B12 prescription?

[quote=“kvsouth, post:9, topic:89959, full:true”]
I know I’m deficient without having the bloodwork, [/quote]

How?

So GO TO THE DOCTOR already. What’s the problem?

Unless there actually isn’t any clinical evidence of a reason for the treatment, of course, in which case you probably don’t in fact need it.

I get a monthly injection and daily (when I remember to take them) 1000mg cobalamin capsules. 10% (I thought it was about 5%, but its a while since I researched it) absorption of such massive doses of oral B12 is still a hell of a lot, and I could probably do without the injection, but its belt and braces, plus patient compliance with long-term oral treatment (mine included) isn’t very good, so clinicians tend to favor injection.

Before I got the stuff prescribed I bought oral capsules from a pharmacy and it was a lot more expensive than on prescription.

On prescription you can also get the injection done at an outpatient clinic, maybe not necessary for you but some people (me, for example) are squeamish about self-injecting.

I just got 20 amples from the pharmacy no problem just now.

Just gonna add this to the discussion:


Obviously not available locally, but in Europe they developed vegan toothpaste, brushing with which twice a day covers vegans’ b12 needs. I love it, because I hated taking pills and I’d hate injections even more. I’d also always forget, but I never forget to brush…

Might be able to order via Amazon – I brought a stash on my last visit.

BECAUSE: I HAVE been to SEVERAL and they all say they don’t give them. I MENTIONED this earlier.

THIS is the problem.

If you have a clinical need, which probably means a blood test that demonstrates low blood levels, they’ll prescribe it.

Mine is prescribed by an NCKU hospital neurologist, and the monthly injections are given at an NCKU hospital out-patients clinic.

Seems a very inefficient way of getting B12, even if you swallow your toothpaste. Healthy individuals need so little, though, that it would probably work.

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Don’t ever regularly swallow toothpaste – at least not those with fluorides. It’s poisonous.
Also, B12 can be absorbed through the oral mucosa. If it works, suffices and is practical, who cares whether it is “inefficient”?

In fact, one might argue that injections are very inefficient in a way, since one has to use extra time and effort to learn how to do it properly, and then do it regularly. Toothpaste on the other hand integrates into everyday life just like that. I am totally loving it.

Kvsouth, it just occurred to me why you are hearing from numerous pharmacists that “you must go to a big hospital.” That doesn’t mean you need a prescription. This is what they will always say if you want to buy something unusual that they don’t normally stock. Most injectable medicines will fall into that category.

In my little town, there is only one good pharmacy that will either stock unusual meds, or they are willing to order. On their computer, they can look up everything and tell me immediately if it’s available anywhere in Taiwan. Several times they’ve ordered for me the injectable drug Buscopan, which I also occasionally need for my intestinal condition.

To find what you want (or to ask if they’ll order it), you could probably save a lot of time by making a few phone calls. To get pharmacy phone numbers, google search for this:

竹北 藥局

or better yet

新竹 藥局

Depends. If you’re a strict vegan, and you are theoretically dependent on this route for ALL your B12 requirement, then you might care if it was inefficient enough to kill you.

You need one microgram a day. A normal individual would absorb 13 micrograms, or 1.3 % from a swallowed 1000 microgram dose. They’d retain 150 micrograms from an injection.

I’d bet your life the absorption is going to be much, much less from brief toothpaste exposure, and I’d guess (though I don’t know, and you havn’t said) that the toothpaste wont have that much B12 in it, since 1000 micrograms is quite a lot.

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Like I said the pharmacies next to the hospitals are much more willing to sell you things and have things in stock or order it for you. The competition is fierce and I can always say oh but the store next door is selling it for like cheaper and they almost always lower their price.

I am a strict vegan (what is a non-strict vegan? An ovo-lacto vegan? lol). As I said, as long as it works and suffices, implying as long as it will cover your needs.

How nice of you to bet MY life. :stuck_out_tongue:

However, absorption is not linear. Afaik, beyond 3 microgram a day, the absorption rate drastically decreases. Also, afaik under the tongue (sublingual) absorption is quite efficient compared with common swallowed tablets (thus you’re supposed to certain chew tablets, not swallow). Toothpaste gets there for a few minutes, potentially longer than a tablet which you just swallow, so I can imagine that absorption is in fact not too bad. Further, the vegan society recommends to

[…]
OR Take one B12 supplement daily providing at least 10 micrograms
OR Take a weekly B12 supplement providing at least 2000 micrograms.
( https://www.vegansociety.com/resources/nutrition-and-health/vitamins-minerals-and-nutrients/vitamin-b12-your-key-facts/what-every-vegan-should-know-about-vitamin-b12 )

The non-linearity is clearly visible here: for weekly doses you need a lot more than seven times the amount of a daily dose. However I don’t know how many micrograms are in one “portion” of toothpaste…

Last but not least, the toothpaste was developed in cooperation with the German vegetarian association (Vegetarier Bund) and tested by some German “Institute for alternative and sustainable nutrition”, suggesting a certain degree of professionalism. If you read German or want to try google translate, feel free to read their article on it.

You’re already doing that, on the basis of a couple of “AFAIK”'s an “imagine” and some “alternative” German.

In detail

Carmel, Ralph. “How I Treat Cobalamin (vitamin B12) Deficiency.” Blood 112.6 (2008): 2214–2221. PMC. Web. 14 Sept. 2016.

“Sublingual or nasal routes cannot be recommended because they are expensive and inadequately studied.”

I don’t get toothpaste under my tongue for a few minutes, but even if I did I wouldn’t bet my life I would absorb much B12 from it.

You’re right about the non-linearity, though. % absorption declines as dose increases, but the absolute amount absorbed does go up.

[quote=“compul, post:32, topic:89959, full:true”] some German “Institute for alternative and sustainable nutrition”, suggesting a certain degree of professionalism.
[/quote]

Well, it suggests a certain degree of German. “Alternative” isn’t normally primarily associated with “professionalism”, more with fringe loopiness, though that’s not a necessary association.

The “sustainable nutrition” thing does raise a point, though. Normal body stores of B12 are large and take a long time to degrade, so you could mine them in a non-sustainable fashion for a long time before you started to show symptoms.

Afaik implies I recall having read that, but did not want to look for sources. But hey, here we go.

First of all, that the institute has “alternative” in it’s name does sound potentially fishy, but they made actual scientific experiments with control groups and a decent enough sample size. Second, the involvement of the vegetarian society suggests that this was created to help vegans, not to make a buck off of “alternative” people.

Looking at the text, he makes a claim which is at most based on his personal experience (no citations or anything). While he may or may not be right, there are papers that claim otherwise:


Conclusion

A dose of 500 µg of cobalamin given either sublingually or orally is effective in correcting cobalamin deficiency.

We can get lost in guesses and bets about technicalities and tooth brushing techniques here, but the study shows a drastic increase in B12 levels due to toothpaste, suggesting that in some way the B12 is absorbed from the toothpaste.

Hypocobalaminemia isn’t in the same league as scurvy, so even if the toothpaste isn’t ideal, I don’t think anyone’s about to die from relying on it. Nice to know people are concerned about each other’s lives though. :2cents:

Absolute B12 deficiency, which is what an unsupplemented vegan diet would theoretically achieve, is fatal.

Prior to the availability of treatment, pernicious aneamia, which results from an inability to absorb dietary B12, had a 100% fatality rate.

Prior to its fatality, it can have severe and irreversible neurological effects, resulting in psychosis, dementia and paralysis.

I’ve already said the requirements are low and may be adequately met by this probably inefficient route, but I’m suggesting that it would be prudent to verify this, and if that isn’t possible, do something of more established efficacy.

Or just do that anyway. How hard is it to take a pill every so often?

Are there no symptoms before irreversible harm occurs?

I don’t know, and I wouldn’t be surprised if no one else does either, given the difficulty of measuring low-level irreversible damage.

A vegan will presumably / hopefully be aware of the dangers so they would probably catch it before much damage was done, but I wouldn’t be confident that NO irreversible damage would accompany symptom onset.

If you are a random case, the neurological symptoms can be hard to interpret and won’t necessarily result in a B12 deficiency diagnosis, at least not at NCKU hospital. I had 4 different neurologists telling me 3 different things, but the take-home message was that I had an incurable but slowly deteriorating condition.

In fact it now appears I had an easily curable but rapidly deteriorating condition, and the latter fact became obvious to me quite quickly.

If I hadn’t spent a solid week researching it (mostly wasted on inconsistently applied and recorded nerve conduction test results, which were basically uninterpretable), worked out my own program of diagnostic tests (which included vitamin levels, though that wasn’t their focus) based on best practice from the literature, and insisted on them doing them, I’d probably be dead.

As it was I almost certainly suffered some irreversible nerve damage (NCV results remain lower than normal several years later) but no one has been very keen on quantifying that.

Left to their own devices they were going to piss about with genetic testing, a completely pointless activity from my point of view, and quite expensive.

A vegan will presumably / hopefully be aware of the dangers so they would
probably catch it before much damage was done, but I wouldn’t be confident
that NO irreversible damage would accompany symptom onset.

If logic prevailed that might be so, but some people make their diet a religion. About five years ago, I knew a young (American) vegan couple living here in Taiwan, and they had a new born baby who was being raised vegan too. The kid wasn’t allowed to have real milk, only soy milk. I was a little concerned and mentioned to the dad about how he and the family ought to consider at least vitamin B12 supplements, but he just sort of laughed at me and said I shouldn’t listen to “carnivore propaganda.” I decided it wasn’t worth my time trying to persuade him. He probably read on some vegan blog that “vitamin B12 deficiency is a hoax”, and it was useless trying to change his mind.

I do wonder if the kid is still alive.

Interesting story, thanks for sharing.