So I have symptoms of B12 deficiency, and to me they are devastating. How much, and what sort of, B12 do I need to take?
B12 is used in the body in huge quantities. It doesn't change, it's a Co-Enzyme or Catalyst or Transporter, so on the whole you don't use any up. But it seems to get deactivated and needs to be re-activated. We believe this process happens through entero-hepatic circulation, which means that inactivated B12 is grabbed by the liver and sent off through the bile ducts into the intestine, from where it's reabsorbed and somewhere along the line it gets reactivated.
This circulation system is extremely efficient. Lots of body biochemistry uses entero-hepatic circulation, and it may be for the same reason. For most people, all of the B12 that goes into the intestine gets reabsorbed. But some people aren't quite so efficient at reabsorbing.
Since everyone is different and people will have different rates of efficiency at reabsorbing, it's difficult to say from the symptoms whether you need tablets (to put more B12 into your gut so that more can be absorbed), or injections (to get it into the blood in the first place).
Since B12 is so safe, it's well worth trying tablets, in fact you can continue with tablets even whilst you are using injections.
The best tablets to use are probably methylcobalamin, methylcobalamin plus adenosylcobalamin, adenosylcobalamin, or a mix of B12, B6 and B9 (which were specially formulated to prevent dementia but probably also work on lots of other B12d symptoms). In simple terms, adenosylcobalamin gives you more energy and methylcobalamin helps your nerves, but your body can convert between the two really easily.
If the tablets really don't seem to be making enough difference - and do try both methylcobalamin and adenosylcobalamin (together if necessary) and check for other deficiencies such as Vitamin D) - then consider injections.
Cyanocobalamin is cheap - too cheap. We consider it too stable to be useful, and BNF (British National Formulary) seems to agree with us - don't use it. Look at the beginning of the name - what's that in with it?
Hydroxocobalamin is an excellent all-rounder. It converts readily into both methylcobalamin and adenosylcobalamin, it's easy to obtain and use, and we can provide 1mg/ml for injections of 0.5ml or 1ml regularly (usually once per month). Our hydroxocobalamin is made up with acetic acid to come to the right buffer pH.
Methylcobalamin is one of the pure forms that the body uses. ONLY get this if hydroxocobalamin doesn't work for you, and consider taking adenosylcobalamin tablets at the same time. The risk with methylcobalamin is that people who can't use hydroxocobalamin may also not be able to convert methylcobalamin to adenosylcobalamin, so you may still lack energy. We ONLY provide methylcobalamin once Dr C has reviewed your symptoms and you have already demonstrated that tablets and hydroxocobalamin don't work, and ONLY for people who need injections at least weekly or more frequently. It comes in 5mg/ml ampoules so you also need to be fairly expert at injecting to get 5 injections (1000mcg in each) out of each ampoule.
Although some companies say that they can provide adenosylcobalamin for injection, we haven't seen any benefit from this preparation so we don't have any.
Note that none of our products have preservative in them, so please use them sensibly.
Janette first appeared in the BBC InsideOut documentary in October 2006. Since then the NHS has forced her doctor to withdraw B12 replacement therapy on a number of occasions, and she tells of her struggles with having B12 and then having it taken away.
She has bravely agreed to be filmed without her usual wig, but her memory is playing up because it is so long since her last injection.
The Scottish Parliament discusses Pernicious Anaemia and vitamin B12 deficiency on Wednesday 7 March 2012.
This video is over 1 hour long and represents real political change - we are at last on our way.
The definitive and original guide to B12 deficiency, Dr Chandy interviewed by Chris Jackson of UK BBC Inside Out Team broadcast 31 Oct 2008.
Dr Joseph Chandy explains symptoms and shows the restorative effect on one patient (other patients' families have asked that we edit out their stories unfortunately)
June describes her suffering when doctors didn't follow the standard protocol after any stomach or intestinal operation - to offer B12 replacement therapy
Susan gets very tired, which isn't much fun especially as she has so much to do. Here she tells her story.
Dr Chandy was nominated for the North East Local Heroes award. The interviewer was at first surprised - people don't get awards for doing what they are paid to do - but she persisted.
Julia found her eyesight going as her eyes refused to focus on the same things as each other. She's been for all sorts of tests and treatment, but now that she's on B12 replacement therapy she's starting to see an improvement.
Just the way it works for humans, oral B12 can make a world of a difference for your pet. My old cat Smudge chases the young cat again, climbs ladders (and climbs down herself), and is generally as fit as she was many years ago.
New documentary out from Elissa Leonard in North America, featuring Sally Pacholok and many other internationally renowned experts.
Donna, like so many women, wants to live a normal life. Vitamin B12 could give her that chance.