I am from Argentina.
My son has been struggling with depression and anxiety for years. 2 years ago we found out he had high homocysteine, low B12 and he has MTHFR.
He is being treated with B12 pills (Jarrow) his values have improved but his symptoms persist.
I saw your information in PERNICIOUS ANAEMIA SOCIETY and contacted you.
We do not have doctors in Argentina who know about the subject.
Does the pill have the same effect as the injection?
We do not know what to do anymore.
Has your doctor reviewed your son in the last two years?
Or repeated blood tests?
Has he other symptoms ?
If b12 tablets are giving no improvements i woukd ask the doctor to prescribe
B12 injections.
If the problem is dietary b12 tablets work well.
If Pernicious anaemia or a functional b12 deficiency or an absorbtion problem b12 injections are needed. .
Also get his folate,vitamin D iron checked.
I hope you get answers.
We don't have b12 doctors in the Uk either .
The Netherlands do.
Dr Hajo Auwerda has an interest.
Look at all the links on sleepybunys posts
Is it due to the MTHFR mutation, in this case does he need an injection?
MTHFR means that one potentially has slightly reduced ability to convert folic acid to its active form , methylfolate. And even then, plenty of people with MTHFR do fine on folic acid. It has nothing to do with B12.
B12 needs folic acid (or its relatives) to do its job. But other than that, low B12 / B12 malabsorption / pernicious anemia needs to be treated with B12. Tablets or injections, depending on the cause of low B12.
If you share more information, as Nackapan asked, we could guide you better to the right information.
Thank you very much for the advice.
The B12, B9 and homocysteine markers improved with the pills but other symptoms such as depression, anxiety, blurred vision did not improve.
In Argentina we do not have injectable B12, doctors do not prescribe it.
It is difficult in our country to get a good treatment
Thank you very much for the advice.
The B12, B9 and homocysteine markers improved with the pills but other symptoms such as depression, anxiety, blurred vision did not improve.
In Argentina we do not have injectable B12, doctors do not prescribe it.
It is difficult in our country to get a good treatment
Indeed I could not find B12 on the list of medications, they have strange formulations such as denverfarma.com.ar/products... which includes Hidroxocobalamina (como Hidroxocobalamina Sulfato) 10 mg Betametasona (como Betametasona Fosfato Disódico) 2 mg Diclofenac Sódico 75 mg Excipientes c.s. . I am not sure I would want to use that.
But there are papers who do refer to both cyano and hydroxo injections in argentina, for example
revistasan.org.ar/pdf_files...
Deficiencia -> Diagnóstico and
Tratamiento
So what are they using, I wonder? In any case this paper could be used to push your doctor.
If you want to order online, there are German pharmacies that will ship world-wide and these ones include Argentina on the list, though you would have to check if there are import restrictions.
shop.apotal.de/ shipping 29,90 €
unserekleineapotheke.de/ shipping 1kg 35 EUR
mycare.de ships to Argentina for 59,99 €
pharmabox.be is in Belgium but I cannot see none-EU shipping rates, though they say they will ship worldwide.
Perhaps you can import for your neighboring countries? For example Uruguay has several injectable cyanocobalamin brands. vademecum.es/equivalencia-l...
Some Canadian pharmacies also say they will ship to Argentina - these will be the cyanocobalamin form.
canadadrugsuperstore.com/in...
You might try googling "b12 inyectable cerca de mí" - sometimes there are beauty and health spas that offer injections. That could get through the short term at least.
You might also start a new post about getting diagnosis / treatment / injectable b12 and put Argentina in the title - maybe others near you will have an idea.
Also, the first injection should be in a medical setting, because there is (rare) risk of anaphylactic allergic reaction.
Thank you very much for the advice.
This B12 scares me because it has other components, Betamethasone and Sodium Diclofenac
We will have to buy in another country.
Thank you very much for all the information, thank you for joining us
If your son has Pernicious Anaemia ,which is a common reason for B12 deficiency , he will need B12 INJECTIONS for life . Here in U.K. our doctors have a poor understanding of Pernicious Anaemia ,and it is difficult to get a diagnosis and adequate treatment .
Yes, having Pernicious Anaemia will cause high Homocysteine ( but other conditions can cause this )
Pernicious Anaemia is an autoimmune condition .
Most of us here on this forum are forced to obtain our supplies of B12 ampoules from German online pharmacies . This is because B12 ampoules for injection are a prescription item ( but not in Germany where they are freely available over the counter . )
Do find out what the position is in Argentina .
A trial with B12 injections would be a good idea . B12 is a very safe medication . It cannot be overdosed , which is excellent .
Also needed is a good supply of Vitamin B9 , Called folate in vegetables and fruit and folic acid if in tablet form . A modest dose of 400 mcg is a good idea .— B12 and B9 work together .
So do try to get B12 injections for your son . Let us know how you get on . Best wishes .
Do you know why your son is B12 deficient. If the problem is dietary then tablets are likely to be sufficient but they will take longer to raise his levels to where they need to be. An injection will raise levels immediately.
Hello Mariana, as others have said, if symptoms are not resolving it may be that your son does need injections. I think that Jarrow tablets are methylcobalamin and some also have folate in the form of methylfolate. Your son may get on better with either a combination methylcobalamin and adenosylcobalamin tablet (I use Cytoplan sublingual) or a hydroxocobalamin (again I use Cytoplan - I take some of each daily). But for me adding methylfolate (as methyltetrahydrofolate - I use Metabolics liquid) to the B12 made a big difference, so if your son is not already taking some methylfolate that might be worth some thought. Start slowly and don't go too high. I use a total of about 400 or 500 mcg daily but split into three doses and never went higher than 1000mcg. Some of the studies for methylfolate use in depression do go higher (even much higher, such as 15mg!) but shouldn't be necessary. If a more normal dose does not help, after some time, you could perhaps go back to your doctors with the research and ask about trying a higher dose. Useful to test serum folate first just for your records, but it may be high and just not be being used. My serum folate was near top of range and actually dropped when I started supplementing methylfolate.
Please don't get too hung up on the MTHFR bit - most people have some sort of theoretical genetic variation here and all of these SNPs work together, so this may only be a little slow and will only be playing a part in the overall picture. The important bits are that he actually has low B12 and high homocysteine, so some part of his folates cycle is not working terribly well. Vit B6 plays a part in the folates cycle too and can be MTHFR affected so may also be low in cells although blood isn't often tested (here anyway) and it is important to supplement the active form, P5P, not pyridoxine, if you use it, especially in any quantity or for a longer period. (The inactive form pyridoxine competitively inhibits the active pyridoxal-5'-phosphate, so blood level looks high but cellularly you are deficient, with deficiency symptoms))
Incidentally, is it just serum B12 which has improved with the Jarrow tablets or has the homocysteine lowered at all?
Best wishes
Can you please tell me how much of a dose you take of the combo B12 and the hydrox B12 daily? Can I buy online as I live in the US? And if I’m reading correctly, you take around 500 mcg of the liquid methyl folate? Thanks so much.
Hi, I take a total of about 8 - 9000mcg B12 daily, using three vitamers and four forms. I use Lamberts 1000 mcg methylcoblamin tablet x 1 daily, approx 2500 mcg as three doses of methylcobalamin liquid (Metabolics - and yes, about 500 mcg of their methyltetrahydrofolate liquid, also split into three doses), then the rest as combo B12 and hydroxo, so usually 3 x combo and 2 x hydroxo, sometimes the other way round, plus or minus one if I'm busy and forget (plus a B12 and B complex skin patch). I just try to keep a steady intake. Someone on here suggested putting the liquid dose into a long drink of water and sipping it all day to increase hydration as well. As far as I know Cytoplan do international shipping, or you likely have similar products available there. Cheers
Hello bookish,
Useful to test serum folate first just for your records, but it may be high and just not be being used. My serum folate was near top of range and actually dropped when I started supplementing methylfolate.
I'm very interested in the fact that it dropped. My folate pre-supplementing was not high, but has dropped to just inside the bottom of the range since March when I started with methyfolate 400mcg.
Did you figure out reason for the drop? I have a couple of MTHFR snps but never sure how much this is affecting me.
Cheers,
Hi, to be honest I didn't really, I just have suspicions much like you do. I only have a single heterozygous (677) MTHFR, so not likely to be a major problem alone (and all theoretical of course) but also have a SNP on MTR and slow COMT so it makes sense to me that my B12 and folate needed some help. I'd been using cyanocobalamin, slight improvement, then methylcobalamin, improvement again, then cut out everything with folic in it and added methyltetrahydrofolate at which point my vertigo went and I stopped walking into doorframes and bouncing off walls. I did take up to approx 1000 mcg for a short while but have settled at 500 ish divided into three doses. Serum was near top of range but dropped to just over half and seems stable now. Are you injecting B12 and had you not been doing so for long? Nerve repair etc is greedy of folate and iron, so maybe you could use a bit more, even short-term, although I wouldn't go very high personally.
This is a sample DNA page, not mine and not the company I used, but the diagram showed nicely how those might affect each other. I'd found pre-testing that magnesium made a big difference and I'd already discovered how much better the methylfolate made me but no-one would test, hence the private testing. Slow COMT certainly made sense of a lot of long-term symptoms for me.
cellsciencesystems.com/pdfs...
Cheers
Hi MarianaCD,
Here's some links to B12 websites that might be worth looking at.
It's possible that some links may have details that could be upsetting to read.
Pernicious Anaemia Society
Based in Wales, UK. It has some overseas members.
pernicious-anaemia-society....
Membership of PAS is separate to membership of this forum.
Testing for PA
pernicious-anaemia-society....
B12 Deficiency Info website
B12 Awareness (US website)
Stichting B12 Tekort (Dutch website with English articles)
stichtingb12tekort.nl/weten...
B12 Institute - Netherlands
Two B12 books I found useful
"What You Need to Know About Pernicious Anaemia and B12 Deficiency" by Martyn Hooper
Martyn Hooper is the former chairperson of PAS (Pernicious Anaemia Society).
"Could it Be B12?: An Epidemic of Misdiagnoses" by Sally Pacholok and JJ. Stuart (USA authors)
Very comprehensive with lots of case studies.
Misconceptions
Many on this forum find that doctors and other health professionals have misconceptions (wrong ideas) about B12 deficiency.
B12 article from Mayo Clinic in US
In my personal opinion, this is one of the best articles on B12 deficiency I've read.
Might be a good one to pass to his doctors.
The Many Faces of Cobalamin (Vitamin B12) Deficiency
ncbi.nlm.nih.gov/pmc/articl...
Table 1 in above article is about frequent misconceptions about B12 deficiency that health professionals may have.
Misconceptions about a B12 deficiency
(From Dutch B12 website - units, ref ranges, treatment patterns may vary from other countries)
stichtingb12tekort.nl/engli...
Diagnosis and Treatment Pitfalls
(From B12 Institute in Netherlands - units, ref ranges, treatment patterns may vary from other countries)
b12-institute.nl/en/diagnos...
Help for doctors
The PAS website has a page for health professionals.
Some details may be specific to UK.
pernicious-anaemia-society....
Club B12
Club B12 is a group of researchers and other interested people across the world who are looking into B12.
They have regular meetings on Zoom and have a conference in Cambridge, UK later this year (2023).
Guidelines
Might be worth you and your son seeing if there are any national or regional guidelines on treatment and diagnosis of B12 deficiency published in your country.
It's possible that the Argentina Society of Hematology (Sociedad Argentina de Hematología - SAH ) may publish B12 deficiency guidelines.
Many UK forum members end up treating themselves as they cannot get enough B12 from our NHS (National Health Service). Some in UK get extra injections from private doctors, some get them from beauty salons, some try high dose oral B12 but this doesn't work for everyone and some as a last resort turn to self injection.
I'm not medically trained.
An MMA (methylmalonic acid) test may be able to show whether your son has a problem with processing the B12 in his bloodstream. This is a blood test.
MMA normally makes links in the bloodstream to the B12 there in order for B12 to get to cell/tissue level in the body. If there is insufficient B12, MMA will start to build up. Once B12 is introduced into the system, the build-up should clear quite quickly. Certainly by the time the loading injections are completed. In the UK, it is common to start the B12 treatment with a "loading dose" of 6 injections within a couple of weeks.
If it happens that there is a problem with the link formation, the MMA in blood will still be raised despite also showing high levels of B12 - this would indicate a problem called functional B12 deficiency. Renal problems or SIBO (small intestine bacterial overgrowth) would have to be ruled out as possible causes for high/raised MMA. SIBO in any case would mean that the bacteria are robbing the "host" of vitamins, including B12.
MMA tests can be used as a secondary indication of B12 deficiency, if B12 levels are not below range, but symptoms are leading the doctor to suspect a deficiency exists. A confirmation.
As Nackapan advises above, folate ferritin and vitamin D should also be tested. Even if not out of range, low readings might be making improvements difficult. These are often affected by B12 deficiency and should be treated with (not instead of) B12. Monitoring of B12 levels, once treatment has started, are meaningless - but folate, ferritin and vitamin D should be monitored. They can take a while to stabilise at better levels.
The first aim (loading) is to significantly reduce the B12 deficiency symptoms, and then to work out at what frequency they could be pre-empted, so that a return of the symptoms is prevented (maintenance). So, to my mind, until the loading dose has any effect, it should be continued. This is not what usually happens however. It is just what I would expect a doctor to want for their patient.
Thank you very much for the advice.
This B12 scares me because it has other components, Betamethasone and Sodium Diclofenac
We will have to buy in another country.
Thank you very much for all the information, thank you for joining us
This must be very concerning for you, and fear can make this seem overwhelming, but Sleepybunny 's suggestion : Sally Pacholok's book - this is a good place to start.
Wishing your son well.
Thank you very much for the advice.
The "Could it be B12?" book by Sally Pacholok is available in Spanish.
Think its title is "La vitamina B12".
Thank you
thank you!
Pill vs b12 injection
Side effects from injections?
Frightened of B12 injection side effects 
B12 injection side effects + testing frequency
