Individuals with pernicious anemia have an impaired ability to absorb vitamin B12 from the small intestine. B12 is necessary for the DNA production of erythropoesis, red blood cell development. Individuals with pernicious anemia lack a chemical called instrinsic factor that passes with orally ingested B12 from the stomach into the small intestine. These individuals benefit from alternative sources of B12, such as sublingual administration, that is, putting a dissolvable B12 tablet under the tongue.
Symptoms of Pernicious Anemia
If you think you may have pernicious anemia, see your physician for laboratory complete blood panel analysis. According to the National Library of Medicine, symptoms include: both diarrhea and constipation, fatigue, loss of appetite, pale skin, problems concentrating, shortness of breath especially during exercise, a swollen or particularly red tongue, bleeding gums, confusion, depression, poor balance, and numbness and/or tingling in hands and feet. Any of these single symptoms may not indicate pernicious anemia, but be mindful of your physical symptoms to tell your doctor when your complete blood count is taken.
Supplements and Foods that Compliment Sublingual B12
Most people absorb adequate B12 through foods: meat, poultry, shellfish, eggs, and dairy. The Office of Dietary Supplements recommends when you begin taking sublingual B12, to make sure you are also getting the recommended daily allowances of folic acid and vitamin C, 400 micrograms and approximately 100mg, respectively. Folic acid, also called folate is highest in fortified breakfast cereals, but is also fairly high in beef liver, black-eyed peas, spinach, and great northern beans. Vitamin C is high in red bell pepper, orange juice, kiwi fruit, oranges, and grapefruit juice.
Dosage of Sublingual B12
The RDA for B12 in the form of cobalamin is approximately 2.5 micgrograms. For individuals with pernicious anemia, 500-1,000 micrograms are given in dissolvable tablet form under the tongue. Sublingual B12 is available without a prescription, however, your doctor may also prescribe sublingual B12 tablets.
Intramuscular B12 Shots
If you remain anemic after several weeks of sublingual B12 therapy, a higher dosage may be recommended, or your doctor may substitute or supplement your sublingual B12 with intramuscular shots of B12. Because B12 is water soluble, it is better absorbed in muscle tissue rather than adipose, or fat.
Pernicious anemia may co-occur with other medical conditions and treatments. Both celiac and Crohn's disease impair oral B12 absorption. Individuals with these conditions will likely take sublingual and/or intramuscular shots for their lifetime. For transient conditions, once the treatment has ended, the pernicious anemia will cease, also. For example, cancer patients undergoing chemotherapy may require sublingual B12 during their chemotherapy, but may return to ingesting B12 orally once in remission.