Medicines and other treatments need to be tested. We want reliable proof that something works and is safe before we recommend it. We don’t like the false dichotomy of “alternative medicine”. If there is good evidence that it works, it’s medicine. If it doesn’t work, it’s quackery. It doesn’t matter who’s doing the quacking. A quack is a quack, even if there’s a medical diploma on the wall. The story: a woman brings in her teenage daughter, complaining that the girl is tired a lot. It turns out that mom herself has had some blood tests that showed a low vitamin B12 level, so her doctor is giving her regular B12 injections. Can her daughter get some, too? I realize that B12 injections are common. Many docs administer these, and many adults get these—probably some of you reading this. So what’s the science behind this practice? Vitamin B12 deficiency is a real thing. It can occur because of a poor diet, or because some medications (like acid blockers) interfere with absorption.
Or it can occur because of a specific autoimmune disorder called “Pernicious Anemia.” Whatever the cause, the health consequences of vitamin B12 deficiency can include anemia, neuropathy, irritability, and depression. There is a simple blood test to measure vitamin B12 levels, though the levels in the blood don’t always correlate with whether there are enough B12 levels in the cells themselves. We can test for this, too, indirectly, through other blood tests including methylmalonic acid and homocysteine levels. So we can, in fact, know if a person is truly deficient. These confirmatory tests are rarely done. Instead, many adults are told that their vague symptoms of tiredness or fatigue are caused by B12 deficiency, instead of actually trying to address genuine issues like insufficient sleep, sleep apnea, overreliance on caffeine, and depression (to name a few of the many genuine causes of fatigue.)The treatment of B12 deficiency, as has been established from studies done in the 1960s, is ORAL B12.
Injections of B12 are not necessary—oral supplements work well, even in pernicious anemia. They’re cheap and they work. I suppose a very rare patient, say one who has surgically lost most of their gut, could require injections. But the vast majority of people with genuine B12 deficiency can get all of the B12 they need through eating foods or swallowing supplements. So why this fetish with injections? From the patient’s point of view, shots feel more like something important is going on. Placebos need rituals—with acupuncture, for instance, the elaborate ritual creates an illusion of effectiveness. And from the doctor’s point of view, injections reinforce dependence on the physician, creating visits and cash flow. So: people seem to think they feel better with injections, and the doctor makes a little cash, and everyone’s happy. So what’s the harm in that? I think it’s wrong to knowingly dispense placebos, even harmless ones. We doctors like to criticize the chiropractors and homeopaths.
We’d better take a close look at what we’re doing, first. Our placebos are sometimes far more dangerous than theirs. More importantly, people should be able to expect more from physicians. Patients come to us for genuine answers—if they wanted a witch doctor, they would have found one. I think we need to hold ourselves to a higher standard than a huckster at the carnival. We’re not here to promise that we’ve got all the answers. We are here to be honest, and to use the best knowledge that science has to offer, using genuine compassion and thought. Let’s leave the quacking to the quacks. We’ll stick with real medicine. Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.Diet/NutritionB12 Shots: Should You Get One?Markham HeidFor more, visit TIME Health.More and more, ours is a worn out, sleep-deprived, distracted nation.
It’s no wonder a shot of energy and focus would appeal to many of us. And that’s exactly what B12 injections deliver—literally—for those who lack sufficient stores of the nutrient.“B vitamins are essential for proper cellular respiration,” explains Dr. Roxanne Sukol, medical director of Cleveland Clinic’s Wellness Enterprise. Without adequate supplies of B12, most of the cells in your body will struggle to take in enough oxygen, which can affect everything from your energy levels to your mood and concentration, Sukol says. Classic symptoms of a B12 deficiency also include diarrhea or constipation, pale skin, and shortness of breath, according to the National Institutes of Health.The nutritional necessity of B12 explains why it’s such a popular supplement, and also why some celebrities have touted B12 injections as the magic ingredient in their health regimens. The vitamin’s links to increased energy have also made B12 popular among some dieters and weight loss clinics—the thinking being that more energy will translate to more exercise.“
But unless you have a B12 deficiency, there’s really no role for it,” Sukol says of B12 shots and supplements. Put simply, more isn’t better. And even if you’re low on B12, there’s no evidence injections of it will help you lose weight, says Dr. Brent Bauer, director of the complementary and integrative medicine program at Mayo Clinic. “Everybody’s looking for a shortcut,” he says. “B12 supplementation has its benefits, but it’s not a solution for weight loss.”So weight loss is out, but B12 shots have been associated with other conditions, too. In fact, there’s some solid research on B12 injections for the treatment of fibromyalgia and myalgia encephalomyelitis.Food sources of the vitamin include eggs, meat, and dairy products. People who eschew those foods are at elevated risk. “When I test vegans for B12, they’re usually on the low side—if not deficient,” Sukol says. Some gut-related diseases like Crohn’s or Celiac—as well as most types of weight loss surgery—can also limit the amount of B12 your system absorbs, she adds.
But figuring out if you’re low on B12 is trickier than you might suppose. A much-cited 2000 study from the American Journal of Clinical Nutrition found nearly 40% of the population have B12 levels that fall at or below what experts consider the low end of normal. While you might assume anything in the “normal” range means you’re in good shape, Sukol says that’s not always the case.“Blood tests are not always black and white the way we’d like them to be,” she says. “If I have a patient taking a lot of naps and complaining about poor concentration, I might recommend B12 supplementation even though the blood tests look normal.”You’ll notice she says “supplementation” and not “injections.” Unless you have one of the above conditions that prevent your gut from breaking down and absorbing the vitamin, a B12 pill is as effective as a B12 poke, research suggests. “For many people, an oral supplement is just as good [as an injection].”Finally, when it comes to the safety of both B12 injections and oral supplements, you don’t have much to worry about.