B12 Vitamin Supplementation for B12 Shots and IV Therapy

What is Vitamin B12?

Vitamin B12 is an important vitamin which is critical for many cellular and metabolic processes which are occurring every second in your body. B12 is a critical step in many areas, such as red blood cell production (deficiencies can lead to megaloblastic anemia), neurologic system function (deficiencies can lead to difficulties in proprioception and spinal cord function), regulating energy levels effecting sleep and mood (deficiencies leading to problems with insomnia and fatigue), and many others.

From population studies, the prevalence (percent of people in a population) of Vitamin B12 deficiency is between 10-40%.

How do we normally get Vitamin B12?

B12 is found naturally in our diet, through animal products (salmon, chicken, eggs), through dairy (milk, yogurt, cheese), fish (from trout, shellfish, tuna, clams, and many others). It is absorbed in the digestive tract (specifically the Jejunum, a part of the small intestine), but only after it is bound by a glycoprotein produced in the stomach called Intrinsic Factor. Without Intrinsic Factor, the free Vitamin B12 in the digestive tract is unable to be absorbed. Deficiencies of this glycoprotein, or a shortening of the small intestine where the B12 is absorbed, can lead to an inadequate amount of dietary Vitamin B12, and eventually a condition called Pernicious Anemia.

Certain populations such as vegetarians and vegans (who do not eat the animal products, dairy, or fish listed above) do not get an adequate amount of B12 in their diet without supplementation. Other problems with the gastrointestinal system from chronic diseases or inflammation (Crohn’s Disease) or complications from intestine shortening from surgeries (Gastric Bypass Surgery) can frequently result in insufficient Vitamin B12.

Types of Vitamin B12

B12 can be supplemented from three main locations, orally or PO (through eating Vitamin B12 rich foods or through supplement pills), in the muscle or IM (from medication), or in the vein from an IV drip. There are four different formulations of Vitamin B12 which can be provided for supplementation.

Cyanocobalamin

An artificial form of B12 that contains a cyanide molecule that provides its stability and prevalence of use. Cyanide is commonly referred to as a poison because it interacts with and disrupts the energy pathways in the cells. The amount of cyanide in Cyanocobalamin is inconsequential to cause harm, has been demonstrated not to cause toxicity, and approved by the FDA for use. Cyanocobalamin is also easily converted by the body into its active form.  It is a very popular form of oral, intramuscular and IV B12 supplement.

Hydroxycobalamin

A natural type of B12 normally produced by bacteria in the digestive tract from food sources. This form of supplemental B12 can also be engineered in the laboratory by isolating it from micro-organism cultures. Hydroxy-B12 is readily converted in the body into the active forms of Adenosylcobalamin and Methylcobalamin.  Hydroxycobalamin is currently our preferred form of injectable B12 at ASAP IVs.

 Methylcobalamin

B12, also known as cobalamin, naturally exists in the body in the form of Methylcobalamin. This active form of B12 works with several enzymes to synthetize amino acids, produce red blood cells, repair DNA, and assists with other important physiologic processes. More expensive to synthesize in the lab, and thus more expensive for injections and oral supplements.

Adenosylcobalamin

This is another intrinsic form of B12 required for energy metabolism present in every cell. Even though this and methylcobalamin are listed as distinct forms of B12, it should be noted that the body can interconvert between the two compounds. Not available as a common PO, IM, or IV supplement as it is difficult to stabilize in the lab for medical use.

What Type of Vitamin B12 should be used for supplementation?

You may be asking yourself after reading about these different types of Vitamin B12, what type is the best? Many other people have asked themselves this question, and in fact it has been studied and published.

1964: European Journal of Hematology suggests Hydroxycobalamin has higher retention rate than Cyanocobalamin when given as injection. They also recommend 1 mg (1000mcg) of Hydroxycobalamin every 3 months as a supplement.

1971: Scandinavian Journal of Gastroenterology comparing types of B12 and their retention rates from PO supplementation, suggests no difference.

2016: Canadian National Institutes of Health review article summarizing multiple studies hinted that supplementation with HIGH DOSE PO Vitamin 12 was as effective as monthly IM supplementation. This was in regards to hematologic and neurologic function in documented deficient individuals, not the energy boost associated with IV and IM supplementation.

Over the last few decades with improvements in formulation and scientific testing, there is no general consensus as to the best form of Vitamin B12 for supplementation. The important thing is the high safety profile which is associated with any of the formulations. At ASAP IVs we have chosen to use Hydroxycobalamin in our formulation for supplementation for IV supplementation.

Which route should you take Vitamin B12 Supplements?

Oral supplementation: slower absorption, and only a small fraction of the Vitamin B12 consumed will be absorbed by the intestine and available for use by the body.  Larger doses must be taken and taken frequently to achieve the same Vitamin B12 level in the body as IV or IM replacement.

IV: faster replacement in the body, larger bio-availability of the medication (what is injected is available to the body for metabolic usage). Stores of the Vitamin in the body last are quickly replaced, but long term supplementation with the PO route will still eventually be needed. Easy to be given when an IV is already in place and a bag of fluids is running.

IM: slower replacement than IV, faster replacement than PO. Involves an additional poke/injection even when an IV is in place. Slower absorption than IV, so there level in the body will last longer before additional PO supplementation is needed.

Summary

Vitamin B12 deficiency is common in the public. It is readily given via supplementation through the PO, IM, and IV routes and has been safely studied through each of them. Vitamin B12 is offered by ASAP IVs as an IV additive with infusion solutions. It can lead to an instant energy boost which will last throughout the week.

At ASAP IVs, we offer various medication and nutrient injections to help you with a variety of needs. We want you to look, feel, and perform your best, to give you confidence in your every day life to enjoy life as much as possible. Through this we will be a happier, healthier, and more productive society.