Summary

Cobalamin, also known as vitamin B12, cannot be manufactured by humans and is obtained exclusively from the diet. Cobalamin is an enzyme cofactor for two enzymes in energy metabolism and methylation/folate metabolism. Cobalamin has critical functions in the nervous system, including via the synthesis of myelin and in the formation of red blood cells. Cobalamin deficiency is fairly common, especially in individuals with vegan-like diets, gastrointestinal conditions, and/or autoimmune disease. Deficiency can result in anemia, functional symptoms (fatigue, weakness, lightheadedness), or neurological features (numbness or tingling, problems walking, psychosis, behavioral changes), which may be irreversible. Dietary deficiency and low blood and brain levels of cobalamin has been reported in ASD children. Several studies in children with ASD using methylcobalamin injection have revealed improved glutathione metabolism or methylation and/or significant clinical improvements, especially in adaptive behaviors. The body’s ability to absorb cobalamin from the gut is limited, which is the reason that injectable forms of cobalamin are employed in many studies related to ASD. Outside of ASD, cobalamin is sometimes used to treat elevated levels of blood homocysteine, and as a general “energy” supplement. The form of cobalamin used in most nutritional supplements is cyanocobalamin, although methylcobalamin is preferred due to the lack of need to detoxify the cyanide component. Side effects are rare at usual doses used in oral supplementation.

Cobalamin in Spectrum Needs

Cobalamin, in the form of methylcobalamin, is present in Spectrum Needs in order to provide what is possible short of injections. This cobalamin is added in order to provide a wide basis of nutrition, especially given the important role of cobalamin in energy metabolism and the preliminary data regarding its use as a food supplement in ASD. Side effects are unexpected. You may wish to speak to your physician regarding starting your child on injectable cobalamin, which can be combined with Spectrum Needs.

The Details

What Is It? Cobalamin, also known as vitamin B12, is one of the eight B-complex vitamins. Cobalamin cannot be manufactured by humans and is thus a true vitamin, obtained exclusively from the diet.

What Does It Do? Cobalamin is an enzyme cofactor for only two human enzymes, yet they are in critical pathways: energy metabolism and methylation/folate metabolism. Among many other functions, some of the more critical requirements for cobalamin are in the function of the nervous system, including via the synthesis of myelin (white matter), and in the formation of red blood cells.

What Does Deficiency Appear as? Cobalamin deficiency is fairly common, especially in individuals with diets poor in animal products, gastrointestinal conditions, and/or autoimmune disease. Deficiency might first present as a megaloblastic (large red blood cells) anemia. Functional symptoms are common, including fatigue, weakness, lightheadedness, constipation, diarrhea, loss of appetite, heart palpitations with shortness of breath. Neurological features are also common, and may in part be irreversible, including numbness or tingling, problems walking, loss of vision or taste, anxiety, depression, mania, psychosis, memory loss, or behavioral changes.

What About Its Use in Autistic Spectrum Disorders (ASD)? Dietary deficiency (https://www.ncbi.nlm.nih.gov/pubmed/23287069) and low blood levels (https://www.ncbi.nlm.nih.gov/pubmed/28074329; https://www.ncbi.nlm.nih.gov/pubmed/27544717) of cobalamin has been reported in ASD children. In addition, cobalamin levels are decreased in ASD brain (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723262/pdf/pone.0146797.pdf). One study revealed differences in the levels of metabolites and common genetic polymorphic differences (SNPs) in relation to cobalamin-dependent enzymes and a cobalamin transporter (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2610366/pdf/nihms68264.pdf). An open-label study demonstrated that glutathione metabolism could be normalized in children with ASD following a three-month supplementation with methylcobalamin injections and oral folinate, suggesting that such a targeted nutritional intervention “may be of clinical benefit in some children who have autism” (https://www.ncbi.nlm.nih.gov/pubmed/?term=19056591). A follow-up study in 37 children with ASD “reported significant improvements in adaptive behaviors with this therapy, which correlated with improvements in glutathione metabolism” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810468/pdf/AURT2013-609705.pdf). A small 12-week double-blind, placebo-controlled (DBPC), cross-over clinical trial of injected methylcobalamin showed that clinical improvements occurred in the children who demonstrated improvements in glutathione metabolism (https://www.ncbi.nlm.nih.gov/pubmed/?term=20804367). An eight-week DBPC study of 50 children with ASD found that methylcobalamin injections improved the Clinical Global Impression scale with improvements correlating with improvements in methylation metabolism (https://www.ncbi.nlm.nih.gov/pubmed/26889605; https://www.autismspeaks.org/Needs/Needs-news/small-study-finds-b12-injections-ease-autism-symptoms-some-children).

What About Its Use in Other Conditions? Cobalamin, often along with folate and pyridoxine, is sometimes used to treat elevated levels of blood homocysteine, which is a risk factor for cardiovascular disease. Although used, its use in cognitive function and dementia have not been substantiated. Cobalamin is a common ingredient in “energy drinks”.

What Form of Cobalamin is Best? Methylcobalamin and 5-deoxyadenosylcobalamin are the active forms of cobalamin used in human enzymes. The form of cobalamin used in most nutritional supplements is cyanocobalamin. Methylcobalamin, the substrate for methionine synthtase, is also available as a supplement, and is preferred due to the lack of need to detoxify the cyanide component, however small, of cyanocobalamin. The body’s ability to absorb cobalamin from the gut is limited by the availability of intrinsic factor, which is the reason that injectable forms of cobalamin are employed in many studies related to ASD

What Are the Common and/or Important Side Effects? Cobalamin is water-soluble and excessive amounts are excreted by the kidneys, so toxicity is unlikely. Far higher dosages are frequently provided by injection in children with ASD. Side effects are rare at usual doses used in oral supplementation.

Is There Any Laboratory Testing? Laboratory testing can reveal the presence of a deficiency of this nutrient, but this test often fails to reveal deficiencies that are mild. The preferred test is to measure blood methylmalonate and homocysteine levels, which are elevated even in mild cobalamin deficiency. Decreased brain and/or spinal cord myelination is another sign of potential cobalamin deficiency.

How and Why is this Nutrient Used in Spectrum Needs

Cobalamin is added to Spectrum Needs in order to provide a wide basis of nutrition, especially given the important role of cobalamin in energy metabolism, and because of the available data suggesting a possible role in the dietary supplementation of ASD. While definitive large double-blind studies have not been performed to date, the multiple studies performed to date, the clinical experience of many physicians, and the generally benign nature of cobalamin supplementation, have convinced many experts to offer cobalamin supplementation to their patients with an ASD. Side effects are unexpected at the doses used in Spectrum Needs.

What About Additional Dosing Beyond Spectrum Needs?

While oral cobalamin supplementation is limited, cobalamin is present in Spectrum Needs in order to provide what is possible short of injections. You may wish to speak to your physician regarding starting your child on injectable cobalamin, which can be combined with Spectrum Needs.