One Vitamin That Might Actually Make Sense to Take
Can't hurt. Might help. Might even help a lot.
For forty years, I've called bullshit on miracle supplements and vitamin hype. So, why do I take vitamin B12 every day?
The formula guides smart health decisions. The formula has three components – See, Believe, and Create. Each is essential, and I hope you’ll read my forthcoming book, which can be pre-ordered now, to find out more.
One component of the “See” part of the formula is to see the pathway to progress. This requires technical rigor, because the plea to “follow the science” is misguided. Even where there’s robust evidence, we must decide which solutions to choose and how to implement them. There are many aspects of technical rigor to find the path to health, but one important tool – and one too rarely used in either public health or clinical medicine – is a crucial concept: Burden × Amenability.
Burden means how many people suffer from a condition. Amenability means how much we can actually do about it. The magic happens when you multiply them—finding problems that affect many people AND can be addressed effectively.
Another crucial factor in health decisions—one far too rarely acknowledged by supplement companies and so-called health gurus—is our level of certainty that something actually works. Think of evidence in three tiers:
Virtually certain interventions have evidence from multiple countries and study types and proven results in rigorous trials. There’s virtually no chance that future studies will reverse what we know about these – cigarettes cause cancer and heart disease, high blood pressure causes strokes and heart attacks, and controlling these risks reduces disability and saves lives.
Strong evidence means good theory, well-conducted studies, and some real-world proof of effectiveness. Our recommendations are probably right, but we must be humble and keep an open mind – there’s a chance future knowledge will reveal that we’re wrong.
Some evidence has theoretical support and at least one high-quality study suggesting benefit. There’s enough evidence to consider following it, but it could definitely be wrong.
Then there's the fourth category: hunches dressed up as science—paleo diets, fish oil for everyone, resveratrol—with convincing-sounding theories but little or no actual evidence from humans. It’s not that all of these are definitely wrong, it’s just that there’s no real evidence they’re right.
Now consider B12. Apply these evidence tiers to B12 supplementation: We have “strong evidence” for benefits in B12-deficient populations and “some evidence” for broader use, particularly in older adults. It's not in the ”virtually certain” category, as blood pressure control is, but it's far from the ”hunches” category of most supplements. The burden is surprisingly high: Up to one in four older adults has borderline-low levels, and deficiency can cause nerve damage and cognitive impairment. The amenability? Remarkably high—simple supplementation may prevent irreversible nerve damage and cognitive decline.
Even the best blood tests for B12 deficiency are far from perfect. You can have "normal" blood levels while your brain lacks enough of this essential nutrient. And even advanced tests—methylmalonic acid, homocysteine—can miss functional deficiencies.
For decades, doctors believed that effective treatment of B12 deficiency required monthly injections. The conventional wisdom was that oral supplements couldn't work because absorption requires a chemical called intrinsic factor that most people produce in the stomach and which deficient patients often lack.
That’s what I was taught in medical school. It was wrong.
More recent research showed that oral B12 (e.g., 1000 micrograms daily) works. It's also infinitely more convenient than monthly shots.
Now apply the Burden × Amenability calculation: High burden (loss of memory, among other serious problems). High amenability (safe, cheap, effective supplementation). And the level of proof? Some evidence. Not virtually certain. Not strong. But some. The formula says it's worth considering.
Here's my reasoning for taking B12: It's water-soluble—your body excretes excess, so at reasonable doses, there's essentially zero risk. Potential benefits include better cognitive function. Cost is pennies per day.
Can't hurt. Might help. Might even help a lot.
Should everyone take B12 supplements? No. Should you? That’s up to you.
I’d be more comfortable with this analysis of the potential benefits of vitamin B12 if Congress stopped preventing the FDA from regulating supplement quality. The multi-billion-dollar supplements industry has blocked this for decades. There's no guarantee that the bottle you buy contains the right amount of what the label claims—or that it's contamination-free.
Compare this to hype about unproven supplements. Ginkgo biloba for memory? No evidence of benefit. Mega-dose vitamins for cancer prevention? Can actually increase mortality. Fish oil supplements (omega-3 fatty acids) to improve heart or brain health in people with average risk? Zero evidence, despite lots of studies.1 The supplement industry formula maximizes their profit, not your health.
I take 1000 micrograms of vitamin B12 daily. I buy products made by manufacturers who voluntarily test their products, though I wish testing were mandatory, independent, and standardized. I stopped using one brand when the pills smelled off … that’s a terrible way to do quality control! (Vitamin B12 is odorless.)
This isn't medical advice—it's one doctor sharing how he applies the Burden × Amenability calculation to his own life. Talk to your doctor, especially if you have symptoms: fatigue, weakness, memory problems, numbness, or tingling.
The Formula applies: See the invisible deficiency that tests might miss. Believe simple interventions can prevent serious problems. Create practical, safe solutions.
But remember: The most powerful health interventions aren't vitamin supplements. They're systematic changes—like taking a brisk walk outdoors for 30 minutes at least 4 days a week, or controlling your blood pressure. These are certain to help you live longer and healthier, and to reduce your risk of cognitive decline.
Next week: The greatest global health president in American history.
Quiz: Who do you think it was:
Herbert Hoover
Barack Obama
George W. Bush
Franklin Delano Roosevelt
I look forward to sharing my vote with you.
Dr. Tom Frieden is author of The Formula for Better Health: How to Save Millions of Lives – Including Your Own.
The book draws on Frieden's four decades leading life-saving programs in the U.S. and globally. Frieden led New York City's control of multidrug-resistant tuberculosis, supported India's efforts that prevented more than 3 million tuberculosis deaths, and led efforts that reduced smoking in NYC.
As Director of the CDC (2009-2017), he led the agency's response that ended the Ebola epidemic. Dr. Frieden is President and CEO of Resolve to Save Lives, partnering locally and globally to find and scale solutions to the world's deadliest health threats.
Named one of TIME's 100 Most Influential People, he has published more than 300 scientific articles on improving health. His experience is, for the first time, translated into practical approaches for community and personal health in The Formula for Better Health.
For certain high-risk people, such as those with familial forms of high levels of unhealthy lipids, very high dose omega-3 supplements, generally requiring a prescription, provide some benefit.