Low B12 levels can lead to pernicious anemia, which is an anemia with improperly formed red blood cells. Vitamin B12 supplements can correct for low B12 levels in your blood and build your stores to prevent further anemia. Stores in your body can last up to 6 years for people who consume adequate amounts of animal flesh, dairy products and foods fortified with B12. The elderly, vegans, vegetarians, "flexitarian" type diets and persons who have had gastric surgery are at increased risk of developing low B12 levels.
Cyanocobalamin
Most nutritional supplements and B12 fortified foods contain cyanocobalamin form of vitamin B12. This form of B12 requires a conversion to methylcobalamin and 5-deoxyadenosylcobalamin, which are the active forms your body uses for energy production and correctly forming red blood cells per the Office of Dietary Supplements.
Hydroxocobalamin
Hydroxocobalamin is used by injecting B12 directly into your muscle or vein. This form is by prescription only and your doses along with frequency of injections are determined by your doctor. Your doctor may prescribe B12 injections if you are unable to absorb B12 from food or have severely low levels that are compromising your health.
Cofactors of B12
Your body must convert cyanocobalamin into methylcobalamin and 5-deoxyadenosylcobalamin in order for necessary chemical reactions in your body, according to authors Laura Matarese and Michele Gottschlich in "Contemporary Nutrition Support Practice." Methylcobalamin help your body turn homocysteine to methionine, which becomes important in lowering your risk of developing cardiovascular disease. Low levels of B12 leave homocysteine levels to increase because your body doesn't have enough B12 to convert to methylcobalamin to lower your homocysteine levels. 5-deoxyadenosylcobalamin participates as a cofactor or derivative of B12 helps your body to break down amino acids and certain fatty acids.
Brands of B12
Most commercial brands of nutritional supplements for vitamin B12 contain cyanocobalamin. Superior Source contains 1000 mcg of sublingual vitamin B12. Life Extension contains 500 mcg of sublingual B12. Each teaspoon of Now Foods Ultra B12 contains 5,000 mcg of vitamin B12 in the forms of cyanocobalamin, methylcobalamin and dibencozide as a cofactor of B12.
Liquid vs. Sublingual
B12 comes in capsule, liquid and sublingual or taken under the tongue, forms. Sublingual forms of B12 bypass your digestive system and go directly into the blood stream by passing through the skin under your tongue. Liquid and capsule forms of vitamin B12 require you to produce enough stomach acid to enhance absorption once inside your intestines. You can find sublingual tablet and liquid forms of B12. Vitamin B12 is also available through nasal spray to enhance blood levels of B12 and is recommended to people with low production of hydrochloric or stomach acid, which unlocks B12 from food and multivitamins to increase absorption.
According to the Office of Dietary Supplements, your body requires small amounts of B12. Your body does better with smaller doses rather large doses as your absorption is dependent on availability of stomach acid and dose. When intakes exceed 1 to 2 mcg of B12, absorption goes down because amounts greater than 1 to 2 mcg can exceed available intrinsic factor, which is produced from stomach acid.
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