Vitamin B12

Written by Slawomir Gromadzki, MPH

WHAT IS VITAMIN B12?

Vitamin B12, also called cobalamin, is a water-soluble, largest and most structurally complicated cobalt-based organic vitamin. Cobalamin is such a unique and complex compound that no scientist is able to make it in the lab, and for this reason, it is often referred to as “the Mount Everest of biosynthetic problems.” However, what scientists can’t accomplish a humble bacteria can, as cobalamin can be synthesized (produced) only by certain probiotic bacterial species, especially those that are anaerobic (e.g., able to thrive in environments that lack oxygen such as intestines). Cobalamin synthesis is an extremely complex process which involves over 30 enzymatic steps and scientists still don’t understand many details associated with it.

BACTERIAL SPECIES ABLE TO MAKE VITAMIN B12

There are two bacterial species that possess all the genes for Cobalamin synthesis and both are used for the commercial production of vitamin B12. The first one is Lactobacillus reuteri (naturally can be found in intestines of many humans) and the second one is Propionibacterium freudenreichii which is a genetically-engineered strain. Several other probiotic bacterial species especially Lactic-acid bacteria such as Bifidobacterium, Lactobacillus or Propionibacterium species can produce cobalamin as a result of teamwork. Certain Lactobacillus probiotics improved vitamin status (B12, folate, and D3) in human studies. Some other species also produce nutrients like B vitamins and folate.

Daily consumption of L. acidophilus significantly improved vitamin B12 and folate levels in children [>].

L. reuteri isolated from sourdough has been shown to produce cobalamin (vitamin B12) [>]

ROLE OF VITAMIN B12

Vitamin B12 is absolutely critical for good mental and physical health. It is essential for the DNA (contributes to the successful synthesis of the cell’s genetic material) and works with other B vitamins to form all types of blood cells. It helps nerve fibres form and function in our brain, spinal cord and peripheral nerves. It supports brain function (memory & focus), immune system, energy production and metabolism of fats, carbohydrates and proteins. It helps to keep our heart and cardiovascular system on track by maintaining normal homocysteine levels. Vitamin B12 plays an important role in fertility and pregnancy. It is crucial in the maintenance of the nervous system and in preventing damage of the myelin sheaths, the insulating material that surrounds nerve cells. Also children require constant Vitamin B12 supply for the healthy development of the immune and nervous systems and to maintain proper appetite.

PREVALENCE OF B12 DEFICIENCY

Unfortunately, due to many different nutritional, physiological, environmental and lifestyle factors Vitamin B12 deficiency is regarded now as a very common and growing problem even among young people. For example, some sources suggest that almost half of the entire American nation may be affected by B12 deficiency (without knowing about it). The problem is similar in the UK and many other countries due to various common environmental and lifestyle factors. 50% of vegetarians and 70-80% of vegans are deficient in Vitamin B12.

SYMPTOMS & CONSEQUENCES OF B12 DEFICIENCY

B12 deficiency is known as the Great Masquerader. Its deficiency can mimic everything from MS or Parkinson’s disease-like symptoms, abdominal problems, going blind, multiple organ failure, red eyes, and chronic diarrhoea to shortness of breath, burning feet, darkened skin, and even the bilateral useless hand syndrome.

B12 deﬁciency includes neurologic and psychiatric symptoms like depression and psychosis. For example, a 47-year-old woman with a five-year history of psychosis, treated with drugs, and cognitively impaired with visual hallucinations, until finally, her mother informed a physician that her daughter was following a strict vegan diet for seven years. She started B12 supplements, and her symptoms went away. Years of her life were lost in a psychotic haze, all because she didn’t want to take a supplement.

There are two types of anaemia (megaloblastic and pernicious) that involve B12 deficiency. In megaloblastic anaemia, red blood cells are fewer and enlarged especially as a result of vitamin B12 and folic acid deficiency. However, in this case, vitamin B12 deficiency alone will not be able to produce symptoms if there is sufficient amount of folate (folic acid). This is why folic acid supplementation even in the absence of vitamin B12 can prevent megaloblastic anaemia.

The second type of anaemia is called pernicious and it is the most common cause of vitamin B12 deficiency in the UK. In case of pernicious anaemia our immune system attacks and destroys the cells in the stomach that produce the intrinsic factor which is necessary for proper absorption of vitamin B12 from our gastrointestinal tract. As a result, the body is unable to absorb vitamin B12 which leads to anaemia caused by a chronic deficiency of vitamin B12.

Anaemia and any form of chronic vitamin B12 deficiency can be expressed in many different symptoms such as mental fogginess, poor memory and concentration, fatigue, numbness & tingling of fingers or toes, abnormal smoothness of the tongue, dementia, irritation, feelings of apathy and lack of motivation, mood swings, muscle weakness, sleeping problems, loss of appetite, constipation, sores at the corners of the mouth, mood disturbances, personality changes, depression, spasticity (a condition in which muscles are continuously tight or stiff), neurological pain, vision changes, incontinence, spasticity of muscles (shaky movements), low blood pressure, vision problems, delusions, hallucinations, cognitive changes, spinal cord damage, etc.

Lack of this vitamin also contributes to weakened immunity and recurrent infections, damage of the myelin sheaths of the nerve cells, birth defects, or increased homocysteine levels and higher risk of cardiovascular problems. Deficiency of vitamin B12 and folic acid lead to hearing loss. According to Alan Greene, M.D., premature grey hair is caused by vitamin B-12 deficiency. B12 deficiency often affects the lining of the uterus, causing an abnormal pap smear that is often mistaken as pre-cancerous. B12 deficiency can also cause nerve damage in the stomach, which prevents the stomach from emptying properly. This results in symptoms of bloating, heartburn, gastric reflux, nausea, or constipation.

Deficiency leads to the impairment of neurological functions since Vitamin B12 is a compulsory factor needed for the development of neurons. Because of the great variety of possible symptoms vitamin B12 deficiency can mimic many diseases such as depression, psychosis, or even Parkinson’s disease. Vitamin B12 deficiency may also lead to the damage of the myelin sheath which surrounds the nerve fibres; it can also mimic the symptoms of multiple sclerosis (MS). Researchers have reported that these symptoms may sometimes occur even when vitamin B12 levels are just slightly lower than normal.

Initial symptoms such as numbness and tingling of fingers or toes may, without treatment, progress to the instability of gait (deviation from normal walking) or paralysis.

Since the preservation of DNA integrity is dependent on vitamin B12 and folate availability deficiency of both of them has been linked to increased risk of various cancers such as breast cancer.

HIGH DEFICIENCY RISK GROUPS

Facts about vitamin B12 (cobalamin) show that in developed countries the number of people with low vitamin B12 is rampant not only among elderly people, vegans and vegetarians but actually among entire population including younger individuals or those who consume dairy and meat products on a regular basis. According to Dr Jennifer Rooke – Assistant Professor in the Department of Community Health and Preventive Medicine at Morehouse School of Medicine, “Cattle no longer feed on grass and chickens do not peck in the dirt on factory farms. Even if they did, pesticides kill B12 producing bacteria in the soil. Heavy antibiotic use kills B12 producing bacteria in the guts of farm animals.”

FACTORS LEADING TO B12 DEFICIENCY

Since apart from fortified and animal-based foods the number and vitality of certain strains of B12 manufacturing probiotic bacteria in our intestines is the key source of this vitamin, the following factors can lead to B12 deficiency by damaging intestinal flora balance: Antibiotics (also found in meat, dairy farmed fish, and tap water), laxatives, chlorine (Sucralose, Splenda, tap water, swimming pools, etc.), sodium fluoride (toothpastes, tap water, etc.), caffeine (coffee, tea, cola drinks, green tea), refined sugar, alcoholic beverages, unhealthy eating habits (lack of dietary fibre), stress, anxiety, depression, etc.

Also, celiac disease, IBS, Crohn’s disease, stomach surgery, autoimmune disorders, diabetes and some other conditions may contribute to the deficiency.

The following drugs reduce the absorption of vitamin B12: Metformin (a medication for individuals with type 2 diabetes), nitrous oxide (commonly used anaesthetic), chloramphenicol and neomycin (antibiotics), colchicine (medicine for gout treatment), Proton-pump inhibitors (e.g., omeprazole and lansoprazole), Proton-pump inhibitors, Histamine2 (H2)-receptor antagonists (e.g., cimetidine, famotidine, and ranitidine), cholestyramine (used in the treatment of high cholesterol).

Individuals taking above-mentioned drugs and medications that inhibit gastric acid secretion should consider taking the sublingual methylcobalamin form of vitamin B12.

INFERTILITY & PREGNANCY

Studies have noted a link between B12 deficiency and abnormal oestrogenic levels that may interfere with the implantation of the fertilized egg. Dr Michael Bennett describes a connection linking B12 deficiency with not only a failure to get pregnant but also a failure to successfully carry a baby full-term as a lack of this vitamin can lead to neural tube defects in pregnancy. Pregnancy can drastically worsen a pre-existing B12 deficiency because B12 is transferred to the growing foetus throughout pregnancy. Maternal B12 deficiency may also increase a child’s risk of type-2 diabetes.

Pregnant women that are on a vegan diet are recommended to take B12 supplements but since about 40% of those who regularly consume meat products and dairy are deficient in this vitamin it is wise for all pregnant women (regardless of diet) to take B12 supplements (especially the sublingual methylcobalamin).

DEFICIENCY FACTORS RELATED TO AGE

Because the chemical structure of cobalamin (B12) is extremely complex its proper absorption from animal foods in our body depends on many factors. Proper stomach acidity is required for this vitamin to be properly absorbed later in the intestine. Antacid drugs, therefore, by reducing gastric acid production cause a decrease in vitamin B12 absorption leading to its deficiency. Another factor which may lead to the same problem is age as the older we get the less stomach acid we make.

There are at least seven factors required for proper B12 absorption from food sources and utilization. Among the most important ones (apart from stomach acid) are intrinsic factor and transcobalamin. Unfortunately, the older we get the less of them we produce. The problem starts especially when we are over 50 years old. However, those who are over 70 usually do not make those factors at all! It means they may be completely deprived of vitamin B12 and as a result can easily develop all kinds of symptoms including severe dementia, neurological problems or even Parkinson’s- or MS-like symptoms!

Since due to a common deficiency of one or more of these seven factors elderly people can’t properly digest and absorb cobalamin (vitamin B12) they can get it only in the form of good quality supplements or B12 shots.

OTHER GROUPS OF INCREASED RISK

Apart from senior citizens, people at higher risk for vitamin B12 deficiency include especially strict vegetarians (vegans), breastfed infants, people with increased vitamin B12 requirements associated with kidney or liver disease, women during pregnancy, those who suffer from haemorrhage, and individuals with malignant cancers.

Also, various prescribed medications such as some diabetes drugs may lead to B12 deficiency. Therefore, even if you are not a vegan you may still need the supplementation as meat and dairy eaters also often experience symptoms of cobalamin (B12) deficiency due to problems with absorption or other factors such as stress, depression, and use of stimulants or laxatives.

POSSIBLE BENEFITS OF SUPPLEMENTING VITAMIN B12

Since vitamin B12 deficiency is a very common problem today proper supplementation of this vitamin is very important as it gives many health benefits: It protects nerve and brain cells from free radical damage, and often reduces pain associated with neuropathies (B12 was considered a painkiller in some countries >), contributes to the creation of healthy DNA and RNA, works with other B vitamins to form all types of blood cells, supports immune system health, improves mood and cognitive functions, protects the cardiovascular system, maintains overall energy levels, etc.

DETOXIFICATION

Vitamin B12 is an amazingly powerful detoxifying agent, particularly when it’s used in the form of sublingual methylcobalamin. Its power lies in the methyl part of the methylcobalamin as a process known as methylation is one of the most critical processes in the body. B12 (especially methylcobalamin), therefore, is used in our body to remove numerous dangerous substances such as arsenic, mercury, glutamates from artificial sweeteners and MSG, mycotoxins, or cyanide.

NERVE PROTECTION AND REGENERATION

Methylcobalamin is absolutely vital in the protection and repair of the nervous system. Its deficiency can lead to peripheral nerve damage (especially in people with chronic high blood sugar levels and those who are on statins and other cholesterol-lowering drugs), brain and spinal cord problems, neural tube defects in pregnancy, or Multiple Sclerosis lesions.

Very few substances have any impact on regenerating damaged nerves in humans. However, a 1994 study in the Journal of Neurological Science (Vol 48) suggested that the methylcobalamin form of vitamin B12 could increase the synthesis of certain proteins that help regenerate nerves. The study showed that extremely high doses of methylcobalamin produced nerve regeneration in rats. A study on the impact of vitamin B12 on the brain found that seniors with the lowest B12 levels had a six times greater rate of brain volume loss compared with those who had the highest levels of B12! Interestingly, none of the participants was actually deficient in vitamin B12 – they just had low levels within a ‘normal’ range! (>).

Also, some individuals with peripheral neuropathy may initially experience worsening of the burning feet but for a short time as it may be just a sign that B12 starts regenerating the damaged nerves thus making them more sensitive.

IMMUNE SYSTEM

Vitamin B12 is involved in the production of white blood cells which are responsible to deal with viral infections and many people with inflammations, weak immune system and autoimmune diseases have low levels of this most important vitamin. “Vitamin B12 deficiency is common among both vegans and meat-eaters alike. The Framingham Offspring Study found that not just vegetarians or older people are deficient in vitamin B12. This study showed no difference in the B12 blood levels of younger and older adults. Most interestingly there was no difference between those who ate meat, poultry, or fish and those who did not eat those foods.” (Jennifer Rooke, MD, November 1, 2014) Read a fascinating article on B12 >

SHOCKING BBC DOCUMENTARY ABOUT A WOMAN WHO RECOVERED FROM MS-LIKE SYMPTOMS AS A RESULT OF B12 SUPPLEMENTATION

There is an extraordinary BBC documentary available on YouTube about a certain British lady by the name Catherine Iceton who was diagnosed with MS and the disease was so advanced that she used a wheelchair as she couldn’t walk because of the severe nerve damage. She also suffered from depression and blurred vision. She was prescribed immune suppressor drugs but they failed to improve her symptoms leading to some bad side effects. Fortunately, her loving husband didn’t give up but took her to an experienced doctor of Indian origin and when that lady with diagnosed MS explained to him all the details about her disease he remembered that before he moved to England and worked as a physician in India he met some vegetarians or vegans with similar symptoms. In their case, however, the problem wasn’t caused by MS but by vitamin B12 deficiency. And when he prescribed them B12 shots they recovered. He, therefore, concluded that also in her case symptoms were caused by chronic and severe B12 deficiency and not by the autoimmune response (MS). And lo and behold, after a series of hydroxocobalamin B12 shots she completely recovered from all her problems! Normally she had to go to bed at half seven to eight o’clock as she couldn’t keep her eyes open. But after the first injection, she wasn’t tired or sleepy even at 9.30 as vitamin B12 greatly increased her energy and alertness. One night she needed to use the bathroom and surprisingly after waking she just got up on her own and walked to the bathroom forgetting about her wheelchair! And only when she was there she realised she did it without a wheelchair! Soon as a result of B12 supplementation, all the symptoms were gone. She described her experience as “waking up from a nightmare.” At the same time, she also recovered from severe depression, muscle cramps and chronic fatigue.

(VIDEO LINK TO THE STORY)

INSOMNIA

Vitamin B12 (cobalamin) is reported to help insomniacs who have problems falling asleep as its deficiency can be one of the key causes of insomnia. The research indicated that as a result of taking B12 supplementation total length of sleep decreases while the restorativeness of sleep increases. It is also important to know that many people who are B12 deficient never get into deep sleep, although they may have enough of shallow, non-restorative sleep.

Certain middle-aged Indian lady who suffered from insomnia for about three years asked me once how to cope with this problem as well as constant tiredness. Knowing that she was over 60 and was probably deficient in B12 I recommended her sublingual methylcobalamin. In addition, I also encouraged her to take B complex, Magnesium citrate, some herbs known to help relax the nervous system, and lifestyle changes. When I met her again after about one month she informed me her insomnia was gone. She also told me she decided to find out which supplement was most helpful and she discovered that only whenever she stopped taking methylcobalamin she couldn’t sleep again even if she kept on taking B complex and all other supplements and remedies!

But although deficiency of B12 can cause difficulties with falling asleep and therefore supplementation helps to cope with it yet the same B12 can also cause some problems with sleeping as it increases alertness and energy. For this reason, take B12 (sublingual methylcobalamin is the best) only in the morning and try to not overdose it (not more than 2,000mcg per day). Also, any B vitamin, Chlorella, Ginseng, Acetyl L-carnitine, Fumarate or DHEA and many other energy-boosting supplements and herbs should be taken only in the morning as they all are known to increase energy and mental alertness.

ARE THERE ANY RELIABLE PLANT SOURCES OF B12?

Strict vegetarians often think that they can provide sufficient amounts of this vitamin with seaweed such as spirulina or kelp but unfortunately, studies demonstrated that these rich in B12 plant sources do not contain a biologically active form of this vitamin. Vitamin B12 present in spirulina or other seaweeds can even interfere with the active vitamin B12 forms and thus may contribute to the deficiency development! Also, barley grass powder does not supply sufficient amounts of vitamin B12.

Some sources claim Brewer’s and nutritional yeast are good sources of B12 but the truth is they do not naturally contain B-12 unless they are fortified. But even if they are fortified the amount of B12 is too low to provide sufficient levels of this vitamin.

CULTIVATED UNDER SUN ORGANIC CHLORELLA – THE ONLY RELIABLE PLANT SOURCE OF B12

There seems to be only one bioavailable plant source of vitamin B12 and it is Chlorella. According to the Journal of Medicinal Food (2015) “Vitamin B12 in chlorella is bioavailable and such dietary supplementation is a natural way for vegetarians and vegans to get the vitamin B12 they need.” Since we know that only bacteria are capable of producing vitamin B12, it is, therefore, bacteria which grow in symbiosis with Chlorella that make this vitamin. Chlorella only absorbs B12 made by bacteria and stores it. However, not every Chlorella is believed to contain the bioavailable form of vitamin B12. Only chlorella which is exposed to natural sunlight contains vitamin B12 in its active form.

While there are different species of chlorella, it is recommended to use Chlorella pyrenoidosa (sun chlorella strain). Apart from chlorophyll, the most important constituent of chlorella is the Chlorella Growth Factor (C.G.F.), and it is believed that only Chlorella pyrenoidosa (sun chlorella strain) contains it in large quantities. Tank-cultivated chlorella that doesn’t use sunlight are much lower in CGF and in addition, they shouldn’t also contain an active form of vitamin B12. Apart from a large amount of sunlight, proper cultivation of chlorella requires other important elements such as plenty of clean groundwater, low rainfall, clean air or stable temperature. A so-called subtropical region like the Taiwan area or the South China Sea (not far from Taiwan) has one of the best conditions for culturing chlorella.

Chlorella is also recommended for those who are or might be deficient in B12 as it is the best possible food for intestinal bacterial species able to produce this vitamin. Chlorella helps them to multiply and thrive in the GI tract.

Nevertheless, even if chlorella contains active B12 the amount of this vitamin may not be sufficient for every person as even properly cultivated Chlorella contains only about 1 µg of vitamin B12 per gram of dry Chlorella. If you take about 2 heaped tablespoons or about 20 tablets of good quality Chlorella every day on a regular basis then it is possible that it will be able to prevent B12 deficiency. But since no Chlorella is standardised for B12 content and it is difficult to have a guarantee that Chlorella we use actually contains active B12 and whether it is a sufficient dose I believe it is still wise to take 1000 mcg of sublingual methylcobalamin at least 2 or 3 times a week.

TYPES OF PROBIOTIC BACTERIAL SPECIES ABLE TO PRODUCE B12

The only one type of bacteria that possesses all the genes for cobalamin (B12) synthesis is Lactobacillus reuteri (naturally can be found in the intestines of many most humans). But fortunately, there are also other probiotic bacterial species, especially Lactic-acid bacteria such as Bifidobacterium, Lactobacillus, or Propionibacterium that are able to synthesise this vitamin and other B vitamins by mutual cooperation and by completing each other’s work.

It is therefore very beneficial for those who want to prevent or increase B12 levels to take good quality probiotic supplements containing the above-mentioned strains.

WHY SOME LONG-TERM VEGANS ARE NOT DEFICIENT IN B12?

Published in 1999 Australian study of 245 Seventh-day Adventist ministers, who followed a vegan diet, found that 70 per cent of them were deficient in vitamin B-12. 30%, however, had normal levels of this vitamin in spite of a diet which was completely deprived of B12 sources.

In another experiment, Dr Donaldson tested 54 Health Ministers who had been on the 100% plant-based Hallelujah Diet for B12 adequacy after they had been on the diet for a minimum of two years. His finding revealed that about 50% of those who had been on The Hallelujah Diet for two years or longer showed signs of B12 deficiency. However, it is very interesting that the second half of the participants, who also were on the same completely plant-based Hallelujah Diet, showed no B12 deficiency at all! The very important question to answer, therefore, is: Why do some individuals who are deprived of animal foods for years show some signs of B12 deficiency, while others on the same diet are never deficient in this vitamin?

The answer to this question is not difficult to find if we take into consideration the fact that vitamin B12 (cobalamin) can be manufactured only by certain strains of beneficial probiotic bacteria that normally should live in our intestines and that there are many factors which can increase their number or destroy them. It means that those long-term vegans who are not deficient in B12 must have enough B12-manufacturing probiotic bacteria not only in the large intestines, where it can’t be absorbed but also in their small intestines where B12 can be still absorbed and used by the body.

There is enough evidence that in some cases a sufficient amount of B12 may come from the microflora found in the intestines even though the diet is deprived of B12 sources, and no supplements are taken. In one of the studies by Dr Donaldson, vegan volunteers were given probiotics and some of them (not all) had significantly improved B12 levels without using any food sources of B12 or supplements. It means that proper care for gut flora and taking supplements with live probiotic bacteria with the known ability to produce cobalamin can in a certain type of people be a sufficient source of B12.

It is also important to remember that although it is true that there are bacteria in our intestines that synthesize B-12 yet in order for B12 to be absorbed into the bloodstream the bacteria must reside also in the small intestine. Unfortunately, in many people, they live well beyond the part of the intestine where B-12 is absorbed.

However, although it is true there are some lifelong vegans who do not seem to suffer from B12 deficiencies, it is still safer and wise to use B12 supplements (especially in the form of sublingual methylcobalamin) just to avoid any possible and dangerous consequences, in case bacteria in the small intestines do not make enough of this vitamin. Although bacteria present in the small intestine produce some B12 yet experts suggest that this amount does not always appear to be sufficient. Apart from that, vitamin B12 in the form of supplements is safe, strengthens our nervous system and boosts energy as it often helps to effectively cope with fatigue. Almost every day I encourage different individuals to take B12 in the form of sublingual methylcobalamin and personally know many people who shortly after taking it experienced an energy boost and other benefits.

So, yes, it is possible that vegans may not develop vitamin B12 deficiency through sufficient B12 production by bacteria in the small intestine as well as chlorella supplementation. However, some experts suggest this is still regarded as an unusual condition, especially in Western countries, and therefore, should not be relied upon.

We also know that vegans (including myself) have almost always a much lower white blood cell count than meat-eaters. In the past, I believed that it was so because being on a meat-free diet our bodies have a lower concentration of toxins or pathogens and therefore do not require so many leukocytes in the blood. But, although it may be one of the causes of this phenomenon, yet today I believe that the key reason for low white blood cell count among vegans is rather vitamin B12 deficiency as it is required in our body for all blood cell production, including white blood cells.

CAN AN ANIMAL-BASED DIET SOLVE B12 DEFICIENCY PROBLEM?

Unfortunately, encouraging people to consume animal products to prevent B12 deficiency is not a very wise idea as meat and dairy greatly increase the risk of many dangerous health problems. Apart from that, even animal foods (including meat, dairy, eggs or farmed fish) today are often deprived of B12 as animals are fed with antibiotics which destroy probiotic bacteria in their gut. Studies have shown that those who are on a typical animal-based diet actually require more vitamin B12 than vegans. This is because their diet gradually destroys bacterial flora and leads to the deficiency of stomach acid and digestive enzymes.

According to The American Journal of Clinical Nutrition, “Low vitamin B-12 levels don’t just occur in older people. And contrary to current wisdom, meat, poultry, and seafood may not be a good source of the vitamin. A surprising 39 per cent of participants (3,000 men and women aged 26-83) had blood levels below 350 pg/ml, the level at which neurological signs of B-12 deficiency or high homocysteine levels sometimes occur.”

Because vitamin B12 is peptide bound in animal foods and in order to be absorbed must be enzymatically cleaved from peptide bonds, a deficiency of hydrochloric acid, digestive enzymes and other factors such as transcobalamines greatly contribute to B12 deficiency as it can’t be properly extracted from food. On the other hand, healthy vegans (especially those who consume mostly raw plant foods) have a much stronger digestive system, and healthier bacterial flora in their intestines may actually get more vitamin B12 even though they do not consume animal foods. Unfortunately, not all vegans practice healthy diet and lifestyle principles as they consume products high in refined sugar and bad commercial pro-inflammatory oils, mostly refined and cooked products. In this way, they cause dangerous nutritional deficiencies (including B12) and health problems bringing disgrace to proper veganism. Especially dangerous with regards to B12 is refined sugar as its negative influence can be similar to that of antibiotics due to its damaging effect on the intestinal flora. Since heating (cooking) unrefined plant foods such as vegetables also kill probiotic bacteria it is very difficult for vegans who consume mostly cooked foods to maintain healthy bacterial balance in their intestines.

WHICH FORM OF B12 SUPPLEMENTATION IS THE BEST?

The two known biologically active forms of B12 are methylcobalamin and adenosylcobalamin. Other forms, such as cyanocobalamin or hydroxocobalamin (aquacobalamin) must be first metabolized to either of the two active forms in order to be used in our body.

Some experts maintain that the most common and inexpensive cyanocobalamin (much cheaper than methylcobalamin) is difficult for the body to absorb, and the small amount that is absorbed usually fails to ﬁnd its way into the cells. As a result, many people who take even large doses of cyanocobalamin may continue to be deficient in B12. I don’t want to suggest that cyanocobalamin doesn’t work at all but that supplementing our body with this form of B12 requires more time and higher doses. In addition, since cyanocobalamin is not a natural form, it has to be converted in our body to the physiological forms (methylcobalamin and adenosylcobalamin), leaving behind the cyanide which has to be removed from the body. However, separating cyanide from cobalamin (B12) and flushing it out of your body requires using methyl groups of molecules that are needed to fight things like homocysteine which greatly increases the risk of heart attacks and strokes. Therefore, taking the cyanocobalamin form of B12, we actually deprive our body of very beneficial methyl groups.

On the other hand, a 2003 study (>) compared 500 µg per day via the sublingual (under the tongue) and oral routes. Sublingual fared no better than oral B12 at raising B12 levels or improving B12 activity (as measured by homocysteine and methylmalonic acid levels). Both routes effectively increased B12 levels (>).

As far as supplements are concerned methylcobalamin is regarded as the final and therefore the most bio-available form of vitamin B12 (cobalamin), and when dissolved under the tongue it is not lost in the digestive process but gets straight into the bloodstream significantly increasing its absorption and effectiveness. Since methylcobalamin can also be absorbed via the oral mucosa, it is available in the form of lozenges, sublingual tablets or drops. Whether this actually has any therapeutic advantages is still to be proven, since the relevant studies have not yet been carried out. However, it is suggested that lozenges or sublingual tablets could be the best form because methylcobalamin may not be chemically stable in the stomach and intestines. Unfortunately, we are no sure as this claim seems to be contradicted by studies which have recorded good absorption of methylcobalamin from the intestines.

Additionally, methylcobalamin plays an important role in detoxifying our body from heavy metals and lowering the homocysteine, which is known to contribute to cardiovascular problems when its levels are too high. In addition, methylcobalamin is the only form of B12 which can directly participate in homocysteine metabolism. Also, converting homocysteine to methionine via methyl B12 increases the supply of SAMe (S-adenosyl methionine), regarded as the body’s most important methyl donor.

Some suggest that the most biologically active form of vitamin B12 is neither cyanocobalamin nor methylcobalamin but hydroxocobalamin because our body can dispose this form of B12 more efficiently. Others, however, oppose this idea by explaining that hydroxocobalamin is completely unstable when put in a tablet or capsule, and can only be taken by injection. This is the reason, they say, why we can’t find hydroxocobalamin in a nutrition supplement made by an honest company.

There is also a notion that methylcobalamin works best for most people but may not work for all possibly because their bodies need two forms of cobalamin – methyl and adenosyl as they aren’t able to convert methyl to adenosyl form of cobalamin.

B-12 is also available in the form of injections but this method requires a trained medical professional, so only few people are willing to pursue this route. Sublingual methylcobalamin, therefore, seems to be the best and most convenient way of dealing with the problem of B12 deficiency.

NORMS & HEALTHY BLOOD LEVELS OF B12

Some experts who studied the subject for decades suggest that “normal” B12 blood levels is set way too low and should be raised from 150 ng/l to over 350 ng/l. This reasonable advice is based on the fact that symptoms of B12 deficiency often start to appear even when blood levels are way over 150 ng/l or slightly below 300 ng/l!

We also need to take into consideration the fact that pseudo vitamin B12 from spirulina, tempeh, nori, etc. give positive B12 blood test results in spite of active B12 deficiency.

High blood levels of folate (folic acid) can make the complete blood count (CBC) test appear normal even though a B12 deficiency exists.

B12 serum testing can also show falsely elevated results for patients with underlying liver disease, alcoholism, lymphoma or harmful intestinal bacteria overgrowth.

RELIABILITY OF BLOOD TESTS

Unfortunately, regular medical tests of B12 levels in the blood can be often inaccurate not only because of wrong norms, which are way too low, but also due to many different possible factors such as high blood levels of folic acid, presence of pseudo forms of B12 (analogues) in the blood (from dietary sources such as spirulina, nori, sea vegetables, etc.) as they can give a falsely high reading of B12 in the blood.

Additionally, increased homocysteine levels, neurological damage and other symptoms can start taking place long before people are diagnosed with anaemia or even if they are told to have normal B12 levels.

The most reliable, therefore, suggested way to find out B12 deficiency is testing the blood homocysteine and MMA (methylmalonic acid) levels as both substances increase when B12 is deficient.

NRV/RDA

The recommended daily intake for Vitamin B12 for adults is 2.4µg. Knowing that the recommended daily intake for this vitamin is so small (only 2.4µg), many people wonder why the suggested supplemental amount of this vitamin is so high (1000-2000µg per day). It is so because the recommended daily amount of 2.4µg stands for the actually absorbed vitamin B12. However, since only about 1% of this vitamin from supplements is actually absorbed the amount we should take to get enough B12 must be much higher. In addition, only certain percentage of the absorbed amount is usable by the body. And, even if we absorb more than we need, the body will remove the excess with urine without any side effects.

DOSAGE

Depending on your diet, lifestyle and all the mentioned above factors which may influence the absorption of vitamin B12 I would recommend taking about 1000 mcg to 2000 mcg of active vitamin B12 supplement (in the form of sublingual methylcobalamin) every day or every other day only after breakfast (all B vitamins should be taken only in the morning as otherwise they may sometimes interfere with sleeping as they increase energy levels for a longer time during the day).

Though RDA for adults is only 2.4 µg of vitamin B12 per day the suggested above amount (1000-2000mcg) is hundreds of times higher because only about 1 per cent of ingested B12 from supplements is absorbed while all the rest is removed with urine. In addition, only certain percentage of the absorbed amount is usable by the body.

Those who are already deficient in this vitamin and experience anaemia and symptoms associated with deficiency should take even higher dosages of about 5,000mcg of sublingual methylcobalamin per day until recovery from symptoms. After that 1,000 to 2,000 mcg per day should be sufficient to prevent deficiency.

B-12 is stored in the liver, blood and muscles. Every day we lose about 0.2% of our cobalamin stores. It means that if we don’t regularly supply our body with this vitamin we will eventually cause deficiency and its consequences.

SAFE UPPER INTAKE

When high doses of vitamin B12 are given orally, only a small percentage can be absorbed, which may explain extremely low toxicity of this vitamin. Because of the low toxicity of vitamin B12, no tolerable upper intake level has been set by the US Food and Nutrition Board.

In EU countries, the safe upper intake (limit) from supplements is set at 2000mcg per day.

SAFETY & TOXICITY

Vitamin B12 supplements are regarded as incredibly safe, even at very high doses. While doctors usually prescribe 0.5 to 1mg, in some studies doses of up to 40 mg per day (40,000 micrograms) were used with no side effects!

Some individuals who overdose vitamin B12 (over 3000 IU daily) for a long time may experience burning feet symptom which should stop 1-3 days after avoiding the supplementation or at least reducing daily doses to 500mcg – 1000mcg daily.

DAILY SOURCE OF VITAMIN B12, MICHAEL GREGER M.D. >

Though it may be cheaper and easier to just take something once a week, some people would rather get into the habit of doing something daily, so they don’t forget. So, how much vitamin B12 would you have to take if you wanted to do it once a day, rather than once a week?

Well, using the formula we just learned, 1.5 plus 0.1 times the quantity (x minus 1.5) equals 4 to 7; solve for x. I’ll wait. Once a day, 250 micrograms or more is all we need. You can put it next to your toothbrush to remind yourself.

The reason we can’t absorb more than about 1.5 at a time directly through our receptors is that they get filled up. But it only takes them about four to six hours to unload their cargo into the body, and then they’re back in business.

So if we got B12 three times a day—breakfast, lunch, and dinner—we could absorb 1.5 each time and end up with 4.5 at the end of the day, which is all we need. And those kind of doses we can get from fortified foods.

The so-called “daily value” on Nutrition Facts labels for B12 is 6 micrograms. So, as long as each serving contains 25% of our daily value, then we can eat a serving of B12-fortified foods at every meal, and we wouldn’t have to take supplements at all!

So, for example, there’s a vitamin B12-fortified nutritional yeast. Two teaspoons counts as a serving, so you could sprinkle that on your meals. But that would cost a few dollars a week, as opposed to just a few pennies a week for B12 supplements.

Whichever path you choose, these are not just recommendations for people eating plant-based diets. They’re for anyone who wants to get a cholesterol-free source of vitamin B12.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the VIDEO >

CYANIDE IN CYANOCOBALAMIN

The cyanocobalamin form of B12 contains traces of cyanide, which is a poisonous substance. Because of this, some concerns have been raised about its possible toxic effects. However, many fruits and vegetables contain these traces, and it is not considered a significant health risk.

PRECAUTIONS

Taking B12 supplements remember that you need more potassium as potassium and methylcobalamin are antagonists. More methylcobalamin equals less potassium and vice versa. However, if you consume a big bowl of raw vegetable salad every day the problem of potassium should be solved.

Although vitamin B12 is considered very safe, taking only one of any B vitamins for a long period of time can result in an imbalance of other B vitamins. It is, therefore, recommended to take B12 with a good B complex formula or multivitamins and minerals (such as Healthy Mega) that include all B vitamins.

Also if you take 400-800mcg of folic acid on a regular basis you need to take B12 as high doses of folic acid can mask B12 deficiency.

Because of the potential interactions with medications, you should take B12 supplements only under the supervision of a knowledgeable healthcare provider.

For instance, vitamin B12 should not be taken at the same time as antibiotic tetracycline because it interferes with its absorption and effectiveness. All vitamin B complex supplements act in this way and must be taken at different times than tetracycline.

Normally B12 is very beneficial for maintaining eye health but in people with Leber’s disease (a disease of the eye), B12 supplements can cause damage to the optic nerve.

INTERACTIONS WITH OTHER NUTRIENTS

– Vitamin B12 (Cobalamin) is required by folic acid (B12 deficiency leads to folic acid deficiency). Vitamin B12 is responsible for converting folic acid back into its bioactive form after various reactions – in other words, it reactivates it.

Without vitamin B12, the body quickly suffers a functional folic acid deficiency, since the folic acid is left stuck inside our body in its unusable form. There is clearly enough folic acid present, but it cannot be converted!

– Supplementing with B12 increases the need for folic acid and vice versa because both play key roles in the methylation cycle.

– B12 requires B6 for absorption.

– Vitamin E is required for the conversion of inactive B12 to the active form.

– Folic acid masks B12 deficiency (in people who take folic acid supplements and are deficient in B12 it is very difficult to detect B12 deficiency).

– More than 1,000 mcg of supplemental folic acid per day can cause symptoms of B12 deficiency.

– In an aqueous solution, vitamin C might degrade B12 especially when B1 and copper are also present.

– B12 in the form of adenosylcobalamin requires biotin for conversion.

DIGESTION & ABSORPTION OF PROTEIN-BOUND B12

Bacteria (living in water, soil, and the digestive tracts of humans and animals), are the only organisms known to manufacture Vitamin B12.

When humans eat animal foods, the B12 present in these foods is bound to protein. When the protein-B12 complex reaches the stomach, the stomach must have enough hydrochloric acid and enzymes to be able to detach the B12 from that protein.

Then, in a process unique to B12, another protein, R-protein (cobalophilin, haptocorrin, and transcobalamin I), found in saliva and stomach, picks up the B12 and transports it through the stomach and into the small intestine.

The stomach cells also produce a protein called intrinsic factor (IF), which travels to the small intestine where it liberates B12 from R-protein complex and carries the cobalamins to the last section of the small intestine, the ileum. The intrinsic factor, apart from transporting B12, also protects it against bacterial and digestive enzyme degradation.

The cells lining the ileum contain receptors for the cobalamin-IF complex where the cobalamin (B12) is finally absorbed into the blood which transports it to various body cells.

DIGESTION & ABSORPTION OF B12 FROM SUPPLEMENTS (UNBOUND B12)

In supplements, B12 (cobalamin) is not bound to protein and therefore does not need digestive enzymes or stomach acid to be detached from a protein.

When taken in large enough doses, unbound cobalamin can overcome intrinsic factor defects and deficiency and part of it is absorbed through passive diffusion.

SUBLINGUAL ABSORPTION

There is evidence that unbound B12, especially when combined with an absorption enhancer, can be directly absorbed through the membranes under the tongue at higher rates than through passive diffusion in the digestive tract. The best example of this kind of sublingual form of Vitamin M12 is Methylcobalamin.

TRANSPORT OF B12 IN THE BLOOD & CELLS

After B12 is absorbed into the intestinal cells, it attaches itself to transcobalamin II, made in the intestinal cells. Transcobalamin II then transports B12 to all body tissues through the blood and cerebrospinal fluid.

Once the B12-Transcobalamin II complexes arrive at the cell, B12 is released from in the form of hydroxocobalamin. It is then converted into methylcobalamin or adenosylcobalamin and used for their respective enzymes.

Transcobalamin II also transports B12 to the liver for storage on transcobalamin III.

CHEWABLE B12 SUPPLEMENTS

Crane et al. (1994) noted that tablets of one vitamin company dissolved slowly in water and acid. They conducted a study to see if vegan patients who hadn’t previously responded to swallowing B12 tablets whole could improve their B12 levels by chewing the tablets. Of 16 participants, 7 chewed tablets of 100 µg once a week for 6 weeks; their average serum B12 levels increased from 86 to 216 pmol/l. Of the 9 who didn’t chew, their serum B12 increased from 91 to only 103 pmol/l. However, a 100 µg dose once a week isn’t much; the more surprising result of this experiment was the large increase in the serum B12 of the 7 people who chewed. Of the 9 who originally didn’t chew, 7 of them then chewed 500 µg/day for 10 days and their levels rose to normal with a final average of 388 ± 174 pmol/l. Three participants couldn’t raise their levels orally and required B12 injections to maintain serum B12 above 222 pmol/l. A 2003 study compared 500 µg per day via the sublingual (under the tongue) and oral routes. Sublingual fared no better than oral B12 at raising B12 levels or improving B12 activity (as measured by homocysteine and methylmalonic acid levels). Both routes effectively increased B12 levels (Sharabi, 2003).

RELATED ARTICLES

Another B12 fascinating story >

INTERESTING VIDEOS ON B12

USEFUL LINKS

SOURCES & REFERENCES

Vitamin B12 Absorption >

Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 2000.

Ashkenazi S, Weitz R, Varsano I, Mimouni M. Vitamin B12 deficiency due to a strictly vegetarian diet in adolescence. Clinical Pediatrics 1987;26(Dec):662-663.

Brants HA, Lowik MR, Westenbrink S, Hulshof KF, Kistemaker C. Adequacy of a vegetarian diet at old age (Dutch Nutrition Surveillance System). J Am Coll Nutr 1990 Aug;9(4):292-302. Dwyer JT, Dietz WH Jr, Andrews EM, Suskind RM. Nutritional status of vegetarian children. Am J Clin Nutr 1982 Feb;35(2):204-16.

Kozyraki R, Cases O. Vitamin B12 absorption: mammalian physiology and acquired and inherited disorders. Biochimie. 2013; 95(5):1002-1007.

Gambon RC, Lentze MJ, Rossi E. Megaloblastic anaemia in one of monozygous twins breast-fed by their vegetarian mother. Eur J Pediatr 1986 Dec; 145(6):570-1.

Drogari E, Liakopoulou-Tsitsipi T, Xypolyta-Zachariadi A, Papadellis F, Kattamis C. Transient methylmalonic aciduria in four breast fed neonates of strict vegetarian mothers in Greece. Journal of inherited metabolic disease. 1996 19S: A84. Abstract.

Lindenbaum J, Rosenberg IH, Wilson PW, Stabler SP, Allen RH. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr. 1994 Jul; 60(1):2-11.

Okuda K, Yashima K, Kitazaki T, Takara I. Intestinal absorption and concurrent chemical changes of methylcobalamin. J Lab Clin Med. 1973 Apr; 81(4): 557-67.

Tucker KL, Rich S, Rosenberg I, Jacques P, Dallal G, Wilson PW, Selhub J. Plasma vitamin B-12 concentrations relate to intake source in the Framingham Offspring study. Am J Clin Nutr 2000 Feb;71(2):514-22.

What Every Vegan Should Know about Vitamin B12, http://www.veganoutreach.org/health/b12letter.html

Norberg B. Turn of tide for oral vitamin B12 treatment. J Intern Med 1999 Sep;246(3):237-8. Lederle FA. Oral cobalamin for pernicious anemia. Medicine’s best kept secret? JAMA 1991 Jan 2;265(1):94-5.

Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J. Effective treatment of cobalamin deficiency with oral cobalamin. Blood 1998 Aug 15;92(4):1191-8. Delpre G, Stark P, Niv Y. Sublingual therapy for cobalamin deficiency as an alternative to oral and parenteral cobalamin supplementation. Lancet 1999 Aug 28;354(9180):740-1.

Dong A, Scott SC. Serum vitamin B12 and blood cell values in vegetarians. Ann Nutr Metab 1982;26(4):209-16. 30.

van den Berg H, Dagnelie PC, van Staveren WA. Vitamin B12 and Seaweed. Lancet Jan 30, 1988.

Areekul S, Churdchu K, Pungpapong V.

Serum folate, vitamin B12 and vitamin B12 binding protein in vegetarians. J Med Assoc Thai 1988 May;71(5):253-7.

Specker BL, Miller D, Norman EJ, Greene H, Hayes KC. Increased urinary methylmalonic acid excretion in breast-fed infants of vegetarian mothers and identification of an acceptable dietary source of vitamin B-12. Am J Clin Nutr 1988 Jan;47(1):89-92.

van den Berg H, Dagnelie PC, van Staveren WA. Vitamin B12 and Seaweed. Lancet Jan 30, 1988.

Schneider Z, Stroinski A. Comprehensive B12. New York: Walter de Gruyter, 1987.

Pratt R, Johnson E. Deficiency of vitamin B12 in Chlorella. J Pharm Sci. 1968 Jun;57(6):1040-1.

Herbert V, Drivas G. Spirulina and Vitamin B12. JAMA 1982;248(23):3096-7.,

Watanabe F, Katsura H, Takenaka S, Fujita T, Abe K, Tamura Y, Nakatsuka T, Nakano Y. Pseudovitamin B(12) is the predominant cobamide of an algal health food, spirulina tablets. J Agric Food Chem. 1999 Nov;47(11):4736-41.

https://www.sciencedaily.com/releases/2016/11/161107111017.htmhttp://www.umm.edu/health/medical/altmed/supplement/vitamin-b12-cobalaminhttp://www.naturalnews.com/032766_cyanocobalamin_vitamin_B-12.html

Allen RH, Stabler SP. Identification and quantitation of cobalamin and cobalamin analogues in human feces. Am J Clin Nutr. 2008 May;87(5):1324-35.

Refsum H, Yajnik CS, Gadkari M, Schneede J, Vollset SE, Orning L, Guttormsen AB, Joglekar A, Sayyad MG, Ulvik A, Ueland PM. Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am J Clin Nutr. 2001 Aug;74(2):233-41.

Sarode R, Garewal G, Marwaha N, Marwaha RK, Varma S, Ghosh K, Mohanty D, Das KC. Pancytopenia in nutritional megaloblastic anaemia. A study from north-west India. Trop Geogr Med. 1989 Oct;41(4):331-6.

Antony AC. Prevalence of cobalamin (vitamin B-12) and folate deficiency in India–audi alteram partem. Am J Clin Nutr. 2001 Aug;74(2):157-9.

Halsted JA, Carroll J, Dehghani A, Loghmani M, Prasad A. Serum vitamin B12 concentration in dietary deficiency. Am J Clin Nutr. 1960 May-Jun;8:374-6.

Wokes F, Badenoch J, Sinclair HM. Human dietary deficiency of vitamin B12. Am J Clin Nutr. 1955 Sep-Oct;3(5):375-82.

Herbert V. Vitamin B-12: plant sources, requirements, and assay. Am J Clin Nutr 1988;48:852-8.

The more detailed Catherine Iceton experience (mentioned above) >

In a BBC One documentary, ‘Inside Out’, which can be seen on You Tube, Catherine Iceton, of Horden, Britain, had been diagnosed with multiple sclerosis. “I could not see or walk properly,” says the mother of two. “My life had come to a standstill.” Seven years went past.

In August, 2006, she came under the care of the Pala-born Dr. Joseph Chandy Kayalackakom, the general physician in the National Health Service (NHS) at Horden. “As soon as I saw her I knew she had a Vitamin B 12 deficiency,” he says.

A blood test revealed that Catherine had a B 12 level of 175 nanogram per litre (ng/l). This was far lower than the normal 500 to 1000 ng/l. Immediately Dr. Chandy put her on 1000 mg injections every day. Within a matter of weeks, there was an unbelievable impact. Catherine was able to walk, and her eyesight was restored. “The nightmare was over,” she says.

The Vitamin B 12 deficiency is little known. And Dr. Chandy stumbled over it by accident. At the Medical College in Alleppey, in 1966, he came across patients who suffered from multiple sclerosis and other neurological disorders. On a sudden inspiration, he checked their Vitamin B 12 levels and discovered that it was very low. He began giving injections and the patients improved quickly. Interestingly, all the patients were vegetarians, but that did not surprise Dr. Chandy.

The B 12 vitamin can only be obtained from red and white meat, milk, eggs, and fish,” says Dr. Chandy, while on a brief visit to Kochi. “So, there is a strong likelihood that vegetarians could have this deficiency.”

Apart from the drawbacks of a vegetarian diet, many people lack an enzyme in the stomach which helps to absorb the B 12. “It is for this reason that among meat-eating Caucasians, 20 to 40 per cent of the population suffers from a B 12 deficiency,” says Dr. Chandy. The absence of this enzyme can be a genetic trait. “That means that if a mother lacks it, there is a strong possibility that her children will also be B 12 deficient,” he says.

So what are the symptoms of this deficiency? “Tiredness, extreme fatigue, depression, and low moods,” says Dr. Chandy. Other signs include dizziness, hair loss, numbness in the hands and feet, mouth ulcers, palpitations of the heart, diarrhoea and burred vision. “It affects every gland and system,” he says.

Incidentally, 80 per cent of Dr. Chandy’s patients are women. “They have more glands than men,” he says. “They have breasts, ovaries, and the uterus. Women have menstrual periods and menopause, and they go through childbirth. All these adjustments causes disturbance to the metabolism. So they are more vulnerable.”

Meanwhile, not everybody was convinced about this diagnosis of Dr. Chandy. In the NHS the rule is that Vitamin B 12 treatment can be prescribed only if the deficiency is 150 ng/l, but the doctor was treating patients even with a count of 300 ng/l. So, he was barred from administering the B 12 by the Primary Care Trust (which is a part of the NHS). Immediately, some patients, who were suffering from multiple sclerosis, went back to their wheelchairs, because of the lack of the vitamin.

“I would have been sacked a long time ago, but I had kept meticulous records of my patients over the years,” he says. Now, the Primary Care Trust has allowed Dr. Chandy to continue, having realised that there is nothing wrong in the treatment. The doctor says that it is a lack of awareness in the medical fraternity that has caused so much of problems for him. “But my best witnesses are my patients,” he says. “Talk to them and they will vouch for the effectiveness of my treatment.”

In Kochi, Thomas George (name changed) had suffered from a debilitating nerve condition. Thomas had an accidental meeting with Dr. Chandy on a previous visit a few months ago. A blood test revealed a figure of 175 ng/l for B 12. The doctor immediately recommended injections.

“I was sceptical,” says Thomas. But he did a lot of research on the Internet and was finally convinced. After two months of injections, the tremors have stopped. “My health has improved remarkably,” says Thomas.

Now, after 30 years, Dr. Chandy is finally receiving recognition for his work. In September, the India International Friendship Society conferred their ‘Glory of India’ award to Dr. Chandy for his outstanding contribution to Britain.

On November 19, Prime Minister David Cameron invited Dr. Chandy, along with several other prominent Asians, to celebrate Diwali at 10 Downing Street. Dr. Chandy took the opportunity to tell Cameron about the miracle vitamin.

VITAMIN B12 FORMS

SOURCE OF THIS ARTICLE >

There are four forms of vitamin B12 you can take. Which one is the best for you?

First, some background. Vitamin B12 (cobalamin) is the largest and most complex vitamin out there. It is unique, because it is the only vitamin that contains a metal ion, cobalt (hence its name). B12 is a co-factor for two enzymes in mammals (and you are a mammal). One is methionine synthase, the other methylmalonyl-CoA mutase.

The molecule that is attached to the cobalamin is called a donor. The two most common donors in supplements are cyanide (making the type of B12 known as cyanocobalamin, or cyano B12) and methyl (making methylcobalamin, or methyl B12). Two other forms you may find are hydroxocobalamin and adenosylcobalamin.

All these forms of vitamin B12 are present to some degree in the foods you eat, with the predominant ones being adenosyl B12 and hydroxo B12. Another B12 form found in foods is sulphitocobalamin. We won’t cover it here because it’s irrelevant, and you will never find any supplement made from that form. It does not exist.

Only adenosylcobalamin and methylcobalamin are active within our body. You’ll find methyl B12 in the blood plasma, cytosol cells, and certain fluids (like cerebral spinal fluid), and adenosyl B12 in cellular tissues where it is stored in the mitochondria.

In fact, the benefits of B12 boil down to two biochemical reactions:The conversion of methylmalonyl-coenzyme A to succinylcholine coenzyme A (by methylmalonyl-CoA mutase, with adenosyl B12 as a co-factor), and the remethylation of homocysteine to methionine (with methyl B12 a co-factor in methionine synthase).

Methylcobalamin vs Cyanocobalamin vs Hydroxocobalamin vs Adenosylcobalamin

CYANOCOBALAMIN

(Also CN-Cbl, or Cyano B12)

Cyano B12 is a cheap, synthetic, slightly-toxic, inactive form of B12 that is made with a cyanide donor and is used commercially. It is the most stable form, because the cyanide molecule has the greatest attraction to the cobalamin, so it protects it from conditions like very high temperatures. Cyano B12, however, doesn’t absorb well and requires a methyl group to detoxify it before it can ever convert to a useful form.

When cyano B12 does absorb, it converts to hydroxo B12 (hopefully discarding of the cyanide in the process). Then, it converts to methyl B12 and adenosyl B12. Taken orally, cyano B12 absorption is drastically reduced if you have any gastric acid issues.

We can’t recommend this form to nobody.

Sure, it’s cheap, but it comes with a price. Again, our body must use a methylation reaction to cleave the cyanide out of this form. Only then it can be converted to an active form that you can use and absorb. This is a demanding process:

Although the amount of cyanide is considered toxicologically insignificant, humans must remove and detoxify the cyanide molecule, reduce the cobalamin to its usable +1 oxidation state, and then enzymatically convert the cobalamin into one of two metabolically active coenzyme forms. Nutritional inadequacies, enzyme defects, and pathological changes to tissues can all contribute to a reduced ability of the body to accomplish the synthesis of the active forms of vitamin B12 from CN-Cbl.

THE COENZYME FORMS OF VITAMIN B12

Methylation is one way through which your body detoxifies. But it requires methyl molecules, which are often in low supply (modern life is full of toxins), especially in folks with a B12 deficiency. This is why people with methylation issues (like autistic children) can get worse on CN-Cbl but not on other forms of B12.

Then why does cyano B12 even exist?

Commercial cyano B12 exists because, when making hydroxo B12 from bacteria, some of the cobalamin binds to cyanide during the charcoal filtration process.

Check out this paper from 1992:

If the indiscriminate dumping of industrial cyanide waste continues unchecked with the inherent risk of pollution of food and water supplies there may well come a time when more widespread chronic cyanide neurotoxicity occurs in the Western hemisphere from a dietary source in persons with a genetic or acquired error of cyanide or vitamin B12 metabolism.

We all get cyanide into our systems – pollution, barbecue, bonfire, second hand smoke, even almonds. The body always has to detoxify it. By taking cyano B12, you’re further depriving your body of methyl groups, a natural antidote, an antagonist for toxins.

Because of that detoxification, cyano B12 could potentially deplete glutathione (GSH), an important anti-oxidant that helps decrease lipid peroxidation associated with oxidative stress. Once glutathione stores are empty, high dose cyanocobalamin might theoretically cause cyanide toxicity, especially in renal failure patients.

Also, some people may have conditions which inhibit them from converting this form of B12 into the active forms that you can absorb. In these cases, serum B12 levels will shoot up (the blood test counts inactive B12 too), but there will be a deficiency of adenosyl B12 and methyl B12 in the cells, tissues and body fluids.

It takes more than 48 hours for cyano B12 to convert to usable methyl B12. Even then, only a small amount is converted. And remember, when it does convert, it requires the interaction (possibly the depletion) of glutathione and other agents. For that reason, it can make Leber’s optic atrophy worse, and nobody should ever use it in that case.

Why can you even buy cyano B12 then?

Despite all that, cyano B12 is the most prescribed form. Reason? It’s cheap. But it’s also the least safe, least effective, and most demanding type of B12.

Not natural to mammals whatsoever.

Why would you try to improve your health with something that requires the depletion of other crucial substances? It makes no sense, especially when there are other, better forms of vitamin B12 that don’t cost much at all.

METHYLCOBALAMIN

(also Mecobalamin, MeCbl, MetCbl, MetB12, MeB12, or Methyl B12)

Methylcobalamin as an endogenous coenzyme plays as important a role in transmethylation of methionine synthetase in the synthesis of methionine from homocysteine. It is transported to nerve cell organelles, and promotes nucleic acid and protein synthesis. Transportation of methylcobalamin to nerve cell organelles is better than both hydroxocobalamin and cyanocobalamin. It is involved in the synthesis of thymidine from deoxyuridine, promotion of deposited folate utilisation and metabolism of nucleic acid. It promotes nucleic acid and protein synthesis more than adenosylcobalamin does.

Methylcobalamin promotes axonal transport and axonal regeneration. Methylcobalamin normalises axonal skeletal protein transport in nerve cells in animal models of diabetes mellitus. It exhibits neuropathological and electrophysiological protective effect on nerve degeneration in animal models of axonal degeneration (adriamycin, acrylamide, and vincristine-induced neuropathies) with spontaneous diabetes mellitus. It promotes myelination (phospholipid synthesis). Methylcobalamin promotes the synthesis of lecithin, the main constituent of medullary sheath lipids, and increases myelination of neurons in tissue culture, more than adenosylcobalamin does. It restores delayed synaptic transmission and diminished neurotransmitters to normal.

Oxford Biosciences.

Methylcobalamin is one of the two active forms of vitamin B12. It reduces homocysteine and generates SAMe (S-adenosyl methionine), the most crucial methyl donor we have. In other words, it supplies methyl groups for the crucial chemical reactions we discussed.

Where methyl B12 shows its greatest utility is with people suffering from degenerative neurological symptoms, where it is often the only promising treatment. It bypasses several potential issues in the absorption cycle and helps relieve or reverse symptoms. It is the best form to help regenerate nerves and treat peripheral neuropathies.

High doses of methyl B12 have been used to treat amytropic lateral sclerosis and Parkinson’s. It also improves visual and auditory symptoms in multiple sclerosis, and it improves memory and intellectual function in Alzheimer’s patients.

Is methyl B12 really so effective?

In fact, so much that Japan uses it almost exclusively to treat B12 deficiency. Of all vitamin B12 forms, the science on methyl B12 is the most breathtaking:

It may dramatically improve recovery for facial nerve function in Bell’s palsy patients. In high doses, it may promote neuronal function, nerve regeneration, and even protect cortical neurons against neurotoxicity. In diabetic neuropathy, it may improve burning sensations, numbness, loss of sensation, muscle cramps, reflexes, lower motor neuron weakness, and sensitivity to pain. If you combine the methyl B12 with ginkgo biloba, or L-methylfolate and pyridoxal 5′-phosphate, improvements may be even better.

When hemolytic hyperchromic anemia and impairment of hematopoiesis in the bone marrow were induced in rabbits, a decrease in methylcobalamin in the blood serum was observed. Methyl B12 administration completely normalized some hematopoiesis and blood patterns, improved the ratio between the B12 forms, and completely regenerated total B12 content. Adenosyl B12, the other active form, showed a much lower effect.

What else?

In both in-vitro and in-vivo experiments, methylcobalamin inhibited the proliferation of malignant cancerous cells. Paired with adenosyl B12, it reduced tumor growth and enhanced survival time of mice with Ehrlich ascites tumor cells. It also increased survival time of leukemic mice, whereas cyano B12 was inactive under the same conditions. Evidence suggests it may also enhance the efficacy of methotrexate.

And there’s more.

Chronic administration of methyl B12 was shown to protect cultured retinal neurons against N-methyl-D-aspartate-receptor-mediated glutamate neurotoxicity. It may also improve deteriorated accommodation following visual work. Methyl B12 produces improvements in several components of heart rate variability, suggesting a balancing effect on the sympathetic and parasympathetic nervous systems.

As you see, methyl B12’s applications are endless

Under experimental conditions, methyl B12 (adenosyl and hydroxo B12 as well, actually) inhibited HIV-1 infection of normal human blood lymphocytes and monocytes.

In one study, methyl B12 at daily doses of 6,000mcg for four months improved sperm count by 37.5%. In another one, at doses of 1,500mcg a day for 4-24 weeks, it increased sperm concentrations in 38% of cases, total sperm count in 54% of cases, and sperm motility in 50% of cases. This is incredible.

One study reported a case of a 48 year old woman with motor weakness, dementia, sensory disturbances, and widespread coarse hair. Classic B12 deficiency symptoms. In response to methyl B12 shots (500mcg every other day), her weird sensations resolved, dementia was reduced, hand grip strengthened, hair texture normalized, and she was now able to walk on tiptoe. Results like this are not by any means rare.

Also, remember we talked about B12 converting homocysteine to methionine?

This is specfically the job of methylcobalamin, and it’s why high levels of homocysteine can be a sign of low methyl B12 levels. In one study, high homocysteine levels went from 14.7 down to 10.2 nmol/ml following methyl B12 shots. Because of this effect, methyl B12 is useful in children with autism, and in reducing cognitive decline and cardiovascular outcomes in older patients.

On methyl B12 and sleep

The science on methyl B12 and sleep is really promising. We don’t fully understand how, but it seems like this type of B12 could modulate the synthesis of melatonin, a hormone involved in regulating your sleep-wake cycle:

Eight young males were subjected to a single blind cross-over test to see the effects of vitamin B12 (methylcobalamin) on the phase-response of the circadian melatonin rhythm to a single bright light exposure. VB12 (0.5 mg/day) or vehicle was injected intravenously at 12:30 h for 11 days, which was followed by oral administration (2 mg x 3/day) for 7 days. A serial blood sampling was performed under dim light condition (less than 200 lx) and plasma melatonin rhythm was determined before and after a single bright light exposure (2500 lx for 3 h) at 07:00 h. The melatonin rhythm before the light exposure showed a smaller amplitude in the VB12 trial than in the placebo. The light exposure phase-advanced the melatonin rhythm significantly in the VB12 trail, but not in the placebo. These findings indicate that VB12 enhances the light-induced phase-shift in the human circadian rhythm.

VITAMIN B12 ENHANCES THE PHASE-RESPONSE OF CIRCADIAN MELATONIN RHYTHM TO A SINGLE BRIGHT LIGHT EXPOSURE IN HUMANS

It makes sense, because the formation of melatonin requires a methyl group. Another study reported that methyl B12 shots improved alertness and increased rectal temp in later daytime hours. This suggests that B12 indeed affects the circadian clock.

One study tested the effects of methyl and cyano B12 on circadian rhythms, well-being, alertness, and concentration in healthy subjects. Sleep time was significantly lower in the methyl B12 group, who reported better sleep quality, focus and a refreshed feel. The authors concluded that “only methylcobalamin has a positive psychotropic alerting effect with a distribution of the sleep-wake cycle toward sleep reduction.”

Some personal cases

Here’s a case of a 13 year old boy with adrenoleukodystrophy who had developed a sleep-wake disorder after a complete loss of vision. His sleep-wake cycle had been 25 hours, but normalized after taking methyl B12, which caused his plasma melatonin and beta-endorphin levels to more or less match those of healthy volunteers. His peak cortisol time shifted backwards. We also saw a case where methyl B12 successfully treated a 32 year old man suffering from recurrent hypersomnia for 12 years.

Here is another interesting case:

Two adolescent patients suffering from persistent sleep-wake schedule disorders appear to have responded to treatment with vitamin B12 (methylcobalamin). A 15-year-old girl with delayed sleep phase syndrome (DSPS) and a 17-year-old boy with hypernychthemeral syndrome complained of not being able to attend school despite many trials of medication. The improvement of the sleep-wake rhythm disorders appeared immediately after the administration of high doses (3,000 micrograms/day) of methylcobalamin. Neither patient showed any laboratory or clinical evidence of vitamin B12 deficiency or hypothyroidism (which can cause B12 deficiency). Serum concentrations of vitamin B12 during treatment were in the high range of normal or above normal.

TREATMENT OF PERSISTENT SLEEP-WAKE SCHEDULE DISORDERS IN ADOLESCENTS WITH METHYLCOBALAMIN (VITAMIN B12)

So, are you having issues with your sleep-wake schedule?

Then methyl B12 may help modulate your melatonin secretion, enhance your light sensitivity, and normalize your circadian and sleep-wake rhythm.

Any other benefits to methyl B12?

In a randomized study, 67 stroke patients received daily doses of 1500mcg methyl B12, while 68 remained untreated. After two years, sensory nerve in the treated group improved significantly compared to the untreated group.

Speaking of stroke, combining methyl B12 with folate is effective in reducing the risk of hip fractures in elderly patients following stroke. Add clonidine and moxonidine to the mix, and you improve baroreflex function in stroke-prone, hypertensive rats.

Some Chinese studies found methyl B12 helpful in lumbar disc herniation, thalamic pain, glaucoma, cervical spondylosis, and cubital tunnel syndrome. They also found methyl B12 shots with acupuncture to help against intractable facial paralysis.

Methyl B12 vs Cyano B12

Now, how does methylcobalamin compare to cyanocobalamin, the previous form we examined, when it comes to absorption rate and bio-availability?

Because of the effort needed to reduce cyano B12 to an active form, its absorption rate varies greatly between people. In contrast, methyl B12 absorbs and retains in the body much better. It is so potent even orally it may help treating pernicious anemia:

A 73-year-old Japanese man with Hashimoto’s disease and diabetes mellitus received regular medical checkups for type 2 diabetes care. Blood tests indicated macrocytic anemia. The laboratory data demonstrated a normal folic acid level with a low vitamin B12 level. An endoscopic examination indicated no signs of gastric or intestinal bleeding. Positive results for anti-intrinsic factor antibodies were strongly suggestive of pernicious anemia. The patient refused cobalamin injections to treat the anemia. However, the oral administration of mecobalamin for the treatment of diabetic neuropathy was simultaneously initiated. Subsequently, the anemia gradually improved. Oral mecobalamin was presumably effective for pernicious anemia management.

MECOBALAMIN IMPROVED PERNICIOUS ANEMIA IN AN ELDERLY INDIVIDUAL WITH HASHIMOTO’S DISEASE AND DIABETES MELLITUS

Of course, we’re not suggesting you treat PA with oral tablets. Injections should always be the treatment (their absorption is far superior, and with PA you can’t take risks). But it still goes to show you the power of methyl B12 among all vitamin B12 forms.

HYDROXOCOBALAMIN

(Also Hydroxycobalamin, Hydroxo B12, OH-Cbl, or B12a)

Hydroxocobalamin, a predominant form in B12 rich foods, is an inactive type of B12. It has the benefit over cyano B12 in that it doesn’t have a toxic cyanide donor, so you bypass the need for detoxification and get to preserve the glutathione source.

Compared to cyano B12, it has a higher affinity to plasma protein and a longer half life, retaining longer in the blood. This may help reduce injection frequency.

Like cyano B12, hydroxo B12 has to convert in the body to either methyl B12 or adenosyl B12. But it converts much easier. Cyano B12 doesn’t react easily to anything (the cyanide makes it very stable), so the body must expend energy for it to convert.

Actually, when you take methyl B12, a good amount converts to hydroxo B12 as soon as it donates its methyl group. Then, it has to receive another methyl group if your body ever wants to convert and use it as active vitamin B12.

Hydroxo B12 reacts chemically with cyanide, nitric oxide, and nitrous oxide. In fact, this form is common as an antidote for cyanide toxicity. Therefore, anybody can use it safely in tobacco amblyopia and in pernicious anemia with optic neuropathy. It’s also good for patients with cobalamin metabolic diseases. But careful:

Suppressing nitric oxide could have adverse affects like elevated blood pressure, digestive disturbances, impotence, susceptibility to infection, even increased risk of cancer. This is especially true during pregnancy, where NO helps control the feto-lacental circulation. Therefore, you’d be better off with methyl or adenosyl B12.

ADENOSYLCOBALAMIN

(Also AdeCbl, cobamamide, cobinamide, dibencozide, or AdoB12)

Adenosylcobalamin is the mitochondrial form of B12. The enzyme methylmalonyl-CoA mutase uses it to convert methylmalonyl-CoA to succinylcholine CoA (in the synthesis of porphyrin). This is why methylmalonic acid (MMA) levels get high when you’re low on adenosyl B12. It also acts as an intermediate in the pathway for valine, threonine, methionine, thymine, isoleucine, cholesterol and odd-chain fatty acids.

Actuallly, our body stores most of our B12 reserves in the liver as adenosyl B12, and converts it to methyl B12 whenever needed.

But what about supplementing with adenosyl B12?

In one study, carnitine and adenosylcobalamin promoted cerebral mass growth, pyramidal neuron volume, neocortical layer thickness, and fully restored normal structure of the neocortex in a model of anorexia nervosa. In the patients, carnitine and adenosyl B12 accelerated body weight gain and gastrointestinal function normalization. Latent fatigue was gone and mental performance sharply increased.

Speaking of anorexia, another study found that the combined use of carnitine and adenosyl B12 eliminated fluctuations in work rate and normalized the scope and productivity of intellectual work in patients with anorexia nervosa in the stage of cachexia. In this one, latent fatigue wasn’t fully gone though.

An Italian study treated 37 persons suffering from viral hepatitis with either adenosyl B12 or cyano B12. The authors found adenosyl B12 to be significantly better than cyano B12 in normalizing total bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and alkaline phosphatase values.

Overall, 13/18 of subjects receiving the adenosyl B12 had their total bilirubin normalized, 15/18 had their SGOT normalized, 10/18 had their SGPT normalized, and 18/18 (all) had their alkaline phosphatase normalized.

Not bad.

Adenosyl B12 vs methyl B12

So, which one is better for you?

Remember, the two inter-convert in the body.

The main benefit of methyl B12 over adenosyl B12 is that it comes with a very beneficial methyl donor, further enhancing your health in a myriad of ways. Also, adenosyl B12 isn’t available in shots, and some people can’t absorb B12 in any other way. However, if you can absorb B12 through the stomach, adenosyl B12 tablets can be a great option.

If your chronic fatigue seems to get better only with adenosyl B12 (and not with methyl B12), it is possible that you have some rare condition preventing your body from inter-converting them. In this case, use a mixture of both methyl B12 and adenosyl B12.

VERDICT

Some types of B12 are better than others, as you now understand. Here’s a good chart to at least try to visually grasp why that happens:

Credit to George Kelly, “On the synthesis of coenzyme forms of B12”.

So, which is the best type of B12?

Let’s wrap things up.

Cyano B12 is an inactive, slightly toxic form of B12. It contains a cyanide molecule, which your body will have to remove through methylation, a reaction that requires methyl groups. Glutathione seems to be the agent performing the decyanation. Only then can the cobalt atom be reduced from an oxidative state of +3 to the biologically active +1, forming methyl B12 in the cytosol and adenosyl B12 in the mitochondria.

This process is demanding and can be hampered in a range of conditions.

Cyano B12 is especially risky to those with liver problems, renal failure, and smokers, because in these people the cyanide can’t be cleared properly. It’s also dangerous for pernicious anemia patients or anyone with high homocysteine levels, because it may deplete the body of glutathione, a substance needed to lower homocysteine.

As a result, we recommend this form to absolutely no one.

Hydroxo B12 is an inactive form of B12 as well, but it is better than cyano B12. That’s because it doesn’t contain cyanide, therefore bypassing the need for decyanation and preserving the glutathione. Just like cyanocobalamin, it has to be reduced from state +3 to +1 before it can become either methyl B12 or adenosyl B12.

We recommend this form to B12 deficiency patients with tobacco amblyopia, cyanide toxicity, and/or early hereditary optic nerve atrophy (Leber’s disease). Remember to always monitor nitric oxide levels during administration. If you can make use of methyl or adenosyl B12, however, it is always the better route.

AND THE BEST VITAMIN B12 FORMS ARE…

Adenosyl B12 and methyl B12 are the native forms of vitamin B12, bypassing several steps in the absorption cycle. Both of them absorb, retain and increase tissue concentration much better. As a result, they often produce clinical results far superior to what either cyano or hydroxy B12 can offer. Their use offers significant benefits and should be the first line of defense against conditions that may benefit from B12.

But if you had to choose, which is the superior choice?

Remember, these two forms of vitamin B12 inter-convert. If you have a rare condition that prevents that from happening, you’ll have to use a combination of both.

For everyone else, more than 99% of people, methyl B12 is the better choice. It exhibits distinct neuroprotective effects, improving nerve regeneration while bringing synaptic transmutations and diminished neurotransmitters back to normal levels.

Unlike adenosyl B12, methyl B12 donates a valuable methyl group that further enhances your health (unlike cyano, which steals one). This is especially important for pernicious anemia patients or anyone suffering from high homocysteine levels. This donation of methyl groups may be the reason why methyl B12 is helpful in so many conditions.

Methyl B12 simply solves the most problems at once.

CYANOCOBALAMIN VS METHYLCOBALAMIN

Written by Slawomir Gromadzki

Vitamin B12, known as cobalamin, plays a crucial role as a water-soluble Vitamin, participating in processes such as red and white blood cell formation, neurological and brain function, energy production, as well as DNA synthesis.

A deficiency of this essential Vitamin is very common today and leads to serious health problems, including nerve and DNA damage, fatigue, depression, memory impairment, and compromised immunity.

There are two types of anaemia caused by B12 deficiency. The first one is known as megaloblastic. In this form of anaemia, red blood cells are fewer and enlarged. The second type is pernicious anaemia. It is the most common cause of B12 deficiency in the UK. In this anaemia, our own immune system attacks and destroys the cells in the stomach that produce the intrinsic factor which is required for the absorption of Vitamin B12. As a result, the body is unable to absorb cobalamin leading to anaemia.

CYANOCOBALAMIN VS METHYLCOBALAMIN

Typically, Vitamin B12 supplements are sourced from two primary forms: cyanocobalamin and methylcobalamin.

Methylcobalamin is natural whereas Cyanocobalamin is artificially produced synthetic form. However, the human body can convert synthetic cyanocobalamin into bioavailable methylcobalamin.

Both forms carry the same cobalamin (Vitamin B12). What makes them different is the molecule attached to the cobalamin. In methylcobalamin, a methyl group is combined with cobalamin, whereas in cyanocobalamin, a cyanide molecule is attached to cobalamin.

Cyanocobalamin, being synthetic and more cost-effective than methylcobalamin, is more commonly used in supplements. It is also the more stable form because the cyanide molecule has a greater attraction to the cobalamin. For this reason, it protects it better against degradation caused by light, high temperatures, and other environmental factors.

Some studies suggest that cyanocobalamin might be absorbed slightly more efficiently by the body than methylcobalamin. For example, one study observed that the body absorbed approximately 49% of a 1-microgram dose of cyanocobalamin, compared to 44% of the same dose of methylcobalamin (1).

However, a different study found that about three times as much cyanocobalamin was excreted in urine, indicating that methylcobalamin is better retained in the body (2).

Methylcobalamin is less stable and more prone to degradation when exposed to light. Consequently, higher doses of methylcobalamin may be necessary in certain cases. For instance, individuals with kidney failure might require daily doses of one to two thousand micrograms, in contrast to the 50 micrograms of cyanocobalamin recommended for individuals with normal kidney function. Remarkably, in one experiment, even doses as high as 2,000 micrograms a day of methylcobalamin failed to correct B12 deficiency in one out of three vegans tested (14).

One study showed that treating seven individuals with a Vitamin B12 deficiency using oral methylcobalamin resulted in normalized Vitamin B12 levels in their blood within just two months (3). Another study demonstrated that taking cyanocobalamin for three months increased Vitamin B12 levels in ten people with pernicious anemia (4).

A review of seven studies found that both methylcobalamin and a B-complex containing cyanocobalamin were effective in reducing symptoms of diabetic neuropathy, a complication of diabetes that causes nerve damage (5). Furthermore, several animal studies have suggested that each form of Vitamin B12 might have neuroprotective effects and could be beneficial in treating conditions that affect the nervous system (6).

The proponents of methylcobalamin argue that cyanocobalamin requires a methyl group to detoxify itself from cyanide before it is converted to methylcobalamin. Although the amount of cyanide is considered toxicologically insignificant, our body still has to remove the small amount of cyanide using glutathione thus depleting this most important antioxidant.

Methylation is one of the main ways through which our body detoxifies itself. It requires methyl donors, in which we are often deficient due to the high levels of toxins. For this reason, methylcobalamin is very beneficial because it is an important methyl donor. Cyanocobalamin, on the other hand, steals methyl molecules as it needs them for its own detoxification. This is why individuals with methylation issues (like autistic children) can get worse on cyanocobalamin while improving on methylcobalamin (8, 9).

Some experts also claim that when taken orally, cyanocobalamin absorption is significantly reduced in people with insufficient gastric acid production (a common problem today).

According to the information from Nutrition Journal, methylcobalamin can slow the growth of tumors and improve the apoptosis (death) of cancer cells (15, 16, 17). According to the same source, cyanocobalamin was not able to produce this effect. Methylcobalamin has also shown promise in increasing the survival time of mice with leukaemia, whereas cyanocobalamin had no effect under the same conditions (18).

Regular administration of methyl B12 has been found to protect cultured retinal neurons from the damaging effects of glutamate neurotoxicity (19).

Methylcobalamin is the best choice for addressing Vitamin B12 deficiency in chronic smokers and individuals with renal (kidney) or hepatic (liver) conditions (20).

According to one trial, participants who took methylcobalamin demonstrated significantly better cognitive performance than those who took cyanocobalamin supplements (11). It is especially beneficial in individuals with degenerative neurological problems and peripheral neuropathies.

However, not all research has consistently demonstrated the superiority of methylcobalamin over cyanocobalamin (12).

Methylcobalamin plays the most vital role in lowering homocysteine levels (21). Sublingual methylcobalamin has become very popular because it is easily absorbed and because it increases the available amount of S-adenosyl methionine (SAMe), which serves as our primary methyl donor and acts as a mood enhancer (22, 23).

High doses of methylcobalamin have been very beneficial in the management of conditions such as amyotrophic lateral sclerosis and Parkinson’s disease (24, 25). Additionally, it demonstrates substantial benefits in improving visual and auditory issues in multiple sclerosis, and in enhancing memory and cognitive function in Alzheimer’s disease (26).

It has the potential to significantly enhance facial nerve recovery in Bell’s palsy patients when administered in high doses (27). Furthermore, at elevated levels, it may promote neuronal function, facilitate nerve regeneration, and protect cortical neurons from neurotoxicity. In cases of diabetic neuropathy, methylcobalamin was able to alleviate burning sensations and numbness (28).

A case study featured a 48-year-old woman with classic B12 deficiency symptoms, including motor weakness, dementia, sensory disturbances, and coarse hair. Treatment with methyl B12 shots (500mcg every other day) led to the resolution of her unusual sensations, reduced dementia symptoms, improved hand grip strength, normalized hair texture, and restored her ability to walk on tiptoe (29, 30).

Studies have reported significant improvements in sperm count and quality as a result of supplementing with methylcobalamin.

A study comparing the effects of methyl and cyano B12 on sleep quality (circadian rhythms), well-being, alertness, and concentration, found that the methylcobalamin group experienced reduced sleep time, improved sleep quality, enhanced focus, and a refreshed feeling. The authors concluded that only methylcobalamin exhibited a positive psychotropic effect (31).

SUMMARY

Unfortunately, due to the lack of a sufficient amount of research and controversial study results, healthcare professionals find it difficult to choose between cyanocobalamin and methylcobalamin.

There are doctors who continue recommending cyanocobalamin due to its lower cost and available more extensive research. They also point to a 2021 experiment with 42 healthy vegans that seemed to prove the superiority of cyanocobalamin over methylcobalamin (7).

Others argue in favour of methylcobalamin because unlike cyanocobalamin it is an important methyl group doner and due to its higher bioavailability, better retention rate, and many additional health benefits.

Some experts recommend taking both forms at the same time. For instance, 1000 mcg of oral cyanocobalamin every other day and at the same time 1000-2000 mcg of sublingual methylcobalamin every day after breakfast.

Sublingual methylcobalamin (1000-3000mcg daily after breakfast) seems to be a better and safer option for individuals with insufficient gastric acid production, elevated homocysteine levels, cancer, autism, IBD (inflammatory bowel disease), low sperm count, liver problems, renal failure, neuropathies, or those who smoke as their bodies may struggle to effectively clear cyanide.

According to one research article, “Cyanocobalamin, a cyanide-containing form of vitamin B-12, may be inappropriate where the body burden of cyanide is already high, e.g. smokers and those exposed to environmental pollutants” (13).

I personally recommend taking sublingual methylcobalamin (1000-3000 mcg daily after breakfast, depending on age, health status, diet, and lifestyle).

RELATED ARTICLES

Silent Epidemic with Serious Consequences

Megaloblastic Anaemia (Vitamin B12 Deficiency)

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Any information or product suggested on this website is not intended to diagnose, treat, cure or prevent any medical condition. Never disregard medical advice or delay in seeking it because of something you have read on this website. Consult your primary healthcare physician before using any supplements or making any changes to your regime.

VITAMIN B12

USEFUL LINKS

The more detailed Catherine Iceton experience (mentioned above) >

METHYLCOBALAMIN

CYANOCOBALAMIN VS METHYLCOBALAMIN

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