Protocol · Nutritional Deficiency
Vitamin B12 Deficiency Treatment Protocol
Vitamin B12 (Methylcobalamin or Cyanocobalamin) is the core of this stack, with 4 supporting supplements. Each row gives the amount the protocol lists and the grade our evidence database holds for that supplement in Vitamin B12 Deficiency Treatment.
We are re-verifying the studies cited on protocol pages; only confirmed citations are shown.
The stack
5 supplements · 1 graded · 1 confirmed study
| Grade | Supplement | Amount listed | Why it’s in the stack | Evidence on file | Shop |
|---|---|---|---|---|---|
| Primary stackThe core of this protocol | |||||
| Vitamin B12 (Methylcobalamin or Cyanocobalamin) | Amount listed: 1,000–2,000 mcg daily oral for mild deficiency; injections for severe or malabsorption | Direct treatment for deficiency; methylcobalamin is active form; cyanocobalamin commonly used
| Grade D for Cognition2,912 people | ||
Confirmed studies for Vitamin B12 (Methylcobalamin or Cyanocobalamin) (titles as PubMed lists them) | |||||
| Supporting stackListed as additions to the core | |||||
| Folate | Amount listed: 400–1,000 mcg methylfolate daily | Works with B12 in methylation; often co-deficient; needed for full recovery | Not graded yet | ||
| Iron | Amount listed: Only if ferritin also low; dose based on deficiency level | Often co-deficient; both needed for red blood cell production | Not graded yet | ||
| B-Complex Vitamins | Amount listed: B-complex with methylated B vitamins daily | B vitamins work synergistically; supports overall nervous system recovery | Not graded yet | ||
| Betaine (TMG) | Amount listed: 500–1,000 mg daily | Alternative methyl donor; may help with homocysteine metabolism when B12 is low | Not graded yet | ||
Shop this protocol
Each opens third-party tested products, matched to the dose above where we can.
- Grade D
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How this protocol works
In plain language
Vitamin B12 is essential for nervous system function, DNA synthesis, and red blood cell formation. Deficiency is common, affecting 6-20% of adults, and can cause serious neurological and hematological problems if untreated.
CAUSES OF B12 DEFICIENCY:
- Pernicious anemia: Autoimmune destruction of intrinsic factor
- Malabsorption: Gastric bypass, Crohn's disease, celiac disease
- Medications: Metformin, PPIs, H2 blockers
- Diet: Strict vegan/vegetarian without supplementation
- Age: Reduced absorption in elderly
- Alcoholism
SYMPTOMS:
- Neurological: Numbness/tingling, balance problems, memory issues, depression
- Hematological: Fatigue, weakness, shortness of breath (anemia)
- Other: Glossitis (smooth tongue), pale skin, palpitations
CRITICAL: Severe B12 deficiency can cause irreversible neurological damage. Early treatment is essential.
DIAGNOSIS:
- Serum B12 level (<200 pg/mL is deficient, 200-300 borderline)
- Methylmalonic acid (MMA) - elevated with B12 deficiency
- Homocysteine - elevated with B12 and/or folate deficiency
- Complete blood count (macrocytic anemia)
TREATMENT:
- Mild deficiency (oral): 1000-2000mcg daily oral
- Severe/malabsorption (injection): 1000mcg IM daily for 1 week, then weekly for 1 month, then monthly
- Pernicious anemia: Lifelong injections or high-dose oral
Methylcobalamin* is the active form; cyanocobalamin also effective.
Folate* should be co-supplemented; both work together.
DO NOT supplement folate alone* without B12 - it can mask B12 deficiency and worsen neurological damage.
Expected timeline: Hematological improvement within 1-2 weeks. Neurological symptoms may take months to improve, and some damage may be permanent if treatment delayed.