Balanced Nutrition is the Foundation for Beautiful Skin
I love the last phrase of this quote: “Vitamin B12, also known as cobalamin, is a water-soluble vitamin that is important in the hematological and nervous systems, and it has a complex relationship with the skin”. Let’s discuss the ‘complex relationship with skin’ which is being reported by Fox News, UK Daily Mail, and maybe others.
Over 40 years ago, it was known that treatments with pharmacologic doses of vitamin B12 (and vitamin B6) may trigger skin outbreaks in select individuals. What do I mean by pharmacological doses? Doses involving 4,000% of the recommended daily allowance for vitamin B6 and 2,000% for vitamin B12.
The bacterial pathogenesis of acne is unknown. Kang and co-authors analyzed genetic changes in a single microorganism, Propionibacterium acnes, isolated from skin microbiota obtained from 20 healthy individuals and 13 with acne. Differences in the genetic regulation of metabolic pathways in P acnes isolated from the skin were found between individuals with or without acne. In fact, over a dozen genes were up- or down-regulated differently. These genes were involved in many metabolic pathways: the tricarboxylic acid (TCA) cycle, triacylglyceride (TAG) synthesis, porphyrin synthesis, tetrapyrole biosynthesis, iron metabolism, and vitamin B12 synthesis. Even though there were many metabolic adaptations in P acnes isolated from subjects with acne vs healthy skin, Kang and colleagues exclusively focused their exploration to genes regulating vitamin B12 metabolism.
In a second experiment, 10 healthy individuals were given intramuscular injections (1 mg vitamin B12) (400 x RDA of 2.4 µg/d). The injections increased serum vitamin B12 concentrations so they ranged between 1,500 to 57,000 pg/mL, way outside the normal range of 200-900 pg/mL. Vitamin B12 biosynthesis in skin microbiota (P acnes) was down-regulated. One individual developed acne. This is not an unexpected finding.
Pharmacologic doses of vitamins are not normal. The biochemistry and metabolism of vitamin B12 is complex. Excessive aberrations in vitamin B12 status, deficiency or excess, is associated with severe dermatologic changes. Vitamin B12 deficiency leads to hyperpigmentation and changes to hair, nails and oral tissues. And we must remember that many regulators of metabolism (other than vitamin B12) were different in skin microbiota isolated from people with acne vs healthy skin.
Paracelsus is thought to have said, “the dose makes the poison”. Deficiencies or pharmacologic overloads of nutrients should be avoided. While scientists may experiment to understand mechanisms of action, consumers should strive for nutritional balance and moderation. Vitamins, including vitamins B12 and B6, are essential. Follow dietary recommendations.
Kang D, Shi B, Erfe MC, Craft N, Li H. Vitamin B12 modulates the transcriptome oft he skin microbiota in acne pathogenesis. 2015 Sci Transl Med doi: 10.1126/scitranslmed.aab2009
Brescoll J, Daveluy S. A review of vitamin B12 in dermatology. 2015 Am J Clin Dermatol doi: 10.1007/s40257-014-01017-3
Braun-Falco O, Lincke H. The problem of vitamin B6/B12 acne. A contribution on acne medicamentosa. 1976 MMW Munchener Medizinische Wochenschrift 118(6):155-160
Jansen T, Romiti R, Kreuter A, Altmeyer P. Rosacea fulminans triggered by high-dose vitamins B6 and B12. 2002 J Eur Acad Dermatol Venerol doi: 10.1046/j.1468-30383.2001.00308.x
Brescoll J, Daveluy S. A review of vitamin B12 in dermatology. 2015 Am J Clin Dermatol doi: 10.1007/s40257-014-0107-3