Supplements in practice - B vitamins

Question 1

Vitamin B1:

Answer 1

Vitamin B1: Thiamine hydrochloride, thiamine mononitrate.
* Stable and water-soluble.
* Deficiency rare; thiamine deficiency is usually easy to reverse with supplementation.
* Risk factors: Alcoholism or advanced age.

Question 2

Vitamin B2:

Answer 2

Vitamin B2: Riboflavin, riboflavin 5’-phosphate (FMN).
* Modified release capsules may be best for bioavailability. High doses have lowered bioavailability.
* Colours urine bright yellow.
* Riboflavin is absorbed best if taken between meals.

Question 3

Vitamin B3:

Answer 3

Vitamin B3: Niacin, niacinamide (nicotinamide) and nicotinic acid.
* Nicotinic acid can cause non-allergic flushing, prickly heat sensation. Tolerance to flushing develops quickly.
* Niacin: Cholesterol and triglyceride levels. Raynaud’s disease.
* Niacinamide: Diabetes and blood sugar control.
* Niacin and niacinamide: Cognitive and mental health uses; to combat deficiency (pellagra).
* Take niacin with meals to avoid irritation of the stomach.
* Periodic liver function tests for doses over 100 mg per day.

Question 4

Vitamin B12:

Answer 4

Methylcobalamin and adenosylcobalamin are the active forms:
* Methyl form used for methylation; adenosyl form in mitochondria.
* Most B12 supplements are cyanocobalamin; this inactive form needs converting to the active form in the body.
* Hydroxycobalamin: Also inactive but with high affinity for plasma proteins; indicated for those who don’t tolerate methyl groups, or to start B12 supplementation if both folate and B12 deficiency.
* B12 supplements do not need stomach acid or digestive enzymes to release it from protein but absorption still requires intrinsic factor.
* Sublingual form beneficial if digestive issues present.