News & Perspectives

A Common B Vitamin for Fibromyalgia and Fatigue

Doctors frequently prescribe vitamins in the B-complex family, most particularly B-12, for people suffering from chronic fatigue syndrome and fibromyalgia. This particular nutrient has long been thought by many researchers to aid in several nerve-related disorders, including multiple sclerosis and Alzheimer’s disease. The typical CFS and fibromyalgia patient also suffers from symptoms that are distinctly neurological, such as numbness and tingling in extremities, memory loss and balance disorders.

Among its many roles in the body, B-12 works with another B vitamin, folate, to manufacture red blood cells. The vitamin also protects myelin, the protective coating around nerves. Deficiencies can cause anemia and irreversible nerve damage.

A Novel, High-Dose Approach

B-12 can be taken orally in supplement form, of course, and it is naturally plentiful in animal protein sources such as tuna, steak, chicken, and yogurt, as well as B-12 fortified cereals. Most people have no problem getting as much B-12 as they need, even without supplements.

But some doctors who specialize in the treatment of CFS and fibromyalgia are choosing to augment oral supplementation of B-12 with injected doses comparable to or higher than doses typically prescribed for patients suffering from a B-12 deficiency (pernicious anemia). Patients self-administer the dose subcutaneously--under the skin--using the same kind of syringe a diabetic would use to inject insulin.

What is the rationale for such high doses, however, and do they actually alleviate symptoms?

North Carolina-based internal medicine specialists Charles Lapp and Paul Cheney, each of who specializes in treating CFS and fibromyalgia, began experimenting with high dose vitamin B-12 therapy in the early 1990s. Initially, they were intrigued by three studies reported in the New England Journal of Medicine, which revealed that high dose B-12 therapy had either cured or greatly improved the symptoms of patients suffering from CFS and fibromyalgia-like neurological symptoms. These symptoms included numbness or tingling in the extremities, memory loss, weakness of the limbs, changes in mood and personality, and even fatigue. Interestingly, the patients in these studies had normal B-12 blood counts, which would suggest that on paper, anyway, they had enough B-12 in their systems.

Drs. Cheney and Lapp discovered that at least half of their CFS and fibromyalgia patients experienced significant improvement in all symptoms, including fatigue, and as many as eighty percent reported at least some improvement, at doses of between 1,000 micrograms to 5,000 micrograms of B-12 injected three times a week. In cases of pernicious anemia, in contrast, doctors tend to prescribe a shot of 1,000 micrograms per day for seven days, and then 1,000 micrograms per month for the rest of the patient’s life.

The doctors and their patients were thrilled with these results, but the mystery of how or why the high dose therapy helped CFS and fibromyalgia patients—even though their B-12 blood levels were normal—remained. Cheney and Lapp speculated that their patients might have a problem with B-12 absorption and utilization at the cellular level. In the intervening years, new research has supported their hypothesis.

Writing in the Scandinavian Journal of Rheumatology in 1997, Swedish scientists described their study of twelve patients who fulfilled the diagnostic criteria for both CFS and fibromyalgia. Although all the patients had normal levels of B-12 in their blood, they had extremely low or non-detectable levels of B-12 in their spinal fluid, and by inference, in their brains. The low amounts of B-12 in the spinal fluid correlated with the degree of fatigue experienced by the patient. The finding suggested that at least some CFS and fibromyalgia patients fail to metabolize B-12 properly.

One year later, these same researchers reported that not only did CFS and fibromyalgia patients lack B-12 in their nervous systems, they also had abnormally high levels of homocysteine, an amino acid-like substance that is normally regulated in the cells by B-12. Among other things, high levels of homocysteine have been linked to heart disease.

Unraveling a Mystery

The Swedish scientists discovered that the higher the homocysteine levels in CFS and fibromyalgia patients--and the levels were typically three times higher than in healthy people--the greater the severity of fatigue. They concluded that the absence of B-12 in the nervous system and high homocysteine levels among CFS and fibromyalgia sufferers constitute "an underlying factor" in both diseases.

Lapp believes the B-12 deficiency in CFS and fibromyalgia occurs because of a defect in the patient’s ability to transport the nutrient into cells. "This is a very significant issue," Lapp says, adding that the same patients also appear to have a similar problem transporting magnesium and potassium into cells. "Why this defect occurs remains to be explained," Lapp continues, but he points out, "Large doses of B-12 markedly improve cognitive ability, mood, irritability, and numbness and weakness in a majority of patients."

Lapp, who practices at the Hunter-Hopkins Center in Charlotte (704-543-9692), currently recommends a subcutaneous dose of 3000 micrograms every two to three days for "a continuous and satisfactory level of improvement." He prescribes cyanocobalamin, as opposed to a second form of B-12 available to consumers, hydroxycobalamin. The former, Lapp says, is less likely to sting upon injection, and is less expensive. The cost of high dose therapy is $8 to $10 a month. The multi-dose vials of cyanocobalamin should be stored in a cool, dark place because light and heat degrade the vitamin.

Worries about toxicity are generally unwarranted, Lapp believes. He points out that because the vitamin is water soluble, any excess is simply excreted through urine.

"I have recommended high dose B-12 to thousands of patients over the past ten years and have seen no adverse side effects," Lapp says.

Lapp strongly advises patients on high dose B-12 therapy to take oral supplements of other vitamins, particularly B-6 and folate, since excess B-12 can potentially compete with other B vitamins in the cells and hinder absorption.

Some Prefer Pills

Of course, many patients may be averse to giving themselves shots. In addition, not every patient can be expected to respond to the therapy. For such patients, oral B-12 supplements remain an important alternative. Dr. Keith Berndtson of American WholeHealth in Chicago suggests that patients who are either shy of injecting themselves, and patients who are "functioning"-- that is, who aren’t fully disabled by their illness--try taking one to two milligrams of B-12 under the tongue each day.

"We do get some improvement that way," Berndtson says. "If that doesn’t work, then it’s definitely worth pulling out the big guns," he adds, especially if the patient is seriously debilitated. The two-dozen or so patients Berndtson has treated with high dose B-12 therapy "have responded well," he says, "especially in terms of neuro-cognitive problems, which is what you would expect to see with this kind of supplementation."

Berndtson adds, "We have seen these reports of non-detectable B-12 in the brain, which suggest there is oxidative neuro-stress going on in these diseases." Like Cheney and Lapp, Berndtson doesn’t believe the diseases are caused by B-12 deficiency, but rather that the deficiency may be a hallmark of the illnesses. "I don’t lump (B-12 deficiency) under the heading of ‘root cause,’" Berndtson says. "But I would say B-12 therapy comes under the heading of ‘damage control.’"

Date Posted: 09/13/2000

Date Published: 09/12/2000
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