What is the best vitamin B12 supplement?
This depends on why you’re looking to supplement. If you have pernicious anemia, for example, you’d take a different approach than someone with a less malign type of B12 deficiency, or someone who’s supplementing with B12 just in case. Yes, some people do that because B12 is water-soluble, so there’s no toxicity or overdose risk.
Let’s have a look at your options.
Best Vitamin B12 Supplement For You
Oral (Tablets & Nasal Spray)
If you’re supplementing just to ensure adequate B12 intake, then nasal sprays or tablets (or, as others call them, “B12 vitamins”) are all you need. In fact, if you’re eating enough B12-rich foods, you may not even need them. Tablets and sprays are particularly great options for vegetarians and vegans, whose diets are typically very low in B12:
Higher rates of deficiency were reported among vegans compared with vegetarians and among individuals who had adhered to a vegetarian diet since birth compared with those who had adopted such a diet later in life. The main finding of this review is that vegetarians develop B12 depletion or deficiency regardless of demographic characteristics, place of residency, age, or type of vegetarian diet. Vegetarians should thus take preventive measures to ensure adequate intake of this vitamin, including regular consumption of supplements containing B12.
How prevalent is vitamin B(12) deficiency among vegetarians?
Thus, with few exceptions, the reviewed studies documented relatively high deficiency prevalence among vegetarians. Vegans who do not ingest vitamin B12 supplements were found to be at especially high risk. Vegetarians, especially vegans, should give strong consideration to the use of vitamin B12 supplements to ensure adequate vitamin B12 intake.
THE PREVALENCE OF COBALAMIN DEFICIENCY AMONG VEGETARIANS ASSESSED BY SERUM VITAMIN B12: A REVIEW OF LITERATURE.
Mean serum vitamin B12 was highest among omnivores, intermediate among vegetarians and lowest among vegans . In all, 52% of vegans, 7% of vegetarians and one omnivore were classified as vitamin B12 deficient.
SERUM CONCENTRATIONS OF VITAMIN B12 AND FOLATE IN BRITISH MALE OMNIVORES, VEGETARIANS AND VEGANS: RESULTS FROM A CROSS-SECTIONAL ANALYSIS OF THE EPIC-OXFORD COHORT STUDY.
If you suffer from food-bound cobalamin malabsorption, which is one of the main causes of B12 deficiency, and the predominant cause in the elderly, tablets and sprays are great options. In this disorder, your body is unable to release the B12 from food, but unlike in the more malign types of B12 deficiency, you still can fully utilize the free crystalline form of B12 found in oral supplements and fortified foods.
Food-cobalamin malabsorption syndrome, which has only recently been identified, is a disorder characterized by the inability to release cobalamin from food or its binding proteins. This syndrome is usually caused by atrophic gastritis, related or unrelated to Helicobacter pylori infection, and long-term ingestion of antacids and biguanides.
An update on cobalamin deficiency in adults
In general, if you can absorb B12 from oral supplements, then sublingual B12 tablets and sprays are great. However, often this is not the case, and only a minority of patients responds clinically to oral therapy. This is why B12 shots are a godsend.
Injections
For anybody who can’t absorb B12 through the gut, such as pernicious anemia patients, injections are the best B12 supplement form. In fact, it’s the only reliable one. When you have pernicious anemia, antibodies are preventing your body from making intrinsic factor, a protein needed for the absorption of B12 from the gut into the blood. The only way to bypass this defect is by injecting B12 shots straight into the bloodstream.
For vitamin B12 to absorb, it has to follow a complex pathway, requiring the acids and enzymes of the small intestine and the pancreas to function properly. One small problem in any of the steps may lead to malabsorption. Therefore, bypassing gastric defects is the biggest benefit of B12 injections. Thanks to this, B12 shots give new life to people who would otherwise deteriorate until their life becomes hell on earth.
Even if you can absorb B12 through the gut, B12 shots are still the gold standard, and will help you saturate your cells and replenish your B12 stores the quickest. As a general rule of thumb, if you show advanced, neurological B12 deficiency symptoms, injections should be your immediate treatment, regardless of the cause of your deficiency.
B12 Supplement Recommendations
Whether you go for oral or injectable B12, make sure the supplement is:
- Methylcobalamin. We like this native B12 form, because it’s the easiest to assimilate and it addresses a variety of B12 deficiency problems. It provides the methyl group that couples to carbon monoxide (derived from CO2) to afford acetyl-CoA, helping to detoxify your body. Methyl B12 is needed for the re-methylation pathway to regain its normal activity, bringing homocysteine down to reasonable levels. Since B12 deficient patients often have high homocysteine levels, methyl B12 solves two problems at once. It is the most promising treatment to relieve or even completely reverse symptoms. Another good option is adenosylcobalamin, another native form. Both these forms can inter-convert into each other. However, the main benefit of methyl B12 over adenosyl B12 is that it comes bundled with the methyl donor.
The two other forms are hydroxocobalamin and cyanocobalamin, who require conversion to the native forms of B12, and are not as effective. Cyano B12 is the worst, since it is a slightly toxic form that may deplete the body of glutathione in order to get rid of the cyanide molecule attached to it. The body needs glutathione for other important tasks, such as lowering high homocysteine levels.
- As free of additives as possible. Some people react to preservatives, binders, fillers, coloring agents, or other additives in the B12. Mannitol, carboxymethyl cellulose, and benzyl alcohol are common triggers of sensitivity. Here’s a case of negative reactions to B12 shots due to benzyl alcohol. Whatever supplement you take, make sure it is as pure as possible. If you choose to inject, try out our 100% pure methyl B12, and dilute it in saline. That way, the only substances you’ll put in your body will be methyl B12, water, and a tiny bit of salt. This is the best way.
Complementary Recommendations
When an anemic person starts producing red blood cells again, potassium levels could drop. So when you first start to supplement with B12, increase your potassium intake. Also, remember that B12 and folate need each other in order to function properly, so if you’re low on folate, we suggest taking l-methylfolate tablets. This form of folate is much better than folic acid. And last, read our dietary recommendations.
All the best, and good luck.