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Feb 10, 2016

B-12 Injection

B-12 can help significantly reduce or resolve the following symptoms:
I have observed up to 90-95% success rates with patients experiencing improvement in one or more of the symptoms listed, especially if patients follow through the complete injection protocol. I have not been able to determine why approximately 5-10% of patients don’t respond. Also, I have had patients who didn’t have any overt symptoms still want to try B-12 injections in attempt to feel even better. This success rate has been over 50%.

Primary symptoms that usually improve:
  • Fatigue, lack of motivation/apathy, low stamina/weakness
  • Sleep problems (insomnia, poor sleep quality, not rested in the morning/hard to get up)
  • Mood issues (irritability, anxiety, mild-moderate depression, low sense of well being)
  • Poor short term memory, lack of focus/concentration, decreased mental sharpness, “fuzzy thinking (While potentially useful for anyone, this is particularly effective in the elderly. But if B-12 levels have been too low for too long in the elderly, success can be limited.)
  • Peripheral Neuropathies (numbness/tingling of extremities), paresthesias, sciatica
  • PMS (especially emotional reactions)
  • Jet lag (reduction in symptoms or susceptibility)
  • Dizziness/balance problems, ringing in ears/tinnitus
  • Loss of appetite
  • Sore mouth/tongue, tingling sensation in mouth
  • Arthritis/Bursitis, chronic pain        

Medical observation has also identified B-12 as being supportive in these conditions: 
  • Wheezing/asthma type problems
  • Eating disorders/Alcohol abuse
  • Cervix problems (PAP smears)
  • Pre-eclampsia (in pregnancy)
  • Infertility
  • MS

B-12 supplementation is important or required with these situations or conditions:
  • Strict vegetarians (vegans) after 1 year
  • Gastrointestinal problems (inc. bypass surgery), use of Rx acid blockers (i.e. Prilosec, Prevacid, Protonex, Nexium)
  • High Homocysteine blood levels (contributes to heart attack, stroke, and Alzheimer’s disease risks)
  • Diabetic Rx use - esp. Glucophage (Metformin)
  • High alcohol intake –  (all B-Complex vitamins are required)
  • Macrocytic/Megaloblastic Anemia (B-12 type)

 Note: Pernicious Anemia requires a different protocol and its treatment requires a different discussion.                                  

Common Questions:
Can B-12 deficiency be identified through blood tests?
  • B-12 activity is not effectively measured in blood. First, what is considered a “normal” range is often too low for optimum benefit. More important - what is in the blood doesn’t necessarily pass into the tissues, so you really need to measure tissue levels. The only effective test for this is Methyl Malonic Acid (MMA), a metabolite of B-12. B-12 is the only chemical in the body that produces this chemical, so there are no confounding factors to its levels. Serum B-12 levels can look falsely normal, while the MMA test can more accurately identify if a deficiency exists. Western medical practitioners are often not aware of this test or its significant value. If testing B-12 levels, serum B-12 is the primary method used. MMA can be measured in blood and urine, but the urine test is more reliable for deficiency identification. If not offered by a local lab, there is a urine collection kit available that can be mailed to a specific lab (see below). I do not routinely test the B-12 levels before initiating treatment, as this has little bearing on the therapeutic success. Patients with “normal” B-12 levels still can benefit from shots.

Why injection?
  • Published research says the oral tablets are just as effective to reverse deficient B-12 blood levels, but I do not see the same therapeutic benefit (symptom improvement) as with the injection. B-12 can be very hard to absorb through the stomach/intestinal route. Then it requires transport from the serum into the tissues via specific Transcobalamin carrier molecules. Injections provide superior delivery which can result in significant therapeutic effects. The second best route is a sublingual dosage (dissolved under tongue), because this avoids stomach/intestinal absorption issues, though I do not see the same therapeutic effect or benefits with the symptoms discussed above compared to the injection. NOTE: IV B-12 does not work as well as the IM injection route due to more rapid detoxification via the liver.

Are there any Toxicity or Side Effects?
  • B-12 is considered to be non-toxic in general. Few side effects are observed generally. Using high dose B-12 (5mg/ml – 1ml doses or higher), urine can turn pink. There are occasional responses that fall out of the norm. I have had a very few patients that get overstimulated initially - if they get the shot in the afternoon they then can have trouble sleeping at night. Morning shots generally do not cause this problem in these cases. A few patients have wanted to take a nap after getting the shot, then they feel refreshed. Rarely – the opposite of expected positive effects have occurred, such as anxiety. A few patients have had itching and redness at the site of injection. The injection site reaction seems to start with mild symptoms but increases with repeated injections. If this occurs, I discontinue the injections. I have had reported a sense of swelling in joints or body overall. Very rarely patients can have an allergic reaction, including hives or breathing difficulties. It is possible that a gout reaction can occur in susceptible patients. Heart palpitations or other chest sensations have been reported, though I have not seen this. I have seen a comment about an association with rosacea and B-12 injections. There has been an association of high levels of B-12 and increased prostate & breast cancer occurrence, but I believe this has been seen in long term use of Folic Acid. A short series of shots or occasional repeat IM B-12 with FA in the future does not seem to qualify for a high quantity or repeated exposure that could possibly create this issue. Also there may be many other factors involved. It is theoretically possible that high dose/long term use of B-12 injectable (especially with Folic Acid) can stimulate the bone marrow to produce excessive amounts of red blood cells and platelets over time. Patients with Leber’s Disease (a hereditary condition) should not supplement with B-12 because it can cause damage to the optic nerve.

Why aren’t dietary sources of B-12 sufficient?
  • B-12 is supplied via foods that have had blood in them – primarily meat, dairy, and eggs. This is why strict vegetarians are at risk. But eating foods containing B-12 does not insure sufficient blood levels due to the absorption issues mentioned above, or therapeutic response. Again, the B-12 injections have the ability to create a therapeutic effect that is not seen with other routes of absorption. I provide a high potency B-Complex tablet if patients require longer-term or high dose B-12 injections to keep an overall balance of B vitamins in their system.