Frequently asked questions
How much B12 supplement should I take?
Unlike most vitamins, you can’t overdose on B12 and it doesn’t build toxicity. It has been used in ultra-high doses to treat cyanide Loop poisoning, peripheral neuropathy, and even to prolong survival of ALS patients. When I say ultra-high doses, I mean it: 25,000 to 50,000mcg twice a week!
Of course, you don’t need that much.
The secret is little and often. Knowledge in B12 among doctors is scarce, and they normally recommend one shot every month or more. That is not nearly enough. To avoid deteriorating and your symptoms return, aim for little and often — daily, if deficiency is severe.
How long am I going to need to supplement with B12?
As a rule of thumb, you should keep injecting daily until your symptoms disappear. The numbers on your blood test can be deceiving, because we care about the B12 in your cells, not the bloodstream.
Those with neurological symptoms could need to inject B12 for life. Nerve damage takes a lot of time to heal, if at all. By injecting daily methylcobalamin, at least you know you’re stopping deterioration.
Knowing why you’re deficient is also important. If you can’t absorb B12 from food, you’ll need injections for life. Whatever case, remember that your goal now should be to fill up your cellular stores of B12 as fast as possible, before your nerves are irreversibly damaged.
Once your symptoms begin to fade, you may decrease your B12 supplement frequency from daily to weekly/monthly, or stop altogether if you’re one of the deficient minority who can actually absorb B12 through the stomach.
Is injecting painful?
Not at all. When you think of painful injections, you probably think of intramuscular vaccines. This is far from it. Subcutaneous injections are nothing to be afraid of and give little to no pain.
Is it safe? What are your vitamin B12 supplement side effects?
B12 is one of the safest supplements you can have. It is a water-soluble vitamin, so any excess goes out with the urine. It is non-toxic even in extremely high doses. There are two caveats:
If you’re allergic to methylcobalamin or cobalt, avoid this supplement. That is extremely rare (I’ve never heard of anybody who suffers from it, but I know it exists). To test if you’re allergic, you can administer a small test dose and see if you experience any allergic reaction such as skin rash, face swelling, itching, or anything unusual. You can ask your doctor for help.
If you have Leber’s disease (early hereditary optic nerve atrophy), methylcobalamin is not the best B12 supplement for you. Hydroxy B12 shots, though not as efficient as methyl B12, are safer in that case, because Leber’s disease can get worse in patients with high methylcobalamin levels.
Again, those are very extreme and rare cases. In general, as Dr. Brent Bauer from Mayo Clinic said, “In the complementary medicine realm B12 is probably one of the safest things you could take.”
Is it hard to self-inject your methyl B12 supplement?
Not at all. Pinch some fat and inject. It only reaches the fat, so there’s no pain.
Can I inhale your B12 supplement instead of injecting?
Some people reported vaping methylcobalamin using an e-cigarette delivery device was as efficient as injecting it. I don’t recommend it. Methylcobalamin is an extremely large molecule with a molar mass of 1344.40 g/mol. It would be very unwise to introduce this into delicate lung tissue.
And what about DMSO?
If you don’t know what DMSO means, forget you read it. If you do consider using DMSO instead of injecting, I recommend not to. Injecting subcutaneously is superior and much safer.
Do you also offer an adenosylcobalamin B12 supplement?
No. Methylcobalamin is the easiest to assimilate and addresses a variety of B12 deficiency problems, including providing the methyl group that couples to carbon monoxide (derived from CO2) to afford acetyl-CoA. Methyl B12 is also required for the re-methylation pathway to regain its normal activity, bringing homocysteine down to reasonable levels. It’s the best all-around form, and gives you the most B12 benefits.
What about cyanocobalamin?
Cyanocobalamin is a cheap, synthetic, and slightly toxic form of B12. To use it, your body needs to waste precious methyl groups (which tend to be in short supply) to get rid of the cyanide ligand from it. It then has to convert it into an active form, and many people have ailments that prevent that. It’s not nearly as effective as methylcobalamin, and is completely unnatural to humans.
Methylcobalamin is the form of B12 you’ll find in natural foods. It is much more absorbable, and has a methyl molecule attached to it. So while cyanocobalamin steals existing methyl groups, methylcobalamin provides fresh ones. This is why people with methylation issues improve on methyl B12 but deteriorate on synthetic B12 like cyano or hydroxy.
Methylcoabalmin is really the only treatment you should consider if you suffer neurological symptoms. It bypasses several problematic steps in the absorption cycle, and it’s why Japan uses it almost exclusively.
Is there an expiration date?
Each vial has an expiration date of a little less than year. Don’t worry, you’re probably going to finish it in a month though.
What’s the best way to store your vitamin B12 supplement?
B12 is always stable when in dry (powder) form. When you dissolve it in saline though, it undergoes photolysis (destruction by light). Our vials are made of Amber glass (best one there is), which prevents 2/3 of the light from coming in. To get rid of the other 1/3, cover the vial with an aluminum foil. Store the vial in 5-25°C (41-77°F). Fridge is good.
Can I just take this supplement orally?
Only a minority of patients responds clinically to oral therapy. This is because most deficient people have issues absorbing B12 through the stomach. Most patients recover much faster by injecting B12 rather than trying to digest it (food, tablets, etc). B12 injections are always the best way to rapidly get your B12 levels back to normal and avoid permanent neurological damage.
Can’t I just buy B12 shots over the counter?
In some countries you can. But unless you’re from Japan (one of the leaders of B12 research), it’s probably made of synthetic cyanocobalamin or hydroxycobalamin. Methylcobalamin is much more effective.
Should I change my diet when I take your vitamin B12 supplement?
You may want to increase your potassium intake. Good sources are salmon, leafy greens like spinach and kale, avocado, banana, and baked potato/sweet potato (careful if you’re diabetic) with the skin on.
Also, if your blood tests indicate you’re not on the upper range of folate, consider taking an l-methylfolate supplement (much more effective than folic acid). B12 and folate (B9) need each other.