Play Hide the Vitamin: Sublingual B12

Boise Weekly | October 20, 2005
My daughter has been a vegetarian for almost 15 years and puts a B12 pill under her tongue every day as a supplement. She now tells me I should also take one to help me with depression and protect me from getting Alzheimer’s. Is she right or is she just crazy?

- Rose

Hiding something under your tongue is a skill mastered in elementary school. Instinctively, kids know the best place for concealing chewing gum from the accusing eyes of a teacher, and a similar talent with a thermometer is fundamental to the pitiful sickly look essential to fooling the school nurse – that plus a quick dip into her coffee cup. Using the same skill, holding a vitamin B12 tab sublingually allows it to dissolve slowly while you reminisce about tormenting substitute teachers.

Vitamin B12, present only in animal products, is an essential nutrient in the creation of red blood cells. It is also used to make the insulating sheath around nerves, similar to the plastic covering on a lamp cord. If your supply of B12 becomes depleted, one common consequence is pernicious anemia. Early symptoms of weakness and fatigue are similar to the more common iron deficiency anemia, however taking iron supplements will have no effect. Neurological changes can happen later when your nerve insulation fails, but unlike a lamp cord, you’re more likely to feel the sparks than to see them.

Normally, the vitamin is absorbed by the small intestine, after being broken free from food by the acid in your stomach. This process requires that you make a protein called intrinsic factor, which attaches itself to B12 and carries it across your intestine into your blood stream – sort of an abdominal escort service. A sublingual B12 tablet under your tongue gets absorbed directly into your system without requiring a stomach acid bath or an intrinsic factor chaperon.

Surprisingly, up to 40% of adults may be deficient in vitamin B12. It’s no longer just vegans at risk; recent studies indicate that up to a third of those over 50 lack the required stomach acid to absorb the vitamin. For the same reason, people who take acid reducers or ulcer medication may significantly reduce their B12 levels. And, as if you need a reason to avoid sushi at the Boy Scout Jamboree, tapeworms in some fish caught in freshwater lakes can flourish in your gut and pilfer every last drop of the nutrient before it can be absorbed.

More and more studies are demonstrating the absolute necessity of adequate B12. A few months ago, Tufts University released findings that low blood levels of this vitamin were directly associated with bone-weakening osteoporosis. Further, it has been known for years that B12, combined with vitamins B6 and folate, can reduce blood levels of an amino acid called homocysteine. High levels of homocysteine appear to damage the inner lining of arteries and encourage layering of the thick, goopy plaques associated with heart disease. Plaques may also occur in the arteries leading into the brain, inspiring promising new studies on Alzheimer’s disease and related dementias.

Contrary to the anti-psychiatric screed on daytime television by a hyperactive movie star and his couch-jumping passion shtick, all mental illness is not caused by vitamin deficiency (Exhibit A: Tom Cruise himself). Having said that, there is now evidence that replenishing levels of B12 rapidly lifts depression in some patients, and a Finnish study has shown that the nutrient increases the effectiveness of psychiatric drug therapy (perhaps Mr. Cruise could emigrate to Finland).

Sublingual B12 tablets are usually megadoses, up to 200 times the daily requirement, and only a small percentage (still plenty) will be absorbed. Research clearly shows this is an excellent way to return blood levels to normal and, in addition, store a nice future supply in your liver. But, don’t neglect the rest of the B vitamins. If your diet’s not perfect, a good strategy is to start with a high-potency multivitamin along with a bottle of sublingual B12. When the B12 bottle is empty, don’t buy more. The daily multi will maintain your new high level.

Your daughter is steering you right; B12 seems to be cheap harmless insurance for some common degenerative diseases of aging, even if all the research doesn’t pan out. Yes, it is strange as an adult to hold something under your tongue, especially since you can’t really talk for 5 minutes. But, if you synchronize it to her daily lecture on the evils of meat, she’ll think you’re a good listener.

Dr. Ed Rabin is a chiropractor practicing in Boise, Idaho. Send your nits to pick and health related questions to (

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