Methyl-B12: Part Three
The Opinion of a B12 Expert
Now, we are going to have a close look at one medical professional’s approach to the B12 situation. The following material is based on an article written by Jonathan E. Prousky, ND, MSc; Chief Naturopathic Medical Officer, Professor, Canadian College of Naturopathic Medicine. He wrote an overview of his 12 years of using B12 (as well as other nutrients) to treat a variety of neuropsychiatric symptoms, for the Journal of Othomolecular Medicine, a journal that brings together conventional and alternative medicines.
The purpose of his article was “to show the rationality of using vitamin B12 therapeutically, even in the absence of classical deficiency.” He went on to say that “vitamin B12 ranks among the most useful, safe, and effective orthomolecules when treating a diverse array of neuropsychiatric conditions,” and “clinical improvement results when serum vitamin B12 levels are optimized or markedly increased following vitamin B12 treatment.”
We saw above that B12 deficiency in the U.S. is considered to be a test result below 200 pg/mL, yet in Canada, where Dr. Prousky resides, B12 deficiency is considered to be present if the blood levels are below 149 pg/mL. His feeling is that if the results are anywhere between 149 and 400 pg/mL then there should be a follow up use of the uMMA test, especially if the patient is showing any unexplainable symptoms.
Dr. Prousky has observed many patients with technically “normal” blood levels of B12, whose elevated urinary concentrations of MMA nonetheless indicated early signs of metabolic B12 insufficiency. His belief is that the urinary MMA test is far more effective than the serum B12 test in identifying those at risk of B12 deficiency, and even more effective at monitoring improvement in B12 levels following therapeutic treatment.
More Symptoms of B12 Deficiency
Now we are going to look at the wide range of symptoms that Dr. Prousky has observed being associated with varying degrees of B12 deficiency; see if you recognize any of them in yourself or loved ones. And if so, remember that you do not need a prescription to buy B12, not even in an injectable form (which can be obtained from most pharmacies, though mostly only in the cyanocobalamin form).
Symptoms that can be indicative of B12 deficiency, both subclinical and clinical, are as follows: anxiety; aphasias (loss of ability to understand or express speech); ataxia (the loss of full control of bodily movements); brain volume loss; cognitive impairment; depression; delusions; developmental delays; fatigue; hallucinations; insomnia; irritability; memory problems; mood swings; muscle weakness; neuralgias; neuropathy; obsessions; paranoia, paresthesias (“pins and needles”); psychoses; seizures.
Oh, and here is one more deficiency symptom that came as a surprise to me: “These results support the hypothesized association between vitamin B12 deficiency and low BMD for both men and women in a population sample.” (“Low Plasma Vitamin B12 is Associated with Lower Bone Mineral Density: The Framingham Osteoporosis Study.🙂
Dosage
Most doses of B12 in supplement form are 1 mg, which people often take daily, however the DV (Daily Value which has replaced the – RDA – Recommended Dietary Allowance) for vitamin B12 is 2.4 mcg for adults and children age 4 years and older, which is quite a difference in range. The thing to remember is that B12 is the one B vitamin that is stored and doesn’t pass through us fast like the other water-soluble B vitamins. Thus we must not be too cavalier about how much we take.
The 1 mg that many people take daily is the amount a doctor will inject a patient with once per month, so while this might seem like a rather low amount it is in fact a rather high amount. (This is why our NutriPods only contain 100 mcg in the daily pack: More than the DV but not excessively so.)
To follow is what I recommend to people and is my opinion and should be regarded as such, rather than a medically endorsed dosage.
For the average person who feels they might be deficient I recommend 1 mg daily for a week, then 1 mg per week. If they should feel a big improvement in energy or brain fog during that week, they should perhaps choose to stay on the 1 mg for longer than a week (skipping weekends). Then ultimately roll back to once per week.
For someone with any of the above mentioned B12 deficiency diseases (dementia, neuropathy, neurological disorders, poor methylation, etc), I recommend taking 5 mg daily for one week, then 5 mg once per week. When symptoms are no longer present I suggest rolling back to 1 mg per week. Of course if this should cause a return of symptoms one would then return to 5 mg once per week.
Now, there are on the market products containing 15 mg of B12, and are mostly for those with severe neurological disorders (MS, ALS, Parkinson’s, Alzheimer’s, etc), but I do not recommend these without the advice of a natural health professional.
We will now look at the medical warning surrounding too much B12, to remind us to err on the side of caution.
Warnings
A Naturopath once told me that he was taught the only way you could hurt yourself with B12 is if you were to be drowned in a bathtub full of it. Yet, we should look at the fact that, unlike the other B vitamins, we do store this one and we do take it in amounts far exceeding what is found in food.
The principles of Orthomolecular medicine are based on using high doses of nutrients, instead of drugs, for short periods of time, then continuing to supplement with maintenance doses, which is what I’ve suggested above.
Here are the primary warnings from a medical website:
- Megadoses of the B12 can lead to outbreaks of acne and rosacea. It is pointed out here “that most of these studies focused on high dose injections rather than oral supplements”.
- Some evidence suggests “that high doses of B12 may lead to negative health outcomes in those with diabetes or kidney disease”. In some people with loss of kidney function due to diabetes, as little as 1 mg daily caused a more rapid decline in kidney function. However, this B12 came along with “high dose B vitamins”, which turns out to mean the pill also included “folic acid (2.5 mg/d), vitamin B(6) (25 mg/d), and vitamin B(12) (1 mg/d), or matching placebo”. Now, for those who don’t methylate well, as I’ve mentioned, cyanocobalamin does not convert well into methylcobalamin, but for such people folic acid is actually detrimental to their health. (Which is why we use methylfolate in our NutriPods products.) So here we have people who are very ill being given 2.5 times the amount of folic acid recommended for most people, and in a form that very well may be toxic to the majority of these patients. Along with a B12 (cyanocobalamin and not sublingual) that they may also not have been able to convert into a form that would have benefited their health. Thus, to my way of thinking, this conclusion is suspect.
- “Another study in pregnant women showed that extremely high B12 levels due to vitamin supplements increased the risk of autism spectrum disorder in their unborn child.” This seems to be contrary to the information on autism I discussed near the beginning of these newsletters, and indeed the study did find that too little as well as too much B12 led to an increased risk of autism in the offspring. (Study)
- (Source: Healthline. com)
To look at this a little closer at this autism study, we find that “very high B12 (≥536.8 pmol/L) showed 2.5 times increased risk” of autism. As I pointed out above “In Europe and Japan the acceptable “normal” level of B12 in the blood is above 550 pg/mL”.
The conversion ratio for vitamin B12 is 1.35 pg/ml = 1 pmol/l. Therefore, 536.8 pmol/L is equal to 728 pg/ml, clearly far above even the higher amounts recommended overseas.
This same study also found that “very high levels of maternal plasma folate at birth (≥60.3 nmol/L) had 2.5 times increased risk of ASD”. Remember that 30 to 40% of the population are poor methylators, so as with the diabetics above, women taking a large amount of last generation folic acid instead of methyfolate may have been doing more harm than good.
Given this information, I would certainly suggest that pregnant women check their multivitamin to ensure that it does not contain 1 mg, or more, of B12 (and that it does contain the methylfolate form of folic acid), as this is becoming more common in multivitamins these days. This is a marketing feature with no thought put into it, and another reason why those of us who self-prescribe with supplements need to keep up on our research and education.
I may even be erring too far on the side of caution with my suggestion that 1 mg daily may be too much, as Healthline.com ends their section on the dangers of too much B12 with this advice:…”studies have demonstrated that daily oral supplements of up to 2 mg (2,000 mcg) are safe and effective in treating B12 deficiency”. But here they are referring to “deficiency” and not thereafter.
Conclusion
If you, or someone you know, appear to have any of the aforementioned symptoms that might lead you to think a B12 deficiency may be the cause, your first step is to get a test. This at least gives you a baseline to work from, which is necessary in order to see if your B12 levels are rising following therapeutic treatment. You may then seek a uMMA test if you feel that your blood levels of B12 are not indicating the whole story.
If you then feel that you need a therapeutic treatment, you should work with a health practitioner to determine the best form of supplementation (injection, sublingual or nasal), and the length of treatment.
Or, if you don’t have a practitioner that will work with you, just take the bull by the horns and try some sublingual B12 (like, perhaps, our Quick B12 product), and a few months later get another test to see if levels have adjusted upwards. If you see no benefit with a sublingual B12, but still believe that deficiency is at the root of your problem, or you have methylation problems, or advance neurological disorders (ALS, MS, Parkinson’s disease, Alzheimer’s disease, etc), you may wish to try injectable methylcobalamin, as in certain extreme cases it is more effective than the sublingual form.
So, I hope that doctors here in the West soon begin to question the lab results of their patient’s B12 tests, and consider using additional testing (like uMMA) to really be sure that one has adequate levels to protect their brains, and long term health. It is really the “ounce of prevention” approach to dealing with the aging baby boomers who will soon be clogging the medical system with ailments based on mental deterioration.
(Author: All newsletters and blogs are written by Ken Peters who has worked as a nutritional consultant for the last 30 years, and as product designer for NutriStart for the last 25 years. He has also authored two books – Health Secrets Vol. 1&2. He may be reached at: kenpetersconsulting@gmail.com)