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Does Vitamin B12 Have a Positive Effect on Multiple Sclerosis?

By: Tori Mackson

Introduction

Could there be a relationship between vitamin B12 and the treatment

of Multiple Sclerosis (MS)?

The Journal of the American Medical Association (JAMA), October 23,

1991 published an article titled MS associated with vitamin B12

deficiency (1). Three months later, The American Family Physician

Journal printed an article with the same title and additional support

(2). The following year JAMA published another similar article

titled Vitamin B12 metabolism in multiple sclerosis (3). Researchers

and authors of these articles believe there is a link between MS and

vitamin B12 deficiency.

As noted in the referenced articles a correlation between MS and

vitamin deficiency may have some merit in possible treatment for MS

patients.

What Is Multiple Sclerosis?

Multiple sclerosis is a disorder of the central nervous system marked

by decreased nerve function with initial inflammation of the

protective myelin nerve covering and eventual scarring. Type and

severity of symptoms vary widely and may progress into episodes of

crisis alternating with episodes of remission (4). There are two

forms of the disease currently noted. The exacerbating remission

form is one in which the disease presents itself with an initial

attack of symptoms and is followed by partial or complete remission.

The chronic progressive form of the disease progresses quickly and

does not show signs of remission. The symptoms MS patients may

experience include: blurred vision, muscle weakness and spasticity,

difficulty walking, poor coordination, bladder problems, numbness,

and fatigue. Between the ages of 20 and 40 is when an MS patient is

most likely to have his/her first attack (5). MS is diagnosed using

a Magnetic Resonance Imaging (MRI) scan of the brain (6).

Although the cause of MS isn't known for sure, scientists generally

assume that MS is an autoimmune disease in which the immune system

attacks the body's own myelin cells (5). The myelin is a fatty

sheath that insulates the nerve fibers allowing impulses to be sent

between the brain, the spinal cord, and the body. There is a thought

that possibly a toxin or virus triggers this autoimmune response in

susceptible people. The susceptibility factor is not equal among the

population. Studies suggest that genetics, geographical location,

and high dietary intake of saturated fat are among the possible

theories of who may be at greater risk for acquiring this disease

(6). These are some common factors identified in people who have been

diagnosed with MS. However, there is no research at this time that

shows that genetics, geographical location and high dietary fat

intake actually increase the chance of a person being diagnosed with

this disease.

What is vitamin B12 (Cobalamine)?

Vitamin B12 is a water-soluble vitamin that contains the essential

mineral element of cobalt. B12 works in conjunction with folic acid

in numerous biological processes including the synthesis of DNA,

choline, red blood cells, and the myelin sheath that surrounds nerve

cells. Vitamin B12 is an essential element for effective metabolism

of carbohydrates, protein, and fat in the body (7).

Symptoms of vitamin B12 deficiency

Deficiency symptoms manifest as changes in the nervous system such as

soreness and weakness in the legs and arms, diminished reflex

response and sensory perception, memory loss, weakness and fatigue,

difficulty walking and speaking, jerking of limbs, disorientation,

and impaired touch or pain perception. These symptoms occur in

varying degrees and combinations (8). " Vitamin B12 deficiency due to

dietary intake is rare, and 95% of B12 deficiencies seen in the

United States are due to inadequate absorption capabilities " (9). A

true B12 deficiency is noted when the serum B12 level is 150mol/L or

below (10).

The Department of Neurology, Cleveland Ohio studied serum vitamin B12

deficiency in MS patients (12). Methods of the study: serum vitamin

B12 and folate levels were determined in 208 consecutively evaluated

patients seen in the outpatient MS clinic setting during a 7-month

period. Blood samples were obtained for 165 of the 208 patients.

One hundred twenty-five patients had clinically defined MS, thirty-

one had probable MS, and nine had idiopathic myelopathy. Serum

methylmalonic acid (MMA) and homocysteine (HCY) concentrations, which

rise in biologically severe vitamin B12 deficiency, were subsequently

determined in all patients whose vitamin B12 levels were lower than

301 pg/ml. Results: A vitamin B12 level lower than 301 pg/ml was

found in 32 of 156 patients with either clinically defined MS or

clinically probable MS but in none with of the patients with

idiopathic myelopathy. Elevated serum methylmelonic acid or

homocysteine levels were found in seven of the 32 patients with

either clinically defined MS or clinically probable MS, six of whom

had elevated homocysteine levels and one of whom had elevated

homocysteine and methylmalonic levels. Conclusion: 32 (19.4%) of the

165 patients with MS and idiopathic myelopathy had vitamin B12 levels

less than 301 pg/ml, only seven (4.2%) of the 165 had elevated

methylmelonic acid or homocysteine levels. The frequency of

biologically severe vitamin B12 deficiency in these patients with MS

and idiopathic myelopathy was very low (12).

What is the recommended dietary allowance for vitamin B12?

The recommended dietary allowance of vitamin B12 in people eleven

years and older is 2.0 micrograms per day. Vitamin B12 is found in

many food sources, which include liver, eggs, fish, cheese, and

meat. This vitamin can also be supplemented into the diet in the

form of a pill or an injection. (Refer to table 1 for specific

vitamin B12 values of selected food items).

Food Sources Amount Vitamin B12 in Micrograms per

3 1/2 oz

Liver, lamb 104

Blue cheese 1.4

Clams 98

Haddock 1.3

Liver, beef 80

Flounder 1.2

Kidneys, lamb 63

Scallops 1

Liver, calf 60

Cheddar Cheese 1

Kidneys, beef 31

Cottage Cheese 1

Liver, chicken 25

Mozzarella cheese 1

Oysters 18

Halibut 1

Sardines 17

Perch, filets 1

Trout 5

Swordfish 1

Table 1: Vitamin B12 content of selected foods, in micrograms per 3½

oz. serving (4).

Vitamin B12 metabolism in multiple sclerosis

The Multiple Sclerosis Disease Prevention newsletter investigates B12

metabolism in patients with MS (13). Studies reported in this

newsletter presented a significant number of people with MS have some

degree of malabsorption, which may be a contributing factor in a B12

deficiency (13). Malabsorption is an important factor since it can

cause multiple sub clinical nutrient deficiencies even when dietary

intake is carefully executed.

Ten subjects (seven women and three men) from 27-51 years of age were

identified at the onset of the neurologic disease, and all presented

with the typical clinical features of MS. Magnetic imaging performed

in seven of the patients revealed multiple lesions in the white

matter consistent with MS. Vitamin B12 deficiency, although unusual

in patients under 40, was present before this age in eight of the

patients. Results of electromyograms revealed no peripheral

myopathy, although this is the most common neurologic manifestation

of a vitamin B12 deficiency. Nine of the patients had serum vitamin

B12 levels below 150 pmol per L. The cause of the deficiency was

unknown in most of the patients and only two of the subjects had

pernicious anemia (2).

The results of this study indicated a correlation between MS and a

vitamin B12 deficiency. Although the cause of the B12 deficiency was

unknown, nine of the ten participants presented with both MS and a

vitamin B12 deficiency. The authors of this study conclude there may

be an association between vitamin B12 deficiency and MS that is more

than coincidental. Further studies of vitamin B12 metabolism,

binding and transport in patients with MS are indicated (2).

A 1993 study by Neuro-Communication Research Labs recognizes an

association between vitamin B12 metabolism and the pathogenesis of MS

(11). Supplementation with vitamin B12 did not reverse the

associated macrocytic anemia nor did the neurological deficits of MS

improve following supplementation with vitamin B12. It has been

suggested that vitamin B12 deficiency may render the patient more

vulnerable to the putative viral and/or immunologic mechanisms widely

suspected in MS (11).

Neuro-Communication Research Labs studied forty-five MS patients

whose serum vitamin B12 levels were significantly lower in those

patients who experienced onset of neurological symptoms prior to age

18 (n=10). Serum vitamin B12 levels were checked at the onset of the

disease to determine if the subjects were deficient in the vitamin in

question. Specific numbers of serum vitamin B12 levels were not

stated in the study it was only noted that the subjects (n=45) all

had low serum vitamin B12 levels, and the patients who were diagnosed

before age 18 (n=10) had significantly lower B12 levels in their

blood than those diagnosed after age 18 (n=35). These findings

suggest a specific association between the timing of onset of first

neurological symptoms of MS and vitamin B12 metabolism (8). The

authors of this study conclude " since vitamin B12 is required for the

formation of myelin and for immune mechanisms, it is proposed that

its deficiency in MS is of critical pathogenic significance " (8).

Discussion

The studies available for the supplementation of vitamin B12 with

patients who have MS represent a total number of instances that is

too small to be of statistical significance. The studies reviewed

did not have any healthy control groups as part of the research. In

the study presented by the Multiple Sclerosis Disease Prevention

Newsletter, the researchers reported that malabsorption in MS

patients is a contributing factor in having a vitamin B12

deficiency. This study did not present any specific figures and

therefore, did not present any statistical evidence that

malabsorption was the reason for patients with MS having a vitamin

B12 deficiency. Furthermore, other possible causes of the

abnormalities of MS were not controlled for in the studies

presented. Although there is some good preliminary research

presented on the relation between MS and a vitamin B12 deficiency,

each study presented with some significant flaws for which further

investigation is needed to determine if there is actually a

relationship between vitamin B12 and the treatment of MS.

Conclusion

The literature reviewed on the effect of vitamin supplementation on

MS was positive in the sense that some of the research provides

evidence that could possibly help slow the progression and/or onset

of the disease. However, none of the articles touched on the fact

that this disease affects every patient differently. The articles

also did not discuss in any detail if this method of treatment is

better for people who suffer from the chronic progressive form or the

exacerbation remission form of the disease. The key to understanding

the studies and theories of MS is to remember that at this point the

disease is from unknown etiology and the literature that is published

is based on small studies that have not been carried out for long

periods of time. The ideas of doctors and theorists have been to

connect possible solutions without really knowing the implications

for the disease itself. As research and technology continues to

progress, hopefully we will have stronger evidence to either support

or reject the theory of vitamin supplementation having a positive

effect of MS.

References:

1. Green, R. Ms associated with vitamin B12 deficiency. The

Journal of the American

Medical Association, JAMA,Oct 23, 1991. v266 n16 p2210(1).

2. Werbach, M. Multilple sclerosis and vitamin B12 deficiency.

American Family

Physician, Dec 1991 v44 n6 p2168.

3. White, H. Vitamin B12 metabolism in multiple sclerosis. The

Journal of the

American Medical Association, JAMA, Oct 7, 1992. v268 n13 p1656(1).

4. http://www.nlm.nih.gov/medlineplus/ency/imagepage/17089.htm.

Medical

Encyclopedia Multiple Sclerosis. October 3, 2001.

5. Reynolds EH. Multiple sclerosis and vitamin B12 metabolism.

J Neuroimmunol.

1992; 40:225-230.

6. Lauer K. The risk of multiple sclerosis in the U.S.A. in

relation to sociogeographic

features: a factor-analytic study. J Clinical Epidemiol. 1994; 47:43-

48.

7. Kirschmann, G Nutrition Almanac 4th ed. New York: McGraw Hill,

1996.

8. Murray, M. Encyclopedia of Nutritional Supplements. Rocklin,

CA: Prima Publishing, 1996.

9. Reynolds, E. Vitamin B12 metabolism in multiple sclerosis.

The Journal of the American Medical Association, JAMA, 1992;49(649-

52).

10. Kuzminski, A. et al.1998. Effective treatment of cobalamin

deficiency with oral

cobalamin. Blood 92:1191-98.

11. Sandyk, R. Vitamin B12 and its relationship to age of onset of

multiple sclerosis.

J Neurosci. 1993; 71(1-4): 93-9.

12. Goodkin, D. Serum vitamin B12 deficiency is uncommon in multiple

sclerosis. Arch

Neurol 1994 Nov; 51(11):1110-4.

13. Recommended Dietary Allowances 10th ed. Washington, DC: National

Academy

Press, 1989.