitamin B12: a cost-effective alternative.”3 We would like to clarify a few of the statements. First, Dr Rosenberg raises the concern that B vitamins increase the risk of cancer and mortality. A systematic review of 12 randomized controlled trials (including the study Dr Rosenberg referenced) that enrolled more than 47 000 patients concluded that B vitamins do not increase the risk of cancer or mortality (and also do not prevent cardiovascular disease).4

Next, we do agree with Dr Vitou that some patients who do not have vitamin B12 (VB12) deficiency might feel less fatigued when they receive intramuscular VB12 injections. Of interest, it appears that the only high-level evidence supporting this practice was a small crossover controlled trial of 28 patients published more than 40 years ago.5 In this study of relatively young, mostly female, non-anemic patients, both intramuscular VB12 injections and placebo improved general symptoms, including fatigue and overall well-being.

We believe that VB12 therapy should be reserved for patients with documented VB12 deficiency and not for cardiovascular disease prevention, for patients with cognitive impairment,6 or for patients with general fatigue. Best evidence suggests that VB12 does not increase cancer or mortality rates.

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Rosenberg T
    . Vitamin B12 doses and the elderly [Letters]. Can Fam Physician 2014;60:321.
    OpenUrlFREE Full Text
  2. 2.↵
    1. Vitou CK
    . Elaboration on vitamin B12 [Letters]. Can Fam Physician 2014;60:321.
    OpenUrlFREE Full Text
  3. 3.↵
    1. Kolber MR,
    2. Houle SKD
    . Oral vitamin B12: a cost-effective alternative. Can Fam Physician 2014;60:111-2. (Eng), 118–9 (Fr).
    OpenUrlFREE Full Text
  4. 4.↵
    1. Martí-Carvajal AJ,
    2. Solà I,
    3. Lathyris D,
    4. Karakitsiou DE,
    5. Simancas-Racines D
    . Homocysteine-lowering interventions for preventing cardiovascular events. Cochrane Database Syst Rev 2013;(1):CD006612.doi:10.1002/14651858.CD006612.pub3.
    OpenUrlCrossRef
  5. 5.↵
    1. Ellis FR,
    2. Nasser S
    . A pilot study of vitamin B12 in the treatment of tiredness. Br J Nutr 1973;30(2):277-83.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Balk EM,
    2. Raman G,
    3. Tatsioni A,
    4. Chung M,
    5. Lau J,
    6. Rosenberg IH
    . Vitamin B6, B12, and folic acid supplementation and cognitive function: a systematic review of randomized trials. Arch Int Med 2007;167(1):21-30.
    OpenUrlCrossRefPubMed
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Canadian Family Physician: 60 (6)
Canadian Family Physician
Vol. 60, Issue 6
1 Jun 2014
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Response to letters about vitamin B12
Michael R. Kolber, Sherilyn K.D. Houle
Canadian Family Physician Jun 2014, 60 (6) 522;

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Michael R. Kolber, Sherilyn K.D. Houle
Canadian Family Physician Jun 2014, 60 (6) 522;
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