Vitamin B-12 deficiency affects an estimated 1.5 percent to 15 percent of the U.S. population, according to the National Institutes of Health statistics. The causes of vitamin B-12 deficiency vary. And depending on the cause, you should choose different type of B-12 supplement using different delivery routes. Supplemental B-12 is often presented as cyanocobalamin, which is readily converted to the active forms methylcobalamin and 5-deoxyadenosylcobalamin in the body. You can find other forms of vitamin B-12 supplements, including methylcobalamin, and they appear to work equally well, states the Office of Dietary Supplements.
Oral Vitamin B-12 Supplements
One major cause of vitamin B-12 deficiency is the lack of stomach acid or a protein factor secreted by the stomach cells, both of which are required for efficient absorption of B-12 from food. The elderly, people who abuse antacid medications, chronic alcoholics, and people with atrophic gastritis or pernicious anemia often have reduced stomach acid production or deficient synthesis of the protein factor. They are thus at greater risk of B-12 deficiency. This type of B-12 deficiency can benefit from an oral B-12 supplement. The high dose of free vitamin B-12 present in the supplements forces the body to absorb B-12 through a passive mechanism, bypassing the need for stomach acid and the protein factor.
Vitamin B-12 Injections
Gastrointestinal disorders such as celiac disease, Crohn's disease, short bowel syndrome or surgical removal of the small intestine can result in vitamin B-12 deficiency. All these diseases affect the distal part of the small bowel, called the ileum, where a unique protein receptor is present to take in vitamin B-12. People suffering from these disorders will not be able to absorb B-12 from foods, fortified foods or supplements. For these individuals, intramuscular injections of B-12 are the preferred treatment, which effectively raises the blood level of B-12 bypassing the digestive tract.
Intranasal Vitamin B-12
An alternative treatment for people unable to absorb B-12 via the digestive tract is the vitamin B-12 gel formulation that can be applied intranasally. A study published in "Gastroenterology" in 1997 demonstrated that intranasal delivery led to sustained increases in blood level of vitamin B-12 even at one week after treatment. If you don't like injections, the intranasal B-12 may be worth of a try.
Sublingual Vitamin B-12
Sublingual B-12 preparations come in the form of tablets or lozenges. They are put under the tongue, where the vitamin diffuses to the blood stream through the capillaries beneath the tongue. This type of delivery is often touted as superior to other preparations. Yet, according the Office of Dietary Supplements, sublingual B-12 offers no advantages over other oral B-12 supplements.
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