B12+D3

Vitamin B12 is an indispensable vitamin for some of the crucial physiological processes in the body such as cellular metabolism, especially in DNA synthesis, methylation, and mitochondrial metabolism, the function of the central nervous system, and the formation of healthy red blood cells. Vitamin D is essential for bone health, immunity, and cardiovascular health.

B12 deficiency can affect individuals of all ages.  People who eat little or no animal foods, such as vegetarians and vegans, might not get enough vitamin B12 from their diets. Only animal foods have vitamin B12 naturally. When pregnant women and women who breastfeed their babies are strict vegetarians or vegans, their babies might also not get enough vitamin B12 [1] [2]. Therefore, Vegetarians and the elderly are at higher risk of vitamin B12 deficiency. Among the elderly, vitamin B12 deficiency occurs in about 20% of the population; more than 60% of these deficiencies are due to food-cobalamin malabsorption syndrome caused by gastrointestinal problems. But in the elderly vitamin B2 deficiency is often unrecognized because the clinical manifestations are subtle [2], [3].

The prevalence of vitamin D3 deficiency is high in India despite being a tropical country with abundant sunlight throughout most of the year [8]. The prevalence of Vitamin D deficiency ranged from 40% to 99%, with most of the studies reporting a prevalence of 80%–90% [6]. Vitamin D deficiency among the population can be attributed to various factors like modern lifestyle, poor or insufficient diet, and other underlying illness etc.

A cross-sectional and interventional study in an office environment at Mumbai to assess the incidence of vitamin B12 / vitamin D deficiency revealed that 65% of the executives were deficient in Vitamin B12 and 28% of the executives were Vitamin D3 deficient. After intervention with B12 & D3 supplementation, a significant increase in serum B12 and D3 values was seen [4]. The study concludes that vitamin D3 is evident in the urban Indian population despite living in tropical climates with abundant sunlight because of corporate lifestyle disorder with long working hours, underexposure to the sun, and a modern environment. Vitamin B12 deficiency is predominantly due to vegetarianism and insufficient diet. [4]

Low levels or deficiency of Vitamin B12 and Vitamin D3 have serious effects on health. This may result in negative clinical manifestations such as elevated levels of homocysteine, anaemia, psychiatric disorders like depression, osteoporosis, poor bone health, diabetes, low immunity, and cardiovascular diseases [9] [10].

For Formulation:   

Vitamin B12 and D3 is formulated with vitamins in their naturally biologically active form and in the right dosage unlike synthetic versions of vitamins in many other supplements that are not biologically active and that contain high dosages of Vitamins than required.

Vitamin D levels are correlated with both vitamin B12 and folate levels. The gastric mucosal effects of vitamin D deficiency may affect other vitamin levels. Vitamin D deficiency may reduce the absorption of B12 and folate via the receptors.

Mode of action:

Vitamin B12:

• Acts as a methyl donor to membrane phospholipids, neurotransmitters, amines, DNA and RNA, and myelin-based proteins [11].
• Helps to transform methyl tetrahydrofolate, the circulating form of folate to tetrahydrofolate, the active form of folate that helps in the synthesis of nucleotides and DNA [11].
• Plays a role in cellular respiration and energy [12].
• Converts homocysteine to methionine.
• Forms new red blood cells through proliferation of erythroblasts (immature red blood cells) [14]

Vitamin B9:

• Production and maintenance of new cells, for DNA synthesis and RNA synthesis through methylation, and prevents changes to DNA.

Vitamin D3:

• Promotes calcium absorption in the gut [16].
• Maintains adequate serum calcium and phosphate concentrations to enable normal bone mineralization [16]

References:

1. https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/

2. O'Leary F, Samman S. Vitamin B12 in health and disease. Nutrients. 2010 Mar;2(3):299-316. doi: 10.3390/nu2030299. Epub 2010 Mar 5. PMID: 22254022; PMCID: PMC3257642.

3. Andrès E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, Noblet-Dick M, Maloisel F, Schlienger JL, Blicklé JF. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ. 2004 Aug 3;171(3):251-9. doi: 10.1503/cmaj.1031155. PMID: 15289425; PMCID: PMC490077.

4. Gulvady, Chaitanya, Shyam Pingle, and Shrinivas Shanbhag. "Incidence of vitamin B12/D3 deficiency among company executives." Indian J Occup Environ Med 11.2 (2007): 83-85.

5. Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica. 2014 May;44(5):480-8. doi: 10.3109/00498254.2013.845705. Epub 2014 Feb 4. PMID: 24494987.

6. Aparna P, Muthathal S, Nongkynrih B, Gupta SK. Vitamin D deficiency in India. J Family Med Prim Care. 2018 Mar-Apr;7(2):324-330. doi: 10.4103/jfmpc.jfmpc_78_18. PMID: 30090772; PMCID: PMC6060930.

7. Vitamin B12 Deficiency

8. G R, Gupta A. Vitamin D deficiency in India: prevalence, causalities and interventions. Nutrients. 2014 Feb 21;6(2):729-75. doi: 10.3390/nu6020729. PMID: 24566435; PMCID: PMC3942730.

9. Oh, Robert C., and David L. Brown. "Vitamin B12 deficiency." American family physician 67.5 (2003): 979-986.

10. Sizar O, Khare S, Goyal A, et al. Vitamin D Deficiency. [Updated 2022 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK532266/

11. Butola, Lata Kanyal, et al. "Vitamin B12-do you know everything." Journal of Evolution of Medical and Dental Sciences 9.42 (2020): 3139-47.

12. Romain, M., et al. "The role of vitamin B12 in the critically ill—a review." Anaesthesia and intensive care 44.4 (2016): 447-452.

13. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to vitamin B12 and contribution to normal neurological and psychological functions (ID 95, 97, 98, 100, 102, 109), contribution to normal homocysteine metabolism (ID 96, 103, 106), maintenance of normal bone (ID 104), maintenance of normal teeth (ID 104), maintenance of normal hair (ID 104), maintenance of normal skin (ID 104), maintenance of normal nails (ID 104), reduction of tiredness and fatigue (ID 108), and cell division (ID 212) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal 2010;8(10):1756. [23 pp.]. doi:10.2903/j.efsa.2010.1756. Available online: www.efsa.europa.eu/efsajournal.htm

14. Koury, Mark J., and Prem Ponka. "New insights into erythropoiesis: the roles." Annu. Rev. Nutr 24 (2004): 105-131.

15. https://med.libretexts.org/@go/page/8763?

16. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/