Vitamin B12 is a water-soluble nutrient that plays many critical roles in your body.

Some people think that taking high doses of B12 — rather than the recommended intake — is best for their health.

This practice has led many to wonder how much of this vitamin is too much.

This article examines the health benefits, as well as potential risks of taking megadoses of B12.

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There’s no question that vitamin B12 is essential for health.

It’s responsible for numerous functions in your body, including red blood cell formation, energy production, DNA formation, and nerve maintenance (1).

Though B12 is found in many foods, such as meat, poultry, seafood, eggs, dairy products, and fortified cereals, many people don’t get enough of this important vitamin.

Health conditions such as inflammatory bowel disease (IBD), certain medications, genetic mutations, age, and dietary restrictions can all contribute to an increased need for B12.

Vitamin B12 deficiency can lead to serious complications such as nerve damage, anemia, and fatigue, which is why those at risk should talk with their doctor about adding a high quality B12 supplement to their diet (2).

Current evidence suggests that people who consume adequate amounts of B12-rich foods and are able to properly absorb and use this nutrient don’t necessarily need to supplement.

For example, a meta-analysis from 2021 found that Vitamin B12 supplementation is likely ineffective for improving cognitive function and depressive symptoms in patients without advanced neurological disorders (3).

Although B12 supplements are commonly taken to boost energy levels, there is currently no evidence suggesting that more B12 increases energy in people with adequate levels of this vitamin.

However, B12 supplements will most likely increase energy levels in those who are deficient, as this nutrient plays an important role in converting food into energy.

Summary

B12 is an important nutrient that is essential for red blood cell formation, DNA synthesis, and many other vital processes. Supplements may help boost mood and reduce symptoms of depression in those who are not deficient in this vitamin.

Since B12 is a water-soluble vitamin, it’s generally considered safe, even at high doses.

No Tolerable Upper Intake Level (UL) has been established for B12, due to its low level of toxicity. UL refers to the maximum daily dose of a vitamin unlikely to cause adverse side effects in the general population.

This threshold has not been set for B12 because your body excretes whatever it doesn’t use through your urine.

However, supplementing with excessively high levels of B12 has been linked to some negative side effects.

Several studies have shown that megadoses of the vitamin can lead to outbreaks of acne and rosacea, a skin condition that causes redness and pus-filled bumps on the face.

Yet, it should be noted that most of these studies focused on high dose injections rather than oral supplements (4, 5, 6).

There is also some evidence suggesting that high doses of B12 may lead to negative health outcomes in those with diabetes or kidney disease.

One 2010 study found that people with diabetic nephropathy (loss of kidney function due to diabetes) experienced a more rapid decline in kidney function when supplemented with high dose B vitamins, including 1 mg per day of B12 (7).

What’s more, the participants receiving the high dose B vitamins had a greater risk of heart attack, stroke, and death, compared to those receiving a placebo. However, more recent studies are needed to support this claim (7, 8).

Another study in pregnant women showed that extremely high B12 levels due to vitamin supplements increased the risk of autism spectrum disorder in their unborn child (9).

Though there is evidence that supplementing with B12 may cause negative health outcomes, studies have demonstrated that daily oral supplements of up to 2 mg (2,000 mcg) are safe and effective in treating B12 deficiency (10).

For reference, the recommended daily intake (RDI) of vitamin B12 is 2.4 mcg for both men and women, though pregnant and breastfeeding women have a higher need (11).

Summary

Although there is some evidence that very high doses of B12 may cause adverse health effects in certain populations, megadoses of this vitamin are commonly used to safely and effectively treat B12 deficiency.

For healthy individuals who are not at risk for B12 deficiency, eating a well-rounded, nutrient-rich diet should provide all the B12 their body needs.

Food sources of this vitamin include eggs, red meat, poultry, seafood, milk, yogurt, fortified cereals, nutritional yeast, and fortified non-dairy milk.

However, individuals taking medications that affect B12 absorption, pregnant or breastfeeding women, vegans, and anyone with a condition that negatively impacts the absorption of or increases the need for B12 should consider talking with their doctor about taking a supplement.

Additionally, evidence from population studies suggests that B12 deficiency in older adults is common, which is why it’s recommended that adults over 50 years old consider taking supplements (12).

While megadoses of up to 2,000 mcg are considered safe in treating B12 deficiency, it’s always best to avoid excessive amounts of any vitamin, especially when it’s not needed.

Though daily high doses of B12 are unlikely to cause harm in most people, extremely high doses should be avoided unless a healthcare professional prescribes it.

If you think you may be deficient in B12, speak with your doctor, who can recommend an appropriate treatment based on your level of deficiency.

While no UL has been set for B12, your body’s ability to absorb the vitamin depends on how much it actually needs.

For example, it’s estimated that only 10 mcg of a 500-mcg B12 supplement is actually absorbed in people without a deficiency (1).

For this reason, taking high doses of B12 does not benefit people without an increased need.

Summary

Although supplemental B12 is required for people with an increased need for this vitamin, it’s unnecessary for those without a deficiency to take high doses.

B12 is an important nutrient that is popularly used as a nutritional supplement, even by those without a B12 deficiency.

Though doses of up to 2,000 mcg of vitamin B12 are considered safe, it’s best to speak with a doctor to find out whether taking a supplement is necessary.

Most people can fulfill their B12 needs through a nutrient-rich diet. However, some people, including older adults and those with certain dietary restrictions, should consider talking with their doctor about supplementation.