How can Vitamin B12 improve your Fibromyalgia

     Fibromyalgia is a condition that causes pain all over the body (also referred to as widespread pain), sleep problems, fatigue, and often emotional and mental distress. People with fibromyalgia may be more sensitive to pain than people without fibromyalgia. (1)

Fibromyalgia affects millions of adults around the world and while the condition is still not known, it is normally stated that it is currently effectively treated and managed.

In my experience with patients that have been diagnosed with fibromyalgia or hinted by their doctors that they suspect this condition, most of them feel they have not been properly diagnosed or given many options of treatment. The reason for this is sometimes doctors lack interpreting patterns or crucial details in a patient’s history or lab results that are mistakenly overlooked. One of them is Vitamin B12 deficiency.

What is Vitamin B12 and why do we need it? 

Vitamin B12 is a water-soluble vitamin. That means our body cannot store it, unlike other vitamins like Vitamin A, D, E and K. Since it cannot be stored, we need to consume it regularly, almost every day, to obtain its benefits. Vitamin B12 can only be found in animal products. Anyone that is on a strict plant-based diet, like vegans, are in more risk of vitamin B12 deficiency.

Vitamin B12 plays a role in forming red blood cells, have a functioning nervous system, and the production of DNA. It is also involved in the production of hormones, proteins, and fats. Its deficiency leads to many symptoms that can last for several years before entering its final stage, which is a type of anemia.

To ensure optimum levels, we can now try supplementing. We can still find foods rich in vitamin B12 but when facing conditions or diseases that could have been caused due to intermediate or low levels, it is best to supplement for some time until having improvement of symptoms. Many patients find a good balance from supplementing and eating foods rich in vitamin B12. (2)

Is vitamin B12 deficiency common?

Vitamin B12 deficiency is very common, and it is significantly underdiagnosed. Studies have shown that vitamin B12 deficiency can be associated with brain fog, heart disease, autoimmune diseases, and several other conditions. One article from the Mayo clinic stated: ‘’Symptoms related to vitamin B12 deficiency may be diverse and vary from neurologic to psychiatric.’’ They also wrote that: ‘’In clinical practice, many cases of vitamin B12 deficiencies are overlooked or sometimes even misdiagnosed.’’ (3). The reason it is being misdiagnosed and underdiagnosed is that conventional testing is not reliable. Many patients I’ve seen have never been tested or just used a conventional marker like, vitamin B12 serum. In conventional medicine, we only look for very deficient levels. Using advanced testing can determine if someone has below optimal or intermediate levels, especially when they are starting to have symptoms. Its important for an early diagnosis to prevent irreversible neurological injury.

Why is it common?

Vitamin B12 deficiency is common because there can be many reasons that can prevent vitamin B12 from being absorbed. Some of these are:       

• Leaky gut and inflammation: our intestinal barrier protect us from viruses, bacteria and parasites from entering our body and at the same time, it allows for nutrients to enter our blood stream. Any infections, inflammation from a bad diet, side effects of medications or toxins from heavy metals can upset this balance.

•        Intestinal dysbiosis:  having a health gut flora is commonly overlooked. Having insufficient beneficial bacteria and increased harmful bacteria can cause issues with the nutrients we absorb.

•     Pernicious anemia: an autoimmune disease that attacks a protein called intrinsic factor that allows our gut to absorb vitamin B12.

•         Atrophic gastritis: stomach acid is needed to digest foods and absorb adequately. As we age, our acid production declines and therefore, may cause issues like heartburn and GERD, leading to digestive issues as well.

•       Medications: the abuse of medications from over the counter or prescribed by doctors can lead to problems with our absorption. For example, acid suppressing drugs.

•         Alcohol intake: abuse can cause gut inflammation and problems with absorption.

 What are the symptoms for Vitamin B12 deficiency?

Some of the most common vitamin B12 deficiencies symptoms are:

•           Depression

•          Tingling or numbness in extremities

•          Cognitive decline

•          Fatigue

•          Anemia

•          Constipation

•          Imbalance

Not all these symptoms will show up at the same time since there are 4 stages to vitamin B12 deficiency. The progression is slow before it gets to its final stage which is a macrocytic anemia with irreversible neurological injury.

What is the link between fibromyalgia and vitamin B12 deficiency?

Vitamin B12 plays an important role in the normal function of the brain and the nervous system. We have always known that vitamin B12 can boost the function of our immune system and how important it is for a person’s overall health.

There has been some research that indicates how treatment with replenishing vitamin B12 levels improves symptoms for patients with fibromyalgia and chronic fatigue. One article had shown that Dose-response relationship and long-lasting effects of B12/folic acid support a true positive response in the studied group of patients with Myalgic encephalomyelitis/fibromyalgia. (4)

 These are 2 conditions that have been commonly found together in these patients. Many people with fibromyalgia have stated to suffer from fatigue, and people with chronic fatigue have also suffered from widespread and persistent pain. Research suggests that these are manifestations of the same underlying condition.

One of the underlying conditions could be, sustained low or intermediate levels of vitamin B12. We have not studied enough how this would affect our nervous system and the potential symptoms it could cause.

How to treat?

As always, it would depend on the underlying cause of the problem. For example, if the patient has a condition in their gut preventing its absorption and its irreversible, they could opt for supplementing with injections, high dose oral or nasal administration. (54) Diet would always need to be changed. There might be certain changes on focusing on whole nutritious vitamin B12 rich foods.  Nourishing your body through whole food is the best way to get the vitamins and nutrients you need. That might be one of the biggest challenges since the type of foods that are rich on B12 are not popular or not easily available depending on the region you live, for example: Liver, clams, organ meats, oysters, and shellfish. Most seafood has high levels of vitamin B12 but if they are not available or not to your liking, you can also attain them from: eggs, cheese, beef and lamb. It is important to note, though, that the amount of B12 in these foods is nowhere near as high as the levels in shellfish and organ meats. 

What is the first step?

It is not easy to know if you are vitamin B12 deficient, but if you are experiencing any of the symptoms and you suspect you have vitamin B12 deficiency, it is important to get tested. It would be highly recommended to seek out a trained physician that understands how to test for vitamin B12 levels. If you are truly vitamin B12 deficient, the next step would be to find the reason that is causing the deficiency. Once that has been identified, we would treat and then provide adequate supplementation dosage, type, and length of treatment. We can then monitor improvement and retest to check vitamin B12 levels.

If you feel you are having any of these symptoms and have not been tested for vitamin B12 levels, make sure get tested. It could be a life changer.

References:

1.       Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management. Firdous Jahan, Kashmira Nanji, Waris Qidwai, and Rizwan Qasim. Oman Med J. 2012 May; 27(3): 192–195.doi: 10.5001/omj.2012.44

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/

2.       Staging vitamin B−12 (cobalamin) status in vegetarians. The American Journal of Clinical Nutrition, Volume 59, Issue 5, May 1994, Pages 1213S–1222S, https://doi.org/10.1093/ajcn/59.5.1213S

https://academic.oup.com/ajcn/article-abstract/59/5/1213S/4732588?ijkey=77e5a63f507da9471488ebd76ea600c85cbbb660&keytype2=tf_ipsecsha

3.       The Many Faces of Cobalamin (Vitamin B 12) Deficiency. Bruce H R Wolffenbuttel, Hanneke J C M Wouters, M Rebecca Heiner-Fokkema, Melanie M van der Klauw.

Mayo Clin Proc Innov Qual Outcomes. 2019 May 27;3(2):200-214. doi:10.1016/j.mayocpiqo.2019.03.002. eCollection 2019 Jun.

https://pubmed.ncbi.nlm.nih.gov/31193945/

4.       Response to vitamin B12 and folic acid in myalgic encephalomyelitis and fibromyalgia. Björn Regland, Sara Forsmark, Lena Halaouate, Michael Matousek, Birgitta Peilot , Olof Zachrisson, Carl-Gerhard Gottfries. 2015 Apr 22;10(4):e0124648. doi: 10.1371/journal.pone.0124648. eCollection 2015.

https://pubmed.ncbi.nlm.nih.gov/25902009/)

5.       Vitamin B12 metabolism and massive-dose methyl vitamin B12 therapy in Japanese patients with multiple sclerosis. Intern Med. 1994 Feb;33(2):82-6. doi: 10.2169/internalmedicine.33.82

https://pubmed.ncbi.nlm.nih.gov/8019047/