There appears to be some confusion among practitioners of natural medicine about whether oral, sublingual or intramuscular administration is preferable for patients requiring vitamin B12 therapy. Blood levels of B12 indicate that sublingual B12 becomes available as early as 15 minutes after administration and are still elevated at 24 hours, suggesting that a once-daily dose of 2000-4000mcg would be an effective preventive measure. [Bhat N.K. - Presentation at the 43rd Annual Meeting, American Academy of Allergy and Immunology, 1987]

A year’s supply of 1,000mcg vitamin B12 tablets costs under $20, which is less than the cost of going to the doctor’s office for injections. On the other hand, patients who are likely to be noncompliant with oral therapy should be seen regularly by a doctor and treated with intramuscular injections.

When vitamin B12 is being used for its pharmacological effects, as in the treatment of fatigue, Bell’s palsy, diabetic neuropathy, subdeltoid bursitis, or asthma, intramuscular injections appear to be preferable to oral administration. Although there is little published research in this area, clinical observations suggest that orally administered vitamin B12 is not particularly effective against these conditions. It appears that very high serum concentrations are usually needed for vitamin B12 to exert its pharmacological effects, and that these serum concentrations can be achieved only with IM administration.

Although cyanocobalamin and hydroxycobalamin are the most commonly encountered supplemental forms of vitamin B12, adenosyl- and methylcobalamin are the primary forms of vitamin B12 in the human body, and are the metabolically active forms required for B12-dependent enzyme function. Evidence indicates these coenzyme forms of vitamin B12, in addition to having a theoretical advantage over other forms of B12, actually do have metabolic and therapeutic applications not shared by the other forms of vitamin B12.

It is important to remember that circulating levels of vitamin B12 are not always a reflection of tissue levels, and that even if an adequate supply of cobalamin appears in the circulation, a functional deficiency of the coenzyme forms might coexist in tissues and other body fluids. Although cyanocobalamine will usually increase circulating levels of cobalamin, its ability to increase tissue levels of the active forms of vitamin B12 can be limited in a range of sub-clinical and clinical conditions. Even in a best case scenario, the activation of cyano- to either adenosyl- or methylcobalamine does not occur instantly, possibly occurring over 1-2 months, and requires the interaction of GSH, reducing agents, possibly alpha-tocopherol, and in the case of Methylcobalamine, SAMe and the active form of folic acid.

The use of either hydroxycobalamine and/or methylcobalamine offers a significant biochemical and therapeutic advantage over other existing forms of vitamin B12 (most commonly cyanocobalamine), and should be considered as a first-line choice for correcting vitamin B12 deficiency and treating conditions shown to benefit from cobalamin administration.

Here is a story shared by Dr. David Gregg regarding the use of B12 and DMSO to enhance absorption without the use of injections.

I discovered another approach which I experimented with personally and which eventually led me to discover what I interpreted to be a very common Vitamin B12 deficiency, independent of the age group. This surprised and puzzled me very much.

Back in 1994 when I was focusing on learning as much as I could about vitamin B12, an experiment came to mind which I decided to try on myself. I saw a bottle of DMSO (dimethylsulfoxide) on the shelf of my health food store and remembered that DMSO is not only absorbed directly through the skin, but it also would carry with it any impurities dissolved in it. This can be a serious problem if the impurities are toxic.

However, I also realized that if I dissolved vitamin B12 in it, it might carry it directly to my blood stream through my skin. I tried it and the results were dramatic for me, far greater than any impact I had ever felt from oral or sublingual tablets. I put some of my vitamin B12 tablets obtained at a health food store into a two liquid ounce bottle with an eyedropper and filled it with DMSO. It took a couple of days for the tablets to fall apart. Once they did, I put an eyedropper load on one arm and rubbed it in. In approximately one hour I started to feel very good, which was a sense of general strength and well being. This lasted all day.

When I tried it again the next day, I got no such feeling. I also didn't experience any bad effects either. Since I knew that approximately one month’s requirement of B12 is stored in your liver, I reasoned that my system was simply fully supplied with Vitamin B12 and that I wouldn't need to use it again for a month or so. When I tried it again a month or so later, I got a significant boost from it again. Since then I have continued to use it on a once every month or so basis.

With time I decided to also add folic acid and a multiviamin-multimineral tablet to give the solution a broader base of nutritional support. I use a two ounce bottle with an eyedropper, add 10mg of vitamin B12 (ten 1000 mcg tablets), 9.6 mg of folic acid (twelve 800 mcg tablets) and a single multivitamin-multimineral tablet and fill it with 99.9% DMSO (leaving a bubble at the top so it can be mixed when shaken). All ingredients were obtained from my local health food store.

The tablets are mostly binder and take a few days to fall apart. They don't fully dissolve, but that doesn't seem to matter in terms of potency. I now use this regularly on approximately a once every month or two basis. It serves as a reasonable mood elevator for me, and I believe it contributes significantly to my general health. My interpretation is I seem to become deficient in vitamin B12 even though I take oral supplements regularly.

Over time I have told a number of other people about this and many have chosen to try it. (I strongly recommended that they consult their physician first.) Of those who have chosen to make up solutions and try it, approximately 50% have told me that they noticed a very significant energy boost, and this was not limited to elderly people. It seemed to be independent of age, from age 25 and up.

Some also found a benefit if they used it as frequently as once every two weeks and others were like me, finding the best time span between use to be in the once-a-month or so range. If I interpret this to indicate B12 deficiencies, the 50% number is much higher than I would have expected, and the impact on young people was particularly unexpected. Is this an indication that there is something happening in our environment that is causing a broad base of Vitamin B12 deficiencies? When I read the news article about automobile exhaust and the production of enough nitrous oxide to affect the greenhouse effect, a light turned on. This may the cause. If so, it is a very important issue.

It is my hope that this article will stimulate a thorough investigation into this issue to systematically evaluate if it is true, and result in an organized effort towards a solution.