Looking for clarity on the best type of injectable B12 please

[Noelnoel]

Information seems to be a bit muddled. I’m looking for the most natural and bioavailable please

From what I read, cyanocobalamin isn’t the way to go but there again I’m not sure whether that’s in reference to oral supplementation

Does anyone have any links or reliable information please

Thanks

[wedgewood]

no-one can really answer that one Noelnoel

. We are all different. I have tried both of those forms of B-12 , and I can find no difference between them . ( except the cost ) So, the only way to get the answer is for you to try them both out ! Some people swear by Methycobalamin, others by Hydroxocobalamin!

[Noelnoel in reply to wedgewood]

Thank you wedgewood. May I have the link to the supplier of both please

[wedgewood in reply to Noelnoel]

The following German online pharmacies will deliver B12 single use ampoules to U.K. .

apohealth.de Site is obtainable in English (Union flag, bottom left on my device ) also deliver World wide but not to Australia or New Zealand .

versandapo.de Site is in German . Use Google chrome to obtain translation .

The following brands are obtainable

Panpharma b12 depot 1mg x 1ml ampoule ( depot indicates Hydroxocobalamin) ref no 16199653. This is the most popular ampule used by PAS members .

It is the best value , but sometimes is out of stock . You can then opt to be emailed to be told when it is back in stock .

Pascoe B12 depot 1.5mg x 1ml ampoules- Packet of 10 ref no 07568672

Pascoe b12 depot 1.5 mg x 1ml ampoules-10 packets of 10 ampoules (100)

Ref no 07568695

Hevert b12 depot 1mg x2ml ampoules packet of 10

Ref no 06078368

Hevert b12 depot 10 packets of 10 ampoules- ( 100)

Ref no 06078380

I obtained single use Methylcobalamin ampoules from Arnika manufacturing chemists in Munich . But that was sometime ago . I don’t know if they still supply to U.K. . You email them with your name address, and how many you want . They speak and write English . [e-mail] or phone them 089 452 468 468. You pay with PayPal or Bank transfer

Some people buy powdered Methylcobalamin from Oxford Bisciences and reconstitute it with saline from a German online pharmacy ( yes saline is a prescription item in U.K. , but not in Germany , just like B12 ampoules !!! Just Google Oxford biosciences, and it will lead you to their site . .

Best wishes .

[Noelnoel]

Can’t thank you enough Wedgwood, that’s SO helpful!

Thank you

[Beckburybelle]

There is a clinic in Shropshire that does a postable subscription service that's good. I am not allowed to name it as it goes against PAS rules.

[Noelnoel in reply to Beckburybelle]

Hi Beckburybelle

Thank you so much for the recommendation. We’re allowed to private message the information so would you mind providing the name of the clinic please?

Do you use injectable B12 and if so, which type?

[am111]

All forms are converted to usable ones in the body. In that sense, there is no difference. However, the body can react differently to different forms, especially since cyanocobalamin takes time to be converted to usable forms. Hydroxy seems to be the most absorbed and fast acting, as apparently, the body transports B12 in this form in the blood.

In higher doses(1ml injection), only about 30% of cyanocobalamin is retained but 75% + is retained of a methyl or hydroxy injection.

After trying various versions, I find cyanocobalamin to be more diffuse, methyl injection was fine, but hydroxy did not suit me, as it gave a more up and down effect. i.e. feeling better just after an injection and feeling worse just before the next injection due.

I currently use cyanocobalamin injection, but only some 50mcg/day (through SC) - partly because I am able to get multi-use vials which are easier to use. I have done 50mcg/day methyl shots with almost similar results (absorption for cyanocobalamin for upto 50mcg is almost 100%). I found once-a-week 500mcg methyl injection to also work very well. Good luck!

[Noelnoel in reply to am111]

Thanks am111, that’s helpful

Not keen on using cyanocobalamin until I become more experienced with this. What started out as investigations for my son has has lead to my entire family wondering whether we have PA. We did the MMA test on Wednesday and are now awaiting the outcome but I think I’ll experiment with B12 injections regardless of the result because my levels are low without supplementation and it now feels as though I’m developing neurological-type symptoms and I’d like to see if these suspicious symptoms respond to injections

Can you explain multi-use vials please and where to get them? Are they available for methyl?

Thanks again

[am111]

Multi-use vials just come with a preservative, so a single vial can be used for upto 42 days or so. Many prefer single-use ampoules for better safety, but I have used multi-use vials for at least 6 months with no issues and I think safety concerns with multi-use vials are over-blown, especially with a single user and single-use syringes.

I think wedgewood has given the link to reconstitute methylcobalamin from powder with a saline solution. That is possible. Cyanocobalamin and hydroxocobalamin are available from German pharmacies as single-use vials. I am not in UK, and these multi-use cyanocobalamin vials are easily available where I am but not in UK, so cannot suggest for you.

In any case, if you find problems with one form, don't hesitate to try another form, as all are not the same.

Regarding supplementation, are you taking some orals already? If you have mild symptoms, once-a-week injection might resolve it. For me, some four injections followed by once-a-month after that worked well. (I had a relapse due to stopping them after a doctor told me my serum B12 was too high - utter nonsense, as serum B12 will always be high after supplementation and one cannot go by it once on any kind of supplementation, including orals).

[Noelnoel in reply to am111]

Right, thank you for that

I started oral supplementation some years ago when I discovered B12 was low. Levels rose well and I maintained it at about mid-range quite easily but I had always wondered about PA

As you know, once you start supplementing it’s difficult to know for sure and being reluctant to stop orals I continued on without ever knowing how much of my mid-range level was being absorbed and utilised. Fast forward to today and I’m noticing tingling and numbness in my feet and lower legs. Also weird spiky, shooting sensation at night

I’ve discovered how hard it is to get a diagnosis and even this MMA test that I’ve done, if it’s negative, isn’t conclusive. Not wanting to take any more chances in blindly supplementing, in these last few days I’ve decided to experiment with injections and if these symptoms resolve I’ll be in a better position to decide how to proceed long-term. I suppose I could just dramatically increase oral supplements and see …

[am111 in reply to Noelnoel]

Your syptoms are definitely of B12 deficiency.

Oral methylcobalamin did not work well for me and I had symptoms when on it. There are some studies that show that oral cyanocobalamin is better but injections give the best results.

If your family is vegetarian/vegan, it could be just low B12 intake for the whole family and not much to do with PA. Also, with supplementation, your MMA might come OK but still with symptoms.

What type of and how much oral are you taking? I switched to daily sub-cutaneous injections with an insulin syringe as it gives me much better relief than tablets...

[Noelnoel in reply to am111]

We’re not vegetarian or vegan and our diet is very good. Lots of fresh fruit and veg daily as well as red meat, poultry, fish and eggs. I also eat liver weekly and I’m GF though admit to it creeping back in, to the detriment of how I feel I must say! In view of this I can only conclude I have absorption problems not particular to B12 but other nutrients too, including ferritin and folate

We abstained from oral B12 complex many weeks before MMA testing and the type we were using was liopsomal for better bioavailability and comprised of

Methyfolate x 400

Methycobalamin 500

So far it has maintained good levels for me

I believe my son has had PA for many years because one of his symptoms of a tremor was noted many years ago. As a child he often complained of “sensations” in his lower limbs and stupidly, we put it down to “growing pains”. Can’t believe I was so blase about it. I on the other hand have only just started considering I may have PA, in view of the symptoms I’ve already mentioned

Why the insulin syringe and not the usual sub-cutaneous PA syringes? Is there a difference? What was your initial starting regime and what is it now?

[am111 in reply to Noelnoel]

Even if it is not B12 deficiency, in all neurological problems, B12 supplementation helps. I suggest once-a-week shot for you, reducing to once-a-month after about 3-4 shots. You can also do daily orals if those work for you, but shots are better, as they act faster and are more effective. If you still see symptoms after 4 shots or so, you can continue the weekly shots, gradually reducing the frequency and taking them as and when the symptoms return.

I initially did this with good effect, but then due to some confusion and wrong advice from the doctor, stopped taking the daily orals I was taking for maintenance. Symptoms returned with a vengeance, with very bad situation.

Now, I just do a daily shot rather than taking an oral everyday. The problem with orals is that the absorption is variable and I get symptoms if I have diarrhoea etc., so to be on the safer side, I do sub-cut injection. It works much better for me and keeps my levels really high with very good symptom relief.

B12 can be injected with IM or sub-cut. I do sub-cut with insulin syringes as it pains much less (31Gx6mm). You can use other types of syringes also or do IM. There is no difference in effectiveness, only in the pain...

Check your thyroid levels. My B12 and iron went down due to hypothyroidism. Our vitamin absorption reduces drastically with thyroid problems.

[Noelnoel in reply to am111]

Thank you so much for all of this, it’s really helpful to hear what you do and how it works (or not) for you

You’re right to mention hypothyroidism, I have Hashi’s and have learnt that my probable absorption issues are due to this. For this reason I supplement with everything I discovered I was deficient in and now levels are very good. My recent TFT showed excellent FT3 but poor FT4 so I’m about to mess around with my Metavive type and dose. Such a pain in the proverbial

[am111 in reply to Noelnoel]

My iron absorption improved after fixing my thyroid issues and now, I don't have to supplement iron. Many times, absorption becomes fine after fixing the thyroid issues and we no longer need to supplement. I still do B12 supplementation as we are vegetarian. Perhaps I don't need to anymore, but I am not sure, so take the shot to be on the safe side.

Check on the thyroid forum how to fix thyroid problems. It is complicated and I am not an expert. For me, 50mcg Levo worked fine and brought everything in range and feeling fine, but T4 only therapy doesn't work for all.

What is metavive?

[Noelnoel in reply to am111]

Apologies, I just saw that I didn’t respond to you

Yes, I’m on the healthunlocked thyroid forum. It’s been an unrivalled source of info, support and inspiration. I feel very fortunate to have stumbled across it

Like you I believe my absorption has improved because my ferritin went way over range earlier in the year and my Vit D remains high, despite no longer supplementing. Will check again after Christmas to check they’re still ok

Dr Peatfield prescribed me Metavive. It’s WDT (whole dessicated thyroid gland) from porcine or bovine sources and works on the same principal as NDT but has supplement status and is available OCT

I’ve taken it since diagnosis six or so years ago and been very happy but every now and again I consider trying levo because it sounds an easier way to manage thyroid replacement

You’re very lucky that such a small dose of levo has worked for you. Lots of us have trouble getting dosage right, whatever thyroid replacement we decide on

[am111 in reply to Noelnoel]

Thanks for the note.

Make sure you don't over-supplement on Iron. It can be toxic.

Looks like you don't need to supplement most things now, but keeping Vit D high is always beneficial. As long as we are not taking more than 10000IU/day, it is fine.

I think FT4 being low on NDT/WDT makes sense, as animal thyroid glands have a higher T3/T4 ratio (1:4) than humans (1:12). FT3 is what is important, so if you feel fine on the current treatment schedule, I don't see any need to change. Perhaps a small amount of levo, which is nothing but T4, might help.

My TSH when started supplementing was "only" 11, so I think my thyroid gland still functions to some extent. There are people who claim that Vit D supplementation and some herbs help. I have been taking these (60000IU Vit D/week) with some improvements in my TSH and symptoms and probably helps my thyroid from deteriorating further.

[Noelnoel]

Yes, I’m on the healthunlocked thyroid forum. It’s been an unrivalled source of info, support and inspiration. I feel very fortunate to have stumbled across it

Like you I believe my absorption has improved because my ferritin went way over range earlier in the year and my Vit D remains high, despite no longer supplementing. Will check again after Christmas to check they’re still ok

Dr Peatfield prescribed me Metavive. It’s WDT (whole dessicated thyroid gland) from porcine or bovine sources and works on the same principal as NDT but has supplement status and is available OCT

I’ve taken it since diagnosis six or so years ago and been very happy but every now and again I consider trying levo because it sounds an easier way to manage thyroid replacement

You’re very lucky that such a small dose of levo has worked for you. Lots of us have trouble getting dosage right, whatever thyroid replacement we decide on