![]() ![]() In blood diseases like leukemia, polycythemia vera and hypereosinophylic syndrome, the cause is often an enhanced production of the transport protein haptocorrin, to which most of the circulating B12 in blood is bound. Maybe the concern for a possible overdose is caused by the knowledge that some life-threatening diseases can be accompanied by a strong increase in the B12 blood value, in some cases to even 30 times the upper reference value. Elevated serum B12 values in serious conditions ![]() If serum values were decisive, even patients with neurological involvement could suffice with the maintenance dose of one injection every two months after the initial loading dose. This also emphasizes that symptoms and not blood values should be used as a guideline. The lack of danger of an overdose is further underlined by the advice to treat patients with neurological involvement with two injections a week for up to two years, if necessary. No reference is made to the serum value or a danger of overdosing, unlike for instance in case of a vitamin D or A deficiency. The recommended treatment in the Netherlands consists of a hydroxocobalamin injection of 1mg every two months, after an initial loading dose of 10 injections in 5 to 10 weeks. Treatment based on symptoms instead of blood values This presumption can have damaging effects for patients with neurological symptoms, which can become irreversible with insufficient treatment. 2Ī high serum B12 value does not mean that symptoms are treated sufficiently. However the blood level of serum B12 rises regardless of therapeutic effectiveness. Apparently the underlying thought is that it is necessary to keep the value between the (upper and lower) reference values. After an injection the serum B12 value rises quickly, well above the upper reference value (on average 150-700 pmol/L), followed by a slow decrease. The result is that many patients are left with recurring or lasting symptoms, which could be relieved by more frequent injections. Yet often physicians reduce injections or even stop treatment altogether out of fear of overdosing B12. Misunderstandings about blood and reference values Changing brands of vitamin B12, forms of B12 (cyanocobalamin vs hydroxocobalamin), or switching from injections to tablets can be a solution in those (rare) cases. Acne, eczema and itching seldom occur and very rarely anaphylactic shock. Of course, like with any medical treatment, side effects can occur. In their report from 2003 “Voedingsnormen: vitamine B6, foliumzuur en vitamine B12” the council joined expert commissions from the American Institute of Medicine and the Scientific Committee for Human Food from the European Union, who had already reported 3 years earlier that toxicity from high dose vitamin B12 poses no real danger. The Dutch National Health Council therefore decided not to determine a safe upper intake level for vitamin B12. No single case has been found in medical literature in the past 60 years. In all that time harmful effects have never been shown from overdose. Usually per injection and often lifelong, as a deficiency is mostly caused by an irreversible absorption disorder. Since then numerous patients have been treated with high dose vitamin B12 worldwide. More than 20 years later the substance that was responsible for that was isolated from liver extract: vitamin B12 or cobalamin. In 1926 it was discovered that patients with pernicious anaemia could be saved from a certain death by eating a pound of raw liver a day. Clinical research and the treatment for cyanide poisoning have shown that even extremely high doses of vitamin B12 and the serum values that go with it are harmless.Ī decennia long history of safe treatment.The Dutch National Health Counsel and the Regional Disciplinary Medical Board of Eindhoven have stated clearly that vitamin B12 is non-toxic.For over 60 years high dose vitamin B12 treatment has been used without any signs of the danger of an overdose. It is very clear this fear of overdosing is based on a misunderstanding.As a result, symptoms can reoccur again and again and even become irreversible.Out of fear of overdosing vitamin B12, treatment is often reduced to below the frequency that is needed by the patient, or, even worse, treatment is stopped completely. ![]()
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