FIGURE 7.8 Vitamin B12 (cobalamin).
A deficiency of this vitamin causes impairment in the methionine synthase reaction. Anemia is the result of impaired DNA synthesis, thus preventing cell division and formation of the nucleus of new erythrocytes, with consequent accumulation in the bone marrow of megaloblastic red blood cells.
A number of drugs have been shown to decrease absorption, including gastric acid inhibitors (Tagamet [GlaxoSmithKline], Pepcid [Merck and Co., Inc.], and Zantac [Warner Lambert Co.]) and proton pump inhibitors (omeprazole and lanso-prazole).47 Other drugs that inhibit absorption of vitamin B12 include cholestyramine (cholesterol binding agent), neomycin (antibiotic), and colchicine (gout treatment). A drug used in the treatment of adult onset diabetes (Metformin [Mylan Laboratories]) requires use with calcium-containing foods in order to allow for vitamin B12 absorption.48
The RDA for vitamin B12 is 2.4 mcg/d for adolescent and adult males and females.8 Food sources are found only in animal products such as cooked beef, salmon, and milk.
No toxic effects have been associated with intake of vitamin B12.
vitamin b12 and wound healing
Although specific studies have not been done that illustrate a direct relationship between vitamin B12 and wound healing, it is clear that its fundamental roles in the maintenance of red blood cells make it an important component of nutrition support before and after the wound was sustained.
It is critical that B vitamins be included in the diet in adequate amounts as specified by the RDA or AI. B vitamins work in concert with each other, for example, if vitamin B12 deficiency is suspected, folate status should also be checked. People who are especially at risk of B-vitamin deficiency are those who have a history of alcoholism or those who have had a nutrient-deficient diet, such as older people or those who are poor or malnourished due to disease or malabsorption. If deficiencies are found, these should be corrected with supplemental B vitamins either individually or as a multiple vitamin.
When an oral diet is inadequate, B vitamins can be provided as a supplement in a multivitamin form that can be swallowed, or it can be provided in a liquid form. Most commercially available enteral (tube feeding) formulas have adequate amounts of B vitamins at a minimal level of formula intake. Higher levels of formula based on increased caloric needs should not pose a problem with toxicity for B vitamins.49,50 Patients who receive parenteral nutrition as their sole source or major source of nutrition support should be receiving an intravenous multivitamin product with adequate amounts of B vitamins. Individual B vitamins are also available in various forms to accommodate the absorptive capacity of the patient with wounds. If a nutrient deficiency is suspected and confirmed, supplementation will be necessary to bring the level to within normal limits.
Wound healing is dependent on B vitamins in a variety of ways. Both laboratory and clinical research indicate that the B vitamins are involved in all three phases of wound development. Studies have shown that B vitamins play a part in necrotic resorption, immunological response to infection, and the actual repair of wounds. These data also show that specific aspects of the recovery process are improved, such as fibroblast function and collagen synthesis and cross-linking. B vitamins should be provided in amounts that meet the RDA or AI and supplemented when deficient in order to assure that their functions in wound healing can be accomplished.
future directions for research
B vitamins have been treated as the neglected stepchild in the field of "nutrition and wound healing." It is clear that this family of vitamins plays a monumental role in wound healing in both the tissue repair process and in the optimization of immune function. Unfortunately, some of these vitamins (niacin, biotin, folacin, and vitamin B12) have not been individually studied in regard to their specific roles in the healing process. In general, more work needs to be done to establish specific roles for the B vitamins in wound healing and to determine how they interact with each other to allow for a successful outcome in the healing process.
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