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Why lozenges?

When taking vitamin B12 as a sublingual tablet it can be directly absorbed into the bloodstream through the oral mucosa; hereby the problem of not being able to convert and absorb vitamin B12 in the gastrointestinal tract is being bypassed.

Important to know: The most common cause of a vitamin B12 deficiency is an insufficient absorption in the gastrointestinal tract. The body is unable to convert and absorb vitamin B12 properly. When supplement vitamin B12 with capsules or multivitamin pills, the body, as with dietary vitamin B12, will still be unable to absorb vitamin B12. Therefore, supplementing vitamin B12 this way is not effective. It may elevate the vitamin B12 blood levels, as these tests always measure both active and non-active forms vitamin B12. It is possible a part of vitamin B12 is taken up in the bloodstream through passive diffusion.

N.B.: Many vegetarians and vegans supplement their diet with spirulina (algae), tempeh (fermented soy) or nori (seaweed), in the belief that these plant foods contain vitamin B12. However, these products only contain a non-active analogue of B12. The human body is unable to activate this form of vitamin B12. 1 2 3

1 Blz. 146 “Is het Misschien B12-tekort?” - Sally M. Pacholok en Jeffrey M. Stuart. ISBN 978-90-202-0490-2
2 Psuedovitamin B(12) is the predominant cobamide of an algal health food, spirulina tablets. Journal of Agricultural and Food Chemistry 1999, 47(11): 4736-4741. Watanabe, F., Kasura, H., Takenaka, S., Fujita, T., Abe, K., Tamura, Y., Nakatsuka, T. en Nakano Y.,
3 Vegetarian Society UK fact sheet, 'Vitamin b12', https://www.vegsoc.org/sslpage.aspx?pid=807

Overview of different options to supplement vitamin B12

Pro's
Injections Methylcobalamin & Adenosylcobalamin (Dibencozide) lozenges Cyanocobalamin & Hydroxocobalamin in lozenges

The injection lasts for a few days

When prescribed by a physician, this will be reimbursed by your health insurance

Recommended when suffering serious neurological symptoms

Both are active forms of B12, meaning that they are directly functional and the body does not have to convert them.

Lozenges are easy to take

Cheap

Easy to take
Con's

In the UK injections containing hydroxocobalamin are given. This is a biologically non-active form of vitamin B12. The body has to convert this into methylcobalamin and adenosylcobalamin B12 in order for the injection it to be effective.

Injections

Unless you can inject yourself, your general practitioner has to approve the treatment.

Injections are most effective in the gluteus or the upper leg

The treatment regimens of injections are often not optimal*

More expensive than other forms of vitamin B12

Cyanocobalamin & Hydroxocobalamin both have to b converted by the body in order to be functional. 95% of all vitamin B12 deficiencies exist because the body is unable to do this

Only 2% of th B12 in these tablets are actually absorbed

*Vitamin B12 often has to be supplemented lifelong, unless the cause of the deficiency is known and treatable. In many cases the injection treatment will stop after a certain amount of time. It is strongly advised to continue treatment (at least once a month). Treatment with injections alone is often insufficient to resolve all symptoms. You can combine injections with taking active B12 supplements.

Can Vitamin B12 lozenges replace injections?

The NHG (the Dutch College of General Practitioners) states: “In patients presenting with symptoms and a vitamin B12 level below 200 ng/l, treatment with 1000microgram a day should be initiated. This can be taken orally, even if pernicious anaemia is present, because with this high dose the absence of intrinsic factor is sufficiently countered by passive diffusion”.."

Therefore, vitamin B12 deficiency can be treated with injections and/or tablets.

Please note: If you suffer from a severe disorder, contact your general practitioner or a health care professional.

Where do I get methylcobalamin and adenosylcobalamin injections?

Unfortunately, methylcobalamin and adenosylcobalamin injections are not together obtainable in the UK. However, they are available in Germany, Japan and for instance Italy.

To get methylcobalamin en adenosylcobalamin (Dibencozide) ampoules from Germany, contact:

Arnika Versandapotheke, Keltenring 8 
82041 Oberhaching (München)
Phone: 0049 - 08961380958
Fax: 0049 - 08961380959
e-mail: therapie@arnika-apo.de
www.arnika-apo.de

The ampoules contain 1000 mcg Methylcobalamin and cost £2,40 a piece and shipping cost are £13,00.

NB: In practice, many people are still given vitamin B12 injections with hydroxo- or cyanocobalamin. Both forms still have to be converted by the body into methyl- and adenosylcobalamin before it can be properly absorbed into the bloodstream. This conversion (methylation) may not be optimal. That possible problem is bypassed with the two active forms: methylcobalamin and adenosylcobalamin (or: dibencozide).

How soon can I expect results after I start taking these two vitamin B12 lozenges?

It is difficult to say: this depends on one’s physical (and mental) condition. If there is a true vitamin B12-deficiency, you should be starting to notice a lot of positive changes after 6 to 12 weeks.

Can I combine injections with lozenges?

A lot of people combine injections with lozenges. Treatment of vitamin B12 with injections is most effective, but, due to the interval between injections, relapses often occur. Combining injections with lozenges may prevent this. Discuss this with your treating physician.

Can I combine vitamin B12 supplementation with other vitamins?

It is safe to combine vitamin B12 with multivitamins. There are no negative complications known of combining vitamin B12 with other vitamins.

What is Emdex

Emdex is filler that is used to bind the vitamin B12 powder in a lozenge. It is an organic water-soluble plant-based starch product, without any further (synthetic) additives and has especially good and safe binding properties. (It is a relatively expensive filler.) Because it’s proven safe and harmless, it is typically used as filler in children’s medication. Another positive fact about Emdex is that it’s not tested on animals.

Which dosage of vitamin B12 should I take??

Our recommended dosage of vitamin B12 may be too little or too much for you. In that case, adjust your dosage at your discretion. If you do not experience sufficient positive effects after 6 to 8 weeks, please contact us. It is important to know that a high intake of vitamin B12 has no harmful side effects and is not addictive. Any vitamin B12 consumed in excess will be excreted in the urine.

Vitamin B12 Dosage for children

Children use less vitamin B12. For children below six years old, 1 lozenge of 1000 mcg methylcobalamin a day combined with 1x 1000 mcg adenosylcobalamin with folic acid is often enough. For the smallest ones: we advise to give them one kind of vitamin B12 and switch between both kinds every other day.

Age Recommended dosage
< 3 years Every other day
  • One day 1x Methyl 1000
    (1000mcg Methylcobalamin with 100mcg Folic acid)
  • The other day, 1x Adenosyl 1000
    (1000mcg Adenosylcobalamin with 100mcg Folic acid)
Between 3 and 9 years Once a day:
  • 1x Methyl 1000
    (1000mcg Methylcobalamin with 100mcg Folic acid)
    combined with
  • 1x Adenosyl 1000
    (1000mcg Adenosylcobalamin with 100mcg Folic acid)
Ages 9 and up The Standard Package once a day:
  • 1x Methyl 3000
    (3000mcg Methylcobalamin with 400mcg Folic acid)
    combined with
  • 1x Adenosyl 3000
    (3000mcg Adenosylcobalamin with 200mcg Folic acid)

During the first 6 to 8 weeks of taking vitamin B12 supplements, it is important to drink an adequate amount of water daily. The body will start to detoxify and by drinking water, your body can appropriately get rid of the toxics.

It is recommended for

  • Children below 12 to drink half a litre of water a day (2-3 glasses)
  • Children over 12 to drink 1 litre of water a day (4-5 glasses)
  • Adults to drink 1.5 litres of water a day (6-8 glasses)

Standard Package dosage advice (4 months)

Once a day:

1 SanaCore Methyl 3000 lozenge (3000 mcg methylcobalamin B12 with 400 mcg folic acid), combined with
1 SanaCore Adenosyl 3000 lozenge (3000 mcg adenosylcobalamin (dibencozide) with 200 mcg folic acid)

Let the lozenges melt in your mouth (underneath your tongue). Preferably take before breakfast or before lunch. For optimal absorption of vitamin B12, it is best not to eat or drink for 15 minutes after intake.

During the first 6 to 8 weeks of taking vitamin B12 supplements, it is important to daily drink an adequate amount of water. The body will start to detoxify and by drinking water, your body can appropriately get rid of the toxics.

Power Package dosage advice

Mornings
1 SanaCore Methyl 10,000 lozenge (methylcobalamin B12 10,000 mcg) combined with
1 SanaCore Adenosyl 10,000 lozenge (adenosylcobalamin B12 10,000 mcg)
1 SanaCore Folic acid 800 lozenge (folic acid 800 mcg)
Let the lozenges melt underneath your tongue. Preferably take before or after breakfast or lunch. For optimal absorption of vitamin B12, do not eat or drink for 15 minutes after intake.

This Power B12 dosage contains 10,000 mcg B12 Methylcobalamin, 10,000 mcg B12 Adenosylcobalamin (Dibencozide) and 800 mcg Folic acid per day in total. We advise you to continue with this dosage for a minimum of 2 to a maximum of 6 months.

After this period, it is recommended to switch to the Standard Package.
Or you could choose to temporarily stop vitamin B12 supplementation and see whether your symptoms are permanently gone. If your symptoms do not return after a period of 3 months, you will most likely not require any more vitamin B12 supplementation.

Should you, after ceasing vitamin B12 supplementation, experience a return of impaired physical and/or mental health, we advise you to contact your treating physician.
If there is no other cause for your symptoms, we advise you to restart the Standard dosage of vitamin B12.
Do this at your own discretion and, of course, preferably in consultation with your treating physician or health therapist.

Gradual build-up to Power Package:
Note: If you have noticed in the past that you are sensitive to medication of any kind, it is advisable to start your vitamin B12 dosage with a gradual build-up according to the schedule below:
Week 1:
Once a day
melt half a SanaCore Methyl 10,000 lozenge (Methylcobalamin B12 10,000 mcg) in your mouth.
Week 2:
Once a day
melt half a SanaCore Methyl 10,000 lozenge (Methylcobalamin B12 10,000 mcg)
and half a SanaCore Adenosyl 10,000 lozenge (Adenosylcobalamin 10,000 mcg) in your mouth.
Week 3:
Use above mentioned dosage advice:
Once a day
Melt 1 SanaCore Methyl 10,000 lozenge (Methylcobalamin B12 10,000 mcg) combined with
1 SanaCore Adenosyl 10,000 lozenge (Adenosylcobalamin (dibencozide) 10,000mcg) and
1 SanaCore Folic acid 800 lozenge (Folic acid 800mcg) in your mouth (underneath your tongue) before or after eating.

During the first 6 to 8 weeks of taking vitamin B12 supplements, it is important to drink 6 to 8 glasses of water a day. The body will start to detoxify and by drinking 6 to 8 glasses of water a day, your body can appropriately get rid of the toxics.

The recipe created by B12-doctor Hans Reijnen prescribes 3 tablets of folic acid a day. The Power Package contains a sufficient number of folic acid lozenges to follow this recipe. If you wish to follow the recipe, we strongly advise you to do so after consulting your health therapist/ specialist. Overview of therapists: list of therapist

Why do I have to drink additional water? ?

A vitamin B12 deficiency causes an accumulation of homocysteine and methylmalonic acid. When taking vitamin B12, these substances will have to be disposed. Drinking 6-8 glasses of water a day allows for this to happen properly. If this does not happen, there is a chance of suffering (or continuing to suffer) from, for instance, headaches and acne.

I feel more tired, restless and irritable during the first week of taking vitamin B12. Is this normal?

Vitamin B12 methylcobalamin and adenosylcobalamin restart certain processes in the body. This releases certain waste products. These need to be disposed properly; otherwise you could suffer from an exacerbation of existing physical or psychological complaints. This is why we strongly recommend drinking 6-8 glasses of water a day in order to properly dispose the toxic substances.

This does not mean that sometimes it can get to be a bit ‘overwhelming’ for someone, both physically and mentally. It is okay to halve your vitamin B12 dosage for a while. After all, this is not a race. If that does not help enough, halve your dosage again (break or cut lozenges in half).

If the situation improves over time, you can slowly increase the dosage again, at your own discretion. Most likely, the symptoms you described are part of the starting phase. After this phase you will really start to notice the benefits of vitamin B12.

For how long should I supplement vitamin B12?

In most cases, vitamin B12 will have to be supplemented lifelong. Unless there is a clear cause of the vitamin B12 deficiency and this can be resolved. As long as the absorption problem of B12 has not been resolved, you will have to help your body and take care of the daily intake of vitamin B12 for yourself. The Standard Package is designed for this daily intake with the right amount of active B12 and folic acid.

What happens if I stop taking vitamin B12 supplements?

That is not a problem on itself. It is not addictive or anything like that – so there will be no withdrawal symptoms should you choose to stop supplementing vitamin B12. However, we do recommend you make sure you do not start to suffer from all of the vitamin B12 deficiency symptoms again that you had just (partially) lost.

I think I have a vitamin B12 deficiency. What should I do?

See: vitaminb12-packages.php

Causes of vitamin B12 deficiency

There are at least forty different possible causes. The most important ones are listed below:
  • Decreased stomach acid (it physiologically decreases after the age of 50, but also decreases when using gastric acid inhibitors)
  • Atrophic gastritis
  • Malnutrition/improper diet/vegetarianism/veganism/macrobiotic diet
  • Eating disorders
  • Gastric bypass (to lose weight)
  • Alcoholism
  • Celiac disease (gluten intolerance)
  • Crohn’s disease
  • Inborn errors of the B12 metabolism
  • Pancreatic issues
  • Liver issues

Medication which may cause a vitamin B12 deficiency

The following medications impair vitamin B12 absorption in various ways:

Medication Reason to use it
Proton pump inhibitors: Prevacid, Prilosec, Protonix, Nexium, Aciphex, Omeprazole Heartburn/gastritis
Gastroesophageal reflux disease (acid reflux)
Ulcers
Upper gastrointestinal bleeding
H. pylori infection
H2-blockers: Zantac, Tagamet, Axid, Pepcid Heartburn/gastritis
Gastroesophageal reflux disease (acid reflux)
Ulcers
Upper gastrointestinal bleeding
Antacids: Alternagel, Maalox, MOM, Mylanta, Riopan, Tums Heartburn/gastritis
Acid indigestion
Peptic ulcer disease
Gastroesophageal reflux disease
Hiatal hernia
Biguanides: Metformin, Glucophage, Riomet, Fortamet, Glumetza, Obimet, Dianben, Diabex, Diaformin, Glucovance diabetes
K-Lor, K-Lyte, Klotrix, K-Dur, Micro-K, Slow-K, potassium chloride Potassium deficiency- often prescribed for patients with congestive heart failure, kidney failure or cirrhosis of the liver, and for patients who receive diuretics (“water pills”) such as Lasix, Bumex or hydrochlorothiazide (HCTZ)
Colchicines gout
Questran Elevated cholesterol levels
Neomycin infections
Para-aminosalicylic acid tuberculosis
Reference: Could it be B12? – Sally M. Pacholok & Jeffrey J. Stuart, blz 53-54

Please note:

Only because these medications may impair vitamin B12 absorption does not mean you should stop taking these drugs. It is, however, advisable to start supplementing vitamin B12.

Medication that is sometimes misprescribed for vitamin B12 deficiency symptoms

If you were prescribed any of the following medications, you could be suffering from vitamin B12 deficiency diagnosed as a different illness. If a vitamin B12 deficiency is not treated, this can create an irreversible or even life-threatening situation.

Medication Generally prescribed for
Celexa, Effexor, Elavil, Nardil, Pamelor, Paxil, Prozac, Serzone, Sinequon, Tofranil, Wellbutrin, Zoloft Depression
Ativan, Klonopin, Librium, Paxil, Serax, Tranxene, Valium, Xanaz Anxiety and panic disorder
Viagra, Xialis, Levitra Erectile dysfunction
Aricept, Cognex, Namenda, Exelon, Reminyl Dementia
Antivert Dizziness, imbalance, and vertigo
Detrol, Ditropan, Levbid Incontinence
Compazine, Geodon, Haldol, Navane, Risperdal, Stelazine, Tegretol, Thorazine Psychosis
Ambien, Dalmane, Halcion, Restoril Insomnia
CCylert, Ritalin Fatigue
Diamox, Inderal, Mysoline, Symmetrel Tremors
Elavil, Neurontin, Tegretol Numbness and tingling
Folic acid (folate), Folvite, apo-folic acid (folate is a dietary supplement that is often given to alcoholics and patients that do not get healthy nutrition, and is also used to diminish stomach cancer risk or treat elevated homocysteine levels) (addition: folic acid and vitamin B12 use each other to function properly within the body, if you take folic acid without extra vitamin B12, you can develop a B12 deficiency) Fatigue
Reference: Could it be B12? – Sally M. Pacholok & Jeffrey J. Stuart, blz 54-55

Please note:

If you take any of these drugs, it is strongly recommended ruling out a vitamin B12 deficiency.

N2O (laughing gas), dental anaesthetics, Narcosis

"The danger to B12-deficient surgery patients involves a very common anaesthetic agent, nitrous oxide (N2O), used millions of times a year to reduce pain and sedate patients during surgical and dental procedures. You probably know this agent better as “laughing gas,” because of its well-known ability to make you feel giggly, an effect that makes it a popular drug of abuse. For people with undiagnosed B12 deficiency, however, there’s nothing funny about N2O’s effects. That’s because nitrous oxide has an unusual property: it inactivates vitamin B12 in the body.”-Quoted from: “Could it be B12?” Sally M. Pacholok and Jeffrey M. Stuart.

Which health complaints are most commonly caused by vitamin B12 deficiency?

In most people, a B12 deficiency causes:
  • Poor immunity (therefore much more susceptible to infections etc.)
  • Low vitality (noticeably pale face),
  • Fatigue (in terrible shape, quick muscle acidification, poor recovery after exertion)
  • A string of peculiar complaints (tingling, dizziness, numbed feeling in the limbs, muscle cramps, joint pains)
  • A feeling of mental imbalance, being less alert (awake), memory deteriorating, and being confused.
  • Classic signs of ageing such as trouble focusing, low energy and a fuzzy head

My vitamin B12 value is within the normal range, should I take B12 supplements?

The NHG states: There is no test available that can definitively confirm or rule out vitamin B12 deficiency as the cause of complaints. The NHG recommends are the Methylmalonic acid test and to a lesser extent the Homocysteine test.
for more certainty, that is why we tell you: judge your symptoms. If your blood levels are normal, but you still recognise a number of symptoms then it is advisable to insist your physician to start a vitamin B12 test treatment.

Blood test results: Folic acid 19, vitamin B12 332 pmol/L. What does this mean?

When the level of folic acid exceeds 13, the value of vitamin B12 becomes invalid. This is because a high level of folic acid can mask a B12 deficiency. Therefore you should always test your folic acid level when having your vitamin B12 blood levels measured.

In the UK, most hospitals use a lower limit of 200 ng/l. The NHG indicates that values up to 338 ng/L are considered as a grey zone and there are various institutions that argue for 400 to 500 ng/L to be considered as a grey zone.

Folic acid, folate (5-MTHF) and vitamin B12

It is important to supplement folic acid or folate in addition to vitamin B12. Folic acid and vitamin B12 use each other to function in the body. If you supplement folic acid without vitamin B12, the vitamin B12 supply in your body decreases. This can cause a vitamin B12 deficiency.

The active form of folic acid is folate (5-MTHF).

All our packages contain folic acid or folate.

Vitamin D3 and Vitamin B12

Many people with a vitamin B12 deficiency notice that they also hugely benefit from taking a vitamin D3 supplement. You can ask your general practitioner to test your vitamin D3 level. These days value of 33 is considered good. The upside is that prescribed vitamin D3 is covered by health insurances.

A good dutch book that has more information about vitamin D: Nieuw licht op vitamine D en chronische ziekten - Gert E. Schuitemaker. (English: New insights of vitamin D and chronic illnesses).

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Experience expert Contact: Lavinia Bijl
question@vitaminb12first.co.uk