A friend recently asked me to recommend a good vitamin b-12 supplement – a perfectly legitimate question and seemingly an easy question to answer. However, I really didn’t have a great response for her. I still don’t. I was tempted to tell her what type and dosage of b-12 I take and leave it at that. I decided that such a response would be incomplete and lazy.
My first thought was to refer her to the “Frequent Topics of Discussion” icon on this site. This document contains some useful information about b-12 – the best of which is the recommendation to take chewable or sublingual (under the tongue) forms of b-12. :
I concluded that this document, as nice as it is, did not provide enough information to fully guide her in her search for a “good” b-12 supplement.
I shared with her that there isn’t a consensus among WFPB docs and dietitians on the ideal type and dosage of b-12 to take.
I decided to send her some information from WFPB advocates who have written their thoughts on b-12 supplementation.
Those advocates include:
Dr. Campbell does not recommend any particular form of vitamin b-12. He suggests either cyanocobalamin or methylcobalamin. He also states that his recommendation is subject to change as we learn more about our gut microbiome.
Dr. Lederman recommends methylcobalamin, not cyanocobalamin. Cyanocobalamin, when broken down, leaves a minimal amount of cyanide behind.
Dr. Greger recommends at least 2.500 mcg of cyanocobalamin once each week. (Ideally as a chewable, sublingual or liquid supplement) or
- At least 250 mcg daily of supplemental cyanocobalamin (You needn’t worry about taking too much)
- Those over 65 years of age should take at least 1.000 mcg cyanocobalamin every day.
- Tip: If experiencing b-12 deficiency symptoms, Dr. Greger states that the best test is a urine Methyl Malonic Acid test (MMA)
Dr. Greger was asked by a visitor to his site if hydroxycobalamin was the best choice of b-12. The questioner stated that an MIT scientist named Raymond Francis recommended hydroxycobalamin.
Here is Dr. Greger’s response:
“Let me guess: Mr. Francis sells hydroxycobalamin supplements?
It’s like the whole coral calcium scam. Calcium is cheap as chalk – in fact it is chalk! So how are you going to bilk people out of lots of money? You sell some sort of special calcium. Same with b-12 supplements.
B-12 is so cheap to produce that supplement manufacturers try to come up with all sorts of fancy ways to “add value” to products so they can charge $30 a bottle. Unless you’re a smoker, have kidney failure, or base your diet on cassava root, cyanocobalamin should be fine. That’s what I take!”
Jack Norris RD recommends either methylcobalamin or cyanocobalamin. However, he recommends only 25 mcg to 100 mcg as a daily range. He cites research that shows that these lower levels are fine for preventing b-12 deficiency.
Dr. John McDougall recommends taking methylcobalamin or hydroxycobalamin. He recommends a daily dose of just 5 mcg, but adds that it is difficult to purchase a b-12 supplement with such a tiny dose.
B-12 is sold in larger doses to correct for people who cannot absorb b-12 adequately. Absorption of b-12 requires binding with a protein called “Intrinsic Factor” (IF). Once bound with IF, b-12 is absorbed in the ileum. Any problems with IF or the ileum will cause problems with b-12 absorption. However, we are able to absorb 1% of b-12 passively or without the help of IF. So anyone who takes 500 mcg of b-12 will absorb 5 mcg, even if IF doesn’t do its job.
The Institute of Medicine (IOM) recommends that adults older than 50 years obtain most of their vitamin b-12 from vitamin supplements or fortified foods (both vegans and omnivores). However, some elderly patients with atrophic gastritis require doses much higher than the RDA to avoid subclinical deficiency.
My thoughts;
B-12 is the only supplement I take.
For the past six years, I’ve been taking 500 mcg of cyanocobalamin on most days. If I forget a day, I don’t fret about it. It is not a chewable, but I I chomp on it and swallow it quickly with some water. Although my daily need is much less than 500 mcg., I’ve decided to play it safe and assume that I have a problem with malabsorption. Most WFPB docs and dietitians don’t seem too concerned about the possibility that doses this high will cause a problem – even for cyanocobalamin.
Although I find the minimal amount of cyanide resulting from the break down of cyanocobalamin a bit disturbing, I’m siding with Dr. Greger on this one. The toxicity of a substance is in the dosage and it appears that the amount of cyanide produced when cyanocobalamin is broken down is so minute that it poses no harm. I am not a smoker, I do not have kidney failure and I don’t base my diet on cassava root, so I think I’ll be ok.
With that being said, my degree of certainty on which b-12 regimen is best for me, or anyone else, is not very high. Therefore, I encourage people to examine the current research and recommendations for b-12 and come to their own conclusions.
I apologize if this blog reads as a long-winded version of “Look it up yourself!”, but that’s the best advice I have at this time.
If you’re interested in my overall philosophy on supplementation, click here.
2020 UPDATE
Jeff Nelson from VegSource Stops B-12 Supplementation
Jeff Nelson from VegSource recently released this video. He addresses a number of studies on B-12 and lung cancer. I currently take 1000 mcg of Methylcobalamin around twice per week. I may reduce my intake to 1000 mcg once per week or maybe even once every two weeks. At some point, I probably should have my B-12 checked. Nelson had his checked last year and his B-12 levels were above the guidelines. He hasn’t taken a B-12 supplement in a year. He will periodically get his B-12 checked and respond accordingly. There is no easy answer when it comes to B-12.
E Excerpt from Laurie Endicott Thomas’s amazing book Thin Diabetes – Fat Diabetes by clicking here!
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