Study Finds Vitamin B12 Superior to Nortriptyline for Diabetic Nerve Pain Relief

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Diabetic nerve pain is a frustrating and debilitating complication faced by millions with diabetes. While medications help some, they often fall short, leaving patients searching for better solutions. Now, an exciting study has found that an essential nutrient - vitamin B12 - may hold the key to greater relief. Could this natural remedy be the answer that so many have been seeking?

Painful diabetic neuropathy (PDN) is one of the most prevalent and difficult to treat complications of diabetes mellitus.1 While medications like tricyclic antidepressants and anticonvulsants are commonly prescribed, they often provide inadequate symptom relief and come with side effects.2 A landmark study published in the International Journal of Food Sciences and Nutrition suggests that a natural alternative - vitamin B12 supplementation - may be more effective than standard pharmaceutical treatments for alleviating PDN.3

In this single-blind randomized controlled trial, 100 patients with PDN were assigned to receive either intramuscular injections of vitamin B12 at a dose of 2,000 micrograms twice weekly, or 10 mg of oral nortriptyline daily, for a period of 3 months. Outcomes assessed included self-reported pain, paresthesia, and other symptoms based on a visual analog scale, as well as sensory tests and nerve conduction studies.

The results were striking - patients in the B12 group experienced an average 3.66 point reduction in pain scores, compared to only a 0.84 point decrease in the nortriptyline group (p<0.001). Tingling and paresthesia also improved by 3.48 and 2.98 points respectively with B12, versus just 1.02 and 1.06 points with the medication (p<0.001 for both comparisons).3 Changes in objective measures like vibration sensation and nerve conduction velocities were not significant in either group.

This study is all the more significant considering that nortriptyline carries the risk of certain side effects whereas vitamin B12 is extremely safe. The most common adverse reactions include drowsiness, dry mouth, dizziness, constipation, increased appetite, and weight gain. More serious but rare side effects are possible, such as cardiac arrhythmias, seizures, angle-closure glaucoma, bone marrow suppression, and hepatitis. Nortriptyline also has a black box warning for increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Close monitoring by healthcare providers is essential, particularly when initiating treatment or adjusting dosages.

While prior studies have yielded mixed results on vitamin B12's impact on diabetic neuropathy,4 this is one of the largest and most robust trials to date demonstrating its benefits for PDN. The dosage used was quite high, with 4,000 micrograms given per week, but vitamin B12 is generally safe even at these doses.5 The potential mechanisms are not entirely clear but may involve B12's role in nerve regeneration, homocysteine metabolism, and synthesis of neuronal fatty acids and lipids.3,6

This study, while not definitive, provides compelling evidence that vitamin B12 could be an effective, natural option for managing symptoms of PDN. Unlike pharmaceutical treatments, B12 is safe, affordable, and accessible. More research is still needed, especially comparing B12 to placebo and using various dosages. But for the millions suffering from PDN, vitamin B12 injections appear to be a promising therapy worth discussing with their healthcare provider. Even if B12 doesn't slow or reverse the neuropathy itself, improving pain and quality of life is a worthy goal that this simple, natural approach may help achieve.

For more research on natural approaches to treating diabetic neuropathy, visit our database on the subject here.

For more research on the therapeutic properties of vitamin B12 visit our database on the subject here.



1. Edwards JL, Vincent AM, Cheng HL, Feldman EL. "Diabetic neuropathy: Mechanisms to management." Pharmacol Ther. 2008;120(1):134. doi:10.1016/j.pharmthera.2008.05.005

2. Bastias AM, Toro CL, Olmos CP. "Intensified insulin therapy plus antineuritic medication is more effective than antineuritics alone in painful diabetic neuropathy." Rev Med Chil. 2006;134(12):15071515.

3. Talaei A, Siavash M, Majidi H, Chehrei A. "Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy." Int J Food Sci Nutr. 2009;60(sup5):7176. doi:10.1080/09637480802406153

4. Sun Y, Lai MS, Lu CJ. "Effectiveness of vitamin B12 on diabetic neuropathy: Systematic review of clinical controlled trials." Acta Neurol Taiwan. 2005;14(2):4854.

5. Hvas AM, Ellegaard J, Nexo E. "Vitamin B12 treatment normalizes metabolic markers but has limited clinical effect: a randomized placebo-controlled study." Clin Chem. 2001;47(8):13961404. doi:10.1093/clinchem/47.8.1396

6. Yaqub BA, Siddique A, Sulimani R. "Effects of methylcobalamin on diabetic neuropathy." Clinical Neurology and Neurosurgery. 1992;94(2):105111. doi:10.1016/0303-8467(92)90066-c

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