Cyanocobalamin, or vitamin B12, is a water-soluble vitamin that cannot be stored in the body. Excess vitamin B12 is passed out of the body through the urine. Vitamin B12 is available as a supplement, and it can be found in animal food sources such as meat, fish, beef liver, clams, eggs, and diary products. Vitamin B12 is often used in combination with other B vitamins in a vitamin B complex formulation. Vitamin B12 is usually taken by mouth. It is available in different forms, including chewable tablets and gummies, capsules, tablets, powders, strips, drops, and liquids. Vitamin B12 is also available in an injectable form to be given subcutaneously (into skin fat), intramuscularly (into muscles), or intravenously (into veins). Table 1 lists the usual dose range and the recommended dietary allowance (RDA) for vitamin B12 for different age groups. People with vitamin B12 deficiency might need doses at or above the RDA.Usual daily dose range and RDA for vitamin B12 for different age groups
Injectables are usually dosed at 250–1000 µg monthly. Your health care provider may have recommended using this product in other ways. Contact a health care provider if you have questions. Vitamin B12 is important in maintaining overall good health. It helps the body to form red blood cells and to metabolize carbohydrates, fats, and proteins. It is important for the proper function and development of the brain and nerves. At doses at or above the RDA, vitamin B12 supplementation is highly effective for preventing and treating vitamin B12 deficiency and associated diseases such as pernicious anemia (a type of anemia due to vitamin B12 deficiency). Some people may have low vitamin B12 levels because of absorption problems or inadequate amounts in their diet (for example, vegetarians are at risk since vitamin B12 is available only from animal food sources). Vitamin B12 supplementation in these cases can help prevent vitamin B12 deficiency. Vitamin B12 has also been studied to prevent heart diseases and to treat Alzheimer’s disease, memory loss, male infertility, diabetes, mental disorders, inflammatory bowel disease, asthma, fatigue, and high cholesterol.
However, there is not enough reliable evidence for these uses; additional studies are required to confirm the benefits of vitamin B12 in these conditions. Vitamin B12 has also been studied together with folic acid and vitamin B6 for prevention of recurrent strokes and breast cancer. However, research has shown that this combination of supplements did not lower the risk of stroke or breast cancer. Your health care provider may have recommended this product for other conditions. Vitamin B12 is generally well tolerated by most people if taken in recommended amounts. Side effects may include mild diarrhea, itching, blood clots, urine discoloration, and allergic reactions. People with Leber's disease (a genetic eye disease) or those who are allergic or sensitive to cobalt or cobalamin should consult their health care provider before taking vitamin B12 supplements. People with anemia need to talk to their health care provider about what treatment is right for them before starting any type of vitamin supplementation.
Taking vitamin B12 supplements before a proper diagnosis from the doctor may make it harder for your doctor to diagnose the type of anemia you have. Vitamin B12 is safe for pregnant or breast-feeding women when taken by mouth in recommended amounts. Vitamin B12 from food sources can interact with certain medications, including proton pump inhibitors (e.g., omeprazole, pantoprazole), H2 blockers (e.g., famotidine, ranitidine), and metformin. These can affect the absorption of dietary B12 into the body, though this does not appear to be a problem with supplements. Heavy drinking for more than 2 weeks can also decrease vitamin B12 absorption. Avoid taking the combination of vitamin B12 and chloramphenicol (an antibiotic) since chloramphenicol can destroy the newly produced blood cells that vitamin B12 helped to make. Vitamin C and potassium supplements can decrease the effects of vitamin B12. It is not known whether this interaction is clinically significant or not. You can avoid this by separating the vitamins and taking them at least 2 hours apart.
Consult your health care provider for more information on drug interactions. Before taking any new medications, including natural health products, speak to your physician, pharmacist, or other health care provider. Tell your health care provider about any natural health products you may be taking. By Rahim Habib ND, Naturopathic Doctor Most doctors think about testing your vitamin B12 levels if you have neurological symptoms such as tingling, numbness, or burning sensations in your arms or legs, weakness, or loss of balance. They may also think of testing it if you have a type of anemia showing large red blood cells on your routine tests. However, in the past decades, newer research has shown that many other symptoms or illnesses have been associated with low levels of this crucial vitamin. cold hands and feet – e.g.: poor memory, seizures, unexplained spinal cord degeneration In fact, the usual (and most common) way to test your levels of vitamin B12 has been through your blood, to literally test the level of B12 in your blood.
However, this method of testing has proven to be not very accurate of the actual levels in your body, or what is actually available in your tissues and cells. Instead, a newer and much more accurate and sensitive way to test your functional level of tissue-containing B12 is through a specific test, for what is called “methylmalonic acid”, or MMA. This is a substance that builds up in your blood or urine if there isn’t enough functional vitamin B12 in your tissues. Many studies have shown that MMA would be a much more effective way to confirm vitamin B12 sufficiency. A 2009 case report appearing in Practical Neurology, from Oxford University’s Department of Neurology refers to a person who developed significant brain and spinal cord neurological damage, due to delayed detection of vitamin B12 deficiency, having relied on the standard method of serum vitamin B12 testing. Once this patient finally received a series of vitamin B12 injections, after testing with the MMA marker, the symptoms reversed.
It makes you wonder how many people are suffering with such profound neurological damage due to outdated methods of testing. Other research has shown that the MMA test can predict which patients with poor cognitive function will decline faster; other studies have also shown the benefit of a neurologically active form of vitamin B12, called methylcobalamin, in some children with Autism. In my naturopathic practice, I suspect a vitamin B12 functional deficiency in about one-third of my patients (keep in mind that some of the same vitamin B12 deficiency symptoms can also be explained by the effect of pesticides or solvents on the nerves). Often, I use a B12 ‘challenge’ test, or a ‘therapeutic trial’ where I administer an intramuscular injection of preservative-free vitamin B12, and wait up to two days for a response. Often patients will tell me that their energy significantly improved, the ‘black cloud’ (representing their mood) cleared up, they slept better, their mind felt a bit sharper, or some other specific improvement.
Usually you would need a few injections to correct the deficiency, or to notice a lasting improvement. Of course, determining the underlying cause of the vitamin B12 deficiency is important. Is it related to a strict vegetarian diet, maldigestion of food, low intestinal absorption, or stomach-acid suppressing medications, since you require sufficient stomach acid to ensure vitamin B12 absorption into the body. Vitamin B12 is a fascinating essential factor in our health. It is likely that many people are low in this vitamin but are not aware of it themselves, or to their doctors. In time, I expect the methylmalonic acid test will likely replace the inaccurate serum vitamin B12 test, as a more accurate method of testing vitamin B12 levels. You can call the office to book a Vitamin B12 Screening Visit for testing and possible treatment – 905-597-7201. Rahim is a registered naturopathic doctor who has a general family practice, with a special interest in helping patients comprehensively detoxify their bodies for preventative and therapeutic benefit.