Polly: There are five known types of vitamin B12.
Cyanocobalamin is the form of vitamin B12 that you will find in most supplements. It is cheaper than the other forms and most people tolerate it well. However, because it contains cyanide, it might be toxic when used in high doses.
Methylcobalamin and adenosylcobalamin and are the active forms of the vitamin found in nature.  You can purchase methylcobalamin fairly readily. Thorne Research makes it. Unlike cyanocobalamin, the methylcobalamin does not require intrinsic factor for absorption.  So when taken orally, the methylcobalamin has a better chance of being absorbed. Methylcobalamin can be found in the cerebrospinal fluid. It supports the healthy structure and functioning of the brain and nervous system. It is the form often recommended for those who have been mercury poisoned.
Adenosylcobalamin is also easily purchased, but it is often not found under that name. Adenosylcobalamin is also called coenzyme B12, cobamamide, cobinamide, or dibencozide. Ecological Formulas makes a separate supplement of it. DEWS includes this form of B12 in with their coenzyme B complex product too. The body readily stores adenosylcobalamin in the liver and mitochondria
The hydroxycobalamin can be found a http://www.Perque.com or it can be ordered through a compounding pharmacy. The body will convert it into the active methylcobalamin and adenosylcobalamin. Large doses of hydroxycobalamin have proved useful in the treatment of both fibromyalgia and chronic fatigue. The reason might be due in part to B12’s ability to mop up excess nitric oxide. Dr. Martin L. Pall hypothesizes that elevated nitric oxide and peroxynitrite may be the common etiology of posttraumatic stress disorder, fibromyalgia, chronic fatigue syndrome and multiple chemical sensitivity. Hypoxia (lack of oxygen) or any traumatic stress can set in motion a vicious cycle that perpetuates the elevated levels of the nitric oxide and peroxynitrite in the body. See http://www.ImmuneSupport.com/library/sho…fm?ID=2976
B12 and folic acid must be kept in balance. Dr. Alan Vinitsky is the author of Energy – the Essence of Environmental Health. He has his patients use a specific ratio of folic acid to B12. His patients use 2.5 as much by weight of folic acid as hydroxycobalamin. A compounding pharmacist can make up separate solutions of these. (College pharmacy carries these. 800- 888-9358 http://www.collegepharmacy.com) The solutions can be used as a nasal or mouth spray. The folic acid needs to be used several times per day. (Folic acid has a short half-life.) You also have the option of making your own folic acid spray. The Life Extension brand carries a concentrated folic acid powder that you could use. This combination of B12 and folic acid should bring up the glutathione levels.
If you don’t want to go through your doctor and pharmacist, Perque carries the hydroxycobalamin. (http://www.PERQUE.com or phone 800-525-7372) Here is something from their site about the benefits of the hydroxycobalamin.
“The connection between vitaminB-12 and folic acid is also critical. VitaminB-12 reactivates folic acid. If an individual has low levels of vitamin B-12, severe folic acid deficiency may develop. Similarly, a B-12-deficient individual taking only folic acid can make the B-12 deficiency worse. PERQUE delivers vitamin B-12 in its superior, activated hydroxocobalamin form. Although it is more expensive and difficult to obtain, hydroxocobalamin lasts longer and raises B-12 blood concentrations higher than other forms. For this reason, it is the only form PERQUE uses. Hydroxocobalamin requires no intrinsic factor and is taken up directly by mucous membranes regardless of digestive competence.* Hydroxocobalamin is easily converted to active but short-lived methylcobalamin and adenosylcobalamin as needed in the body. Hydroxocobalamin, the parent to other B-12 forms, provides better, long-lived B-12 action in the body.”
Those with mercury poisoning may not be able to tolerate B12 supplements. Try a sublingual B12 before experimenting with the higher dose shots. SAMe is also important to the proper use of folic acid and B12. If B12 levels are particularly low, check for a parasite infection. Giardia and Diphylobothrium latum interfere with the absorption of B12. Pancreatic enzymes are required to absorb B12. Also, adequate sulfates might be important since they activate the CCKA receptor that regulates intrinsic factor.
Carol S: Personally, Dr. Cheney started me off on 5000 mcg/ml of cyanocobalamin, 1 cc sub Q, three times a week, in 1996. In the spring of 1998 he switched me to 10,000 mcg/ml of hydroxycobalamin, 1cc daily. After reading the Swedish research on B-12 depletion in Chronic Fatigue Syndrome patients in the cerebrospinal fluid (when blood levels showed normal!), Cheney wanted to raise the dose. He realized the only way to safely get the higher dose was to use hydroxycobalamin. He hadn’t been aware of it. He said that most American doctors only know about cyanocobalamin. He read and learned that the British used in it high doses as a detoxifying agent. It really excited him. I found the difference in dose and type of B-12 to be very significant. The hydroxy not only gave me a little more energy; it also helped me sleep more deeply if I took it at bedtime, and my pain level dropped some. It’s definitely worth the much higher price.
Dr. Cheney employs B-12 injections of 10,000 mcg/ml of hydroxycobalamin, 1 cc or more daily at bedtime, given subcutaneously or intramuscularly. (Here is an article on his work: http://virtualhometown.com/dfwcfids/medi…valry.html ) This form and dosage of B-12 is a potent detoxifier of the brain, increases energy, assists with sleep, and provides pain relief for some patients. Patients report that they needed to push to plateau (keep increasing dose until benefits stop increasing) to get a sustained effect. In a recent study most CFS patients had no detectable B-12 in their cerebrospinal fluid, though all had normal B-12 blood levels. It is suspected that there is dramatically increased consumption or destruction of B-12 in the brain. Another published study documents the use of up to 26 mg a day of B-12 with great benefits, and no side effects. At these high doses hydroxycobalamin rather than cyanocobalamin must be used to avoid the toxicity of the cyanide in the later.
A few patients have reported feeling hyper/jittery or lethargic or have experience acne and diarrhea when taking the hydroxycobalamin. The dosage should be reduced if this occurs. Cheney speculates that it’s acting as a detoxifier and is pulling out toxins too fast. This problem with B-12 appears to generalize to other B-vitamins as well. (The British used hydroxycobalamin 5 gm infusions to successfully detox people with cyanide poisoning.) It’s important to supplement other B vitamins moderately when taking high dosages of B-12. This form of B-12 is available only through a compounding pharmacy and can be found locally. If there isn’t a source near you, the Wellness Pharmacy offers 30 1cc injections for around $80. This preparation is preservative free and contains 10 mg per mil. Website http://www.wellnesshealth.com and phone (800) 227-2627.
Polly: This is a quote from Raymond Peat’s April 1999 newsletter:
“One of the most interesting approaches to inhibiting carbon monoxide production is to use vitamin B12, as hydroxocobalamin, as an antidote to nitric oxide, preventing the nitric oxide from stimulating the formation of heme oxygenase. Wherever carbon monoxide mediates a biological malfunction, as in acquired immunodeficiency, Alzheimer’s disease, and cancer, vitamin B12 seems to have a place as a detoxicant.”
These are a few tidbits from Dr. Mercola’s article on B12 in his August 27, 2000 newsletter. http://www.mercola.com/2000/aug/27/vitam…ciency.htm He states that an alternative to the injections would be to use DMSO to carry the B12 through the skin. Intranasal B12 is also available, but it is very expensive. Be careful about the use of Prilosec (an antacid) because it decreases B12 absorption.
Matt in UK: B-12 is one of the most common deficiencies with small intestinal candida and bacterial overgrowth. There is a paper available at http://www.biolab.co.uk correlating specific nutrient deficiencies with the above situation. I think the most commonly seen pattern is low B1, B2, B6 and zinc.
Polly: 2008 Update —
Methyl-B12 is potentially very important for anyone that is autistic or who has been mercury poisoned. However, if the methyl-B12 causes undo agitation or hyperactivity, then consider eliminating or reducing the use of folinic aid / folate and TMG / DMG.
There are two methods for effective delivery of this methylcobalamin — shots in the buttocks or a nasal spray. A spray of methyl-B12 in the nose will sometimes be better than the shots or sometimes the opposite is true. As for the shots, several years ago, Dr Neubrander pioneered the use of these with the autistic. He has gotten some very good results with his protocol. Dr. Neubrander feels that it is very important that the methyl-B12 shots be given just under the skin in the fat layer of the buttocks. This fat layer will slow down the rate of absorption into the blood stream and allow more of the B12 to be used by the body. Please visit his site for other protocol details that will enhance the favorable outcome when employing these shots. http://www.drneubrander.com The other effective delivery method for methyl-B12 is through the nose. Stan Kurtz appears to be one of the first to employ and promote this for use with the autistic and other people. If you wish to try this, you will want to purchase a methyl-B12 liquid with no additives. Such a product is available from New Beginnings. It is called Methyl-mate. One or two sprays per day for an adult is about right.