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Vitamin B12 (cobalamin, cyanocobalamin)
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[2008 updates are highlighted in red]
| Description: |
Supplements of vitamin B12, also known as cobalamin or cyanocobalamin, are sometimes claimed to be effective therapies for MS. |
| Rationale: |
Vitamin B12 is essential for maintaining normal nervous system functioning. People with vitamin B12 deficiency, like some people with MS, have injury to the optic nerves and the spinal cord. For these and other reasons, it is sometimes concluded that vitamin B12 supplements could be effective MS therapies. |
| Evaluation: |
The mechanism by which nervous system injury occurs in MS is different from that associated with vitamin B12 deficiency. In addition, most people with MS have normal vitamin B12 levels. For people who have normal vitamin B12 levels, there is no evidence that vitamin B12 supplements provide any definite beneficial effects. Importantly, there is a small subgroup of people with MS who have vitamin B12 deficiency. In that case, treatment with vitamin B12 is recommended. One study of six people with progressive MS found that massive doses of vitamin B12 did not provide any definite clinical benefit over a six-month period. In another study, 138 people with MS were placed in two treatment groups, one of which was treated with vitamin B12 alone and the other with the “Cari Loder regime” (vitamin B12 along with two other compounds, phenylalanine and lofepramine). In this 24-week study, both groups showed mild neurological improvement after two weeks of treatment. The group treated with the “Cari Loder regime” showed some additional mild neurological improvement and had mild relief of some MS symptoms, including fatigue. The significance of the small therapeutic effects seen in this study is not clear. Further studies of this treatment regimen are needed. |
| Risks: |
Vitamin B12 supplements are usually well tolerated. Rarely, vitamin B12 may cause diarrhoea, rashes, and itching. |
| Costs: |
Vitamin B12 is inexpensive. |
| Committee opinion: |
In the opinion of the Committee, vitamin B12 supplements are inexpensive and generally safe. For people with MS who have normal vitamin B12 levels, supplements of vitamin B12 do not provide any definite benefit. For people with MS who have low vitamin B12 levels, vitamin B12 supplements are recommended. One study with vitamin B12, phenylalanine, and lofepramine has shown mild beneficial effects; further studies of this therapy are needed. |
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