About oral supplementation:

FIRST: Don’t use any oral supplements without testing your serum levels.

Important note and disclaimer: we do not sell vitamins, vit B12 injections, ampoules, (sublingual) tablets, nor do external parties, companies and such financially support us.

We want to alert you to the following:

Although some scientists accepts that oral supplementation has been proven as equal as injections in the treatment of B12 deficiency, we think their efficacy on symptoms has not been scientifically established yet.

Almost all research is not, or hardly, linked to symptoms, but only to B12 blood serum values. Testing bloodlevels of B12 is meaningless after supplementation, which is also acknowledged by scientists: “We do not see that testing the B12 serum level after receiving supplementation as useful”. There is literature about the more limited effect of tablets [2].

The efficacy of tablets is also not scientifically validated. We think this is an important problem because more and more people (and children) treated with oral supplements (or sprays or oral active B12) are seeking help in our clinical practice because of their persisting (or worsening) symptoms (See also our response[3] to the NHG protocol[4]).

Research shows, and that is also our clinical experience, that hydroxocobalamin i.m. injections are the most proven superior treatment in B12 deficiency. Hydroxocobalamin i.m. facilitates both pathways (conversion to methylcobalamin and adenosylcobalamin) and it works in a more natural way. Hydroxocobalamin is used in very serious metabolism disorders and is also used as an anti-dote of (cyanide) toxins.

Oral supplements does not treat neurological and psychological symptoms sufficient enough.

Recovery from a B12 deficiency with substantial symptoms unfortunately requires time and patience and also has ups and downs. Patience and faith in your recovery is very important and keep monitoring your symptoms [5].

Don’t forget to rule out other underlying factors causing remaining symptoms such as: thyroid problems, Lyme disease, copper deficiency and high B6 due to use of B-vitamins.

© Clara Plattel | B12 Institute | Founder, director


[1] NHG = Nederlands Huisartsen Genootschap -> Dutch General Practitioners

[2] (Chevalier, 2007; A. Freeman, Wilson, Foulds, & Phillips, 1978; A. G. Freeman, 1999; Hunt, Harrington, & Robinson, 2014; Kaplan, Mamer, & Hoffer, 2001; Regland et al., 2015; Rundles, 1946; L. R. Solomon, 2006; L. R. R. Solomon, 2004) (British Society for Haematology, 2014; Carmel, 2008; Schrier, 2014)

[3] Reactie op standpunt NHG https://b12-institute.nl/reactie-op-het-nieuwe-nhg-standpunt-diagnostiek-van-vitamine-b12-deficientie/

[4] Dutch GP protocol: https://www.nhg.org/standpunten/nhg-standpunt-diagnostiek-van-vitamine-b12-deficientie

[5] (Carmel, 2008)


British Society for Haematology, T. (2014). Guidelines for the diagnosis and treatment of Cobalamin and Folate disorders. The British Committee for Standards in Haematology (BCSH) http://www.bcshguidelines.com/documents/BCSH_Cobalamin_and_Folate_Guidelines_%282%29.docx.pdf.

Carmel, R. (2008). How I treat cobalamin (vitamin B12) deficiency. Blood, 112(6), 2214-2221. Retrieved from http://www.bloodjournal.org/content/112/6/2214.abstract

Chevalier, P. (2007). Vitamine B12 oraal of intramusculair toedienen? Minerva, Tijdschrift voor Evidence-Based Medicine, 6(2), 2.

Freeman, A., Wilson, J., Foulds, W., & Phillips, C. (1978). Why has cyanocobalamin not been withdrawn? Lancet, 1, 777 – 778.

Freeman, A. G. (1999). Oral or parenteral therapy for vitamin B12 deficiency. The Lancet, 353(9150), 410-411. doi:http://dx.doi.org/10.1016/S0140-6736(05)74987-4

Hunt, A., Harrington, D., & Robinson, S. (2014). Vitamin B12 deficiency, Clinical review. 349. doi:10.1136/bmj.g5226

Kaplan, L. N., Mamer, O. A., & Hoffer, L. J. (2001). Parental vitamin B[sub12] reduces hyperhomocysteinemia in end-stage renal disease. Clinical & Investigative Medicine, 24(1), 5. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=afh&AN=4137198&site=ehost-live

Regland, B., Forsmark, S., Halaouate, L., Matousek, M., Peilot, B., Zachrisson, O., & Gottfries, C.-G. (2015). Response to Vitamin B12 and Folic Acid in Myalgic Encephalomyelitis and Fibromyalgia. PLoS ONE, 10(4), e0124648. doi:10.1371/journal.pone.0124648

Rundles, R. W. (1946). PROGNOSIS IN THE NEUROLOGIC MANIFESTATIONS OF PERNICIOUS ANEMIA. Blood, 1(3), 209-219. Retrieved from http://www.bloodjournal.org/content/1/3/209.abstract

Schrier, S. L. (2014, 2014). Up To Date: Diagnosis and treatment of vitamin B12 and folate deficiency.   Retrieved from http://www.uptodate.com

Solomon, L. R. (2006). Oral pharmacologic doses of cobalamin may not be as effective as parenteral cobalamin therapy in reversing hyperhomocystinemia and methylmalonic acidemia in apparently normal subjects. (0141-9854 (Print)).

Solomon, L. R. R. (2004). Oral vitamin B12 therapy: a cautionary note. Blood, 103(7), 2863-2863.