Vitamin B12 Supplementation
General Principles

When it comes down to what the best vitamin B12 supplement form for you is, things aren’t as simple as just choosing a type based on which one is absorbed the most. The following few things have to be taken into consideration.

  • The cause of the deficiency

Is it due to low intake? gastric or intestinal surgery? fish tapeworm infestation? a chronic disease such as crohn’s or pernicious anemia?. Those who are deficient only because they aren’t taking in enough of this vitamin won’t need the same form as those who can’t absorb properly due to pernicious anaemia or a gastric surgery, for instance.

  • The severity of the deficiency

Those who have a very severe deficiency and have undergone severe nervous system damage should be treated with injections for rapid delivery of B12 to their tissues.

  • The possible efficacy as well as side effects of the form of supplementation chosen.
  • Finally, the cost of the chosen supplement.

Various Forms of Vitamin B12 Supplements

Before I list the various forms of B12 supplements, let’s make one thing clear. People might refer to these forms as the various ‘types’ or ‘kinds’ of supplements. These words are used interchangeably also for the chemical type of B12 found in these supplements too, so it might be a little confusing.

There are three types of the vitamin B12 when it comes to their chemical composition, namely hydroxocobalamin, methylcobalamin and cyanocobalamin. The first one is the best form but it is too expensive and thus, methylcobalamin is currently believed to be practically the best one. If you want to know why, please go through our ‘Cyanocobalamin vs. Methylcobalamin’ comparison.

The method by which these chemically varied forms of B12 can be administered to the human body are what I will refer to as the forms of B12 supplementation. Without wasting any more time, let’s go through them and try to decide which one suits which group of individuals.

Oral Supplements

These include pills which you can swallow, sublingual tablets and oral sprays. Although sublingual tablets have been marketed as a superior form when it comes to absorption, this is not true. Research favors oral sprays instead. Tablets which you can swallow have only two advantage: they’re easily available over the counter and are cheap.

They contain cyanocobalamin (read more about it here) and cannot be absorbed. Methylcobalamin is the preferred chemical form of B12 for most people. In addition, oral pills which can be swallowed are literally of no use to those who have a deficiency due to gastrointestinal problems (gastric surgery, crohn’s disease, etc) since the orally taken B12 won’t be absorbed.

The worst downside is probably the fact that B12 tablets cannot be absorbed completely because the total amount of B12 absorbed in the intestines depends on the amount of intrinsic factor produced. The maximum amount of intrinsic factor production will only help you absorb around 10 mcg even if the ingested dose is 500 mcg. So if you want to take in high doses of B12, forget about ingestable tablets.

To cut the long story short, sprays are the best form out of all the available oral supplemental forms but they’re expensive. Tablets have pretty much the same pros and cons regardless of whether they’re to be swallowed or kept under the tongue.

Injections (Also marketed as shots)

This is one of the two best forms of B12 supplements (want to know the other one? Read on!) because it does not depend on intrinsic factor for absorption and high doses go straight into the blood stream. Moreover, you can get the highly useful methylcobalamin via this route and injections are not expensive.

The disadvantage is that B12 shots are not available over the counter (however, they can be bought online at TrimNutrition, our favorite vendor), can cause pain where injected and might require you to learn how to inject yourself (If you buy them online, they usually come with easy-to-follow instructions).

Read more about vitamin B12 shots.

Nasal Gels

This form is a good alternative for those who don’t want to use injections. However, these gels are slightly expensive and are usually available by prescription only. Their efficacy is comparable to that of injections and nasal sprays (see below).

Nasal Sprays

A rather uncommon form but yes, it does exist. These sprays boast amounts of B12 pretty much comparable to that obtained through B12 shots. In addition, they are available over the counter as well as by prescription and you don’t need to learn how to use them (as opposed to taking B12 shots).

Before you get your hopes up high, just know that this particular form is pretty expensive. It’s an excellent form, yes, but it’s just not worth the money when you have other cheaper and equally effective forms. Sure you can choose this form if you have a little extra money and don’t want to go through the hassle of getting B12 shots.

However, not all of us are that fortunate so let me unveil the second of the two best forms of B12 supplements which isn’t expensive at all.

The B12 Patch

In addition to B12 shots, B12 patches are the best available supplements available these days. It’s a matter of personal preference when it comes to which one is better out of these two. The B12 patch is extremely easy to use (the B12 shots are hard to self-administer), there is no need for multiple doses since you can wear the patch once a week and it usually only needs to be worn for 24 hours. It doesn’t cost much because you only have to wear it once a week and you can easily order it online.

Surely, there must be a downside? Skin reactions (which have been reported by a small minority of people who used this patch) are the only disadvantage. Whether you’re B12 deficient due to a chronic disease, etc or just want to take B12 regularly because you’re a vegan – you can use either the B12 shots or the B12 patch whichever one you like better.

My personal preference would definitely be the B12 patch due to its ease of use and larger ‘dosing intervals’ (meaning I would need to use it less often as compared to B12 shots).

Additional Options for Vegans

All vegans should regularly supplement their diet with vitamin B12. Supplementation with forms of B12 containing cyanocobalamin should be avoided. Therefore, you can use either B12 shots or the B12 patch. If you can’t afford these or simply can’t find them easily, don’t leave out supplementation altogether.

Take the oral B12 supplements (the ones you swallow or the sublingual form – whichever one you prefer) but do not allow yourself to get deficient in B12. You can also include the B12 rich nutritional yeast in your diet, it’s one of the best sources of B12 for vegans overall.

Final Verdict: Winners of the Best B12 Supplement

To sum things up, our favorite supplements are the highly-effective methylcobalamin B12 shots and the easily-applied patches. I highly advise you to take care of your deficiency as soon as possible. It can get pretty nasty later.

Written by Dr. Aqsa Ghazanfar, main author of ‘The B12 Deficiency Survival Handbook’.