Should We Ban Vitamin B12?

So, with Roger Clemens stating that the only thing he has injected into his body is vitamin B12 (with lidocaine), I wondered if there are any performance-enhancing benefits from using the substance. And if there are, should we seek a ban (although, I think it would be nearly impossible to police)?

Once again, we have a substance that players are taking that appears to do nothing for healthy individuals. First, from the NY Times article:

In a telephone interview Thursday, Dr. Jerome Groopman, a hematologist and professor at Harvard Medical School, described lidocaine as a common local anesthetic whose injectable form would probably require a prescription. Groopman said that vitamin B12, which does not require a prescription, is administered to patients with a serious deficiency of the vitamin, usually the elderly, and that its value as an energy enhancer was “an urban legend.”

“For someone like Roger Clemens, who certainly looks robust, the likelihood that he would be deficient in vitamin B12 is a stretch,” Groopman said, noting that he had not seen Clemens’s medical records. “It would have no physiological effect. It would only have a placebo effect.”

Here are some results from a quick PubMed search.

Vitamin supplementation and athletic performance
Williams, MH
International Journal for Vitamin and Nutrition Research, Suppl. 1989;30:163-91

Vitamins serve primarily as regulators of metabolic functions, many of which are critical to exercise performance. Depending upon the nature of their sport, e.g., strength, speed, power, endurance, or fine motor control, athletes may use megadoses of various vitamins in attempts to increase specific metabolic processes important to improved performance. Surveys have indicated that most elite athletes do take vitamin supplements, often in dosages greater than 50-100 times the United States Recommended Dietary Allowances. The theoretical basis underlying the use of each vitamin depends upon its specific metabolic function in relation to sport. Vitamin A functions to maintain night vision; thiamin, riboflavin, niacin, and pantothenic acid are all involved in muscle cell energy metabolism; niacin may also block free fatty acid release; pyridoxine is involved in the synthesis of hemoglobin and other oxygen transfer protein; folic acid and vitamin B12 are integrally involved in red blood cell (RBC) development; vitamins C and E are antioxidants, possibly preventing the destruction of the red blood cell membrane during exercise; vitamin D may be involved in muscle cell energetics through its influence on calcium. These are but a few of the possible metabolic functions of vitamins which have been suggested to have ergogenic applications to sport. Research has shown that a vitamin deficiency impairs physical performance. If this deficiency is corrected, performance usually improves. In general, vitamin supplementation to an athlete on a well-balanced diet has not been shown to improve performance. However, additional research with certain vitamins appears to be warranted, such as with the vitamin B complex and fine motor control, and with vitamin E and endurance at high altitudes. Moreover, research with megadose supplementation may also be necessary.

Vitamin and mineral status: effects on physical performance
Lukaski HC
Nutrition 2004 Jul-Aug;20(7-8):632-44

Public health recommendations encourage the selection of a balanced diet and increasing physical activity to foster health and well-being. Whereas the adverse effects of restricted intakes of protein, fat, and carbohydrate on physical performance are well known, there is limited information about the impact of low intakes of vitamins and minerals on the exercise capacity and performance of humans. Physically active people generally consume amounts of vitamins and minerals consistent with the recommendations for the general public. However, when intakes are less than recommendations, some noticeable functional impairments occur. Acute or short-term marginal deficiencies, identified by blood biochemical measures of vitamin B status, had no impacts on performance measures. Severe deprivation of folate and vitamin B12 result in anemia and reduce endurance work performance. Evidence of vitamin A and E deficiencies in athletic individuals is lacking apparently because body storage is appreciable. In contrast to vitamins, marginal mineral deficiencies impair performance. Iron deficiency, with or without anemia, impairs muscle function and limits work capacity. Magnesium deprivation increases oxygen requirements to complete submaximal exercise and reduces endurance performance. Use of vitamin and mineral supplements does not improve measures of performance in people consuming adequate diets. Young girls and individuals participating in activities with weight classifications or aesthetic components are prone to nutrient deficiencies because they restrict food intake and specific micronutrient-rich foods. This information will be useful to professionals who counsel physically active people and scientific groups who make dietary recommendations to improve health and optimize genetic potential.

UPDATE: My exercise physiologist colleague John McLester had this to say when I asked him about the ergogenic effects of B12.

Coaches as far back as I can remember have been
convincing their athletes to take B12 (our high school coach lined us up
every year for a megadose injection of B12; he was highly uneducated in
this area). They always say “it will give you energy”. The fact is B12
is used in the metabolic reactions that break down foods to make ATP
(energy). However, it will not “give you energy” since it contains no
calories. And it will not speed up those metabolic reactions unless you
are deficient. Actually, the major side effect of B12 deficiency is
pernicious anemia. Since anemia will make you feel tired all the time,
an ergogenic fallacy is born. By the way, the most likely population
susceptible to B12 deficiency is strict vegans because B12 is usually
found only in animal foods , not veggies (other than mushrooms if you
count those as veggies).

Further Update: David Pinto puts his biochemistry major to good use to discuss the possible effects of vitamins.

12 Responses “Should We Ban Vitamin B12?”

  1. Ron says:

    You’re assuming that Clemens actually was injected with B-12 and not the more likely case that his claim to have taken B-12 is as phony as Bonds’ claim to have taken flaxseed oil. See also: excuses by Palmeiro and Tejada.

  2. NSILMike says:

    In an interview on a local Boston sports radio station last night, Jose Canseco said that steroids when ‘openly used’ in baseball locker rooms, were referred to by the code words “B-12 injections.”

    Hmmm…..

  3. JC says:

    Before the comments get off track, let me make something clear. I have no idea what Clemens may or may not have injected in his body. That is not the point of this post. I am just curious as to why so many athletes use actual B12 (they do) and what the effects might be. It turns out that it does nothing.

  4. Mike says:

    One interesting note from the first quote is: “However, additional research with certain vitamins appears to be warranted, such as with the vitamin B complex and fine motor control”

    Wouldn’t that be fascinating, if it turns out that B12 helps you hit a baseball?

    NSIL Mike, I heard the same thing on WEEI in Boston a couple months ago. Like Ron said, it’s the classic “flaxseed oil” defense… except if the B12 nickname was as popular as Canseco claims, there will be a bunch of guys who take it and Clemens can claim he just never new it really meant steroids. Palmeiro has already used it, saying he thought he was taking B12 from Tejada, and that it must have been “tainted”.

  5. JC says:

    From the Mitchell Report

    In that investigation, Palmeiro said he had received injectable, and legal, vitamin B12 from Tejada; Palmeiro said it was possible the vitamin B12 had been tainted and had been the reason for his positive test for steroids. Tejada admitted to investigators that he provided injectable vitamin B12 to Palmeiro and two other unidentified Orioles players during the 2005 season. The congressional report said that the Players Association had tested another vial of vitamin B12 provided by Tejada and it showed no signs of steroids.

    B12 may also be slang for steroids, but it is clear that many athletes and non-athletes get actual B12 injections. If Clemens was getting tainted B12 without being aware of it, he would have started failing drug tests. He claims to still take B12.

    In the end, nothing will be resolved here. I don’t see how McNamee is going to succeed in suing Clemens. He didn’t have any documents to give to federal prosecutors, so I doubt he’ll produce any in the future. He has no proof that Clemens is lying.

  6. charles killebrew says:

    People who use vitamins swear by them. People who “poo poo”
    the use of vitamins, saying that a normal diet is all the body needs, will never change their minds. I take every vitamin known to mankind. I am 76, in excellent physical and mental condition, and have been taking vitamins and anything else I deem to be helpful to the immune system for 60 years. I am 5’10″, 170 lbs,
    6.7% body fat and will challenge anyone my age to any sport (sprints, tennis, golf, bowling, bridge, gin rummy, etc.).
    I have personally known elderly people who have been given B12
    shots and have greatly benefitted by them. If it is psychological
    what’s the difference? It still works!

  7. huop says:

    JC, McNamee’s Lawyers claim there is some “evidence” that the mitchell report didn’t seek…or something to that extent that i read on ESPN.

    If it’s true, they may have evidence that mcnamee injected roger with banned drugs.

  8. Ed says:

    Roger may need some more of that B12 after digging his own grave during that 60 minutes interview. His 10 minutes of broken-English denial did nothing but show one of the negative side-effects of this “B-12″: a short temper.

  9. What about Cortisone? People just need to except that science is a part of sports. Sometimes it may be dangerous, other times it may make the event more engaging and entertaining, and sometime it might be both. Obviously baseball has been having some of its best financial seasons so the ‘steroid’ era can’t be all bad!

  10. jaymee gabriel says:

    Sorry but advocating Major League ball players police themselves is incredibly short sighted and irresponsible.

    These guys already make millions. They don’t need any more money. Money would not induce those who choose to do drugs or steriods to quit. Why should it when they can buy or do anything they want as it is already?

    You want to clean up the sport? Take AWAY all the big bucks we pay them. Put them all on salaries of $100,00- $200,000 a year. THEN see how many of them do steriods.
    1. Saving a $100,000 job wouldn’t be worth the chance of getting caught.
    2. These guys might learn the value of a buck and learn some fiscal and social responsibility.

    And I blame all the steroid problems in sports on the fans and consumers who generate the players’ grotesque salaries by paying thru the nose for tickets and retail merchandise and 24 hour sports cable channels and the like.

    Boycott professional sports till the value goes down as well as the salaries. Perhaps when players see the value of their sport plummet, it might shake them up enough to THEN police themselves.

  11. Dave says:

    Hi all, just to chime in… I’m a primary care physician. I give a fair number of vitamin B12 shots. For people who are B12 deficient (which usually means elderly patients, who are more likely to develop the autoimmune condition pernicious anemia and be unable to absorb B12, or people who are vegetarian/vegan, as B12 is only in animal products), it certainly helps with fatigue. It anecdotally can help with mood and energy level as well — I take a B complex vitamin daily. Is there great evidence for its use? Nope. Any my pee (sorry if this is too much information) is bright yellow, because as a water soluble vitamin, if you take more than you body needs, you pee it right out. So even if B12 could help performance, injecting more tahn you need would lead you to pee it out.

    Lidocaine is used to numb the area of an injection if it’s a particularly large (> 1-2 mL) injection; most standard shots such as flu shots are 0.5 mL. B12 is rarely given in doses larger than 1 mL at a time, and it’s given monthly. So the B12 ain’t for his joints and it ain’t for B12. Whether Clemens knew he wasn’t getting B12 or is being disingenouous, I don’t know.

    NSIL Mike quotes Jose Canseco above. Not sure how trustworthy he is (he’s been pretty on the money so far), but let’s not forget that Palmeiro and Tejada were reportedly both injecting B12; both have been outed in the Mitchell report for using PEDs. And B12 is one of the few medications that might be legally and commonly prescribed that are usually injected (e.g. a reasonable ruse for steroids).

    One other thing… Vioxx does not “destroy” your heart, as Roger suggested… there is a slight statistical increase in the number of heart attacks that people on Vioxx had, but a 45 year old pro athlete is unlikely to have a heart attack. By the time Vioxx came off the market people knew of its potential… so if he took it, it was before anyone realized that it slightly increased risk of heart disease. And Toradol (which he made sound like it was a hose tranquilizer) is essentially just very strong Motrin… it’s just that it (like Winstrol and other steroids) is injectable only… so it’s faster acting but alo could be used as a guise for steroid injection.

  12. Dr. Doug says:

    There is no unequivocal minimum or maximum vitamin supplementation level as the knowledge base keeps changing. For example, current vitamin D recommendations are now thought to be grossly inadequate by vitamin D researchers.

    Given that folic acid and vitamin B12 are integrally involved in red blood cell (RBC) development, the endurance athlete benefits most when used in combination with erythropoietin (EPO), which increases RBC. Only vegan, no animal products, athletes are likely to suffer pernicious anemia.

    Vitamin B12 injections have been used by professional cyclists for decades (long before the availability of EPO).

    Injecting B12 is now a euphemism for illegal ergogenic drugs and procedures (anabolic steroids, EPO, homologous blood doping, etc., and their masking agents), regardless of athlete protestations.

    Baseball should take a page out of professional cycling (see http://news.yahoo.com/s/nm/20080109/sp_nm/cycling_passport_dc).

    To keep drug testing from the control of baseball, athlete testing should be done by the World Anti-Doping Agency (WADA), which is the drug testing organization for the Olympics and federations of sports that are participants in the Olympics. The agency is independent of sport governing federations.

    J.C. Bradbury poses an interesting incentive/disincentive program for eliminating drug use in baseball (NY Times: Let Baseball Players Police Themselves). Penalties for athletes who cheat should, at a minimum, be as in professional cycling (one years salary) or better yet, one years salary for each year of illegal ergogenic drug use. Illegal recreational drug use is controlled by the local and federal police, although I advocate enforcement is ineffective and poor public policy.

    Unfortunately, athletes will be tempted by illegal ergogenic drugs as long as athletes are grossly overpaid. This will not change until TV and TV advertising sponsors, companies who employ athletes as spokesmen, and sports fans are willing to pay these athletes. When TV refuses to broadcast sporting events where there is illegal ergogenic drug use and endorsement contracts of druged athletes are recinded, then there athlete behavior may change. I say may, since many Olympic athletes have used illegal ergogenic drugs, and many of these athletes are in very low profile sports that are very low-paying and have almost no commercial value.