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Pernicious Anaemia Society
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B12 Absorption ??? Do I have absorption problem or not ?

1- If you have plenty of meat, chicken in your diet and your B12 comes very low in blood results does that mean you have a "definite" absorption problem ?

2 - Does fish also a source of B12 ?

3 - if you have a definite absorption problem do sublinguals or sprays help( or work on you) ? Do they bypass your stomach and enter your bloodstream, therefore work even though you have an absorbtion problem ???

5 Replies

Hi Ryaan A lot will depend on the cause of your B12 deficiency. Have a look at the following and see if you "identify" with any of the "People":

Anyone at any age, can become B12 deficient. However, certain people are at an elevated risk. They include the following:

Vegetarians, vegans and people eating macrobiotic diets.

People aged sixty and over

People who’ve undergone any gastric and/or intestinal surgery, including bariatric surgery for weight loss purposes (Gastric bypass).

People who regularly use proton-pump- inhibitors. H2 blockers, antacids, Metformin, and related diabetes drugs, or other medications that can interfere with B12 absorption.

People who undergo surgeries or dental procedures involving nitrous oxide, or who use the drug recreationally.

People with a history of eating disorders (anorexia or bulimia).

People with a history of alcoholism.

People with a family history of pernicious anaemia.

People diagnosed with anaemia (including iron deficiency anaemia, sickle cell anaemia and thalassaemia).

People with Crohn’s disease, irritable bowel syndrome, gluten enteropathy (celiac disease), or any other disease that cause malabsorption of nutrients.

People with autoimmune disorders (especially thyroid disorders such as Hashimoto’s thyroiditis and Grave’s disease) Type 1 diabetes, vitiligo, lupus, Addison’s disease, ulcerative colitis, infertility, acquired agammaglobulinemia, or a family history of these disorders.

If you have an absorption problem with your digestive system then unless you do what I was threatened with having to do 45 years ago and that was to eat raw liver three times a day - or else have the B12 injections for the rest of my life - then no matter what is in your daily diet none (or not enough) will get through.

I'm not medically trained but there are others on here who will be able to give you further advice.


Thanks for your reply Clive. Did you actually eat raw liver 3 times a day.

How do you absorb B12 from raw liver if you have an absorption problem ?

I'm just wondering what you chose.


Hi again Ryaan fortunately (for me) my doctor was "joking" as she prepared to tell me the result of a "Schilling" test confirming that I had P.A. She had started off the conversation by asking me whether I wanted to good news or the bad news. I asked for the bad news. She told me that I had two years to live.

There was I a 30 year old with a sick wife and two daughters under six so naturally I was keen to know what the good news was.

That's when she went on to say about the raw liver or the injections. Suffice to say I chose to have the cyanocobamalin B12 injections every four weeks for the rest of my life and by my calculation I have now had over 600 and I'm still "clivealive" at 75 so I guess they are working :)

I think my lovely, humourous lady doctor (who incidentally went on from being a G.P to become the head of the U.K. Prisons Psychiatric Service and is now a Dame of the British Empire) must have read a similar history to the following gleaned from Wikipedia.

"Pernicious anemia was a fatal disease before about the year 1920, when George Whipple suggested raw liver as a treatment.[citation needed] The first workable treatment for pernicious anemia began when Whipple made a discovery in the course of experiments in which he bled dogs to make them anemic, then fed them various foods to see which would make them recover most rapidly (he was looking for treatments for anemia from bleeding, not pernicious anemia). Whipple discovered ingesting large amounts of liver seemed to cure anemia from blood loss, and tried liver ingestion as a treatment for pernicious anemia, reporting improvement there, also, in a paper in 1920.[citation needed] George Minot and William Murphy then set about to partly isolate the curative property in liver, and in 1926 showed it was contained in raw liver juice (in the process also showing it was the iron in liver tissue, not the soluble factor in liver juice, which cured the anemia from bleeding in dogs); thus, the discovery of the liver juice factor as a treatment for pernicious anemia had been by coincidence.[citation needed] Frieda Robscheit-Robbins worked closely with Whipple, co-authoring 21 papers from 1925-30.[citation needed] For the discovery of the cure of a previously fatal disease of unknown cause, Whipple, Minot, and Murphy shared the 1934 Nobel Prize in Medicine.[54][full citation needed]

After Minot and Murphy's verification of Whipple's results in 1926, pernicious anemia victims ate or drank at least one-half pound of raw liver, or drank raw liver juice, every day.[citation needed] This continued for several years, until a concentrate of liver juice became available. In 1928, chemist Edwin Cohn prepared a liver extract that was 50 to 100 times more potent than the natural food (liver).[citation needed] The extract could even be injected into muscle, which meant patients no longer needed to eat large amounts of liver or juice. This also reduced the cost of treatment considerably.[citation needed]

The active ingredient in liver remained unknown until 1948, when it was isolated by two chemists, Karl A. Folkers of the United States and Alexander R. Todd of Great Britain.[citation needed] The substance was a cobalamin, which the discoverers named vitamin B12. The new vitamin in liver juice was eventually completely purified and characterized in the 1950s, and other methods of producing it from bacteria were developed.[citation needed] It could be injected into muscle with even less irritation, making it possible to treat PA with even more ease.[citation needed] Pernicious anemia was eventually treated with either injections or large oral doses of B12, typically between 1 and 4 mg daily.[citation needed]

One writer has hypothesized that Mary Todd Lincoln, the wife of American President Abraham Lincoln, had pernicious anemia for decades and died from it.[55][56]"

Thank you George Whipple


people vary a lot in how much B12 they need to be healthy so some people will just have low levels anyway but not have a problem.

If your diet contains plenty of meat/fish/dairy/egg then it is unlikely that a deficiency will be dietary and that means an absorption problem. - So that is a yes to fish as a source of B12 - salmon is supposed to be one of the richest sources.

Sublinguals - tablets and sprays- do work for some people but not for everyone. Although the theory is that sublinguals are absorbed through membranes in the mouth the uptake from them seems to be very similar to the amount that would be absorbed passively (in the gut but outside the ileum) - just over 1% - however, as always this is an average - so some will have better absorption and others will have much lower absorption.



I was diagnosed with PA 17 yrs ago and have posed your 3 questions to various doctors in the U.S. over the years. I can synthesize their responses as follows:

1. Yes. Any kind of protein meat, and you can add eggs to that, are optimal sources for metabolizing B12 vitamin to the extent required by other human body mechanisms. Therefore, if you are eating like a cave-man and are still B12 deficient, there is most likely something wrong with the absorption process.

2. Yes and no on fish. Fish classified as "fatty" are yes. Other fish, including many farm-raised types, are not so good sources of B12, although fine for other alimentary purposes.

3. Some doctors will say yes to sublinguals, sprays and such that by-pass the digestive system. But I have had at least one learned young fellow say no, not unless you spray or sublingual such a large volume of it you would probably barf... So, I'm thinking the jury is still out on that question. Personally, I gave up on all B12 sources except for my every-3 weeks subQ injection, which I know works because if I'm late in doing it, I start turning into a turnip (i.e. a lumpy vegetable).


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