More on B12

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From www.drmyhill.co.uk

Wallace

B12 - rationale for using vitamin B12

5th November 2003

Over the last 22 years of treating over 3,000 patients with chronic

fatigue syndrome, I have developed a programme of treatment which I

believe all patients must do as the foundation before proceeding to

other treatments. Vitamin B12 by injection I see as an integral part

of this programme and it is effective for many, regardless of the

cause of their chronic fatigue syndrome.

Those patients who respond to B12 are not obviously deficient in B12,

indeed blood tests usually show normal levels. The " normal " levels of

B12 have been set at those levels necessary to prevent pernicious

anaemia - this may not be the same as those levels for optimal

biochemical function. B12 has a great many other functions as well as

the prevention of pernicious anaemia. However, what is interesting is

how B12 is beneficial in so many patients with fatigue, regardless of

the cause of their CFS, and suggests that there is a common mechanism

of chronic fatigue which B12 is effective at alleviating.

General mechanism by which B12 relieves the symptoms of CFS

Professor Pall has looked at the biochemical abnormalities in

CFS and shown that sufferers have high levels of nitric oxide and its

oxidant product peroxynitrite. These substances may be directly

responsible for many of the symptoms of CFS and are released in

response to stress, whether that is infectious stress, chemical

stress or whatever. B12 is important because it is the most powerful

scavenger of nitric oxide and will therefore reduce the symptoms of

CFS regardless of the cause.(1, 2, 3, 4, 5, 6)

Nitric oxide is known to have a detrimental effect on brain function

and pain sensitivity. Levels are greatly increased by exposure to

chemicals such as organophosphates and organic solvents(7). When

sensitive tests of B12 were applied (serum methylmalonic acid and

homocysteine) before and after B12 therapy, the following symptoms

were noted to be caused by subclinical B12 deficiency: parasthesia,

ataxia, muscle weakness, hallucinations, personality and mood

changes, fatigue, sore tongue and diarrhoea.(8)

B12 in fatigue syndromes

The " foggy brain " with difficulty thinking clearly, poor short term

memory and multitasking are often much improved by B12.(9, 10, 11).

Mood and personality changes, so often a feature of patients with

chemical poisoning, can be improved by B12(12). The physical fatigue

and well being are often both improved.

A study

Twenty eight subjects suffering from non-specific fatigue were

evaluated in a double-blind crossover trial of 5 mg of

hydroxocobalamin twice weekly for 2 weeks, followed by a 2-week rest

period, and then a similar treatment with a matching placebo. The

placebo group in the first 2 weeks had a favourable response to the

hydroxocobalamin during the second 2 week period with respect to

enhanced general well being. Subjects who received hydroxocobalamin

in the first 2-week period showed no difference between responses to

the active and placebo treatments, which suggests that the effect of

vitamin B12 lasted for over 4 weeks. It is noted there was no direct

correlation between serum vitamin B12 concentrations and improvement.

Whatever the mechanism, the improvement after hydroxocobalamin may be

sustained for 4 weeks after stopping the medication. " A Pilot Study

of Vitamin B12 in the Treatment of Tiredness, " Ellis, F.R., and

Nasser, S., British Journal of Nutrition, 1973;30:277-283.

Practical Details

Vitamin B12 has no known toxicity and B12 surplus to requirement is

simply passed out in the urine (which may discolour pink). It is

theoretically possible to be allergic to B12, but in the thousands of

injections that I have sanctioned this has only ever occurred after

several injections and causes local itching, redness and swelling

(although the commonest cause of redness and swelling is poor

injection technique). It does not seem to matter whether

hydroxocobalamin or cyanocobalamin is used. I usually start with 2mgs

weekly by i.m. injection, then adjust the frequency according to

response - some patients will respond straight away, some need

several doses before they see improvement. I would do at least 10

injections before giving up. Many of my patients learn to inject

themselves - this means they can be independent of their doctors. The

cost is & #65443;1.60 per injection (2ml B12 plus syringe and needle).

(1) Pall ML. Elevated, sustained peroxynitrite level as the cause of

chronic fatigue syndrome. Medical Hypotheses 2000;54:115-125. Pall

ML. Elevated peroxynitrite as the cause of chronic fatigue syndrome:

Other inducers and mechanisms of symptom generation. Journal of

Chronic Fatigue Syndrome 2000;7(4):45-58.

(2) Pall ML. Cobalamin used in chronic fatigue syndrome therapy is a

nitric oxide scavenger. Journal of Chronic Fatigue Syndrome, 2001;8

(2):39-44.

(3) Pall ML, Satterlee JD. Elevated nitric oxide/peroxynitrite

mechanism for the common etiology of multiple chemical sensitivity,

chronic fatigue syndrome and posttraumatic stress disorder. ls of

the New York Academy of Science 2001;933:323-329.

(4) Pall ML. Common etiology of posttraumatic stress disorder,

fibromyalgia, chronic fatigue syndrome and multiple chemical

sensitivity via elevated nitric oxide/peroxynitrite, Medical

Hypotheses, 2001; 57:139-145.

(5) Pall ML. Levels of the nitric oxide synthase product citrulline

are elevated in sera of chronic fatigue syndrome patients. J Chronic

Fatigue Syndrome 2002; 10 (3/4):37-41

(6) Pall ML. Chronic fatigue syndrome/myalgic encephalitis. Br J Gen

Pract 2002;52:762. Smirnova IV, Pall ML. Elevated levels of protein

carbonyls in sera of chronic fatigue syndrome patients. Mol Cell

Biochem, in press.

(7) Pall ML. NMDA sensitisation and stimulation by peroxynitrite,

nitric oxide and organic solvents mechanism of chemical sensitivity

in multiple chemical sensitivity. FASEB J 2002;16:1407-1417.

(8) Neuropsychiatric disorders caused by cobalamin deficiency in the

absence of anaemia or macrocytosis J Lindenbaum et al New Engl J Med

1988; 318: 1720-1728.

(9) Mac Holmes J. Cerebral manifestations of vitamin B12

deficiency. Br Med J 1956; 2: 1394-1398.

(10) Ellis FR, Nasser S. A pilot study of vitamin B12 in the

treatment of tiredness. Br J Nutr 1973; 30: 277-283

(11) Langdon FW. Nervous and mental manifestations of pre-pernicious

anaemia. J Amer Med Assoc 1905; 45: 1635-1638

(12) Strachan RW, JG. Psychiatric syndromes due to

avitamiosis B12 with normal blood and marrow. Ouart J Med New Series

XXXIV 1965: 303-317