B Vitamins: Food or supplementation?
Many of us are inundated with messaging about supplementation, implying we're not able to get what we need from the foods we eat (in some cases that might be true). B vitamins, while not contributing to the major trends of today's healthism culture, are still singled out as something everyone needs “more” of. The fact is we can easily get what we need from our food, or with awareness of specific conditions that contribute to deficiency, we can supplement as needed.
The group of eight water soluble vitamins in the B vitamin complex are:
B1 (thiamine) plays a critical role in the production of energy from food. Food sources high in thiamine are fortified breakfast cereals, enriched white rice, peas, brown rice, some nuts, lentils, and enriched breads.
B2 (riboflavin) is important for the metabolism of carbohydrates, fats, and proteins. Riboflavin is also involved in the metabolism of vitamin B6, niacin, and folate. Foods rich in this vitamin include fortified cereals and breads, whole grains, cooked eggs, almonds, cooked spinach, and roasted chicken.
B3 (niacin) is vital in metabolism, cellular signaling, and DNA production and repair. Food sources include poultry, fish, nuts, legumes, and enriched grains.
B5 (pantothenic acid) is an essential nutrient in the production of energy from food and synthesis of coenzyme A and fatty acids. B5 is available in a variety of foods such as avocados, yogurt, cooked chicken, cooked sweet potatoes, and lentils.
B6 (pyridoxine) is involved in the breakdown of macronutrients, is vital for gluconeogenesis, supports nervous system function, immune health, and red blood cell formation. Foods high in B6 are chickpeas, beef, fish, boiled potatoes, and bananas.
B7 (biotin) is needed to help synthesize fatty acids. Again it is easy to obtain biotin needs from food. Interestingly, a healthy gut will also produce biotin to help an individual meet their needs. Note that long term use of sulfa drugs or antibiotics will decrease the gut’s ability to synthesize this vitamin. Foods rich in biotin are beef, cooked eggs, fish, pork, and some seeds.
B9 (folate), or folic acid in its synthetic form, is well known to be preventative of neural tube defects such as spina bifida in developing fetuses. Because of this it is highly recommended that persons who can get pregnant take a supplement that has folic acid since NTDs occur in the very early stages of pregnancy before a person even knows they are with child. Generally healthy individuals are able to get the recommended amount of folate from foods such as dark leafy greens, enriched breads, pastas, and cereals.
B12 (cobalamin) is the most complex vitamin in the B group also playing an important role in energy production from proteins and fats. Absorption of this vitamin requires normal function of the stomach, pancreas, and small intestine. Individuals who have undergone gastric surgery or have had an ileal resection require lifelong B12 supplementation. Other causes of deficiency can be celiac disease and other malabsorptive diseases, pernicious anemia, strict vegetarianism or veganism, or alcoholism. Food sources for B12 are of animal origin such as milk, eggs, and meat or can be found in fortified foods such as breakfast cereals.
Are you Deficient?
B vitamin deficiencies are actually quite uncommon with no need for vitamin B supplementation in generally healthy individuals. There are certain situations that can result in deficiencies; malabsorptive disorders, gastric or intestinal resection, eating disorders, or poor diet due to alcohol and drug abuse or food insecurity. Since many of the B vitamins come from animal origin, strict vegetarianism or veganism will also likely need supplementation in addition to fortified foods. For older adults, it can be common to have a B12 deficiency due to a number of factors: a decrease in stomach acid production and reduced intrinsic factor which is vital for absorbing B12 from food, certain medications, and atrophic gastritis.
Regardless of having an actual diagnosed deficiency, there is a current trend for B12 injections. These high dose treatments are said to increase energy, improve mood and concentration, and the ever popular buzz words, aid in weight loss. There is however no scientific evidence to support these claims, instead creating additional confusion around what is effective, and needed, supplementation.
Toxicity
B vitamins have no known effects of toxicity from food sources but adverse effects have been documented from long-term supplementation or very high doses. High intake of B6 has in some cases resulted in neurological damage, particularly of the extremities. Common side effects of high doses of niacin in supplementation can cause flushing, often of the face and neck, itching, or GI disturbances such as nausea and vomiting. Energy drinks are particularly high in niacin. Adverse effects of high B12 supplemental intake, usually linked with high-dose injections, are acne or rosacea flare-ups, difficulty sitting or holding still, headaches, heart palpitations, high blood pressure, and anxiety.
Blood tests that show high serum B12 can be the result of high dose supplementation, or it can be a marker of underlying disease. Conditions associated with elevated B12 are liver disease (cirrhosis, hepatitis), kidney failure, myeloproliferative disorders (e.g., leukemia, polycythemia vera), and solid tumors. It is important to discuss elevated B12 results in blood work to rule out any disease or health concerns.
Closing Thoughts
Yes, B vitamins are important for energy but it is helpful to recognize they assist in the production of energy from the food we eat, rather than providing energy themselves. Know your recommended amounts and be critical when reading claims about supplementation. If you are feeling tired, weak, and generally low in energy, consider reaching out to a registered dietitian to help with identifying eating patterns and behaviors, examine food beliefs, and assist in food skills development.
Lastly, in all the research, alcohol abuse is stated as one of the most common risk factors for deficiency for all of the B vitamins due to overall insufficient dietary intake, poor absorptive abilities, and excessive renal excretion. If you are struggling with alcohol abuse, consider seeing a healthcare provider for bloodwork and an exam. Also know that help for addiction is available at 988 Lifeline: call or text 988 to talk to someone today.
References:
Hanna, M., Jaqua, E., Nguyen, V., & Clay, J. (2022, June 29). B vitamins: Functions and uses in medicine. The Permanente journal. https://pmc.ncbi.nlm.nih.gov/articles/PMC9662251/
Higdon, J., & Drake, V. (2012). An evidence-based approach to vitamins and minerals: Health benefits and intake recommendations (2nd ed.). Thieme.
NHS. (2020, August 3). B Vitamins and Folic Acid. NHS choices. https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/
U.S. Department of Health and Human Services. (n.d.). Dietary supplements. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/list-all/
Written by Patricia Kunz, RD, LN, CIEC
Patricia specializes in: Eating disorders, disordered eating patterns, intuitive eating, and general wellness.