B-12 injection ???

[Senior_FKG]

Whats up with vitamin B 12 injections. I heard it is supposed to increase your appetite...can someone tell me if this is true or not, and if it has any other purpose.

[max-it]

increased energy and appetite

[powerlifter]

It works Bro

[Da Bull]

increased energy and appetite

Yep...but you do hear ppl saying it isn't worth a dam...to each is own....it works for me tho.

[big4nuthin]

Where do most get their injectable b-12? Can it be vet grade? What is a good dosage and is there a preferred time to administer? Thank you!

[ECFATCAT]

most use Lion's B12

you can go to www.anabolicreview-research.com

[ChefJ]

its good stuff and doesn't have to me intramuscular it is just fine subq

[magicstick2003]

lions b12 is a little over priced for me.. look around bro and you can find some vet stuff for like 10-12 bucks and it does the same thing.

[Gilster]

Vet B-12 stuff looses its effestiveness for me in about 14 days. But human grade b-12 gives me the same good effects for a good 2 months. I think it is worth the $ for the human grade stuff.

[khurrams]

You can get injectable B-12 over the counter at any pharmacy...In Canada you can get it for $4.99 for a 10ml vial so Im assuming it wouldn't be hard to get in the states as well....b/c the Pharmaceutical Laws in Canada are much stricter than the states so I don't think u'll have a problem.

[AandF6969]

They have it at IBE now

[ECFATCAT]

Guy's Im an expert on this stuff....Im know on the boards as such .Vet Grade can have up to a level of 6% impuritys...it's the metals used in processing it's bad news ....you can do searches for B12 on most boards and read my articles B12 try this one

Vitamin B12 - cyanocobamin Why you need it to GROW

Introduction


Vitamin B12 is a member of the vitamin B complex. It contains cobalt, and so is also known as cobalamin. It is exclusively synthesised by bacteria and is found primarily in meat, eggs and dairy products. There has been considerable research into proposed plant sources of vitamin B12. Fermented soya products, seaweeds, and algae such as spirulina have all been suggested as containing significant B12. However, the present consensus is that any B12 present in plant foods is likely to be unavailable to humans and so these foods should not be relied upon as safe sources. Many vegan foods are supplemented with B12. Vitamin B12 is necessary for the synthesis of red blood cells, the maintenance of the nervous system, and growth and development in children. Deficiency can cause anaemia. Vitamin B12 neuropathy, involving the degeneration of nerve fibres and irreversible neurological damage, can also occur.

Functions

Vitamin B12's primary functions are in the formation of red blood cells and the maintenence of a healthy nervous systemB12 is necessary for the rapid synthesis of DNA during cell division. This is especially important in tissues where cells are dividing rapidly, particularly the bone marrow tissues responsible for red blood cell formation. This is important for muscle tissue growth .If B12 deficiency occurs, DNA production is disrupted and abnormal cells called megaloblasts occur. This results in anaemia. Symptoms include excessive tiredness, breathlessness, listlessness, pallor, and poor resistance to infection. Other symptoms can include a smooth, sore tongue and menstrual disorders. Anaemia may also be due to folic acid deficiency, folic acid also being necessary for DNA synthesis.

B12 is also important in maintaining the nervous system. Nerves are surrounded by an insulating fatty sheath comprised of a complex protein called myelin. B12 plays a vital role in the metabolism of fatty acids essential for the maintainence of myelin. Prolonged B12 deficiency can lead to nerve degeneration and irreversible neurological damage.
When deficiency occurs, it is more commonly linked to a failure to effectively absorb B12 from the intestine rather than a dietary deficiency. Absorption of B12 requires the secretion from the cells lining the stomach of a glycoprotein, known as intrinsic factor. The B12-intrinsic factor complex is then absorbed in the ileum (part of the small intestine) in the presence of calcium. Certain people are unable to produce intrinsic factor and the subsequent pernicious anaemia is treated with injections of B12.

Vitamin B12 can be stored in small amounts by the body. Total body store is 2-5mg in adults. Around 80% of this is stored in the liver.

Vitamin B12 is excreted in the bile and is effectively reabsorbed. This is known as enterohepatic circulation. The amount of B12 excreted in the bile can vary from 1 to 10ug (micrograms) a day. People on diets low in B12, including vegans and some vegetarians, may be obtaining more B12 from reabsorption than from dietary sources. Reabsorption is the reason it can take over 20 years for deficiency disease to develop in people changing to diets absent in B12. In comparison, if B12 deficiency is due to a failure in absorption it can take only 3 years for deficiency disease to occur.

B12 has no known toxicity and high intakes are not thought to be dangerous

[Da Bull]

Posted by workinhard @ Fitnessgeared.com

Vitamin B12

Also indexed as: Adenosylcobalamin, Cobalamin, Cyanocobalamin, Hydroxocobalamin, Hydroxycyanocobalamin, Methylcobalamin

* What it does
* Where found
* Helpful for
* Are you deficient?
* Amount to take
* Safety check
* References

What does it do? Vitamin B12 is needed for normal nerve cell activity, DNA replication, and production of the mood-affecting substance SAMe (S-adenosyl-L-methionine). Vitamin B12 acts with folic acid and vitamin B6 to control homocysteine levels. An excess of homocysteine is associated with an increased risk of heart disease, stroke, and potentially other diseases such as osteoporosis and Alzheimer’s disease.

Vitamin B12 deficiency causes fatigue. Years ago, a small, double-blind trial reported that even some people who are not deficient in this vitamin had increased energy after vitamin B12 injections, compared with the effect of placebo injections.1 In recent years, however, the relationship between B12 injections and the energy level of people who are not vitamin B12-deficient has been rarely studied. In a preliminary trial, 2,500–5,000 mcg of vitamin B12, given by injection every two to three days, led to improvement in 50–80% of a group of people with chronic fatigue syndrome (CFS), with most improvement appearing after several weeks of vitamin B12 shots.2 The ability of vitamin B12 injections to help people with CFS remains unproven, however. People with CFS interested in considering a trial of vitamin B12 injections should consult a doctor. Oral or sublingual (administered under the tongue) B12 supplements are unlikely to obtain the same results as injectable B12, since the body’s ability to absorb large amounts is relatively poor.

Where is it found? Vitamin B12 is found in all foods of animal origin, including dairy, eggs, meat, poultry, and fish. Small, inconsistent amounts occur in seaweed (including nori and chlorella) and tempeh.3 However, many researchers and healthcare professionals believe that people cannot rely on vegetarian sources to provide predictably sufficient quantities of vitamin B12.

Vitamin B12 has been used in connection with the following conditions (refer to the individual health concern for complete information):
Rating Health Concerns
3Stars Depression (in people with vitamin B12 deficiency)
High homocysteine (combination with folic acid and vitamin B6)
Pernicious anemia
2Stars Age-related cognitive decline (in people with vitamin B12 deficiency)
Bell’s palsy
Canker sores (for deficiency only)
Chronic fatigue syndrome
Cystic fibrosis (in people with vitamin B12 deficiency)
Infertility (male)
Low back pain (in combination with vitamin B1 and vitamin B6)
Sickle cell anemia (for sickle cell patients with B12 deficiency)
1Star Alzheimer’s disease
Asthma
Atherosclerosis
Bipolar disorder
Bursitis
Crohn’s disease
Dermatitis herpetiformis (in people with vitamin B12 deficiency)
Diabetes
Heart attack
Hepatitis
HIV support
Hives
Immune function
Insomnia
Lung cancer (reduces risk)
Osteoporosis (to lower homocysteine)
Pain
Phenylketonuria (in people with vitamin B12 deficiency)
Pre- and post-surgery health
Preeclampsia
Retinopathy (associated with childhood diabetes)
Schizophrenia
Seborrheic dermatitis (injection)
Shingles (herpes zoster)/postherpetic neuralgia (injection)
Stroke
Tinnitus (injection)
Vitiligo


Who is likely to be deficient? Vegans ( vegetarians who also avoid dairy and eggs) frequently become deficient, though the process often takes many years. People with malabsorption conditions often suffer from vitamin B12 deficiency, including those with tapeworm infestation and those with bacterial overgrowth in the intestines. Malabsorption of vitamin B12 can also result from pancreatic disease, the effects of gastrointestinal surgery or various prescription drugs.4

Pernicious anemia is a special form of vitamin B12 malabsorption due to impaired ability of certain cells in the stomach to make intrinsic factor—a substance needed for normal absorption of vitamin B12. By definition, all people with pernicious anemia are vitamin B12-deficient. They require either vitamin B12 injections or oral supplementation with very high levels (1000 mcg per day) of vitamin B12.

Older people with urinary incontinence5 and hearing loss6 have been reported to be at increased risk of B12 deficiency.

Infection with Helicobacter pylori, a common cause of gastritis and ulcers, has been shown to cause or contribute to adult vitamin B12 deficiency. H. pylori has this effect by damaging cells in the stomach that make intrinsic factor—a substance needed for normal absorption of vitamin B12. In one trial, H. pylori was detected in 56% of people with anemia due to vitamin B12 deficiency. Successful eradication of H. pylori led to improved blood levels of B12 in 40% of those infected.7 Other studies have also suggested a link between H. pylori infection and vitamin B12 deficiency.8 9 Elimination of H. pylori infection does not always improve vitamin B12 status. People with H. pylori infections should have vitamin B12 status monitored.

In a preliminary report, 47% of people with tinnitus and related disorders were found to have vitamin B12 deficiencies and may benefit from supplementation.10

HIV-infected patients often have low blood levels of vitamin B12.11

A disproportionate amount of people with psychiatric disorders are deficient in B12.12 Significant vitamin B12 deficiency is associated with a doubled risk of severe depression, according to a study of physically disabled older women.13

A preliminary study found that postmenopausal women who were in the lowest one-fifth of vitamin B12 consumption had an increased risk of developing breast cancer.14

Although blood levels of vitamin B12 may be higher in alcoholics, actual body stores of vitamin B12 in the tissues (e.g., the liver) of alcoholics is frequently deficient.15 16

Low blood levels of vitamin B12 are sometimes seen in pregnant women, however, this does not always indicate a vitamin B12 deficiency.17 The help of a healthcare professional is needed to determine when a true vitamin B12 deficiency exists in pregnant women with low blood levels of the vitamin.

How much is usually taken? Most people do not require vitamin B12 supplements. However, vegans should supplement with at least 2–3 mcg per day.

People with pernicious anemia are often treated with injections of vitamin B12. However, oral administration of 1,000 mcg per day can be used reliably as an alternative to vitamin B12 injections.18 19 20 21 22

Absorption of vitamin B12 is reduced with increasing age. Some research suggests that elderly people may benefit from 10–25 mcg per day of vitamin B12.23 24 25

When vitamin B12 is used for therapeutic purposes other than correcting a deficiency, injections are usually necessary to achieve results.

Sublingual forms of vitamin B12 are available,26 but there is no proof (nor is there any reason to expect) that they offer any advantage to oral supplements (i.e. a sublingual preparation is eventually swallowed).

Are there any side effects or interactions? Oral vitamin B12 supplements are not generally associated with any side effects.

Although quite rare, serious allergic reactions to injections of vitamin B12 (sometimes even life-threatening) have been reported.27 28 Whether these reactions are to the vitamin itself, or to preservatives or other substances in the injectable vitamin B12 solution, remains somewhat unclear. Most, but not all, injectable vitamin B12 contains preservatives.

If a person is deficient in vitamin B12 and takes 1,000 mcg or more of folic acid per day, the folic acid supplementation can improve the anemia caused by vitamin B12 deficiency. The effect of folic acid on vitamin B12 deficiency-induced anemia is not a folic acid toxicity. Rather, the folic acid supplementation is acting to correct one of the problems caused by B12 deficiency. The other problems caused by a lack of vitamin B12 (mostly neurological) do not improve with folic acid supplements, and can become irreversible if vitamin B12 is not provided to someone who is vitamin B12 deficient.

Some doctors are unaware that vitamin B12 deficiencies often occur without anemia—even in people who do not take folic acid supplements. This lack of knowledge can delay diagnosis and treatment of people with vitamin B12 deficiencies. This can lead to permanent injury. When such a delayed diagnosis occurs in someone who inadvertently erased the anemia of vitamin B12 deficiency by taking folic acid supplements, the folic acid supplementation is often blamed for the missed diagnosis. This problem is rare and should not occur in people whose doctors understand that a lack of anemia does not rule out a vitamin B12 deficiency. Anyone supplementing 1,000 mcg or more per day of folic acid should be initially evaluated by a doctor before the folic acid can obscure a proper diagnosis of a possible B12 deficiency.

[ECFATCAT]

nice read Da Bull

[Da Bull]

Using vitamin B-12 for the management of Chronic Fatigue Syndrome (CFS)
by By Charles W Lapp, M.D.
ImmuneSupport.com

02-25-2000

In the late 1980s, Dr. Paul Cheney and I heard several anecdotal reports of chronic fatigue syndrome (CFS) patients who improved when their primary care physicians administered B-12. Given the scarcity of effective treatment options for CFS, we set out to try various doses and preparations in our own patients.
This treatment was based on three articles that appeared in the New England Journal of Medicine demonstrating that persons with CFS-like neurological symptoms and normal blood counts could benefit from the administration of vitamin B-12 injections.

In these patients, problems such as numbness or tingling in the extremities, abnormal gait, memory loss, weakness of the limbs, changes in mood and personality and even fatigue were improved, and even resolved, with B-12 therapy. In addition, during this period of time Dr. Les Simpson was describing how changes in the red blood cells in persons with CFS reversed when high doses of B-12 were administered. With this in mind, we began treating patients with cyanocobalamin (a form of vitamin B-12 that is readily available in the U.S.) at doses from 1000 mcg weekly to 5000 mcg three times weekly, given subcutaneously (through injections under the skin).

Patients appeared to have a significant response at approximately 2000-2500 mcg, and reported increased energy levels, improved stamina or an enhanced sense of wellbeing within 12-24 hours of administration. The effects lasted two to three days on average. However, many patients required up to six weeks to achieve regular, consistent results, and a wide range of dosing proved to be effective, from 1000 mcg injected daily to 5000 mcg injected three times per week. To obtain a continuous and satisfactory level of improvement, we now recommend injections of 3000 mcg of cyanocobalamin every two to three days.

An informal poll of our patient population revealed that 50-80% improved to some extent with this simple therapy. However, we found that oral or nasal spray preparations of B-12 did not produce a demonstrable effect.

Scientific explanation:
The vast majority of our patients had normal serum B-12 and folate levels prior to the start of therapy, which indicates that routine laboratory tests may not reveal a deficiency. It also suggests that our therapy was effective because vitamin B-12 was not being absorbed or utilized properly by individual cells.

Difficulties can arise at any point during metabolism of B-12, resulting in many negative effects on the body, including nerve damage. Potential problems can include:

--Transport failure-the B-12 does not make it through the cell wall from the bloodstream. This is problematic because once inside the cell, B-12 functions as a cofactor, which means that it helps start important chemical reactions that allow the cell to function.

--Failure to degrade completely-if the process of metabolism is working correctly, the B-12 compound is broken down in a series of reactions. When the enzymes (synthetase and reductase) that facilitate those reactions do not do their job, chemical byproducts can build up and nerve cells can be damaged.

--Dietary insufficiency-this rarely happens because many of today's processed foods are supplemented with vitamins, including B-12.

Research findings

Studies from SpectraCell Laboratories using the EMA technique (which measures the metabolic response of a patient's blood cells to individual nutrients) demonstrated that more than 70% of 66 individuals with chronic fatigue-not necessarily CFS-demonstrated B-12 deficiency, compared to about 40% of the normal population. It follows logically that individuals with chronic fatigue syndrome would also experience abnormalities in B-12 metabolism.

At The Cheney Clinic, we measured homocysteine and methylmalonate (organic acids that are elevated when B-12 is not metabolized properly by cells) in CFS patients. Homocysteine was elevated in 33% of the individuals tested, methylmalonate in 38%, and both were elevated in 13%. Thus, about one third of CFS cases could perhaps have symptoms attributable to B-12 deficiency.

Researchers have hypothesized that the B-12 deficiency seen in CFS may be due to a genetic abnormality. The enzyme reductase, which plays a key role in B-12 metabolism, is controlled by multiple genes. Genes for a trait or enzyme occur in pairs, and how they act in combination determines how active the enzyme is. Dominant genes are expressed or translated more fully than recessive genes. Half of the population has two dominant genes for reductase, which causes normal activity of the enzyme. Approximately 40% have only one dominant gene, resulting in only 50% enzymatic activity. And 10% are homozygous (two recessive genes) with only 30% enzymatic activity. Swedish researchers examined the genetic makeup of 11 CFS patients with abnormal B-12 metabolism and determined that those who responded best to B-12 injections had normal reductase activity, and those that responded poorly had one or no dominant genes for reductase.

However, my experience suggests that inability to transport B-12 across the cell membrane is the major cause of abnormal B-12 metabolism in persons with CFS, because large doses of B-12 markedly improve cognitive ability, mood, irritability and numbness and weakness in a majority of patients. Those who respond poorly to high doses of B-12 may have low reductase activity. The latter should improve somewhat if they supplement their diet with folic acid, which helps improve the action of this crucial enzyme. I generally recommend 1 mg of folic acid daily, in tablet form, for those individuals who do not respond well or at all to B-12 injections.

Administration

Two forms of B-12 are available to consumers: cyanocobalamin and hydroxycobalamin. Of the two, I have always preferred cyanocobalamin because it is less likely to cause adverse reactions and stings much less than hydroxycobalamin when injected. The cost of high dose B-12 therapy is approximately $8 to $10 per month.

Patients can be taught to administer their own injections of B-12 using the same lcc insulin syringes diabetics use. They will need to obtain a supply of the B-12 solution from their physician - cyanocobalamin is typically prepared in 10 ml or 30 ml multi-dose vials, and should be stored in a cool dark place because both heat and light degrade the product rapidly. A cabinet or refrigerator are satisfactory.

Large doses of B-12 could theoretically compete with other B-vitamins in the cell, so to prevent deficiencies I always recommend that patients starting injections supplement their diet with multivitamins containing B-vitamins as well as folate.

Toxicity and adverse effects

Toxicity or "poisoning" from cyanocobalamin, a form of B-12 that is combined with very small amounts of cyanide, has been the major cause of patient concern about high-dose B-12 therapy. I have not encountered any evidence of cyanide toxicity. The amount of cyanide administered is so minuscule that it affords wide margin of safety even at doses of 15,000 mcg per week. Although this dose may seem inordinately large, medical textbooks have long recommended doses of 1000 mcg per day (or 7000 mcg per week) for the treatment of nerve problems due to B-12 deficiency. The only exception is in individuals with kidney failure. In patients with normal B-12 levels and intact kidney function, excess cyanide and B-12 are simply excreted through the urine.

I have recommended high-dose B-12 to thousands of patients over the past 10 years and have seen no serious adverse effects. The major complaint about B-12 from patients is bruising at the injection site. This is harmless, goes away quickly and can usually be eliminated by inserting the needle perpendicular to the skin or using a longer needle. The "bruise" may actually be accidental leakage of the crimson-colored B-12 solution under the skin.

Although some drug references indicate that idiosyncratic reactions are not uncommon with B-12, I have only had one patient who developed hives and chills after an injection, and even that person could tolerate occasional small doses.

A rare individual will develop a raised red bump at the injection site, but this is usually attributable to agents added to the B-12 solution to inhibit the growth of bacteria in the vial and not the B-12 itself. In such cases, the pharmacist can prepare small vials of B-12 without the bacteria-inhibiting agent. With high doses of B-12, an acne-like rash also may occur, but the rash usually responds promptly to a reduction in dosage.

Some patients respond so well to B-12 that they become hyperactive-nervous and excitable-but this too can usually be resolved by reducing the dose. Because of this excitatory effect, I recommend that B-12 be administered in the morning, so that it will not interfere with sleep.

Very rarely, a patient's urine will be faintly pink-tinged following a dose of B-12. This “cobalaminuria” occurs intermittently, and although it looks alarming, seems to be entirely benign.

Is B-12 therapy for you?

B-12 injections are an effective, safe and inexpensive treatment in the management of CFS. There is evidence that B-12 metabolism at the cellular level is abnormal in persons with CFS, possibly due to reduced transport of the vitamin across the cell membrane or abnormalities in the enzymes that help break it down inside the cell. The mechanism has yet to be defined, but in my clinical experience, large doses of B-12 provide improvement in energy and well-being in a majority of CFS patients. Persons with CFS who are interested in B-12 therapy and are willing to take an injection two to three times a week should consult with their physician.

Things to keep in mind about B-12 therapy

1. Don't rule out therapy because of test results. Blood serum levels do not necessarily reflect a deficiency, so you may need more B-12 even if your test results are normal.

2. You must be comfortable with injections. Many individuals are not willing to get a shot two or three times a week. Unfortunately, the oral or nasal spray preparations are less effective than injections.

3. You can administer the shots yourself. If it is more convenient for you to inject yourself with B-12 at home, you can ask your physician to show you how and provide the injection solution.

4. Report adverse reactions. Be sure to tell your physician immediately if you experience a rash, skin discoloration, chills or any other reaction following an injection.

5. B-12 does not interact. There have been no reported instances of B-12 interacting in a negative way with medications or other nutritional supplements, so you can rest easy if you are taking other substances to treat your CFFDS.

6. Take a multivitamin a day. B-12 can potentially hinder your absorption of other vitamins-taking a supplement can help prevent additional deficiencies.

7. Results might not be immediate. It takes up to six weeks to see improvement with B-12 therapy, so be patient.

References 1. Lindenbaum J, et al., "Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis," NEIM 1998; 318(26):1720-1728.

2. Beck WS, "Cobalarnin and the nervous system," NEJM 1988; 318 (26):1752-4.

3. Carmel R, et al., "Hereditary defective cobalamin metabolism presenting as a neurological disorder in adulthood," NEIM 1988; 318(26):1738-1741.

4. Simpson LO, "CIBA Symposium on Myalgic Encephatomeylitis," Cambridge University, England, April 1990.

5. Personal communication with Dr. Luke R. Bucci, Director of Science and Quality at SpectraCell Laboratories, Houston, Texas, in a letter dated August 12,1994.

6. Regland B et al., "One-carbon metabolism and CFS," presented at The Clinical and Scientific Basis of Chronic Fatigue Syndrome (international symposium), Sydney, Australia, February 1998.

7. Communications from Dr. Paul Cheney and the Department of Biochemistry at the University of North Carolina, 1994.

8. Sherertz EF, "Acneiform eruption due to megadose B-6 and B-12," Cutis, 1991; 48: 119-120.

[khurrams]

Using vitamin B-12 for the management of Chronic Fatigue Syndrome (CFS)
by By Charles W Lapp, M.D.
ImmuneSupport.com

02-25-2000

In the late 1980s, Dr. Paul Cheney and I heard several anecdotal reports of chronic fatigue syndrome (CFS) patients who improved when their primary care physicians administered B-12. Given the scarcity of effective treatment options for CFS, we set out to try various doses and preparations in our own patients.
This treatment was based on three articles that appeared in the New England Journal of Medicine demonstrating that persons with CFS-like neurological symptoms and normal blood counts could benefit from the administration of vitamin B-12 injections.

In these patients, problems such as numbness or tingling in the extremities, abnormal gait, memory loss, weakness of the limbs, changes in mood and personality and even fatigue were improved, and even resolved, with B-12 therapy. In addition, during this period of time Dr. Les Simpson was describing how changes in the red blood cells in persons with CFS reversed when high doses of B-12 were administered. With this in mind, we began treating patients with cyanocobalamin (a form of vitamin B-12 that is readily available in the U.S.) at doses from 1000 mcg weekly to 5000 mcg three times weekly, given subcutaneously (through injections under the skin).

Patients appeared to have a significant response at approximately 2000-2500 mcg, and reported increased energy levels, improved stamina or an enhanced sense of wellbeing within 12-24 hours of administration. The effects lasted two to three days on average. However, many patients required up to six weeks to achieve regular, consistent results, and a wide range of dosing proved to be effective, from 1000 mcg injected daily to 5000 mcg injected three times per week. To obtain a continuous and satisfactory level of improvement, we now recommend injections of 3000 mcg of cyanocobalamin every two to three days.

An informal poll of our patient population revealed that 50-80% improved to some extent with this simple therapy. However, we found that oral or nasal spray preparations of B-12 did not produce a demonstrable effect.

Scientific explanation:
The vast majority of our patients had normal serum B-12 and folate levels prior to the start of therapy, which indicates that routine laboratory tests may not reveal a deficiency. It also suggests that our therapy was effective because vitamin B-12 was not being absorbed or utilized properly by individual cells.

Difficulties can arise at any point during metabolism of B-12, resulting in many negative effects on the body, including nerve damage. Potential problems can include:

--Transport failure-the B-12 does not make it through the cell wall from the bloodstream. This is problematic because once inside the cell, B-12 functions as a cofactor, which means that it helps start important chemical reactions that allow the cell to function.

--Failure to degrade completely-if the process of metabolism is working correctly, the B-12 compound is broken down in a series of reactions. When the enzymes (synthetase and reductase) that facilitate those reactions do not do their job, chemical byproducts can build up and nerve cells can be damaged.

--Dietary insufficiency-this rarely happens because many of today's processed foods are supplemented with vitamins, including B-12.

Research findings

Studies from SpectraCell Laboratories using the EMA technique (which measures the metabolic response of a patient's blood cells to individual nutrients) demonstrated that more than 70% of 66 individuals with chronic fatigue-not necessarily CFS-demonstrated B-12 deficiency, compared to about 40% of the normal population. It follows logically that individuals with chronic fatigue syndrome would also experience abnormalities in B-12 metabolism.

At The Cheney Clinic, we measured homocysteine and methylmalonate (organic acids that are elevated when B-12 is not metabolized properly by cells) in CFS patients. Homocysteine was elevated in 33% of the individuals tested, methylmalonate in 38%, and both were elevated in 13%. Thus, about one third of CFS cases could perhaps have symptoms attributable to B-12 deficiency.

Researchers have hypothesized that the B-12 deficiency seen in CFS may be due to a genetic abnormality. The enzyme reductase, which plays a key role in B-12 metabolism, is controlled by multiple genes. Genes for a trait or enzyme occur in pairs, and how they act in combination determines how active the enzyme is. Dominant genes are expressed or translated more fully than recessive genes. Half of the population has two dominant genes for reductase, which causes normal activity of the enzyme. Approximately 40% have only one dominant gene, resulting in only 50% enzymatic activity. And 10% are homozygous (two recessive genes) with only 30% enzymatic activity. Swedish researchers examined the genetic makeup of 11 CFS patients with abnormal B-12 metabolism and determined that those who responded best to B-12 injections had normal reductase activity, and those that responded poorly had one or no dominant genes for reductase.

However, my experience suggests that inability to transport B-12 across the cell membrane is the major cause of abnormal B-12 metabolism in persons with CFS, because large doses of B-12 markedly improve cognitive ability, mood, irritability and numbness and weakness in a majority of patients. Those who respond poorly to high doses of B-12 may have low reductase activity. The latter should improve somewhat if they supplement their diet with folic acid, which helps improve the action of this crucial enzyme. I generally recommend 1 mg of folic acid daily, in tablet form, for those individuals who do not respond well or at all to B-12 injections.

Administration

Two forms of B-12 are available to consumers: cyanocobalamin and hydroxycobalamin. Of the two, I have always preferred cyanocobalamin because it is less likely to cause adverse reactions and stings much less than hydroxycobalamin when injected. The cost of high dose B-12 therapy is approximately $8 to $10 per month.

Patients can be taught to administer their own injections of B-12 using the same lcc insulin syringes diabetics use. They will need to obtain a supply of the B-12 solution from their physician - cyanocobalamin is typically prepared in 10 ml or 30 ml multi-dose vials, and should be stored in a cool dark place because both heat and light degrade the product rapidly. A cabinet or refrigerator are satisfactory.

Large doses of B-12 could theoretically compete with other B-vitamins in the cell, so to prevent deficiencies I always recommend that patients starting injections supplement their diet with multivitamins containing B-vitamins as well as folate.

Toxicity and adverse effects

Toxicity or "poisoning" from cyanocobalamin, a form of B-12 that is combined with very small amounts of cyanide, has been the major cause of patient concern about high-dose B-12 therapy. I have not encountered any evidence of cyanide toxicity. The amount of cyanide administered is so minuscule that it affords wide margin of safety even at doses of 15,000 mcg per week. Although this dose may seem inordinately large, medical textbooks have long recommended doses of 1000 mcg per day (or 7000 mcg per week) for the treatment of nerve problems due to B-12 deficiency. The only exception is in individuals with kidney failure. In patients with normal B-12 levels and intact kidney function, excess cyanide and B-12 are simply excreted through the urine.

I have recommended high-dose B-12 to thousands of patients over the past 10 years and have seen no serious adverse effects. The major complaint about B-12 from patients is bruising at the injection site. This is harmless, goes away quickly and can usually be eliminated by inserting the needle perpendicular to the skin or using a longer needle. The "bruise" may actually be accidental leakage of the crimson-colored B-12 solution under the skin.

Although some drug references indicate that idiosyncratic reactions are not uncommon with B-12, I have only had one patient who developed hives and chills after an injection, and even that person could tolerate occasional small doses.

A rare individual will develop a raised red bump at the injection site, but this is usually attributable to agents added to the B-12 solution to inhibit the growth of bacteria in the vial and not the B-12 itself. In such cases, the pharmacist can prepare small vials of B-12 without the bacteria-inhibiting agent. With high doses of B-12, an acne-like rash also may occur, but the rash usually responds promptly to a reduction in dosage.

Some patients respond so well to B-12 that they become hyperactive-nervous and excitable-but this too can usually be resolved by reducing the dose. Because of this excitatory effect, I recommend that B-12 be administered in the morning, so that it will not interfere with sleep.

Very rarely, a patient's urine will be faintly pink-tinged following a dose of B-12. This “cobalaminuria” occurs intermittently, and although it looks alarming, seems to be entirely benign.

Is B-12 therapy for you?

B-12 injections are an effective, safe and inexpensive treatment in the management of CFS. There is evidence that B-12 metabolism at the cellular level is abnormal in persons with CFS, possibly due to reduced transport of the vitamin across the cell membrane or abnormalities in the enzymes that help break it down inside the cell. The mechanism has yet to be defined, but in my clinical experience, large doses of B-12 provide improvement in energy and well-being in a majority of CFS patients. Persons with CFS who are interested in B-12 therapy and are willing to take an injection two to three times a week should consult with their physician.

Things to keep in mind about B-12 therapy

1. Don't rule out therapy because of test results. Blood serum levels do not necessarily reflect a deficiency, so you may need more B-12 even if your test results are normal.

2. You must be comfortable with injections. Many individuals are not willing to get a shot two or three times a week. Unfortunately, the oral or nasal spray preparations are less effective than injections.

3. You can administer the shots yourself. If it is more convenient for you to inject yourself with B-12 at home, you can ask your physician to show you how and provide the injection solution.

4. Report adverse reactions. Be sure to tell your physician immediately if you experience a rash, skin discoloration, chills or any other reaction following an injection.

5. B-12 does not interact. There have been no reported instances of B-12 interacting in a negative way with medications or other nutritional supplements, so you can rest easy if you are taking other substances to treat your CFFDS.

6. Take a multivitamin a day. B-12 can potentially hinder your absorption of other vitamins-taking a supplement can help prevent additional deficiencies.

7. Results might not be immediate. It takes up to six weeks to see improvement with B-12 therapy, so be patient.

References 1. Lindenbaum J, et al., "Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis," NEIM 1998; 318(26):1720-1728.

2. Beck WS, "Cobalarnin and the nervous system," NEJM 1988; 318 (26):1752-4.

3. Carmel R, et al., "Hereditary defective cobalamin metabolism presenting as a neurological disorder in adulthood," NEIM 1988; 318(26):1738-1741.

4. Simpson LO, "CIBA Symposium on Myalgic Encephatomeylitis," Cambridge University, England, April 1990.

5. Personal communication with Dr. Luke R. Bucci, Director of Science and Quality at SpectraCell Laboratories, Houston, Texas, in a letter dated August 12,1994.

6. Regland B et al., "One-carbon metabolism and CFS," presented at The Clinical and Scientific Basis of Chronic Fatigue Syndrome (international symposium), Sydney, Australia, February 1998.

7. Communications from Dr. Paul Cheney and the Department of Biochemistry at the University of North Carolina, 1994.

8. Sherertz EF, "Acneiform eruption due to megadose B-6 and B-12," Cutis, 1991; 48: 119-120.

In lamens terms how much and how often should be taken....I heard running b12 during PCT is really effective....

[emplate]

hey do any of you also inject b12 with b6 at all? i've been looking for information about injecting b6 as well as b12...

[ECFATCAT]

never have injected B6 it doesn't have the absorbtion problem that B12 does. It's not listed in any of our pharmasuticle catalogs....but there is an expensive B complex,but it's much more painful than the worst prop...