Last month I discussed vitamin B12's importance in the practice of neural therapy and some of the practical aspects of its use. What the discussion boiled down to was a recommendation that daily vitamin B12 injections should be given as a therapeutic trial whenever deficiency is suspected.
One of my readers, Dr Mason-Woods ND asked why I recommended cyanocobalamin, when methycobalamin is a more effective and more physiological substance. He points out the advantages of the methyl form:
- no toxicity from the cyanide residue
- better absorption and retention in the tissues
- better for vision (the cyano form is ineffective in this application)
- helps in sleep regulation.
To answer Dr Mason-Woods' question: in an ideal world, methylcobalamin would be my first choice also. However (at least where I practice in Ontario, Canada) methylcobalamin is less available, is more expensive and is not covered by the seniors' drug plans. Cyanocobalamin has (in this jurisdiction and in the last year) become a non-prescription item, is inexpensive and can be purchased in 30 ml bottles in some supermarkets. For these reasons, I save methylcobalamin for exceptional circumstances.
The situation is similar to that of folic acid and folate. Folic acid, like cyanocobalamin, is a pharmaceutically engineered product. It is cheap and easily available, but folate is what is found in nature, is more effective and probably safer.
Before leaving the subjects of cobalamin and folate, I would like to share a "pearl", taught me by another colleague, Barb Powell MD. This has to do with unusual requirements of vitamin B12 and folate in some of our patients.
Last month I mentioned that after one week of vitamin B12 injections, the patient should either feel better, or not. If there is no improvement, B12 deficiency is unlikely to be the problem. However if the patient feels better, the next question is going to be: when should the injections be repeated?
The answer seems to be: whenever needed. Some patients will need a repeat injection in a few weeks; some will need repeat injections every two days. If the patient needs frequent injections there is likely an abnormal genetic defect in the body's handling of both cobalamin and folate - a methylenetetrahydrofolate reductase (MTHFR) pleomorphism. This is surprisingly common in patients with fatigue, depression, detoxification difficulties, and signs of B12 and/or folate deficiency. A history of thromboembolism or children with neural tube defect or congenital heart problems are additional clues. And a high serum homocysteine can be another marker.
Testing for MTHFR pleomorphism is commercially available, and in Ontario, Canada, is even covered by the government health insurance plan. It is tucked away in a panel of genetic tests used in investigating thromboembolic disease. The thrombophilia panel includes two genetic variants: p.ALA222Val and p.Glu429Ala. If one or both are present, the degree of "folate dependency" (Dr Powell's term) can be estimated by whether one or both are present and whether the genes are heterozygous or homozygous.
If the patient is homozygous for one or both genes, he/she may require daily supplementation of dietary folate of 5 mgm/day or more, in addition to frequent doses of vitamin B12. The response to treatment may be slow. The full benefit of high dose folate may take six months or more to be evident. Both Dr. Powell and I have seen patients' general health and whole world view change with this simple treatment.
Neural therapy's most distinctive attribute is the detection and treatment of interference fields. However, the skilled neural therapist knows that simply treating interference fields can take one only so far. The health of the whole nervous system must be taken into account. Ensuring that the patient has adequate vitamin B12 and folate are key factors in optimizing the patient's health and his/her response to neural therapy.
The Neural Therapy in Practice newsletter was intended as a complement to Dr. Kidd's book, Neural Therapy: Applied Neurophysiology and Other Topics, which is still available for sale through Amazon.