Pernicious Anaemia Society
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Why are all B12 supplements Methylcobalin and not Hydroxocobalamin ?

Hi I'm in uk and was just checkiing for oral B12 on Amazon UK.

They all say Methylcobalamin as supposed to Hydroxocobalamin which is the only form licensed in UK. Is the licensing for injections only ?

My wife is very low on B12, does anyone recommend what strength would be best and if later this strength should be reduced as the levels get higher.

If so Is there any indication as to when the strength should be changed.

Thank you all in advance for your help and time, I don't know what I would have done without this site, it's so helpful.

10 Replies

you can get other forms - suspect methyl is the one that is there because that's the one that gets pushed.

I use this site and they have a range of other forms

the licensing you refer to relates only to prescriptions and only to injectable B12 - all other forms are covered by regs relating to vitamin supplements and injectable B12 is only covered because all injectable substances are covered by prescription only rules.

Has your wife been diagnosed as having a B12 deficiency caused by absorption problems? wouldn't recommend jumping to supplements unless you have exhausted all possibilities of getting a diagnosis.


Gp put her on injections for life and said your body doesn't absorb but hasn't doesn't any specific tests as to why.

He is going by blood tests which seem to come low on B12 and her symptoms of fatigue and tired and some neuro symptoms.

He doesn't want to know about why !

I posted once that Me,my wife, my mother and my 3 kids (18, 16 and 13 yrs) are all deficient, all live together and doc says all can't absorb. Strange.

My symptoms were the worst and was too desperate to try getting it from diet. It was very low and went straight on to injections. I had good life changing results and felt like dead before jabs (I'm 41) so I kept going on jabs self injecting. I haven't even tried orals because gp said won't help neither have any of my family.

I thought I'll rather inject than feel like dead. Too scared to come off injections because I don't want to return to that state before injections.

Gp only goes by blood results and no other tests.

I asked him why I can't absorb once and he said some people don't have intrinsic factor so you're one of them!

(I don't know how he knows that)

I had too many visits to gp and just got fed up and decided to go on the jabs

I didn't know what else to do. I inject every 2 weeks 1ml hydroxo.

My doc don't like questions and I didn't have the energy to fight it.

Also have low folate, vitD, which I buy and don't knw about the rest.

Blood tests are very basic and doc dnt like to answer questions.

Sorry about long reply and thanks for your replies.


If you read up on it, the methylcobalamin is more like what the body produces where as the other is the synthetic version. So you want methylcobalamin. I take Garden of Life Spray for the mouth in that form. I cannot take injections because I will have an allergic reaction due to two things. I am missing the IF factor in the stomach and cannot absorb anything really except through the spray through the membranes of the cheeks and my DNA has proven that I am a fast metabolizer so I cannot take 98% of all supplements or pills out there. I can tell you this, my B12 level was 105 and in just 4 weeks with only taking one spray at 500 MCG my B12 level went from 105 to 455 my brain fog was gone in just 5 days! My bone health specialist wanted me at 2500 MCG per day to start but my body couldn't handle it but since the lower dose worked so well for me that's all I've stayed on. So if you do end up ordering that you can adjust it to whatever you want it to be. It's inexpensive only $15 and has a hundred and forty sprays in it. For me it was Miracle Worker!

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jackiekay, I'm really glad that methyl worked well for you.

However, it is far from the true that it is best for everyone.

This article from the pinned posts makes some comments, based on recent research on whether methyl is better than hydroxo and cyano and in general research isn't coming up with any evidencet to support this

there is also this recent review of studies on the matter

Whilst there is a possible logic that says methyl should be best there are a couple of problems with this

a) the body needs both methyl and adenosyl forms of B12 - most people don't have a problem converting methyl to adenosyl but there have been some reported cases where people haven't been able to do this - though everyone can convert hydroxo and cyano to both forms

whilst the efficiency of this conversion can be affected by genetic factors the impact of these factors is quite low on B12 and can be corrected by increasing the amount of B12 used.

b) it neglects the actual biochemistry that is involved in getting B12 from blood to cells and the way B12 is bound to proteins and separated from them and assumes that the form that goes in is the one that ends up in the cell which isn't necessarily the case.

Personally I find that methyl works well for me with some system but has absolutely no impact on other symptoms - particularly the neuropsychiatric problems, which are my more significant set of problems.


Do you use only 1 spray which delivers 50mcg ?

Could you tell me which spray it is also how many times a day do you use it and where did you purchase it.



I use Garden of Life B12 spray. I get it from a store called Harvest Health. Each spray is 500mcg's. I only use one spray a day because that is ally body needed but my bone health specialist recommended 2500 mcg's daily to raise it but my body didn't need that much. Your body will tell you how much you need when your symptoms start disappearing. If one spray doesn't do it use two sprays. If two doesn't do it, use three. It's only about $15 a bottle. I actually just got it on sale for $12 a bottle. And there's a hundred forty sprays in a bottle. So, great price and it works. I hope you get it and it works for you!

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I agree that the same thing does not work best for everyone. I had to really go by trial and error to find something that works. I'm one of the lucky ones that it took all my nero symptoms away and my fog brain but I also did not have low folate or low hemoglobin it was just the B12 and the vitamin D. I hope you find what's right for you. I know it's not easy

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Thanks, what do you use.


I just googled 'hydroxocobalamin supplement UK' and found two on Amazon, a sublingual by a company called Prohealth and drops by a company called Lipolife.

I haven't tried these so I'm not recommending them, but they are available.

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Ryaan - hear the desperation in your response to my reply

In terms of testing - the test for PA is actually very problematic as it produces false negatives so much of the time so you might need to have it done several times before you get a positive - so really it's easier to rule out other possibilities - so start by ruling out drug interactions then rule out other absorption problems (coeliacs and h pylori and crohn's ...) and if none of those apply you are left with PA. With the possibility of h pylori the treatment is the same whatever the cause. As tests cost it can be quite difficult to balance the benefits of knowing against the cost of all the tests as in most cases the benefits of knowing can be quite small as the risk of other health issues from different conditions can be quite low - particularly compared to the costs of on-going monitoring. Not saying that cost should always be a limiting factor but ...

PA has a genetic component so if there is a strong family history of B12 problems then it makes PA as the cause much more likely.

However, there is also a lot of looseness about the way PA is used and many GPs do just use it as a catchall for an unidentified absorption problem.

Although most B12 is absorbed in the ileum a small amount is absorbed outside the ileum which means that flooding the gut with very large amounts of B12 can result in getting enough through. 1% is the average amount that is absorbed 'passively' (outside the ileum) but this varies a lot from person to person. so a dose of 1mg is about 400xRDA - 1% of 400xRDA = 4xRDA. Not going to be enough to deal with a severe deficiency but could be enough to handle an on-going absorption problem. However, the amount that people do absorb passively varies a lot - probably from a few % to a small fraction of a % so the dose that would be needed would vary a lot ... and it isn't going to be helpful for some people.

So, it isn't that oral doesn't work - it's more that it isn't very efficent and there is no way of actually knowing how much oral would be needed.

Although sublinguals are supposed to work by being absorbed through membranes in the mouth the studies actually show that there isn't really much difference in the amount that gets into your blood and the amount that gets absorbed passively so most of it probably is passive absorption. Nasal sprays are a bit better but most of that is probably passive absorption as well.

This is link to a specific product - nasal spray - I use for B12 supplementation - along with various members of the family - a single 'squirt' delivers 500mcg


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