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Vitamin B12 is also known as Adenosylcobalamin, Methylcobalamin, Cyanocobalamin or Hydroxocobalamin. Vitamin B12 is water-soluble and plays a critical role in DNA and red blood cell (RBC) production. Vitamin B12 is also found in foods such as red meat, fish, dairy products, poultry, eggs, soy products, and fortified cereals. Healthcare providers will commonly prescribe vitamin B12 injections to treat pernicious anemia and B12 deficiency. Vitamin B12 injections allow individuals to receive a full dose directly into the body, and this is considered the most effective way to treat vitamin B12 deficiencies. However, in order to experience some of the benefits of B12, there have to be clinically diagnosed low levels of B12 in the body. In order to identify whether you have low levels of B12, your primary care provider should order blood tests. These labs can also be ordered by the Nurse Practitioner at MA&CB and can be included in the fees for the B12 injection.

Not all individuals experience symptoms contributing to B12 deficiency. If individuals do experience symptoms, the following are some examples:

• Fatigue

• Insomnia

• Confusion

• Mood changes

• Low energy

• Impaired concentration

• Muscle weakness

• Increased heart rate

• Loss of social or emotional interest

The preferred approach for treatment is to treat the underlying cause of B12 deficiency and to support interventions required for individuals at risk. Examples of underlying conditions or health concerns requiring alternative treatment or intervention are the following:

• Untreated chronic infections (ie. H. Pylori)

• Chronic use of anti-acid therapy

  • Antacids (ie. Alka-Seltzer, Gas-X with Maalox)

  • Proton pump inhibitors (ie. Prilosec, Nexium, Pantoprozole)

  • Histamine Receptor 2 blockers (ie. Famotidine, Ranitidine, Cimetidine)

• Oral anti-diabetic medications such as Metformin

• Chronic Alcohol Use

• Chronic caffeine intake

The recommended duration of Vitamin B12 injection therapy depends on the cause of B12 deficiency. If the cause is reversible, individuals only require supplemental therapy for a short time period or until B12 levels are corrected. If the individual has an underlying condition, the condition should be treated separately by your primary care provider. Irreversible causes of B12 deficiency usually require life-long therapy.

The following are individuals who usually require continuous vitamin B12 supplementation:

• Prior gastric or bariatric surgery

• Strict vegan or vegetarian diet

• Pregnant or lactating women with limited intake of foods from animals

• Autoimmune thyroid condition (ie. Hashimotos)

  • B12 injections can prevent and reverse digestive autoimmunity and low stomach acid.

• Over the age of 50

• Compromised digestive system

  • Inflammation in the GI tract can lead to decreased stomach acid which impairs absorption of B12. lower stomach acid which impairs the absorption of B12.

• Specific gene mutations (ie. MTHFR)

Having a slow metabolism will cause weight gain and fatigue. The slow metabolism causes weight gain, and fatigue decreases the ability and the desire to exercise. Vitamin B12 injections will give your metabolism a boost and speed up your body’s processes by converting fats and proteins in your body into energy which will increase your metabolism and allow individuals to burn off more calories. There is a significant amount of evidence that indicates individuals with low B12 levels are more likely to suffer from obesity.

Vitamin B12 is significantly important for neurological function and health. When individuals are B12 deficient or have low levels, this will affect the process that is involved with the synthesis of serotonin and dopamine. Serotonin and dopamine are neurotransmitters responsible for mood regulation, and the repercussions of B12 deficiency include anxiety and depression. When individuals improve B12 levels, this will improve an individual's mood and their overall mental health. In fact, numerous research studies indicate that supplementation of vitamin B12 can delay the onset of anxiety and depression and have also been acknowledged to improve the effects of prescribed anti-depressants when in conjunction with vitamin B12.

Injections are given directly into the patient's muscle. The injection is given in the middle third of the vastus lateralis muscle of the thigh, deltoid muscle of the upper arm, or the dorsogluteal muscle in the buttocks. You may experience some pain, swelling, or itching when the injection is completed. This is usually a short-lived experience.

Symptoms for individuals may improve within a few days or weeks. Individuals will begin to feel less tired and have improved energy levels within 24 hours. Symptom improvement depends on how low the individual's levels are prior to receiving treatment. Individuals with deficiencies may require 2-3 injections which is approximately 2-3 months before experiencing improved symptoms.

How long and how often you receive treatments is different for every individual and depends on the severity of symptoms. Some individuals require life-long therapy related to an underlying health condition or previous surgical procedure. During the consultation, the required duration of treatment is reviewed and discussed.

• Individuals who have had a previous reaction to a vitamin B12 injection or any other serious allergic reaction to any other medication.

• Individuals who have been told that they have an underlying condition that should be corrected prior to any administration (see above risks for underlying health condition).

• Individuals who have been told by their primary provider or any other previous or recent labs that indicate low levels of potassium.

• Individuals with a diagnosed heart arrhythmia, or have an irregular or increased heart rate during the physical assessment prior to administration.