Vitamin B-12–Fortified Toothpaste Improves Vitamin Status in Vegans: A 12-wk Randomized Placebo-Controlled Study
Published In: The American Journal of Clinical Nutrition
Publication Year: 2017

Study Design

This study was a 12-week double-blinded, randomized, placebo-controlled trial investigating the effects of vitamin B-12–fortified toothpaste on vitamin B-12 status in vegans.

Funding Sources

The study was partially supported by a grant from Logocos Naturkosmetik AG. The funders did not influence study design, data collection, analysis, interpretation, or manuscript preparation.

PICO Framework – what was studied and how?

Population:
Healthy vegans aged 18–50 years, following a vegan diet for at least 2 years.

Intervention:
Use of a vitamin B-12–fortified toothpaste twice daily for 12 weeks.

Comparison:
Use of an identical-appearing placebo toothpaste without vitamin B-12.

Outcomes:
Changes in blood markers of vitamin B-12 status:

• Serum vitamin B-12

• Holotranscobalamin

• Methylmalonic acid (MMA)

• Total homocysteine (tHcy)

In Paragraph Form:
This study investigated whether brushing twice daily with a vitamin B-12–fortified toothpaste could improve vitamin B-12 biomarkers in healthy vegans, comparing changes to those using a placebo toothpaste over a 12-week period.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Aged 18–50

• Vegan for ≥2 years (or ≥5 years total vegan)

• Apparently healthy

Exclusion Criteria:

• High-dose B-12 therapy (≥1 mg)

• Pregnancy or lactation

• Anemia or malabsorption syndromes

• Chronic medication use (except oral contraceptives)

• Gastrointestinal diseases

• Prior use of B-12–fortified toothpaste

Demographics and Study Groups

Total Recruited: 76 participants

• Placebo group: 34 participants (30 completed)

• Vitamin B-12 group: 42 participants (36 completed)

Subjects were evenly distributed by age (mean ~29 years) and BMI (~21.6 kg/m²). About 69.7% reported some B-12 supplement use.

Primary Outcome Variable Results

Key Biomarker Changes (Adjusted for Baseline Levels):

Conclusions

The study concludes that vitamin B-12–fortified toothpaste significantly improves vitamin B-12 biomarkers in vegans. The benefits were particularly notable in those who were not taking other B-12 supplements. The oral mucosa allows sufficient B-12 absorption to correct or improve subclinical deficiency markers.

Discussion: Strengths and Limitations

Strengths:

• Rigorously controlled, randomized, double-blind design

• Relevant population (vegans, who are at higher risk for B-12 deficiency)

• Multiple validated biochemical markers assessed

• High compliance and consistent methodology

Limitations:

• Self-reported supplement use could not be fully verified

• Short intervention period (12 weeks)

• Unknown absorption mechanism and amount of B-12 actually absorbed

• No data on long-term sustainability of improved B-12 levels

Citation

Siebert A-K, et al. Vitamin B-12–fortified toothpaste improves vitamin status in vegans: a 12-wk randomized placebo-controlled study. Am J Clin Nutr. 2017;105(3):618–625. 

Link to article.

Visual Aids

Simple Chart: Change in Vitamin B-12 Biomarkers Over 12 Weeks