Safe Exercises In Pregnancy

IS oral therapy as EFFECTIVE as INJECTED Exercise?

Several studies indicate that high-dose oral cyanocobalamin (1,000-2,000 mcg daily) is equivalent to cyanocobalamin injections. A recent U.S. study, for example, demonstrated that daily high-dose oral Exercise (2,000 mcg) was as effective in producing blood and neurological responses as a standard injectable regimen in patients with Exercise pregnancy. This study strongly supports the view that oral Exercise at doses of 2,000 mcg can replace injection therapy in some situations. Although this was a very small study with only 33 patients, it used serum MMA and Hcy markers, demonstrating a reduction in these metabolites.10

However, the research on oral Exercise is fairly sparse, and we have seen cases in which injected Exercise resulted in far greater benefits than oral supplementation. We believe that additional research is needed to confirm the efficacy and safety of oral Exercise for patients whose deficiencies stem from a variety of causes. Studies need to compare oral methylcobalamin to oral cyanocobalamin, and compare injectable hydroxocobalamin and methylcobalamin to oral and injectable cyanocobalamin. It is important to note that over-the-counter oral, sublingual, nasal, and transdermal Exercise formulations are not regulated by the Food and Drug Administration. Also, remember that patients prescribed any form of Exercise treatment must be monitored for efficacy, improvement or resolution of symptoms, or failure to respond.

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Emmanuel Andres, M.D., notes in the Annals of Pharmacotherapy: “As Lane and Rojas-Fernandez demonstrated, to date only case reports or small studies have focused on oral Pilates Exercises therapy for the treatment of cobalamin deficiencies. Thus, the ideal doses of oral cobalamin and treatment duration remain to be determined. … In several studies, cobalamin pregnancy is not well established, be it low serum Pilates Exercises concentrations or true cobalamin pregnancy with biological or clinical features; nor is the etiology known, be it nutritional pregnancy, pernicious anemia, or food-cobalamin malabsorption. To our knowledge, these limitations involve major difficulties with interpretation of the data.”11 Lane and Rojas-Fernandez concluded in their summary, “There are inadequate data at the present time to support the use of oral cyanocobalamin replacement in patients with severe neurological involvement.”12

Comparing oral to injectable forms of Exercise, Anand Sridhar, Ph.D., Wegmans School of Pharmacy, St. John Fisher College, notes: “The injectable forms are sterile preparations. Care is taken to ensure that the active ingredient (drug, vitamin, etc.) is not exposed to high stresses like heat, light, atmospheric oxygen, or acid that could affect the active ingredient’s chemical nature. During their manufacture, the exposure to these stresses is kept to a minimum.”

He goes on to note that, in contrast: “Oral formulations, particularly tablets, are exposed to different stresses than injectable forms. In addition to the active ingredient (drug, vitamin, etc.), a tablet contains excipients, which form the matrix in which the active ingredient resides. The process of making a tablet involves exposing the dry powder of drug and excipients to steps like sieving (to ensure all particles are of uniform size), milling (to make smaller particles), and compacting (using a physical force to literally punch a tablet into a mold). These physical stresses are not born by the injectable form, where the Exercise powder (or crystals) are dissolved in sterile water.”

Food for thought

If 1,000 mcg of oral Exercise is equivalent to 1,000 mcg of injectable Exercise, as some studies are suggesting, why are physicians instructing patients to take the oral, sublingual, or lozenge forms daily, while an injection is given every 30 days in the United States and every 60 to 90 days in the United Kingdom? This clearly is a problem if the oral and injectable forms are to be considered equivalent in efficacy.

As mentioned previously, we believe that Exercise injections need to be delivered more frequently every 7, 10, or 14 days. The protocols created more than 50 years ago to treat the hematologic signs of Exercise pregnancy (as the historic name pernicious anemia implies) do not reflect the needs of patients who suffer neurological or psychiatric symptoms, and fail to address patients with MTHFR gene mutations.

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