Vitamin Therapy

Vitamin B12

If you are considering having a Vitamin B12 treatment, we recommend that you read the following information. This will help you to be fully prepared and know what questions to ask.

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What are Vitamins?

Vitamins are essential micronutrients required in trace quantities for normal growth and development and to ensure normal body functioning.

Essential nutrients cannot be synthesised by the body in sufficient quantities and must be taken in via a healthy diet. Their impact on the body’s health is critical and deficiencies of these micronutrients can have severe and even life-threatening effects on the body.

Vitamins B are water soluble:

These vitamins are soluble in water and some of these are not easily stored within the body, requiring a constant source from the diet. They include Vitamin C (Ascorbic acid), Thiamin (B1), Riboflavin (B2), Niacin (B3), Pantothenic acid (B5), Pyridoxine (B6), Biotin (B7), Folic acid (B9) and Cobalamin (B12).

What is Vitamin B12 and what does it do?

Vitamin B12 is one of the water-soluble vitamins and available as an intramuscular injectable medication called Hydroxocobalamin. Vitamin B12 is required to help your body to use fat and carbohydrate for energy and it also helps to make protein and DNA. It is an essential vitamin to help maintain blood, nerve cells and neurological function.

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Vitamin B12 is only found naturally in animal products and dietary sources include:

Liver, fish, meat, eggs, dairy products, yeast extract (such as marmite) and foods that have been fortified with B12. Although there are different medications of Vitamin B12, the World Health Organisation recommends the use of hydroxocobalamin as it remains in the body longer than other formulations, which means less treatments over time. Injected B12 begins to work immediately, but it can take days or weeks to feel the benefit.

Brain Function

Low levels of Vitamin B12 have been linked to decline in brain function and recent evidence suggests there is also a link with dementia. However, there is no evidence to suggest brain function can be improved in people with normal Vitamin B12 levels.

Osteoporosis (Brittle bones)

There is a link between low levels of B12 and reduced bone mass, increasing the risk of fractures.

Depression

It has been suggested that low levels of Vitamin B12 is associated with depression and long term treatment with B12 may reduce recurrence and severity of depression.

Energy, weight loss and mood

There is a link between low levels of Vitamin B12 and reduced energy levels and concentration and a reduced metabolism.

Vitamin B12 deficiency is relatively common, and the main causes of deficiency include:

✓ Pernicious anaemia (a medical condition where your own immune system attacks healthy cells in the stomach, preventing the absorption of Vitamin B12)

✓ Vegan and Vegetarian diets

✓ Episodes of extreme dieting or a poor diet over a long time

✓ People taking certain medications, including metformin, anti-convulsants, and antacids

✓ Previous bowel surgery or medical conditions affecting the bowel

✓ Increasing age

✓ Risk factors also include smoking and alcohol excess

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How does the body absorb and store Vitamin B12?

The absorption of Vitamin B12 from the diet begins within the mouth, where proteins within the saliva attach to the vitamin to prevent it from being destroyed by the acid in the stomach. Specialised cells (parietal cells) within the stomach produce a substance called intrinsic factor, which binds to Vitamin B12 enabling it to be absorbed within the small intestines. Once it enters the blood stream, it can be reabsorbed along with bile to be stored for a long time in the liver (60%) or within muscle (30%) until it is required. Anything that interferes with this process can lead to low levels of Vitamin B12 within the body.

Is the injection painful?

Vitamin B12 is injected using a fine needle, usually into the muscle at the top of the arm. As with any injection, it can sting and cause a slight burning sensation when it is administered. It can also cause some discomfort and throbbing in the area for a few hours or days afterwards.

If the injection is very painful, you should inform your treating practitioner.

Is it safe?

Yes, it is a commonly used worldwide, any concerns discuss with your practitioner, the risks are very low.

You should not have B12 injections if:

✓ You have an allergy to hydroxocobalamin or any of its ingredients.

✓ You have low potassium levels or medication that may reduce your potassium.

✓ You have other deficiencies, including folic acid or iron.

✓ You have a blood disorder.

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Side Effects

Generally, side-effects are uncommon, often mild, and usually resolve within a few days of treatment. You may experience some pain, itching, redness or swelling at the injection site. This will usually settle quite quickly without any intervention, however, if you experience any prolonged side-effects, it is important to contact your practitioner/GP for a review. Bruising is uncommon, but if it does occur, it may take up to 2 weeks to fully resolve.

We do not recommend that treatments are performed in a non-clinical environment.

Possible side-effects include:

If vomiting and diarrhoea are more severe, this can affect the oral contraceptive pill and additional precautions will be required.

Rarely, adverse effects can be serious and include:


Signs and symptoms of a serious allergy may include a rash, wheezing, difficulty in breathing, tight chest or throat, trouble speaking and swelling of the mouth, face, lips, tongue and/or throat. If you experience any of these, you must ring 999 immediately.

What does the procedure involve?

Prior to treatment, you should complete a medical history with your practitioner, you should also receive all the relevant information you need to make an informed decision about whether to go ahead with treatment or not, as well as possible side-effects specific to your treatment and costs involved.

Before treatment, you should be given the opportunity to have any further questions answered and sign a consent form, either printed or electronically produced. The practitioner will examine the treatment area to determine the most appropriate injection sites and dosage required for optimum results.

The area for injection will most likely be at the top of your arm into the muscle, it is usual to use the non-dominant arm. The area will be inspected to find the best place for injection. Some practitioners may disinfect the skin prior to injection, but this is not a requirement. The skin will be gentle pinched prior to treatment and the actual injection can cause a stinging or burning sensation that can vary in intensity. Some people find that it is quite painful, whereas most just experience a mild stinging. The actual injection will last for a few seconds only.

Following the procedure, your skin may be cleaned again, or gentle pressure applied if there had been some bleeding at the site.

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You will be asked to remain for 15 minutes after your injection to allow time for you to recover and for the practitioner to ensure that you do not have a reaction to the injection. If you are due to have a series of injections, you will then be able to schedule your next appointment. For maintenance.

If you develop any unexpected side-effect after treatment, it is important to contact your practitioner as soon as possible, who may be able to offer advice or corrective treatment.

Vitamin B12 injections may be administered every 6 to 12 weeks. Your practitioner will record the batch number, expiry, and site of injection on your treatment record and will provide you with appropriate verbal and/or written aftercare.

Am I suitable for treatment? Most people are suitable for Vitamin B12 injections, although it is recommended that you have your B12, folate, iron and potassium levels checked prior to commencing treatment. If you have very low levels of B12, this should be investigated further by your General Practitioner.

You may not be suitable for treatment if any of the following apply:

✓ If you are under the age of 18 years.

✓ If you are pregnant or breast-feeding.

✓ Previous allergy to hydroxocobalamin.

✓ If you have kidney problems or previously low potassium levels.

✓ If you have other deficiencies such as folic acid or iron.

✓ If you have any blood disorders.

✓ If you have a severe needle phobia.

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Pre-treatment advice

If you have never previously had a Vitamin B12 injection, it is important to allow 15 minutes for observation.It is important to be honest about your medical history, and any medication taken, so that you can have a safe and effective treatment.

Post-treatment advice

After treatment, most people can resume their normal daily activities. Immediately after treatment, there may be some discomfort, redness, and minor swelling at the injection site, which should settle in time. If you develop any bruising, which may be apparent at the time of treatment, it is usually minor and settles within a few days. Occasionally, more significant bruising can occur. Rarely, you may develop a headache after treatment which can last a few days. Simple analgesia can be taken for this if needed.

Many practitioners advise the following

✓ Try to avoid touching or rubbing the area of injection.

✓ Avoid heavy exercise and over-use of the injected muscle for 24 hours.

✓ If you develop any diarrhoea, ensure you maintain good hydration by increasing fluid intake.

✓ Contact your practitioner if you experience any unwanted side-effects.

Vitamin D

Getting enough vitamin D is crucial for healthy bones and teeth, deficiency in children can lead to a condition called rickets, where the bones are weak, then soften, this leads to bone deformity (with bowlegs). In adults, even low levels of vitamin D can increase your risk of osteoporosis, or thinning of the bones. This along with our aging process in the decline of bone protective hormones can increase the risk of breaking a bone.

Improving muscle strength.

Keeping your immune system strong, helping to fight off infections.

Protecting you against certain cancers.

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Reducing your risk of falls.

Helping to stave off depression and low mood.

Keeping your energy levels up.

How much vitamin D do I need?

Vitamin D is sometimes known as the ‘sunshine vitamin’: The natural type of vitamin D is produced in your skin when you’re exposed to sunlight, and we should get 80% of our Vitamin requirement this way.

However, in the UK, sunshine isn’t strong enough to allow you to make your own vitamin D especially in the winter. So it’s now recommended that everyone over 1 year old take 10 micrograms (400 International Units) a day from October to March.

Certain groups of people are at higher risk of low vitamin D, and will require all year-round replacement:

  • Are pregnant or breastfeeding.
  • Are aged 1-4 years.
  • Are over 65 (older adults are less efficient at producing vitamin D).
  • Have little exposure to sunlight, because you:
    • Are housebound/confined indoors for long periods.
    • Cover your skin for cultural reasons.
  • Have darker skin, because your body is not able to make as much vitamin D from sunlight.
  • There are certain medical conditions, that you GP or specialist services may recommend that you take a replacement all year round i.e. certain gut (bowel), kidney or liver diseases.
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How to get vitamin D

Vitamin D comes from sunlight and even for fair skin and winter months we should still be outside enough. The sunlight must fall directly on to bare skin (through a window is not enough). Too much exposure to the sun’s rays can be damaging i.e. Sunburn can increase the risk of skin cancer. You can also get some Vitamin D from foods that either contain it naturally or have it added to them. Or take replacement therapy.

Vitamin D deficiency symptoms

Many people have no vitamin D deficiency symptoms or may experience vague symptoms such as tiredness or general aches, due to this Vitamin D deficiency is often missed. The diagnosis is more easily recognised in severe deficiency with some of the classical (typical) symptoms and bone deformities.

Vitamin D deficiency symptoms in adults

  • General tiredness, vague aches and pains and a general sense of not being well.
  • In more severe deficiency (known as osteomalacia), there may be more severe pain and weakness in bones and muscles (the latter is noticed when experiencing difficulty in climbing stairs or getting up from the floor or a low chair or having a waddling gait when walking.
  • Bones can be painful to moderate pressure often more noticeable in the ribs or shin bones, but it is not uncommon for people to have a hairline fracture in the bone which is causing tenderness and pain. Other areas that bone pain often occurs is the lower back, hips, pelvis, thighs, and feet.
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Who gets vitamin D deficiency?

This can occur for various reasons:

  • People who get very little sunlight on their skin are at risk of vitamin D deficiency. This is more of a problem in the more northerly parts of the world (including the UK) where there is less sun. In particular:
    • People who stay inside a lot. For example, those in hospital for a long time, or housebound people.
    • People who cover up a lot of their body when outside.
    • The strict use of sunscreen may increase the risk of vitamin D deficiency, particularly if high sun protection factor (SPF) creams (factor 15 or above) are used. However, there is no evidence that the normal use of sunscreen does cause vitamin D deficiency in real life. Everyone, should always be protected from the harmful effect of the sun’s rays.

 

  • Elderly people are unable to produce as much vitamin D. This leaves older people more at risk of vitamin D deficiency.
  • People who have darker skin are not able to make as much vitamin D.
  • Some medical conditions can affect the way the body handles vitamin D. People with Crohn’s diseasecoeliac disease, and some types of liver and kidney disease, are all at risk of vitamin D deficiency.
  • Rarely, some people without any other risk factors or diseases become deficient in vitamin D. It is not clear why this occurs. It may be due to a subtle metabolic problem in the way vitamin D is made or absorbed. So, even some otherwise healthy, fair-skinned people who get enough sun exposure can become deficient in vitamin D.
  • Vitamin D deficiency can also occur in people taking certain medicines, i.e. carbamazepinephenytoinprimidone, barbiturates and some anti-HIV medicines.
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Not enough dietary vitamin D

Vitamin D deficiency is more likely to occur in people who follow a strict vegetarian or vegan diet, or a non-fish-eating diet.

Procedure

This is given intramuscular in the upper outer quadrant of buttock (the Dorsogluteal) at 300,000units given every 6 months, ideal with some evidence of Vitamin D deficiency. Ideally a calcium and kidney function should have been undertaken recently and are in the normal levels, discuss this with your practitioner.

How common is vitamin D deficiency?

A lack of vitamin D is very common. One survey in the UK showed that about 1 in 5 adults and about 1 in 5 children in the UK have low vitamin D levels. More people have low vitamin D levels in the winter and spring because of less exposure to sunlight.

Vitamin C

Vitamin C Injections deliver pure vitamin C directly into the bloodstream via an intramuscular (IM) injection. Regular Vitamin C Injections can enhance physical wellbeing and prevent the onset of illness, this is because vitamin C is a natural antioxidant that protects the body against the effects of harmful agents.

Symptoms of Vitamin C deficiency

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What are the benefits of a Vitamin C injection?

Vitamin C has numerous health and wellness benefits and should be an important part of any diet.

Vitamin C is said to help prevent you from catching a cold, in reality this is not the case, but studies have found that Vitamin C does help you fight a cold, and also helps in preventing serious complications that can be connected with the common cold.

Stress is a familiar enemy for most of us. Sometimes work, family, and other commitments can lead to feeling overwhelmed and stressed out. Vitamin C will not necessarily make you less stressed but will help your body remain healthy even under extreme duress by keeping your immune system strong even during times of stress.

A recent study found that Vitamin C lowers the risk of having a Stroke, though the findings are not published, but still an intriguing possible benefit of Vitamin C.

Other benefits linked with Vitamin C replacement is healthier and younger, looking skin. High dosages of Vitamin C have been found to lead to a lower likelihood of dry skin and wrinkles and in general those with a high amount of Vitamin C have better more youthful skin.

Vitamin C(Ascorbic acid) is a powerful antioxidant, that is needed for your body tissue to survive and thrive. It is also a very powerful antioxidant that can protect your body from harmful free radicals. Free radicals can lead to cancer, heart disease and arthritis, so in essence Vitamin C can help prevent these.

Vitamin C is available in food, though their effects will not be as strong as when receiving a Vitamin C injection.

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How often can Vitamin C injections be given?

For treating vitamin C deficiency, the typical vitamin C injection dose is 200 mg once daily for up to a week, then periodically. If for wound healing, the typical vitamin C injection dose is 1 gram once daily for 5 to 21 days.

Doses may be given daily or periodically at different intervals, this will be dependent on the consultation.

Side Effects following Vitamin C injection:

Vitamin C injections are completely safe, the most common side effects are pain and swelling at the injection site, in rare cases people may feel slightly nauseous.

Precautions:

If you’re thinking about getting high doses of vitamin C through injection, talk with your practitioner about the potential risks.

Vitamin C increases iron absorption from the food you eat. If you take very high doses of vitamin C, your body might absorb too much iron. This could be a potential problem if you already have high levels of iron in your body.

If you have kidney disease, very high doses of vitamin C might result in kidney damage.

High-dose vitamin C injections might increase your chance of developing a kidney stone. People who’ve had kidney stones in the past may have a greater risk.

When any injection is given, there is also risk for infection.

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Vitamin C can interact with some other medications:

Vitamin C can make your urine more acidic. In some cases, this can change how your body gets rid of certain medication. This in turn can change levels of some medications in your body and result in decreased effectiveness or increased side effects. Some of these medications include:

  • fluphenazine (Prolixin)
  • magnesium salicylate (Novasal)
  • mexiletine (Mexitil)
  • salsalate

There is some concern that high-dose vitamin C might make radiation therapy and some chemotherapy drugs less effective. However, this is controversial, and more evidence is needed.

If you’re taking other medications or being treated for cancer, talk with your practitioner before taking high-dose vitamin C injections.