Each member of the B vitamin family has unique therapeutic properties. What the B vitamins have in common is that they occur together in nature, and they are responsible for producing energy from the carbohydrates, proteins and fats in our foods.
The B vitamins play an essential role in the Krebs energy cycle, support the adrenals and proper neurological, cognitive and cardiac function, help maintain and repair the myelin sheath, help lower homocysteine levels and help the body cope with stress.
The B vitamins are water-soluble and any excess is readily excreted in the urine and so B vitamins are generally low in toxicity. When nutrients are water soluble it means that they are not stored in the body for long and so supplements must be taken in 2 or 3 or more doses spread throughout the day rather than all at once.
Because the B vitamins are so intertwined, it is important to take B vitamins as a complex rather than taking a large amount of one or two B vitamins and possibly creating new imbalances. Individual B vitamins should never be taken without also taking a B complex product of a roughly similar strength.
B vitamins are supplied in small amounts by foods such as eggs, meat, nuts, seeds and unprocessed whole grains and some fruits, vegetables and beans.
Different ways of taking B vitamins
Many severely ill patients or other very ill patients do far better taking B vitamins intravenously (by IV) or intramuscular (IM) injections or – even better – in their coenzymate (or ‘active’) forms, than orally.
In some cases, particularly where liver function or metabolic function is very poor, coenzymated B vitamin products will be the best choice. All other forms of B vitamins may have little or no effect and may also build up in the body if they cannot be used. (This is explained further in the section on coenzymated B vitamins to come.)
What follows is a basic overview of each of the B vitamins. (If you’re overwhelmed by too much information, then just skip this section and know that you can easily cover your basic needs just by taking a good quality coenzymated product like Thorne Basic B Complex at least 1 – 3 times daily with some extra sublingual B12 as methylcobalamin. Getting the B vitamins you require need not be complicated!)
Dosages given are only a very general guide and are intended for reading by those with very severe illness and not healthy members of the public.
A basic overview of each of the B vitamins
Vitamin B1 is essential in treating cardiomyopathy and chronic heart failure as it improves cardiac function. Vitamin B1 also improves peripheral neuropathy, nerve function and chronic pain and is known as ‘the brain energiser.’ Vitamin B1 also improves the body's ability to withstand stressful conditions and strengthens the immune system.
Vitamin B1 is an important nutrient for patients with Alzheimers, an overactive thyroid, serious mental health or addiction issues, learning difficulties and lead poisoning.
The therapeutic dosage of thiamin (vitamin B1) is generally 50 – 300 mg but may sometimes be significantly higher (when used to treat severe pain or neurological disease). Dr Atkins explains that a dose of 1 – 4 g daily, taken orally, may be used to treat pain. 150 – 300 mg daily is the dosage used to cardiomyopathy or chronic heart failure and 400 mg daily is the dose needed to treat depression (and to act as a mood elevator). Peripheral neuropathy treatment requires B1 injections (or benfotiamine supplements).
Dr Klenner’s neurological disease treatment protocol strongly emphasises vitamin B1 as it plays an important role in the metabolic cycle, facilitating muscle function and also aids in the remyelination of damaged nerves. (Klenner’s protocol recommends 1g of thiamine HCl taken orally thirty minutes before meals and at bedtime, plus 400 mg of thiamine given IM 5 – 7 days a week – plus large amounts of each of the other B vitamins.)
Dr Atkins recommends a dose of 1400 mg of B1 daily in Parkinson’s disease (and similar neurological diseases) and writes that in his opinion, less than 300 mg is all that is needed for most patients and daily doses over 1000 mg should be taken only under medical supervision. (This seems a very sensible and important guideline to follow. High doses such as these are for those under the care of highly educated nutritional medicine experts.)
Thiamin diphosphate (TDP), also called thiamin pyrophosphate (TPP) or cocarboxylase, is the active, coenzyme form of vitamin B1. This may be the best form of B1 for treating severe pain.
TPP is a critical link between the glycolytic cycle and its main energy-producing cycle, the Krebs’ cycle, and plays key roles in the Krebs’ cycle itself. TPP participates in the conversion of amino acids into energy and is a key coenzyme in the pentose phosphate pathway, which provides red blood cells with their energy. TPP is also critical in fatty acid synthesis, synthesis of the key neurotransmitter acetylcholine, and for nerve cell membrane function (this is critically important since the nerves’ messages must pass along its cell membrane).
A synthetic fat soluble form of vitamin B1 called benfotiamine (belonging to the family of compounds knows as "allithiamines’) is also more bioavailable and physiologically active than thiamin. Benfotiamine raises the blood level of TPP, the biologically active coenzyme of thiamine. Benfotiamine controls formation of advanced glycation end-products (AGEs) and helps maintain healthy cells in the presence of blood glucose. Dosage is usually 250 mg daily.
Vitamin B2 is an antioxidant involved in energy production. It is one of the major nutrients involved in recycling glutathione. Riboflavin limits the cell damage caused by stroke or heart attack and minimises respiratory damage from various toxins. Low vitamin B2 levels increase the risk of depression. Signs of B2 deficiency include cracks at the corners of the mouth and difficulty adjusting to darkness or bright lights.
The therapeutic dosage of riboflavin (vitamin B2) is generally 50 – 200 mg. Riboflavin may cause urine to turn a bright yellow colour. (This is not cause for concern. It is a sign that you are taking enough B2 and that it is being properly absorbed, according to Dr Atkins.)
Flavin mononucleotide (FMN), also called riboflavin phosphate, is one of the two metabolically active coenzyme forms of vitamin B2. FMN is the precursor for the other B2 coenzyme, FAD. FMN is also involved in bioconverting B6 to its coenzyme form.
Vitamin B3 is critical for energy production as well as heart health and optimal circulation. It is involved in over 50 reactions that turn fat into energy. Vitamin B3 comes in two forms, niacin and niacinamide. While both will meet the body’s requirements for B3, their overall therapeutic qualities differ.
Niacinamide helps osteoarthritis (at a dose of 1.5 – 2 g daily) and may help prevent diabetes. Niacinamide will not cause skin flushing but neither will it improve blood circulation. Like niacin, niacinamide has a gentle sedating effect.
Niacin can improve heart health and circulation, promote relaxation and relieve anxiety. Niacin taken at night can promote sleep. Niacin is one also of the major orthomolecular treatments used at high doses to treat schizophrenia and other mental illnesses.
Doses of niacin larger than 50 mg should be taken as flush-free niacin/inositol hexanicotinate (IHN) where the ‘niacin flush’ is undesirable. The niacin flush is a harmless feeling of warmth that occurs when certain amounts of niacin are taken, and lessens over time. There is some uncertainty whether or not flush-free niacin could be used instead of the plain niacin recommended by Dr Klenner and others for those who wish to avoid the ‘niacin flush’ that these doctors want patients to aim for. Some doctors recommend flush-free niacin as an excellent replacement for niacin and comment that is has all the same benefits as standard niacin, just without the flushing.
Taking enough of the flushing form of niacin 3-4 times daily to flush each time is recommended by some doctors, including Dr Klenner who includes it as an essential part of his protocol. This dilation of blood vessels helps get the nutrients you are taking to all the parts of the body and brain where they are needed. Dosage should begin at just 25 mg daily and be worked up very slowly. The flush should always be mild and last no longer than 10 minutes. The dose needs to be cut right back if flushing is worse than this. Note that for some people the flush can be very severe even at low doses. Go slowly!
Note that vasodilating drugs will need to be lowered with niacin or IHN supplementation and this should be done with the help of the doctor that prescribed these drugs for you.
The three forms of B3 are generally safe to supplement in moderate doses of 500 - 1000 mg. More than 1000 mg of niacin should be taken under a doctor’s care. To improve heart health, a dose of 800 – 2400 mg IHN daily is usually necessary, according to Dr Atkins. For basic health maintenance, 100 mg of niacinamide daily will suffice. High doses of niacinamide may cause nausea or extreme drowsiness in some people.
Nicotinamide adenine dinucleotide (NAD), is one of two main metabolically active forms of vitamin B3. The other is NAD phosphate (NADP). Some doctors suggest that taking NAD has little effect however, and recommend instead a sublingual supplement containing NADH. (Enteric coated NADH is not recommended.) NADH is a coenzyme, antioxidant form of vitamin B3. Dosage for sublingual NADH is 5 - 10 mg daily tried for 4 weeks. If this initial dose is ineffective, the dose may then be raised to 10 mg twice daily.
Some find NADH very helpful, while others feel it is not worth the expense and than taking extra B2 and B3 (as niacin or IHN) gives a more powerful effect at a cheaper price.
Vitamin B5 supports the adrenals and can help patients with adrenal problems lower their cortisone dosage as it allows the adrenal glands to produce more cortisone. Vitamin B5 helps in the formation of acetylcholine, the metabolism of fatty acids, and the incorporation of fatty acids into cell membrane phospholipids. It is also involved in making steroid hormones, vitamin A, vitamin D, and cholesterol. Pantethine helps to control yeast infections, helps the body with detoxification issues which arise as a result of a yeast infection and helps treat autoimmune diseases and allergies.
Vitamin B5 is available as pantothenic acid and pantethine. Both forms have their own unique therapeutic effects and often they are both prescribed for a patient. The therapeutic dosage of pantothenic acid and/or pantethine is generally around 200 - 600 mg daily.
Pantethine is a combination of pantothenic acid (vitamin B5) and beta-mercaptoethylamine. Pantethine is the precursor to coenzyme A (CoA), the critical starting point in the Krebs energy production cycle. CoA also works with CoQ10 in improving detoxification.) While both forms of B5 can be used to make CoA, at least twice as much CoA will be formed with pantethine as opposed to pantothenic acid.
To tame inflammation, allergies or an autoimmune condition the dosage is 600 – 900 mg of both pantethine and pantothenic acid daily, according to Dr Atkins. Pantethine is also available in sublingual form.
Vitamin B6 is a natural antihistamine and detoxifier and helps lower homocysteine levels. It is also integrally involved in women’s health, diabetes and heart disease prevention, arthritis treatment and immune system strength and a useful treatment in neurological and mental disorders. One of the signs of vitamin B6 deficiency is the inability to recall dreams.
The therapeutic dosage of pyridoxine (vitamin B6) is usually 50 – 200 mg. More than 200 mg of B6 should not be necessary, according to some nutritional experts.
Doses of 200 – 400 mg may sometimes be used for some of the conditions mentioned previously (if a higher dose proves necessary) under medical supervision. Some experts note that without additional magnesium, zinc and a B complex supplement, doses of B6 above 500 mg can very rarely cause temporary sensory neuropathy: a numbness or tingling in the arms or legs.
Dr Atkins comments that many people cannot convert pyridoxine into its active form. He recommends that at least 20% of the B6 supplemented should come from P5P. Others recommend that B6 only be taken as P5P as this form is far safer. Taking B6 only in the P5P form is the best option, and is highly recommended – if budget allows.
If you notice new onset numbness or tingling in your arms or legs a few months after starting a B6 supplement or even years after taking a B6 supplement then you should investigate the possibility that you may have a B6 toxicity and possibly a poor ability to convert pyridoxine to P5P. You may need to avoid standard B6 containing- supplements entirely and instead take a low-moderate dose of P5P once your adverse symptoms have subsided.
Pyridoxal-5'-Phosphate (PLP or P-5'-P or P5P) is the main metabolically active coenzyme form of vitamin B6. It is primarily in the liver that P5P is synthesized from pyridoxine, with the help of enzymes that require vitamin B2, zinc and magnesium for their activity. P5P is associated with numerous enzymes, many or which are involved in the conversion of amino acids into the neurotransmitters dopamine, norepinephrine and serotonin. P5P is also required for the synthesis of the hemoglobin molecule. Only 20% as much P5P is needed as compared to standard pyridoxine supplements. 20 mg of P5P is the equivalent of 100 mg of standard B6 as pyridoxine.
Biotin, vitamin B7
Biotin is particularly important in childhood. Biotin promotes healthy skin, hair and nerves. Dosage for biotin starts at 50 – 180 mcg. The therapeutic dosage of biotin is 300 – 3000 mcg or more. Dosages of 2 -4 mg may be used to treat hypoglycaemia.
Inositol, vitamin B8
Inositol is the relaxing and sleep inducing B vitamin. Inositol is needed for cell growth and is required by the brain and spinal cord. Dosage begins at 25 – 150 mcg.
As Dr Atkins explains, the therapeutic dosage of inositol for improving sleep and relieving insomnia is 1 – 1.5 g taken at bedtime. At a dose of 6 - 18 g daily, inositol is a safe and effective treatment for obsessive compulsive disorder (and also depression and panic disorders) and can replace tranquilisers and sleeping pills. For moderate anxiety Dr Atkins recommends 1 – 2 g daily.
Folate helps to lower homocysteine levels, is needed in red blood cell formation, can prevent neural tube birth defects, may improve skin problems and peripheral neuropathy, is essential for brain and nerve function and is a useful treatment in various neurological and mental disorders. Folate can also treat chronic pain at high dose.
Doses of 40 mg daily or more can improve transient or long-term diarrhoea and various intestinal disorders such as Crohn’s disease and colitis. Folate at a dose of 40 – 60 mg daily has oestrogen-like effects and can be used by women who cannot tolerate the side-effects of standard oestrogen replacement therapy. 50 mg of the methyl form of folate is sometimes used to treat depression.
Standard synthetic folate supplements (folic acid) may not be adequate for many people nor entirely safe. 30% or of the population are not able to utilise standard folate supplements properly due the MTHFR polymorphism. These individuals require activated folates such as methyl folate. Absorption of methylfolate may be blocked by standard folic acid supplements and folic acid can build up unused in the body possibly increasing cancer risk.
This website recommends that everyone avoid all supplements containing standard synthetic folic acid entirely, and also folate-enriched foods including many breads and flours.
The activated folates are folinic acid and methyl folate. Good forms include Metafolin, Quatrefolic and L-5-MTHF. For more information on MTHFR and the best folate supplements see the Basic MTHFR protocol and MTHFR video by Dr Ben Lynch. See also: New Views On Folic Acid by Karlis Ullis M.D. and Is the mainstream still cheating you out of the best health possible—with folic acid?! by Dr. Jonathan V. Wright.
The therapeutic dosage of folate is 1 mg (1000 mcg) or more. Those with the MTHFR polymorphism may need higher doses of activated folate and also of methyl B12. This supplement should be started at very small doses such as a tenth of a tablet in serious illness as it can cause large detoxification reactions in some people.
Dr Atkins recommends a dose of 3 – 8 mg of standard folate daily for those with neurological or cardiovascular disorders, 10 – 20 mg for those with high homocysteine levels and 20 – 60 mg daily for those with cancer, menopausal symptoms and severe colitis. Note that standard folate supplements are not recommended.
Dosage recommendations for folate vary widely. Dosages of 1600 – 5000 mcg of methylfolate are common in the treatment of MTHFR polymorphisms although some patients cannot tolerate more than 400 – 800 mcg. The higher doses of methylfolate may be needed for those with homogeneous MTHFR polymorphisms as opposed to heterogeneous ones.
In rare cases folate doses over 15 mg daily may cause gastrointestinal and sleep problems.
It is important to take extra folate when extra B12 is taken; at least 1 mg (1000 mcg). To enhance the body’s absorption of folate, take a probiotic supplement.
Vitamin B12 guards against stroke, lowers homocysteine levels, improves general wellbeing and sleep, improves allergies and asthma, treats peripheral neuropathy, is required by the body to make myelin, is needed for healthy nerve function, improves CNS function and cognitive function, can help normalise low blood pressure (and low blood pressure or faintness on standing), improves digestion, plays an important role in forming red blood cells and supports detoxification processes. Doses over 1mg should also be taken with at least 1mg of folate. There are several different forms of vitamin B12.
Hydroxycobalamin: This form of B12 is longer acting and raises blood levels of B12 higher. It is a potent detoxifier. Hydroxycobalamin functions in the body as a vitamin B12 complex (unless your body has a problem doing some of the conversions, which can happen). Your body can (usually) convert hydroxycobalamin to the active forms; methylcobalamin and adenosylcobalamin. The therapeutic dosage of sublingual hydroxycobalamin is usually 1 – 6 mg daily, or sometimes 10 mg daily at the beginning of treatment.
Hydroxycobalamin may be given intramuscularly (IM) to treat B12 deficiency, although the methylcobalamin form is preferred for IM use where the deficiency has caused significant neurological issues as it may be more effective at reversing them. IM dosage is usually 1 mg given monthly, weekly, or even daily.
Adenosylcobalamin/dibencozide: Adenosylcobalamin is a coenzyme form of vitamin B12. It is required for processing branch chain amino acids through the Kreb's cycle for sustained energy production and is involved in methionine and choline metabolism, red blood cell formation, and maintaining the integrity of myelin (a fatty insulation that covers some nerves), as well as promoting normal folic acid metabolism. Sublingual dosage is usually 1 – 3 mg daily. Taking higher doses may at first cause agitation in some people. Adenosylcobalamin may also very rarely be given IM in a 1 mg dosage.
Methylcobalamin: Methylcobalamin is a coenzyme form of vitamin B12 and is essential for cell growth and replication. It is more concentrated than other forms of B12 in the cerebral spinal fluid where it can be used by the central nervous system. It donates methyl groups to the myelin sheath that insulates certain nerve fibers. It also plays a role in maintaining a healthy sleep/wake cycle, as well as normal nerve function.
Methylcobalamin cause significant detoxification reactions and can also cause relapse due to the effect it has on resetting circadian rhythms which can involve the patients sleeping fewer hours. This form of B12 may only be able to be tolerated in low doses in some patients. As with activated folate a good starting dose for very sensitive patients may be just 1/10th of a (1 mg) methylcobalamin sublingual a day. If no methylcobalamin dose is tolerated, it may be a good idea to switch to hydroxycobalamin instead and start raising the dose of that only very slowly.
The recommended dosage is often 1 – 5 mg taken sublingually daily – even for healthy people. Vitamin B12 deficiency is becoming increasingly common and daily methylcobalamin taken sublingually is increasingly recommended as an insurance policy. The dosage used to treat neurological diseases, B12 deficiency and MTHFR/methylation issues etc. is often 5 – 20 mg taken sublingually daily, depending on the patient’s response.
Cyanocobalamin: This form is probably okay to take for most people if it is included in very small amounts in multivitamins or B complex products but should never be the form of B12 chosen when purchasing a stand-alone B12 supplement. At high doses hydroxycobalamin, methylcobalamin or adenosylcobalamin rather than cyanocobalamin must be used to avoid the toxicity of the cyanide in the later. Those with MTHFR polymorphisms, smokers and ex-smokers should strictly avoid cyanocobalamin.
Making sure to avoid patients having needless relapses from taking lots of B12 at once is important but it is also vital to ensure that a serious B12 deficiency is not going untreated and being allowed to worsen. Feeling very fatigued, spaced out and strange after starting daily B12 sublingual can actually be a sign that you’re very low in B12 and have a serious deficiency!
If you have any new onset neurological symptoms, cognitive issues, headaches, arm and leg pains, occasional or constant numbness and tingling in your hands/feet/ arms/legs, balance problems, oedema, breathlessness, chronic cough, strange bladder and kidney issues including incontinence, retention or recurrent UTI-type symptoms then looking into the possibility of a B12 deficiency is a MUST!
They are more common in vegans and vegetarians but eating a super-healthy diet containing adequate meat doesn’t mean that you are immune from B12 deficiency either. Risk factors also include low stomach acid, autoimmune disease and the use of some drugs (e.g. antacids and nitrous oxide). B12 deficiencies are very common and early diagnosis and treatment is vital or symptoms may be too far along to be reversed. Patients may be left permanently bedbound and incontinent if treatment is very delayed. It is recommended that tests be done to look for a B12 deficiency before B12 treatment is started as once B12 supplements are taken the tests will be useless. For some great information on B12 deficiency please see the Great B12 books and links page on this site. If in doubt, make sure you check B12 deficiency out!
Vitamin B12 may given by IV or IM, or taken as sublingual tablets and there are also nasal forms of B12 and B12 transdermal patches. Vitamin B12 given orally may be absorbed at a rate of only 1% and even this low rate may plummet to almost zero if the patient has certain gut issues or pernicious anaemia. With serious B12 deficiency and pernicious anaemia in particular some patients NEED to be given B12 in an injected form as they just do not get the same benefits from taking sublingual preparations. Many patients do well just on high-dose sublinguals, but not all patients do. Patient response should always be the guide in determining the correct dosage and form of B12 replacement therapy. There is no risk in treating patients in this way and the cost is very low also. Tests can sometimes be quite inaccurate and misleading on this issue. More accurate tests seem to be needed.
It is a good idea to take some of each of the two active forms of B12 if you can as they each do slightly different things in the body. Taking just adenosylcobalamin could still leave you at risk for B12 deficiency. That means taking some methylcobalamin (or hydroxycobalamin which can usually be converted in the body to methylcobalamin) and a small amount of adenosylcobalamin daily.
Whichever forms you take, if you’re a super sensitive type, it is probably a good idea to start at a low dose and work up slowly as B12 helps with detoxification. Vitamin B12 is non-toxic and very safe even in high amounts.
As the section on folate explained, 30% or more of people have the MTHFR polymorphism. This affects the use and need for folate and also B12. Activated folate is needed for the body to use B12 properly. It is a very complex subject! For more information on MTHFR (and other polymorphisms such as CBS) and the best folate and B12 supplements see the Basic MTHFR protocol and the MTHFR video by Dr Ben Lynch.
The therapeutic dosage of choline (a B vitamin) is 50 - 1150 mg or more. Choline is a component of lecithin. Choline may be supplemented equally well via lecithin granules (1 – 3 tsp daily) or phosphidatylcholine.
While it is not actually a B vitamin, para-aminobenzoic acid (PABA) is sometimes included in B complex supplements in small amounts as it helps us synthesise folic acid in our gastrointestinal tract. PABA may be prescribed to treat autoimmune disorders at a dose of 500 – 1500 mg daily. Some patients cannot tolerate PABA and must avoid it.
The therapeutic dosage of PABA (sometimes called vitamin Bx) is often 250 - 500 mg. A PABA supplement is usually not necessary.
Oral B vitamin supplements
Probably the easiest and cheapest way to take a B vitamin supplement is to take a 50 mg B complex capsule or tablet 2 – 3 times daily or a 100 mg product 1 – 1 ½ times daily (along with a good quality multivitamin).Higher doses are needed only in serious illness. There is no need to take a higher dose if you are not severely ill.
(Note that B complex products labelled ’50 mg’ do not contain the same amount of each of the B vitamins, as this would be inappropriate. The ’50 mg’ refers to the dosage of the main vitamins such as vitamin B1 and B2 etc.)
Some ill people may find that oral B supplements are adequate, but that somewhat higher doses are needed due to absorption problems caused by illness. Where higher doses of some of the B vitamins are required, one or more additional single B vitamin products may also be taken with the B complex product in oral, sublingual or injectable form.
Taking B vitamins in activated and/or sublingual forms
In order for B vitamins to be utilized by the body, they must first be converted into their active coenzyme forms by the liver. This conversion takes time and requires metabolic energy, which may be in short supply in M.E. and other serious diseases. For most healthy, young individuals, this conversion of synthetic B vitamins into coenzymated vitamins may not present a problem. However, in older, ill or nutritionally-deficient people or certain individuals with a particular biochemical deficiency, the conversion may be problematic. When this occurs, supplementing with non-coenzymated B vitamins may have little effect.
Our livers are working harder than ever before with the hugely increased amount of toxins they have to process and neutralise in the 21st century. This is one reason why the liver’s ability to coenzymate vitamins into their active forms can be greatly impaired (which can affect our entire biochemistry). Some people also have particular problems converting vitamin B6 or folate to their active forms. For these people, only the coenzymated form of these vitamins will be able to be used by the body.
Where there are problems converting one or more of the B vitamins into their active coenzyme forms by the liver coenzymated sublingual B vitamins will be by far the best choice of B supplement. In studies with chronic alcoholics (a group at high risk of poor liver function) large doses of B vitamins were given by IV. Normally, the administration of these IVs would raise the body’s coenzyme levels, but in the case of liver-impaired alcoholics, it did not. This shows that a compromised liver may not be able to coenzymate vitamins optimally. Thus when a person cannot convert B vitamins properly, even injections or IVs of non-coenzymated vitamins will have little or no effect. So for some people, the optimum way to take in B vitamins is not by IV but through coenzymated products.
Coenzyme forms of vitamins are biologically identical to those used by the body, making them highly bioavailable, especially when they are also in a sublingual form. Sublingual tablets are absorbed rapidly into the highly capillarised tissues found in the cheeks and under the tongue and enter the bloodstream intact, without the risk of being degraded or diminished by the digestive system. Taking coenzymate and sublingual forms of B vitamins also conserves valuable metabolic energy and reduces the load on the (probably very overworked already) liver. Vitamins taken in this form will also be faster acting.
Smaller doses are needed when the coenzymate forms of vitamins are taken and when nutrients are taken sublingually. Coenzymated forms of vitamin B are up to five times more biologically active than other forms. One study using both sublingual and oral supplements (testosterone in this case) found that the absorption of the sublingual was twice that of the oral dose.
Taking 1-3 doses daily of a B vitamin complex product – depending on how ill you are – should bring noticeable benefits within a month. It should improve wellbeing generally, improve concentration, improve mood and make you feel more able to cope with stress. You should really be able to feel a significant difference although the full effects will take place over an extended period of time.
Choosing B complex products has recently become a lot more difficult however with the new information that synthetic folate as folic acid should be strictly avoided. Unfortunately this rules out the use of the vast majority of B complex products including even the otherwise excellent Source Naturals Coezymated B Complex Sublinguals. Opinions vary but in my own opinion it is also a very good idea to take only the activated P5P form of vitamin B6, and only the activated forms of B12. Activated B1 and B2 are a bonus. The Thorne Basic B Complex meets these criteria and another option is to buy each sublingual/coenzymated nutrient separately. Source Naturals makes coenzymated B1, B2, NADH, and B6 and many companies sell coenzymated folate and B12.
The downside of sublingual vitamins is the higher cost and taking in so much mannitol or sorbitol and other undesirable substances. Sourcing coenzymated sublingual vitamins can also be somewhat difficult.
Avoid products which contain a mixture of standard and coenzymated B vitamins and which do not disclose how much of each type is contained in the product. (You may be paying a premium price for a product that contains only 1% or less of the more expensive coenzymated form of the vitamin. If the percentages are not listed, assume the coenzymated vitamin percentage in the product is very low!)
Taking B vitamins in injectable or IV form
Intravenous administration of nutrients can achieve serum concentrations not obtainable with oral, or even intramuscular administration.
B vitamin injections or IVs must be administered by an experienced and qualified practitioner and thus may not be a practical or affordable option for all patients.
Individual B vitamins may be given via injection, and this may be combined with an oral or sublingual B complex product, or a B complex product may be given via injection or IV. IV vitamin expert Dr Klenner says of B vitamin complex given by IV, ‘Intravenous medication can be given daily; it should be administered at least twice weekly. Due to sensitivity possibilities, we always have the patient take the intramuscular injections for three weeks before starting intravenous therapy.’
Some doctors may offer a ‘Myers’ cocktail’ which is an IV containing B vitamins, magnesium and calcium in particular amounts. This IV may be taken once or twice weekly or more (along with daily B vitamins etc. given orally each day). This treatment must be administered by an experienced and qualified practitioner. For more information on this treatment and instructions for doctors on how to make the IV, see the excellent article: Intravenous nutrient therapy: the "Myers' cocktail" by IV vitamin expert Alan R. Gaby. He explains,
All ingredients are drawn into one syringe, and 8-20 mL of sterile water (occasionally more) is added to reduce the hypertonicity of the solution. After gently mixing by turning the syringe a few times, the solution is administered slowly, usually over a period of 5-15 minutes (depending on the doses of minerals used and on individual tolerance), through a 25G butterfly needle. Occasionally, smaller or larger doses than those listed in Table 1 have been used. Low doses are often given to elderly or frail patients, and to those with hypotension. Doses for children are lower than those listed, and are reduced roughly in proportion to body weight. The most commonly used regimen has been 4 mL magnesium, 2 mL calcium, 1 mL each of B12 (as hydroxycobalamin), B6, B5, and B complex, 6 mL vitamin C, and 8 mL sterile water.
As the Myers’ cocktail only contains a relatively small amount of vitamin C, full-strength vitamin C IVs may also be given (perhaps on alternate days). The preservatives used in vitamin C or B complex IVs (or injections) can cause problems in some patients and preservative free preparations may be a better (if more expensive) choice. Patients that are very sensitive to chemicals may do better when glass rather than plastic IV bags/flasks are used.
While the Myers’ cocktail is generally very well tolerated, the magnesium (and calcium) in the Myers’ IV may cause problems for those with low blood pressure – which includes M.E. patients. For this reason, it may be preferable to get a Myers’ cocktail without calcium and magnesium and to take these supplements separately. (Magnesium should be taken in transdermal or liquid form, if possible, rather than orally, in this instance.) As with standard B complex IVs, it is recommended that the vitamins be given IM first for several weeks to check that they are well tolerated, before the IVs begin.
Some doctors may follow the Klenner protocol for treating neurological diseases which involves high dose vitamin C and B vitamins given by IV and injection as well as orally.
Taking B vitamins in liposomal forms
The B vitamins have recently become available in a liposomal delivery system. A liposomal B complex product is now available from Livon Labs and the product is called AGE blocker. The downside here is that the B vitamins are not available individually and so it may not be possible to get enough B1 or other more desired B vitamins without getting more than needed of the other B vitamins as well as the other nutrients included in the product.
Liposomal delivery systems make nutrients very bio-available and so smaller amounts are needed than with oral forms.
Vitamin B cautions
Occasionally, high-dose B vitamins may interfere with sleep. If you have trouble getting to sleep at night, try taking your B vitamins as early in the evening as possible and see if this helps.
Betaine trimethylglycine (betaine TMG or TMG) may be included in some B complex formulas. Such products may be best avoided as TMG is often very poorly tolerated in M.E. and can cause severe relapse while the supplement is taken and for a week or so afterwards. If well tolerated however, TMG is a beneficial supplement as it aids in the process of methylation. TMG is probably best taken alone to start with, at very small doses of just 100 - 200 mg.
B vitamins given by IV or IM should be given by medical practitioners that have considerable experience in this area. The collected works of Dr Klenner and the article Intravenous nutrient therapy: the "Myers' cocktail by Alan R. Gaby are essential reading for patients and doctors involved with IM or IV B vitamin therapy. These papers include all sorts of useful cautions and extra information that comes with administering this treatment to many thousands of patients over many years.
Dr Atkins warns that women who need to shrink uterine fibroids, or prevent breast cancer recurrences, or deal with endometriosis or fibrocystic breasts should limit supplemental folate to 600 mcg daily.
Please see the vitamin B6 section above for information on B6 toxicity.
An advantage of water-soluble nutrients is that any side-effects wear off very quickly. The exceptions to this are benfotiamine, which is a fat-soluble form of vitamin B1, and vitamin B12. Side effects from vitamin B12 (such as changes to the sleep/wake cycle) take several months to wear off, as B12 is stored in the muscles and in organs.
There is evidence that a poliomyelitis infection can be overcome with the administration of large doses of vitamin C by IV, over several weeks, if this treatment begins as soon as possible after the infection has begun. High dose vitamin C by IV is also used to treat Multiple Sclerosis, Myasthenia Gravis and other neurological diseases, along with high doses of the B vitamins by IV (particularly vitamin B1). The effectiveness of this protocol – the Klenner protocol – depends in part on how early it is begun (how much damage the body has sustained already, in other words).
a. Dr Klenner’s protocol for poliomyelitis. For polio Dr Klenner recommends ascorbic acid given intravenously at 300 to 500 mg per kg of weight (or oral vitamin C to bowel tolerance if this is all that is available), muscle massage, plus thiamin 100 to 250 mg a day for three months afterwards to help rehabilitate the nerves.
b. Dr Klenner’s protocol for Multiple Sclerosis, Myasthenia Gravis and other neurological diseases. Dr Klenner notes that ‘Early M.S. cases will respond quickly’ and cites examples where the protocol has taken 2 weeks to work in some early cases, and 5 years or more of constant treatment to be effective in longer-term cases.
One paper makes the statement that it may take a year of treatment for every two years spent ill with MS for the full benefits of treatment to be seen. (He also notes that a cut-down version of his treatment protocol may also work but that it may take much longer and not be effective in some cases.) He says: “Any victim of Multiple Sclerosis who will dramatically flush with the use of nicotinic acid and has not yet progressed to the stage of myelin degeneration, as witnessed by sustained ankle clonus, can be cured with the adequate employment of thiamin, B complex proteins, lipids and carbohydrates. We had patients in wheelchairs who returned to normal activities after five to eight years of treatment.”
For more information on this program please see the Klenner Protocol page on this site.
Many very ill patients do far better taking B vitamins intravenously (by IV) or intramuscular (IM) injections or in their coenzymate (or 'active') forms, than orally. For some patients, oral supplements are fine but somewhat higher doses are needed to overcome problems with absorption.
B vitamins given by IV have the most powerful effect, generally speaking. In some cases, however, particularly where liver function or metabolic function is very poor, coenzymated B vitamin products will be the best choice, and all other forms of B vitamins may have little or no effect.
Smaller doses are needed when the coenzymate forms of vitamins are taken and when nutrients are taken sublingually. Coenzymated forms of vitamin B are up to five times more biologically active than other forms and sublingual supplements may be twice as well absorbed as oral supplements.
Taking 1-3 doses daily of a B vitamin complex product should bring noticeable effects and benefits within 2 - 4 weeks. It should improve wellbeing generally, improve concentration, improve mood and make you feel more able to cope with stress. You should really be able to feel a significant difference. No benefit may mean that you require some or all of your vitamins to be coenzymated. You may wish to try coenzymated products.
A short trial of this nature is a very good idea in severe illness and is very highly recommended as it's an easy way to see if perhaps your body is not converting the B vitamins to their useable forms very well. If this is the case a far more noticeable effect will be seen from the coenzymate product than from standard B vitamin products.
Patients that have access to a doctor experienced in giving vitamins by injection or IV may also want to try this method of treatment for a period of time to see if it provides extra benefits (if budget allows). A B complex IV, a Myers’ cocktail IV or a vitamin IV made to the specifications of Dr Klenner may be useful in M.E. or similar diseases. Intravenous administration of nutrients can achieve serum concentrations not obtainable with oral, or even intramuscular administration.
The B vitamins are water-soluble and any excess is readily excreted in the urine and so B vitamins are generally low in toxicity. When nutrients are water soluble it means that they are not stored in the body for long and so must supplements must be taken in 2 or 3 or more daily doses spread throughout the day.
Initial doses may be quite different to maintenance doses. Over time, the doses of some of the B vitamins given at therapeutic doses may be able to be lowered. They may also no longer need to be injected or given by IV. How you feel should be used to determine the correct dosage of each of the B vitamins over time.
Individual B vitamins should never be taken without also taking a B complex product of a roughly similar strength. High-dose B vitamins may interfere with sleep. If you have trouble getting to sleep at night, try taking your B vitamins as early in the evening as possible and see if this helps.
As an absolute minimum dosage it is important to take something such as Thorne Basic B Complex once daily.
Supplementing some of the B vitamins individually, along with a B complex product
Some of the B vitamins that are most important or beneficial for M.E. patients in particular to supplement in higher doses (if budget allows) than are included in a B complex product include the following:
Vitamin B1 as thiamine HCl or TDP/TTP (conezymated B1) or benfotiamine, improves cardiac function, pain, cognitive and neurological function and aids in the remyelination of damaged nerves.
Vitamin B3 as niacin or IHN (flush free niacin) can improve heart health and circulation, promote relaxation and relieve anxiety. It is also is critical for energy production.
Vitamin B5 as pantethine, supports the adrenals, boosts coenzyme A production, helps the body with detoxification issues which arise as a result of a yeast infection and helps treat autoimmune diseases and allergies.
Vitamin B12 as hydroxycobalamin (or dibencozide or methylcobalamin IF this form is well tolerated) supports detoxification, improves allergies and asthma, is required by the body to make myelin, is needed for healthy nerve function, improves CNS function and cognitive function and can help normalise low blood pressure (and low blood pressure or faintness on standing).
Activated folate works with vitamin B12, helps to lower homocysteine levels and is essential for brain and nerve function.
The Vita-Nutrient Solution, Orthomolecular Medicine for Everyone: Megavitamin Therapeutics for Families and Physicians, Fire your Doctor: How to be Independently Healthy and The Optimum Nutrition Bible
Clinical Guide to the Use of Vitamin C The Clinical Experiences of Frederick R. Klenner, M.D. and Response of Peripheral and Central Nerve Pathology to Mega-Doses of the Vitamin B-Complex and Other Metabolites and Observations On the Dose and Administration of Ascorbic Acid When Employed Beyond the Range Of A Vitamin In Human Pathology by Dr Klenner.
Intravenous nutrient therapy: the "Myers' cocktail in Alternative Medicine Review, Oct, 2002 by Alan R. Gaby (PubMed link) This article includes instructions for doctors on administering the Myers’ cocktail.
The NEW optimum nutrition bible by Patrick Holford
Fire your doctor! : how to be independently healthy by Andrew W. Saul.
How to live longer and feel better by Linus Pauling.
Coenzymated™ Sublingual B-Vitamins: A Radical Step in the Evolution of Vitamin Supplements by Source Naturals (a company which makes these vitamins)
Various papers by Dr Paul Cheney on the use of hydroxycobalamin injections
MTHFR information from the Genetics Home Reference website
Nutrigenomic Testing and the Methylation Pathway by Dr Amy Yasko (MTHFR infomation)
The Sinatra Solution by metabolic cardiologist Dr Stephen T. Sinatra
Alternative Medicine Magazine's Definitive Guide to Sleep Disorders: 7 Smart Ways to Help You Get a Good Night's Rest by Herbert Ross and Keri Brenner
Circadian rhythm sleep disorders by Kathryn J. Reid, PhD, Anne-Marie Chang, PhD, Phyllis C. Zee, MD, PhD. Center for Sleep and Circadian Biology, Northwestern University, Evanston, IL 60208, USA
Information on melatonin and vitamin B12 by Dr Michael T. Murray, N.D.
Methylcobalamin B12 supplement benefit and side effects by Ray Sahelian, M.D.
Circadian Rhythms by Andrew B. Hollander
The United Mitochondrial Disease Foundation website.
“Intravenous administration of nutrients can achieve serum concentrations not obtainable with oral, or even intramuscular (IM), administration. For example, as the oral dose of vitamin C is increased progressively, the serum concentration of ascorbate tends to approach an upper limit, as a result of both saturation of gastrointestinal absorption and a sharp increase in renal clearance of the vitamin. The highest serum vitamin C level reported after oral administration of pharmacological doses of the vitamin is 9.3 mg/dL. In contrast, IV administration of 50 g/day of vitamin C resulted in a mean peak plasma level of 80 mg/dL. Similarly, oral supplementation with magnesium results in little or no change in serum magnesium concentrations, whereas IV administration can double or triple the serum levels, at least for a short period of time. Various nutrients have been shown to exert pharmacological effects, which are in many cases dependent on the concentration of the nutrient. For example, an antiviral effect of vitamin C has been demonstrated at a concentration of 10-15 mg/dL, a level achievable with IV but not oral therapy.” Intravenous nutrient therapy: the "Myers' cocktail" by Alan R. Gaby
“This treatment works so dramatically in Myasthenia Gravis, that should a given patient’s physician refuse to administer this schedule, I have this recommendation: One gram thiamin hydrochloride one hour before meals and at bed hour, and during the night if awake. Niacin taken at the same time, and in amounts sufficient to produce a good body flush. Two hundred mg. calcium pantothenate and 100mg pyridoxine before meals and at bed hour. Ten grams ascorbic acid, taken in divided doses. Naturally, the full schedule will afford more dramatic response.” Frederick Klenner M.D.
“Coenzyme A (COA, the active form of pantothenic acid) is in limited supply in M.G. It, COA, intercepts pyruvic acid at the end point of glucose metabolism. Another enzyme, cocarboxylase, splits the carboxyl group (COOH) away from pyruvic acid to form CO2 and free hydrogen. The remaining two carbon fragment (acetate) join with coenzyme A to form acetyl coenzyme A. A high energy package named NADH2 is formed from the carboxyl group from pyruvic acid and a sulfur group from coenzyme A.
Thiamin is important in all this energy production as two molecules of thiamin combined with two molecules of phosphoric acid become cocarboxylase. This enzyme must be present for the continuance of the metabolic cycle. When thiamin is deficient, pyruvates and lactate accumulate, and at the neuromuscular junction the nerve end plate becomes swollen and poorly operative. That same enzyme is necessary for the syntheses of acetylcholine, the neurotransmitter that initiates muscle contraction. “Thiamin deficiency inhibits lactic acid metabolism.” A thiamin deficiency means a cocarboxylase deficiency. Liver enzymes are mainly responsible for the phosphorylation of thiamin to cocarboxylase. Liver disease would obviously reduce this synthesis. “The activity of choline esterase (breaks down acetylcholine) is inhibited by this same double thiamin unit.”
In the conversion of fatty acids to energy some of the same enzymes are necessary: coenzyme A, hydrogen carriers (niacin-adenosine-dinucleotide) and Vitamin C. The latter acts as a hydrogen transport.
He puts Myasthenia Gravis and Multiple Sclerosis in the same therapeutic group as he found thiamin was the key to the therapy. M.G. is a genetically transmitted disease and M.S. is triggered by a virus and mimics poliomyelitis. Nerve damage in M.S. is due to microscopic hemorrhages in the nervous system. During healing, scar tissue contracts clamping off capillary flow and nutrition. This wasting results in loss of the myelin sheath protection.
He felt that remyelinating these damaged nerves was every bit as hopeful as the myelination that occurs normally in infancy with nothing more spectacular than breast milk. It requires two years of treatment to repair the damage caused by one year of the disease.
He cites works in the late 1930s by Stern at Columbia University who used thiamin intraspinally for the treatment of Multiple Sclerosis with astonishing results. After 30 mg of thiamin was injected into the spinal canal of paralyzed MS. victims, they had a temporary remission. They could walk for a while. And Stern felt it was a B1 avitaminosis. It was known at that time that polyneuritis can cause degeneration of myelin sheaths.” Frederick Klenner M.D. (comments abbreviated, summarized and annotated by Lendon H. Smith, M.D.)
“The Myers' often produces a sensation of heat, particularly with large doses or rapid administration. This effect appears to be due primarily to the magnesium, although rapid injections of calcium have been reported to produce a similar effect. Too rapid administration of magnesium can cause hypotension, which can lead to lightheadedness or even syncope. Patients receiving a Myers' should be advised to report the onset of excessive heat (which can be a harbinger of hypotension) or lightheadedness. If either of these symptoms occurs, the infusion should be stopped temporarily and not resumed until the symptoms have resolved (usually after 10-30 seconds). Patients with low blood pressure tend to tolerate less magnesium than do patients with normal blood pressure or hypertension.
For elderly or frail individuals, it may be advisable to start with lower doses than those listed. When administered with caution and respect, the Myers' has been generally well tolerated, and no serious adverse reactions have been encountered with approximately 15,000 treatments. In 1995, the author's last year in private practice, the cost of the materials for a Myers' was approximately $5.00. The use of preservative-free nutrients at least doubled the cost of materials. Nursing time and administrative factors represented the majority of the cost of IV nutrient therapy. In 1995, the author's fee for a Myers' was $38.00. Other doctors have charged as little as $15.00 or as much as $100.00 or more. Since 1995, the cost of most of the injectable preparations has increased by 50-100 percent.” Intravenous nutrient therapy: the "Myers' cocktail" by Alan R. Gaby
“The early papers by Dr Fred R. Klenner provide much information about the use of large doses of Vitamin C in preventing and treating many diseases. These papers are still important.” Linus Pauling, Ph.D.
Note that the aim of this site is to provide a starting point for health and healing research for ill people; especially very overwhelmed and disabled ill people. This site provides recommendations, summaries and reviews of books but is not meant to be a replacement for actually reading some of these wonderful health books if the reader is at all well enough to do so. (Plus getting individualised advice from a doctor that is also an orthomolecular medicine expert if possible). There is no substitute for reading as many of these books as you can. The HHH site can only really hint at their full brilliance. The amount of insight, scientific references, logic, intelligence, compassion and experience in the recommended books will most likely amaze you. HHH aims to encourage people to do their own reading and learning, and to always make up their own minds. All content copyright Jodi Bassett 2006 - 2014.