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Vitamin B12 for nerve health and chronic pain

Vitamin B12 for nerve health and chronic pain

Vitamin B12, also known as cobalamin,  is a vital but often overlooked nutrient for nerve health and chronic pain syndromes.

Symptoms of B12 deficiency

  • Persistent pain
  • Pins and needles / numbness
  • Fatigue
  • Depression/ anxiety
  • Ulcers/ mouth sores
  • PMS
  • Allergy-like symptoms

Am I deficient?

B12 deficiency has been found to be reasonable common affecting between 1.5% and 15% of the general population.

Certain populations such as vegetarians and vegans are even more likely to have inadequate B vitamin levels as B12 is found almost exclusively in animal products. In one study 70% of all vegetarians and over 90% of all vegans have evidence in their bloodwork of early B12 deficiency.

Causes of deficiency

A common cause of low B12 is poor absorption from the digestive tract. This is often the case with people with disorders such as IBS or inflammatory bowel diseases (Crohn’s / ulcerative colitis) or those who have undergone weight loss surgery. Nutrient absorption also tends to reduce as we age leaving people over 60 years of age at higher risk of deficiency.  

Certain medications can also reduce B12 absorption. Proton pump inhibitors (PPIs) such as omeprazole or Lansoprazole are commonly prescribed to reduce stomach acid. However, stomach acid is needed to break B12 from food so that it can be absorbed and so these medications can lead to reduced absorption and ultimately deficiency. In one study “ Nearly 50% of the patients on prolonged acid suppression therapy were either “deficient” or “insufficient” in blood  vitamin B12 levels” Damodharan, 2020]

Metformin has also been shown to reduce vitamin B12 absorption.  

Vitamin B12 and Pain

Vitamin B12 is thought to alleviate pain by a number of mechanisms including promoting myelination (nerve insulation), increasing nerve regeneration and decreasing nerve “mis-firing”.

Vitamin B12 and low back pain

Vitamin B12 can help in the treatment of back pain

In a study of patients with chronic low back pain, Vitamin B12 given for 2 weeks reduced pain by 32% compared to placebo [Chiu, 2011]

Vitamin B12 and painful neuropathy 

In a 2020 systematic review looking at the use of B12 for nerve-related pain it was found that there is moderate evidence for the therapeutic effect of B12 in the treatment painful peripheral neuropathy [Julian, 2020].

Vitamin B12 for pain relief and injury recovery

If you suffer with more than one of signs of B12 deficiency (and particularly if you are in an “at-risk group i.e., vegan/ vegetarian, >60 yoa, or taking PPIs or metformin), try a 1-month trial of increased B12-rich food intake (see below) along with a good quality B12 supplement and review your symptoms.

You can download the ‘Modified Multiple Symptoms Questionnaire’ and complete it before and after your trial to help you do this.

Best food sources of Vitamin B12

  • Liver*
  • Clams and oysters*
  • Meat and fish
  • Milk and cheese
  • Some mushrooms (black trumpet, chanterelle, or shiitake)
  • If you don’t eat liver, oysters, or clams, you must eat at least 350 grams of meat, poultry, fish, or dairy reach your RDA

B12 supplementation

Sublingual B12 tablets are particularly useful as they are absorbed in the mouth which bypasses any absorption issues in the bowel (i.e. patients >60 yoa, those with IBS or inflammatory bowel diseases, or those taking PPI’s or metformin)


Take 1000-5000mcg daily of the active forms of B12 (methyl-cobalamin and adenysl-cobalamin) for 1 month and then re-assess symptoms.

Vitamin B9 (folate) and vitamin B6 work together with B12, supplementing these at the same time often gives better results.

We recommend:

Combined with

Available from the Dynamic Health Clinic or online at The Natural Dispensary (use practitioner ‘Steffen Toates’ to register)

Who shouldn’t take B12

Vitamin B12 is non-toxic and thus 100% safe however the ‘active’ forms of B12 (methyl-cobalamin and adenysl-cobalamin) should NOT be taken by patients with a history of severe anxiety.

Instead use 500mcg of ‘inactive’ B12 (hydroxycobalamin) ONLY, without any other B vitamins to start.

We recommend  

Available from the Dynamic Health Clinic or online at The Natural Dispensary (use practitioner ‘Steffen Toates’ to register)

Related articles


  • Chiu, C. K., Low, T. H., Tey, Y. S., Singh, V. A., & Shong, H. K. (2011). The efficacy and safety of intramuscular injections of methylcobalamin in patients with chronic nonspecific low back pain: a randomised controlled trial. Singapore medical journal, 52(12), 868-873.
  • Damodharan, S., Raj, G. M., Sakthibalan, M., Dakshinamoorthy, K., & Muraliswaran, P. (2020). Effect of long-term acid suppression therapy with proton pump inhibitors or H 2 receptor blockers on serum vitamin B 12 levels in elderly population. Irish Journal of Medical Science (1971-), 1-5.
  • Julian, T., Syeed, R., Glascow, N., Angelopoulou, E., & Zis, P. (2020). B12 as a Treatment for peripheral neuropathic pain: a systematic review. Nutrients, 12(8), 2221.

This post was written by Steffen Toates. Steffen is a chiropractor at Dynamic Health Chiropractic in Jersey CI. For more information about Steffen click here.

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