B12 injections ...a sure shot way to recovery?

I have read numerous articles on the efficiency of sublinguals in treatment of b12 deficiency and also seen patient testimonials lauding the efficacy of b12 pills/sublinguals. If that's the case, why r injections still considered to be superior to sublinguals? Could anyone on this forum help me understand the working of a sublingual in comparison to an injection and the difference between the two? The way I understand is that both help in elevating the b12 blood serum level but do injections ensure that b12 reaches the place where it is required (brain and cells)? My GP in US still is insisting on sublinguals and hence the question (though I m flying out next week). Also if my GP in India hands over a prescription recommending regular injections, would my GP in US comply?

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13 Replies

  • This is what the leading expert in the Netherlands has to say about sublinguals and tabs, and I agree:


    I do not believe a GP in the US has to follow a dr in any other country, so I wouldn't get my hopes up. Ask the Indian GP to teach you how to self inject?

  • I love you people! Thanks for the link. x

  • Why do you see so many testimonials lauding the efficacy of X?

    Check out the Amazon reviews of something you've bought that turned out to be a load of junk. It's a pretty good bet that there will be many that praise the product in a totally unjustifiable manner.

  • I would be interested in fbirder's thoughts on sublingual methyl spray efficiency please

  • Sublingual methyl spray? It tastes OK. Didn't seem to do much else for me.

  • You mention the efficiency of B12 pills/ sublinguals in B12 DEFICIENCY. The important word being deficiency . Deficiency doesn't necessarily mean non-absorption problems, whereas Pernicious Anaemia does . People with low B12 for reason of inadequate intake of B12( Vegans, strict vegetarians , users of PPIs , Metformin, fish tapeworm etc.) will be able to benefit .But in the main , Pernicious Anaemia patients find that the only solution is an injection as they cannot make use of B12 in any other way. Believe me the GPs would be handing out tablets to PA patients if they thought they would do the job. That said, I occasionally do hear that PA patients find help in sub-linguals, but only if they are also on injections . I tried every sort of B12 except injections, when I found that the three- monthly injection( standard NHS procedeure) was insufficient to keep symptoms at bay . No use at all to me . But , we are all different !

  • i would like to go on record as saying i feel 1000 times better taking high dose sublingual methylcobalimin vs injections. i take 7000 mcg daily and the difference, compared to how i felt with injections is unbelievable. i think it is very personal and may not be the case for everyone, but if you feel lousy on injections, go for the tablets. i use solgar, but many people like jarrow. research always finds what it's looking for. i have three specialists versus my gp who think the tablets are the way to go. even my pharmacist thinks the injections are not great. the proof is in the pudding. i hope this helps!

  • GPs usually only prescribe tablets in the form of Cyanocobalamin and these are useless.

    I have taken Jarrows Methylcobalamin 5000 Mcg SL for a while now and find they work well for me but I do not have neurological problems.

    Sally Pacholok recommends both injections and sublinguals for neurological symptoms.

  • In UK , GPSs usually prescribe Hydroxocobalamin injections

  • Sorry, I meant Cyanocobalamin in tablet form - have edited.

  • I agree jkay that everyone has different responses to B12 even though, most people with PA do better on injections because of the problem of absorption.

    Part of a letter from Wilhelmina Reitsema in 'Rapid responses' to the BMJ research document - see her last paragraph - "Is it important which form is used ....."


    " There are two active forms of the B12 enzyme in the human cell. First, Methylcobalamin acts as a co-enzyme for the conversion of homocysteine to methionine. Methionine then acts as a methyl-donor to a great number of reactions that need a methyl group, including the synthesis of myelin, serotonin, dopamine, noradrenalin, DNA and phospholipids.

    Second, Adenosylcobalamin is a co-enzyme for the conversion of L-methylmalonyl-CoA into succinyl-CoA which feeds into the citric acid cycle.

    "Is it important which form is used in treatment? In most people, it does not matter. They can convert cyano- and hydroxo-cobalamin into the active forms needed. However, I have recently reported a case in which it did matter. The severe vitamin B12 deficiency, including dementia and psychosis, responded to treatment with high dose oral methylcobalamin, but not to equally high dose oral hydroxocobalamin. [1]

    1. Rietsema WJ. Unexpected Recovery of Moderate Cognitive Impairment on Treatment with Oral Methylcobalamin. Journal of the American Geriatrics Society 2014;62(8):1611-12 doi: 10.1111/jgs.12966[published Online First: Epub Date]|. "

  • ps on my last post - i have PA, not merely B12 defeciency.....

  • How are you feeling now

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