B vitamins and folic acid

B vitamins comprise a group of chemically distinct vitamins that play important roles in the health of the body, especially in the processes of cell growth and reproduction. Once thought to be a single vitamin, we now recognize eight different B vitamins, including vitamins B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folic acid), and B12 (various cobalamins). Supplements that contain a mixture of all of these are generally referred to as a vitamin B complex. A growing body of research has examined the role of different B vitamins in arthritis and other health conditions.

Whole grains, such as rye, barley, and wheat, fish (salmon and tuna), chicken and pork, bananas provide dietary sources of B vitamins, including vitamin B6 (pyridoxine), vitamin B3 (niacin), vitamin B5 (pantothenic acid), and vitamin B12 (cobalamin). Dietary sources for vitamin B9 (folic acid) include leafy vegetables (spinach, broccoli, lettuce), okra, asparagus, cereals, fruits (lemons, melons, bananas), organ meat, legumes, yeast, mushrooms, and orange and tomato juice.1

As with all supplements, whether vitamins, minerals, herbal or chemical products, consult with your doctor before you start taking B vitamins. There may be health risks associated with use of these vitamins, including interactions with medications that you are taking and negative effects associated with health conditions you may have. Your doctor is also in the best position to determine the proper and safe dosage for any supplement.


Vitamin B6 and reduction of inflammatory markers for RA

There is some evidence that B vitamins may provide benefits in people with RA. For instance, vitamin B6 has been shown to reduce levels of inflammatory markers, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), in patients with RA.2


Vitamin B6 and possible benefits in carpal tunnel syndrome

There is also some limited evidence that vitamin B6 may be useful in relieving stiffness and pain associated with carpal tunnel syndrome, a common comorbidity with RA. Some studies suggest that patients with carpal tunnel syndrome may be deficient in vitamin B6.3 However, findings from a recent systematic review failed to confirm this theory and concluded that more study is necessary.4


Vitamin B12 and joint pain

Vitamin B12 supplementation has been shown to improve elbow joint pain. This evidence came from a single randomized, controlled trial in which patients received vitamin B12 injection directly into the joint along with acupuncture or vitamin B12 injection alone. Results showed that vitamin B12 resulted in some relief of pain, with no additional pain relief provided by acupuncture.5


B vitamins for heart and bone health

In addition to its potential benefits in RA, B complex vitamins, including B6, B9 (folic acid), and B12, taken together can lower homocysteine, an amino acid which is linked to increased cardiovascular risk. Elevated homocysteine blood levels have been associated with abnormalities in blood clotting, atherosclerosis, myocardial infarction (heart attack), and ischemic stroke. The exact relationship between homocysteine levels and risk for death or disability from cardiovascular causes is still not clear. Nor do we know whether vitamin B supplementation (particularly vitamin B12 and folic acid) can protect against this increased risk. However, because individuals with RA face increased risk for cardiovascular disease, getting adequate amounts of B complex vitamins (which lower homocysteine) does appear to be important.5,6

If you take a B complex vitamin supplement, a recommended daily dose for reducing homocysteine levels includes 10 mg of B6, 1 mg of folic acid, and 0.4 mg of B12.7

In addition to the potential benefits of B vitamins for cardiovascular health, vitamin B12 and folic acid supplementation also appears to contribute to bone health and decrease risk of fracture. In one study, B vitamin supplementation lowered the incidence of fracture by 75%. This is important because individuals with RA (both men and women, but particularly women around and after the age of menopause) face increased risk for bone loss and fracture.5


Folic acid (vitamin B9) and methotrexate toxicity

Folic acid supplementation is recognized as a useful measure to counteract toxicity associated with the disease-modifying anti-rheumatic drug (DMARD) methotrexate, which is commonly used in the treatment of RA and other autoimmune diseases. Methotrexate can cause a range of side effects, including fatigue, decreased energy, hair loss, and mouth sores. Taking a folic acid supplement along with methotrexate can be an effective way to counteract these and other side effects associated with the drug.6

Written by: Jonathan Simmons | Last reviewed: September 2013.
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