Vitamins

[Rach77788]

Does anyone know the link to the guide on all the other vitamins you must take alongside SI B12? Tried looking through them all and can't find, TIA

[wedgewood]

I’m sorry that I can’t help you with a link . But I think that it very much depends on the reason why you are injecting B12 . Firstly we all know that what ever the reason, vitamin B9 , know as folate in food and folic acid in tablet form , works together with B12 and it’s wise to supplement modestly , say a 400 mcg folic acid tablet daily , what ever the reason for your B12 deficiency.( the amount recommended in pregnancy .) Many people prefer taking a Methylfolate capsule .

Patients with Pernicious Anaemia have an extra need for a supplemental vitamin and mineral tablet .This is because they lack not only the Intrinsic Factor , but also stomach acid which is needed to help the absorption of all other vitamins , minerals and trace elements. The parietal cells in Pernicious Anaemia patients are destroyed by the antibodies that they produce. These cells produce The Intrinsic Factor and stomach acid,

But Pernicious Anaemia patients can help absorption by eating smaller meals more often , chewing thoroughly to allow the enzymes in saliva to start the work of breaking down food , and also taking an acidic drink with protein meals eg diluted apple cider vinegar with the mother.

.. There are also apple cider vinegar capsules with the mother that are helpful in acidifying the stomach . More serious cases of very low or no stomach acid can be helped with Betaine HCl capsules with pepsin and other digestive enzymes . I would also suggest a probiotic drink to help establish good stomach flora .

[Technoid]

It is not clear that there is any increased requirement for any other nutrient as a result of EOD B12 injections. But folate, due to it's close metabolic association with B12, is definetely something to monitor and supplement as needed. But there is no essential nutrient that is not important to to support the B12 deficiency healing process. Unless there are dietary restrictions, the best source of all these nutrients is the diet. Beyond a very good diet there are some supplement "tweaks" that may also be helpful but in general these are just icing on the cake.

[WIZARD6787 in reply to Technoid]

There is no evidence that the best source of all these nutrients is the diet. It is a seems like a good idea conclusion reinvented every 20 years or so as to what is currently believed to be true. Pseudo science as new data is cited.

[Technoid in reply to WIZARD6787]

If there can be said to be any generally consistent outcome from nutrition research, it is that nutrition obtained from the diet tends to be superior to nutrition obtained from supplements. Where a deficiency is present, of course it is advantageous to use supplementation at supra-physiologic levels to quickly correct the deficiency.

Specific supplementation may be recommended in some specific conditions, e.g. for older adults with low caloric intakes or low stomach acid, absorption issues, pregnancy, heavy menstrual bleeding, restrictive diet, low sunlight exposure or other health conditions that effect adequate nutrient uptake or metabolism. There are also a small number of nutrients such as Creatine which have a proven benefit when supplemented at levels not normally supplied in the diet.

But for the great majority of nutrients, the health benefits that are seen by consuming adequate amounts of that nutrient from food often do not show a similar effectiveness when tested in isolation. In several cases, high dosage supplementation of isolated nutrients has actually had negative health effects, which has been seen with high dosage supplementation of vitamin C, E and beta-carotene.

There is also some concerning studies showing an increase in cardiovascular disease risk or cancer risk with high dosage calcium supplementation. High supplemental doses of some nutrients may inhibit the absorption of, or disrupt the metabolism of another, such as Calcium Vs Iron or Zinc Vs Copper/Magnesium.

With supplements, there is the additional concern of unlisted harmful substances being included in the supplement, or the amount of nutrients in the supplement not being the same as stated on the label. Supplement regulation can be quite poor, especially in comparison with food or medicines. In my previous longform post on supplements I posted a documentary which went into some of the issues with supplement purity and fidelity to the label contents and even issues with third party testing.

There are benefits from food which simply cannot be substituted with supplementation - the many different forms of fibre and thousands of phytonutrients for example which it is not feasible to supplement and which have a beneficial impact on the gut microbiome which no supplement, or combination of supplements, can replicate.

Whole foods works to benefit health in ways that we still do not fully understand but seem to work in a synergistic fashion which we do not yet know how to replicate via supplements.

I am not anti-supplement, indeed I rely on quite a few supplements and regard them as an integral part of my nutrition. But for optimal nutrition, getting most of the necessary nutrients from your diet and supplementing only where there are gaps or specific issues to address, is much more likely to have a benefit for your health than consuming a low quality diet and thinking you can make up for that by choosing a particular set of supplements.

So yes, for the vast majority of nutrients, the best source is the diet, with attention to supplements in certain cases as described above.

Several studies which relevant to this discussion are mentioned in this article:

medicalnewstoday.com/articl...

A Harvard Health Letter article on the issue:

web.archive.org/web/2019100...

[WIZARD6787 in reply to Technoid]

>>But for the great majority of nutrients, the health benefits that are seen by consuming adequate amounts of that nutrient from food often do not show a similar effectiveness when tested in isolation.

An error is assuming that any food has a constant level of nutrients which it does not. A tomato is not the same as the next. It is called building on an incorrect assumption.

It is helpful to understand that no one understands for me.

[Technoid in reply to WIZARD6787]

"An error is assuming that any food has a constant level of nutrients which it does not. A tomato is not the same as the next. It is called building on an incorrect assumption. "

I am not making that assumption. In previous threads I posted on the topic of variations and reductions in nutrients in the food supply, variations which are sometimes exaggerated but are largely moot if one follows a good diet for which multiples of the RDA can easily be consumed for some nutrients (e.g. 2.5x the folate RDA).

If one chooses to follow a poor diet or a diet that is low in or absent specific nutrients, or where one of the previously listed issues apply, then of course the nutrient will need to be supplemented accordingly.

In the process by which the RDA's and other dietary reference intakes are decided upon, these type of variations and considerations are already built into the decision process.

[WIZARD6787 in reply to Technoid]

RDA is little more than a best guess. It is also a guess as to what level will prevent a person from needing medical intervention and does not allow for weight, activity etc.

If you accept the RDA as a standard and build from that it is building from a false assumption.

I am not accusing you of making an assumption I am referring to the assumption built on by others.

[Technoid in reply to WIZARD6787]

It would be more accurate to characterize the values derived for the RDA as an estimate rather than a "best guess".

This blog describes the difference between the two quite well:

"A guess is a casual, perhaps spontaneous conclusion. An estimate is based on intentional thought processes supported by data."

from herdingcats.typepad.com/my_...

In the United States (for example) the derivation of the RDA and the other dietary reference intake values is an extremely involved process involving several standing committees and expert panels that review the requirements for specific nutrients, ultimately producing a collection of reports known as the DRI publications, totaling nearly 5,000 pages.

The documents describe in detail the systematic review processes by which the DRI's are arrived at along with specific guidance on how to use the appropriate values to assess and plan the diets of groups and individuals. This process includes adjustment for incomplete utilization, differing bioavailability among food sources (addressing your previous comment) and adjustment for the variation in requirements among individuals.

The DRI values comprise:

EAR (Estimated Average Requirement)

The average daily nutrient intake level that is estimated to meet the requirements of half of the healthy individuals in a particular life stage and gender group

RDA (Recommended Dietary Allowance)

The average daily dietary nutrient intake level that is sufficient to meet the nutrient requirements of nearly all (97–98 percent) healthy individuals in a particular life stage and gender group. The RDA is derived from the EAR using statistical methods (2 standard deviations above the EAR).

AI (Adequate Intake)

The recommended average daily intake level based on observed or experimentally determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate; used when an RDA cannot be determined.

UL (Tolerable Upper Intake Level)

The highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population. As intake increases above the UL, the potential risk of adverse effects may increase.

These are further described in the Institute Of Medicine publication - "Dietary Reference Intakes : The Essential Guide to Nutrient Requirements"

nap.nationalacademies.org/c...

I think it would be reasonable to describe the AI figure as a guess but an AI is only derived for nutrients where the available data is inadequate to determine an EAR/RDA.

Important limitations to the RDI values exist which are mentioned in the IOM DRI publication:

"First, the Dietary Reference Intakes (DRIs) apply to healthy people and do not pertain to those who are sick or malnourished or whose special circumstances may alter their nutrient needs. Second, an individual’s exact requirement for a specific nutrient is generally unknown. The DRIs are intended to help practitioners arrive at a reasonable estimate of the nutrient level required to provide adequacy and prevent adverse effects of excess intake. Third, using the DRIs for assessment and planning is most effective when conducted as a cyclical activity that comprises assessment, planning, implementation, and reassessment."

...

"Dietary assessment is not an exact science. In fact, it generally has always involved a process that included a “best estimate” of an individual or group’s intake. The new DRIs, however, afford an opportunity to substantially improve the accuracy of dietary assessment because they allow practitioners to calculate the probability of inadequacy for an individual and the prevalence of inadequacy within a group and to plan for a low probability of inadequacy while minimizing potential risk of excess"

[Technoid in reply to Technoid]

A common misconception is that the DRI's are set at a level that prevents deficiency but this is generally not the case. For example, the values for Vitamin C were set based on the amount of vitamin C that would nearly saturate leukocytes without leading to excessive urinary loss, rather than the level necessary to prevent scurvy.

Certainly, as the above caveats explain, no-one would suggest that the DRI values are flawless nor should they be interpreted as the optimum nutrient intakes for any given individual or population, indeed there is an entire chapter dedicated to specific guidance on applying the DRI's in the aforementioned publication:

nap.nationalacademies.org/r...

In the case of several nutrients, such as, for example Vitamin D and Protein the data available to derive an EAR/RDA is quite problematic and requires many caveats which can be seen in the wide variations in advice on adequate levels of these nutrients from official sources in different countries and variations in expert consensus even among those that extensively study these nutrients.

Some nutrients, such as Choline, lack sufficient data to even form an EAR/RDA and thus only have an AI (Adequate Intake), fairly described as a guess and often based on average assessed intake.

However, despite the many caveats, it is quite reasonable to use the DRI's judiciously as one part of an assessment on the adequacy of a diet. With a properly planned diet, it is certainly possible to achieve adequate intakes of most nutrients from the diet alone, with supplementation filling in common dietary gaps such as inadequate Vitamin D or B12 in vegan diets.

So yes, the best source of most nutrients is the diet and adequacy of intake according to DRI values can be productively used (with caveats) to assess adequacy of intake.

As I mentioned previously, with adequate caloric intake and a well-planned diet it is possible to get multiples of the RDA of some nutrients. So even if there were some subpar estimations involved in the production of the RDA, a diet that includes intakes of more than double that RDA, in healthy individuals, could not reasonably be assessed as inadequate for that nutrient.

Many supermarket A-Z multivitamins provide 100% of the RDA of many common vitamins/minerals and can be helpful as "insurance" for those days when diet composition is inadequate.

The intake curve for most vitamins and minerals follows a "normal distribution" where low intakes result in deficiency and high intakes result in toxicity. This is reflected in the UL (Tolerable Upper Limit) of the DRI's.

But as we know, some nutrients do not have a UL because insufficient data was available to indicate toxicity. However, even for nutrients with no UL, with the long-term continuous delivery or intake of very high amounts of a nutrient, there exists the possibility of negative consequences which have not yet been discovered because of the absence of long-term safety trials of extremely high intake volumes/frequencies.

[WIZARD6787 in reply to Technoid]

Best guess is more accurate if you evaluate the work done.

[Technoid in reply to WIZARD6787]

Since you apparently claim to have evaluated the RDA development work, which comprises several expert panels, multiple publications and several thousand pages of output, I would be interested to hear you support your dismissal of the RDA as a "best guess" with something substantive.

I already explained the process of developing the RDA, from which it seems relatively clear that it involves considerably more than just making a "best guess".

If you're not prepared to offer any substantive criticism I'm not sure why your contention that the RDA is a "best guess" should be taken seriously since it contradicts what is known about the process of developing the RDA.

[WIZARD6787 in reply to Technoid]

Look up appeal to authority and ad hominem. That will explain very clearly the fallacious arguments you are making. It does not follow that you will understand them. Also look up confabulation and begging the question for clarity.

It would be helpful if you studied logic and reasoning but the above addresses your current argument against 'Best Guess'.

[Technoid in reply to WIZARD6787]

I am familiar with these logical fallacies.

The process I described does not easily square with your contention that the derivation of the RDA value is a "best guess".

It is clear that you do not intend to present evidence to back up your claim which is your choice but it also means I do not need to take your claim seriously.

[WIZARD6787 in reply to Technoid]

Well you are obviously familiar with using them. I was referring to identifying and understanding them.

Perhaps try to understand inductive reasoning where you are starting with that's a good committee. Not a bad committee. And building from that belief system.

Or perhaps you don't have enough experience in practicing in the sciences to know we do a lot of best guesses

[mledovich]

Here's a list, but it is not specific to SI B-12, just B-12 in general: b12-vitamin.com/combinations/

[bookish in reply to mledovich]

Thank you, interesting about biotin/adenosyl and raised MMA which I hadn't heard before.

[WIZARD6787 in reply to mledovich]

Thank you for that it was helpful!

[OldmanD in reply to mledovich]

Nice and short and enough to going on with. . . . . .

[WIZARD6787]

I use this as my reference theb12society.com/treatment