Cyanide for anaemia?

This post is about vitamin B12.

…No, I haven’t accepted vast sums of money to abandon promotion of vitamin D. 🙂 Vitamin D interests me most, but I have something to relate about the treatment of  anaemia.

My mother has had pernicious anaemia for quite a few years now and standard treatment for this in the UK (and elsewhere) is an intramuscular injection seasonally since B12 orally appeared to be absorbed improperly in such people. While she had no quarrel with the treatment, one side effect my mother had was quite bad headaches for a day or two following the injection. Furthermore, she really hates needles, let alone ones that drive into a muscle.

So, when I discovered studies that found high dose B12 tablets are as good (or perhaps) better than injections, my mother was more than happy to take a printout of an abstract of a Welsh study (best to use data closer to home) and debate with her doctor at her annual appointment about switching. By good fortune the doctor allowed her to have a go. This is the second instance where a doctor has listened and I commend that, as it’s best not to go behind the back of a care giver.

The only problem was that the tablets offered were not actually high dose at all, but normal dose, which as written in studies will not be effective in maintaining B12 levels and will bring her back on injections permanently. So, after explaining this to my mother (who, of course still wants to avoid the needle, bar necessary blood tests) she’s going to take the B12 of my choosing.
This is not a dangerous thing to do, because first of all vitamin B12 has an excellent safety record: apart from general side effects that can happen even at a low doses, no one seems to have fallen ill or died from it. More astonishing is that you can buy high dose B12 locally and cheaply – easily, whereas lower dose for anaemia is available on prescription….Strange.

One interesting fact about the prescribed oral cyanocobalamin is that it contains a little bit of cyanide, but not enough to be a concern for anyone but the most sensitive to it. Regardless, the B12 I’m recommending my mother is methylcobalamin as it’s said to be better absorbed and lasts longer; this is what we want.

If my mother’s next blood test in a season or so shows improvement or sustained levels, then the last refrigerated ampoule can go in the bin. What I’m sure of is that if she took 50mcg of cyanocobalamin rather than 1000mcg of methylcobalamin, she would certainly continue with sore arms and headaches four times per year.
When I can, I’ll let you know if her levels are fine on the tablets – here. If they’re not, then back to the injections – but I have very high hopes.

The moral of the story then is that if you can find evidence of a more desirable treatment avenue, print an abstract (not the whole paper!) and discuss it with your doctor. It’s often the case that discoveries like this take way too long to filter down to general care givers. In fact it was known for years that oral B12 can be as effective as injections, and a few places in the world already use it as a standard practice. The injection would still be wise though for those who cannot be relied on to take their medication.

I apologise for the lack of hyper-links in this post, but if this interests/affects you, search for something along the lines of: vitamin B12 oral or injection. You should find links to studies and debates that expand much more on what I’ve written here.



  1. I hadn’t heard about methylcobalamin. When trying to figure out which form of B12 to take, I stumbled upon this on
    “Cyanocobalamin is the form of B12 most commonly found in vitamin supplements. However, this form of the vitamin is only found in the laboratory, where a cyanide molecule is added to the vitamin to help stabilize it in tablet or capsule form. Once inside of the body, the cyanide portion is broken off and the vitamin is activated. While no suggestion has been made as to increased risk of cyanide poisoning through the use of B12 in this form, some healthcare professionals prefer the hydroxycobalamin or dibencozide forms of the vitamin which do not contain the cyanide molecule and are naturally-occurring.”


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