Do You Need B12 Shots For Neuropathy

Another post from kevinmd.com (see link below) today and an interesting one for neuropathy patients too. Many people living with neuropathy either take in extra vitamin B12 because they choose to, or take it because it has been proved that their B12 levels are low. A lack of B12 can be responsible for neuropathic symptoms. However, there are pitfalls, especially when it comes to clinics charging high prices for B12 injections, as is highlighted below. It is important to note that this article is opinion-based and although the author is clearly medically qualified, he doesn't have a very positive view of alternative treatments. Not that B12 supplementation is in any way 'alternative' but it is a supplement and thus is mostly not prescribed by a doctor. The article is worth reading if only to start you off on further research of your own and on several issues he may well have a point.

Behind the fetish of vitamin B12 shots

ROY BENAROCH, MD | FEBRUARY 3, 2013

Medicines and other treatments need to be tested. We want reliable proof that something works and is safe before we recommend it. We don’t like the false dichotomyof “alternative medicine”. If there is good evidence that it works, it’s medicine. If it doesn’t work, it’s quackery.

It doesn’t matter who’s doing the quacking. A quack is a quack, even if there’s a medical diploma on the wall.

The story: a woman brings in her teenage daughter, complaining that the girl is tired a lot. It turns out that mom herself has had some blood tests that showed a low vitamin B12 level, so her doctor is giving her regular B12 injections. Can her daughter get some, too?

I realize that B12 injections are common. Many docs administer these, and many adults get these—probably some of you reading this. So what’s the science behind this practice?

Vitamin B12 deficiency is a real thing. It can occur because of a poor diet, or because some medications (like acid blockers) interfere with absorption. Or it can occur because of a specific autoimmune disorder called “Pernicious Anemia.” Whatever the cause, the health consequences of vitamin B12 deficiency can include anemia, neuropathy, irritability, and depression.

There is a simple blood test to measure vitamin B12 levels, though the levels in the blood don’t always correlate with whether there is enough B12 levels in the cells themselves. We can test for this, too, indirectly, through other blood tests including methylmalonic acid and homocysteine levels. So we can, in fact, know if a person is truly deficient. These confirmatory tests are rarely done.

Instead, many adults are told that their vague symptoms of tiredness or fatigue are caused by B12 deficiency, instead of actually trying to address genuine issues like insufficient sleep, sleep apnea, overreliance on caffeine, and depression (to name a few of the many genuine causes of fatigue.)

It gets worse. The treatment of B12 deficiency, as has been established from studies done in the 1960s, is ORAL B12. That’s right. Pills. Injections of B12 are not necessary—oral supplements work well, even in pernicious anemia. They’re cheap and they work. I suppose a very rare patient, say one who has surgically lost most of their gut, could require injections. But the vast majority of people with genuine B12 deficiency can get all of the B12 they need through eating foods or swallowing supplements. No needles needed.

So why this fetish with injections? From the patient’s point of view, shots feel more like something important is going on. Placebos need rituals—with acupuncture, for instance, the elaborate ritual creates an illusion of effectiveness. And from the doctor’s point of view, injections reinforce dependence on the physician, creating visits and cash flow.

So: people seem to think they feel better with injections, and the doctor makes a little cash, and everyone’s happy. So what’s the harm in that?

I think it’s wrong to knowingly dispense placebos, even harmless ones. We doctors like to criticize the chiropractors and homeopaths. We point fingers. They’re the quacks. We’d better take a close look at what we’re doing, first. Our placebos are sometimes far more dangerous than theirs.

More importantly, people should be able to expect more from physicians. Patients come to us for genuine answers—if they wanted a witch doctor, they would have found one. I think we need to hold ourselves to a higher standard than a huckster at the carnival. We’re not here to promise that we’ve got all the answers. We are here to be honest, and to use the best knowledge that science has to offer, using genuine compassion and thought. Let’s leave the quacking to the quacks. We’ll stick with real medicine.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

http://www.kevinmd.com/blog/2013/02/fetish-vitamin-b12-shots.html

Flu shots and neuropathy

Somewhere around the world, it will be approaching flu season and the annual question as to whether it's advisable to have the shot. HIV patients are used to reading articles which cast doubt on the yearly vaccine and you will come across internet articles which advise against for neuropathy patients too. This article from Neuropathy News seems to clear the way for most people to safely have the flu jab and whatever flu is currently making the headlines in any given year, is probably a worse alternative.

Influenza Vaccinations in Patients with Neuropathy:
Should You Get a Flu Shot?
BY KENNETH C. GORSON, M.D.

The perennial question of whether or not to get a flu shot arises every fall with the reemergence of the influenza virus in the general population. Many neuropathy patients are uncertain whether they should receive a vaccination. For the vast majority of patients with peripheral neuropathy, the answer is yes.

In an average year, the influenza virus is responsible for more than
200,000 hospitalizations and 36,000 deaths. There is no evidence that the influenza vaccination aggravates neuropathy symptoms in patients with neuropathy resulting from diabetes mellitus, nutritional deficiencies, kidney,liver or thyroid disease, celiac disease, various connective tissue disorders,HIV infection, or exposure to toxins. In fact, the Center for Disease Control (CDC) urges these patients to receive an annual flu vaccination because they are at high risk of developing serious complications from infection with the influenza virus. Similarly, there are no neuropathic complications of vaccination for those with an inherited neuropathy or neuropathy of an unknown cause (“idiopathic” neuropathy).

There is, however, some controversy around the administration of the flu vaccine to patients with immune neuropathies—patients with a history of Guillain-Barré Syndrome (GBS) or chronic inflammatory demyelinating polyneuropathy (CIDP). The flu vaccination effectively prevents influenza infection by stimulating the patient’s immune system to generate antibodies directed against the virus. In patients with immune neuropathy, there is a theoretical concern that this immune stimulation may actually trigger GBS in a healthy individual or cause a relapse in patients with a history of GBS or CIDP.

In 1976, there was a highly publicized relationship between the Swine flu vaccine and an excess number of GBS cases within weeks of the vaccination. This observation seems restricted to that specific vaccine, as another large population study demonstrated that the vaccine administered during the 1993-1994 flu season was associated with only one excess case of GBS (i.e., greater than the background frequency of GBS in non-vaccinated individuals in the general population) per million people vaccinated. This extraordinarily low risk of influenza vaccine associated GBS also was
confirmed in a recent study in the United Kingdom. Furthermore, because up to two-thirds of patients with GBS have reported a preceding viral illness in the weeks before the onset of the neuropathy, the flu vaccination theoretically might reduce the risk of contracting GBS. Therefore, healthy individuals without neuropathy should have little concern about developing
GBS after a flu vaccination.

The CDC recommends that those rare patients who developed GBS after a flu vaccination should not be vaccinated. Many neuromuscular experts also recommend that GBS patients should not be vaccinated for at least one year after recovery, but this is an arbitrary time interval. Similarly, those with active CIDP may wish to avoid vaccination, but this decision needs to be balanced with the risks of infection associated with advanced age, other chronic medical conditions, and the potential for triggering a relapse as a consequence of infection with the influenza virus. Relapses after vaccination are usually mild and respond to standard therapies for CIDP.

Below are the current CDC recommendations for influenza vaccination
(also available on the CDC website). People who should get vaccinated each year include:

Children aged six months until their 19th birthday
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions (chronic
lung, heart, liver of kidney diseases, blood disorders, diabetes mellitus)
People who live in nursing homes and other long term care facilities
People who live with or care for those at high risk for complications
from the flu, including:
— healthcare workers
— household contacts of persons at high risk for complications from
the flu, and
— household contacts and out-of-home caregivers of children less than
six months of age (these children are too young to be vaccinated).


Ultimately, the decision to receive the flu vaccine needs to be individualized in consultation with your neurologist who is familiar with these issues.

Kenneth C. Gorson, M.D. is Professor of Neurology at Tufts University
School of Medicine. Dr. Gorson also serves on the Association’s Medical
Advisory Committee.