Friday, May 4, 2012

Tiredness- a little history of B12 treatment

Vitamin B 12 (cyanocobalamin ) Has been available for many years. The early treatment of pernicious  anemia was a little tough to swallow- large quantities of raw liver had to be eaten daily in 1934. Fortunately cobalamin(vitamin B12 ) was isolated from liver  in 1948 making treatment  a little more palatable .

A little history of the treatment of tiredness.
The use of B12 injections was a common treatment in older people complaining of tiredness. It apparently worked in some people because B12 injections was common practice for many years . My medical training labeled this use of B 12 as something just a little short of witch craft and I recommended that patients stop the B12 injections . It turns out that I may have been right about 80 % of the time . Recent studies have shown that about 20% of elderly people are at risk of B12 deficiency.
Another little bit of history about the treatment of tiredness in years past involved thyroid hormone use. The diagnosis of hypothyroidism was not as easy as it is now. I recall one older OBGYN doctor who decided that all women were tired so they must all be deficient in thyroid hormone. He started all of his patients on thyroid hormone. He used desiccated thyroid hormone which contained the active ingredient T3. This resulted in an initial buzz  of energy until their own thyroid gland turned off. The availability of accurate laboratory test ended the above treatments.

The treatment of B12 deficiency is very easy now.

Vitamin B12( cyanocobalamin )

Vitamin B12 is available by injection ( least expensive )
                                             oral ( moderate cost )
                                             intranasal spray ( most expensive )

Most multivitamins contain B12 and folic acid
many cereals are fortified with B12 and folic

Pernicious anemia
The injection of B12 is recommend for the treatment of Pernicious Anemia .

Metformin users
The treatment for Metformin induced B12 deficiency can be done with oral B12 supplements . Calcium supplements  also  improve B12 absorption in this situation.

Senior citizens 
    one study reported in J.AM Geriatr Soc. 2002 Aug; volume 50(8) pp. 1401-4 reported that the amount of B 12 found is multiple vitamins ( 2 - 35.5 microg/day ) may be sufficient  to correct the deficiency . The dose can be adjusted based on laboratory test

Have fun Be Smart and Defeat Diabetes and the Pills we use to treat it.
 David Calder,MD

Tomorrow :  what about those Glitazones  ( ACTOS and Avandia )

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Your comments and questions are appreciated. David Calder,MD