Influence of Treatment Parameters on Symptom Relief in Individuals with Vitamin B12 Deficiency

Objective: Ever-growing numbers of displeased vitamin B12 deficiency patients are joining online support groups seeking help. The current study attempted to assess, quantitatively, several of the concerns of these patients.

Methods: A survey was developed, advertised and administered to 204 vitamin B12 deficiency patients through the online research website Mendus.org. The survey assessed the impact, on symptoms, of discrete, historical, epochs of B12 treatment characterized by a) type of B12 used, b) administration route, c) dosage, d) frequency and e) additional supplements. The final sample consisted of data from 192 individuals.

Findings: B12 injections were associated with greater mean symptom improvement than oral supplements. However, the combination of injections and additional oral cobalamin resulted in the greatest improvement. There were no differences observed for the form of cobalamin used. Compared to daily (DLY) or weekly (WKLY) injections, monthly (MNTH) or every two to three month (MNTH+) injections were associated with less symptom improvement. While additional oral B12 improved the effectiveness of daily, weekly and monthly injections, it was insufficient to ‘rescue’ the ineffectiveness of MNTH+ injections. Lastly, folate intake, but not iron, was associated with greater symptom improvement.

Conclusions: Patient’ symptom reports suggest that oral supplements are not as effective as B12 injections. This is in contrast to previous work that relied primarily on biomarker change as a proxy for effectiveness, suggesting more research is necessary. The frequency of injections perceived as most effective by patients was far in excess of that often prescribed, suggesting under-treatment may be occurring. Taken together, further investigation with more definitive tests and the inclusion of patient reports is necessary.