Bogus Vitamin B?

January 13, 2013 4:11 PM

My psychiatrist, who practices holistic/integrative medicine, says non-food-based brands of vitamin B are useless because the body does not actually absorb them. Is this true?

YANMD, but:

My psychiatrist told me that the only brand of vitamin B I should take is MegaFoods Balanced B. Her reason is that it's completely food-based, allowing the body to absorb it properly. She claims that other over-the-counter B vitamins that are not food-based don't do anything at all.

Is this true? Since she practices holistic/integrative medicine (meaning she suggests vitamins/herbs and alternative treatments to accompany prescription medication), could she perhaps be paid by vitamin companies to push a specific brand? Or is what she saying actually true?

posted by shiggins to Health & Fitness (22 answers total)

No, my mom stopped being able to feel the bottom of the tub with the soles of her feet and taking a B complex supplement has really helped her regain feeling. She doesn't use that specific brand.

Your doc is a shady shill.
posted by discopolo at 4:19 PM on January 13, 2013 [6 favorites]

There are some instances of B vitamin deficiency where supplements might not be absorbed properly and injections might be required. This is common in B12 deficiency.

There are also some forms of vitamins that some people with certain genetic variations might not absorb properly. For example, my genetics make me poor at utilizing beta-carotene as A because I am an inefficient converters of beta-carotene to the retinol form the body needs. I also have the MTHFR gene that makes it hard for me to use folic acid in supplements.

Other vitamins might require co-factors to be absorbed and utilized properly.

But if she is just telling you food-based are better absorbed, that is not a real reason. I would ask for more specific information on why she believes this particular supplement is better absorbed.
posted by melissam at 4:41 PM on January 13, 2013 [3 favorites]

I don't know about the validity of your psychiatrist's particular statement but I've come across the term bioavailability that would seem to reference the same concept and appears to be a legit scientific thing.

(But since medical professionals being influenced by the marketing efforts of pharmaceutical manufacturers is common, I would expect the same goes for dietary supplements even moreso and just the fact that it's a real phenomenon doesn't necessarily confirm what this person is saying. Friends of mine who got into a multilevel marketing thing would try to pitch their supplement products based upon higher bioavailability than retail products and they were definitely full of crap.)
posted by XMLicious at 4:41 PM on January 13, 2013 [2 favorites]

She claims that other over-the-counter B vitamins that are not food-based don't do anything at all.

She is wrong about the bioavailability of any of the B vitamins from non-"food based" supplements, as a quick survey of the history of B vitamin supplementation for treatment of various disorders would amply illustrate. Cf. prenatal folic acid supplementation. That she recommended a specific brand on top of that is worrisome.

Frankly I would be extremely skeptical of any medical professional who bills themselves as "holistic/integrative" meaning "pushes unproven 'alternative medicine'" rather than "holistic/integrative" meaning "examines relevant circumstances and recommends appropriate lifestyle changes and/or non-drug therapies".
posted by Inspector.Gadget at 4:41 PM on January 13, 2013 [15 favorites]

My doctor teaches integrative medicine at a very fancy medical school and prescribed me a completely different B supplement (and in fact neither the clinic pharmacy nor the highly respected compounding pharmacy they work with sell this brand). So, no, this particular brand is not the current gold standard in integrative medicine, let alone the only one that works. Either your shrink is trying to sell you a bill of goods or someone sold them a bill of goods.

And I would question why your shrink was ordering blood levels for vitamin deficiencies in the first place. That's really the province of either a primary care doc or a specialist in functional medicine or nutrition.
posted by Sidhedevil at 5:47 PM on January 13, 2013

And if your shrink is suggesting vitamin supplements without having blood levels, I would really question their understanding of the current state of thinking about supplementation within integrative medicine.
posted by Sidhedevil at 5:51 PM on January 13, 2013 [1 favorite]

I don't think it's sketchy that a shrink is ordering blood tests for vitamin deficiencies - various deficiencies can cause things that overlap with symptoms of depression, anxiety, and other things that a shrink might deal with. Low vitamin D levels and, in some people, anemia, come to mind. But it is sketchy that a shrink (or anyone) says that only their preferred brand of B vitamin can be absorbed properly. There are certainly variations in how well certain formulations are absorbed, but it's not an all-or-nothing thing like that.
posted by needs more cowbell at 5:56 PM on January 13, 2013 [1 favorite]

Response by poster: She did order blood tests. I am severely deficient in iron (anemic), and also quite deficient in B12 and D. She says the reason she orders blood tests (which sounds totally legit) is that vitamin/mineral deficiencies can cause symptoms of depression (or be the underlying cause of the depression-like symptoms).

I have been seeing her for six months, and the combination of drugs/vitamins/minerals she has me on has completely turned around my depression and anxiety (along with therapy). I really like her, and because I am feeling so much better, I don't plan to stop seeing her.

Mostly, I was just wondering if I need to keep buying this expensive-as-shit B vitamin or if I could go with something else. Even if she is being shady and pushing a certain brand on me, I don't really care; she's gotten me to where I am now, and I'm very grateful for that.
posted by shiggins at 5:59 PM on January 13, 2013 [2 favorites]

says non-food-based brands of vitamin B are useless because the body does not actually absorb them. Is this true?

No. Vitamin B12 or any other vitamin is a chemical. That mean it has a constant composition and properties no matter if it is fermented in a pharmaceutical company's lab or if it comes from eating crab. She might have learned this in high school chemistry class.

Anyway, using b12 as an example, it doesn't really come from food. It comes from bacteria (that is the Saccharomyces cerevisiae in the product info at Amazon). Animal products only contain it because they carried the bacteria.

Seconding discopolo's comment. I recommend science-based medicine.
posted by Tanizaki at 6:54 PM on January 13, 2013 [1 favorite]

The "food" answer seems like a simplification. But there are different forms of the B vitamins, and perhaps her experience suggests that certain forms of the vitamins work better for some people.

Consider magnesium supplements. Some magnesium salts go flying right through you, others do not have that effect and are more easily taken up by the body.
posted by gjc at 8:50 PM on January 13, 2013 [1 favorite]

If you don't absorb b12 from supplements, I would make sure to get another option because you may need injections and they should screen you for digestive problems that would prevent absorption like celiac disease.


I have been seeing her for six months, and the combination of drugs/vitamins/minerals she has me on has completely turned around my depression and anxiety (along with therapy). I really like her, and because I am feeling so much better, I don't plan to stop seeing her.

Sounds like she might suspect you have what I have (MTHFR variants), because I've heard in holistic medicine that depression gets way better once you discontinue the folic acid, which is useless or worse in people with MTHFR, and start supplementing with forms of folate closer to what occurs in food.

You don't need to stop seeing her, just dig a little deeper to figure out why she thinks these things.
posted by melissam at 9:19 PM on January 13, 2013 [1 favorite]

I was just wondering if I need to keep buying this expensive-as-shit B vitamin or if I could go with something else

Injections are much cheaper, at least in my neck of the woods, and much easier as well. I pay under $10 for a vial that will get me 10 shots, once a month (the shots are free at any clinic I go to). I cannot absorb vitamin B efficiently via the stomach, though a common plan of attack is to take a lot of supplements in hope of getting enough absorbed, so I don't by the non-food line whatsoever. As has been mentioned, both the pill and food have the vitamin in them and both are ingested so there really isn't any difference. I discussed it with my doctor and really, the injections are much easier than large amounts of supplements and much cheaper.
posted by juiceCake at 9:31 PM on January 13, 2013

Integrative medicine is supposed to be science-based medicine, and it is in my experience. Glad to know she took blood levels. However, if you haven't already done so, you need to talk with your primary care doctor about these results, shiggins, because the impacts of iron-deficient anemia and pernicious anemia and low vitamin D levels go way beyond mood.

I don't know, maybe you feel comfortable with just passing over her weird brand loyalty to this one B supplement as a blip in an otherwise good doctor-patient relationship. That's your call. There's no evidence that her belief that this particular B supplement is superior is an accurate one.

Get your primary care doctor's input. They may suggest injections rather than oral supplements, which could save you an enormous amount of money as well as potentially being more effective. Pernicious anemia is nothing to fuck with!
posted by Sidhedevil at 10:26 PM on January 13, 2013 [2 favorites]

You should also think about seeing a gastroenterologist. Serious vitamin B deficiencies in people with access to a varied diet are generally reflective of issues in the gastrointestinal system.
posted by Sidhedevil at 10:34 PM on January 13, 2013 [2 favorites]

"My psychiatrist told me that the only brand of vitamin B I should take is MegaFoods Balanced B. Her reason is that it's completely food-based, allowing the body to absorb it properly. She claims that other over-the-counter B vitamins that are not food-based don't do anything at all."

Your psychiatrist does not know that they are talking about. That MegaFoods bottle you linked to is wildly, as in at least an order of magnitude, overpriced for what it provides you. Being "food-based" is a qualification that means precisely nothing. If vitamin B supplementation is indeed right for you, and I would encourage you to discount your psychiatrist's advice on this out of hand, the cheapest shit on the shelf that shows a wide range on the nutrition facts label will be just fine if taken with a meal. Also your primary care physician can provide injections that are much more effective and even cheaper.
posted by Blasdelb at 4:16 AM on January 14, 2013 [1 favorite]

"She did order blood tests. I am severely deficient in iron (anemic), and also quite deficient in B12 and D. She says the reason she orders blood tests (which sounds totally legit) is that vitamin/mineral deficiencies can cause symptoms of depression (or be the underlying cause of the depression-like symptoms)."

For a while there were huge pitched battles in the medical literature between oncologists and endocrinologists over exactly how much vitamin D people actually need, with endocrinologists seeming to see huge benefits from vitamin D and oncologists seeing huge drawbacks to sun exposure. In the last few years however, those battles have ended as it has become clear that enough of the endocrinologists involved were as full of shit as the oncologists were saying all along to skew their literature and indeed we need less vitamin D than they were saying by at least a factor of four. Given your psychiatrist's ability to fall for the 'food-based' bullshit, and the fact that this is solidly outside of her specialty even if it might be technically in her scope of practice, I would encourage you to suspect that she might also not be interpreting the Vitamin D results of your blood work correctly in light of the current understanding.
posted by Blasdelb at 4:32 AM on January 14, 2013 [3 favorites]

"Balanced B Complex is a 100% whole food dietary supplement from MegaFood. This vitamin B complex supplement is made from nourishing organic brown rice, broccoli and Saccharomyces cerevisiae to provide a balanced ratio of 100% whole food B complex vitamins and synergistic cofactors. The B complex vitamins work together in many metabolic pathways in the body and play a vital role in energy production, maintaining a healthy nervous system and hormone balance. This whole food supplement is gentle on your stomach."

For clarity, you are absolutely right, what is being sold to you here is:

(<$0.01) Vegetable fiber

(~$0.30) The same industrial extractions of yeast lysate that all of the other companies that want to sell you B vitamins use

(~$1.50) Standard packaging, marketing, and distribution

(~$28.19) Bullshit

posted by Blasdelb at 4:58 AM on January 14, 2013 [4 favorites]

You do not need the expensive supplements, but you should see your GP to get everything checked out. I've been anemic, had low B levels, and a Vitamin D deficiency...but I was a vegetarian grad student in England, so as soon as I got the heavy doses of supplements I needed and access to legit sunshine, my levels were way better. (I also started eating red meat when my iron levels were in the danger zone, which is what works for me.) My doctor in no way recommended specific supplements aside from one course of prescribed vitamins and one type of iron pills, just because they tend to be easier on the digestive system.
posted by jetlagaddict at 5:21 AM on January 14, 2013

Science Based Medicine!

Also, coming from someone who has had a decade long battle with depression, anxiety, lethargy, etc.. etc.. and *NEVER* having a GP test for testosterone because I was a 'physically healthy young male'.... *ANY* diagnostic tests done by any medical professional is a *GOOD THING*... now finding a doctor that knows *YOU* and *SCIENCE* well enough to interpret them, that's another story... but at least its additional information to add to the discussion.. and well GPs in my experience are good for little more than cold/flu and dictating to them your desired treatment paths...
posted by anthroprose at 9:33 AM on January 14, 2013

"*ANY* diagnostic tests done by any medical professional is a *GOOD THING*"

Ahem...

Q: Say a new medical procedure has been shown to be effective in the early detection of an illness, and as an otherwise healthy patient you take it. The probability that the test correctly identifies the illness as positive is 0.99, and the probability that the test correctly identifies someone without the illness as negative is 0.95. The incidence of the illness in the general population is 0.0001. You test positive, what is the probability that you have the illness?

A: About 1 in 500, because statistics.

Diagnostics is a really non-intuitively complicated discipline.
posted by Blasdelb at 10:04 AM on January 14, 2013 [1 favorite]

Find a scientific, methodical doc and get a blood test. I am a Type 1 diabetic and was tested for deficiencies, and found to be actually deficient in vitamin D and B. Since taking prescription vitamin D and B my levels of both are back up in the normal range. I do feel a bit better.
posted by pearl228 at 12:33 PM on January 15, 2013 [1 favorite]

Best answer: IANADYet-- From my nutrition text:

Vitamin B12 is bound to protein in food, and is released from these proteins by the acid in the stomach (and by the proteinase, pepsin). The released B12 binds to "R" proteins. The stomach also produces Intrinsic Factor (IF) which will bind B12 further down the GI tract; pernicious anemia results from the inability to synthesize Intrinsic Factor.

In the duodenum, B12 is released from the R protein (by proteases and the rise in pH) and is bound by the Intrinsic Factor. Nothing happens to B12 until the end of the small intestine (the ileum) where binding to the microvilli and absorption occurs. (A tiny amount can be taken up without the intervention by IF, allowing for some benefit from massive doses of oral B12 [in pernicious anemia, where Intrinsic Factor is absent or deficient-TWH]). This absorption mechanism is so efficient at reclaiming secreted B12, that deficiency doesn't develop for decades if a B12 deficient diet is eaten. However, if absorption is disrupted (e.g., a ileal resection), then even taking in high amounts of B12 can produce deficiency in 3-6 months due to inadequate absorption.

Your psychiatrist seems to be misunderstanding how B12 is absorbed. Because B12 is acid sensitive, it requires chaperoning through the high-acidity environments of the stomach and duodenum. These chaperone roles are played by R Factor and Intrinsic Factor (IF). IF also plays a role in the actual absorption of vitamin B12 in the small intestine.

Long story short, it doesn't really matter how the B12 is derived (food-based or non) for vitamin B12. What matters is that IF and R Factor are around to protect the vitamin from the acidity of your stomach. The Megafoods Balanced B product does not contain IF or R Factor, so it is in no way better or more complete than plain old run-of-the-mill B complex vitamins.
posted by The White Hat at 6:30 AM on January 16, 2013 [1 favorite]