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B12 Deficiency From Drugs

Further to How To Ingest B12 Orally the following, complements the original post with more data, courtesy of Eddie Vos, and adds serious concerns regarding the impact of drugs on this nutrient. This is, yet again, a clear demonstration on how drugs in addition to their general toxicity continue to exacerbate the very nutrient deficiencies that they pretend to treat under the pretence of a cure no less...

Also note the comment regarding Vitamin C. Its amazing how resilient our bodies are for these Mafioso's to exploit! 

Certainly I should prefer the raw oyster route with their superb taste to boot.

Chris Gupta

Subject: RE: B12 and article Canadian Medical Association Journal (http://www.cmaj.ca)
Date: Sun, 15 Aug 2004 22:19:27 -0400
From: "Cory Mermer" =================

You mention that B12 deficiency can be caused by "effects from drugs". One of the biggest culprits, in my humble opinion, are the drugs taken for "upset stomach" or "reflux" or whatever you want to call it. The popular of these recently in the US has been PRILOSEC (Omeprazole) which recently has gone "over-the-counter".

One of the most common and profound adverse effects of omeprazole is that it severely reduces the absorption of cyanocobalamin (vitamin B-12) (Marcuard 94). Increasing this risk further is the fact that a significant percentage of patients taking omeprazole are also being treated for or are at high risk for heart disease, and therefore are almost always instructed to eat a diet low in red meat (or devoid of it completely) and other animal products, which of course are the best source of vitamin B-12.

Also, omeprazole also reduces gastric ascorbic acid (vitamin C) levels (Mowat 99).

In the US, prescription Prilosec has been replaced, I believe, by NEXIUM. I think that NEXIUM works in the same way, and is only a slightly modified version of PRILOSEC.



Marcuard SP, Albernaz L, Khazanie PG. Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B-12). Ann Intern Med 1994; 120: 211-215.

Mowat C, Carswell A, Wirz A, McColl KE. Omeprazole and dietary nitrate independently affect levels of vitamin C and nitrite in gastric juice. Gastroenterology 1999; 116: 813-822.

Marshall E. Deutsch MED41@aol.com wrote:

Eddie Do you want to tell him that Kilmer McCully told us that oysters are the best source of B12?- M.
Hello Marshall, yes, but not everyone in the group had our pleasure of having oysters with Kilmer and the Ravnkovs in the Union Oyster House in Boston. USDA: oyster = 19 mcg B12/100g [7 medium sized] while beef liver has 60 mcg/100g. Oyster however has 90 mg Zn and ~60 mcg Se -while liver has more of some other B's [300 mcg B9/folate]. 7 oysters will also get you 0.6 g omega-3 [ISSFAL's 'adequate'], beef zero. Both are hard to beat for micronutrients, and flavor!

Maybe, Cory, you can forward this and the attachments to the group. 2 articles on oral B12, the 2nd one [in Blood] is very interesting to the effect that oral may be more effective than injected B12, and that amounts smaller than those used [2 mg/d] are likely to be effective via the process of passive diffusion --and how effectively this therapy lowers homocysteine in these patients. It also illustrated how truly nasty low B12 really is, and how avoidable. It also suggests that these patients ingested little betaine or choline that bypass the Hcy lowering pathway shut by lack of either B9 or B12.

Best, Eddie
-- Wellness: It's the Micro-Nutrients. Stupid! --

Treatment of Vitamin B12–Deficiency Anemia: Full paper is here)
Oral Versus Parenteral Therapy
Lenee A Lane and Carlos Rojas-Fernandez

OBJECTIVE: To evaluate the use of oral cyanocobalamin therapy in the treatment of cobalamin (vitamin B12)–deficient anemia. DATA SOURCES: Primary and review articles were identified by MEDLINE search (1966–May 2000) and through secondary sources. DATA SYNTHESIS: Cobalamin-deficient anemia is among the most common diagnoses in older populations. Cobalamin-deficient anemia may be diagnosed as pernicious anemia, resulting from the lack of intrinsic factor required for cobalamin absorption or as protein malabsorption from the inability to displace cobalamin from protein food sources. Several studies provide evidence that daily oral cyanocobalamin as opposed to monthly parenteral formulations may adequately treat both types of cobalamin-deficient anemias.

CONCLUSIONS: Daily oral cyanocobalamin at doses of 1000–2000 µg can be used for treatment in most cobalamin-deficient patients who can tolerate oral supplementation. There are inadequate data at the present time to support the use of oral cyanocobalamin replacement in patients with severe neurologic involvement.

KEY WORDS: cobalamin, cobalamin deficiency, pernicious anemia, vitamin B12.
Ann Pharmacother 2002;36:1268-72.
Author information provided at the end of the text.

Treatment of Cobalamin Deficiency With Oral Cobalamin (Full paper is here)
By Antoinette M. Kuzminski, Eric J. Del Giacco, Robert H. Allen, Sally P. Stabler, and John Lindenbaum

Because cobalamin deficiency is routinely treated with parenteral cobalamin, we investigated the efficacy of oral therapy. We randomly assigned 38 newly diagnosed cobalamin deficient patients to receive cyanocobalamin as either 1 mg intramuscularly on days 1, 3, 7, 10, 14, 21, 30, 60, and 90 or 2 mg orally on a daily basis for 120 days. Therapeutic effectiveness was evaluated by measuring hematologic and neurologic improvement and changes in serum levels of cobalamin (normal, 200 to 900 pg/mL) methylmalonic acid (normal, 73 to 271 nmol/L), and homocysteine (normal, 5.1 to 13.9 mmol/L). Five patients were subsequently found to have folate deficiency, which left 18 evaluable patients in the oral group and 15 in the parenteral group. Correction of hematologic and neurologic abnormalities was prompt and indistinguishable between the 2 groups. The mean pretreatment values for serum cobalamin, methylmalonic acid, and homocysteine were, respectively, 93 pg/mL, 3,850 nmol/L, and 37.2 mmol/L in the oral group and 95 pg/mL, 3,630 nmol/L, and 40.0 mmol/L in the parenteral therapy group. After 4 months of therapy, the respective mean values were 1,005 pg/mL, 169 nmol/L, and 10.6 mmol/L in the oral group and 325 pg/mL, 265 nmol/L, and 12.2 mmol/L in the parenteral group. The higher serum cobalamin and lower serum methylmalonic acid levels at 4 months posttreatment in the oral group versus the parenteral group were significant, with PF .0005 and PF.05, respectively. In cobalamin deficiency, 2mg of cyanocobalamin administered orally on a daily basis was as effective as 1 mg administered intramuscularly on a monthly basis and may be superior.

© 1998 by The American Society of Hematology.


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