The benefit of B12 injections

Mrs. S, age 75, presented with fatigue, declining cognition and osteoporosis. As part of my treatment program I recommended weekly B12 injections for five weeks, then monthly thereafter. Then Mrs. S asked me a common question that I hear in my practice.

“My MD recently checked my serum B12 blood levels and said they were normal. Why do I need B12 injections?”

Over the last number of years MSP (Medical Services Plan) has declined paying for B12 injections unless there is proof of deficiency. So what I am noticing is that serum B12 blood tests are done much more frequently and it is rare to see a frank deficiency (normal range is 207-553 pmol/L) so B12 injections are not recommended.

Early in my naturopathic education vitamin B12 injections were recommended for a variety of neuropsychiatric symptoms at three times the dosage that conventional medicine recommends. Over the years I have seen therapeutic doses of B12 by injection improve the following symptoms: anxiety, difficulty expressing words, ataxia, cognitive impairment, depression, delusions, fatigue, hallucinations, insomnia, irritability, mood swings, muscle weakness, neuralgias, neuropathy, numbness and tingling.

Vitamin B12, cobalamin, is a water soluble vitamin that is non toxic at ten thousand-fold doses with excesses being excreted in the urine. It is necessary for nine important functions of the body: energy production; production of genetic materials DNA and RNA; increased production of SAMe (S-adenosyl-methionine) which participates in the formation of the myelin sheath, that protective fatty layer surrounding nerves, methylation pathways as well as neurotransmitters; production of acetylcholine, a neurotransmitter that helps with memory and learning; slowing the cognitive decline that comes with aging; the synthesis of red blood cells; cardiovascular health (B12, folic acid and B6 lower homocysteine which is a risk factor for heart disease and stroke); and anti-inflammatory effects.

I explained to Mrs. S that a trial of IM (intramuscular) B12 would be the best way to determine if it would be effective. The most accurate test for B12 status is measuring the cerebral spinal fluid (CSF) which is done for research purposes only.

It was found that the serum levels of B12 did NOT correlate with CSF levels. Urinary methymalonic acid is the easiest, more accurate

test for determining B12 tissue deficiency at a cost of $200.

The only test that I recommended for Mrs. S was homocysteine to evaluate her risk factor for heart as well as bone health. Her level was 13 and optimal is 5-7.

I also explained that as we age we have less intrinsic factor in our intestinal tract to absorb oral B12 from our diet and that vegetarians essentially don’t get B12 in their diet so they need to supplement orally. Oral supplementation of methylcobalamine can be effective at maintaining serum B12 levels but the injections are the most effective at increasing CSF levels and immediate symptom treatment. Once her symptoms were improved then I would start her on the oral chewable or sublinqual form.

Many of us have other risk factors that block the absorption of B12 which include: zinc deficiency, high levels of copper and neurotoxins such as alcohol, industrial solvents or halogenated hydrocarbons, mercury and cadmium.

Mrs. S did have her serum B12 measured again after a month of injections and her doctor was alarmed at how high it was at 1,476 pmol/L. I assured her that these higher levels reflected a more normal level that would now be found in her CSF. Mrs. S was also happy that her energy was improving, along with her sleep and her memory.

I also quoted the following research to Mrs. S that showed that B12 prevented brain atrophy. In one study in 2008, 107 elderly people were evaluated for their brain size and found that when serum B12 levels were less than 308 pmol/L that there was an increased rate of brain volume loss. So keeping serum levels of B12 higher than the normal range is optimal.

Dr. Ingrid Pincott, naturopathic physician, can be reached at 250-286-3655 or

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