“Does vitamin B12 really do anything for autism?” is a question that comes up many times in the practice of providing biomedical treatments. Sometimes, the desire to use B12 is even the primary driving force that brings patients to our office. At the DAN! 2004 conference, Methyl-B12 was awarded “most recommended medical treatment”.

Here are the top questions and answers about vitamin B12 that I encounter in the practice:

  • Does it work?
    • In many ASD patients, I have seen remarkable improvements, in Speech and Language and in communication, as well. That is, the child will not only improve in words, then articulation, but many parents report that their children notice things that were previously ignored, respond to questions with more understanding and even begin to ask questions spontaneously.
    • The scientific literature is presently woefully short of research in this area. Probably, the best research so far is a rigorous 12 week clinical trial on 30 ASD patients aged 3 to 8 years. “No statistically significant mean differences in behavior tests or in glutathione status were identified between active and placebo groups.” However, “detailed data analysis suggests that methyl B12 may alleviate symptoms of autism in a subgroup of children”. In my practice, I have found that there are clinical symptoms that can help identify those responders.
  • How does it work?
    • A couple of studies were able to demonstrate some autism patients who had decreased intake of the vitamin in their restricted diets 1,2. Therefore, those patients benefitted from the supplementation of the vitamin B12.
    • The prevailing theory on why Vitamin B12 may be effective in many neuromuscular and other conditions is that the METHYL (methylcobalamin) group acts to aid in detoxification and to improve cellular energy.
    • Additionally, high-dose administration of Vitamin B12 has been validated to stimulate the activity of the body’s TH1 suppressor T-Cells, which has been implicated as a problem in ASD individuals.
  • How is it administered?
    • Vitamin B12 is water soluble vitamin and so there are many available forms – oral, gel, nasal, sublingual, and even in lollipop form. In practice, however, I have only found a biologic effect when it is given subcutaneously. This clinical observation is possibly because the methylcobalamin delivered by this method is better absorbed into the bloodstream, or it is more bio-available, or the effect is more noticeable because of the constantly higher blood level. After all, you can’t keep a sucker in your mouth all day long! No good word has come out yet on the B12 patch.
    • The best dietary sources are from animal products such as meat, fish, eggs and dairy (which causes inflammation in many of our patients). As a side note, no plant foods can be relied on as a sole source of vitamin B12.
    • We usually start a patient with a twice-a-week dosage regimen. We advise the parents to give it shortly after the child has fallen asleep, in the upper outer quadrant of the buttocks, so that there isn’t disruption from the injection itself, which is quite benign and painless. This negates the need for additives such as lidocaine or expensive protocols that include EMLA cream (to numb the skin). Done in this manner, it is quick and painless for the child and the parent. Sunday and Wednesday dosing helps the child focus and improve for the entire school/therapy week.
    • The dosage is pretty much standard for each child, though depending on the clinical response, we may change the frequency of the injections to maximize improvement or minimize annoying effects (below). The product is delivered periodically through a compounding pharmacy.
  • How long does it take to see an improvement from the Vitamin B12 protocol?
    • We usually tell the parent to look for changes after approximately 4 doses, (= ~2 weeks).
    • More importantly, from our interviews and observations, we try to tell the parents exactly WHAT to look for in EACH child – since they are all so different and individual effects can vary.
    • The therapy can be discontinued at any time without harm to the patient.
  • What are the side effects of B12 injections?
    • I always tell my patients that the main side effect of increased energy is increased energy. It is for this reason that:
      • The patient needs to have yeast and intestinal flora under control first and
      • Aggressive and other disruptive behaviors may become more pronounced when therapy is begun. I have had more than a few parents who felt that the “shots didn’t work” because that was their ONLY autism therapy.
    • A common clinical observation has been that, as the child gains core strength and increased sensation in the oral-motor pathways, oral stims sometimes become more frequent (and alarm the parent that the child is ‘regressing’).
    • Liver, kidney and allergic reactions have been reported with other forms (NOT methylcobalamin) of B12. Because of the low toxicity of vitamin B12, no tolerable upper intake level was set by the Food and Nutrition Board in 1998 when the RDA was revised.
    • There is a certain type of anemia associated with too much B12, and so clearly, a physician should be ordering the medication, and should follow the patient closely for any problems.
    • Some antibiotics may not be absorbed as well when taking B12 externally.
  • How much will it cost?
    • The average overall cost of having a child with ASD is $20,000 to $40,000 extra per year.
    • The cost of the B12 ‘shots’ is approximately $6 per week.
  • How long will the child need to get the subcutaneous injections?
    • On the average, our patients seem to get the best benefits in the first 6 – 9 months of treatment. Some individuals have taken this therapy for years, however.

For the correct patient, subcutaneous methylcobalamin is an effective, inexpensive, and safe therapy that can have a significant impact on the child’s ability to take therapy and improve. As with most biomedical treatments, it is most effective when administered under the supervision of an experienced physician.

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