Response to Vitamin B12 and Folic Acid in Myalgic Encephalomyelitis and Fibromyalgia

Abstract

BackgroundPatients with myalgic encephalomyelitis (ME, also called chronic fatigue syndrome) may respond most favorably to frequent vitamin B12 injections, in vital combination with oral folic acid. However, there is no established algorithm for individualized optimal dosages, and rate of improvement may differ considerably between responders.ObjectiveTo evaluate clinical data from patients with ME, with or without fibromyalgia, who had been on B12 injections at least once a week for six months and up to several years.Methods38 patients were included in a cross-sectional survey. Based on a validated observer’s rating scale, they were divided into Good (n = 15) and Mild (n = 23) responders, and the two groups were compared from various clinical aspects.ResultsGood responders had used significantly more frequent injections (p<0.03) and higher doses of B12 (p<0.03) for a longer time (p<0.0005), higher daily amounts of oral folic acid (p<0.003) in good relation with the individual MTHFR genotype, more often thyroid hormones (p<0.02), and no strong analgesics at all, while 70% of Mild responders (p<0.0005) used analgesics such as opioids, duloxetine or pregabalin on a daily basis. In addition to ME, the higher number of patients with fibromyalgia among Mild responders was bordering on significance (p<0.09). Good responders rated themselves as “very much” or “much” improved, while Mild responders rated “much” or “minimally” improved.ConclusionsDose-response relationship and long-lasting effects of B12/folic acid support a true positive response in the studied group of patients with ME/fibromyalgia. It’s important to be alert on co-existing thyroid dysfunction, and we suspect a risk of counteracting interference between B12/folic acid and certain opioid analgesics and other drugs that have to be demethylated as part of their metabolism. These issues should be considered when controlled trials for ME and fibromyalgia are to be designed.

Infection Elicited Autoimmunity and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: An Explanatory Model

“…The results were at the time interpreted as suggesting a block of inflow over the blood brain barrier of B12 and/or folic acid ( 277 ). The derangement in one-carbon metabolism is supported by 20 years’ experience of vitamin B12 and B9 treatment in ME/CFS patients, which tends to diminish impaired cognition (“brain fog”) ( 306 ). It is not immediately evident why the one-carbon metabolic pathway would change after a block of aerobic energy production.…”

Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: all roads lead to Rome

“…However, further research is needed because the studies carried out to date have been small and have used inconsistent dosing regimens and/or non‐biologically active forms of vitamin B 12 (hydroxocobalamin) (Swanink et al, ; Bjorkegren, ; Norberg, ; Hagglof, ). Recently, this question has been addressed (Regland et al, ), drawing on 15 years' experience of treating CFS/ME patients with vitamin B 12 (methylcobalamin, as the biologically active form). During this time, the CFS/ME patients were shown to respond best to the injected form of vitamin B 12 .…”

“…This research group concluded (Regland et al, ) that frequent injections of highly concentrated methylcobalamin combined with an individual daily high dose of oral folic acid may be safe and effective for fatigue and other CFS/ME symptoms. Moreover, CFS/ME patients should be tested for certain opioid and analgesic drugs and for co‐existing thyroid dysfunction.…”

A Biermer’s Disease Revealed by a Myogeneous Syndrome About a Rare Case in Young African Black Subject and Literature Review

“…But we have asked ourselves the question of whether it is a direct complication of the disease or is it a co-morbidity. However, Regland B. et al [10] showed that the injection of vitamin B12 leads to an improvement in myalgic encephalomyelitis syndrome.…”