Maybe the Old-Time Doctors Were Right to Give B12 Shots!

Form of B12 Deficiency Affecting the Central Nervous System May Be New Autoimmune Disease- B12 deficiency with normal labs caused by antibodies to B12 uptake receptors

For years, giving vitamin B12 shots to people with normal vitamin B12 levels has been considered a “poster child for unscientific medicine.” But a new study shows that the old-time doctors may have been right. And millions of people may be suffering from crippling neurologic problems that may potentially be helped by B12 shots or tablets. Despite totally normal blood levels.

Why?

The new study showed that B12 deficiency in the brain in people with the autoimmune disease lupus was four times as common in those with neurologic and brain symptoms. These people had normal blood vitamin B12 levels but severe deficiency in the brain fluid. It was found that they had an autoimmune molecule that blocked the B12 from getting from the blood into the brain.

These autoantibodies target CD320 — a receptor important in the cellular uptake of B12. While the person’s blood tests are normal, B12 in the patient's brain fluid (CSF) are nearly undetectable.
This is not a rare phenomenon. About 6% of the healthy population have these antibodies. And 21% of people with lupus who have neurologic problems. Suggesting low B12 in the brain can be a major problem in many people with crippling neurologic conditions. It also raises the question that this is just the tip of the iceberg, with milder but still devastating intermediate deficiencies being present.

This study began with a serendipitous finding 10 years ago by a neurology resident at UCSF. And is just now being published.

"These findings suggest a model in which anti-CD320 impairs transport of B12 across the BBB, leading to autoimmune B12 central deficiency (ABCD) with varied neurologic manifestations but sparing peripheral manifestations of B12 deficiency," the authors wrote.

Unfortunately, this antibody blood test is still largely only available in research settings. And most spinal fluid tests do not routinely check for B12 levels and require a lumbar puncture (spinal tap) to obtain the specimen. But treatment can be done easily and low-cost. By simply taking B12 tablets by mouth.

Is this a new phenomenon? Unfortunately, no. Research presented 28 years ago showed that low levels of vitamin B12 in the brain fluid are common in CFS and fibromyalgia (Evengard B, Nilsson CG, Astrom G, Lindh G, Lindqvist L, Olin R, et al. Cerebral Spinal Fluid Vitamin B12 Deficiency in Chronic Fatigue Syndrome [Abstract]; Proceedings of The American Association for Chronic Fatigue Syndrome Research Conference; 1996 Oct 13-14; San Francisco, California.). Despite B12 blood levels being normal and no anemia being present. Yet many of the symptoms of CFS, fibromyalgia, and even now long Covid suggest B12 vitamin deficiency.

Personally, I think it is reasonable for anybody with significant non-stroke neurologic diseases to take vitamin B12 tablets 5 mg (5000 µg) sublingual tablets daily for six months to see the effect. Or 3000 mg of methyl or hydroxycobalmin injections every 1 to 4 weeks if they can talk their doctor into those.

In this study, they looked at a group of people with MS as well. Prevalence of the B12 blocking antibody was the same 6% as the regular population. But that 6% showed evidence of significant vitamin B12 deficiency in the brain, and B12 is critical for nerve healing.

The good news? B12 shots, and even low cost 5 mg vitamin B12 tablets by mouth, can bypass this problem. By driving blood levels of B12 very high (which is a good thing), they can easily raise levels of vitamin B12 in the brain. Safely, effectively, at low-cost, and accessible to everyone. It can take 3 to 6 months to begin to see the improvements, but often they will begin quite quickly. With healing continuing over years.