Inna Rudoy

Effectiveness of Vitamin B12 in Treating Recurrent Aphthous Stomatitis: A Randomized, Double-Blind, Placebo-Controlled Trial

Background: The frequency of recurrent aphthous stomatitis (RAS), the most common oral mucosa lesions seen in primary care, is up to 25% in the general population. However, there has been no optimal therapeutic approach. Our objective was to confirm our previous clinical observation of the beneficial treatment of RAS with vitamin B12. Methods: A randomized, double-blind, placebo-controlled trial was done using primary care patients. A sublingual a dose of 1000 mcg of vitamin B12 was used in patients in the intervention group for 6 months. Results: In total, 58 patients suffering from RAS participated in the study: 31 were included in the intervention group and 27 were included in control group. All parameters of RAS among patients in the intervention group were recorded and compared with the control group. The duration of outbreaks, the number of ulcers, and the level of pain were reduced significantly (P < .05) at 5 and 6 months of treatment with vitamin B12, regardless of initial vitamin B12 levels in the blood. During the last month of treatment a significant number of participants in the intervention group reached “no aphthous ulcers status” (74.1% vs 32.0%; P < .01). Conclusion: Vitamin B12 treatment, which is simple, inexpensive, and low-risk, seems to be effective for patients suffering from RAS, regardless of the serum vitamin B12 level.

Modern Society and Prospects of Low Vitamin B12 Intake

Background: Vitamin B12 deficiency can occur in individuals with dietary patterns that exclude animal foods and patients who are unable to absorb vitamin B12 in food. Material and Method: Our clinic serves a high-income population living in Southern Israel. We hypothesize that a tendency to decrease of level of vitamin B12 in our population is caused by a premeditated decrease in consumption of animal products. We analyzed 512 medical histories of patients undergoing blood tests for vitamin B12 level for various reasons. Result: The level of vitamin B12 in 192 patients (37.5%) was less than 250 pg/ml. Conclusion: As a result of media information disseminating the relationship between meat, cholesterol and cardiovascular diseases, consumption of meat, particularly beef, has decreased. Changes in life style among segments of the population with high socioeconomic level, on one hand, and the existence of poverty, on the other, are two main factors in the decreasing consumption of animal products. This causes a decrease in the level of vitamin B12 in the general population, and as a consequence, this will increase pathology due to vitamin B12 deficiency. In lieu of these possible developments and in order to prevent serious health problems, vitamin B12 fortification should be seriously considered and discussed.

What are the recommended guidelines for checking vitamin B12 by primary practitioners

Vitamin B12 deficiency is a common problem that affects the general population. Early detection of vitamin B12 deficiency is clinically important, and there is evidence that such deficiency occurs more frequently than previously anticipated. If the disorder is untreated, complications may cause significant morbidity and irreversible neurological deficits (1). There are no generally accepted guidelines for the definition, diagnosis, treatment, and follow-up of cobalamin (vitamin B12) deficiency. Persons with the deficiency may be asymptomatic, but a high index of suspicion of B12 deficiency is required in patients presenting with myelopathy, cognitive decline, neuropathy, psychiatric disturbances, or specific hematologic signs and symptoms. Total serum vitamin B12 may not reliably indicate vitamin B12 status. Probability of ‘‘functional’’ vitamin B12 deficiency decreases with increasing level of vitamin B12. To get more specificity and sensitivity in diagnosing vitamin B12 deficiency, the concept of measuring homocystein (HCY), methylmalonic acid (MMA), and holotranscobalamin II (holoTC)*a sub-fraction of vitamin B12*has aroused great interest. HoloTC, as a biologically active vitamin B12 fraction, promotes uptake of its vitamin B12 by all cells. However, diagnostic algorithms using vitamin B12, MMA, and HCY measurements reflect studies in some academic centers, and their negative predictive values have not been established; therefore, this problem remains controversial (2). One of the purposes of this study was to understand reasons for checking vitamin B12 by primary physicians, and to try to evaluate sensitive clinical and laboratory predictors of vitamin B12 deficiency.