Sublingual B12 no better than just swallowing
Question (edited for clarity):
It is always explicitly recommended that Vitamin B12 tablets should be dissolved under the tongue (aka “sublingual”). I wonder if that is also true for other minerals and vitamins of special concern to vegetarians, such as iron and vitamin D2? If not, why is this the case with vitamin B12?
Answer:
I have always told people who asked about sublingual B12 that there was no evidence, of which I was aware, that sublingual was any better than just chewing. Despite this, until today, I had been recommending sublingual in my Step 1 Recommendations, which are geared towards people who have not recently had a reliable source of B12. I have recommended sublingual as a precaution just in case it was more effective. In recent years, I have been more diligent about trying not to recommend anything just to be prudent unless specifically stating that is why I am recommending it. This suggestion for sublingual (versus just oral) was a remnant left over from previous times.
Still, I did not know whether sublingual was better than oral until I got this question and decided to check in on the research. As it turned out, there was a study as long ago as 2003. Yikes! I guess I hadn’t checked in quite a long time.
The 2003 study compared 500 µg per day via the sublingual and oral routes. The results were that sublingual was absolutely no better than oral B12 at raising vitamin B12 levels or improving B12 activity (as measured by homocysteine and methylmalonic acid levels). The report did not specifically state whether the tablets were chewed or not (I assume that they were swallowed whole). So now I’m not sure I should even suggest that the tablets be chewed, but because other studies have shown a benefit to chewing, I will leave that in my recommendations.
As for other vitamins and minerals, I have never checked into the research on taking them via the sublingual route, but my sense is that there would not be any benefit. It might even be dangerous to try this with iron given that it is a pro-oxidant and probably should not be held in constant contact with your tissues.
Reference
Sharabi A, Cohen E, Sulkes J, Garty M. Replacement therapy for vitamin B12 deficiency: comparison between the sublingual and oral route. Br J Clin Pharmacol. 2003 Dec;56(6):635-8. | link
April 6th, 2012 at 6:01 pm
Does it matter if we choose cyanocobalamin or methylcobalamin?
April 6th, 2012 at 6:11 pm
The study was done on cyanocobalamin, but I have no reason to think methylcobalamin would be any different.
April 7th, 2012 at 4:57 am
I have long been under the impression that B12 sublingual administration was superior to to swallowing because it bypassed the digestive process and was absorbed directly into the bloodstream. I also thought that B12 sublingual absorption was equivalent to B12 injections. I have been passing this on to numerous people on a plant-based diet.
Are you saying that there are no studies that support my contentions, or that one study refutes it? Are B12 injections superior?
I have also read that an intrinsic factor is required to absorb B12 via swallowing, and that some lack this factor–another reason to administer sublingually. But on the other hand, I have also read that it is instead B12 deficiency that causes the loss of the intrinsic factor.
Any studies yet on B12 transdermal patches? They tout superior absorption.
Thanks!
April 8th, 2012 at 6:20 pm
Rick,
> Are you saying that there are no studies that support my contentions, or that one study refutes it?
I am saying both. I don’t know of any other studies on the subject and this one was fairly convincing.
> Are B12 injections superior?
Oral B12 of 2,000 µg per day has been shown to be just as effective as B12 injections. You can read more about that here:
http://veganhealth.org/b12/formula
1 to 1.5% of B12 is absorbed through passive diffusion and doesn’t require intrinsic factor.
> Any studies yet on B12 transdermal patches? They tout superior absorption.
I’m sure they do. I don’t now of any studies, but I haven’t gone looking.
April 7th, 2012 at 5:21 am
This is a great post Jack, something I hadn’t looked into and am so glad you put up here! It now makes a lot of sense to me why those vegans who tried sublingual to correct a deficiency with no results had to turn to injections – or worse, thought that they needed to turn to animal foods.
April 8th, 2012 at 6:23 pm
Heather,
> It now makes a lot of sense to me why those vegans who tried sublingual to correct a deficiency with no results had to turn to injections
I maybe should have been more clean in my post. Oral B12 was effective at raising B12 levels, as was sublingual. It’s just that sublingual was not more effective than sublingual. As I said to Rick regarding his comment, 2,000 µg of B12 per day, orally, has been shown to be just as effective as injections. I don’t know how much B12 the people you know of were taking, though, so maybe they weren’t taking enough.
April 7th, 2012 at 2:51 pm
I don’t understand the reasoning in the second to last paragraph. If other studies show benefits with chewing, wouldn’t that benefit be had via sublingual dissolution too? If not, what could be the difference?
Sidenote: where I live (europe) sublingual B12 wasn’t so easy to find. I’ve never seen it available at a physical pharmacy and had to buy it through an online store at a higher price than oral B12 (though both are still pretty inexpensive).
April 8th, 2012 at 6:26 pm
mar,
Okay, I see where I’ve caused confusion. When I said this:
“The results were that sublingual was absolutely no better at raising vitamin B12 levels or improving B12 activity…”
I meant this:
“The results were that sublingual was absolutely no better *than oral B12* at raising vitamin B12 levels or improving B12 activity..”
Now does it make sense? I’ll make that addition to my post.
April 9th, 2012 at 12:12 am
Jack, no because I was/am confused by the statement on chewable. You wrote:
“The results were that sublingual was absolutely no better than oral B12 at raising vitamin B12 levels or improving B12 activity (as measured by homocysteine and methylmalonic acid levels). The report did not specifically state whether the tablets were chewed or not (I assume that they were swallowed whole). So now I’m not sure I should even suggest that the tablets be chewed, but because other studies have shown a benefit to chewing, I will leave that in my recommendations.”
I read that as saying:
– all three sublingual, chewable and swallow whole are adequate for B12 intake
– previously we thought there was extra benefits with sublingual and chewable over oral (swallow whole)
– now we think sublingual is no better than oral
– but chewing still has a “benefit”
That seems to entail that chewable is better than both sublingual and oral. Which seemed puzzling to me. How could chewing bring extra benefits that sublingual dissolution doesn’t? The two studies (no extra benefit with sublingual vs extra benefits with chewing) sound inconsistent to me.
April 9th, 2012 at 12:29 am
Jack, not quite. I read the post as saying:
1. a new study give evidence that sublingual and oral are equally good (both being adequate modes of B12 intake).
2. another study give evidence that chewable has extra benefits over oral.
Those two pieces of evidence together seem to entail that chewable has extra benefits over sublingual too. I was puzzled over how that could be, given that both involve breaking the B12 pill down to smaller particles while in the mouth.
April 9th, 2012 at 8:14 am
mar,
Okay, I see what you mean.
Maybe it would help if I pointed you to my write-up about the study that found that some (but not all) B12-deficient vegans could not raise their B12 levels without chewing the supplements:
http://veganhealth.org/b12/vegansources#CHEW
Based on the results of the two studies, it seems that some B12 tablets are much easier dissolved in the digestive tract than others (for some, but not all, people – or maybe for some, but not all vegans?).
It *is* possible that chewing is better than both swallowing whole and sublingual for some reason that is not obvious (perhaps the B12 gets too degraded in the mouth if it sits there for a long time?). But my money is on the suspicion that the tablets used in the 1994 study were harder to dissolve than those in the 2003 study.
April 9th, 2012 at 5:36 am
Jack – yes, I did understand that what you were saying in your post was that sublingual was no more effective than oral at the same dose. I think it was me who wasn’t clear… What I’ve seen is that people were taking an oral dose, then took the same, or slightly higher (1000 mcg) as a sublingual and didn’t see results, so they turned to injections. So exactly what you suggested – the problem was that they weren’t taking enough, but they thought the problem was a failing of the supplement since they were told sublingual should have been more effective than their regular oral form. And until reading this post, I would have agreed! I would have tried taking a higher dose of sublingual myself, but I would have also looked into injections – and I certainly wouldn’t have gone back to straight oral doses.
April 11th, 2012 at 11:08 am
Hello Jack. I take NOW’s “ultra b-12” 5000mcg oral solution (1 teaspoon) daily. Is liquid B-12 as effective as tabs? Thanks for your awesome work.
April 11th, 2012 at 1:12 pm
Edward,
> Is liquid B-12 as effective as tabs?
I don’t know of any research but I have no reason to think it wouldn’t be just as effective as tablets.
April 12th, 2012 at 8:08 pm
Hi Jack, Due to what I’ve been reading by you about B-12, and being a 30-year vegan, I just had a homocysteine level test. It came out 4.8. Everything I read starts at a level 5. What does 4.8 mean? Love your work!
April 12th, 2012 at 9:14 pm
Lori,
Sounds like you have excellent homocysteine levels. Congratulations.
August 8th, 2012 at 2:49 pm
Sorry to be late to this topic, but if you’re still responding to comments here, I’d like to ask:
Does this post suggest that pregnant vegans can skip the injunction to only rely on sublingual or chewable B12 in your (very helpful) supplement summary in your book, Vegan For Life?
I’m very interested in this question, bc every sublingual and chewable B12 supplement I’ve checked into (about a dozen) contains sweeteners which I can’t digest too well. If I’m successful in getting pregnant, I’ll have enough digestive challenges to deal with without piling sorbitol reactions on top of that. I take the Deva Vegan Multi, additional D, and a liquid cal/mag supplement.
Thanks again for all your work to clear away the hype and the false information standing between vegans/near-vegans and good health!
August 8th, 2012 at 3:01 pm
Ninufar,
Eating B12-fortified foods twice per day should be just fine.
September 2nd, 2012 at 12:03 pm
Wait a minute this post is confusing me. I have a medically induced B12 deficiency, I am not a vegan or vegetarian I purely just have a problem and I came here looking for some answers but found a shallow discussion, though maybe I’m just wrong or perhaps this site is ONLY meant for vegans/vegetarians that have B12 deficiencies and that is is not meant for actually B12 deficient patients with complications.
The sublingual tablets are made for people with B12 deficiencies caused by genetic or health factors (and subsequent disability to produce intrinsic factor via loss of gastric parietal cells). The reason there are two methods is not because one is better or worse, and for all the people that are getting caught up in this, the only reason I take sublingual over oral is because it is IMPOSSIBLE for me to get b12 oral compared to sublingual.
You should only have an interest in sublingual if you do not like swallowing or you have a metabolic disorder (like me) that causes many b12 deficiencies in omnivores.
The fact that a study revolves around which one is better is almost sad considering the genesis of either was made in consideration to the medical circumstance, not whether one or the either was more effective. That is what concentrations are for, to mediate the transfer of proteins via diffusion.
Maybe this is only for vegetarians, but you should know in any case that you shouldn’t be concerned over whats better, just do what you prefer. If I could, I would definitely take oral since the sublingual looks kind of like guts in my mouth lol.
September 2nd, 2012 at 4:32 pm
Ben,
1. This site is intended for vegetarians and vegans.
2. The study highlighted here was conducted both on vegetarians/vegans and on people with abnormal B12 absorption determined by a Schillings Test. As the authors say, “There was no significant difference in cobalamin concentrations between the subjects with a normal and abnormal Schilling test.” So it appears that sublingual is no better than oral for people with B12 absorption problems.
September 4th, 2012 at 6:47 pm
I’ve been vegan for 13 years, and take a multi-vitamin/mineral supplement that contains B12. Lately I had been dragging myself around, too tired to get things done in the evening, not able to concentrate, etc. I ordered some liquid B12 and wow, what a difference! I just turned 55 and feel like 35 again.
So I wonder about the B12 that is supposed to be in the multi-vitamin tablet (100 mcg once a day). Or maybe I just needed a megadose (1,200 mcg twice a day).
September 5th, 2012 at 8:44 am
Donna,
I’m (very) surprised that 100 mcg wasn’t enough to prevent an overt B12 deficiency which it sounds like you were starting to get. Did you have any tingling in your fingers or toes? How long had you been taking 100 mcg per day from the tablet and how consistent were you?
September 5th, 2012 at 9:22 am
I’ve been taking this particular brand of multivitamin everyday since 1/2011. I don’t recall any tingling in toes or fingers.
September 5th, 2012 at 9:26 am
Donna,
That’s very strange. But I’m glad you figured out you needed more.
You might have a defect for producing intrinsic factor, aka “pernicious anemia”. People with PA need large doses of vitamin B12.
September 5th, 2012 at 10:07 am
That makes sense — I have had Hashimoto’s for several decades and this page says it raises my risk for PA: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001595/
September 26th, 2012 at 2:23 am
hi!! i was diagnosed with b12 deficiency with a level of 85. i started taking 5oo mcg of injections every alternate day.i felt better for few days but after 6 injections i am again feeling very weak and tired with depression. i feel i will never be fine again. my doc says it’ll take time to heal. he prescribed total of 10 injections after that pills.. should i consult another doctor. how can i find whether i’ve pernicious anemia or not. i’m 22 and also a vegetarian. is such low level due to any thing else?? pls reply.i’ll be very greatful.
September 26th, 2012 at 8:24 am
gaurav,
The test for pernicious anemia is a Schilling’s Test, and it is not uncommon, so you might want to talk to your doctor about it. I would suggest that you just keep monitoring your symptoms with your doctor. If the injections are not working, then your doctor needs to figure out what else could be wrong.
September 26th, 2012 at 7:04 pm
@jack
my doc says it’s all psychological problem because after 10 injections symptoms due to vit b 12 deficiency should go away. how long can it take to recover full?. he asked me to make dietry correction. as i said i feel tired and weak specially in legs.i feel urge to stretch my legs and body frequently also my bones make sometimes when i move my legs or body. can there be any other deficiency other than b 12? like vit d3 or sumthng? it’s very crucial time ofmy life so i’m very worried. i keep constantly thinking abt my illness and that results in tension and depression with sumtimes fear and rapid heartbeat.i.e. anxiety
September 26th, 2012 at 8:10 pm
gaurav,
How long it should take for a full recovery will vary from person to person, but 10 injections should have resulted in significant improvement.
Vitamin D deficiency sounds consistent with many of your health problems. You should talk to your doctor about other reasons for your problems, or find a new doctor.
December 13th, 2012 at 11:03 am
@Jack,
Following an accident resulting in serious nerve damage, one of my doctors wrote a script for 2500 mcg of B12 daily. He cited studies showing positive development in nerve regeneration. I’ve been religiously taking it since that time. I can’t say if its the reason for improvement since there are other factors and regrowth of nerves happens at a snail’s pace anyway.
A few months ago, an acquaintance who learned of this and also must take B12 told me I should be very careful to look for B12 with Methylcobalamin rather than Cyanocobalamin so as to truly get the benefit. This week my travels got extended so I had to stop at a drug store to have enough supplies to make it through the rest of the stay. I couldn’t find any of the B12 offering Methylcobalamin, so I asked the pharmacist about it. He asked for my reasons, what I take, and then proceeded to tell me that pretty much everything on the other side of the counter did nothing more than produce expensive urine.
I’d appreciate your thoughts on Methylcobalamin vs. Cyanocobalamin, and any studies you can point me to read for greater understanding. Also, any feedback on the pharmacist’s comment?
Thanks, j
December 13th, 2012 at 5:53 pm
JL,
Nice last name!
I normally don’t think there’s any need to take methylcobalamin and it presents some problems (instability) that cyano- doesn’t have. Here is my write-up on it:
http://veganhealth.org/b12/noncyanob12
Once your nerves have regenerated you can probably cut way back on the B12, but talk to your doctor first.
December 14th, 2012 at 3:43 am
hi jack i was vegan for 2.5 years and i tested for b12 two months ago my level of b 12 is 86 and my doctor gave me five injections for five days back to back and now one every month for six months and then ill be tested again but iam on second month and no serious improvment can i take between the shots any supplement of b 12?what you think for sprays b12 (methylcobalamin) ?is there any problem between injections and oral b12?i mean if the oral can affect the shots?sorry for my english thanks anyway.
December 14th, 2012 at 10:09 am
panos,
I don’t think it would hurt to take 1,000 µg per day. I’d choose chewable cyanocobalamin tablets over methylcobalamin, unless you are a smoker. If you smoke, I’d take more like 2,000 µg of methylcobalamin. I don’t know how well sprays works, so I’d tick with chewable tablets.
March 24th, 2013 at 10:18 am
I can’t imagine why there is all this talk about swallowing B12 when injectable is so readily available and is very easy to administer to yourself.
March 24th, 2013 at 8:32 pm
I believe that most people prefer oral administration of anything to injections if efficacious.
April 24th, 2013 at 5:06 am
This is an interesting topic that I have been looking into for some time
My wife a 35 year strict vegetarian was found B12 deficient 15 months ago her blood level was 162
Her symptoms have been on-going for 4 -5 years, but became much worse last year
She suffers daily with extreme fatigue, burning hands and feet white skin patches, vision and cognitive impairment,
She did decide to eat some meat again but has discovered that she can no longer tolerate or digest it without much bloating and discomfort
After her diagnosis she started on Jarrow methycobalamin 5000mcg 2- 3 daily, within a few weeks her blood level was up to 2000, great we thought just a few weeks and her symptoms should subside!
15 months later she is no better, maybe even even slightly worse, it appears that the b12 in her blood is either not enough to remedy the problem or it is not actually available to be used where it is needed in her body
This is an interesting topic but fails to make any meaningful sense as to the requirement to rectify long term deficiencies, it appears that those who just want protection from low b12 can pretty much use anything to keep toping up reserves, but once those bodily reserve have been depleted and damage has occurred it’s a whole new ball game to remedy.
We are about to try patches hopefully these will give a more controlled and steady b12 release
Unbelievably her GP has never offered to give her any b12 injections on the basis that her blood levels are now sufficient.
April 24th, 2013 at 9:09 am
Mark,
I’m really sorry to read that. I would not assume that B12 deficiency is her problem – you should try to rule out other things if you can, possibly see a neurologist.
You might also try cyanocobalamin for a few days to see if that works any better. I don’t know why it would if her B12 levels went to well above normal (the same thinking that your doctor is apparently having about injections), but it seems worth a try. Maybe the methylcobalamin is inactive analogues…
Keep me posted and feel free to contact me privately: http://jacknorrisrd.com/contact_form.php
January 8th, 2014 at 3:03 am
nice post, but as pointed out in some comments, it only cover cyanocobalamin.
This is used in supplements for two main reasons. Damn cheap, and greater stability in the gut before absorption. As a result, more is available to be absorbed by the body, so has a roughly equal rating with sublingual.
The Methyl version however is less stable so by the time it reaches lower intestine for absorption, there is not much left, so sublingual methyl works much better than standard oral.
Additionally cyanocobalamin is converted in the body to methylcobalamin and adenosylcobalamin, leaving behind cyanide which has to be cleaned up by the body and removed.
In summary: on a simple level B12 is just as good swallowed as sublingual, but high quality B12 (methyl) is more effective sublingually and better for you anyway.
January 8th, 2014 at 8:48 am
reppac,
That’s interesting and I’d like to know if it’s true. Do you know of any scientific research that backs it up?
January 29th, 2014 at 2:26 pm
This article says “methylcobalamin is not absorbed well from the stomach, which is why vitamin products contain cyanocobalamin.”
So they made a study: methyl-B12 is better absorbed by injection or through the nose than sublingual.
http://www.greatplainslaboratory.com/home/eng/b12.pdf
I conclude then cyano-B12 can be absorbed as we wish, but we have to be more careful for the methyl-B12.
January 29th, 2014 at 2:43 pm
Laury,
> methylcobalamin is not absorbed well from the stomach, which is why vitamin products contain cyanocobalamin.
Although I don’t know for sure, I don’t see why that would be, and to my knowledge it’s not why vitamin products contain cyano. Rather, they contain cyano because cyano is a much more stable form.
February 1st, 2014 at 2:45 pm
Jack,
there is a lot of info there drawn in from a number of sources, but a good starting point is the following article which gives the process of converting the cyano into a useful version for the body:
Pezacka E, et al Glutathionylcobalamin as an intermediate in the formation of cobalamin coenzymes. Biochem Biophys Res Commun 1990;169(2):443-50.
February 2nd, 2014 at 1:20 pm
reppac,
Thanks for the citation. I was thinking more along the lines of a clinical trial showing this to be the case. Piecing this info together via animal studies is one thing, but actually showing it in a trial in humans is much more reliable.
April 3rd, 2014 at 5:47 pm
This comments thread appears to have great longevity so I’ll offer my question. I understand the contention the sublingual is no better than oral in terms of raising overall levels however does sublingual have any advantage in terms of speed of absorption? To me this gets to the real heart of the issue – which is, is sublingual absorption actually happening at all or are we just dissolving then swallowing with no direct-to-bloodstream effect? In terms of B12 this may be an irrelevant point but I actually arrived on the topic as I was interested in the effect of chewable vs sublingual melatonin, where speed of action is a factor.
April 3rd, 2014 at 5:49 pm
BenC,
I have seen no studies on this question in humans.
April 4th, 2014 at 1:37 pm
For anyone following this thread, I’m not putting any comments through saying that sublingual is better unless they provide reasonable evidence to back up their claim. I am getting commenters who I believe to be merely trolls trying to promote sublingual B12.
April 14th, 2014 at 4:50 am
Jack, that study Laury posted basically showed the sublingual methylcobalamin did nothing. Correct? I was always curious if perhaps my sublingual b12 lozenges which dissolve in under 5 seconds even gave enough dissolve time to permeate the membrane of the tongue. Any thoughts? The study she posted is quite alarming.
April 14th, 2014 at 9:04 pm
cj,
That PDF Laury linked to is not exactly a peer-reviewed study and I wouldn’t worry about it. My thoughts are that swallowing is just as good as sublingual.
April 24th, 2014 at 8:04 am
Hi all!
I just like to say how helpful this page was.
I am not a vegetarian but i suffer from vitiligo! I have been told that taking vitamin B12 Might help with my condition.
Every research i have read over the past few monts talked about taking B12 injections and i had a difficult time excepting the fact that i cant get hold of such thing…
I am very happy that you just confirmed that I can just take B12 vitamin pills and get the same effect than the injections…
(I hope i got that right)
Thank you for your help!
April 24th, 2014 at 7:12 pm
Anita,
I would discuss with your doctor but, yes, large doses of oral B12 can provide enough vitamin B12 for people with absorption problems:
http://veganhealth.org/b12/formula#ORAL
April 25th, 2014 at 1:06 am
HI Anita
My sister and I also suffer from vitiligo. Talk to your doctor about Tacrolimus Monohydrate (Protopic). There are lots of studies on it too (search via google), here is one: http://archderm.jamanetwork.com/article.aspx?articleid=479293
Good luck
May 24th, 2014 at 12:47 pm
My MD has diagnosed me as having pernicious anemia. She prescribes Vitamin B12 shots for the remainder of my life. (I’m past 65). I see no discussion here of that diagnosis for ordinary people.
I’m currently injecting the cyan coblamine (sp) 1 mcg per month, plus taking 20,000 units of sublingual B12. I’m still not zipping around.
What’s anyone’s take on that?
May 28th, 2014 at 7:40 am
Barbara,
My understanding is that injections are usually hydroxocobalamin rather than cyanocobalamin. You might want to switch to hydroxo-. By 20,000 units, do you mean 20,000 micrograms? And do you mean “per day”? That seems like too much, in my opinion. That said, this is really a job for your doctor to figure out.
July 8th, 2014 at 1:15 pm
Do you still maintain that cyanocobalamin is an effective form of B12? Almost everything I’ve read elsewhere says to stay far away from that form as it is inactive, and therefore the body must convert it. And, of course, there’s the whole cyanide thing.
July 8th, 2014 at 1:20 pm
Among mainstream nutrition professionals and scientists studying B12, the idea that cyanocobalamin is an effective form of vitamin B12 is uncontroversial – it most definitely is effective and probably the most effective in terms of response per dosage (except in the rarest of cases).
July 8th, 2014 at 1:44 pm
Hmmm. Interesting.
What do you think about Dr. AG Freeman (who suggested that cyanocobalamin be removed from the market)?
July 8th, 2014 at 10:13 pm
Lynn,
Heavy smokers might want to avoid cyanocobalamin, based on theoretical evidence, but I haven’t see any clinical trials showing that it’s not effective in them and anecdotally, I haven’t seen any vegan smokers who rely on cyanocobalamin develop B12-deficiency. It’s something to keep in mind.
August 8th, 2014 at 4:28 pm
Not sure if this question really relates to this thread, but here goes. I am interested in knowing if sublingual has less side effects than traditional vitamins(swallowing). I have IBS, so I am prone to stomach upset & looking for the best option that is least likely to cause stomach upset.
September 25th, 2015 at 10:57 am
For those that suffer with pernicious anemia – there is no benefit to taking B12 in pill form since the body won’t absorb it.
September 25th, 2015 at 12:23 pm
Li,
> For those that suffer with pernicious anemia – there is no benefit to taking B12 in pill form since the body won’t absorb it.
While people with pernicious anemia cannot absorb B12 via the intrinsic factor proteins that efficiently shuttle B12 into the cells, they can absorb B12 through passive diffusion. A number of studies have found that large doses of oral B12 are adequate to replenish their B12 stores. See here: http://veganhealth.org/b12/formula
November 11th, 2015 at 9:41 pm
Here is a question from Italy:
I have been vegan for about 5 or 6 years. That sounds like enough time to develop a B12 deficiency. I have always known that I should take supplements, and that’s why I always kept B12 tablets in the kitchen, but since I find it difficult to form habits in general, I rarely took the supplement, irresponsibly.
Recently I lost a little bit of hearing in one ear, possibly due to an infection but it isn’t clear, and now I have slight tintinnus in both ears. My ENT didn’t mention a deficiency as a possible cause, but I’d like to know if it’s possible in your opinion.
I have no other unusual symptom.
The tablets I have (they are new, not 5 years old, just to clarify) are hydroxocobalamin (2000 micrograms). Are they just as useful as cyano or methylcobalamin? When I first went vegan I tried liquid methylcobalamin, but it made me sleepless, a side effect which the tablets didn’t seem to have. How is that possible?
I swallow the tablets whole. Is that alright? They are extremely friable, so I can’t believe I need to chew them.
Thank you for your wonderful kindness in answering the comments.
November 11th, 2015 at 10:01 pm
Someone,
I haven’t heard of developing tinnitus from B12 deficiency. I don’t know much about oral supplementation with hydroxocobalamin. I’d probably use those up and then get cyanocobalamin. It doesn’t sound like you need to chew them. Good luck–I hope it clears up!
March 5th, 2016 at 11:16 am
Jack,
Doesn’t this more recently published article from ‘The journal of family practice’ state the opposite of what you are saying:
https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/13371/HighDoseOralB12.pdf?sequence=1
March 7th, 2016 at 6:17 pm
Justin,
> Doesn’t this more recently published article from ‘The journal of family practice’ state the opposite of what you are saying:
I read it and it doesn’t compare sublingual to swallowing, so I would say, no, it does not state the opposite of what I’m saying.
July 24th, 2017 at 7:33 am
There is a prescription for B12 that also includes Intrinsic Factor. This seems to be a logical choice for those of us who do not produce enough of it (IF). What are your thoughts on this.
August 6th, 2017 at 6:29 pm
Annette,
It’s not my area of expertise, but your doctor should know if it’s been shown to be effective.
August 25th, 2017 at 6:41 pm
Hey Jack – I read recently of concerns over high doses of B12 so I have been looking for regular dose supplements that just meet the RDA but they are hard to find. Any suggestions? https://www.theatlantic.com/health/archive/2017/08/b12-energy/537654/
September 2nd, 2018 at 11:01 am
I have a concern with sublingual B12 (methyl) that I haven’t heard anyone mention. Both my daughter and I have discontinued the sublingual because it seems to burn our tongues, leaving them swollen and prickly feeling. I also felt my teeth ache for several days after one particular form and suspected it might be corroding my tooth enamel.
Has anyone else experienced this effect?
March 22nd, 2020 at 8:12 pm
Gael-
I too started using the Jarrow brand of methyl B12 1000mcg sublinguals about 2 months ago & my tongue/cheeks/gums have been burning ever since. I discontinued using the sublinguals about 10 days ago & my symptoms seem to be improving. It was as if all the mucous membranes in my mouth were becoming more sensitive & I was even developing canker sores. Very strange.
Back story: I originally started taking B12 because I was getting little lie bumps on my tongue here & there & had blood work done & my level was 272. I felt fine, maybe a little tired, but the main concern was the random swollen taste buds every 10-14 days & the roof of my mouth started peeling. My doctor had initially told me it was oral herpes (which I have never displayed symptoms of), but the bumps were nowhere else in my mouth except the top surface of my tongue, only appeared one at a time & very, very tiny. They also would go away in about 2-3 days. Just didn’t seem consistent (in my opinion) with herpes. When I got the blood results back, I decided to try the sublingual Tablets & the bumps stopped but then the burning mouth started. Anyone have recommendations?? The doctor had put it in my head that it’s herpes so although I am doubtful, I am still cautious as not to kiss my kiddos on the mouth or share food with them because of what the doctor had previously “diagnosed”. But I don’t think it’s a coincidence that as soon as I started taking B12 the bumps stopped appearing. I also recently had blood work done again & this time my level was 673. I am also seeing an ENT this week for a second opinion, as I have been dealing with this ordeal Since November ! I’m exhausted.