Vitamin B12
“The Myelin & Methylation Vitamin.” The nutrient we use to restore neurological ‘wiring’ and methylation throughput when fatigue and nerve symptoms point to an absorption or demand problem.
The Naturopathic Perspective
“The Quiet Essential.”
Vitamin B12 is one of those “quiet essentials” that becomes obvious only when it’s missing. In naturopathic practice, we think of B12 as a foundational nutrient for nerve integrity and clean energy metabolism—not as a stimulant. Clinically, B12 sits at the intersection of neurology (myelin maintenance) and blood building (DNA synthesis for red blood cells).
When B12 is inadequate, the body can’t run two key enzyme systems efficiently (methionine synthase and methylmalonyl-CoA mutase), which is why deficiency looks like a mixed picture: fatigue, brain fog, mood change, and tingling/neuropathy. Root-cause wise, B12 problems are often less about “not eating enough” and more about not absorbing enough (low stomach acid, intrinsic factor issues, or gut inflammation).
💡 Clinical Insight: The Depletion Gap
Why is there a gap between intake and status?
1. Medication Impact: Long-term PPIs/H2 blockers reduce acid, impairing the release and absorption of food-bound B12.
2. The Metformin Effect: Metformin is consistently associated with lower B12 status, especially with higher dose and longer duration.
“We prescribe this when digestion or medication blocks natural absorption.”
Naturopathic Use Cases
How we use this in clinical practice, validated by evidence.
1. B12 Deficiency Correction
Clinical Goal: Restore Myelin & RBCs
The Clinical Logic:
We reach for B12 when signs suggest impaired DNA synthesis (macrocytosis) or impaired myelin maintenance (neuropathy). Mechanistically, restoring B12 supports methionine synthase activity (methylation) and methylmalonyl-CoA mutase activity (preventing MMA accumulation).
This directly maps to the clinical picture of “blood + nerves”—correcting fatigue, cognitive fog, and paresthesia.
Very High
Grade A
Verdict: Validated. Reliably corrects biochemical deficiency and improves haematologic abnormalities. High-dose oral therapy (1000–2000 mcg) is effective via passive diffusion even without intrinsic factor.
2. Diabetic Peripheral Neuropathy
Clinical Goal: Neurotrophic Support
The Clinical Logic:
In neuropathy, B12 is used as a neurotrophic support to normalize the environment for myelin maintenance and repair signaling.
It also addresses a common contributor—metformin-associated B12 lowering—that can worsen neuropathic vulnerability over time.
Moderate
Grade B
Verdict: Clinical trials suggest B12 (often methylcobalamin) can improve neuropathic symptoms and pain scores. Best positioned as an adjunct, especially when deficiency risk is present.
3. Methylation & Biological Function
Clinical Goal: One-Carbon Metabolism
The Clinical Logic:
B12 is an essential cofactor for methionine synthase (supporting methylation and homocysteine processing) and methylmalonyl-CoA mutase (mitochondrial metabolism). These functions underpin myelin maintenance and normal blood cell development.
Incontestable
Grade A+
Verdict: Established biological fact.
Form Matters: Quality Comparison
Why we prescribe Methylcobalamin over other forms.
The “Active Coenzyme” Advantage
We prioritize Methylcobalamin because it is a biologically active coenzyme form used directly in methylation pathways. It is clinically preferred for neurological presentations, and high oral doses allow for absorption via passive diffusion even when digestion is compromised.
Food First Philosophy
We prefer food sources, but absorption barriers often necessitate supplementation.
Clams (Cooked)
~84 mcg per 3 oz
Beef Liver
~70 mcg per 3 oz
Fortified Cereal
~6 mcg (Varies)
Salmon
~4.8 mcg per 3 oz
📚 Clinical References & Evidence
-
Deficiency & Oral Treatment:
“Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency.” Cochrane Review (2018).
[Read Source] -
Diabetic Neuropathy:
Yaqub, B.A., et al. (1992). “Effects of methylcobalamin on diabetic neuropathy.” Clinical Neurology and Neurosurgery.
[Read Source] -
General Pharmacology:
“Vitamin B12 – Health Professional Fact Sheet.” Office of Dietary Supplements.
[Read Source]
*Disclaimer: Links connect to third-party scientific repositories. Access may require institutional login for some journals.
📋 Dosage & Safety Guidelines
1-2 mg
1000-2000 mcg Daily (Oral Correction).
- Folate (5-MTHF): Partners in one-carbon metabolism.
- Vitamin B6: Complements homocysteine handling.
- Depletions: Watch for Metformin & PPI use.
Unsure if this is right for you?
Supplements work best when tailored to your individual biochemistry.