… It’s important to choose the right type of B12 for your individual MTHFR profile to balance your methylation needs

B12 Supplements
4  things you need to know absorption and delivering enough B12

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1/
B12 comes in 4 different types each with different properties you should choose the right one to suit your health goals and genetics to read more about this see:
How to Choose the Right Type of B12 for Your Genetics
How to Choose the Right Type of B12 for Your Health Goals
 
2/ It can be surprisingly difficult to get therapeutic effects from B12 supplements because so little is absorbed from the digestive system when you swallow it, so if you want to use B12 as a medicinal remedy rather than just to prevent B12 deficiency you need to know how to bypass the digestive system to deliver enough.
3/ The 3rd thing that might surprise you is it appears being deficient of lithium can impede B12 utilisation and so to get the most out of your B12 supplements you may want to pave the way I started with safe micro dose of lithium from lithium orotate.
4/ The 4th thing you need to know is you may not get the benefits you are looking for from supplementing methyl B12 without also raising your glutathione levels.
 
B12 is not efficiently absorbed from the digestive system, injections and sublingual delivery is vastly superior.
 

What the science says about B12 absorption

Even under the most ideal conditions if you have perfect digestion and abundant intrinsic factor (needed for B12 absorption) the most B12 you can absorb from the digestive system is 56% but there are many commonly occurring things that a person can have that reduce this ideal 56% absorption down to minuscule amounts in the range of 1 to 3%[i].
 
Now if your only concern is consuming the minimum amount to prevent deficiency then even in the worst case scenario of you are one those people that has poor absorption of say 1% and you are vegan so your diet supplies no B12 at all then you would only need to swallow 250 mcg of B12 a day or a 2000 µg supplement once a week to obtain enough to meet the B12 requirements of 97.5% of healthy individuals which is the RDA of 2.4 mcg. However you would not start on this dose because you may be deficient and it would take a long time to correct a pre-existing deficiency on just this dose, I would recommend starting with 2000 mcg a day for the first 4-6 weeks to quickly replenish you levels. 
 
If your goals are to use B12 as a therapeutic or medicinal remedy however then to get enough B12 into the body you have to bypass the digestive tract and deliver B12 into your body by more efficient routes.
 
Routs of Absorption
The most efficient route is by injections directly into the bloodstream, alternative routes are transdermal (absorption through the skin, B12 patches) or through the mucous membrane of the mouth sublingually or under the tongue, and waiting for someone to make B12 suppositories. Skin patches are available for some types of B12 but they’re expensive, injections are expensive, slightly painful and time-consuming visiting the doctor, another disadvantage to injections is you get a massive shot once a week as opposed to a more even daily supplement; this leaves the sublingual delivery system as the best option, certainly the best self-help option.
 
There is a downside to sublingual delivery and that is that you have to hold the liquid or crushed lozenge under your tongue without swallowing for several minutes and this is actually surprisingly difficult because of the intense urge to swallow as your mouth fills up with saliva. To minimise this problem look for the type of B12 you want to take in either a liquid form or a soft quick-melt…
 
When choosing a sublingual format make sure you get a sublingual tablet that very quickly dissolves under the tongue.  Many manufacturers are selling B-12 lozenges that you suck like a boiled sweet effectively swallowing the B-12 in the saliva it generates.  Some of the B-12 will be absorbed under the tongue but most is swallowed and once in the intestines only 1% is absorbed; so these lozenges are basically little better than swallowing a tablet.  A true sublingual is quite different, it dissolves very quickly under the tongue within say 90 seconds and the B-12 is absorbed directly into the bloodstream through the blood vessels under the tongue.  Some poorly designed sublingual pills do not dissolve quickly, and you need to crush the lozenge ideally between two spoons or in folded paper into powder/small crumbs that will dissolve quickly.  You can crush the pill with your teeth and push the pieces under your tongue, but this often does not work well as the bits tend to stick to your teeth and you end up swallowing most of what’s produced. 
For a sublingual to work you need to hold the saliva containing the B-12 under your tongue for 2-3 minutes without swallowing, which is actually harder than you might think.  With practice the technique becomes easy. 
 
A 10 mg injection once a week is a good option if you can organise it but it is expensive, taking B12 under the tongue. Crush the sublingual-tablet then move the pieces underneath your tongue and hold mixture of saliva and B12 under your tongue without swallowing for several minutes. It's actually surprisingly difficult because of the urge to swallow but you quickly developed the technique.

Many experts believe the current RDA for vitamin B12 is too low. Data suggests daily intake between 6 and 10 mcg better ensures acceptable B12 concentrations in people with adequate vitamin B12 status and absorption.8 Those taking various medications, namely metformin; proton-pump inhibitors, such as Prilosec; or H2 receptor antagonists, such as Pepcid, may need more vitamin B12 due to these drugs’ ability to interfere with B12 absorption.
“I recommend the use of supplements with between 500 to 1,000 mcg a day for people with serum levels less than 350 pg/mL,” Tucker says. “The need for such a high amount is that only a small proportion of the B12 from a supplement pill gets absorbed.”
In addition, there’s no Tolerable Upper Intake Level set for this vitamin, so toxicity isn’t a concern. Only those individuals with Leber’s disease, a hereditary eye condition, shouldn’t take supplemental B12.

Delivering therapeutic doses of B12 to the body is not straightforward, because it is often so poorly absorbed from the intestines, furthermore there is debate about what the daily intake and blood levels should be and finally I’m saying even if you are delivering enough to maintain blood levels considered medically normal you might still obtain better health with higher levels from additional high-dose supplements.
 
Let me tell you what I’ve learnt about B12 in 30 years of studying and practising nutritional functional medicine:-
 
Firstly despite the lack of definitive scientific evidence to prove this I’m hundred percent convinced that delivering B12 sublingually that is underneath the tongue is vastly more efficient than swallowing B12 or at least it can be anyone with less than perfect digestion such as low stomach acid for a lack of intrinsic factor on overgrowth of bacteria in the small intestines.
 
I have swallowed thousands of micrograms of B12 in different formats and never felt any therapeutic effects from in comparison however just 1000 µg of B12 held under my time for several minutes will deliver powerful therapeutic effects that become noticeable within 1-2 days. I’m not saying you couldn’t get enough to prevent B12 deficiency from swallowing it I’m talking about producing beneficial therapeutic effects not just preventing deficiency, to understand how nutritional therapy works you must understand the difference between those 2 things.
 
Secondly the type of B12 you take really makes a big difference and moreover those effects are not entirely predictable so you have to do some personal experimentation. For example I’ve taken thousands of micrograms of cyanocobalamin (the synthetic form I don’t recommend) under my tongue and it does nothing noticeable to me; surprisingly adenosyl B12 the type you normally think of for increased cellular energy does not give me increased energy whereas methyl B12 the type of B12 you think of for DNA methylation and neurotransmitter production does give me significantly more energy.
 
Thirdly, and this is really with hardly any scientific validation there seemed to be a relationship between B12 metabolism and lithium, I’ve taken my preferred dose of 2000 µg of methyl B12 when I have been on and off a low dose of lithium derived from lithium orotate supplements and when I take the 2 together the B-12 affect me noticeably differently.
 
I can’t be certain that it’s the lithium improving the effects of the B-12 or the other way around, however there are 2 things that make me suspect it’s the lithium affecting the B-12. Firstly the effect I experience when I take lithium and B12 together is increased physical energy which is a common effect people experience when they raise B12 levels particularly from B12 shots, in fact I know people that have B12 shots to deliberately get a boost in energy when they need or want it, in contrast people don’t say lithium gives them more energy.
 
Secondly if you know the work of Dr Amy Yasko a functional medicine doctor specialising in treating the MTHFR gene mutation she also came to the observation that adequate lithium is required for B12 utilisation, and that when you have the MTHFR gene mutation you should begin with eliminating the possibility that you are lithium deficient by taking a low dose of lithium orotate supplement before you begin supplementing B12 in order to improve the utilisation of B12 or as Dr Yasko believes improve the delivery of B12 into our cells.
 
Decreased DNA methylation has been observed in people with bipolar disorder that respond positively to lithium treatment[ii], and numerous studies have consistently shown under methylation, reduced glutathione and increased oxidative stress in the brains of people with bipolar disorder and elevated DNA oxidation is associated with increased number of manic episodes in bipolar type I[iii]. From what I can glean similar chemical features exist in people with schizophrenia and chronic depression. This understanding actually gives us a useful therapeutic approach, if you have any of these conditions you can try flooding your brain with free radical scavengers acting against both oxidative and nitrosative stress, emphasising glutathione and also supplements to enhance methylation. I’ve used this treatment with great effects on myself and some patients; this isn’t a replacement for treatment focused on rebalancing neurotransmitters but it can enhance stability and well-being.
 
I personally have gained complete control of my bipolar disorder and some of the remedies that I thrive on include daily 2000 µg of methyl B12, 10 mg of lithium from orotate, glutathione enhancing along with several powerful anti-inflammatory and free radical scavenging remedies. I’m also very aware that the significant effects this combination has on my individual brain may not pertain to other people’s brains, I have bipolar disorder, I have it completely under control now however in the past what I lived with most of the time manifested as bipolar type II with prolonged clinical depressions; with this situation you could easily imagine that the combination of methyl B12 and lithium could be useful. In my individual case I benefit from the mood stabilising effects of lithium from lithium orotate and the antidepressant effects of methyl B12 but this combination may not be so useful in your individual case.
 
Before you give up on the idea of supplementing lithium with B12 let me point out to you that lithium supplementation is not only useful for the treatment of bipolar disorder but that it can have therapeutic effects for chronic depression [] perhaps by regenerating and stabilising serotonin pathways [], it can be useful for the treatment of migraines, it is anti-inflammatory and perhaps the most powerful single remedy I know of to stimulate neuroplasticity and regeneration in the brain capable of both protecting and reversing brain shrinkage and cognitive decline []. See Lithium Isn’t Just for Bipolar Disorder
 
So you should think about trying the combination of B12 in a lithium supplement if you have bipolar disorder (type I, type II cyclothymia), chronic recurrent depression, a decline in neurological function or any neurological degeneration disease.
 
Let me also address a concern you may have if you have bipolar type I, above I said that methyl B12 gives me an increase in energy and well-being now if you have bipolar especially bipolar type I you would rightly be concerned that this is something you may want to avoid but in my case methyl B12 has no mania inducing effects whatsoever and I assure you I’m very conscientious about monitoring and controlling such effects. The explanation for this could be relatively straightforward methyl B12 or methylcobalamin enhances methylation metabolism which as I have just mentioned is deficient in the bipolar brain, and methylation is not only used to increase the production of neurotransmitters but it is also used for the break down and control of dopamine after it has been discharged into the synaptic cleft. So at least in some individuals the enhanced methylation from methyl B12 can be antidepressant without provoking mania, there are not many substances that can do that, others include lithium which is known primarily for being mood stabilising but it is also somewhat antidepressant and as just mentioned lithium enhances DNA methylation, NAC cysteine is a powerful free radicals and an glutathione elevator and can be both antidepressant and mood stabilising that you have to get the dosage right, high doses can be antidepressant in a way that provokes mania but in moderate divided doses I have found to be mood stabilising, I believe by increasing the rate of glutamate removal from the synapses (elevated glutamate is a central component of bipolar mania disorder).
 
Many experts believe the current RDA for vitamin B12 is too low. Data suggests daily intake between 6 and 10 mcg better ensures acceptable B12 concentrations in people with adequate vitamin B12 status and absorption.8 Those taking various medications, namely metformin; proton-pump inhibitors, such as Prilosec; or H2 receptor antagonists, such as Pepcid, may need more vitamin B12 due to these drugs’ ability to interfere with B12 absorption.
“I recommend the use of supplements with between 500 to 1,000 mcg a day for people with serum levels less than 350 pg/mL,” Tucker says. “The need for such a high amount is that only a small proportion of the B12 from a supplement pill gets absorbed.”
In addition, there’s no Tolerable Upper Intake Level set for this vitamin, so toxicity isn’t a concern. Only those individuals with Leber’s disease, a hereditary eye condition, shouldn’t take supplemental B12.
 
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It’s completely safe to experiment with B12 supplements
With regard to safety B12 supplementation is incredibly safe I have yet to find one single reported case ever of a person suffering toxicity from B12 supplementation, it’s also cheap and so anyone with low energy, depression, mania, schizophrenia or psychosis can safely experiment with supplementing B12 with or without blood tests.
 
People have been injected with mega high doses of 25,000 mcg a day for weeks without any toxic side-effects[viii] and rats have been injected with astronomically high doses of 30,000 mcg per kilo gram of their body weight daily for 4 weeks resulting in neuroprotective effects and no signs of toxicity. This is equivalent to 150 lbs, 11 stone or 65 kg person being injected with over 2 million mcg a day (yes 2,000,000 mcg!) for 4 weeks without toxic side-effects[ix]. To reproduce this dosage you would have to consume 33 bottles of 60×1000 mcg sublingual lozenges a day for 4 weeks, this shows that B12 is one of those rare exceptional substances which are virtually non-toxic even when we are exposed to unnaturally high doses. So don’t be afraid to experiment with B12.
 
I usually recommend dosages from 1000-3000 mcg for many of my patients and rarely go up to 5000 mcg delivered sublingually which is more efficient than swallowing it but going to be somewhat less efficient than injections.
 
CAUTION the exceptions to the safety rule are:
[ADD]
B12 deficiency is rarely obvious, you could have it right now
without knowing it
If you have a poor diet, or a good diet but you are vegetarian/vegan, or poor digestion, or low stomach acid, if you have intestinal parasites, if you have drunk alcohol heavily, if you’ve taken antacid drugs, metformin and other drugs you may well have sufficiently low levels of B12 that it’s dragging your health down.
 
You may think that you don’t have B12 deficiency because you take a multivitamin but this may not be providing you with sufficient B12 to achieve your optimum health, moreover most multivitamin supplements contain cyanocobalamin a vey poor form of B12. Furthermore even if your diet or multivitamin provides sufficient B12 to prevent clinical B12 deficiency you may still experience worthwhile improvements in your health by taking an additional B12 supplement of the right type of B12 and by a more efficient delivery route into your body, I’ll discuss all these points in these pages.
 
Something that is both confusing and misleading is it is said that you can store enough B12 in your liver to last potentially for 3-5 years without consuming any. Just because you may be able to store enough B12 in your liver for several years before dying from B12 deficiency doesn’t imply that you would be healthy throughout those years B12 deficiency, for the last few years will probably have poor health. The ability of the liver to store such a long reserve of B12 means that B12 deficiency creep up on you very slowly.
 
Something I’ve seen many times in my practice is when people switch to a vegan or vegetarian diet they may have sufficient stores of B12 in the liver to tide them over for a few years and initially experience improvements in the health especially if they have switched from a junk food diet to a healthy vegetarian/vegan containing a lot of vegetables and excluding unhealthy junk. Some years later however B12 reserves run out they become sick and because of the lengthy timelag between changing to a vegetarian/vegan diet which contain very low through to zero levels of B12 and becoming ill they may not make the connection between their ‘new’ diet and their current health problems.
 
Absorbing enough B12 from diet and supplements can be a problem
 
Below I’ll discuss dosages to experiment with.
 
Choosing the right type of B12
B12 comes in 4 different types cyanocobalamin, methyl-B12, hydroxo-B12 and adenosyl-B12 choosing the right type for your individual metabolism based on your genetics or your symptoms and health goals can make a difference.
 
If you’ve had your genetic profile tested you can you can use the information to guide you as to which type of B12 may be the most compatible with your metabolism see How to Choose the Right Type of B12 for Your MTHFR Gene Mutation alternatively you can experiment with the different types of B12 below and see which one best helps you achieve your health goals.
  
Even if you’re blood tests show normal levels of B12 you may still improve your health by supplementing it, because you may have an above average need of B12 for example if you have the MTHFR gene mutation or a mental health problem you may simply benefit from supplemental B12, furthermore standard B12 blood tests do not show how you are using B12 inside your cells, I’ll discuss B12 blood tests elsewhere. 
I specialise in treating and coaching people with mental health problems how to obtain better mental health with natural remedies and self-help techniques. If you would like me to look into your individual case and develop a tailor-made programme of natural remedies, dietary advice and brain training exercises I’m available for private consultations at my London clinic and online for people that live too far away.
I also run regular meditation classes in London and online.
Click on the 
bookings tab to make an appointment.
I’m passionate about treating mental health and I’d be very happy to work with you.
 
[i] How common is vitamin B-12 deficiency? Lindsay H Allen The American Journal of Clinical Nutrition, Volume 89, Issue 2, 1 February 2009, Pages 693S–696S, https://doi.org/10.3945/ajcn.2008.26947A Published: 30 December 2008
[ii] Int J Neuropsychopharmacol. 2014 Apr;17(4):561-9. doi: 10.1017/S1461145713001569. Epub 2013 Dec 17.
Decreased global methylation in patients with bipolar disorder who respond to lithium.
Huzayyin et al PMID: 24345589 DOI: 10.1017/S1461145713001569
[iii] Int J Neuropsychopharmacol. 2013 Aug;16(7):1505-12. doi: 10.1017/S1461145713000047. Epub 2013 Mar 1. Number of manic episodes is associated with elevated DNA oxidation in bipolar I disorder. Soeiro-de-Souza MG et al PMID: 23449001 DOI: 10.1017/S1461145713000047
[iv] How common is vitamin B-12 deficiency? Lindsay H Allen The American Journal of Clinical Nutrition, Volume 89, Issue 2, 1 February 2009, Pages 693S–696S, https://doi.org/10.3945/ajcn.2008.26947A Published: 30 December 2008
[v] How common is vitamin B-12 deficiency? Lindsay H Allen The American Journal of Clinical Nutrition, Volume 89, Issue 2, 1 February 2009, Pages 693S–696S, https://doi.org/10.3945/ajcn.2008.26947A
[vi] J Psychopharmacol. 2005 Jan;19(1):59-65.
Treatment of depression: time to consider folic acid and vitamin B12.
Coppen et al PMID: 15671130 DOI: 10.1177/0269881105048899
[vii] J Psychopharmacol. 2005 Jan;19(1):59-65. Treatment of depression: time to consider folic acid and vitamin B12. Coppen A PMID: 15671130 DOI: 10.1177/0269881105048899
[viii] Izumi Y and Kaji R. [Clinical trials of ultra-high-dose methylcobalamin in ALS]. Brain Nerve. 2007 Oct;59(10):1141-7
[ix] J Neurol Sci. 2015 Jul 15;354(1-2):70-4. doi: 10.1016/j.jns.2015.04.052. Epub 2015 May 8. Neuroprotective effect of ultra-high dose methylcobalamin in wobbler mouse model of amyotrophic lateral sclerosis. Ikeda K et al. PMID: 25982504 DOI: 10.1016/j.jns.2015.04.052
[x] J Am Geriatr Soc. 1988 Dec;36(12):1105-12.
What are the psychiatric manifestations of vitamin B12 deficiency? Hector M1, Burton JR.  [J Am Geriatr Soc. 1989] PMID: 3057051
[xi] Neurology. 2011 Sep 27;77(13):1276-82. doi: 10.1212/WNL.0b013e3182315a33. Vitamin B12, cognition, and brain MRI measures: a cross-sectional examination.
Tangney CC et al Neurology. 2011 Nov PMID: 21947532 PMCID: PMC3179651 DOI: 10.1212/WNL.0b013e3182315a33
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