B-12 Treatment in ME/CFS

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_http://me-cfs.se/b12.htm_ (http://me-cfs.se/b12.htm)

Kanadas koncensusrapport

I Kanadas koncensusrapport (**Myalgic Encephalomyelitis/Chronic Fatigue

Syndrome: Clinical Working Case Definition, Diagnostic and Treatment

Protocols**

, Carruthers et al, ISBN 0-7890-2207-9, år 2003,

_http://www.mefmaction.net/documents/journal.pdf_

(http://www.mefmaction.net/documents/journal.pdf) ) står

följande om vitamin B12 (kobalamin) injektioner.

Sidan 56:

Cyanocobalamin

Start with 1,000 mcg once per week parenterally, IM or deep SC. Build up to

a maximum of 3,000 mcg every 2-3 days

Measure B12 and folate levels before commencing this treatment. Patients can

be taught to self-administer injections using the same1cc insulin syringes

used by diabetics. Cyanocobalamin should be stored in a cool, dark place to

prevent it from being degraded by light. It is recommended that those who do

not respond well take 1 mg of folic acid daily in tablet form. To prevent

deficiencies of other B complex vitamins, it is recommended that patients

supplement their daily diet with multi-vitamins containing B complex and folic

acid

which are best taken in the morning due to their occasional excitatory

effect. See additional comments below. Note: oral and subliminal B12 are

usually

ineffective.

Sidan 57:

B12/Cyanocobalamin: Based on anecdotal reports of CFS patients improving

with B12 injections and research studies demonstrating that persons with normal

blood counts who had CFS-like neurological symptoms may benefit from

injections of cyanocobalamin (120,121,122), Cheney and Lapp began treating CFS

patients with cyanocobalamin parenterally. Fifty to eighty percent of their

patients

reported some improvement. Most patients had normal serum B12 and folate

levels prior to treatment. Measurements of homocysteine and methylmalonate

levels taken at the Cheney Clinic showed elevation in approximately one/third

of

CFS patients suggesting a B12 deficiency may be a contributing factor in the

symptomology of this subset of patients. Lapp suggested that this may be due

to a reduced ability of B12 to be transported into the cell, as major doses of

B12 gives marked improvement of energy level, cognitive ability, and mood,

and reduced irritability, numbness and weakness in this subgroup. Improvement

is usually seen in six weeks (123). Lapp reports treating thousands of

patients with high dose B12 over a ten-year period with no evidence of cyanide

toxicity even at 15,000 mcg per week, and no serious adverse effects other than

some bruising at injection site. Rarely the urine may have a slight pinkish

tint following injection but that appears to be benign. The occasional patient

may develop an acnelike rash but it responds quickly to a reduced dosage. B12

injections are contra-indicated for patients with kidney failure. Another

theory is that hydroxocobalamin is a nitric oxide scavenger and may address

suspected elevated nitric oxide/peroxynitrite (124).