With headlines such as: “Earlier death with higher vitamin B12 value” and “Greater risk of mortality due to too much vitamin B12”, several Dutch media reported last week about vitamin B12 following a press release from the University of Groningen (UMCG). The press release had the title: “Higher vitamin B12 value predicts greater risk of death” and also read: “reason to believe that a person can indeed have too much vitamin B12”, “that a too high B12 level can entail health risks” and “UMCG researchers warn people who take supplements or receive injections”. A storm of messages on social media, in newspapers and on radio and TV, was the result. Many people were shocked and scared, because if you receive injections or take high-dose tablets, your B12-value will, of course, be high.
Not their intention
A day later the press release was supplemented with: “The study shows an association between a high vitamin B12 level and the risk of earlier death within the general population. This deserves further investigation, but was a reason for the researchers to issue a warning. The study says nothing about people with a medically proven B12 deficiency. For these people it still stands that it is good to supplement a B12 deficiency if this is medically necessary. In case of doubt, contact your doctor”. And another day later, they published a new press release: “Continue to use vitamin B12 in the event of a medical deficiency”. They never intended, they write, to cause unrest and questions in patients. The study establishes (only) an association and people who received injections were excluded from the study.
Why this was not part of the first press release? Good question. The press department of the UMCG maybe should have checked better with the researchers what was actually researched, what the real conclusion was and perhaps also inquired about the difference between an association and a causal relationship, before they wrote the press release. The researchers themselves indicated, when asked by the media, that they wanted to give a signal that there might be need for a maximum for (the intake of) B12, that further research was needed, and that the results were related to taking B12 without there being a deficiency. It would have saved a lot of unrest if that had already been mentioned in the original press release.
What does the research actually say? If we read the media sources where the authors were asked to comment, we see the following:
There is no causal relationship between higher B12-values and increased mortality risk (one does not lead to the other).
People who received injections were excluded from the study and the results therefore do not relate to these patients.
The researcher suspects that we should see the vitamin B12 concentration here as a biomarker of a different condition, and that that condition could be the cause of the earlier death.
They wanted to warn against the supplementation with B12 without a deficiency. Whether this warning is justified at all remains to be seen.
The actual article also shows that nothing is known about the cause of death of the deceased, whether B12 was supplemented and whether other factors might have played a role. There is much more to be said about the research itself; many have written about it last week, see the links at the bottom of this page. In short, there is still a lot of research to be done to see if anything can be said about the found association at all and whether the issued warning is even justified in this early stage.
The UMCG says the media misinterpreted the research, but their original press release was the cause of all the unrest. If you state in the title that a higher value predicts a greater chance of dying, you know that the media will pick that up. If you then also write that a higher value entails health risks, that too much B12 is indeed possible, and that people who receive injections or take supplements must be warned, the damage is done . It’s easy to blame the media, but the fault lies with the press department. It would have credited (the press department of) the UMCG if they had admitted they made a mistake, or at least had been to rash in publication, and not blame the media. As a press department you know very well how the media will pick up something, so a slightly more nuanced press release would have been appropriate.
What could have been (or should have been) the title of the press release? Maybe: “Investigators warn: be careful when taking B12 if you do not have a deficiency.” And then in the press release itself they could have written that further research needs to be carried out, that the high level of B12 is probably more a signal of an (underlying) condition that increases the mortality risk than that the amount of B12 itself is, but that they (just) wanted to warn people not to take too much B12 if you do not have a deficiency. That could have prevented a great deal of uncertainty, unrest, stress, questions and problems, and would have been much more accurate. Hopefully such sensationalist journalism, which in my opinion does not belong at (the press department of) a university, will be avoided in a subsequent press release about a possible follow-up study.
High B12 value
It has been known for a long time that a high B12 value can be a marker of an underlying condition and that if such a high value is found in blood tests (without receiving injections or taking supplements!) it is advisable to do further testing. Increased B12 concentrations are a reason for further testing, but of course it does not automatically follow that serum values that are increased by treatment with vitamin B12 can lead to a serious illness (or in this case, increased risk of mortality). We would like to direct the researchers’ attention to this article: The significance of a too high cobalamin concentration in the blood from the NTVG 2002 and the references cited. There are also a lot of examples of long-term treatment with high to very high doses of B12 in the scientific literature, in which of course also very high values were present. And there’s also evidence that the serum B12 test is not very accurate and can give false-high and false-low values, and therefore does not say as much as is often assumed. Perhaps a literature study can help the researchers formulate the research question for the follow-up studies they are talking about? I am curious to see the results …
The article : Association of Plasma Concentration of Vitamin B12 With All-Cause Mortality in the General Population in the Netherlands
Press releases UMCG: Hogere vitamine B12-waarde voorspelt grotere kans op sterfte en Blijf vitamine B12 gebruiken bij medisch tekort (Dutch)
Reaction B12 kliniek (Dutch)
Reaction B12 Institute (Dutch)
Reaction Sally Pacholok
Medisch Contact article (Dutch)
Vitamine B12, ijsjes & verdrinkingsgevallen – Meer over medisch (Dutch)
Treatment with high-dose B12