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Vitamin B12 - Uses and FAQs

Since I've passed a recent exam, I've gained a few new prescribing rights, including ability to administer intramuscular cobalamin injections...a.k.a Vitamin B12 shots!

Here's what you need to know about Vitamin B12 in general:

It's required for:

-nerve function: to prevent and treat peripheral neuropathies

-brain health: memory, mood, and function

-carbohydrate and protein metabolism

-red blood cell production a.k.a oxygen delivery to tissues

-cardiovascular health

-DNA repair and synthesis

Signs & symptoms of deficiency or sub-optimal levels:

-fatigue, weakness, or vague "unwell" feeling

-depression or anxiety

-neuralgias/neuropathies - tingling and numbness in hands and feet

-conditions like ADHD, Alzheimer’s disease, MS, etc.

-high blood pressure and cardiovascular disease


-issues with balance and walking

Reasons for deficient/sub-optimal Vitamin B12 levels:

1. Food intake is inadequate - the primary food sources are meat and eggs. Vegans and vegetarians may require supplementation.

2. You have deficient stomach acid production- Stomach acid is required to release Vitamin B12 from proteins bound in food. Seniors are at greater risk of deficiency because stomach acid levels decrease with age, and they don't chew their food as well - both of which are required for proper digestion and release of B12. Chronic stress can result in lower levels of stomach acid because of you need parasympathetic nervous system activity ("rest and digest") to activate the vagus nerve and release of stomach acid while eating. Lastly, certain medications have been implicated in Vitamin B12 deficiency, especially in older patients, like long-term use of PPIs, Metformin, and NSAIDs.

3. Absorption in small intestine is compromised -Food intolerances, IBD, Celiac Disease, infection, dysbiosis etc.

4. You have an undiagnosed autoimmune condition, pernicious anemia - where the immune system attacks the cells in the stomach that release intrinsic factor (IF.) IF is bound to Vitamin B12 once it's released from food, allowing it to be absorbed by the small intestine.


1. Vitamin B12 injection vs. oral supplementation?