Download Dr Kathleen Janel ND 728 Second Street/Mukilteo WA 98275/425

Dr Kathleen Janel ND
728 Second Street/Mukilteo WA 98275/425 523 0878
gastricmedicine.com
Vitamin B-12 information sheet for patient & practitioner
I am completely amazed at the benefits that the B-12 shots provide as a sole therapeutic agent. It has
become a primary treatment modality in my practice. Still, it is important to consider long-term diet &
lifestyle, adrenal, thyroid, blood sugar, sex hormone and other balancing protocols for optimal patient
health.
In my view, there is a difference between "clinical" & "therapeutic" uses of B-12. A traditional medical view of
appropriate vitamin levels is to follow the Required Daily Amounts concept which is identified to prevent
overt deficiency. This is not the same amount that may be required to promote optimum health. Aside from
treating pernicious anemia, B-12 supplementation is usually used when blood levels are below the "normal"
range. I describe this as a clinical use. (Also, what is considered to be the low end of "normal" range is likely
far too low for optimum health). A therapeutic use is achieving a positive benefit regardless of blood levels.
In the 1950's - 1960's it was common for MDs to give patients B-12 injections in this therapeutic manner. I
believe this practice died out along with the older physicians as no pharmaceutical company has been
promoting its use.
B-12 is considered to be non-toxic in general. The following information is oriented towards therapeutic uses
and benefits, primarily from B-12's supportive effect on brain chemistry and the nervous system.
B-12 can help significantly reduce or resolve the following symptoms:
I have observed up to 90% success rates with patients experiencing improvement in one or more of the
symptoms listed, especially if patients follow through the complete injection protocol. I have not been able
to determine why approximately 10% of patients don't respond. Also, I have had patients who didn't have
any overt symptoms still want to try B-12 injections in attempt to feel even better. This success rate has been
over 50%.
Primary symptoms that usually improve Fatigue, no motivation/apathy
Sleep problems (insomnia, poor sleep quality)
Mood issues (irritability, anxiety, mild-moderate depression, low sense of well being)
Poor short term memory, lack of focus/concentration, decreased mental sharpness, "fuzzy thinking"
(While potentially useful for anyone, this is particularly effective in the elderly. But if B-12
levels have been too low for too long in the elderly, success can be limited.)
Peripheral Neuropathies (numbness/tingling of extremities), paresthesias, sciatica
Also PMS (especially emotional reactions)
Jet lag (reduction in symptoms or susceptibility)
Dizziness/balance problems, ringing in ears/tinnitus
Sore mouth/tongue, tingling sensation in mouth
Arthritis/Bursitis, chronic pain
Medical observation has also identified B-12 as being supportive in these conditions –
Wheezing/Asthma
Eating Disorder/Alcohol abuse/MS
Cervix problems (PAP smears)
Pre-eclampsia in pregnancy/Infertility
B-12 supplementation is important or required with these situations or conditions
Strict vegetarians (vegans) after 1 year
Gastrointestinal problems (inc. bypass surgery), use of Rx acid blockers (i.e.
Prilosec, Prevacid, Protonex, Nexium)
High Homocysteine blood levels (contributes to heart attack, stroke, and Alzheimer's
disease risks)
Diabetic Rx use - esp. Glucophage (Metformin)
High alcohol intake - (all B-Complex vitamins are required)
Macrocytic Anemia (B-12 type)
Note: Pernicious Anemia requires a different protocol and its treatment
requires a different discussion.
Common Questions:
Can B-12 deficiency be identified through blood tests?
B-12 activity is not effectively measured in blood. First, what is considered a "normal" range is often too
low for optimum benefit. More important - what is in the blood doesn't necessarily pass into the tissues,
so you really need to measure tissue levels. The only effective test for this is Methyl Malonic Acid (MMA),
a metabolite of B-12. B-12 is the only chemical in the body that produces this chemical, so there are no
confounding factors to its levels. Serum B-12 levels can look falsely normal, while the MMA test can more
accurately identify if a deficiency exists. Western medical practitioners are not often aware of this test or
its significant value. If testing B-12 levels, serum B-12 is the primary method used. MMA can be measured
in blood and urine, but the urine test is more reliable for deficiency identification. If not offered by a
local lab, there is a urine collection kit available that can be mailed to a specific lab. I do not routinely
test the B-12 levels before initiating treatment, as this has little bearing on the therapeutic success.
Patients with "normal" B-12 levels still can benefit from shots.
Why injection?
Published research says the oral tablets are just as effective to reverse deficient B-12
blood levels, but I do not see the same therapeutic benefit (symptom improvement) as
with the injection. B-12 can be very hard to absorb through the stomach/intestinal route. Then it
requires transport from the serum into the tissues via specific Transcobalamin carrier molecules.
Injections provide superior delivery which can result in significant therapeutic effects. The second best
route is a sublingual dosage (dissolved under tongue), because this avoids stomach/intestinal
absorption issues, though I do not see the same therapeutic effect or benefits with the symptoms
discussed above compared to the injection.
Is there any Toxicity or side effects?
B-12 is not known to be toxic. No side effects are observed generally. I have had a very few patients
that get overstimulated initially - if they get the shot in the afternoon they then can have trouble
sleeping at night. Morning shots generally do not cause this problem in these cases. A few patients have
wanted to take a nap after getting the shot, then they feel refreshed. It is theoretically possible that high
dose/long term use of B-12 injectable (especially with Folic Acid) can stimulate the bone marrow to
produce excessive amounts of red blood cells and platelets over time. I provide a high potency BComplex tablet if patients require longer-term B-12 injections to keep an overall balance of B vitamins in
their system.
Why aren't dietary sources of B-12 sufficient?
B-12 is supplied via foods that have had blood in them - primarily meat, dairy, and eggs. This is why strict
vegetarians are at risk. But eating foods containing B-12 does not insure sufficient blood levels due to the
absorption issues mentioned above. Again, the B-12 injections have the ability to create a therapeutic
effect that is not seen with other routes of absorption.
What forms of B-12 injection are available for therapeutic use?
Cyanocobalamin is the most common and inexpensive form for injectable use. I use this first, and
then switch to the other forms if the Cyano form has not helped sufficiently.
Hydroxocobalamin is a longer acting form. I use this if the Cyano form has not had any
effect (especially after being combined with Folic Acid) OR when it has stopped producing
beneficial effects after repeated injections OR when it does not maintain a sufficient duration of
activity after repeated injections.
Methylcobalamin is the active form of B-12 - it requires the least metabolic processing. I use this when
treating specific neurological problems (i.e. peripheral neuropathies) if the Cyano form has had
insufficient effect, OR if the Cyano or Hydroxo form has not had sufficient effect (when
combined with Folic Acid).
Why don't you just use the MethylB-12 form to start with, since it requires the least metabolic
transformation?
I started the protocol with the CyanoB-12 form as it was the least expensive and most readily available.
Between the plain CyanoB-12 injection and the Cyano-B-12 plus Folic Acid combination, I have been
achieving success in about 2/3 of the patient population. I did briefly try starting with the HydroxoB-12 or
Methyl-B-12 forms, but did not seem to see as much symptom improvement. There were times that while
having good success with the CyanoB-12 (with or without Folic Acid), but switched formulas to try and
get even better effects, and had patients request they go back to the CyanoB-12 form.
Why do you use Folic Acid in injections?
Folic Acid is another B vitamin. It does not have the same absorption challenges that B-12 does,
though people's dietary intake can be insufficient. It seems to have a synergistic effect with B-12
when included in the same syringe. Once the CyanoB-12 has not worked (or stopped working
over time) I add Folic Acid. If this combination does not work and other forms of B-12 are
required, I continue to include the Folic Acid with any further B-12 injection.
Why don't you use B-Complex in the injections?
I do not include B-Complex-100 1M in my injections. The B-Complex vitamins do not present absorption
issues requiring 1M injection. While a spectrum of B-Complex vitamins is important to maintain, I have
not seen it act synergistically with the B-12. Note that Folic Acid is not included in the B-Complex
injection formula, as it is not easily compatible with the other vitamins in the injection solution. Also BComplex can cause significant stinging when injected. This can discourage patients from returning for
more injections. B-12 rarely stings if injected properly.
What if patients are sensitive to preservatives in the injection formulas?
B-12 & Folic Acid are available preservative free for use in rare cases when patients are
sensitive to the preservatives. Preservative free bottles need to be refrigerated.
Adapted from clinical research of Dr Bill Cardona ND