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Dietary Supplement Fact Sheet: Vitamin B12

Office of Dietary Supplements • National Institutes of Health
Table of Contents

Introduction
Recommended Intakes
Sources of Vitamin B12
Vitamin B12 Intakes and Status
Vitamin B12 Deficiency
Groups at Risk of Vitamin B12 Deficiency
Vitamin B12 and Health
Health Risks from Excessive Vitamin B12
Interactions with Medications
Vitamin B12 and Healthful Diets
References
Introduction

Vitamin B12 is a water-soluble vitamin that is naturally present in
some foods, added to others, and available as a dietary supplement and
a prescription medication. Vitamin B12 exists in several forms and
contains the mineral cobalt 1-4, so compounds with vitamin B12
activity are collectively called "cobalamins". Methylcobalamin and
5-deoxyadenosylcobalamin are the forms of vitamin B12 that are active
in human metabolism 5.
Vitamin B12 is required for proper red blood cell formation,
neurological function, and DNA synthesis 1-5. Vitamin B12 functions
as a cofactor for methionine synthase and L-methylmalonyl-CoA mutase.
Methionine synthase catalyzes the conversion of homocysteine to
methionine 5,6. Methionine is required for the formation of
S-adenosylmethionine, a universal methyl donor for almost 100
different substrates, including DNA, RNA, hormones, proteins, and
lipids. L-methylmalonyl-CoA mutase converts L-methylmalonyl-CoA to
succinyl-CoA in the degradation of propionate 3,5,6, an essential
biochemical reaction in fat and protein metabolism. Succinyl-CoA is
also required for hemoglobin synthesis.

Vitamin B12, bound to protein in food, is released by the activity of
hydrochloric acid and gastric protease in the stomach 5. When
synthetic vitamin B12 is added to fortified foods and dietary
supplements, it is already in free form and, thus, does not require
this separation step. Free vitamin B12 then combines with intrinsic
factor, a glycoprotein secreted by the stomach's parietal cells, and
the resulting complex undergoes absorption within the distal ileum by
receptor-mediated endocytosis 5,7. 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) 8.
Pernicious anemia is an autoimmune disease that affects the gastric
mucosa and results in gastric atrophy. This leads to the destruction
of parietal cells, achlorhydria, and failure to produce intrinsic
factor, resulting in vitamin B12 malabsorption 3,5,9-11. If
pernicious anemia is left untreated, it causes vitamin B12 deficiency,
leading to megaloblastic anemia and neurological disorders, even in
the presence of adequate dietary intake of vitamin B12.

Vitamin B12 status is typically assessed via serum or plasma vitamin
B12 levels. Values below approximately 170–250 pg/mL (120–180
picomol/L) for adults 5 indicate a vitamin B12 deficiency. However,
evidence suggests that serum vitamin B12 concentrations might not
accurately reflect intracellular concentrations 6. An elevated serum
homocysteine level (values >13 micromol/L) 12 might also suggest a
vitamin B12 deficiency. However, this indicator has poor specificity
because it is influenced by other factors, such as low vitamin B6 or
folate levels 5. Elevated methylmalonic acid levels (values >0.4
micromol/L) might be a more reliable indicator of vitamin B12 status
because they indicate a metabolic change that is highly specific to
vitamin B12 deficiency 5-7,12.
Recommended Intakes

Intake recommendations for vitamin B12 and other nutrients are
provided in the Dietary Reference Intakes (DRIs) developed by the Food
and Nutrition Board (FNB) at the Institute of Medicine (IOM) of the
National Academies (formerly National Academy of Sciences) 5. DRI is
the general term for a set of reference values used for planning and
assessing nutrient intakes of healthy people. These values, which vary
by age and gender 5, include:
Recommended Dietary Allowance (RDA): average daily level of intake
 sufficient to meet the nutrient requirements of nearly all
 (97%–98%) healthy individuals.

Adequate Intake (AI): established when evidence is insufficient to
 develop an RDA and is set at a level assumed to ensure nutritional
 adequacy.
Tolerable Upper Intake Level (UL): maximum daily intake unlikely
 to cause adverse health effects 5.

Table 1 lists the current RDAs for vitamin B12 in micrograms (mcg) 5.
For infants aged 0 to 12 months, the FNB established an AI for vitamin
B12 that is equivalent to the mean intake of vitamin B12 in healthy,
breastfed infants.
Table 1: Recommended Dietary Allowances (RDAs) for Vitamin B12 5

Age
Male

Female
Pregnancy

Lactation
Birth to 6 months

0.4 mcg
0.4 mcg

7-12 months
0.5 mcg

0.5 mcg
1-3 years

0.9 mcg
0.9 mcg

4-8 years
1.2 mcg

1.2 mcg
9-13 years

1.8 mcg
1.8 mcg

14+ years
2.4 mcg

2.4 mcg
2.6 mcg

2.8 mcg
Adequate Intake

Sources of Vitamin B12
Food

Vitamin B12 is naturally found in animal products, including fish,
meat, poultry, eggs, milk, and milk products. Vitamin B12 is generally
not present in plant foods, but fortified breakfast cereals are a
readily available source of vitamin B12 with high bioavailability for
vegetarians 5,13-15. Some nutritional yeast products also contain
vitamin B12. Fortified foods vary in formulation, so it is important
to read product labels to determine which added nutrients they
contain.
Several food sources of vitamin B12 are listed in Table 2.

Table 2: Selected Food Sources of Vitamin B12 13
Food

Micrograms (mcg)
per serving
Percent DV

Liver, beef, braised, 1 slice
48.0

800
Clams, cooked, breaded and fried, 3 ounces

34.2
570

Breakfast cereals, fortified with 100% of the DV for vitamin B12, 1
serving
6.0

100
Trout, rainbow, wild, cooked, 3 ounces

5.4
90

Salmon, sockeye, cooked, 3 ounces
4.9

80
Trout, rainbow, farmed, cooked, 3 ounces

4.2
50

Beef, top sirloin, broiled, 3 ounces
2.4

40
Cheeseburger, double patty and bun, 1 sandwich

1.9
30

Breakfast cereals, fortified with 25% of the DV for vitamin B12, 1
serving
1.5

25
Yogurt, plain, 1 cup

1.4
25

Haddock, cooked, 3 ounces
1.2

20
Tuna, white, 3 ounces

1.0
15

Milk, 1 cup
0.9

15
Cheese, Swiss, 1 ounce

0.9
15

Beef taco, 1 taco
0.8

13
Ham, cured, roasted, 3 ounces

0.6
10

Egg, large, 1 whole
0.6

10
Chicken, roasted, ½ breast

0.3
6

DV = Daily Value. DVs were developed by the U.S. Food and Drug
Administration (FDA) to help consumers determine the level of various
nutrients in a standard serving of food in relation to their
approximate requirement for it. The DV for vitamin B12 is 6.0 mcg.
However, the FDA does not require food labels to list vitamin B12
content unless a food has been fortified with this nutrient. Foods
providing 20% or more of the DV are considered to be high sources of a
nutrient, but foods providing lower percentages of the DV also
contribute to a healthful diet. The U.S. Department of Agriculture’s
Nutrient Database Web site (http://www.nal.usda.gov/fnic/foodcomp/search/
13) lists the nutrient content of many foods and provides a
comprehensive list of foods containing vitamin B12:
http://www.nal.usda.gov/fnic/foodcomp/Data/SR20/nutrlist/sr20w418.pdf.
Dietary supplements

In dietary supplements, vitamin B12 is usually present as
cyanocobalamin 5, a form that the body readily converts to the
active forms methylcobalamin and 5-deoxyadenosylcobalamin. Dietary
supplements can also contain methylcobalamin and other forms of
vitamin B12.
Existing evidence does not suggest any differences among forms with
respect to absorption or bioavailability. 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 8.

In addition to oral dietary supplements, vitamin B12 is available in
sublingual preparations as tablets or lozenges. These preparations are
frequently marketed as having superior bioavailability, although
evidence suggests no difference in efficacy between oral and
sublingual forms 16,17.
Prescription medications

Vitamin B12, in the form of cyanocobalamin and occasionally
hydroxocobalamin, can be administered parenterally as a prescription
medication, usually by intramuscular injection 12. Parenteral
administration is typically used to treat vitamin B12 deficiency
caused by pernicious anemia and other conditions that result in
vitamin B12 malabsorption and severe vitamin B12 deficiency 12.
Vitamin B12 is also available as a prescription medication in a gel
formulation applied intranasally, a product marketed as an alternative
to vitamin B12 injections that some patients might prefer 18. This
formulation appears to be effective in raising vitamin B12 blood
levels 19, although it has not been thoroughly studied in clinical
settings.

Vitamin B12 Intakes and Status
Most children and adults in the United States consume recommended
amounts of vitamin B12, according to analyses of data from the
1988–1994 National Health and Nutrition Examination Survey (NHANES
III) 5,20 and the 1994–1996 Continuing Survey of Food Intakes by
Individuals 5. Data from the 1999–2000 NHANES indicate that the
median daily intake of vitamin B12 for the U.S. population is 3.4 mcg
21.

Some people—particularly older adults, those with pernicious anemia,
and those with reduced levels of stomach acidity (achlorhydria) or
intestinal disorders—have difficulty absorbing vitamin B12 from food
and, in some cases, oral supplements 22,23. As a result, vitamin B12
deficiency is common, affecting between 1.5% and 15% of the general
population 24,25. In many of these cases, the cause of the vitamin
B12 deficiency is unknown 8.
Evidence from the Framingham Offspring Study suggests that the
prevalence of vitamin B12 deficiency in young adults might be greater
than previously assumed 15. This study found that the percentage of
participants in three age groups (26–49 years, 50–64 years, and 65
years and older) with deficient blood levels of vitamin B12 was
similar. The study also found that individuals who took a supplement
containing vitamin B12 or consumed fortified cereal more than four
times per week were much less likely to have a vitamin B12 deficiency.

Individuals who have trouble absorbing vitamin B12 from foods, as well
as vegetarians who consume no animal foods, might benefit from vitamin
B12-fortified foods, oral vitamin B12 supplements, or vitamin B12
injections 26.
Vitamin B12 Deficiency

Vitamin B12 deficiency is characterized by megaloblastic anemia,
fatigue, weakness, constipation, loss of appetite, and weight loss 1,3,27.
Neurological changes, such as numbness and tingling in the hands and
feet, can also occur 5,28. Additional symptoms of vitamin B12
deficiency include difficulty maintaining balance, depression,
confusion, dementia, poor memory, and soreness of the mouth or tongue
29. The neurological symptoms of vitamin B12 deficiency can occur
without anemia, so early diagnosis and intervention is important to
avoid irreversible damage 6. During infancy, signs of a vitamin B12
deficiency include failure to thrive, movement disorders,
developmental delays, and megaloblastic anemia 30. Many of these
symptoms are general and can result from a variety of medical
conditions other than vitamin B12 deficiency.
Typically, vitamin B12 deficiency is treated with vitamin B12
injections, since this method bypasses potential barriers to
absorption. However, high doses of oral vitamin B12 may also be
effective. The authors of a review of randomized controlled trials
comparing oral with intramuscular vitamin B12 concluded that 2,000 mcg
of oral vitamin B12 daily, followed by a decreased daily dose of 1,000
mcg and then 1,000 mcg weekly and finally, monthly might be as
effective as intramuscular administration 24,25. Overall, an
individual patient’s ability to absorb vitamin B12 is the most
important factor in determining whether vitamin B12 should be
administered orally or via injection 8. In most countries, the
practice of using intramuscular vitamin B12 to treat vitamin B12
deficiency has remained unchanged 24.

Folic acid and vitamin B12
Large amounts of folic acid can mask the damaging effects of vitamin
B12 deficiency by correcting the megaloblastic anemia caused by
vitamin B12 deficiency 3,5 without correcting the neurological
damage that also occurs 1,31. Moreover, preliminary evidence
suggests that high serum folate levels might not only mask vitamin B12
deficiency, but could also exacerbate the anemia and worsen the
cognitive symptoms associated with vitamin B12 deficiency 6,11.
Permanent nerve damage can occur if vitamin B12 deficiency is not
treated. For these reasons, folic acid intake from fortified food and
supplements should not exceed 1,000 mcg daily in healthy individuals 5.

Groups at Risk of Vitamin B12 Deficiency
The main causes of vitamin B12 deficiency include vitamin B12
malabsorption from food, pernicious anemia, postsurgical
malabsorption, and dietary deficiency 12. However, in many cases,
the cause of vitamin B12 deficiency is unknown. The following groups
are among those most likely to be vitamin B12 deficient.

Older adults
Atrophic gastritis, a condition affecting 10%–30% of older adults,
decreases secretion of hydrochloric acid in the stomach, resulting in
decreased absorption of vitamin B12 5,11,32-36. Decreased
hydrochloric acid levels might also increase the growth of normal
intestinal bacteria that use vitamin B12, further reducing the amount
of vitamin B12 available to the body 37.

Individuals with atrophic gastritis are unable to absorb the vitamin
B12 that is naturally present in food. Most, however, can absorb the
synthetic vitamin B12 added to fortified foods and dietary
supplements. As a result, the IOM recommends that adults older than 50
years obtain most of their vitamin B12 from vitamin supplements or
fortified foods 5. However, some elderly patients with atrophic
gastritis require doses much higher than the RDA to avoid subclinical
deficiency 38.
Individuals with pernicious anemia

Pernicious anemia, a condition that affects 1%–2% of older adults 11,
is characterized by a lack of intrinsic factor. Individuals with
pernicious anemia cannot properly absorb vitamin B12 in the
gastrointestinal tract 3,5,9,10. Pernicious anemia is usually
treated with intramuscular vitamin B12. However, approximately 1% of
oral vitamin B12 can be absorbed passively in the absence of intrinsic
factor 11, suggesting that high oral doses of vitamin B12 might also
be an effective treatment.
Individuals with gastrointestinal disorders

Individuals with stomach and small intestine disorders, such as celiac
disease and Crohn's disease, may be unable to absorb enough vitamin
B12 from food to maintain healthy body stores 12,23. Subtly reduced
cognitive function resulting from early vitamin B12 deficiency might
be the only initial symptom of these intestinal disorders, followed by
megaloblastic anemia and dementia.
Individuals who have had gastrointestinal surgery

Surgical procedures in the gastrointestinal tract, such as weight loss
surgery or surgery to remove all or part of the stomach, often result
in a loss of cells that secrete hydrochloric acid and intrinsic factor
5,39,40. This reduces the amount of vitamin B12, particularly
food-bound vitamin B12 41, that the body releases and absorbs.
Surgical removal of the distal ileum also can result in the inability
to absorb vitamin B12. Individuals undergoing these surgical
procedures should be monitored preoperatively and postoperatively for
several nutrient deficiencies, including vitamin B12 deficiency 42.
Vegetarians

Strict vegetarians and vegans are at greater risk than lacto-ovo
vegetarians and nonvegetarians of developing vitamin B12 deficiency
because natural food sources of vitamin B12 are limited to animal
foods 5. Fortified breakfast cereals are one of the few sources of
vitamin B12 from plants and can be used as a dietary source of vitamin
B12 for strict vegetarians and vegans.
Pregnant and lactating women who follow strict vegetarian diets and
their infants

Vitamin B12 crosses the placenta during pregnancy and is present in
breast milk. Exclusively breastfed infants of women who consume no
animal products may have very limited reserves of vitamin B12 and can
develop vitamin B12 deficiency within months of birth 5,43.
Undetected and untreated vitamin B12 deficiency in infants can result
in severe and permanent neurological damage.
The American Dietetic Association recommends supplemental vitamin B12
for vegans and lacto-ovo vegetarians during both pregnancy and
lactation to ensure that enough vitamin B12 is transferred to the
fetus and infant 44. Pregnant and lactating women who follow strict
vegetarian or vegan diets should consult with a pediatrician regarding
vitamin B12 supplements for their infants and children 5.

Vitamin B12 and Health
Cardiovascular disease

Cardiovascular disease is the most common cause of death in
industrialized countries, such as the United States, and is on the
rise in developing countries. Risk factors for cardiovascular disease
include elevated low-density lipoprotein (LDL) levels, high blood
pressure, low high-density lipoprotein (HDL) levels, obesity, and
diabetes 45.
Elevated homocysteine levels have also been identified as an
independent risk factor for cardiovascular disease 46-48.
Homocysteine is a sulfur-containing amino acid derived from methionine
that is normally present in blood. Elevated homocysteine levels are
thought to promote thrombogenesis, impair endothelial vasomotor
function, promote lipid peroxidation, and induce vascular smooth
muscle proliferation 46,47,49. Evidence from retrospective,
cross-sectional, and prospective studies links elevated homocysteine
levels with coronary heart disease and stroke 46,49-58.

Vitamin B12, folate, and vitamin B6 are involved in homocysteine
metabolism. In the presence of insufficient vitamin B12, homocysteine
levels can rise due to inadequate function of methionine synthase 6.
Results from several randomized controlled trials indicate that
combinations of vitamin B12 and folic acid supplements with or without
vitamin B6 decrease homocysteine levels in people with vascular
disease or diabetes and in young adult women 59-67. In another
study, older men and women who took a multivitamin/multimineral
supplement for 8 weeks experienced a significant decrease in
homocysteine levels 68.
Evidence supports a role for folic acid and vitamin B12 supplements in
lowering homocysteine levels, but results from several large
prospective studies have not shown that these supplements decrease the
risk of cardiovascular disease 48,62-67. In the Women’s Antioxidant
and Folic Acid Cardiovascular Study, women at high risk of
cardiovascular disease who took daily supplements containing 1 mg
vitamin B12, 2.5 mg folic acid, and 50 mg vitamin B6 for 7.3 years did
not have a reduced risk of major cardiovascular events, despite
lowered homocysteine levels 65. The Heart Outcomes Prevention
Evaluation (HOPE) 2 trial, which included 5,522 patients older than 54
years with vascular disease or diabetes, found that daily treatment
with 2.5 mg folic acid, 50 mg vitamin B6, and 1 mg vitamin B12 for an
average of 5 years reduced homocysteine levels and the risk of stroke
but did not reduce the risk of major cardiovascular events 63. In
the Western Norway B Vitamin Intervention Trial, which included 3,096
patients undergoing coronary angiography, daily supplements of 0.4 mg
vitamin B12 and 0.8 mg folic acid with or without 40 mg vitamin B6 for
1 year reduced homocysteine levels by 30% but did not affect total
mortality or the risk of major cardiovascular events during 38 months
of follow-up 66. The Norwegian Vitamin (NORVIT) trial 62 and the
Vitamin Intervention for Stroke Prevention trial had similar results 67.

The American Heart Association has concluded that the available
evidence is inadequate to support a role for B vitamins in reducing
cardiovascular risk 48.
Dementia and cognitive function

Researchers have long been interested in the potential connection
between vitamin B12 deficiency and dementia 47,69. A deficiency in
vitamin B12 causes an accumulation of homocysteine in the blood 6
and might decrease levels of substances needed to metabolize
neurotransmitters 70. Observational studies show positive
associations between elevated homocysteine levels and the incidence of
both Alzheimer's disease and dementia 6,47,71. Low vitamin B12
status has also been positively associated with cognitive decline 72.
Despite evidence that vitamin B12 lowers homocysteine levels and
correlations between low vitamin B12 levels and cognitive decline,
research has not shown that vitamin B12 has an independent effect on
cognition 73-77. In one randomized, double-blind, placebo-controlled
trial, 195 subjects aged 70 years or older with no or moderate
cognitive impairment received 1,000 mcg vitamin B12, 1,000 mcg vitamin
B12 plus 400 mcg folic acid, or placebo for 24 weeks 73. Treatment
with vitamin B12 plus folic acid reduced homocysteine concentrations
by 36%, but neither vitamin B12 treatment nor vitamin B12 plus folic
acid treatment improved cognitive function.

Women at high risk of cardiovascular disease who participated in the
Women’s Antioxidant and Folic Acid Cardiovascular Study were randomly
assigned to receive daily supplements containing 1 mg vitamin B12, 2.5
mg folic acid and 50 mg vitamin B6, or placebo 76. After a mean of
1.2 years, B-vitamin supplementation did not affect mean cognitive
change from baseline compared with placebo. However, in a subset of
women with low baseline dietary intake of B vitamins, supplementation
significantly slowed the rate of cognitive decline. In a trial
conducted by the Alzheimer's Disease Cooperative Study consortium that
included individuals with mild-to-moderate Alzheimer's disease, daily
supplements of 1 mg vitamin B12, 5 mg folic acid, and 25 mg vitamin B6
for 18 months did not slow cognitive decline compared with placebo 77.
Another study found similar results in 142 individuals at risk of
dementia who received supplements of 2 mg folic acid and 1 mg vitamin
B12 for 12 weeks 75.
The authors of two Cochrane reviews and a systematic review of
randomized trials of the effects of B vitamins on cognitive function
concluded that insufficient evidence is available to show whether
vitamin B12 alone or in combination with vitamin B6 or folic acid has
an effect on cognitive function or dementia 78-80. Additional large
clinical trials of vitamin B12 supplementation are needed to assess
whether vitamin B12 has a direct effect on cognitive function and
dementia 6.

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. These claims are based on the fact that correcting
the megaloblastic anemia caused by vitamin B12 deficiency should
improve the associated symptoms of fatigue and weakness. However,
vitamin B12 supplementation appears to have no beneficial effect on
performance in the absence of a nutritional deficit 81.

Health Risks from Excessive Vitamin B12
The IOM did not establish a UL for vitamin B12 because of its low
potential for toxicity. In Dietary Reference Intakes: Thiamin,
Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid,
Biotin, and Choline, the IOM states that "no adverse effects have been
associated with excess vitamin B12 intake from food and supplements in
healthy individuals" 5.

Findings from intervention trials support these conclusions. In the
NORVIT and HOPE 2 trials, vitamin B12 supplementation (in combination
with folic acid and vitamin B6) did not cause any serious adverse
events when administered at doses of 0.4 mg for 40 months (NORVIT
trial) and 1.0 mg for 5 years (HOPE 2 trial) 62,63.
Interactions with Medications

Vitamin B12 has the potential to interact with certain medications. In
addition, several types of medications might adversely affect vitamin
B12 levels. A few examples are provided below. Individuals taking
these and other medications on a regular basis should discuss their
vitamin B12 status with their healthcare providers.
Chloramphenicol

Chloramphenicol (Chloromycetin®) is a bacteriostatic antibiotic.
Limited evidence from case reports indicates that chloramphenicol can
interfere with the red blood cell response to supplemental vitamin B12
in some patients 82.
Proton pump inhibitors

Proton pump inhibitors, such as omeprazole (Prilosec®) and
lansoprazole (Prevacid®), are used to treat gastroesophageal reflux
disease and peptic ulcer disease. These drugs can interfere with
vitamin B12 absorption from food by slowing the release of gastric
acid into the stomach 83-85. However, the evidence is conflicting on
whether proton pump inhibitor use affects vitamin B12 status 86-89.
As a precaution, health care providers should monitor vitamin B12
status in patients taking proton pump inhibitors for prolonged periods
82.
H2 receptor antagonists

Histamine H2 receptor antagonists, used to treat peptic ulcer disease,
include cimetidine (Tagamet®), famotidine (Pepcid®), and ranitidine (Zantac®).
These medications can interfere with the absorption of vitamin B12
from food by slowing the release of hydrochloric acid into the
stomach. Although H2 receptor antagonists have the potential to cause
vitamin B12 deficiency 90, no evidence indicates that they promote
vitamin B12 deficiency, even after long-term use 89. Clinically
significant effects may be more likely in patients with inadequate
vitamin B12 stores, especially those using H2 receptor antagonists
continuously for more than 2 years 90.
Metformin

Metformin, a hypoglycemic agent used to treat diabetes, might reduce
the absorption of vitamin B12 91-93, possibly through alterations in
intestinal mobility, increased bacterial overgrowth, or alterations in
the calcium-dependent uptake by ileal cells of the vitamin
B12-intrinsic factor complex 92,93. Although this effect has not
been thoroughly tested, small studies and case reports suggest that
10%–30% of patients who take metformin have reduced vitamin B12
absorption that might lead to clinically significant effects 92,93.
Some studies suggest that supplemental calcium might help improve the
vitamin B12 malabsorption caused by metformin 92,93, but not all
researchers agree 94.
Vitamin B12 and Healthful Diets

According to the 2005 Dietary Guidelines for Americans, "nutrient
needs should be met primarily through consuming foods. Foods provide
an array of nutrients and other compounds that may have beneficial
effects on health. In certain cases, fortified foods and dietary
supplements may be useful sources of one or more nutrients that
otherwise might be consumed in less than recommended amounts. However,
dietary supplements, while recommended in some cases, cannot replace a
healthful diet."
The Dietary Guidelines for Americans describe a healthy diet as one
that:

Emphasizes a variety of fruits, vegetables, whole grains, and
 fat-free or low-fat milk and milk products:
Milk and milk products are good sources of vitamin B12. Many
ready-to-eat breakfast cereals are fortified with vitamin
B12.

Includes lean meats, poultry, fish, beans, eggs, and nuts.
Fish and red meat are excellent sources of vitamin B12. Poultry
 and eggs also contain vitamin B12.

Is low in saturated fats, trans fats, cholesterol, salt (sodium),
 and added sugars.
Stays within your daily calorie needs.

For more information about building a healthful diet, refer to the
Dietary Guidelines for Americans (http://www.healthierus.gov/dietaryguidelines/index.html)
and the U.S. Department of Agriculture's food guidance system,
MyPyramid (http://www.mypyramid.gov).
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Updated: 10/12/2009

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General Safety Advisory

Health professionals and consumers need credible information to make
thoughtful decisions about eating a healthful diet and using vitamin
and mineral supplements. These Fact Sheets provide responsible
information about the role of vitamins and minerals in health and
disease. Each Fact Sheet in this series received extensive review by
recognized experts from the academic and research communities.
The information is not intended to be a substitute for professional
medical advice. It is important to seek the advice of a physician
about any medical condition or symptom. It is also important to seek
the advice of a physician, registered dietitian, pharmacist, or other
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dietary supplements and their potential interactions with medications.

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