by Greg McClure

In part one, we looked at the many body processes affected by vitamin B12 deficiency and the reasons why someone may become deficient.

B12: Not “Just a Simple Vitamin” part one

Part 2:

The treatment methods and forms of B12 (also known as cobalamin) are also a source of conflict.  Here is the basic information:

• Forms of Cobalamin [1]:
• Cyanocobalamin is a synthetic form of cobalamin. It does not normally occur in the human body.  While it does work on most people, the body must first convert it to a form of cobalamin it can use.  This leaves a small amount of cyanide in the body.  People who have Leber’s Optic Disease cannot use this form.
• Hydroxocobalamin must also be converted by the body, but is more easily converted to the active forms of cobalamin than cyanocobalamin, and is also retained in the body longer.
• Methylcobalamin is one of the two active forms that the body can use without the need to convert it. It is the only form capable of passing thru the blood-brain barrier.
• Adenosylcobalamin is the other active form of cobalamin that the body can use without conversion.
• Administration Methods [1]:
• Dietary Sources: Meat, dairy products, and eggs.  Most people (except vegans, etc.) consume enough of these foods to supply all of the B12 they need.  However, many of them become deficient anyway because they have an absorption or utilization problem as mentioned earlier.
• Parenteral Injections (shots).
• Oral tablets, including as a part of a multivitamin.
• Sublingual (under the tongue) tablets.
• Nasal Gel.
• Liquid
• Transdermal Patch.

So which form and administration method should you use?  Will oral vitamin B12 supplements work, or are injections required?  What doses are required for each method and form?  Can you treat once per day or should you divided the dose?  Will a good multivitamin work?
 

There just is not an answer to those questions that is correct for every person.  Each person is deficient for different reasons and may require different treatment protocols.  What works for one may not work for another. 

The same is true for the amount of supplementation.  Ample arguments can be found supporting or opposing each of the administration methods and forms of cobalamin above, as well as the amount to supplement.  The battle of studies will rage for some time yet. 

In my opinion, the only factor to consider about treatment is whether the treatment you are using is working for you.   This is accomplished by monitoring your symptoms and testing with the uMMA test to ensure you are not deficient at the cellular level.

One reason B12 is overlooked is its insidious nature. The stages of vitamin B12 Deficiency, as shown by the CDC in their continuing education course “Why Vitamin B12 Deficiency Should Be on Your Radar Screen: A Continuing Education Update Course WB1349” is as follows [4]:

• Stage I: Circulating Serum B12 levels depleted. (Patients are typically asymptomatic and can remain in this stage for several years).
• Stage II: Cellular stores of B12 are depleted. (Patients can remain asymptomatic.  This stage can also continue for several years.)
• Stage III: Evidence of bio-chemical deficiency via increases in serum homocysteine and Methylmalonic acid. (Vitamin B12 is required for the conversion of these compounds.)
• Stage IV: Clinical signs and symptoms apparent. (The spectrum of clinical manifestations is broad and the sequence of symptom development varies markedly.)

The sequence of stages and symptoms is markedly different for each individual.  I believe it’s likely that damage starts occurring before symptoms occur in many people.  Most patients are not diagnosed until stage IV (remember my story?). 

I believe there will be much better outcomes if the disease is diagnosed at Stage II.  The uMMA test gives us the ability to do that the majority of the time.

I also believe vitamin B12 Deficiency is far more prevalent than is generally recognized.  The CDC, in the same continuing education course listed above [5], using data from NHANES, suggests the prevalence of vitamin B12 deficiency to be only about 1.46% of total population between the ages of 9 and more than 51 years of age.  They base that assumption on a serum B12 level of less than 200 is vitamin B12 deficient.

However, the same data with the controversial (but I believe more accurate) cutoff range applied on the serum B12 test of 400 pg/ml, the prevalence jumps to 30.24%. If that figure is correct, over 97 million Americans could be affected.  

And don’t forget there is data that suggests there are some people with vitamin B12 dysfunction at levels as high as 550 pg/ml on the serum B12 test. [1] [2]

The net result of all of this medical confusion and conflict about vitamin B12 deficiency is that patients are being harmed.  It’s senseless because:

• A reliable test exists (uMMA) to resolve deficiencies before damage begins (stage II).
• Treatment with vitamin B12 is very inexpensive, especially compared to almost all pharmaceutical treatments. [1]
• Treatment with vitamin B12 is also very safe with almost no potential side effects, again, especially compared to pharmaceutical treatments. [1]

It will take years of additional study to resolve all of the questions and controversy about B12 Deficiency.  In the meantime, while the studies continue, testing with the uMMA and treating as indicated seems to be the most reasonable approach. 

Greg McClure

References:

[1]   Sally M. Pacholok, R. N., B.S. N. & Dr. Jeffrey J. Stuart, D.O. (Could It Be B12?; Could It Be B12?, 2nd Edition, What’s Wrong with My Child?)
[2]   Eric J. Norman, PhD. (Norman Clinical Laboratory, Inc.), website: www.B12.com).
[4] “Why Vitamin B12 Deficiency Should Be on Your Radar Screen: A Continuing Education Update Course WB1349”, Table 2; 
[5] “Why Vitamin B12 Deficiency Should Be on Your Radar Screen: A Continuing Education Update Course WB1349”, Table 3; 

Greg McClure Bio:
I have always been interested in the medical field, even though my life led me in other directions.  
Like many in my generation, severe family medical issues gave me ample opportunities to observe and study our health system, especially as it relates to the elderly. 
I learned to be medically self-empowered and to apply common sense principles to my own health, the health of those I love, and the health-related research I am doing. 
Most of my career is in manufacturing operations, but the skills I utilized there are very applicable to researching medical issues:  problem solving, root cause analysis, continuous improvement, and data management, to name a few.
The net result of my experiences and my research has been to create the B12 PROJECT with the goal of eliminating the unnecessary damage that is being caused by this insidious disease. 

February 2016