B12 Wound Healing

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.

b-vitamin intake

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.


1. Dietary Reference Intakes (RFI) and Recommended Dietary Allowances (RDA), Food and Nutrition Information Center, www.nal.usda.gov/fnic/etext/000105.html.

2. Leininger, S.M., The role of nutrition in wound healing, Crit. Care Nursing Q., 25 (1), 13, 2002.

3. DeBiasse, M.A. and Wilmore, D.W., What is optimal nutrition support?, New Horizons, 2 (20), 122, 1994.

4. Shils, M.E. et al., Thiamin, in Modern Nutrition in Health and Disease, 9th ed., Shils, M.E., Olson, J.A., Shike, M., and Ross, A.C., Eds., Lippincott Williams & Wilkins, Baltimore, MD, 1999, chap. 21.

5. Klein, M., Weksler, N., and Gurman, G.M., Fatal metabolic acidosis caused by thiamine deficiency, J. Emerg. Med, 26 (3), 301, 2004.

6. Suter, P.M., Vergessene metaboishe Nebenwirkungen der Diuretika: Lipid-Glucose-und Vitamin B1 (thiamine) metabolism [Forgotten metabolic side effects of diuretics: lipids, glucose and vitamin B1 (thiamine) metabolism, Schweiz. Rundsch. Med. Prax, 93 (20), 857, 2004.

7. World Health Organization, Thiamine Deficiency and Its Prevention and Control in Major Emergencies (WHO Monograph Series No. 13), Geneva, 1999.

8. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, Institute of Medicine (IOM), National Academies Press, Washington, DC, 1998.

9. Ostrovskii, A.A. and Nikitin, V.S., Morphological characteristics of cellular elements in the focus of posttraumatic inflammation in thiamine deficiency, Vopr Pitan (Voprosy Pitaniia) Sept.-Oct., 5, 57, 1987.

10. Alvarez, O.M. and Gilbreath, R.L., Effect of dietary thiamine on intermolecular collagen cross linking during wound repair: a mechanical and biochemical assessment, J. Trauma, 22 (1), 20, 1987.

11. Lakshmi, R., Lakshmi, A.V., and Barnji, M.S., Skin wound healing in riboflavin deficiency, Biochem. Med. Metab. Biol., 42 (3), 185, 1989.

12. Lakshmi, R. et al., Effect of riboflavin or pyridoxine deficiency on inflammatory response, Indian J. Biochem. Biophys, 28 (5-6), 481, 1991.

13. Bosse, M.D. and Axelrod, A.E., Nutrition, in Fundamentals of Wound Management in Surgery, Levenston, S.M., Seifter, E., and Vanwinkle, W., Eds., Appleton-Century Crofts, South Plainfield, NJ, 1977, p. 37.

14. Prasad, R., Lakshmi, A.V., and Bamji, M.S., Impaired collagen maturity in vitamins B-2 and B-6 deficiency: probable molecular basis of skin lesions, Biochem. Med., 30 (3), 333, 1983.

15. Prasad, R., Lakshmi, A.V., and Bamji, M.S., Metabolism of 3 H-proline in riboflavin deficiency, Ann. Nutr. Metab., 30, 300, 1986.

16. Williamson, P.R. and Kagan, H.M., Alpha-proton abstraction and carbanion formation in the mechanism of action of lysyl oxidase, J. Biol. Chem., 262 (17), 8196, 1987.

17. Levene, C.I., O'Shea, M.P., and Carrington, M.J., Protein lysine 6-oxidase (lysyl oxidase) cofactor: methoxatin (PQQ) or pyridoxal? Int. J. Biochem, 20 (12), 1451, 1988.

18. Elbanna, H.M., Tolba, K.G., and Darwish, O.A., Dietary management of surgical patients: effects on incisional wounds, 2 (2), 243, 1996.

19. Sugiyama, M., Role of physiological antioxidants in chromium (VI) induced cellular injury, Free Rad. Biol. Med., 12 (5), 397, 1992.

20. Brown, B.G. et al., Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease, N. Engl. J. Med., 345 (22), 1583, 2001.

21. Garg, A., Lipid-lowering therapy and macrovascular disease in diabetes mellitus, Diabetes, 41 (Suppl. 2), 111, 1992.

22. Jonas, W.B., Rapoza, C.P., and Blair, W.F., The effect of niacinamide on osteoarthritis: a pilot study, Inflamm. Res., 45 (7), 330, 1996.

23. Jacques, P.F. et al., Long-term nutrient intake and early age related nuclear lens opacities, Arch. Ophthalmol., 119 (7), 1009, 2001.

Hymes, J. and Wolf, B., Human biotinadase isn't just for recycling biotin, J. Nutr., 129 (2S Suppl.), 485-s, 1999.

Romero-Navarro, G. et al., Biotin regulation of pancreatic glucokinase and insulin in primary cultural rat islets and in biotin-deficient rats, Endocrinology, 140 (10), 4594, 1999.

Debourdeau, P.M. et al., Life-threatening eosinophilic pleuropericardial effusion related to vitamins B5 and H, Ann. Pharmacother., 35 (4), 424, 2001. Flodin, N., Pharmacology of Micronutrients, Alan R. Liss, New York, 1988. Casadio, S. et al., On the healing properties of esters of D-pantothenol with terpene acids, with particular reference to D-pantothenyl trifarnesylacetate, Arzneim. Forsch., 17 (9), 1122, 1967.

Weiser, H. and Erlemann, G., Acceleration of superficial wound healing by panthenol zinc oxide, Cosmetics Toiletries, 103 (1010), 79, 1988.

Neidermeir, S., Animal experiment studies on the problem of treating corneal lesions, Klin. Monatsbl. Augenheilkd., 190, 28, 1987.

Hosemann, W. et al., Normal wound healing of the paranasal sinuses: clinical and experimental investigations, Eur. Arch. Otorhinolaryngol., 248 (7), 390, 1991. Lacroix, B., Didier, E., and Grenier, J.F., Role of pantothenic and ascorbic acid in wound healing processes: in vitro study on fibroblasts, J. Vitam. Nutr. Res., 58 (4), 407, 1988.

Weimann, B.J. and Hermann, D., Studies on wound healing: effects of calcium D-pantothenate on the migration, proliferation and protein synthesis of human dermal fibroblasts in culture, Int. J. Vit. Nutr. Res., 69 (2), 113, 1999. Lacroix, B., Didier, E., and Grenier, J.F., Effects of pantothenic acid on fibroblastic cell cultures, Res. Exp. Med., 188, 391, 1988.

Vaxman, F. et al., Effect of pantothenic acid and ascorbic acid supplementation on human skin wound healing process. A double-blind, prospective and randomized trial, Eur. Surg. Res, 27 (3), 158, 1995.

Ackermann, Z. et al., Overload of iron in the skin of patients with varicose ulcers, Archv. Detmatol., 124 (9), 1376, 1988.

Levenson, S.M. and Seifter, E., Dysnutrition, wound healing and resistance to infection, Clin. Plast. Surg., 4 (3), 375, 1977.

Williamson, P.R. and Kagan, H.M., Reaction pathway of bovine aortic lysyl oxidase, J. Biol. Chem., 261 (20), 9477, 1986.

Ruberg, R.L., Role of nutrition in wound healing, Surg. Clin. North Am., 64 (4), 705, 1984.

Carville, D.G.M. and Strain, J.J., The effect of a low copper diet on blood cholesterol and enzymatic antioxidant and defense mechanisms in male and female rats, Int. J. Vitam. Nutr. Res., 58 (4), 456, 1988.

Aprahamian, M. et al., Effects of supplemental pantothenic acid on wound healing: experimental study in rabbit, Am. J. Clin. Nutr, 41 (3), 578, 1985. Levenson, S.M. and Seifter, E., Dysnutrition, wound healing and resistance to infection, Clin. Plast. Surg., 4, 375, 1977.

Rucker, R.B., Murray, J., and Riggins, R.S., Nutritional copper deficiency and penicillamine administration: some effects on bone collagen and arterial elastin crosslinking, Adv. Exp. Med. Biol., 86B, 619, 1977.

Osiecki, H., The Physician's Handbook of Clinical Nutrition, 5th ed., Bioconcepts publishing, Kelvin Grove, Queensland, Australia, 1998.

Bender, D.A., Non-nutritional uses of vitamin B6, Br. J. Nutr., 81 (1), 7, 1999.

46. Shils, M.E. et al., Cobalamin, in Modern Nutrition in Health and Disease, 9th ed., Shils, M.E., Olson, J.A., Shike, M., and Ross, A.C., Eds., Baltimore, MD, Lippincott Williams & Wilkins, 1999, chap. 27.

47. Kasper, H., Vitamin absorption in the elderly, Int. J. Vitam. Nutr. Res., 69 (3), 169, 1999.

48. Herbert, V., Vitamin B12, in Present Knowledge in Nutrition, 7th ed., Ziegler, E.E. and Filer, L.J., Eds., ILSI Press, Washington D.C., 1996, pp. 191-205.

49. National Advisory Group on Standards and Practice Guidelines for Parenteral Nutrition Formulations, J. Parenter. Enteral Nutri., 22, 49-66, 1998.

50. Parenteral multivitamin products: drugs for human use; drug efficacy study implementation; amendment (21 CFR 5.70), Federal Register, April 20, 2000; 65, 77, pp. 21200-21201.

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