B-12 Deficiency–Treatment Options

should ask for B-12 injections. You might wonder if there is a reason for it, and the answer is YES! If you take B-12 orally, most of the vitamin gets lost during digestion process. If you have an autoimmune disease or digestive problems, your stomach won’t be able to process of absorb B-12 effectively, so you will be wasting your time and money.

There is a form of B-12 called lozenges, that you can take by placing tablets under your tongue, like a candy, and some of it will absorb through your salivary glands–it is a better option than tablets you have to swallow.

Another option is B-12 nasal spray–which will bypass your digestive system altogether.

There are also B-12 patches you can apply behind your ear, so that B-12 would absorb through your skin, going directly into the blood stream.

With all these options, injections have been proven to be the best way to go–injections are administered into the muscle, which is supposed to store part of our B-12 storage by design already. While all other types of supplementation/treatment might take time to show benefits, with injections a difference can be felt within the same day, especially in those suffering from severe deficiency or neurological deficiency symptoms. However, even if you fall in the gray zone [300-450 pg/ml--subtle deficiency] but are very symptomatic, be emphatic with your doctor to request injections. I would not hesitate to ask for injections even if I came up with 550 pg/ml and was symptomatic–after all, it is my money that pays for it, and again, remember that there is no danger of overdosing!  In addition to that studies* have shown that even omnivores with “normal” B-12 levels can greatly benefit from injections, alleviating such symptoms as depression, and a sense of wellbeing was reported in many. [*Source]

Types of B-12 {Cobalamin} Treatments

B-12 is produced in three forms used for B-12 deficiency treatments:

1. cyanocobalamin
2. hydroxocobalamin
3. methylcobalamin

Studies have shown that hydroxocobalamin is superior to cyanocobalamin, and methylcobalamin is superior to methylcobalamin.

80% of the injected cyanocobalamin dose is excreted within the first 24-hours [Source]. You will be surprised to find out that cyanocobalamin is made with poison–cyanide, and who needs that in their bodies? Not only that but patients with Leber’s neuropathy cannot properly clear cyanide from their system, so cyanocobalamin can be life-threatening to them.

Cyanocobalamin is the WORST choice of B-12!  ”Not only does cyanocobalamin require a higher dosage for the same effectiveness of hydroxocabalamin, but it is entire ineffective for several conditions related to vitamin B-12 deficiency.” [Source]

Since 1970′s several researches presented strong cases to remove cyanocobalamin as an option for treatment altogether. It is unfortunate that the US still has not heeded their educated advice, while Great Britain got on board with their recommendations.

In contrast hydroxocobalamin has a greater retention rate [28-days after injection retention rates is nearly three times greater than cyanocobalamin], and it is more available to cells and is processed more efficiently by them. [Source]

Methylcobalamin, as you have read in my last post, unfortunately is not as familiar in the US, not even to doctors. Methylcobalamin, unlike its two less effective cousins, “bypasses several potentially problematic steps of B-12 metabolism. Furthermore, methylcobalamin provides the body with methyl groups essential for various biological oxidation-reductions. Studies show that a small oral dose of methylcobalamin results in a greater accumulation of cobalamin in the liver than an oral dose of cyanocobalamin, and methylcobalamin is retained approximately three times longer in the tissue than cyanocobalamin.” [Source]

“Degenerative neurological problems are where methylcobalamin shows its greatest benefits over other cobalamin preparations, and it is often one of the ONLY promising treatments for these tragic diseases. While Japan uses methylcobalamin nearly exclusively and it is the form present in prescription vitamin B-12 there, the United States has virtually ignored the hundreds of studies that show the benefits this simple vitamin can bring.” [Source]

With this information you should be outraged to see cyanocobalamin in pre-natal vitamins, which unfortunately is the case.

How Much B-12?

If you are low and your doctor agrees to B-12 injections, assuming that you will request methylcobalamin [fight for it tooth and nail--it will be worth your money], the author of Could it Be B12? book, Sally M Pacholok, RN, suggest the following regimen:

1. Initial intramuscular injections of B12—1,000 mcg daily or every other day for 5-7 days, followed by
2. Intramuscular injections of B12—1,000 mcg weekly for four weeks, followed by
3. Intramuscular injections of B12—1,000 mcg either weekly, bi-weekly or monthly, to be individualized for each patient.

Patients can get their injections at their doctor’s office, or, if you are a brave soul like me and wish to save money, you can ask your physician, or his/her nurse, to teach you how to give injections yourself.

When ordering methylcobalamin from a pharmacy, ask for the one without preservatives, if at all possible.

The bi-monthly/monthly injections after the initial treatment can be maintained as long as needed, for some for the rest of their lives, or, if you are able to properly and easily absorb B-12 vitamin through other forms of supplementation, the upkeep can be done with those options.

Personally, we are going to go through 3 months of injection treatment, then we will have a check up and either continue with injections or/and switch to sublingual form of B-12. We are also planning to supplement with sublingual B-12 in-between our shots, once we go on a biweekly regimen. Again, remember that B-12 is not toxic and you cannot overdose, so doing both, injections and supplementation is totally safe.

Sublingual and Oral Dosage

If you, or your doctor, for one reason or another, decide that you are not doing injections, when choosing B-12 supplementation, look for the same options as in injections–methycobalamin is still the best way to go.

There are many dosage options out on the market. When I shopped for B-12 for the first time a couple of years back, I found options ranging from 25 mcg/dose to 6,000+ mcg/dose. At the time I did not know any better and settled for 500 mcg lozenges. Had I known then what I know now I would have gone with at least 2,000-5,000+ mcg/dose. If you read my first article, you know that even a short treatment with 5,000 mcg/day of B-12 provided a huge relief to my muscle spasms–something I had not experienced for years.

I can tell you, however, that 6 mcg, 25 mcg, or even 100 mcg, are not going to make much of a difference even for people with normal levels of B-12.  It is like a grain of sand on a large beach–it will be lost and you would have wasted your precious time and money.  I know that it can be misleading to read on a bottle that the dosage you take is 8000% of daily value–remember that a lot of it gets lost in the absorption/retention process.

And yet again, remember that YOU CANNOT OVERDOSE WITH B-12! So, don’t be timid and afraid to go for 5,000 mcg of B-12 or more a day.

What I Use

The moment my blood was drawn today, since I was holding off on supplementing with B-12 for the last week and a half, I popped in a 5,000 mcg lozenge into my mouth, and later in the day followed up with another one.  Can you blame me?  I just want to feel better FAST!

I used Jarrow formula of methylcobalamin, which also happens to be safe for vegans to use:

The same company produces a different strength of this supplement:

There are other formulas that come recommended by those in the vegan community:

choose between 1000 and 5000 mcg

Urinary MMA, aka uMMA, stands for urinary methylmalonic acid.  The test measures methylmalonic acid (MMA) by selected ion monitoring isotope dilution gas chromatography mass spectrometry (GC/MS) in a random spot urine specimen. The MMA value is normalized to urine creatinine to correct for urine dilution. The urinary MMA/creatinine ratio (uMMA) test is more accurate than the blood test as it indicates tissue/cellular B12 deficiency.

If it happens that you do not have an insurance, or your insurance does not cover uMMA, which they should, you can go directly to the source to have it done for $150 per test–it’s a small price to pay compared to what you might have to pay if you don’t catch the deficiency in time to get it treated!

Norman Clinical Laboratory, Inc. (NCL) provides a means to test individuals through the mail for cobalamin (vitamin B12 ) deficiency. NCL, established in 1985, was the first commercial laboratory to provide the uMMA test. NCL introduced the Mayo Clinic to the uMMA assay and Mayo Clinic has also provided the uMMA test for years. Now other laboratories around the world are offering the uMMA test which has benefited thousands.

The lab is located in Cincinnati OH [go, Ohio!], and the turnaround time for the test results is around 3 days, once they have your sample.  All you have to do is call them [800-397-7408] and ask for them to mail you materials and container needed for the test, and they will respond immediately. I called them, just in case if our insurance did not cover the test.  Having left a message I heard back from them within an hour, and in a couple of days I received all I needed to collect a sample in the mail, along with instructions on how to do it.

Complete B12 Research

To get the entire report of my B12 research either:

1. subscribe and download the 180-page report, which had an entire Appendix dedicate to the topic (the entire research, and how the findings helped me), or
2. go through B-12 category on this site, starting from the earliest post.