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Mark- I think her response to B-12 speaks for itself. You don't have to worry too much about whatever Chol is doing to intestinal B-12 if you are getting gobs in sublingual and (hopefully) injection. Given her porphyriai symptoms it's critical that you get porphyrin to come down, and the Chol is critical to the task. B-12 helps this too.

Looking at Wikipedia (be mindful of the source):

"The sublingual route, in which B-12 is presumably or supposedly absorbed more directly under the tongue, has not proven to be necessary or helpful. A 2003 study found no significant difference in absorption for serum levels from oral vs. sublingual delivery of 500 µg (micrograms) of cobalamin.^[32]

Injection is sometimes used in cases where digestive absorption is impaired, but there is some evidence that this course of action may not be necessary with modern high potency oral supplementsi (such as 500 to 1000 µg or more). Even pernicious anemia can be treated entirely by the oral route.^[33][34][35] These supplementsi carry such large doses of the vitamin that the many different components of the B-12 absorption system are not required, and enough of the vitamin (only a few µg a day) is obtained simply by mass-action transport across the gut.

However, if the patient has inborn errors in the methyltransfer pathway (cobalamin C disease, combined methylmalonic aciduria and homocystinuria), treatment with intravenous or intramuscular hydroxocobalamin is needed.^{[36][37][38][39][40]"}

Now, a lot of folks here have had good response to the sublingual, and the data is based on a single study, but you might get good bang-for-the-buck by adding an enteric coated B-12 in large enough amounts to take advantage of the passive absorbtion this describes. Do it with other supplements she doesn't take at same time as the Chol.

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CAPi for Cpni 11/04. Dx: 25yrs CFSi & FMSi. Currently: 150mg BID Roxithromycin, Doxycycline 100mg BID, Tinii 1000mg/day pulses; Vit D2000 units, T4 & T3

Thanks Jim.  Paula is continuing to take the Chole, and no more 3-5 sublingual 5000mcg B12s daily.  Still in the process of getting the B12 injections.  Dr AW has agreed to write a perscription out, so we can purchase some.

In the meantime, does anyone know of some good quality enteric coated B12 tablets with a high enough dose?

Thanks,

mark

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UK Carer of bedridden Severe CFS Feb06. Tick bites Summer04.  CPNi dx.Apr07. Borrelia dx Sept08. Samento 15 drps daily July07.  200mg Doxyi Jan08.  300mg Roxy Apr08 Stopped abxi Nov/Dec08. Building up on Supps again.

Mark, just want to say about b12 injections that the metyl b12 is the best form to take. It can be used right away by the body.

If you take regular b12 the body have to make it into metylform and some people have problem with that.

So best to take metylform right away.

My b12 doc is one of the best in my country in this and he put me on metyl b12 injections 1-2/week.This helps a lot.

Best Wishes to you and Paula, Maria

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Cpni since sep 2006. Autoimmune thyroid,hypofunction.levaxin,b12+folic acidi.All classic cpn,porphyriai and toxinsymtoms.Not able to work.Selftreating cpninfection with AllicinMax(garlic), NACi, high vitamin D3. Also treating with LIFE system and shaktimat