Sheldon Zablow, MD

Author of
Your Vitamins Are Obsolete

COVID Supplementation Beyond Vitamin D—Bioactive B Vitamers

Oct 13, 2020 by Dr. Sheldon Zablow

Recently Vitamin D has been noted as a nutrient that can reduce the severity of COVID outcomes. Rarely mentioned is the importance of the most essential of the essential vitamins B12 and folate (B12/F). In their bioactive (vitamer) forms, these two vitamins are critical to the efficient biochemical functioning of cellular energy production, waste management (homocysteine reduction) and optimization of the inflammatory response through DNA epigenetic methylation. A deficiency of B vitamers causes a worsening of any medical illness particularly whole-body viral infection (sepsis). Without enough B12/F all treatments will not work well, for example, you can have plenty of Vitamin D and calcium but still develop osteoporosis. [B12/F are co-vitamins and can only work well when there is enough of both.]

The wide variety of COVID presentations have been called “mysterious” and ”strange” by the medical community from classic sepsis, to systemic micro blood clots to COVID toes to strokes in the young, pulmonary emboli, neurologic complications and unusual immune reactions in children. We now know certain patients are predisposed to a more severe course if patients are older, male, overweight, diabetic, smokers, have high alcohol consumption, or are African American.

Recent research suggests the connection between these predispositions is the B12/F deficiency increase in homocysteine.  Homocysteine causes damage by increasing inflammation in cells lining blood vessels (endothelium) and increasing blood viscosity. Thicker blood causes micro-clots which are resistance to blood thinning agents and damage alveolar capillaries, kidneys, the brain, and toes through microvascular dysfunction.  Homocysteine elevation corresponds to the severity of COVID progression on lung scans and is the biomarker physicians have been looking for to evaluate the severity of illness.

↓B12/F→↑Homocysteine → Endothelial Inflammation + ↑ Blood viscosity → Micro-clots

B12/F levels decrease, and homocysteine increases with age, obesity (fat reduces folate), diabetes, smoking, alcohol consumption, vegan diets (low B12), ethnicity (African-Americans have higher homocysteine levels), male gender, and genetics. The prescription of NSAID’s, metformin, hormones (estrogen, testosterone, hydro-cortico steroids), and PPI’s also lower B12/F. Use of synthetic folic acid can reduce the body’s ability to use the bioactive vitamer forms of folate. If someone has a deficiency of the enzyme (MTHFR) that converts folic acid into folate, they are at greater risk of the serious complications of COVID.

Age, Obesity, Diabetes, Smoking, Alcohol consumption, Vegan diets, Ethnicity, Male gender, Genetics, NSAID’s, Metformin, Hormones, PPI’s → ↓B12/F

Most physicians discount B12 deficiency because we were incorrectly taught that the body has a three-year store of B12 in the liver and that it contains the highest concentration of B12. The body cannot store water soluble vitamins and the pituitary has the highest concentration of B12. The pituitary regulates the immune response so if there is a B12/F deficiency, the acute immune response is reduced and the chronic immune response is exaggerated.

↓B12/F→ ↓ Acute Inflammatory Response         ↓B12/F→↑ Chronic Inflammatory Response

It follows from above that homocysteine and MTHFR should be routinely tested for in every COVID patient and proactive treatment with both B12 and folate in their vitamer forms initiated to reduce symptom severity and death.

Vitamers are the different molecular forms of vitamins, the bioactive forms are the ones the body is able to use. Folic acid and cyanocobalamin are artificial forms of Vitamin B the cells have to convert into the bioactive vitamers before use. Methylcobalamin, adenosylcobalamin and 5-methyltetrahydrofolate are the bioactive vitamers.

The above is condensed from my book, Your Vitamins Are Obsolete by Sheldon Zablow, MD

The following is a partial selection of references for the above:

Vitamin B12: the forgotten micronutrient for critical care    

Manzanares, W., Hardy, G.,  Curr Opin Clin Nutr Metab Care, 2010; 13(6):662–8.

“B12 may prove an innovative approach to treat critically ill systemic inflammatory response syndrome patients, especially those with severe sepsis/septic shock. In this setting, vitamin B12 and transcobalamins could modulate systemic inflammation contributing to the anti-inflammatory cascade and potentially improve outcome.”

Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors Christopher V. Almario, MD, et al. Am J Gastroenterol (July 7, 2020)

Homocysteine as a potential predictor of cardiovascular risk in patients with COVID-19  Giovanni Ponti, et al. Med Hypotheses. 2020 Oct; 143:

“we suggest the routine determination of plasma homocysteine as a potential marker for severe disease in SARS-CoV-2 patients. Very recent data witnessed a predictive value of homocysteine for severe pneumonia on chest CT at first week from COVID-19 patients”

SARS CoV ‐2 aggravates cellular metabolism mediated complications in COVID ‐19 infection  Yogendra Singh  18 June 2020 Dermatologic Therapy

“…folic acid, and Vitamin B12 should be incorporated in the treatment regimen for SARS CoV‐2 infections to suppress complications, as the virus mediates altered host cell metabolism.”

Life-threatening course in coronavirus disease 2019 (COVID-19): Is there a link to methylenetetrahydrofolic acid reductase (MTHFR) polymorphism and hyperhomocysteinemia?  Matthias Karst, et al. Med Hypotheses. 2020 Nov; 144: 110234.        “In conclusion, we propose a theory of specific vulnerability to a severe course of COVID-19 initiated by H-Hcy, which can be triggered by the presence of the C677T polymorphism.” “During the SARS-CoV-2 pandemic early risk stratification by measurement of Hc-plasma levels and possibly screening for the presence MTHFR polymorphism appears promising. Additionally, treatment with vitamins and micronutrients in addition to standard supportive care seems to be warranted to protect and support the most vulnerable patient groups.”

Higher total homocysteine concentrations and lower folate concentrations in premenopausal black women than in premenopausal white women  Glenn T Gerhard, et al The American Journal of Clinical Nutrition, Volume 70, Issue 2, Aug 1999, Pg 252–260

Gender: a primary homocysteine level-effecting factor for patients suffering homocysteine-related diseases  Ai-Feng Wang, et al.  Biomedical Research (2017) Volume 28, Issue 1

“…male patients suffering from the eHcy associated diseases bear higher Hcy levels than female patients, which may provide explanation why male population has higher prevalence of eHcy associated diseases.