Treatment of B12 Deficiency

DISCLAIMER: This material, as well as any other information on this website, is for educational purposes only and is not meant to diagnose, treat, cure, or prevent any medical condition. These approaches are to be used solely under the recommendation and guidance of a physician or other appropriate health professional with expertise in this area. 


I have found many approaches to the treatment of B12 deficiency. I will list three of them to facilitate beginning a dialogue with your physician.


1. Protocol described by Sally M. Pacholok, R.N., B.S.N. and Jeffrey J. Stuart, D.O. in Could It Be B12?, 2nd Edition:

  • Initial intramuscular injections of vitamin B12, 1,000 mcg daily or every other day for five to seven days, followed by
  • Intramuscular injections of 1,000 mcg weekly for four weeks, followed by
  • Maintenance intramuscular injections of 1,000 mcg monthly, bi-monthly, or weekly depending on patient response.

The recommendation is methyl-B12 or hydroxo-B12. The patient, or a family member, can be taught to administer subcutaneous injections.

“G. Richard Lee, M.D., notes in Wintrobe’s Clinical Hematology that a single injection, even of massive amounts of B12, is not sufficient to replenish body stores. This is because the body’s ability to retain the injected B12 is limited. Thus, he writes, ‘If greater than 1 mg of B12 is to be stored, several injections separated by at least twenty-four hours need to be administered, rather than a single dose.'” (Could It Be B12?, 2nd Edition, pp. 223-224.)

“Under the regimen outlined above, hematologic improvements typically commence within five to seven days, and the deficiency should resolve after three to four weeks of therapy. If the B12 deficiency has been long-standing, and neurological manifestations are present, it can take six months or longer before signs of improvement appear. In cases where neurologic signs and symptoms have been present for a year or longer, or where impairment is severe, neurologic damage may be permanent. Overall, neurological symptoms are completely resolved in about half of cases, while residual deficits remain in the other half; however, nearly all patients improve to some degree.” (Could It Be B12?, 2nd Edition, p. 223.)


2.  The B12 Deficiency Protocol of Joseph Chandy, M.D., of Shinwell Medical Centre, Horden, Co Durham, England. Dr. Chandy has been working with B12 deficiency for 30 years. You can download his protocol, as it is too extensive to be reproduced here. This link will also allow you to leave a message for Dr. Chandy on the B12 deficiency Support Group website.


3. Protocol  from American Family Physician

Oral Route: 

  • Initial dosage: 1,000 to 2,000 mcg per day for one to two weeks
  • Maintenance dosage: 1,000 mcg per day for life

Intramuscular route:

  • Initial dosage: 100 to 1,000 mcg every day or every other day for one to two weeks
  • Maintenance dosage: 100 to 1,000 mcg every one to three months



Click here for more information on oral or sublingual B12 vs. injections.



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