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Vitamin B12, also known as cobalamin, is a vital but often overlooked nutrient for nerve health and chronic pain syndromes.
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.
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 is thought to alleviate pain by a number of mechanisms including promoting myelination (nerve insulation), increasing nerve regeneration and decreasing nerve “mis-firing”.
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]
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].
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.
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)
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)
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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Should I be taking sublingual vit b12. daily and magnesium, at what dose and magnesium. I also take folic acid
I would love to see you face to face but I live in the UK. My own GP is not too knowledgable on treatments for my condition and I am finding it very hard to do my own research.
I am 77 years old with numerous health conditions but these are pretty much under control. The neuropathy however is getting me down. Is there any advice you could give John
Thank you Sincerely Elaine
I have sciatic pain I've done a lot of physical therapy and doing my exercises but still my sciatic if I lift anything or up on my legs too long it starts to ache. Let me know what I need to take to heal.
6 back surgeries