B12 injections vs oral sup and sprays

[davemarq71]

Hi does anyone know or have any solid evidence of which is more effective and beneficial method of absorbing B12..injections orals or sprays? To boost B12 levels or food sources.Which way works best /better and for what reason please?Is any of them ineffective?

[Gambit62 Administrator]

Studies of delivery methods tend to focus on measuring the amounts that get into your blood and how long it stays there - not sure if I've come across one that used other markers for B12 deficiency (MMA, Homocysteine ... and most importantly patients symptoms - probably because the later is considered subjective).

Not aware of any studies involving skin patches - but then I haven't looked for them.

Will try to dig out links to the studies but results are basically

sublinguals: just above 1% seems to get into the blood as an average

nasal: somewhere around 3% gets into the blood

injections (IM or SQ) 100% gets into the blood.

Studies with comparing high dose oral and high dose sublinguals (>= 1000mcg daily) show very little variation between how much B12 gets into the blood - so conclusion is that high dose oral can be used as an effective way of delivering B12 even in patients with absorption problems, though at least one study did look at how patients felt about it as an alternative to injections and it certainly wasn't 100% who preferred it though it was quite high - over 60% - so my take from that is that it can be effective for delivery but it doesn't work for everyone ... and people really need to have options so they can choose the treatment that suits them best.

The rate of removal of B12 from your blood depends on the amount that is in your blood - and the relationship is exponential rather than linear - so with an injection (on average) half of it is removed in the first 24-48 hours. So would be unfair to claim that it was 100x more efficient at putting useable B12 into your blood as that obviously isn't going to be the case.

Looking at treatment protocols with cyanocobalamin - injections monthly 1000mcg versus tablets daily 1000mcg - would make cyanocobalamin injections about 3x more efficient than tablets in terms of the amount delivered into your blood ... and if you added in nursing time for administration of shots then it would probably come out cheaper but these are all averages based on populations that are known to vary a lot so although you can draw general conclusions these aren't conclusions that can then be applied back to an individual with any degree of confidence that you will really get a good treatment.

Unfortunately the only way at the moment of knowing which method(s) of delivery works best for you (and which type(s) of cobalamin works best for you at the moment is to try them and see. Biochemistry of B12 is quite complex and genetic factors add a whole new layer of complexity.

ncbi.nlm.nih.gov/pmc/articl...

sciencedirect.com/science/a...

gastrojournal.org/article/S...

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

[Barneyboy48 in reply to Gambit62]

I've read somewhere, I'm sure I have, that absorbtion is limited when using sublingual sprays because the B12 molecule is too large to penetrate the mucus membrane thus making absorbtion by this method impractical.

Has any one seen a post directly relating to this?

My GP wants to reduce me from a 6 week schedule for injections to 12 weeks but use some homeopathic product from Holland & Barrett called "B12 Boost" which is a sublingual type spray.

Has this product even been clinically proven or certified?

I am not confident.

I am taking PP Inhibitors so absorbtion through digestion is nigh on impossible. I feel if the sublingual B12 cannot be absorbed through the mucus membrane then it has to be swallowed where, in my case, it is just going to urine.

I'd appreciate some in sight please.

[Gambit62 Administrator in reply to Barneyboy48]

With apologies to davemarq71 who originally posted.Barneyboy48

a) B12Boost isn't a homeopathic remedy - homeopathy is prefaced on the use of microdoses and B12Boost is anything but microdoses. It is based on very high doses.

It is, however, a vitamin supplement rather than a medication.

b) if you are in the UK I think there is currently no licensed high dose oral in the BNF.

This doesn't mean that available vitamin supplements don't work - just that the controls on the dosage per tablet isn't as strict as it would be with a medication . This can be an issue with some supplements made, for example from plant extracts can show considerable variance in dosage. However, the method for manufacturing B12 supplements is different and there should be less variation but there could still be some, ie you may not always get 1000mcg - sometimes you could get more and sometimes less.

c) The PAS is looking to work with a manufacturer to do a clinical trial of 1000mcg cyanocobalamin tablets in the UK - the trial may be underway.

d) There have been many trials of high dose orals - including the studies mentioned above that show that high dose oral - working with passive absorption can work and there are people in those studies that actually preferred it to injections.

e) On average 1% of an oral dose is absorbed outside the ileum but there is variance from individual to individual and passive absorption doesn't seem to work for everyone - looking at comparative studies of people with different absorption problems it seems to be between 20%-35% - though most of these are small scale studies. This is consistent with one larger scale study in Canada which showed that around 60% of those involved were happy with high dose oral.

f) High dose oral is used in other countries

g) Despite what you may have seen, the fact is that the mechanisms behind passive absorption aren't fully understood and osmosis doesn't appear to be the primary mechanism.

h) Passive absorption was basically what was used to treat patients with PA in the decades between discovering how PA worked and working out how to manufacture B12 specifically. The treatment during this period was a product based on large quantities of nearly raw liver.

So, passive absorption is real, it works in patients with PA as well as patients with other absorption problems, but it doesn't work for all patients. Unfortunately the reason for variation isn't understood and the only way of really knowing if it will work for you is to try it.

[Barneyboy48 in reply to Gambit62]

I have actually tried it. It doesn't work for me. It tastes quite nice but that is as far as it goes. Unfortunately the doctor at my surgery doesn't believe me, so I have no idea how I can convince him otherwise.

This stuff works out really expensive too. Each spray contains 40 doses and it is recommended to dose 4 times daily, so there's only 10 days supply in each container. I would need 4 containers every other 6 weeks, so the cost increases. At £12.00 a pop it ain't cheap and having to have 4 at at a time I'm looking at £42 a batch. I just can't afford it on my pension.

You can reduce the price by multi-buying or agreeing to monthly supplies but doesn't work out much cheaper.

Of course if the doctor could prescribe it, for me it would be free, but of course because of what it is it can't be prescribed. But it doesn't work anyway so that's neither here not there!

[Brian77]

There are studies showing oral is equivalent for maintenance, though should load with injections, especially if neurological symptoms present.

ncbi.nlm.nih.gov/pmc/articl...

Oral dose of 1000 mcg (1mg) per day typical for maintenance, should still check levels occasionally.

ncbi.nlm.nih.gov/pmc/articl...