Do I Need Vitamin B12 “shots”?
You may have come across clinics offering vitamin B12 “shots” (a.k.a intramuscular cobalamin injections) and wondered whether you should I get one too.
I often get asked; what’s the difference between oral and vitamin B12 “shots”? Is there a difference between types of vitamin B12? (did you know there are at least 3?!) What are the benefits? Do the “shots” hurt?
We can measure vitamin B12 also known as cobalamin levels in our blood to diagnose a form of anemia called pernicious anemia. But there are many other roles that vitamin B12 plays in our body.
Vitamin B12 is crucial to our nervous system, energy production and hormone balance. The amount of Vitamin B12 in the blood doesn’t always reflect the amount of the vitamin required by the nervous system. As a result, you may experience fatigue, depression or anxiety or more advanced symptoms of a vitamin B12 deficiency such as tingling in the hands and feet.
Causes for vitamin B12 deficiency
If you’re a vegan or vegetarian, getting adequate amount of vitamin B12 is especially challenging. Animal products such as meat, shellfish, dairy, eggs are primary sources of vitamin B12 leaving these individuals relying on supplementation.
Aside from adequate dietary vitamin B12, proper absorption is critical to optimal function. Adequate amount of stomach acid and an intestinal protein called the Intrinsic Factor (IF) are required to release vitamin B12 from proteins bound in food.
Undiagnosed pernicious anemia, where the immune system attacks cells in the stomach that release IF, may be another cause for reduced absorption in small intestine.
Seniors are at a greater risk of deficiency because they don’t chew their food well and stomach acid levels decrease with age – both of which are required for proper digestion and release of B12.
Certain medications have been implicated in Vitamin B12 deficiency, especially in older patients such as long-term use of PPIs, Metformin, and NSAIDs. The list also includes birth control pills, antibiotics, stomach acid blockers (Zantac, Tecta, Losec, Nexium, Tums, Rolaids), alcohol and nicotine (from cigarettes).
Food intolerances, IBD, Celiac Disease, infection, and dysbiosis that compromise health of small intestines may also impact absorption.
What is the best form of vitamin B12 to use?
Vitamin B12 can be found in various forms, including Cyanocobalamin, Hydroxycobalamin and Methylcobalamin being the most active form. This means that it can be readily used by the body while the others must be metabolized into this active form. Our body uses methyl groups to detoxify and remove: waste products, neurotransmitters, medications, and hormones from the body.
How is this different from vitamin B12 I get from my doctor?
Medical doctors use Cyanocobalamin, a synthetic form of vitamin B12. It does will increase vitamin B12 stores in the body, but you don’t get the perks of the methyl group. If you’ve done genetic testing and have MTHFR mutations, methylation is especially important.
What is the benefit of an injection?
Injection bypasses absorption in the gut and eliminates the need for stomach acid and healthy stomach mucosa for absorption. This way, it is also more readily available to the nervous system. Although more invasive, it is a more effective at delivery and only small doses are required.
Studies have shown that patients who receive intramuscular injection of methylcobalamin for four weeks followed by oral administration of methylcobalamin for additional eight weeks experience spontaneous pain relief by 73%!
Oral supplementation is still an effective and can be used for maintenance once a deficiency has been corrected.
Is vitamin B12 safe? Do the “shots” hurt?
Being a water-soluble vitamin, excess amounts B12 is excreted by the body in the urine. You may experience local injections site reactions such as pain, redness, swelling, irritation and itching. Other risks include digestive upset, muscle cramps, irregular heartbeat, infection. Vitamin B12 injections are contraindicated in allergy to cobalt, Leber’s disease, pregnancy, kidney disease and megaloblastic anemia.
Where are injections administered?
The most common injection site is the deltoid muscle in the arm. For pain relief, vitamin B12 can be injected into the buttock muscle for piriformis syndrome and the back to relieve low back pain and sciatic pain.
How often do I need a Vitamin B12 injection?
The answer depends on the individual, but can ranges between once per week to once per month. Factors affecting this include medication, amount consumed through diet and amount absorbed and the condition being treated.
Have more questions about Vitamin B12 injections?
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Dr. Anna ND
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- Vidal-Alaball J, Butler CC, Cannings-John R, et al. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev. 2005;(3).
- Prousky JE. Understanding the serum vitamin level and its implications for treating neuropsychiatrie conditions: an orthomolecular perspective. J Orthomolecular Med. 2010;25.