The Importance of B12

The Importance of B12

For instructions on how to give B12 injections, please click on the "shots" link at the top of this page.

On this page, I’m going to give you my experience, knowledge and opinions of B12. I’ll also be giving you some
personal stories and information from a few people who are in an even better position medically and
professionally to understand the potential of B12 and its effectiveness. Again, these are only our experiences
and opinions based on what we’ve learned and done with B12 in the last several years. We hope to see some
better studies develop in the near future to further investigate our findings and help initiate some changes and
more education about B12. Please be advised that I do not advocate nor do I suggest using B12 instead of any
medications and/or medical treatment needed for your cat. B12 is to be used in addition to the treatments and/or
medications prescribed by your veterinarian.

As I’ve stated on previous sections of this website, if I’d known earlier about the magic of B12 and how quickly
and effectively it helps cats with many diseases, not just IBD or malabsorption issues, I would have started Alex
on it right away. I only began to learn about it towards the end of her life and by the time I did start the injections,
it was indeed helping, but it was too little, too late. For that reason I believe it’s imperative to start them on B12 at
the first sign of illness.

B12 is non-toxic, water soluble and has the largest and most complex chemical structure of all vitamins. The list
of benefits and symptoms of deficiencies are both long. There are no known side effects other than it can
produce occasional diarrhea, though rare and the benefits far outweigh the risks.

B12 helps to support adrenal function, maintain a healthy nervous system, aid in the production of DNA and
RNA, and the production of neurotransmitters. It affects the development and maintenance of red blood cells,
nerve cells and normal myelination (the fatty sheaths that cover and protect nerve endings). It’s needed to
prevent anemia, required for the proper digestion and absorption of food, and the metabolism of carbohydrates
and fats.

A B12 deficiency can cause poor cell formation in the digestive tract and lead to nausea, vomiting, loss of
appetite, poor absorption of food (malabsorption syndrome), constipation, gas, weight loss, fatigue, lethargy,
abdominal pain, and/or diarrhea. Absorption of B12 requires normal function of the stomach, pancreas and small
intestine. Sound familiar? These are the very symptoms that cats with IBD and other gastric disorders exhibit. A
b12 deficiency also inhibits and decreases the body’s ability to produce blood, increases blood cell destruction
and is very harmful to the nervous system which can cause neurological disorders and severe and sometimes
irreversible nerve damage. Because a healthy liver is able to store many years worth of B12, signs of deficiency
may not be obvious for a long time. Which may be why some cats seem to benefit even when they test negative
for deficiency.

To be absorbed in the body, B12 needs to combine with a substance called intrinsic factor. IF is produced by
your stomach lining where B12 from foods is released from its protein complex by hydrochloric acid and
enzymes. The secreted IF will bind to B12 and this combination will travel to the end of the small intestine which
then crosses the intestinal wall into the bloodstream. B12 is stored in the liver after being absorbed and excess
is excreted in the urine. If it’s not absorbed (ie due to malabsorption), it’s excreted in feces since it never leaves
the GI tract.

On PetPlace.com, they clearly state that a congenital B12 malabsorption syndrome has been reported in cats
(as well as some specific dog breeds). It also states that for dosing in cats, no good data is available and oral
treatment is unlikely to be of much benefit in malabsorption states (e.g. pancreatic disease interfering with the
production and release of pancreatic IF). This is why injections are used instead of pills. Injections will bypass
the stomach and go straight to the liver but the pills will have a long way to get there, will break down a lot
sooner and not have nearly the same affect.
www.petplace.com/drug-library/vitamin-b12/page1.aspx

Some risk factors for B12 deficiency are a weakened immune system and impaired white blood cells, gluten
allergies and/or sensitivities and helicobacter pylori infection (bacteria that can be common in IBD). Antacid, H2-
blockers, anticoagulants and potassium supplements can impair the absorption of B12, broad spectrum use of
antibiotics or anti-convulsants and parasites (specifically tapeworm). Large parasites like the beef tapeworm
compete for nutrients by robbing the body of micronutrients and vitamins.

I gave Alex .50 ml of B12 injections twice a week, with my vet’s consent, and besides helping her malabsorption,
it had the dramatic and helpful side effect of making her ravenous! I had also been giving my sister’s elderly cats
1 ml each every 7-12 days for almost two years and I am convinced it saved their lives as they weren't on any
medication, just holistic treatments, a better quality diet and B12. Moufasa started out with severe weight loss,
explosive diarrhea and kidney insufficiency. He could barely lift his head, was so malnourished it was pitiful and
it took a long, long time for him to become stable. But he did begin improving immediately. Initially the B12 helped
with hunger issues due to nausea but it took at least 6 months for the diarrhea to completely stop and for his
body to fully absorb his nutrients again. Sadly we lost Moufasa in December of 2010, he was an older guy who
had some serious health issues. The last two years of his life were filled with love and joy and he had a great
quality of life. I believe B12 played a major role in giving him those last two years.

Shortly after he passed, her other elderly cat Midnight, began vomiting bile, losing weight, not eating. Again I
turned to holistic treatments and B12 immediately. At first she received 1 ml of B12 every two weeks but now she
gets 1 ml of B12 once every month. There are many factors involved in how they got to this point; eating a
horrible, cheap, grain-filled, dry food only diet their entire lives, age and other health factors such as arthritis. So
the damage had been done and at 15 and 16 years old, they both did better than anyone expected considering
how bad off they were. The fact is, the longer the malabsorption has been present, the longer it will take to heal
and stabilize, just like anything else. So have patience and don’t expect miracles or for things to improve
immediately.

Another example is Purr Panther, who is in our Tributes section. Purr was diagnosed with chronic interstitial
pancreatitis in 2004 and was going downhill very quickly despite being on several medications and a diet
change. After reading about B12, his parents began giving him injections immediately and within 24 hours, he
was turning the corner. Purr lived another five years and with great quality of life. He took pancreatic enzymes,
stayed with his new diet and got B12 injections right up until his passing, which was quite sudden and
unexpected. Before he received B12 he was very near death and his parents feel it saved his life. His dad now
works with cats that have cancer and many of these parents go ahead and give their kitties 1 ml per week or so.
Some cases are too late to help unfortunately, nothing can change that. But there are a lot of cases where it’s
helped the cats tremendously and makes all the difference in their recovery.

Based on these experiences, I personally don’t believe that the .25 ml standard amount is enough to sustain
most cats that are in crisis or have been dealing with IBD and/or other GI diseases for any long length of time. A
cat metabolizes food much quicker than a human, approximately 12-16 hours for the cat as opposed to 35-55
hours for us humans. For this reason, it doesn’t make sense to me to use such a tiny amount. I'd like to see the
standard raised to at least .50 ml. Also, cyanocobalamin doesn’t have staying power in the system because it’s a
synthetic form of B12, which is to me another good reason for giving it at higher doses and more frequently than
the standard protocol suggests. cyano goes through a conversion process which ends up being
methylcobalamin.

Methylcobalamin is better absorbed so your tissues retain higher amounts of it, which enables it to work much
more effectively. Methyl is used primarily in your liver, brain and nervous system and is needed for proper
nervous system health. Methyl should be considered in the treatment of all neurological diseases including
diabetic neuropathy. Cats with this condition are now being given a dose of at least 3,000 mcgs per day of oral
Methyl B12 with amazing results!

Methyl breaks down faster and is only available orally, whereas cyano is available both orally and in injection
form. For this reason, cyano injections are the primary choice to be sure they receive an adequate amount. A
B12 deficiency is common in cats with gastrointestinal, pancreatic and/or liver disease, and in particular, with
idiopathic hepatic lipidosis (fatty liver disease). In people with liver disease, although high blood levels of vitamin
B12 are common, it is not unusual to actually have a correspondingly low liver tissue concentration of vitamin
B12 and its enzymes; which in my opinion is another reason to go ahead with B12 treatments for a cat with liver
disease and other GI conditions, regardless of testing results.

In a paper written for the World 2006 Congress by Sharon A. Center, DVM, DACVIM, she discusses how
supplementing B12 on top of what’s in a commercial pet food diet can help somewhat therapeutically. But cats
with severe IBD and/or malabsorption, (including lymphoma) may require parenteral “loading” and extended
therapy with parenterally, administered B12 (1,000 mcg = 1 mg = 1 ml) She also states that doses of 5-7 day
intervals to possibly once per month have been established in individual cats). B12 insufficiency can increase
development of hepatic lipidosis (fatty liver disease). Click on this link for more information and scroll down to
where it says B12.
www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2006&PID=15828&O=Generic

I have suspicions that because most kitties respond well to B12 injections whether they test normal or not, that
an imbalance/deficiency of B12 or other B vitamins in their diet is contributing to a possible cause of IBD. Vitamin
B12 is found naturally in food sources (principally animal products) in protein-bound forms. The body cannot
produce it; it can only store it. The human body has up to a 3-year supply of B12 and 30% of that found in food
is typically destroyed by cooking. Over-processed pet food could be a possible culprit in a lot of these
deficiencies, dry food being the worst of the offenders.

Read the label on some of the well-known commercial foods that are constantly peddled as healthy pet food; an
abundance of grains (carbohydrates) that are turned into sugars by the body, unhealthy fillers, etc. Not much
meat and if there is, it’s usually meat meal, meat by-products, meat filler. And if they do use real meat, it’s not the
first ingredient but down the list which means there’s not a high percentage of it. Many of the premium brands of
cat food have improved greatly on these ingredients and we now see quite an array of grain free foods offered.
Still, there’s a lot to be said for some of their ingredients and we as pet parents know it. It’s no wonder to me as
to why there’s an epidemic of intestinal diseases with cats these days as their bodies are being overworked
trying to convert all of these sugars. The pancreas has to produce amylase to digest the sugar and insulin for the
body to use it. The digested sugar (glucose) is an energy source that is used by the body and stored in the liver
as glycogen for extra energy needed with excess being converted into body fat. There’s also an epidemic of
obesity in cats these days, which puts them at a higher risk of developing hepatic lipidosis, especially if they stop
eating. That’s what happened to my Alex unfortunately.

Dr. Jorg M. Steiner of Texas A&M University states that regardless of the cause, animals with reduced B12
levels and absorption can in fact be expected to deplete their stores of B12 at some point. He also states that
there is evidence that a B12 deficiency can contribute and even cause gastrointestinal disease in some pets,
and that the half life of the compound is drastically reduced with GI disease.
http://vetmed.tamu.edu/gilab/research/cobalamin-information

It should be noted that Dr. Steiner was asked by a support group about the dosing of B12 and if an increase
would benefit a cat more and his official opinion was that it wouldn’t help at all. Although I greatly respect Dr.
Steiner, we are clearly seeing that it does in fact benefit them greatly and in many cases the higher dose has
made all the difference in the world. I’d like to see a more thorough study done on this in the near future by any
willing veterinary teaching school and I would eagerly work closely with them on any information they’d want from
some of our case studies.

Below are some personal accounts and experiences with the success of B12 in different areas.

Jennifer Hearin, Gump's mom, (Gump is in the Parent's Speak section, look under Feline Diabetes): I
started giving Gump weekly B12 injections about a month ago after he became ill and we discovered he has
chronic pancreatitis (he's also diabetic, but has gone into remission this year); we also had his cobalamin levels
(B12) tested, which came back low. We decided to increase the standard veterinary dose and give it on an
ongoing/weekly basis. Gump seems energetic and his blood glucose levels have gotten a little better than they
were - I don't know if it's a fluke, but it could be related (that's with no insulin). It seems to me that B12 could be
beneficial for sick kitties, older kitties and perhaps just in general.

Barbara Aggarwal MD, Bumbly’s mom. (Bumbly is our Living with IBD section): The whole B12 issue is
so complex, its absorption and metabolism are more complicated than any other vitamin, and there are still
unknowns, particularly in metabolism. One thing that is quite sure is that an acidic environment is required to
absorb protein-bound B12; i.e. that from food, so it's beneficial that cats have lots of acid from that standpoint. In
people there is the possibility of becoming B12 deficient by taking chronic acid inhibitors like
Prilosec/Prevacid/Nexium (the PPIs), though it takes about 2 years to use up all our reserves. Pepcid, and all the
other H2 blockers, are not as completely effective in blocking acid, but it would still be possible to run into
problems from chronic use, and it’s probably a good idea to give injections to cats taking Pepcid or any other
antacids long-term.

It could be that cats aren't getting enough B12 because they're designed to eat so much protein, which is the
only place B12 is found naturally. But instead most commercial foods contain carbohydrates. Cats may be
inefficient naturally at absorbing B12 because they were designed as carnivores to have ample supply in their
diets. So when their diets consist of mostly carbohydrates and fat, they become relatively deficient. Also,
increased number of bacteria in the GI tract may use up B12 before it can be absorbed, and with an abnormal GI
tract, these cats may have bacterial overgrowth. Bumbly definitely has small bowel bacterial overgrowth and has
to have Flagyl to maintain. On the other hand, I never needed more than the TAMU protocol for her, and there
are a lot of kitties where that is fine. So the interesting study would be to try to figure out what characteristics the
cats that need high doses share. Then you could more easily predict who would benefit from it. We can’t explain
why some need or seem to benefit from higher doses. It could be either a faster metabolism, which may be sped
up more than usual when they are sick, or it could be some defect in the biochemical processes needed to utilize
it.

A lot of the kittens I foster come in with bad diarrhea, URIs, very weak, etc, and I will often give them a B12
injection to help them recover. On one group of kittens with diarrhea I tried treating with Albon, probiotics and
fenbendazole without resolution. Then it got acutely worse and very smelly so I tried Flagyl for bacterial
overgrowth and .25 ml of B12. The next day I was seeing formed stools. Another success story was with a foster
who wasn’t gaining weight like the others. He was eating fine, acting normally and no diarrhea, but he was
terribly thin and could not gain weight. I gave him B12 and within a week he gained ½ lb., more than double the
usual gain. My other 12 year-old cat began having early AM vomiting so I started giving her Pepcid at night
which helped immensely. But with the addition of B12 she no longer needed the Pepcid every night. She’s now
14 and back on pepcid every night but still gets B12 every month due to dilute urine and IRIS stage 2 – these
kitties excrete out B12 more quickly due to the dilute urine and it’s recommended they all get supplementation.
She has trouble maintaining weight, so I may up her to every 2 weeks, which my vet completely approves of.

As far as using B12 in the pill form, the whole problem with IBD is that the part of the intestine needed to absorb
it may not be functioning so no matter how much you eat, it never gets to the bloodstream, so you have to
bypass the GI tract with injections. Even if that part of the intestine isn't involved with IBD, certain medications
like Pepcid/famotidine may make it more difficult to absorb since the breakdown process in the stomach is
affected by the change in pH. Also several steps occur to prepare the B12 for absorption before it reaches that
part of the intestines, so if anything isn't working right there, it won't be absorbed. The No Shot B12 will work in
people because you're supposed to put it under your tongue to dissolve and there's so many blood vessels
under there, the theory is that some gets absorbed through the mucus membrane of the mouth and into the
vessels/blood stream, that's why they use 5000mcg, so that even if only a tiny percentage of that gets absorbed
you are still getting a decent dose in the blood if you use it frequently enough. Problem with kitties is you can't
get them to hold it under their tongue, if they swallow it and any step of the "preparation" and absorption of the
B12 is off due to the GI disease, then you will get little or no absorption. Realistically, since B12 is in all meat and
quality cat diets, particularly canned and raw food, are mostly meat, if they've become deficient while eating B12
all the time, then it won't work to give them an oral supplement of it, either.

In a person it takes a long time to deplete B12 stores but with cats everything seems to go quicker. For IBD
kitties, I’ve gotten to the point where I don’t think they should have B12 levels measured. Just start giving it to
them because it too often works even if the level is normal. A lot of vets are doing that now.

In human medicine they’re looking at a lot of RDAs for various vitamins and finding that some may be too low.
Most are based on very old data so there’s no reason to think that the recommendations for supplementation of
pet food are perfect either. There may very well be multiple deficiencies in regular food both because there is a
lot unknown. But also, vitamins may degrade with cooking, processing and time. Things change with aging and
probably are increased in the elderly or ill cats. Plus many of them are on meds which may change the
absorption of vitamins and suppressing acid definitely suppresses B12 absorption.

Peekie’s mom, (Peekie is also in the Living with IBD section), is the Vice President of a rescue league
in Nova Scotia and this is her personal experience and opinions on B12 and what she’s seeing with
kittens being born B12 deficient:

I can’t say for certain without actually testing the kittens for B12 levels to know if they are deficient. I do know
that when kittens who are orphaned and are not doing well with weight gain or growth receive B12 treatments,
they do improve somewhat. I may only need to give them one dose but sometimes it could be weekly doses for
two to three weeks. The improvement is quite remarkable and in some kittens that have looked underweight and
sickly one week, look almost normal after a few weeks of therapy. Most go on to be quite normal after their initial
treatment(s) and I’m not sure if they were actually deficient OR maybe there is some sort of switch that is turned
on when they're really young and the B12 helps to activate that switch. I can’t say for certain but I would be
interested to see some research done by veterinary pediatric medicine.

When they're young and sickly, a lot of the time they just feel it's best to put them out of their misery rather than
try and figure out what maybe wrong with them. Even the vet we deal with doesn't know for certain what may be
wrong with some of the kittens we bring to see her. BUT it was she who said that sometimes kittens can be born
with B12 deficiencies, that it can cause a whole host of problems and in some cases even death. I have seen
some kittens so sick that some vets gave them only fluids, and hoped and prayed that they’d live. I treated them
with B12 shots, amoxicillin and probiotics and within a few days they improved quite dramatically. The amount of
B12 varies but for wee tiny kittens less than 1b. and up to 1lb, it's .1cc of 1000ug/ml of B12 and the older ones,
up to 3 lbs I give .15-.2cc. I give it weekly unless I find they do well but start to fail before the 7 days are up. I had
to give it daily to a few really sickly kittens for 3 days straight until I saw a good enough improvement in health.
But usually in a week so much so, you wouldn't even know they were ever ill. Orphaned kittens are bombarded
with bacteria from the moment they come into this world and without their mothers' milk loaded with nutrients they
fail to develop good defenses. Mild Antibiotics, B12 and probiotics seem to be the key for many and has saved
their lives when I'm almost positive they would have died.

B12 is very important for releasing energy for weight gain, growth and normal cell regeneration as well as proper
digestion of fats, proteins and carbohydrates. Without it the body cannot maintain itself and in the very young it
can lead to problems in growth and development. I do belief that Peekie was born with a B12 deficiency and
while she was young she went through the most crucial part of her growth without enough B12....she wasn't
deficient enough for her not to survive but enough to cause a whole host of problems throughout her life
including IBD and pancreatic episodes. Now that she is getting regular B12 shots she seems to be holding her
own quite well. My belief (from the TAMU research) is that with the majority of B12 deficient animals some may
actually stop needing B12 supplementation but others will always need it because their bodies can never make
or store enough.

I'd be really interested to see if research would go further by trying to prevent B12 deficiencies and the
development of diseases like IBD, endocrine and/or pancreatic insufficiency by giving B12 to pregnant animals
and then to their young before the damage is done. As I said I can’t say with certainty that kittens are actually
born with B12 deficiency only that what I have seen is that many more rescue kittens seem to have some
problems with growth and digestion that resolve when put on B12 therapy.

Deneen Fasano, DVM: These comments are primarily from my personal experience and not backed up by
research.

I mostly use B12 injections for any cat that is not eating, for older cats and for diseases such as renal and liver
disease. I believe it stimulates their appetite and gives them an energy boost. I use it anytime I'm giving SQ
fluids, no matter what the illness and I usually give 1/2 to 1 ml per cat.

I am not a fan of feeding dry food in cats. Meat is one of the best sources of vitamin B12 and if cats are being fed
dry food, they may not be getting enough B12. There are toxins everywhere and our pets sometimes get the
worst of it because they are small and exposed to ground level, picking up toxins. I believe it can contribute to
diseases, especially liver disease. I think with IBD, dry food combined with vaccines and probably toxins are
affecting their immune systems, making it go haywire, causing inflammation in the GI tract, and making them
sensitive or allergic to certain foods. www.animalhealingsolutions.com/

For further information, IBD Kitties recommends the following reading:
Some great reading and information on B12:
www.vitamins-supplements.org/vitamin-B12-cyanocobalamin.php

This website is extremely thorough and informative about everything related to B12:
http://lpi.oregonstate.edu/infocenter/vitamins/vitaminB12/

American Family Physician - Vitamin B12 Deficiency
www.aafp.org/afp/2003/0301/p979.html

This book is based strictly on B12 for humans but written by a nurse and doctor. This book has opened my eyes
to the potential B12 has for healing of many conditions if done early enough and the dangers of what a
deficiency can cause. Could It Be B12?: An Epidemic of Misdiagnoses
www.amazon.com/Could-Be-B12-Epidemic-Misdiagnoses/dp/1884956467
Also, Could It Be B12? 2nd Edition
http://b12awareness.org/2011/05/10/could-it-be-b12-2nd-edition-to-be-released-march-2011/

methylcobalamin (scroll down past the vitamins until you see the article, VERY informative:
www.vitadigest.com/methylcobalamin-b12.html?gclid=COO41NuFspgCFQrFGgodtUufUA
Information on Methyl B12 for diabetic neuropathy:
http://laurieulrich.com/jasper/
www.sugarcats.com/articles/Neuropathy-in-Diabetic-Cats/

Feline Malabsorption Syndrome:
www.petplace.com/cats/malabsorption-in-cats/page1.aspx
www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/23313.htm
http://jn.nutrition.org/content/134/8/2068S.full

.25 ml
1/4 cc

.50 ml
1/2 cc

.75 ml
3/4 cc

By Lisa Provost
Barbara Aggarwal, MD
& several other contributors

100 ml
1 cc

Be sure to check out
my blog!
http://ibdkitties.blogspot.com/