The Role Of B12 Vitamin In Neuropathy

What is Peripheral Neuropathy?

Peripheral neuropathy (often referred to simply as “neuropathy”) describes any kind of damage to the peripheral nerves, which are the nerves found outside of the brain and spinal cord.

Neuropathy may have many different causes and contributing factors. One possible cause is a deficiency in vitamin B12 (cobalamin), an essential nutrient. 

In addition to supporting red blood cell formation and the production of DNA, vitamin B12 plays a significant role in maintaining nerve function. Specifically, one of its key responsibilities is helping to form and maintain the myelin sheath, a protective layer of insulation around your nerve cells.

Damage to the myelin sheath leaves nerve cells exposed, fragile, and less efficient in sending electrical signals to other cells in the body. This is one of the main causes of peripheral neuropathy, and can be directly related to vitamin B12 deficiency. 

Supplementing with B12, either through diet, oral supplementation, or intramuscular injections, can help to prevent and treat neuropathy, especially for those who are deficient in the vitamin.

If left untreated, peripheral neuropathy caused by vitamin B12 deficiency can lead to permanent nerve damage.

What Causes a Vitamin B12 Deficiency?

Vitamin B12 deficiency is the most common B vitamin deficiency in the US, and one of the most common nutritional deficiencies overall.

Why is this? For one, many people don’t get enough B12 from their diets. Vitamin B12 is only thought to be found naturally in animal products, including meat, fish, poultry, eggs, and dairy products. For those who eat vegetarian or vegan diets, B12 supplements are generally necessary in order to make up for the dietary lack.

Some people also struggle to absorb vitamin B12, whether through food or oral supplements. This can occur because of low stomach acid, certain digestive disorders including Crohn’s disease, autoimmune conditions, and history of gastrointestinal surgery.

Some medications increase the risk of vitamin B12 deficiency by lowering stomach acid, which is required for the absorption of B12. These include proton pump inhibitors (PPIs) and certain kinds of antihistamines (H2 blockers).

Risk of B12 deficiency also increases with age, largely because of decreases in stomach acid production. It’s estimated that more than 20% of those over the age of 80 may be deficient in vitamin B12.

Some people with vitamin B12 deficiency, especially in its early stages, don’t experience symptoms. Symptoms also may be mild and non-specific (such as low level fatigue), and so may go unnoticed.

Blood tests can help to determine whether you have, or are at risk for, a vitamin B12 deficiency.

Drip’s Comprehensive Wellness Panel Test includes a complete blood panel and hemoglobin check, among other tests, to assess for vitamin B12 deficiency.

How Peripheral Neuropathy is Treated

Peripheral neuropathy (damage to or dysfunction or disease of the peripheral nerves) generally causes symptoms including numbness, weakness, tingling, and/or pain, most commonly in the hands and feet.

Many standard treatments for neuropathy focus primarily on treating or reducing pain and other symptoms. These include pain-reducing medications, topical creams or patches, and treatments that aim to reduce pain signals using electrical impulses.

While these treatments may offer relief, it’s important to try to identify and treat the cause of peripheral neuropathy in order to prevent it from recurring, worsening, and/or leading to further complications.

A number of different conditions can lead to peripheral neuropathy. The most common of these is diabetes. Diabetic neuropathy occurs when blood sugar levels are unregulated, which can lead to nerve damage over time. Better control of blood sugar is typically associated with a lower risk or level of neuropathy among those with diabetes.

It’s also important to note that the use of metformin, a medication commonly used to treat type 2 diabetes, has been shown to lead to B12 deficiency in a number of studies.

Vitamin B12 deficiency, independent of diabetes and metformin use, may be a cause of neuropathy. When low B12 is a cause or contributing factor, the deficiency should be addressed with B12 treatment in order to help reduce symptoms, restore nerve function, and prevent further damage.

Vitamin B12 supplements or injections may help to treat peripheral neuropathy whether or not deficiency is present, because of the important role it plays in the protection and function of nerve cells. 

The Role of B12 in Nerve Pain

Nerve pain is a common symptom of peripheral neuropathy. Supplementing with vitamin B12 may help to reduce nerve pain and prevent it from recurring.

B12 helps to build and restore the protective myelin sheath around nerve cells, which can then lead to reduced pain, tingling, and other symptoms. Vitamin B12 also plays a role in nerve regeneration, which can help to rebuild healthier nervous system function.

A number of studies have reported reduced nerve pain among those taking vitamin B12 supplements for peripheral neuropathy.

Can B12 Help With Neuropathy in the Feet?

Neuropathy symptoms can affect different parts of the body, but most commonly the pain, tingling, and numbness associated with peripheral neuropathy show up in the hands, the feet, or both.

Neuropathy in the feet can be particularly disruptive for many, often making standing and walking difficult or painful. In advanced cases, neuropathy that affects the feet can lead to complications including infections in the area, a loss of feeling, or foot ulcers. For those with diabetic neuropathy, this is sometimes referred to as the “diabetic foot”.

Can B12 help with neuropathy in the feet? Studies on vitamin B12 treatment for neuropathy don’t tend to separate out the effects on feet compared to hands compared to other parts of the body, as the area of target is really the peripheral nervous system as a whole.

Studies have shown benefits for neuropathy in general when using B12, and we can apply these findings to neuropathy in the feet. One double-blind, controlled clinical trial involving patients with diabetic neuropathy found that, in addition to improving pain and quality of life, B12 supplementation improved sudomotor function feet, which is an important factor in the prevention of “diabetic foot”.

How B12 May Help With Nerve Damage and Regeneration

One of the major benefits of vitamin B12 when compared to many other treatments for neuropathy is that, beyond just treating symptoms, B12 can actually help to repair damage and regenerate nerves.

Vitamin B12 is most likely to be able to restore nerve damage in neuropathy cases that are caught earlier or are less advanced. Combining B12 with other B vitamins, particularly B1 (thiamine) and B6 (pyridoxine), may help to enhance nerve regeneration.

When it comes to neuropathy resulting from nerve injury, supplementing with vitamin B12 combined with additional B vitamins may help to speed up the regeneration of nerves, especially when done as soon as possible following the injury.

What is the Best Way to Boost B12 Levels?

There are a few different ways to approach vitamin B12 treatment. While increasing your intake of B12-containing foods can be helpful, if you’re using B12 to help treat neuropathy, diet alone may not be sufficient.

Oral B12 supplements work well for many people, and can be purchased at your local health food store or pharmacy, or online.

The most efficient and potent vitamin B12 treatment option is usually thought to be intramuscular injection. This is necessary for many people who have impaired absorption (due to low stomach acid, a digestive disorder, or medication use, for example).

Even for those without impaired absorption, B12 may be made available to the body more easily when injected rather than being taken orally. However, some studies have also found that the two forms are comparable.

If you’re interested in incorporating additional B vitamins into your routine for more nervous system support, a B complex taken as an oral supplement is generally a good option.

What to Expect for B12 Dosage

The dose of oral B12 for peripheral neuropathy can range between 500 and 2000 mcg per day, depending on an individual’s actual B12 levels and the severity of their condition. Always speak with a practitioner to help determine the best dose for you.

B12 injections for neuropathy are generally given in doses of between 500 and 1000 mcg, and may be done anywhere from daily to biweekly or monthly, again depending on the individual case. In some cases, a protocol may involve starting with injections daily or every other day, and then decreasing to weekly, biweekly, or monthly for maintenance.

When taken as recommended, side effects of oral B12 are rare and usually mild. Side effects may be more common with injected B12, and can include pain at the injection site, dizziness, vomiting, diarrhea, or headache. In rare cases, more serious side effects, including pulmonary edema or anaphylaxis, may occur.

How Much Do B12 Supplements Cost?

Oral B12 supplements are readily available and usually inexpensive, with a 30-60 day supply generally running somewhere between $5 and $30 in the US.

Injections are more expensive in comparison, and may cost between $20 and $80 per dose without insurance. In many cases, particularly with a documented vitamin B12 deficiency, insurance will cover some or all of the cost of B12 injections.

How to Start B12 Treatment

The first step is to speak with your practitioner about whether B12 is a good fit for you. They will likely run a test or two to see what your current B12 levels are. Then, based on your condition and other factors, they can help you to determine whether supplements or injections are most suitable for you, and establish a good starting dose. 

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