Vitamin B12 Pills – Careful Which you Choose
What should you be aware of when buying vitamin B12 pills? How do you find the right product for you? Since vitamin B12 tablets can be a bit problematic due to controversial additives, it is advisable to carry out some basic research before buying. This article is designed to help you choose the right vitamin B12 pills.
Pills and Lozenges
Among the vitamin B12 supplements available, vitamin B12 tablets are one of the most frequently chosen and their effectiveness is well-documented.1,2 There are two main types of B12 tablets:
- Vitamin B12 lozenges and chewable tablets (sublingual)
Absorbed partly through the oral mucosa
- Vitamin B12 pills
Absorbed through the small intestine
Lozenges can be helpful if there is an absorption difficulty in the intestine, but they contain the most additives. These will be looked at more closely later on. Firstly, however, it is important to look at the most obvious distinguishing feature of vitamin B12 tablets: the vitamin B12 itself.
Vitamin B12 Pills: The Active Ingredients
Vitamin B12 is in fact not simply vitamin B12 – it exists in many different forms, which are in turn metabolized by the body in different ways. So what are the various active ingredients, and what makes them different?
At present, there are four different active ingredients used in vitamin B12 pills, which are summarized in the table below. All of these are proven to be therapeutically effective and appropriate to help cure a B12 deficiency, yet there are some differences.
|Type||Natural Form||Description||Notes||Who is it suited for?|
|Cyanocobalamin||Artificial form only||Synthetic form which doesn’t, occur naturally in nature or in the body and cannot be readily substituted.||Breaks down into B12 and the poison cyanide once in the body. Smokers should therefore choose a different active ingredient. A different active ingredient will should also be chosen for detoxification. Numerous metabolic steps needed to obtain usable B12.||Cheapest drug, very well researched. For healthy people to meet their daily needs. Not suitable for smokers or for the purpose of detoxification.|
|Methylcobalamin||Foods, body cells, central nervous system||Bioidentical coenzyme, can be directly replaced.||In this form, the B12 circulates in the body, detoxifying the cells which are often used in preparations.||A little more expensive. Recommended for all applications.|
|Adenosylcobalamin||Foods, body cells, liver||Bioidentical coenzyme, form of vitamin B12 stored in the body which can be directly replaced.||Detoxifying form of B12 found in the liver and the mitochondria. Not approved for dietary supplements.||A little more expensive. Recommended for all applications.|
|Hydroxocobalamin||Foods, intermediate form in the metabolism||Natural form of vitamin B12, like that produced by microorganisms or found in foods. Can be maintained very well in the blood – ideal for slow release.||Partly usable as cyanocobalamin, ideal storage effect. Also used for detoxification.||Rarely available in tablet form. Good for body storage and detoxification. Recommended for all applications.|
In our view, the three natural forms – methylcobalamin, adenosylcobalamin and hydroxocobalamin – are the best active ingredients for vitamin B12 compounds. These forms occur naturally in our body and our diet.
Cyanocobalamin is an artificial form which shows numerous practical disadvantages (see the separate article) and is not recommended by most naturopathic doctors.
A combination of hydroxocobalamin and methylcobalamin is considered to be ideal, as it usefully combines the advantages of the direct effectiveness of the methylcobalamin with the sustained release of hydoxocobalamin.
Vitamin B12: Sublingual Lozenges or Regular Pills?
Vitamin B12 deficiency is often as a result of malabsorption in the intestine. Since B12 can however also be absorbed through the oral mucosa, vitamin B12 lozenges can also be suitable to help prevent certain malabsorption disorders. Both methylcobalamin and cyanocobalamin have responded very well to sublingual application in clinical trials and can be used with success.3
However, in most cases, very high doses of over 1000 mcg mean that the advantages of sublingual absorption over normal pills are all but lost, since the majority of vitamin B12 is absorbed through passive diffusion and malabsorption is no longer of any significance. In cases of parasites, sublingual absorption could bring about further advantages, however there has been no full research into this.
Dosage of Vitamin B12 in Tablets
There is a wide range of dosages to choose from when it comes to vitamin B12 – everything from 3 µg right up to 5000 µg. But which dosage is correct for you?
This depends entirely on what the supplement is being taken for. The daily requirement is set at between 2.5 and 3 µg. However, it is worth noting for all products that the body can only absorb around 1.5 µg of vitamin B12 per dose through the intrinsic factor – regardless of how high the dosage is. In addition to this, 1% of the dosage is absorbed through passive diffusion, meaning the actual intake level is made up of a combination of both these factors.4
Specific information regarding the dosage levels of vitamin B12 can be found under the following article entitled vitamin B12 dosages, this article will just provide a simple overview.
|Replenishing the body store||1000 – 2000 µg daily||11 – 21 µg|
|Supplementing daily requirement||3 x 3 – 5 mcg or 1 x 250 – 500 µg||3 – 7 µg|
|Therapy for intake disorders||300 – 1000 mcg µg||3 – 10 µg|
Vitamin B12 which is not used by the body is simply excreted, which is why a B12 overdose is essentially not possible. Therefore, it is best to simply take a higher vitamin B12 dosage in order to ensure optimal effect.5
How and When Should B12 be Taken?
Tests have shown that vitamin B12 is best taken on an empty stomach, because it reacts with certain foods. Different foods cause vitamin B12 to be more poorly absorbed, leading to the intake of a much smaller proportion of the overall dose.
Vitamin B12 Pills – Mainly Additives
Although vitamin B12 pills are certainly one of the handiest dosage forms, they do have marked disadvantages. Tablets are almost impossible to manufacture without additives, so it is important to pay close attention to the composition of the pill – after all, vitamin tablets are taken for health reasons and so it makes no sense to consume a dubious mixture of additives at the same time. In fact, vitamin B12 pills actually contain more additives than anything else, as the dosage of the active ingredient vitamin B12 is only a few micrograms – a fraction of the total tablet.
A particularly high number of additives can be found in vitamin B12 lozenges. This is because it is not just the consistency of the tablets that must be preserved here, but also their taste and the way they dissolve in the mouth. Questionable sweeteners, flavourings and dyes are therefore commonplace in these.
Vitamin B12 Pills – Purity is an Important Feature
The purity of a vitamin B12 product is in our eyes a big indicator of quality.This is not only because additives tend to have a generally adverse effect health-wise, but also because the way that different additives affect the intake of vitamin B12 is often not fully explained. In particular, the somewhat unstable coenzyme forms methylcobalamin and adenosylcobalamin could be affected by chemical additives in certain circumstances. Unfortunately, there have been very few studies on this thus far.
Below is a list of the predominant additives in tablets. All additives have been approved by health authorities as being safe for consumption. Naturopathy takes a slightly different standpoint here, namely that, from our perspective, all artificial sweeteners are suspected to adversely affect glucose metabolism and to have negative effects on the liver. As a result, it is questionable as to whether these substances really belong in vitamin B12 supplements.
Given that vitamin B12 is afforded in extremely small doses, it is impossible for a product without any additives whatsoever to be produced. At the very least, cellulose or rice flour are required as a carrier. Ideally, these would also be the only additions to the product, as most others are suspected to irritate the intestine, decrease the level of absorption or cause other harmful side effects.
Some additives are very controversial. Our marking below is intended to show which additives may be of concern and should thus be avoided for the sake of your health.
|Cellulose (E 460)||Harmless, natural additive, which is excreted without digestion by the body|
|Microcrystalline Cellulose||Like cellulose, can however pass through the intestinal wall. Full consequences not yet known, but no adverse effects have been found so far|
|Croscarmellose sodium||Like cellulose, seen as harmless|
|Glycerin (E 422)||Chemically synthesised or natural. Natural glycerin is considered safe|
|Di calcium phosphate (E 341)||Viewed as harmless, but large quantities can negatively affect the calcium balance|
|Stearic acid (E 570)||Saponification of vegetable or animal oils/fats, GM technology possible|
|Silicon dioxide ( E 551)||Comes from sand, approved for organic products. Often contains nano-particles, the risks of which have not fully been assessed yet|
|Iron(III) oxide (E 172)||Considered safe|
|Xylitol (E 967)||Comes from birch wood, can have a laxative effect, genetic engineering possible|
|Mannitol (E 421)||Can have a laxative effect, genetic engineering possible|
|Sorbitol (E 420)||Can have a laxative effect, genetic engineering possible|
|Stevia||Positive characteristics, but also adverse effects during animal testing|
|Magnesium stearate, magnesium salt der fatty acids (E 470 b)||Magnesium compounds of saturated fatty acids, can be of herbal or animal origin, genetic engineering possible. Proven adverse effect on the release of active ingredients in trials|
|Titanium oxide (E 171)||Considered safe on the whole, but could be carcinogenic in high doses. Harmful side effects during animal testing. There is no estimating the risk of many nano-particles|
|Aspartame (E 951)||Sweetener which is suspected to be extremely harmful. Consumerists strongly advise against it, genetic engineering possible|
Vitamin B12 Pills or Capsules?
Pills have been proven to be very effective in vitamin B12 therapy and numerous studies have shown them to be suitable for balancing out a vitamin B12 deficiency and covering all daily intake requirements.
Nevertheless, it is recommended to use capsules over tablets, since they have the highest purity and hence are probably the most efficient with the lowest strain on the body. Capsules often only contain cellulose as an additive and therefore, along with vitamin B12 sprays which contain little more than glycerin, represents the purest form of vitamin B12 supplement.
1 Andres, E., Dali-Youcef, N., Vogel, T., Serray, K. and Zimmer, J. (2009), Oral cobalamin (vitamin B12) treatment. An update. International Journal of Laboratory Hematology, 31: 1–8. doi: 10.1111/j.1751-553X.2008.01115.x
2 Takasaki Y, Moriuchi Y, Tsushima H, Ikeda E, Koura S, Taguchi J, Fukushima T, Tomonaga M, Ikeda S, Effectiveness of oral vitamin B12 therapy for pernicious anemia and vitamin B12 deficiency anemia The Japanese Journal of Clinical Hematology [2002, 43(3):165-169]
3 Sharabi A, Cohen E, Sulkes J, Garty M. Replacement therapy for vitamin B12 deficiency: comparison between the sublingual and oral route. Br J Clin Pharmacol 2003;56:635–638
4 Berlin H, Berlin R, Brante G . Oral treatment of pernicious anemia with high doses of vitamin B12 without intrinsic factor. Acta Med Scand 1968;184:247-258
5 Eussen SM, de Groot LM, Clarke R, et al. Oral Cyanocobalamin Supplementation in Older People With Vitamin B12 Deficiency: A Dose-Finding Trial. Arch Intern Med. 2005;165(10):1167-1172. doi:10.1001/archinte.165.10.1167.