The Marketing, Scarcity, Rising Costs and Future of Vitamin B12

1ml bottlesIt is said that every person reacts differently and recovers differently after having a total gastrectomy (TG). But something that everyone has in common is malabsorption of vitamins and minerals, which people experience to varying degrees. And one problem that is persistent in every TG patient is deficiency in the vitamin B12.

B12 is a vitamin essential to the healthy functioning of nerve cells and red blood cells. It is found readily in animal meats and products such as milk and eggs, so anyone who eats a non-vegan diet is likely getting plenty of B12 through the foods they consume. It is even commonly added to fortified cereals and other similar products.

Unique to B12 is how it is made usable by the body. According to a fact sheet from the National Institutes of Health, “Two steps are required for the body to absorb vitamin B12 from food. First, hydrochloric acid in the stomach separates vitamin B12 from the protein to which vitamin B12 is attached in food. After this, vitamin B12 combines with a protein made by the stomach called intrinsic factor and is absorbed by the body.”

Now if you were paying attention there you surely noticed that in order to process and absorb B12 from food you need to have a stomach. Those who have had TG and even some who have had gastric bypass rely on not just supplementation of B12, but specifically the injectable cyanocobalamin form of B12. Because without the intrinsic factor in the stomach the body suffers what is called pernicious anemia and is unable to convert vitamin B12 to a usable form; so one can pop all the pills they can swallow and it will likely do no good.

Syringes Pernicious anemia causes the body to slow production of red blood cells and according to the above-linked article, “Without enough red blood cells to carry oxygen to your body, you may feel tired and weak. Severe or long-lasting pernicious anemia can damage the heart, brain, and other organs in the body. Pernicious anemia also can cause other problems, such as nerve damage, neurological problems (such as memory loss), and digestive tract problems.”

I had my first shot at the doctor’s office in September 2010 and took home a prescription for a 30mL bottle (which @1mL per dose is 30 doses). I had a friend who is an RN come over and give me my next shot a month later. After that I made Dan watch a YouTube video showing how to give a subcutaneous injection and he gave me shots for several months before I could muster the courage to do them myself. The general rule of thumb is to take a shot a month, so a 30mL bottle is about a two and a half year supply.

I think it was within the first six months of my surgery I started hearing a little buzz about a shortage of B12 but didn’t think too much of it at the time. I guess I felt that I would be okay as I basically had enough for more than two years. Drug shortages happen here and there in the pharmacuetical business and it would likely be resolved by the time I needed more.

1ml bottlesLast February, I had to see the doctor for a new prescription. This time the pharmacy was unable to provide me with a 30mL bottle due to the shortage and I had to resort to using 1mL bottles and they could only provide me with 12. (I am currently holding on to my used ones because I fear that one day I will have to pop them all open for the small remainder still inside and combine them just to get a few much needed doses).

Looking into the shortage I discovered that it was ongoing; it hadn’t been temporary as I had previously thought. I heard rumblings on an internet forum somewhere that manufacturers are having trouble sourcing the raw materials to make it. So a few months ago I emailed one of only two FDA approved manufacturers of injectable cyanocobalamin about the shortage.

In reviewing his response from October 2013 he simply said, “What I can report is that we are not manufacturing cyanocobalamin presently but hope to place this product onto manufacturing schedule very soon. The decision to place a product back onto manufacturing schedule is not a simple process and involves several internal departments and regulatory agencies.”

Which I take to be a sincere and professional way of saying, “I have no idea when we are making more.”

The Food and Drug Administration maintains a database of all drug shortages. I have been checking this periodically over the past year and every time the anticipated release date comes, they revise and push the date back further.

But the halt in production of injectable cyanocobalamin is only a small piece in the puzzle of why the shortage is so alarming. Because the main reason for the shortage, the reason the manufacturers have been unable keep up with demand is because it has become fashionable to get B12 shots. That’s right, it’s all the rage these days in the health clubs and the “medical” spas. It’s being touted as a weight loss miracle.

The problem with this is there is absolutely zero evidence that injectable B12 is any more effective than taking oral supplements for healthy individuals. None. The only reason it “gives you energy” and “makes you feel revived” is because some copywriter in a marketing department somewhere is telling you that it does. Medical professionals and journalists alike have found that selling B12 injections as energy builders and an aid in weight loss is just a snake oil ruse. And there is no evidence that B12 aids in weight loss according to the Mayo Clinic.

The fact is that normal, healthy individuals will get the same result taking oral B12 supplements as they get with a shot. Vegans who do not get enough through their diet will also be just fine with oral supplements. But as I explained above, TG patients, gastric bypass patients and others with various stomach and intestinal disorders, including the elderly, are increasingly missing out on these MEDICALLY NECESSARY injections because celebrities like Madonna and Justin Timberlake want to have more pep in their step.

Last summer, Dr. Jane Sadler lamented the B12 shortage and explains it’s the placebo effect that makes people think they are getting “results” from the shots. I can attest to the placebo effect at work here because I had told my doctor how I felt it working immediately and he smiled at me the way one would smile at a child that has just told the most unbelievable, fantastic tale. In other words, you don’t feel anything working; you just think you do.

Another physician likens the current B12 shot craze to a “fetish” and calls out it’s overuse. Regrettably, he does not mention that there are some people for which oral supplements do not work and they are the ones most harmed by this increasingly popular practice.

Also, a television station in Salt Lake City, Utah (video seen here) investigated the use of B12 injections for non-medical reasons and did a good job in pointing out that people are basically wasting their money. What it failed to do is bring to light how this recreational use of injectable B12 is actually harming people who need it because it is making it very hard to find and also causing the costs to skyrocket.

The increasing cost brings up another point: if you are getting B12 injections at the gym or the spa, man are you getting ripped off. Oh. My. Word. Are you ever getting ripped off! Even with the rising costs people are paying too much for these shots. This alone should enrage current proponents of the “needle-fed B12 fad” and send them right to the vitamin aisle for a $10 jar of oral supplements.

I called a local “medspa” and inquired about their B12 injections. I was told that it would be $100 for a month long treatment. Upon further inquiry she explained that it would be one 1mL injection per week for four weeks. So that’s $25 for a 1mL shot. That seems to be a bargain as the journalist from KSL TV in Salt Lake City reported that people are paying up to $80-90 a shot. No wonder so many outlets are offering these “miracle” shots. It’s all about the money.

I dug up my receipts and can report the following:
September 2010 I paid $31.90 for a 30mL bottle and 30 syringes = $1.06 per 1mL dose.
February 2013 I paid $42.90 for 12 1mL bottles and syringes = $4.40 per dose
February 2014 I paid $61.95 for only 9 1mL bottles and syringes = $6.88 per dose.

This demonstrates both the rising costs of injectable cyanocobalamin and exemplifies the ridiculous markup associated with the trendy marketing of this vitamin outside the medical community. And those are retail prices. You know these health clubs and spas aren’t paying retail; they’re paying much less than that. Basically, if you are paying more than about $10 for a 1mL injection, you’re being bamboozled. And it seems a lot of people are paying 5-10 times more than that.

Then there is the dosage to consider. People who need injectable B12 because they cannot absorb it from food or oral supplements are prescribed about a 1mL injection every month. I know of some who get one every two weeks and others who get one every 2-3 months, but once a month seems to be the average.

Getting the shots once a week is just overkill for healthy people who have their stomachs intact. And I’ve even seen references in weightlifting forums to people taking them every 3-4 days. That’s literally pissing money away because your body is not storing all that. You’re getting too much, paying too much, and it’s being excreted through your urine.

I’m not against people who strive for a healthy lifestyle and choose B12 supplementation as a way to maintain that health and well-being. I just ask that people reconsider their use of the injectable form. Most people simply don’t need it. And they are causing a shortage for others who can suffer severe effects, including death, if they have to go without for too long.

B12 PillsLooking on the bright side, there is some indication that the sublingual and nasal spray forms of B12 are absorbed directly into the bloodstream, through the mouth or sinus cavity respectively, circumventing intestinal absorption and the need for intrinsic factor. Anecdotally, I have heard they work for some people; I have also heard it does NOT work for other people and they need the shots to keep their levels from getting dangerously low.

It is also speculated that the methylcobalamin form of B12, while more expensive, is better absorbed by the body and that it’s use shows promise. If absorption is viable using the above delivery methods, rather than injection, it may prove to be beneficial to those who cannot absorb it through the intestine.

So if it turns out that I can dissolve a few sublingual tabs under my tongue every day and still get a decent amount of B12 to keep my body healthy, I will surely ditch the needles. Then all the fad dieters and body builders can continue to pay ridiculous amounts of money for injections that do very little for them. After all, this is America, and people have every right to be swindled by charlatans.

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