Vitamin B-12; Do You Need It?

May 18, 2015

By Bill Caradonna, R.Ph., N.D.
(Note from me: As many of you know, I am a deeply committed advocate of Vitamin B-12 and have written about my own experiences on several occasions. I decided to ask an expert to give us his thinking about this vitamin so essential to human health.)
A half-century ago, doctors commonly administered vitamin B12 shots to their patients. As prescription drug development and use increased, vitamin B12 use declined. As Naturopathic physicians have re-emerged in the health care picture, so has vitamin B12 use.
Why is vitamin B12 so important?
Vitamin B12 helps maintain healthy nerve and red blood cells, and is also needed to make DNA, the genetic material in all cells. While it is well known to prevent pernicious anemia, it can also play an important role in preventing fatigue, insomnia, depression, cardiovascular disease, nerve damage (including numbness or tingling in extremities, difficulty maintaining balance, diabetic neuropathies), loss of appetite, soreness of the mouth or tongue, poor memory, and senile dementia (confusion in the elderly population). It has also been helpful in certain types of arthritis, asthma, infertility, multiple sclerosis, shingles, and ringing in the ears.
Some of these symptoms can also result from a variety of medical conditions other than vitamin B12 deficiency. It is important to have a physician evaluate these symptoms so that appropriate medical care can be given. 
Why do B12 deficiencies exist?
Vitamin B12 is naturally found in meat, poultry, fish, milk and other dairy products, eggs, and also is in fortified breakfast cereals. It can be difficult to absorb from our diet, especially in people with certain digestive imbalances. One problem is low hydrochloric acid in the stomach. This can be aggravated by chronic use of prescription and non-prescription acid blockers. Low HCL is also common in elderly populations. The presence of H. Pylori (a bacterium associated with stomach ulcers) has also been associated with low B12. Another cause is certain intestinal conditions or diseases that cause or contribute to malabsorption. Vegetarians are also at risk due to the absence of animal foods in their diet, and especially with vegans since dairy products and eggs are not consumed. Up to 42% of people over 65 years of age have been identified as B12 deficient. Surprisingly, another study identified a 26-49 age group as having a similar deficiency percentage.
Lab testing for B12 levels
Standard Western medicine testing exists for determining blood levels of B12. While this can identify a frank deficiency, what is considered the low end of normal may not actually be an optimal level. Blood B12 levels can be in the normal range, but clinical symptoms can be present, which can be  reversed with B12 administration.
Also, the blood test is not the most accurate way of identifying deficiencies. Anemia from B12 deficiency is easy to identify from a red blood cell blood test. But identifying low B12 levels that can result in nerve damage is more difficult because there is an inexact relationship between blood and tissue B12 levels. The B12 must still be transported from the blood into the cells. The best way to identify the actual levels of B12 activity in the cells is by measuring the metabolite Methyl Malonic Acid in blood or urine.
B12 supplement options
B12 is available in oral, sublingual and injectable forms. B12 is included in most all multivitamins and B-Complex formulas. The most common form is called Cyanocobalamin. There are other specialty forms – methylcobalamin, hydroxocobalamin, and adenosylcobalamin. The oral supplements have the same absorption challenges as the B12 in our food. Sublingual tablets avoid those issues as they are absorbed directly into the circulation from under the tongue. Oral doses can range from 100mcg to 1,000mcg (or 1mg). Sublingual doses range from 500mcg to 5,000mcg (5mg). The cyanocobalamin is the most common injectable form, but other specialty forms are used, mostly by Naturopathic physicians. Often Folic Acid is added to the injection for synergistic support.
B12 shots have more impact than supplements
While B12 blood levels have been shown to raise, with oral and sublingual supplement forms, shots deliver B12 directly into the system. In my clinical practice, I have seen rapid and dramatic impact on correcting symptoms of fatigue, sleep issues, mood challenges and memory/focus/concentration when using the appropriate injection formula. Unfortunately, there are no tests to determine which formula option is the best one for the individual patient. Following a protocol trial will ultimately demonstrate which formula is the most appropriate. In my practice, I do not rely on blood levels to determine whether I provide an injection protocol series. B12 can provide a therapeutic benefit of symptom improvement regardless of the blood levels. B12 is virtually non-toxic, and for most people, the shots are nearly painless.
B12 and fatigue
There can be many reasons for fatigue. These include lack of sleep, inadequate nutrition, lack of stable blood sugar levels throughout the day, use of stimulants which then cause the body to “crash” a few hours later, and long term stress.  In the absence of diagnosed anemia, many people find that B12 gives them an energy boost, both short and long term. Athletes have reported increased endurance as well.
B12 and insomnia
People often report improved sleep with B12 shots. Melatonin is a chemical secreted from the pineal gland that tells the brain to go to sleep. Vitamin B12 influences melatonin secretion. While there can be many causes of insomnia, this may be one reason why B12 shots can help people sleep better. Also, wintertime depression has been linked to imbalanced melatonin levels. I have seen many people with Seasonal Affective Disorder improve after receiving the appropriate type of B12 (and if needed – Folic Acid) injections.
B12 and depression
Research shows that those who suffer from depression respond better to drug treatment if they have high levels of vitamin B12 in their blood. One theory of why vitamin B12 helps is that it plays a role in the manufacture of brain chemicals, a shortage of which is believed to be linked to depression. Another theory is that people diagnosed with depression had low plasma levels of cobalt, the mineral that forms the center of the B12 molecule. I have also seen B12 shots reduce mild to moderate depression without the use of anti-depressants.
B12 and heart disease
Homocystene, a nerve and blood vessel toxin, is produced by imbalanced biochemical processing in our body. It has been associated with higher incidence of death by heart disease and stroke. The cause of this production has been tied to deficiencies of several B vitamins, including B12. High levels of Homocystene have also been predictive of increased incidences of dementia and Alzheimers Disease.
B12 and memory
Vitamin B12 is linked to the production of acetylcholine, a neurotransmitter that assists memory and learning. Supplemental B12 can be crucial in supporting brain function, especially in the elderly. I have not seen anything that has worked as dramatically as B12 shots for improving focus or concentration in adults of all ages either.
B12 deficiency and the elderly.
It is especially important to diagnose B12 deficiency early in the elderly because if left untreated it can lead to permanent impairment of neurological and mental function. A recent study following 370 individuals aged 75 or older for three years found subjects with low levels of serum B12 or folate had twice the risk of developing Alzheimer’s Disease. 
About the Author – Bill Caradonna, R.Ph., N.D. is a registered Pharmacist and Licensed Naturopathic physician. He is a graduate of Bastyr University, Seattle, WA, where he also was a faculty member. He has been in the natural medicine field for over 30 years, and is in private practice at the Queen Anne Naturopathic Center in Seattle, WA. More information can be found at