www.vincoinc.com • (p) 1-800-245-1939 or 724-538-5050 • (f) 724-538-9801

Vitamin B12 - 2500P R O F E S S I O N A L F O R M U L A T I O N

www.vincoinc.com • (p) 1-800-245-1939 or 724-538-5050 • (f) 724-538-9801

Vitamin B12 is a water-soluble vitamin that is naturallypresent in some foods, added to others, and available as a dietary supplement and a prescription medication.Vitamin B12 exists in several forms and contains themineral cobalt, so compounds with vitamin B12 activity are collectively called "cobalamins”.Methylcobalamin and 5-deoxyadenosylcobalamin are the forms of vitamin B12 that are active in humanmetabolism.

Vitamin B12 is essential for normal energy metabolismof carbohydrates, fat and protein, and is also requiredfor nucleic acid or DNA synthesis. Along with VitaminB6 and Folic Acid, adequate levels of Vitamin B12 arerequired to maintain normal plasma homocysteine levels.Elevated plasma homocysteine may be an independentrisk factor for developing cardiovascular disease.

Vitamin B12 DeficiencyVitamin B12 deficiency is characterized by megaloblasticanemia, fatigue, weakness, constipation, loss of appetite,and weight loss. Neurological changes, such as numbnessand tingling in the hands and feet, can also occur.Additional symptoms of vitamin B12 deficiency includedifficulty maintaining balance, depression, confusion,dementia, poor memory, and soreness of the mouth or tongue. The neurological symptoms of vitamin B12 deficiency can occur without anemia, so early diagnosisand intervention is important to avoid irreversible damage.During infancy, signs of a vitamin B12 deficiency includefailure to thrive, movement disorders, developmentaldelays, and megaloblastic anemia. Many of these symptoms are general and can result from a variety ofmedical conditions other than vitamin B12 deficiency.

Vitamin B12 and HealthCardiovascular Disease

Cardiovascular disease is the most common cause ofdeath in industrialized countries, such as the UnitedStates, and is on the rise in developing countries. Riskfactors for cardiovascular disease include elevated low-density lipoprotein (LDL) levels, high blood pressure,low high-density lipoprotein (HDL) levels, obesity, anddiabetes.

Elevated homocysteine levels have also been identifiedas an independent risk factor for cardiovascular disease.Homocysteine is a sulfur-containing amino acid derivedfrom methionine that is normally present in blood.Elevated homocysteine levels are thought to promotethrombogenesis, impair endothelial vasomotor function,promote lipid peroxidation, and induce vascular smoothmuscle proliferation. Evidence from retrospective, cross-sectional, and prospective studies links elevatedhomocysteine levels with coronary heart disease andstroke.

Vitamin B12, folate, and vitamin B6 are involved inhomocysteine metabolism. In the presence of insufficientvitamin B12, homocysteine levels can rise due to inadequatefunction of methionine synthase. Results from severalrandomized controlled trials indicate that combinationsof vitamin B12 and folic acid supplements with or without vitamin B6 decrease homocysteine levels inpeople with vascular disease or diabetes and in youngadult women. In another study, older men and womenwho took a multivitamin/multimineral supplement for 8 weeks experienced a significant decrease in homocysteine levels.

Dementia and Cognitive Function

Researchers have long been interested in the potentialconnection between vitamin B12 deficiency and dementia.A deficiency in vitamin B12 causes an accumulation ofhomocysteine in the blood and might decrease levels ofsubstances needed to metabolize neurotransmitters.Observational studies show positive associations betweenelevated homocysteine levels and the incidence of bothAlzheimer's disease and dementia. Low vitamin B12status has also been positively associated with cognitive decline.

Energy and Endurance

Due to its role in energy metabolism, Vitamin B12 is frequently promoted as an energy enhancer and an athletic performance and endurance booster. Theseclaims are based on the fact that correcting the megaloblastic anemia caused by vitamin B12 deficiencyshould improve the associated symptoms of fatigue andweakness.

(V-B12)

www.vincoinc.com • (p) 1-800-245-1939 or 724-538-5050 • (f) 724-538-9801

Interactions with MedicationsVitamin B12 has the potential to interact with certainmedications. In addition, several types of medicationsmight adversely affect vitamin B12 levels. A few examplesare provided below. Individuals taking these and othermedications on a regular basis should discuss their vitamin B12 status with their healthcare providers.

Chloramphenicol

Chloramphenicol is a bacteriostatic antibiotic. Limitedevidence from case reports indicates that chloramphenicolcan interfere with the red blood cell response to supplemental vitamin B12 in some patients.

Proton pump inhibitors

Proton pump inhibitors, such as omeprazole and lansoprazole, are used to treat gastroesophageal refluxdisease and peptic ulcer disease. These drugs can interfere with vitamin B12 absorption from food by slowing the release of gastric acid into the stomach. However, the evidence is conflicting onwhether proton pump inhibitor use affects vitamin B12 status. As a precaution, health care providers should monitor vitamin B12 status in patients takingproton pump inhibitors for prolonged periods.

H2 receptor antagonists

Histamine H2 receptor antagonists, used to treat pepticulcer disease, include cimetidine, famotidine, and ranitidine. These medications can interfere with theabsorption of vitamin B12 from food by slowing therelease of hydrochloric acid into the stomach. AlthoughH2 receptor antagonists have the potential to cause vitamin B12 deficiency, no evidence indicates that theypromote vitamin B12 deficiency, even after long-termuse. Clinically significant effects may be more likely inpatients with inadequate vitamin B12 stores, especiallythose using H2 receptor antagonists continuously formore than 2 years.

Vinco’s Vitamin B12 - 2500

This product contains NO sugar, starch, milk, lactose,soy, gluten, yeast, fish, artificial color, or preservatives.Sodium Free

ReferencesAmerican Heart Association Nutrition Committee, Lichtenstein AH,Appel LJ, Brands M, Carnethon M, Daniels S, et al. Diet and lifestylerecommendations revision 2006: a scientific statement from theAmerican Heart Association Nutrition Committee. Circulation2006;114:82-96.

Boers GH. Hyperhomocysteinemia: A newly recognized risk factor forvascular disease. Neth J Med 1994;45:34-41.

Carmel R. Megaloblastic anemias. Curr Opin Hematol 1994;1:107-12.

Clarke R. B-vitamins and prevention of dementia. Proc Nutr Soc2008;67:75-81.

Clarke R, Birks J, Nexo E, Ueland PM, Schneede J, Scott J, et al. Lowvitamin B-12 status and risk of cognitive decline in older adults. Am JClin Nutr 2007;86:1384-91.

Combs G. Vitamin B12 in The Vitamins. New York: Academic Press,Inc., 1992.

Flynn MA, Herbert V, Nolph GB, Krause G. Atherogenesis and thehomocysteine-folate-cobalamin triad: do we need standardized analyses? J Am Coll Nutr 1997;16:258-67.

Fortin LJ, Genest J Jr. Measurement of homocyst(e)ine in the predic-tion of arteriosclerosis. Clin Biochem 1995;28:155-62.

Herbert V. Vitamin B12 in Present Knowledge in Nutrition. 17th ed.Washington, DC: International Life Sciences Institute Press, 1996.

Herbert V, Das K. Vitamin B12 in Modern Nutrition in Health andDisease. 8th ed. Baltimore, MD: Williams & Wilkins, 1994.

Hutto BR. Folate and cobalamin in psychiatric illness. ComprPsychiatry 1997;38:305-14.

Institute of Medicine. Food and Nutrition Board. Dietary ReferenceIntakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12,Pantothenic Acid, Biotin, and Choline. Washington, DC: NationalAcademy Press, 1998.

Malinow MR. Plasma homocyst(e)ine and arterial occlusive diseases: amini-review. Clin Chem 1995;41:173-6.

National Institutes of Health. Third report of the National CholesterolEducation Program Expert Panel on Detection, Evaluation, andTreatment of High Blood Cholesterol in Adults (Adult TreatmentPanel III). Bethesda, MD: National Cholesterol Education Program,National Heart, Lung, and Blood Institute, National Institutes ofHealth, September 2002. NIH Publication No. 02-5215.

Refsum H, Nurk E, Smith AD, Ueland PM, Gjesdal CG, Bjelland I, etal. The Hordaland Homocysteine Study: a community-based study ofhomocysteine, its determinants, and associations with disease. J Nutr2006;136(6 Suppl):1731S-40S.

Refsum H, Ueland PM, Nygard O, Vollset SE. Homocysteine and cardiovascular disease. Annu Rev Med 1998;49:31-62.

Rimm EB, Willett WC, Hu FB, Sampson L, Colditz GA, Manson JE, etal. Folate and vitamin B6 from diet and supplements in relation torisk of coronary heart disease among women. J Am Med Assoc1998;279:359-64.

Schulz RJ. Homocysteine as a biomarker for cognitive dysfunction inthe elderly. Curr Opin Clin Nutr Metab Care 2007;10:718-23.

Selhub J, Jacques PF, Bostom AG, D'Agostino RB, Wilson PW, BelangerAJ, et al. Association between plasma homocysteine concentrationsand extracranial carotid-artery stenosis. N Engl J Med 1995;332:286-91.

Selhub J, Jacques PF, Wilson PF, Rush D, Rosenberg IH. Vitamin statusand intake as primary determinants of homocysteinemia in an elderlypopulation. J Am Med Assoc 1993;270:2693-8.

Seshadri S, Beiser A, Selhub J, Jacques PF, Rosenberg IH, D'AgostinoRB, et al. Plasma homocysteine as a risk factor for dementia andAlzheimer's disease. N Engl J Med 2002;346:476-83.

Siri PW, Verhoef P, Kok FJ. Vitamins B6, B12, and folate: associationwith plasma total homocysteine and risk of coronary atherosclerosis. JAm Coll Nutr 1998;17:435-41.

Termanini B, Gibril F, Sutliff VE, Yu F, Venzon DJ, Jensen RT. Effect of long-term gastric acid suppressive therapy on serum vitamin B12levels in patients with Zollinger-Ellison syndrome. Am J Med1998;104:422-30.

Ubbink JB, van der Merwe A, Delport R, Allen R H, Stabler S P, RiezlerR, et al. The effect of a subnormal vitamin B6 status on homocysteinemetabolism. J Clin Invest 1996;98:177-84.

Zittoun J, Zittoun R. Modern clinical testing strategies in cobalaminand folate deficiency. Sem Hematol 1999;36:35-46.

Supplement FactsServing Size: 1 Sublingual TabletServings per Container: 60

Amount per Serving %DV*

Vitamin B12 (as Cyanocobalamin) 2,500 mcg 41,667%

*(DV) is based on a 2,000 calorie diet**Daily Value (DV) not established

Other Ingredients: Mannitol, Crospovidone, Natural FlavorContains <2% of: Beet Juice Color, Sucralose, Vegetable Magnesium Stearate

These statements have not been evaluated by the FDA.This product is not intended to diagnose, treat, cure or prevent any disease.