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Kelly Brogan MD
Holistic Women's Health Psychiatry
caring for the whole woman naturally
Holistic Women's Health Psychiatry
caring for the whole woman naturally
Reforming Psychiatry

Friday, February 7th, 2014

Vitamin B12 Deficiency and Brain Health

Posted by Kelly Brogan MD in Article

One of the most remarkable papers I have read in the psychiatric literature was about a 57 year old woman who was treated with months of both antipsychotic and antidepressant medications and given two rounds of electroconvulsive treatment before anyone bothered to check her vitamin B12 level.

Her symptoms were years in the making including tearfulness, anxiety, movement abnormalities, constipation, lethargy, and eventually perceptual disturbances (hearing her name called) and the ultimate in severe psychiatric pathology: catatonia. Despite her inpatient treatment, she remained suicidal, depressed, and lethargic.

Within two months of identifying her deficiency, and subsequent B12 treatment, she reverted to her baseline of 14 years previous, and remained stable with no additional treatment.

If this is not a wake up call to the average psychiatric prescriber, I’m not sure what is. Much of what we attribute to serotonin and dopamine “deficiencies” melts away under the investigative eye of a more personalized style of medicine that seeks to identify hormonal, nutritional, and immune imbalances that can “look” psychiatric in nature.

How can B12 impact brain health?

B12 supports myelin (which allows nerve impulses to conduct) and when this vitamin is deficient, has been suspected to drive symptoms such as dementia, multiple sclerosis, impaired gait, and sensation. Clinically, B12 may be best-known for its role in red blood cell production. Deficiency states may result in pernicious anemia. But what about B12’s role in psychiatric symptoms such as depression, anxiety, fatigue, and even psychosis?

The one-carbon cycle  refers to the body’s use of B vitamins as “methylators” in DNA synthesis and the management of gene expression. There are three concepts that relate to B12’s role in chronic, long-latency neuropsychiatric syndromes:

  1. Methylation
    This process of marking genes for expression, like little “read me!” signs, is also critical for detox and elimination of chemicals and hormones (estrogen), building and metabolizing neurotransmitters, and producing energy and cell membranes.
  2. Homocysteine recycling
    B12 is a primary player in the one-carbon cycle and a co-factor for the methylation, by activated folate, of homocysteine, to recycle it back to methionine. From there, SAMe is produced, the body’s busiest methyl donor.
  3. Genetic override
    Sufficient supply of an activated/bioavailable form of a vitamin (ie methylfolate vs folic acid)  is even more necessary in the setting of gene variants such as transcobalamin II, MTHFR, and MTRR which may function less optimally in certain individuals and result in pathology under stress. An example of this is a report of death in a B12-deficient patient with genetic variants who underwent anesthesia with nitrous (which causes stress to the system). Notably the B12 blood level was normal, so this fatal case was attributed to functional deficiency, suggesting that access to B vitamins may not always guarantee proper utilization. For this reason, supplementing with activated forms of B vitamins enhances their likelihood of effectively supporting cellular processes.

How Do We Test?

There are few empirical treatments, meaning treatments that apply to everyone, in functional medicine, but I believe B12 to be one of them, particularly in light of the fact that some 2/5ths of the population present with severe deficiency. Testing is available, and most data on deficiency has relied on blood levels, with deficiency defined as being below 150-200 pg/ml. It turns out that testing for deficiency by blood level is not always a reliable indicator of what is going on in the brain, or functionally, in the body.

An important study in women identified markers of B12 deficiency in 27% of depressed patients by using methylmalonic acid  instead of B12 levels. Relatedly, an excellent review of clinical improvement with B12 treatment speaks to ten studies which demonstrated “normal” B12 levels, often finding mean levels in the 3-400pg/ml range (but never above 600) in patients with fatigue, sleep disorders, depression, and dementia.

Correlation with cerebrospinal fluid levels is also inconsistent, including in cases of postpartum depression where women improved with empirical application of B12. High copper levels – potentially caused by zinc deficiency – postpartum have been associated with depression and may effectively impair B12 transport. Utilization of a given vitamin is more clinically relevant than its sufficiency, and for this reason, two tests have been proposed as reliable surrogate markers:

  1. Homocysteine
    May be elevated in the setting of either B12 or folate insufficiency or dysfunction (often related to genetic variants).
  2. Methylmalonic Acid (urine or serum)
    This value is more specific for B12 deficiency, but potentially insufficiently sensitive.

Screening for signs of anemia (megaloblastic) is no longer reliable because of wrong-headed recommendations that toxic foods like flour be “fortified” with synthetic folic acid. For those unable to metabolize this synthetic compound, levels may build up with unknown consequences, but at least one study suggests deleterious effects including immune impairment. Additionally, folic acid may “mask” B12 deficiency by correcting for blood changes without actually allowing for the one-carbon cycle to proceed as it would like to.

What causes deficiency?

Once it is established that a patient has overt serologic evidence of deficiency (in blood) and/or they respond to treatment, we must ask how they became deficient in the first place. Here are some considerations:

1. Achlorhydria
This is the fancy term for low stomach acid, something which sometimes occurs in the setting of low thyroid function, chronic stress, aging, and most salient to a recent (December 2013) paper – acid blocking medications.

A Common Scenario

A patient is eating foods that they are unable to properly digest and that promote local inflammation, further perpetuating poor digestion and transit. These may include processed dairy, foods fried in vegetable oils, and cereal grains. The patient experiences the reflux of this poorly mobile, poorly digested sludge, or chyme, as a sign that they have high stomach acid.

They are put on a medication (or buy one over the counter) that has never been studied for long-term use, and that population-based observational studies link to pathogenic overgrowth of bacteria, fracture, and nutrient deficiency. Why? Because stomach acid is critical for triggering digestive enzymes along with an escort called “intrinsic factor” for B12 absorption and managing local microbial populations.

If this patient’s B12 deficiency and digestive imbalance goes unattended, they will likely develop symptoms that will earn them a prescription for an antidepressant, and the medications start to pile up.

The aforementioned paper, Proton Pump Inhibitor and Histamine Receptor 2 Antagonist Use and Vitamin B12 Deficiency, was a case control evaluation of 25,956 patients on acid-blocking mediation, which found that 12% of those taking these medications were deficient in B12 at a two year evaluation, and that the higher their daily dose, the stronger the association. We’ve already reviewed the false negative rate of this blood test for B12 sufficiency, so we can only assume that many more of those pill-popping patients were suffering from the effects of deficiency that was not detected.

2. Dietary Restricition

Animal foods are primary sources of B12, although algae and fermented foods may represent promising options for some diligent individuals. Stores deplete over time, and deficiency-related symptoms may present long after dietary restriction. Carefully sourced animal foods are also a unique source of pre-formed fat soluble vitamins, creatine, choline, and carnitine.

3. Automimmune

One of the possible mechanisms of deficient B12 absorption is pernicious anemia, an autoimmune response to parietal cells, associated with atrophic body gastritis in the stomach. H. pylori infection and associated molecular mimicry are thought to represent a plausible trigger.

 4. GMO/Gluten

The powerful synergy of gluten-containing and genetically modified processed foods may have an impact on everyone’s guts, not just those people with biopsy-confirmed Celiac disease. In fact, the biopsy is fast losing position as the gold standard diagnosis because of extraintestinal manifestations of gluten immune response that don’t cause observable changes to the small intestinal villi (joint pain, or rash, or gait-instability without obvious gut symptoms). In these individuals, the innate immune system responds to gluten in these grains, and food fragments may pass into the blood stream through zonulin-gated tight junctions. Direct damage to the cells in the small intestine may result from whole grain foods with high amounts of inflammatory lectin.

Genetically modified corn may be playing a part in small intestinal villious changes as demonstrated in this study, in mice consuming corn oil. There is also reason to believe that Bt-toxin from Monsanto’s GMO corn plays a role in intestinal permeability as it was found in the blood of 93% of pregnant women and 80% of their fetuses. The herbicide itself also changes the existing flora, preferentially killing beneficial bacteria, and potentially allowing for growth of pathogenic microbes in the small intestine.

5. Medications

Notably, Metformin, the blood sugar regulating medication, has been demonstrated to be a risk factor for deficiency, a fact that few patients are informed of before complying with their prescribed treatment.

The cure?

When treating B12 deficiency, while the underlying cause is being investigated, use of an activated form of the vitamin is recommended, and preferentially effective at improving levels. Cyanocobalamin is a synthetic form of B12 that has been bound to a cyanide molecule (nice!), while hydroxy, adeno, and methyl are all forms of B12 that are active, natively, in the body.

There is a debate over the comparative efficacy of injectable vs oral dosing, and it has been my clinical experience that injectable dosing yields a more robust and reliable clinical effect. Dosing is typically 1000mcg-5000mcg 2-3x times/week for one to two months depending on patient characteristics and response. Consider the power of this vitamin. Respect its necessity and protect your body’s access. It may very well be the last antidepressant you’ll ever need.

This perspective on the role of B12 in mental health was recently featured on in an article entitled Long-Term Use of Proton Pump Inhibitors and Other Antacids Can Cause Vitamin B12 Deficiency.


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  1. February 8, 2014 at 12:18 pm
    amber says

    Is it ever possible to react negatively to methyl b12 ie with anxiety for some reason? If so what might cause this. In someone who started with b12 of 73…


  2. February 8, 2014 at 1:11 pm
    Kelly Brogan MD says

    Yes – this is definitely possible. Alternative forms (hydroxy), coadministration with methylfolate, and/or niacin may be used as an “antidote”. discusses this in more depth.


  3. February 8, 2014 at 5:49 pm
    Jessica Cox says

    What type of B12 is usually injected? Is it safe?


  4. February 9, 2014 at 5:28 am
    Owen says

    I’m aware of blood profiling for cholesterol / lipoproteins as a common practice in the states, here in the UK I know of testing for allergies and things like anemia. But is there a similar practice to look at the overall vitamin/mineral levels, or indeed hormonal profiling of someone’s blood? If not would this be a feasible or indeed viable as an alternative medical service?

    One of the challenges to this here in UK is that you are not allowed to do blood tests as an alternative medical practitioner unless its an ‘official’ service because its an invasive procedure.


  5. February 9, 2014 at 2:29 pm
    Kelly Brogan MD says

    As I mention in the post, I believe B12 supplementation to be a safe and potentially high yield empirical intervention (meaning try it regardless of testing)…


  6. February 10, 2014 at 7:20 pm
    Debbie Simons says

    I am a nurse practitioner in an out patient psychiatric practice. Thank you for the B12 information. I try to look at the whole person before prescribing medication. This is a level I will add to my initial new client lab work.


  7. February 12, 2014 at 3:28 am
    Karen Thompson says

    I thank Kelly Brogan for bringing the initial case study relating to the mis-diagnosis to our attention. To differentiate between the emotional and pragmatic issues this example highlights is very difficult. The patient in question, in my opinion, underwent procedures and drug administration, that in light of her real illness, were no less than toturous – this kind of practice belongs in mediavel society, not contemporary. I find it hard to get past what this woman was subjected to. Yet the problems still occur – patients whether they are suffering from physical symptoms or psychiatric have their concerns dismissed or misattributed. The attention given to functional disorders, which essentially has become the ‘pit’ into which all symptoms and patients are tossed when medics cannot find substantive ‘evidence’ of injury, should be covered over. This avenue of diagnostics should be closed to the medical profession. B12 deficiency and the neurological problems it causes is typical of the problems that result relating to functional disorders. It is difficult to initially diagnose with current tests. It is difficult to substantiate physical injury with current tests (especially in cases where the patient has undergone treatment) and the medical profession, although surrounded on a daily basis by examples of it, are woefully ignorant of the condition outside that of haematological indicators. It is time for the individual observation to return to science. Functional disorders give science an answer, a reason, an excuse and are in essence ensuring that science is regressing rather than advancing. And, as if any further evidence is necessary, the one case highlighted proves that. What we need to ask ourselves is, how many more like that are there? How many more are not getting this illness picked up because they are either not tested or not treated correctly (doctors treat haematological symptoms not physical) and are condemed to institutions or certain death?


  8. February 12, 2014 at 12:36 pm
    Marilyn Gill says

    Finally! a doctor of psychiatry who is looking for the underlying causes of illness/mental disorders and taking action and talking about it. Yeah! I have eschewed psychiatry for many years now seeing the neurological damage done to our son. I have known for years that his condition is due to allergies, toxicity and deficiencies. I remember a psychiatrist telling me that the drug was out of his blood after 2 weeks and therefore what we saw was truly mental illness. I retorted with, “Man is not made of blood alone”. Unfortunately, I didn’t have anyone in this environment who saw it as I did and unfortunately, I was not well enough educated in what some of the tests (if they existed then) or the solutions might be. I would be more than willing to work with a psychiatrist who was looking for these underlying causes of deviating-from-the-norm behaviors.

    From my perspective, a psychiatrist who is willing even to look at these issues and work with a nutritionist and any other doctor the client wants is one whom I would endorse and employ in a heartbeat. I once suggested to Dr. Grace Jackson before she wrote her books that she ought to think of titling herself as an ‘environmental psychiatrist’. She seemed to like the idea. I think that this is definitely the time for psychiatry to restructure itself. Unfortunately, psychiatric labels stick with a person for years and with the kind of Big Brother society we have – these labels may affect some folks lives in ways they never dreamed of. Perhaps, the whole medical lot needs revamping.

    WELL DONE, Dr. Kelly Brogan! How about getting your male counterparts in on your more holistic approach and getting Big Pharma less in the picture when it comes to psych drugs? Thank you.


  9. February 12, 2014 at 5:21 pm
    Dr. Mike Greenberg says

    Dr. Brogan,
    Thank you for this insightful article. I can utilize the information immediately.
    Dr. Mike


  10. March 7, 2014 at 3:44 am
    Rebekah says

    I had a biomeridian body scan done. My intestinal cilia is in good shape, but my intrinic factor is low and I’m not absorbing B vitamins as I should. Does this require the GAPS Diet as opposed to just eating a Weston Price type diet but adding in more broth?
    If so, for how long? I”ve read that this problem is autoimmune.


  11. March 18, 2014 at 1:19 pm
    Angie says

    In point #4 about GMOs, I was very interested in reading the study about fetal contamination of the Bt toxin. However, upon reading the abstract, I noticed there was a comment from PubMed essentially saying the study was weak and used incorrect methods. Do you know of any studies worth referencing? I mean according to the comment, they didn’t even use a test validated for mammalian tissue. That seems pretty flimsy to me. I don’t doubt the presence of unwanted toxins in our blood, and of course, the fetus within, but I don’t like crappy science either.


  12. March 22, 2014 at 10:46 am
    Kelly Brogan MD says

    Hello and thank you for your insightful point. Yes, the kit uses an enzyme linked immunoassay to assess for Bt protein. There is the possibility for cross-reactivity with the human proteome; however, this would only substantiate further risks of molecular mimicry. Given these possibilities, this study raises a substantial signal of harm that should activate the precautionary principal until proven otherwise.


  13. April 24, 2014 at 9:29 am
    B12 Deficiency and Neuro-Psychiatric Disorders by Jeffrey Dach MD - Jeffrey Dach MD says

    […] with related interest: See this excellent article, Vitamin B12 Deficiency and Brain Health by Kelly Brogan […]


  14. June 10, 2014 at 2:43 pm
    April says

    What is best to take for b12? Like what brand?


  15. June 11, 2014 at 12:44 pm
    Kelly says

    I would also love to know recommended brands for vitamin supplements. What is superior? And, am I wasting my money and time taking other brands?


  16. June 11, 2014 at 12:51 pm
    Kelly Brogan MD says

    The important factor is that it is not a cyanocobalamin and that there aren’t a bunch of additives. You can peruse some of my selections here, but I don’t endorse any specific companies…


  17. June 16, 2014 at 1:01 pm
    sush says

    Thank u for the wonderful mom is into depression on and off since the last 20 yrs…last week a pyschiatrist recommended a vitamin b12 test …we found it to b 176..can vitamin b12 supplement help her


  18. July 20, 2014 at 10:02 pm
    caleb says

    I liked this article. I have been sick for about 7 year and been to many doctors it wasn’t till I got into the uc neurology system that I found out I’ve been b12 deficient for along time. I’ve gone though years of nausea abdominal pain changes in balance vision and personality. Nerve pain tingling pins and needles through out my body and really think I’m going to diagnosed with dementia. I’m 31 and just started shots. Which I find I’m walking little better. Looks like I had issues with mtfr genes antacids and gut absorption.


  19. August 4, 2014 at 1:56 am
    jamie says

    I had anxiety for 15 years that was just a b12 deficiency. a lot of doctors. none of them figured it out or even checked it until I lost feeling in 3/4ths of my body. then the MRI report suggested I had it, and a blood test confirmed. Now I feel so great, with my 1x a month shot. but the shots…the doctors are so hesitant to give shots and its really bad b/c the pills and sublingual do NOT work as well. thank you for bringing awareness to this issue!


  20. September 19, 2014 at 1:18 pm
    Heather says

    My son is B12 deficient, according to labs, and has ADHD-inattentive type. We are doing everything holistically, including supplementing iron (per lab test results), magnesium, zinc, and fish oil. Whenever we give him B12, whether is be methyl, hydroxyl, or several others, it affects his moods in extreme ways! I really think the B12 could be the “missing piece” that he needs to be able to focus better, but he just can’t tolerate it. We can’t afford genetic testing right now, so I am looking for something to try. I’ve read about lithium supplements to take with the B12. What do you think about this? Do you have any other suggestions? Thank you!!!!


  21. September 19, 2014 at 6:36 pm
    Kelly Brogan MD says

    Hi Heather – as the saying goes, “start low and go slow” and use the other cofactors like methylfolate, B1, B2, B3 in conservative doses.


  22. September 24, 2014 at 11:32 pm
    Curtis says

    “A patient is eating foods that they are unable to properly digest and that promote local inflammation, further perpetuating poor digestion and transit. These may include processed dairy, foods fried in vegetable oils, and cereal grains.”

    Why are patients being fed this crap in the first place?

    “Let thy food be thy medicine.” -Hippocrates


  23. September 26, 2014 at 6:14 pm
    Amy Rossitto says

    I am 48 y/o female in good health taking Prilosec every day (1-2 times/day) for a year when I developed tremors, balance issues, speech issues, foggy brain, anxiety, heart palpitations, etc. Went to the ER 3 times and family Dr and they were all mystified. All labs and MRI scans perfectly normal. I read your article and realized that I’m vitamin B12 deficient as a result of the antacid meds. I stopped antacids. I’m taking Vitamin B12 at a dosage of 5000 mcg once a day. What is the normal course of therapy in this situation?


  24. September 26, 2014 at 6:45 pm
    Kelly Brogan MD says

    orally, it varies, but two months is reasonable.


  25. September 26, 2014 at 11:55 pm
    Amy Rossitto says

    Do tums also interfere with absorption of vitamin B12? I’m trying to find a less damaging means of dealing with my acid reflux.


  26. October 3, 2014 at 12:24 pm
    Myvites says

    It is important to keep the brain functioning properly otherwise, the whole body will be disrupted!


  27. October 15, 2014 at 2:54 am
    MERRYL says

    I am so happy I found this article. My teenage daughter has been suffering worsening depression, anxiety and panic attacks over the past year, and after trying to treat it with exercise and diet, the GP has finally put her on medication. But he also suggested a blood test for B12, and the result came back severely deficient. We can’t identify what has caused the deficiency however (it’s not diet, and nothing else seems to fit either ) – can it be the result of illness? Just before the symptoms started showing, she was diagnosed with hand, foot and mouth disease. Also, the chemist has given her a B12 mouth spray, which he says is more efficient than tablets – what are your thoughts?


  28. October 15, 2014 at 8:02 am
    Kelly Brogan MD says

    I recommend seeing a Functional Medicine doctor, using injections, and exploring the possibility of an autoimmune process (parietal cell) as an underlying cause. Best of luck…


  29. October 25, 2014 at 8:03 am
    manisha says

    hey i have experienced severe anxietyand accompanied depersonalization(i think it is),my doctor told me it was just anxiety and prescribed me medicines(anti depressants).i didnt take them though except fora mild doze of opiprol.i have been experiencing anxiety since past 5 months and depersonalization too.i researched a lot on the topic and hence got to know the imp of b12.i got my b12 levels checked and they wer 256pg/ml.
    ever since the past week m taking 1500 mcg mecobalamine .
    can it be that my anxiety and even depersonalization developed coz of b12?
    and they will be fine as soon as b12 levels get back to normal.i have had no traumatic events to cause anxiety otherwise.


  30. October 26, 2014 at 10:11 am
    manishamanisha says

    and in any case is 256pg/ml is low enough to cause such conditions?


  31. November 6, 2014 at 12:09 pm
    nov 5 2014 says

    I’m a 52 yr old male. Approx. 6 months ago anxiety, paranoia, and agoraphobia swept over me. I am a very healthy and active. I have never been on any medication in my life and only had a couple anxiety episodes, many years ago. What came over me was absolutely terrible, I really felt psychotic- that I was “losing it”. I tried to live with it for a few months and see if it would exit as it came. I went to Doctor and got blood tests done. All turned out normal except my B12 was 330. The test sheet said below my B12 reading- “Although the reference range for vitamin B12 is 200-1100 pg/ml, it has been reported that between 5 & 10% of patients with values between 200-400 pg/ml may experience neuropsychiatric and hematologic abnormalities due to occult B12 deficiency. ..”. Wow, yet . My Dr. never mentioned it. After much research and reading the book “Could it be B12” I started taking methyl B12 5000 mcgs daily. I’ve been doing this now for about 1 month and have seen an absolutely dramatic change for the better. I still have slight symptoms, some days worse than others and sometimes no symptoms at all. I hope full recovery is close. The scary thing is, the doctor offered me antidepressants; I said no. If I had taken them I would be attributing my recovery to them and not B12 if I were taking both.


  32. November 7, 2014 at 12:56 pm says

    What an irresponsible doctor to want to put you on antidepressants. They are extremely difficult to get off of and they hardly benefit anyone on the long run. The mechanism you might want to look into is methylation. It has a lot to do with B12. If you study the pathway, you can understand that things can happen at more then one of the steps. You can adjust your supplements accordingly.


  33. December 22, 2014 at 10:37 pm
    Kevin says

    Dr. Brogan,

    Can you speak to the issue of taking Sublingual Methylcobalamin vs. a tablet? Specifically, how much higher of a dose should be taken in tablet form to make up for the loss of uptake from the gut (for the average person). I realize everyone’s gut absorption will be different per your article, but is there any benchmark listed in any studies?


  34. December 23, 2014 at 8:16 am
    Kelly Brogan MD says

    The literature supports equivalency, however, in my clinical experience, intramuscular injection is more effective. The dosages would be the same – from 1-5mg daily.


  35. December 27, 2014 at 12:25 am
    Karen says

    Dr Brogan,
    Long story, but the short of it is that the doctors have dx her with Dementia/Alzheimer’s. She was on Prilosec for 3 years along with Metapropolol, Tremadal, etc. My sister and I tried to get her off but only after 3 years and article that said that Prilosec may be causing the extreme pain she had for 3 years and memory loss did our father finally get her off of that and Metapropolol. For the next year anxiety grew until she totally lost it the day of our father’s hip surgery. We had to put her in Geriatric Psych unit, then memory care unit for 2 months. She was then in my house for 1 month while we gut repaired her and started her on Methylation (she is MTHFR mutation). After gut repair, she has been on B12/folate methyl tablets with other Bs. She doesn’t like taking pills, and for some reason vit/min are harder to take than prescription meds. She was nurse for 40 years so she ‘knows everything’. Not… She is on Celexa and we would like to wean her off of that and the Synthroid they have her on. Then test (thyroid/B12/folate, MMA, homocystine, etc). Her lead levels went from 18 to 11 with some detoxing and hopefully the methylation working. Will do another round and hope to get it further down.

    More to the story, but you keep mentioning the injection for B12. We would LOVE that option, but I know that the Methyl version of the shot is not easily come by. Any suggestions as to how and where to get it for her and would Medicare/drug insurance pay for at least part of this? We have some compounding pharmacies where I live. Do they do this type of medication? Thanks so much for your information. I think it may be too late for our mother, but would still like to find out if it was deficiencies, stress, chronic pain, prescription meds, etc that caused her to have Dementia. My sister and I say yes, drs not a clue…


  36. December 29, 2014 at 2:44 pm
    S says

    About the benefits of potato starch: What about the potato starch in cooked rice bread or other foods that often contain it? Or, does it need to be never cooked, or raw?–or can it be cooked and then cooled? What about rice flour and tapioca flour? And, any blood sugar problems with any of these, including the potato starch?

    Thank you very kindly for all you do.



  37. December 31, 2014 at 12:00 pm
    Susan IS says

    About 14 months ago I experienced an emotional trauma. I asked my GP for something to help me sleep and was prescribed an anti depressant. I was assured that the drug was no longer used as an antidepressant but was found to be effective in aiding sleep. After my first dose I experienced many negative side effects – shakiness in hands and arms, panic/anxiety, heart palpitations. I was told these symptoms were caused by my emotional trauma. Not being sure, I followed the advice of the psychiatric team and thus began my five month journey with various antidepressant, antianxiety and antipsychotic medications. At five months I refused to take any further anti anything medications. I used Valium to settle my symptoms and then gradually weaned from the Valium over 5 months. No further symptoms since. Two months in to this experience I had a medical assessment and was prescribed monthly B12 injections. I have not noticed any positives or negatives with mood or energy. I have noticed an increasing pain in the sites of injection which worsen after each injection. The pain includes burning, tightness, locking of the joint, snapping and cracking of joint and area. I did not connect the problem to the B12 injections for over a year. Am now stopping the injections and hoping this will eventually eliminate the problem. I realize this is an unusual reaction to the B12 injections. It just goes to show that we are all individuals and we must be vigilante in our quest to find what works best for our own unique makeup. On the positive side of this experience I eliminated gluten and dairy and added magnesium citrate and vitamin D3 which I attribute to the elimination of gut problems. I was told for years I had irritable bowel syndrome. Have not had any of the gut problems (bloating, constipation, pain, spasms) for just under a year. I made these changes after doing my own research as I could not find a doctor to help – they all wanted to give me drugs. Thank goodness I had the ability to do this on my own. I am concerned about people that are not able to do this and are blindly following these cookie cutter approaches. I wish we all had access to functional medicine doctors. It is a proactive approach to our health. Good luck to you all in your search for health and happiness.


  38. January 29, 2015 at 3:00 pm
    jody FIELD says

    I Was just recently told my B12 level was at 117 I have under gone 3 injection of 1000mg and on 1000 oral with my first injection things looked good for three weeks no symptom. then a week shy of having another monthly injection I went and received another one. My symptoms did not go away. I am experiencing tingling and a burning sensation mainly in my thighs but also sometimes in face and arms. I saw Neurology and mainly was afraid of MS. He reassured me that it was not. during all of this my mind does not stop thinking of the terrible things that could be wrong so therefore I am causing some major anxiety. My days are not so bad but at night things seem to be worse. Is there any suggestions you could give me to get health back.


  39. February 2, 2015 at 5:41 pm
    Hope Thompson says

    I have been dealing with yeast overgrowth for 18 months now. Long story….but my question is, do I need to be careful with Vit B? When I get a shot I absolutely feel better, but I have bee cautioned that yeast loves Vit B. Is there any information on this that anyone knows of? Thanks for any responses in advance.


  40. February 11, 2015 at 1:31 pm
    Tracy Wilson says

    Can you tell me in layman’s terms, what blood test I need to ask for? How can I demand B12 injections when my provider tells me that over the counter supplements are just as effective. I need to advocate for my daughter, but when the medical professionals cause a barrier, I don’t know what to do.


  41. February 14, 2015 at 8:06 pm
    lK says



  42. February 14, 2015 at 8:14 pm
    lK says



  43. February 17, 2015 at 7:17 am
    JannahJannan says

    My 5 yr old tested extremely high for B12. Should I be concerned? I did give him a B12 spray several months before, since he seemed to show signs of deficiency. But that methylcobalamine was discontinued before testing, as were multivits.


  44. February 21, 2015 at 7:26 pm
    Tina Forsythe says

    I have be diagnosed with b12 and vitamin D deficiencies. I have suffered for years with no energy, memory issues getting worse by the day, which is making me wonder if I won’t get fired from my job, trouble with my sight sometimes, the list goes on. I recently was started on injections once a week and did that for a couple of weeks. Then I started to get a terrible rash on my face and neck and also terrible blister like pimples on my chest face ears and neck. Within 2 days I looked like I had the worst sunburn ever on my face, and red rash sunburn like rings starting to form around my neck. I headed to my primary care doctor the one who started me on the shots and he said I was having a reaction to the b12 injections, like I was allergic to them. I was hospitalized for antaphylatic shock. After a few days on iv drugs I was sent home. Now after a week we are starting back on one injection which didn’t raise my levels. I am concerned about the damage that is probably already done to my brain, because I am failing fast. Please any advice would be helpful. I think this is much more serious than everyone thinks it is.

    Thank you.


  45. February 26, 2015 at 3:29 pm
    Rob says

    If only other doctors would actually listen to this info (a skill that eludes most of them).

    I saw a psychiatrist because I was suffering from fatigue, weight gain and sweats etc. I was prescribed antidepressants without a single blood test within 5 minutes of my first visit. They all say “there is no test for depression” which may be true but there are tests for other conditions which cause the same symptoms – something they should know after 7 years of med school. After wasting 3 years, thousands of dollars and going through painful withdrawal from those useless pills, I went to see a different type of doctor and got blood tests which showed low testosterone and high epinephrine. The former cause my initial symptoms and the latter was caused by the meds prescribed by that doctor.

    After 3 years without an accurate diagnosis, my symptoms had become severe enough to stop me from working. I am a 34-year old male who couldn’t stay away through the day, yet my shrink was ready to put me on the next antidepressant brand.

    The problem is that doctors are not incented to find underlying conditions as they make more money through the ongoing treatment of symptoms. Patients being forced to come in for monthly appointments to get their prescription is easy money for them. Also, they get paid even of they don’t help at all. Imagine a mechanic expecting payment after failing to fix your car… There is also no penalty if they make you worse through their lazy practice.

    “depression”, “chronic fatigue Syndrome” etc are not a diagnosis. They are symptoms. The same doctors who claim that you have an “imbalance” also tell you that their is no test to prove it. That sounds convenient when they charge $500 / month to scribble Zoloft on a piece of paper. Perhaps there is no test because there is no such thing as an imbalance without a tangible underlying condition. How can men of science offer treatment based on so little evidence.

    My doctor told me (eventually) that psychiatrists only focus on treating symptoms, not conditions. Perhaps more worrying is that they seem to use a lot of “new” medications for which they have no idea of what the long term damage might be or even how they really work. The only information they have on these pills comes from the drug company. Many doctors know less than what you would find from a quick google search about the meds they prescribe.

    It takes 4-8 weeks for most antidepressants to start working which is the same amount of time it takes to develop a physical dependence. Stopping ineffective meds takes the same amount of time again, to avoid painful withdrawal which means it can take 4 months to try each medication. When one doesn’t work, they never consider sending you for tests, they just switch you to the next brand and there is no shortage of different pills to keep you on the hamster wheel. Each one has their own nasty side effects but common ones are loss of sex drive, weight gain, sweating, fatigue, anxiety – just what you need when you feel depressed…. some of these effects are not 100% reversible….

    Anti depressants should be prescribed as a last resort only, after every type of test known to man has been performed. The fact that that woman had electricity run through her brain when all she needed was a vitamin supplement, is criminal (or it should be). Instead, her doctor probably got paid in full and is still in practice doing the same thing to other people.

    Has anyone ever met a person who was depressed but now they are all cured as a result of taking antidepressants? Everyone I know who takes them is just as depressed as they ever were. Even the studies conducted by the drug manufacturers shows that they aren’t a lot more effective than tic tacs. Plus, few conditions effect the body in isolation. While my low T was untreated, I gained 60lb and nearly became a diabetic…..

    I used to trust doctors but not anymore. My days of starting new medications based on a 5 minute doctor visit and their “best guess diagnosis” are over. These days you have to be your own advocate and do your own research. Most doctors are lazy and indifferent to our suffering. Most have become “specialists” who only treat one area and do no testing. If your condition falls outside their area, they will miss it. They do less and less over time because we incent them to by paying them regardless of how lazy their treatment is. By the end of my time with my shrink, I was paying him $500 for a 5 minute appointment where he wrote prescriptions for meds that didn’t help me. Had I allowed it to continue, I may have ended up being zapped in the brain myself.

    As well as not being treated correctly, going to a psychiatrists has other negative conitations. A “history of mental illness” (like going to a psychiatrist suggests you have) makes other doctors dismiss all of your symptoms as depression. It can stop you getting an organ transplant when you need one and even raise your insurance premiums. I once got locked in a psych ward overnight because I told an ER doctor that I saw a shrink… They should just get rid of this terrible branch of faith healer medicine. Whatever happened to “do no harm”?

    They should just make doctors get out of our way and let us order our own tests these days. At the very least doctors shouldn’t get paid if they can’t or won’t help.


  46. March 2, 2015 at 9:50 pm
    Scott says

    I went to my doctor because I had been fighting extreme fatigue and it was affecting my work she found I was deficient in b12 and began weekly doses after 1 month she changed to a monthly schedule I felt like my normal self by the second weekly shot and was encouraged however before I made a month to the next shot I was feeling fatigue again and she pulled a blood test and it had risen from close to 100 to 350 so she felt it was normal range but the constant fatigue continued Initially I felt so good just to be normal again that I think returning to fatigue was depressing I finally convinced her to at least go to every other week which made a slight difference but still I fight fatigue and have never returned to that level of normal that I initially felt any suggestions that would help me work with my doctor? Also we believe I may not be able to absorb b12 because during a SBO surgery they had to remove 8- 10″ of my small intestine because it was completely wrapped with scar tissue. Thanks in advance for your response


  47. March 17, 2015 at 12:15 pm
    Lynn says

    I too am wondering how high our levels can be on normal blood work, and it is still ok. I take a supplement. But now I am concerned, after reading what high levels can mean, that it is too high. Help?!


  48. April 5, 2015 at 8:51 pm
    Amber F says

    My two year old has a moderate-severe expressive speech delay. I have read about its power to support kids with delays. Can I give her methyl b12? If I get the lozenges, or liquid form, can I incorporate this in with her routine of multivitamin and fish oil? Thanks!


  49. April 24, 2015 at 7:56 pm
    BRM says

    Has anyone heard of Eligen B12? It’s a prescription oral tablet I recently read about that works as well as the IM B12 injection, even if you don’t have intrinsic factor. Apparently it came out a month or two ago


  50. May 17, 2015 at 1:44 am
    Marina R. Infante says

    Thanks Kelly for the useful post. You nicely presented here lots of important information on how Vitamin B12 deficiency affects our brain health and how we can get cured of it. I’m now 51 and about 2 years ago I had a weight-loss surgery. Most of all, I’m hardly interested in eating meat or even dairy products. As a result, I had been with Vitamin B12 deficiency for last 6 months. One thing to say that my elder son is a doctor and he has been in a clinic for 3 years. He made me get everything and learn how to treat this deficiency. I’m now taking supplements according to his suggestions and have been feeling okay for several weeks. I would like to read about Vitamin B12 deficiency at my leisure to know more important things. Here is another amazing post which I really like – .


  51. June 4, 2015 at 8:39 pm
    HW says

    My husband is a 63 year old man with no prior history of depression or dementia, nor family history. He started to have diarrhea, extreme insomnia, he could not sleep and then anxiety. He was treated for depression immediately and then referred to a physiatrist even though he said he was not depressed something is wrong. The physiatrist treated with anti depression and phys. medication with no improvement. Is it not true that the elderly is at risk for B12 and presenting with the above symptoms his B12 should have been tested?
    Months later another doctor tested for B12 and found his B12 to be 90.


  52. June 29, 2015 at 5:28 am
    C Smith says

    The book, Could it Be B12, An epidemic of Misdiagnosis by Sally M. Pacholok, R.N. B.S.N & Jeffrey J Stuart, D.O. 2nd Edition is a revelation on this issue.


  53. July 2, 2015 at 9:11 pm
    Isabelle says

    Most B12 on the market are synthetic. You need to find a whole food version. In fact, this goes for any supplements.


  54. October 3, 2015 at 9:03 pm
    Sam Barbary says

    I read a great article about niacin deficiency and schizophrenia. Dr. Abram Hofer cured 85% of his schizophrenia patients with niacin. One of his colleagues cured alcoholics with niacin as well.
    Thank you for the great article on B12.


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