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Vitamin B12 Supplementation in Pets with EPI

Exocrine pancreatic insufficiency (EPI) impairs an animal’s ability to digest and absorb the nutrients available in food. Because there are insufficient digestive enzymes created by the pancreas, food passes through the body basically undigested. The affected animal will begin to lose weight and have loose, foul-smelling diarrhea. Animals with EPI eat voraciously because they are not able to gain nourishment from the food they do ingest.


Treatment for this condition focuses on the use of enzyme replacements in the food. Replacements are typically required for the remainder of the animal’s life. Other factors will play a role in this disease condition, and your veterinarian will need to monitor your pet long-term to see if additional supplements, such as vitamin B12, or medications are necessary to maintain control.


Vitamin B12 (Cobalamin) Deficiency


Both dogs and cats with exocrine pancreatic insufficiency (EPI) are at risk of developing a vitamin deficiency at some point. Vitamin B12 (cobalamin) deficiency is extremely common in cats with EPI, and is seen in more than half of dogs with the condition. Because the body can store up the vitamin under normal conditions, it may take some time before it reaches a critically low point. The reason an animal becomes deficient is that vitamin B12 is not absorbed from the food eaten by animals suffering from EPI.


Dogs and cats with EPI may be additionally compromised by decreased production of a substance called intrinsic factor (IF) by the cells of the pancreas. This substance helps the body to absorb the vitamin into the bloodstream. Without sufficient IF, the animal will have even greater difficulty in getting enough vitamin B12. In the cat, the pancreas is the only site of intrinsic factor production. and when the pancreas is compromised, IF deficiency (and thus B12 deficiency) results.


Once a deficiency of B12 does occur, the animal will have difficulty gaining (or maintaining) weight, even when he or she may have been doing well on enzyme replacement therapy. The dog or cat will also become lethargic and confused. This is because vitamin B12 plays an important role in intestinal health, as well as brain function.


Because of this, any animal that is not improving on enzyme replacement therapy should be checked for B12 deficiency to determine if supplementation is necessary. Your veterinarian will need to run blood tests to check your pet’s levels of B12 in the blood. Low levels of vitamin B12 are sometimes associated with another condition called small intestinal bacterial overgrowth (SIBO). This build-up of bacteria can lead to B12 deficiency in dogs as the organisms bind the vitamin and make it unavailable for absorption by the intestine.


Treating Vitamin B12 Deficiency


Those animals who are not properly treated for B12 deficiency will have a very poor prognosis and will not show improvement when only treated for EPI. Because animals with EPI are unable to absorb certain nutrients and have a diminished capacity to produce intrinsic factor, giving them oral supplementation of B12 doesn’t help. Thus, the most effective method of vitamin B12 supplementation is by injection.


Doses are typically given weekly for many weeks, followed by every two weeks for many weeks, then monthly. Your veterinarian may consider teaching you to give your pet these injections at home, depending on the situation. Blood tests will be taken again after the course of injections has been given. This will allow your veterinarian to determine if the animal has reached sufficient levels of B12.


Your pet will continue to receive injections of B12 until levels are high enough and any secondary intestinal problems are improved. Once an animal has a normal level of B12 in the bloodstream, he or she should begin to gain weight and improve considerably, even in the face of EPI.


Image: aspen rock / via Shutterstock


Comments  17

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  • 08/07/2013 02:30pm

    We have a companion dog who is afflicted with EPI. He is a German Shepherd Dog, who is five-and-a-half years old, and who is a rescue, and has been living with us for about 2 years and change. We knew he had EPI when we adopted him into our lives. We must disagree with your statement above that "...giving them oral supplementation of B12 doesn't help." Perhaps the most effective method of supplementation is by injection, but we, and hundreds of our friends who have EPI dogs and belong to an EPI Forum, have been adminstering B12 supplementation orally with a product that contains the Intrinsic Factor [IF]. There are two products available, one based on Cyanocobalamin, and one based on Methylcobalamin. We prefer the latter because we believe there is less danger with the Methyl-based product and that the B-12 is more readily available for the dog's system. Both are available on the internet, and we have found that an occasional sub-q injection, perhaps monthly, or two every three months, and periodic cobalamin/folate testing to ensure a good level of B-12 is perfectly adequate in treatment.

  • 08/08/2013 03:09pm

    What are the names of these supplements and how long after you began administering them did the dog show improvement?
    I am on EPI4Global and EPIDOG forums and they are all using injections (that I have seen) My girl has had EPI for 7 years and just became cobalmin deficient recently. we are starting injections tomorrow but if we can use tabs/pills we of course want that for her.

  • 08/08/2013 04:29pm

    We use Wonderlabs Trinfac-B [http://www.wonderlabs.com/itemleft.php?itemnum=6881] You must use a B-2 that has the Intrinsic Factor [IF] othewise the dog cannot utilise the B-12. Our dog has intermittent injections, but has been fine using the capsules, one, three times each week; Mondays, Wednesdays, & Fridays. They cost about $15.00 for 120 caps. I am also on EPIDOGS.com, as well as EPI4Dogs.

  • 08/09/2013 01:02am

    Thank you so much, we will give her injections and order a bottle of this too.
    May I ask how long after you began administering the B-12 did you see improvement in your dog? My girl is not keeping weight on and has a shortage of energy; my hope is that she will bounce back fairly quickly.
    Thanks again
    PS. I have looked for the answer to this on both groups and can't find anything so I really appreciate the help.

  • 08/09/2013 03:36pm

    He was in good spirits when we started the Trinfac-B, and he has not flagged. There was no imporvement pre se, but his attitude did not get worse. Rather, the Trinfac-B acted as a stabilizer, and we found that, giving the caps, we did not have to have the injections every month. Now, we just have them from time to time, maybe once every two ro three months, but he gets 3 Trinfac-B every week.

  • 08/09/2013 03:39pm

    By the way, I don't know how many times you feed your girl, or how much you feed her. One of the tricks to increasing weight is to give a small snack right before bed time, and when you're starting treatment for EPI, you should give your dog as much as 150% of her normal food intake until you see a positive weight gain.

  • 08/09/2013 05:30pm

    She was diagnosed with EPI in 2006, we have managed her diet regimen beautifully for 7 years. She has been healthy, energetic & happy until just recently, weight started coming off, stools liq. with mucous, no appetite and losing energy. I started her on Tylan for SIBO last week and then Tested her Cobalamin and she tested LOW, 150 is as low as the test will go and she was below that. We start injections today so my hope is she will feel better and get back to herself again real soon! If not for her silver muzzle (she is a Blue GSD) you would never have know she is 13 yrs old!
    I hope this makes a difference for her as she loves to go for long walks everyday.
    Thank you again, I'll let you know how it goes (if you want)

  • 08/12/2013 01:53am

    HI! We are just now getting my dog stabilized with the right amount of medicine and B-12 shots and we're working on getting some weight on her. I was interested in our comment about a snack before bed time. What kind of snacks do you suggest? Are there snacks you can give EPI dogs that don't have to be taken with the pancreatic enzymes?
    Thanks in advance for your help. We would love to see some weight get on her ASAP! :)

  • 08/12/2013 05:25pm

    I am sorry; I should have been more specific. What I meant by "snack" before bedtime was actually a small meal of her ordinary kinds of meals. We actually do give small untreated snacks. I dehydrate Chicken breasts, and give our boy about a fingernail size treat whenever warranted. However, your dog should be completely stabilized before you even think of giving that kind of treat. As I wrote previously, to get the weight on, you may give up to 150% of her meals until she puts on weight.

  • 08/13/2013 01:53am

    Thank you for the clarification. It was very helpful! I'll wait for a while before starting the treats.

  • 01/16/2014 08:39pm

    Can you tell me the size and weight of your pet? We have an EPI pom weighing 9.5lbs and I would like to use the B12 product you sent a link for, but I am not sure of the dosing for such a small dog. Wonderful information. Thanks for sharing.

  • 08/15/2014 03:28pm

    Hi Flushing Sceptic!

    My dog (13.5 y.0.) lab/shepherd was diagnosed with sibo and we just finished her Tylan protocol and continue to do the B12 injections. I just saw your info and was wondering how to move toward the IF capsules. We have done 3 weekly injections and then 1 dose in 30 days ahead, refreshing 30 days after 2 baccteria have been treated successfuly so far and we have not retested B12 levels since they came up in the low range.
    She is finally eating her g/f Kangaroo with more interest. Jassy's pli was consistent with pancreatitis and her tli results in the referece range at this point.
    What would you do now? I have not started specific probiotics or additional preventative enzymes other than those I purchased from petalive.com which have been very helpful so far. She has never done well on probiotics so I am not sure what to do following the tylan.


  • 08/18/2014 05:59pm

    Hello, Karen:

    I would simply give the Wonderlabs TrinfacB and, if your dog likes it, a couple of spoonfuls of plain yoghurt with every meal.

  • 09/10/2016 03:48am

    Did Braad ever mention the beautiful dog he gave to the farm in Pa, 1975 for the young boy there? Or of what happened to make him want to do that for him? My wife and I both have 2 dogs, a boxer and a boston terrier. We love them both. I will never forget what he said when he left that dog on that day. "Every young boy should have a dog" I read your bio on Brad and just wondered if you have heard the story. He was a friend to me back then, and I will never forget him for that. Here is my wife's facebook if you would like to contact me. [email protected] under Debra Kirk. Thank You

  • 02/13/2014 01:47am

    I would like to know the dosage information for the Trinifac-B. I have a 40 lb dog (should be 48 lbs).

  • 02/13/2014 03:02pm

    We give our 80 lb. GSD three TrinfacB per week; Monday, Wednesday, and Friday. You need to remember that you cannot overdose; any excess will be peed out.

  • 10/27/2015 06:48am

    Thank you for adding the details about what you've used to treat your dog- it really helped me to start navigating this topic which has me feeling overwhelmed.

    I'm hoping you might point me in the right direction to find the injectible b 12 (Methylcobalamin version)...?

    I've read articles that it's safer as you say, but can find only the other type.

    Many warm thanks, Lokismama

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