08/25/2026
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I STARTED INJECTIONS - WHAT TO EXPECT - from one our files.
It is best not to expect too much when starting on injections as it creates less frustration if you notice no improvement, with loading doses, at all. TIME is the magic word in healing and it does take time and many injections to reach a point where you notice improvement. This can take 6 months to a year for any significant improvement to occur. Remember that B12 is in every cell in the body and there are billions of cells. It took you years to become deficient so “loading doses” or 3 months of every other day or daily injections are comparable to dropping a pebble into the ocean.
1. Can I get too much B12 or can one overdose on B12.
The answer is no. B12 is a water soluble vitamin and the body excretes any excess b12 it cannot use. The World Health Organization has not placed a safe upper limit as thy ere has not ben a recorded incident of B12 toxicity.
2. I am considering self treating. Can I just start doing my own injections.
Yes, provided you have had B12 injections. If this is your first injection, it should be supervised. Reactions are rare but it can happen. Health Clubs, Beauty Salons and Wellness Centres do give out B12 injections. Contact one near you. Once you have had your first injection, then you can do your own.
3. My doctor has said my B12 level is too high and is stopping my injections. Should he doing this.
No, your doctor should not be stopping injections and neither should he be testing B12 when you are getting injections. The World Health Organization has stated that B12 toxicity does not exist and researchers say that B12 level provide no information as to how effective they are, once on injections. “ Cobalamin and holo-transcobalamin II levels are uninformative because they rise with cobalamin influx regardless of therapeutic effectiveness, the extent varying only with the timing in relation to injection”. Carme,l How I treat Vitamin B12 Deficiency. In other words, Carmel is saying that B12 levels do not show the effectiveness of the treatment on symptoms. There is template for a letter to the doctor when injections have been stopped, in the file section. For those members in the UK, the BSH and NICE guidelines state that once on treatment, no further testing of B12 is required.
Many doctors confuse therapeutic levels of B12 with pathological levels of B12 and will try to tell you that high B12 levels are toxic.
4. Why do I feel sleepy and so tired when I get an injection
Learn to listen to your body…your body has been starved of an essential vitamin. It is now receiving that essential vitamin so there is a period of adjustment. If you feel more tired and more fatigued when you get an injection, listen to your body and rest. Don’t fight the fatigue.
5. Why do I feel worse since starting injections
Recovery from PA/B12 Deficiency is not a smooth process. It is very much up and down. You will have good days and bad days and in the beginning you may experience what we call reversing out symptoms. You will feel aches and pains that you did not think you had but they were there all along, just not as noticeable to you.
B12 deficiency is a demyelinating condition which means the deficiency erodes the myelin sheath. The Myelin Sheath is the fatty insulation that covers the nerves. Whenever erosion occurs, it exposes a nerve and that nerve dies off. B12 injections can regenerate nerves and bring them back to life so when you start on injections and notice a return or a worsening of symptoms, it is most likely those nerves, that died off from erosion of the myelin sheath, are waking up and they are sore. You may even notice new symptoms you thought you did not have before. Symptoms can creep up on you so slowly that your body compensates for it, meaning that your body adjusts to the pain so that it becomes unnoticeable. We have a file called Symptoms of B12 Deficiency which is broken down into neurological, psychological, haematological, neuropsychiatric and vascular symptoms.
6. I am deficient in folate. My doctor has prescribed 5mg folic acid daily but has told me not to start it until after my loading doses of B12. Is this correct.
No, it is not correct. B12 needs methionine in order to be utilized in the body. Folic acid, when converting to its active form, recycles homocysteine to methionine. Folate deficiency creates a methionine deficiency by not being able to recycle homocysteine to methionine. Please start folic acid as soon as possible. If you have a problem absorbing folic acid, we recommend folinic acid.
7. When will I notice improvement.
Improvement is dependent on several factors. The length of time it took to be diagnosed and treated, if you have a coexisting deficiency and or another autoimmune condition. For those who have very mild symptoms, you should notice improvement within 3 months. For those who have neurological symptoms or gastric symptoms, it can take from 6 months to a year for any significant improvement to occur. This can be very frustrating as improvement occurs in stages. It is important to keep a diary of symptoms, record them daily and rate them on a scale from 1 to 10, with 10 being the most severe. It is your diary that will tell you when you are improving. If one of your symptoms is 10 and two weeks later it is 8, that is an improvement. That is how symptoms improve as they climb back down that scale of pain to zero.
8. I finished loading doses and doctor tells me I now have enough B12 to last me a couple of years. Is that correct.
No, that is not correct. When I was with the old PAS forum, I asked a friend of mine, a Scots Paramedic who was also a retired aeronautical engineer to look at research articles and find one that states, PA/B12 Deficiency patients can access liver stores and can store B12. No such article could be found because the words the researchers used were “it is presumed that liver stores can be accessed or it is “thought that liver stores can be accessed. There was no article that stated definitely, liver stores “can” be accessed and most importantly how the stores could be accessed. The word “can” was never used. Fast forward to last year when the B12 Dutch Institute Conference looked at this liver stores and determined the same. No researcher had ever proven that liver stores could be accessed.
9. My skin is broken out with acne. Is that a side effect of B12 injections.
Yes, it can be. It seems to occur more with hydroxocobalamin but has occurred in some cases with cyanocobalamin use. Speak to your doctor or pharmacist and ask for a topical preparation or a cream that is used to treat acne. Do not stop your injections because of this. The Injections are saving your life.
10. My doctor told me I do not have pernicious anaemia because my intrinsic factor antibody test was negative. Is this true?
No, it is not true. While the test for intrinsic factor AB is accurate, only 60% of pernicious anaemia patients carry the antibody. You can still have pernicious anaemia as you may fall within the 40% who do not carry the antibody. When you receive a negative result for antibodies to intrinsic factor, ask your doctor to test you for parietal cells antibodies. Parietal Cells Antibody test is not as sensitive for pernicious anaemia because it can show up in those with Hashimotos Disease (autoimmune hypothyroidism) Graves Disease ( autoimmune hyperthyroidism) and diabetes. Parietal Cells Antibodies often show up in those with autoimmune gastritis. The end result of autoimmune atrophic gastritis is pernicious anaemia. (Prof. Ban Hok Toh, Monash University).
11. If I don’t have pernicious anaemia, why are my B12 levels so low.
B12 malabsorption. There are many other causes of B12 malabsorption that will prevent you from absorbing B12. Treatment for B12 malabsorption is the same as for pernicious anaemia. Some of the causes.
Ileitis, gastric by pass, Crohns Disease, Colitis, coeliac disease, parasites, Small intestinal Bacterial Overgrowth, Irritable Bowel Syndrome, H-pylori Disease, autoimmune atrophic gastritis, Imerslund-Graesbeck syndrome -a genetic disorder causing malabsorption in the ileum, Nitrous Oxide Esposure, Diverticulitis, if area affected is on the small bowel, genetic disorders involving the transcobalamin carriers.
12. How much B12 is absorbed from the injection
Anywhere from 10% to 2% and that does not mean it is active B12. Up to 98% of a cyanocobalamin injection and 90% of a hydroxocobalamin injection is excreted within 48 hours with most being excreted within 24 hours. There is no research to state how much methylcobalamin is excreted but it has been noted that methylcobalamin leaves the body more quickly than cyanocobalamin.
13. I am self treating. Do I need to take any thing else besides B12.
Yes. If you are injecting frequently you may need to supplement folic acid or folinic acid. B12 needs a high level of folate in order to be utilized in the body. If folate is low, you will not get the full benefit of the Injection. Other supplements you may need are:
iron if your ferritin or iron levels are low. Magnesium helps with muscle cramps and aids in the absorption of potassium. Magnesium also has a calming effect. If injecting frequently, increase your potassium intake via food. B12 injections increase red blood cell production. B12, folate, iron, magnesium and potassium form part of the red blood cell. Any increase in production of red blood cells will create a demand for more of all the above mentioned. You may also need to supplement Vitamin D if your level is low. Vitamin D deficiency can affect B12 via the cubilin receptor.
14. Why is a B complex recommended in the protocol file
Research has found that taking any single B vitamin such as B12 for a period of time, will create an imbalance or a deficiency in some of the other B vitamins. We recommend a B complex to prevent this from happening. Note: We have B complex listed in the where to source supplies file but if you purchase elsewhere, make sure the B6 in the complex does not exceed 10mg per day. B6 is the only vitamin that can cause a toxicity if too much is taken. Research has found that when B6 exceeds 10mg per day, it can cause B6 toxicity. Symptoms of B6 toxicity are the same as those for B12 deficiency. Therefore we suggest that you take a B complex for 4 months and then stop for two months. Note: B6 is an important B vitamin as it supports B12 and also helps with neuropathy.
15. I am injecting Methylcobalamin. Do I have to take Adenosylcobalamin as well.
You may have to. Research suggests that methylcobalamin does convert to adenosylcobalamin through an intracellular processing pathway but they also say this pathway can be an issue for many people as metabolic bottlenecks can occur and block the intracellular conversion. Methylcobalamin helps with symptoms but it is Adenosylcobalamin that provides energy. Make sure to monitor symptoms and do not take methylfolate when injecting methylcobalamin as this increases the risk of over methylation. We recommend either folic acid or folinic acid.
16. My doctor has told me I have pernicious anaemia and has prescribed oral B12 tablets for me. Is this the correct treatment. No, it is not. This also applies to those with B12 malabsorption issues such as autoimmune gastritis, Crohns and other conditions that prevent you from absorbing B12 from food. The Dutch B12 Institute in the Netherlands has just published a paper stating the following:
“Treatment Protocol Regarding Oral Supplementation. The effectiveness of oral supplementation, which is increasingly recommended as the first or sole treatment, remains questioned by many researchers, clinicians, and experts.10-14 Clinical trials and interventions used as proof that oral supplements work just as well as injections mainly focus on raising blood values rather than assessing clinical outcomes.15-18”. Lack of Clinical Evidence Regarding the Guidelines for Vitamin B12 Deficiency: An Analysis From Literature and Recommendations From Clinical Practice. It is as we keep saying..oral B12 which includes sublingual will increase your B12 level but will not permanently improve your symptoms.
17. It has been one year since I have had any blood tests done. What tests should I ask for.
A full blood count to include potassium and magnesium, folate (RBC folate is a better test than just serum folate), iron, ferritin, thyroid (because of the close link between B12 deficiency and thyroid disorders), vitamin D.
