Vitamin B12: Sublingual Form?

Question:
Dear Sir
I have been advised to purchase Jarrow sublingual methyl b12 (1000m)
My questions are:
1) Is a lozenge classed as sublingual? I understand that a lozenge slowly absorbed under tongue is better than swallowing b12 in pill form. But with a lozenge are you not also swallowing a lot of the product with your saliva and wasting it? As I have been advised sublingual is best do you recommend I purchase your methyl b12 lozenge? would that be correct?
2) Is it necessary to take other supplements with it for it to work properly for eg. folic acid and b6? and if so what doses do I need with daily b12 (1000) lozenge?
Thank you for any advice . . .kind regards,
[DP]

Answer:

Your question highlights one of the more common misconceptions in the nutritional supplement field, i.e. that sublingual vitamin B12 is superior to other oral dosage forms. It’s amazing how so many health food store clerks and so-called nutritionists continue to perpetuate this idea.

Here is how it started. One of the major causes of vitamin B12 deficiency is malabsorption, and one of the most notorious forms of vitamin B12 malabsorption is pernicious anemia. A substance secreted by cells in the stomach, intrinsic factor, is needed for the normal absorption of vitamin B12. When this substance is not present, as is the case in pernicious anemia, a vitamin B12 deficiency occurs. At one time, the only way to overcome this was thought to be the administration of vitamin B12 by injection, which, of course, bypasses the need for “intrinsic factor,” and absorption from the gut.

Well, you cannot sell injectable vitamin B12 in the health food store, so some clever marketing guy came up with another idea for getting around the absorption problem–sublingual absorption! What a great idea. You can bypass the malabsorption problem by having the substance be absorbed directly from under the tongue. Sublingual vitamin B12 was thus born, and has become a very popular type of nutritional supplement.

There is only one problem. Vitamin B12 is not absorbed sublingually.

Sublingual absorption works for small molecules, not large ones, and vitamin B12 is a very large molecule.

It turns out, however, that subsequent research revealed that even people with pernicious anemia can, in fact, benefit from oral vitamin B12. The trick is that they need to take very high dosages. If they do this, enough will be absorbed in spite of the malabsorption problems. Since B12 is inexpensive, and “high dosage” is still very small compared to other vitamins (micrograms vs milligrams), this is easy to accomplish.

So what about sublingual, or lozenge-forms of vitamin B12? It turns out that they work, but only because you end up swallowing the vitamin B12 as the lozenge dissolves, allowing it to be absorbed in the gut just as if it was a normal tablet or capsule.

You were concerned that swallowing the vitamin B12 was “wasting it.” Ironically, the opposite is true.

Buy a lozenge if you wish, but don’t be misled into thinking it will result in sublingual absorption. What is important is that it is a high dose.

The methylcobalamin (Methyl B12) form is thought to be better absorbed than the regular form of B12, and I see no reason not to use it. Jarrow (and others) makes a 5,000 mcg dosage, however, as well as a 1,000 mcg dose, and I would opt for the higher dose.

Vitamin B6 and folic acid work with vitamin B12 to control homocysteine levels, and if that is the reason you are taking the B12, then you should consider that. You should be taking a multivitamin supplement, and perhaps an additional B-Complex supplement, however, and this should provide plenty of those two vitamins.

Don Goldberg

About Don Goldberg

Hello. I am what you might call a Nutritional Pharmacist. After college, I worked in the Pharmaceutical and Nutritional Industry, first in Quality Control, and then in Manufacturing and Product Development. Increasingly, as the years passed, I became more involved with nutritional supplements. I spent many years detailing physicians, herbalists, and homeopaths about nutritional and herbal therapies and products. In 1992, along with my friend Arnie Gitomer, I bought Willner Chemists, a well-established nutritionally oriented pharmacy. For the first time, I had an opportunity to communicate directly with the consumer, the patient, and the customer. I love it. This blog is an additional way for me to extend my personal views and opinions directly to you. You can also hear me on the radio, every Sunday, from 2 to 4 pm on WOR radio in NY (710 AM), or WGKA in Atlanta (920 AM). Or check our website, www.willner.com.
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5 Responses to Vitamin B12: Sublingual Form?

  1. D. Kuchera says:

    I read that if you are taking Acid Blockers (PPI’s) B12 is not absorbed in the stomach as it should be. Therefore requiring a form that is absorbed by sub-lingual form. I have GERD and take Aciphex daily for this chronic condition. What are my choices for B12?

    • Don Goldberg says:

      “Requiring a form that is absorbed by sub-lingual” misses the point. B12 is _not_ absorbed sub-lingually. Period. It is absorbed orally. If, for any reason, you need supplemental B12 and have a valid reason to fear that oral administration of high doses will not work, you should talk to your physician about parenteral B12 (injections). A B12 supplement can bear a label that says “sub-lingual,” but that does not make it so.
      Don Goldberg

    • Don Goldberg says:

      . . . additional information on this subject, from our most recent Willner Chemists E-Newsletter:

      Vitamin B12 and Antacid Medications: What About Supplements?

      A recent study, reported in the newspapers, created some concern and confusion among people taking antacids or acid-suppressing drugs. The study looked specifically at people taking a type of drug called proton-pump inhibitors, or P.P.I.’s and histamin 2 receptor antagonists. Examples of this type of drug are Prevacid, Prilosec and Nexium.
      “People who are taking these medications are more likely than the average person to be vitamin B12 deficient, and it’s a potentially serious problem,” said Dr. Douglas A. Corley, senior author of the new study, published in The Journal of the American Medical Association. “This raises the question of whether people taking these medications for long periods should be screened for vitamin B12 deficiency.”
      This is not unexpected news. The confusing part is how this applies to vitamin B12 in food versus supplements. Here are the key points:
      (1) Yes, if you are taking acid suppressing drugs, you will be interfering with your body’s ability to absorb vitamin B12 from food. This can be a serious problem.
      (2) Does this apply to vitamin B12 supplements as well? No. Can you take vitamin B12 supplements to offset the effects of acid suppressing drugs? Yes.
      Here is the reason. The vitamin B12 in your diet is usually combined with protein. The hydrochloric acid in your stomach, along with the enzyme pepsin, breaks down the protein and releases the vitamin B12. The vitamin B12 then combines with a substance normally secreted by the stomach lining called “intrinsic factor,” and this complex is then absorbed into the bloodstream. A small percentage of unbound vitamin B12 is also absorbed, through “passive diffusion,” and this is why high doses or oral supplemental B12 are effective–even in pernicious anemia, where secretion of “intrinsic factor” is impaired.
      The type of vitamin B12 used in supplements is not bound to protein, so it’s absorption is not dependent on stomach acid.
      (3) Those who take antacids on a regular basis, then, might be well advised to take high potency vitamin B12 supplements as well. It does not matter if it is labeled as “sublingual” or not. As I have explained many times in the past, there is no evidence that vitamin B12 is absorbed sublingually–it dissolves in you mouth, you swallow it, and it is then absorbed through a combination of active and passive diffusion.
      (4) The typical dose, from supplements, can range from 1000 mcg to 5000 mcg per day. Select “B12″ from the “By Generic Product” quick search on http://www.willner.com to see a list of products.

  2. julieann calandrino says:

    i would like to know your opinion on Gabba for restful sleep.
    Thx julieann calandrino

  3. Eddy Kong says:

    Vitamin B12 deficiency symptoms are manifest not because people are taking less vitamin B12 than recommended. Deficiency of vitamin B12 affects every cell in the body, but is most severely felt in the tissues where the cells normally divide rapidly, as in the blood-forming -tissues of the bone marrow and in the gastro-intestinal tract. The deficiency can also lead to neurological changes such as numbness and tingling in the hands and feet. It also include mood disorders, anxiety, insomnia, restlessness, night terror etc.
    Reference:
    http://www.b12deficiency.org/fundamental-information-about-b12-deficiency/

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