Vitamin B-12

B-12 is essential for brain and nerve health, sleep regulation, metabolism, serotonin metabolism (mood) and what people usually care the most about- ENERGY! I like to tell my patients that B-12 optimization replaces the need to drink coffee to function. Personally, my B-12 stays adequate and I never drink coffee. I simply cannot tolerate it; it is too stimulating.

Just like with what I wrote about vitamin D- that doesn’t mean go run out and buy the first B-12 you see on the shelf. They are NOT all created equal and I will explain why. First, most B-12 marketed is cyanocobalamin- a cheap, synthetic form of B-12. Forty percent of the population, due to mutations like MTHFR, cannot methylate B vitamins. For this group, nearly half of us, taking cyanocobalamin will have no beneficial effects and for some, it could make you sick. That’s why it’s important for everyone to take it in its natural form, methylcobalamin. Second, because there’s no regulation of vitamins and supplements, a manufacturer can put salt in a capsule and tell you it’s B-12- or anything else they want to say it is- and nothing is to stop them. For this reason, you always want to buy your vitamins from a reputable manufacturer and retailer. I prefer companies that use organic materials, who have scientists developing their product, and who do quality testing on every batch of product. Third and lastly, the route is important. Anything ingested orally is not processed as well as something delivered in injection format or intravenously. This is particularly true for B-12 due to lack of intrinsic factor in your stomach that is needed to absorb B-12. Research varies but reports suggest only 2-5% of orally administered B-12 is actually absorbed by your body! People who have gut issues or who have had weight loss surgery have even more difficulties processing vitamins. Vegan diet, hyperthyroidism, bleeding disorders, cancer, and liver/kidney disease are other less common contributors to poor B-12 absorption.

An important issue I see frequently is the amount of people that come into my office with weight gain, brain fog, difficulty sleeping, depression, and feeling fatigued. They tell me they had labs done with their PCP and their doctor told them everything was fine. They now feel worse because they’re concerned it might be all “in their head.” They come to me as their “last chance”- praying I find something others have overlooked. I smile, let

them know they’re not alone and this is a very familiar story. I explain we not only have a different lab panel than conventional medicine providers, but we INTERPRET LABS DIFFERENTLY. In conventional medicine, B-12 results of approximately 300-850 is “normal” and therefore supplementation is never recommended. That’s if the test is even done. In functional medicine, we know that OPTIMIZED is what is important and that normal is not what we should aspire to. If you’re experiencing a symptom, we will find the root cause and we will treat it. Most people feel their best when their B-12 is over 1600. As B-12 is water-soluble, there is no Tolerable Upper Intake Level (UL) due to its low level of toxicity.

We offer methylcobalamin injections at the clinic. They’re self-administered in a subcutaneous injection syringe- the same as is used for insulin or Botox. Once mixed, they need to be refrigerated. We give them to you in a bag with instructions. You can purchase a single syringe or buy a series. We recommend they be taken daily for 5 days then weekly for 12 weeks. If you don’t live close to the clinic but would like to purchase a series, we ship them as well. Presentation is slightly different but everything you need is shipped to your door in a shelf stable package. After the series is complete, most people continue taking an injection once or twice a month. Some do more. Others switch to oral dosing. It’s important to do what is right for your body.

B-12 levels are tested with our standard pre-pellet blood work for both men and women. It is generally not retested with post-pellet blood work to the efficacy and low toxicity of our injections. Should you take the B-12 and want your values retested, this is not a problem. Be sure to inform the front desk when they give you your post-pellet lab order form.

In health,

Dr. Miranda Lawrence, DNP, APRN-FPA