Is oral B12 as effective as intramuscular injections?

[Korn]

In cases of severe B12 deficiency/in patients with pernicious anemia or ileal disease, intramuscular B12 shots has been thought to be the only solution until a few years ago. Recent studies have shown that large amounts of oral/ublingual B12 can be effective treatment even in people with pernicious anemia, and promised (in some other thread) to post source for this info...

Here is a link to an article which states that oral vitamin B12 replacement is as effective as intramuscular injections, even in patients with pernicious anemia or ileal disease:
Vitamin B12 deficiency (from American Family Physician). (http://www.aafp.org/afp/20030301/979.html)


Here's another link to an article about the same topic:
Medical intelligence in Sweden. Vitamin B12: oral
compared with parenteral? (http://pmj.bmj.com/cgi/reprint/81/953/191.pdf)


Some more links:
Vitamin B12 injections versus oral supplements. How much money could be saved by switching from injections to pills? (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=11212437&dopt=Citation)

Oral vitamin B12 therapy in the primary care setting: a qualitative and quantitative study of patient perspectives. (http://www.cababstractsplus.org/google/abstract.asp?AcNo=20053147199)

Is Oral Vitamin B12 as Effective as Intramuscular Injection? (http://www.aafp.org/afp/20060101/cochrane.html#c2)

[feral]

I asked my vegetarian gp about that this week and she says it is absorbed as well as the injection. The problem, she finds, is trying to get a pure VitB12 tablet that isn't just part of a multivitamin.

[Korn]

Two more links:

Oral Cobalamin for Pernicious Anemia: Medicine's Best Kept Secret? (http://www.vitab12.com/perniciousanemia.html)


Oral B12 equivalent to B12 injections (http://www.lef.org/magazine/mag99/aug99-report3.html)


For decades, people have been injecting themselves with vitamin B12 because they thought oral supplements were not adequately absorbed. New research indicates that oral B12 supplements may be as good or better than injections.

[Fuhzy]

I asked my vegetarian gp about that this week and she says it is absorbed as well as the injection. The problem, she finds, is trying to get a pure VitB12 tablet that isn't just part of a multivitamin.
Really? Here we have GNC, a vitamin/supplement store where you can get B12 tabs for under your tongue, pretty cheap...

[celtic rose]

Vegan sublingual B12 (1000mcg Methylcobalamin) manufactured by Deva is available through the internet.
I got mine from All Seasons Health.

[ClawsyWP]

Methylcobalamin is b12 that doesnt need to be processed by the liver right?

[Korn]

Cyanocobalamin isn't active as such in the body, and has to be converted into either methylcobalamin or adenosylcobalamin (by removing the cyanide) to have any effect... This isn't necessary for methylcobalamin.

[cobweb]

Vegan sublingual B12 (1000mcg Methylcobalamin) manufactured by Deva is available through the internet.
I got mine from All Seasons Health.


thanks, i just bought some via amazon :thumbsup:

[Cherry.Chops]

i have pink B12 tablets from Deva which desolve in the mouth. I got them from vegan store. around £12.99 i think

[Zorillo]

http://www.wddty.com/03363800370346848114/long-term-b12-injections-are-a-scam.html

[Zorillo]

http://www.wddty.com/03363800370147851335/depression-is-it-just-a-vitamin-b-deficiency.html

[harpy]

That's interesting. If pills are as good as injections and cost less, I wonder why they still do the injections? (They do seem to, unless this is out of date:
http://www.nhs.uk/Conditions/Anaemia-vitamin-B12-and-folate-deficiency/Pages/Treatment.aspx)

[Korn]

Even if it would be proven ten times that injections were as good as pills (for almost everybody, at least, people (incuding many health professionals) would still assume that injections were needed for a long time. Things take time.

[harpy]

That's true, unfortunately - unless someone stands to make money out of it. I guess there isn't too much money in vitamin B12 supplementation.

[Korn]

New encapsulation to increase B12 absorption (http://www.nutraingredients-usa.com/Research/New-encapsulation-to-increase-B12-absorption)


B12 bioavailability

B12 is a "very poorly absorbed molecule", Bob Madison, senior director of corporate communications told NutraIngredients-USA.com.

While its absorption levels for injected B12 is between 7 and 30 percent, B12 tablets only have a bioavailability of 1 percent, according to Madison.

However, he said that so far the studies of the companies' encapsulation technology have shown bioavailability of between 7 and 30 percent - therefore the same as its achieved in injecting the vitamin.

"Our elogen molecules bind with whatever vitamin we are using them with, and protect it through the digestive tract," he said.

"The encapsulation technology flows with the body's natural fluids and is then released into the bloodstream via the intestinal lumen of the small intestine."

The product is not yet commercially available as first it has to be tested on humans in the last stage before being approved by the Food and Drug Administration. Emisphere hopes the technology will be available by early 2009.

B12 vitamin

Madison said that B12 deficiency is a big problem in the US and elsewhere.

Five million people in the US receiving 40m B12 injections annually to treat a variety of medical conditions. At least an additional five million people are consuming over 600m B12 tablets of varying strengths.

Madison "However, it is very hard to get people to have injections - the oral route of administration is much more desirable, which is why we have been working on a tablet that delivers the same bioavailability as the injection."

As well as being used in supplement, the company said it has had much interest in its encapsulation technology from functional foods companies.

[Marrers]

Emisphere hopes the technology will be available by early 2009.
This report is date April 2008. I presume we'd have heard about it if there was a new type of B12 tablet out, so it's at least a year late.

[Korn]

Oral vitamin B12 for patients suspected of subtle cobalamin deficiency: a multicentre pragmatic randomised controlled trial (http://www.ncbi.nlm.nih.gov/pubmed/21232119)

CONCLUSIONS: Oral vitamin B12 treatment normalised the metabolic markers of vitamin B12 deficiency. However, a one-month daily treatment with 1000 μg oral vitamin B12 was not sufficient to normalise the deficiency markers for four months, and treatment had no effect on haematological signs of B12 deficiency.
PMID: 21232119

[Korn]

Oral or intramuscular vitamin B12? (http://dtb.bmj.com/content/47/2/19.long#ref-8)

Comparison with intramuscular therapy
A systematic review identified two non-blinded randomised trials comparing oral and intramuscular vitamin B12 in people with low serum vitamin B12 concentrations.12 In one trial, involving 70 patients with megaloblastic anaemia, 1 mg of cobalamin, either orally or intramuscularly, was administered daily for 10 days and then once weekly for 4 weeks.23 In all, 60 patients completed the study and mean vitamin B12 concentrations in both groups were higher than at baseline (p<0.001) at 90 days and had increased similarly. Neurological symptoms had also lessened in both groups (i.e. at day 30, in 7 of 9 in the oral group and 9 of 12 in the intramuscular group). In the other study, 38 patients with newly diagnosed vitamin B12 deficiency either received 1 mg cyanocobalamin intramuscularly on days 1, 3, 7, 10, 14, 21, 30, 60 and 90, or took 2 mg cyanocobalamin orally each day for 4 months.24 In all, 33 patients completed the study and, after 4 months, vitamin B12 concentrations had increased in both groups (p<0.001), but more so in the oral therapy group (1,005 pg/mL vs. 325 pg/mL, p<0.0005). The reviewers concluded that these limited studies suggested that 1–2 mg of oral vitamin B12 initially daily, and thereafter weekly and then monthly, might be as effective as intramuscular administration in obtaining short-term haematological and neurological responses in patients with vitamin B12 deficiency. However, whether this regimen is effective in the long term needs further study. More studies are also required to test whether oral vitamin B12 is suitable in patients with vitamin B12 deficiency and associated severe neurological defects and, if so, to determine the appropriate dose. It is also unknown whether oral vitamin B12 should be taken with food or on an empty stomach.
Ref.: DTB 2009;47:19-21 doi:10.1136/dtb.2009.01.0002

[Korn]

Vitamin B12 replacement therapy: how much is enough? (http://www.ncbi.nlm.nih.gov/pubmed/8053222) (1994)


Vitamin B12 deficiency becomes increasingly common with advancing age. Diverse recommendations exist for initial and maintenance therapy of deficiency states. With cyanocobalamin, the only B12 preparation available in the United States, much greater amounts of the vitamin are retained with a 1000 micrograms injection than with 100 micrograms, with no disadvantage in cost or toxicity. Maintenance therapy using the larger dosage may be necessary to meet metabolic requirements in many patients. Thus, it is recommended that parenteral regimens use 1000 micrograms cyanocobalamin: 5 or 6 biweekly injections for loading, and once-a-month for maintenance. Oral therapy with 300-1000 micrograms per day may be therapeutically equivalent to parenteral therapy.

[Korn]

Vitamin B12 deficiency: a challenging diagnosis and treatment (http://www.ncbi.nlm.nih.gov/pubmed/19024576) (2008)

Vitamin B12 deficiency is usually evoked in presence of compatible hematologic or clinical (usually neurologic) signs. However, many cases of deficiency are little or not symptomatic. Pernicious anemia, caused by a deficiency in intrinsic factor, is a rare cause of vitamin B12 deficiency. The most frequent causes are gastric disorders, pancreatic insufficiency, or chronic drug treatment (proton pump inhibitors or metformin) that interfere with the digestion of vitamin B12 digestion, or disorders of the ileum mucosa reducing the absorption of vitamin B12. Oral treatment of vitamin B12 deficiency is possible whatever the etiology, but it has only been validated in small series. Parenteral treatment remains indicated for severe neurologic deficits or whenever patient adherence with treatment is doubtful.
PMID: 19024576

[Korn]

March 2012:

(https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/13371/HighDoseOralB12.pdf?sequence=1) (https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/13371/HighDoseOralB12.pdf?sequence=1) (https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/13371/HighDoseOralB12.pdf?sequence=1) (https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/13371/HighDoseOralB12.pdf?sequence=1)Is high-dose oral B12 a safe and effective alternative to a B12 injection? (https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/13371/HighDoseOralB12.pdf?sequence=1)