CAUTION: Vitamin B12 Sublinguals — The Citric Acid Additive Can Erode Tooth Enamel

[perchance dreamer]

Squigle Tooth Builder has really helped my sensitive teeth. I buy it from AZ. Here are the ingredients:

http://www.squigle.com/tbingredients.html

 

[JalapenoLuv]

I don't have a problem activating B12 so I use the cheapest form, solid sublingual cyanocobalamine. I take super megadoses and haven't had any problems with enamel erosion.

However, I have had it in general and my dentist has told me to use the prescription high flouride toothpaste to remineralize it. It works very well. Ask your dentist.

 

[colinmb]

My daughter - Anna - is suffering worsening sensitivity as a consequence of having 5 EnzyTher B12s packed behind her upper lip for 2 hours twice daily - 4 hours a day of fructose swilling around the teeth and leading to acid erosion? There are various differing thoughts in this old thread, but I get the impression that this is the rough consensus as to what's going on. Don't know why the makers of this product are so obtuse. Regarding what to do about it... Well, given we're stuck with ET-B12, being the optimum delivery method, one suggestion is to put it under the lower lip instead. But (a) I'm not convinced this would make such a great difference, and (b) I read elsewhere on the board that this is far less effective than behind the upper lip... anyone have any experience of this? [Elsewhere it is said that this substance can not be absorbed at all in the mouth owing to molecule size - I don't know what to make of that.] Another suggestion is washing the mouth with sodium bicarb before taking the B12. And maybe again after they've done dissolving? Doesn't sound to me very likely it would help much, but anyone had any success with this? I guess I'm just hoping to re-open this topic and hear some more recent thoughts and observations.

 

[perchance dreamer]

I do well with NeuroBiologix Neuro Methylation Cream. It's a transdermal.

However, it has ingredients other than just the B12, and the formula is proprietary, so most of the dosages aren't listed.

http://www.neurobiologix.com/Neuro-Immune-Stabilizer-B12-B6-Vitamin-D-Cream-p/46.htm

 

[Hip]

My daughter - Anna - is suffering worsening sensitivity as a consequence of having 5 EnzyTher B12s packed behind her upper lip for 2 hours twice daily - 4 hours a day of fructose swilling around the teeth and leading to acid erosion?

When I had tooth sensitivity from my sublingual B12, I bough some concentrated fluoride mouthwash and gargled and brushed my teeth with this liquid twice a day. Fluoride helps considerably with remineralization of the tooth enamel, and I found that after a couple of week of brushing and gargling with concentrated fluoride mouthwash, my tooth sensitivity had gone.


A very good vitamin B12 product that I have used is Hydroxo-12 from Scientific Botanicals. This hydroxocobalamin liquid only contains one other ingredient, potassium sorbate, and is very potent at 1 mg (= 1,000 mcg) per drop, having 325 such drops in the 15 ml bottle. Costs around $45. This Hydroxo-12 can also be bought at various places; see here. Most other B12 liquid brands are much weaker: they contain 1 mg of B12 per pipette dropperful, but not a highly concentrated 1 mg per drop.

I actually put two or three drops of the Hydroxo-12 liquid into each of my nasal cavities by placing a pipette into my nose with my head titled right back. You can use the Hydroxo-12 liquid intranasally in this way, but don't try putting any B12 liquid containing citric acid into your nasal cavities, as this will likely sting.

The nasal mucous membranes are about 10 to 20 times better at absorbing B12 hydroxocobalamin than the oral mucous membranes (ref: here). So intranasal administration of B12 is far better that sublingual.

You can get adenosylcobalamin, methylcobalamin and hydroxocobalamin liquid drops from Holistic Health International. These are also potent at 1 mg per drop, but they contain citric acid.

 

[PennyIA]

I'm glad this thread has resurfaced. While I can tolerate a small amount of citric acid ... too much or apparently too much time in contact with my gums... and I develop sores inside my mouth. I figure it's an intolerance kind of reaction (have had it my whole life). And it helps explain why I've been getting sores where my sublingual jarrow methylcobalamin is in contact with my gums. I've tried managing it by moving the tablet around about mid-process to try to limit contact. But that doesn't always work as sometimes it's too soft & wants to crumble. I might consider switching to another form.

 

[Hip]

Note that @xks201 has argued (see here) that B12 may not be absorbed at all in the sublingual mucous membranes of the mouth, because the molecular weight of B12 is around 1350 to 1580 daltons (depending on the form of B12), and although the nasal mucous membranes can absorb molecules of up to around 2,000 daltons in molecular weight, sublingual mucous membranes can only absorb molecules of up to 300 daltons. So by this argument, the B12 molecule appears to be too large to be absorbed sublingually.

So intranasal administration of B12 would appear to be better that sublingual.

 

[CFS_for_19_years]

Note that @xks201 has argued (see here) that B12 may not be absorbed at all in the sublingual mucous membranes of the mouth, because the molecular weight of B12 is around 1350 to 1580 daltons (depending on the form of B12), and although the nasal mucous membranes can absorb molecules of up to around 2,000 daltons in molecular weight, sublingual mucous membranes can only absorb molecules of up to 300 daltons. So by this argument, the B12 molecule appears to be too large to be absorbed sublingually.

So intranasal administration of B12 would appear to be better that sublingual.

I remember reading this in a scientific published article and I was going to do some poking around to find it, however, I'm glad you beat me to it, as I'm really out of gas today.

I think the only advantage of going the sublingual route is if someone wants the B12 to trickle from their mouths into their stomach and lower parts for extended periods of time where it will eventually be absorbed. I can't see running the risk of eroding dental enamel for that. You could accomplish the same thing by swallowing small amounts of sublingual B12 at frequent intervals.

Hip, I see that you've already begun to respond in this other thread regarding getting B12 by nasal inhalation:
http://forums.phoenixrising.me/index.php?threads/methylcobalamin-inhalation-therapy.33045/
Interesting stuff if other readers want to take note!

 

[Hip]

I remember reading this in a scientific published article and I was going to do some poking around to find it, however, I'm glad you beat me to it, as I'm really out of gas today.

I would like to see that paper, because the source cited by @xks201 regarding sublingual B12 absorption was this one, which is from a blog, not a scientific published paper. xks201 also cites slide 51 of this powerpoint document about human chorionic gonadotropin (hCG), which I paste below:

Oral hCG

•1999 – Daniel Beluscio writes an artcle regarding hCG in an oral form.
–It is refused publicaton in any PubMed refereed journal, and instead, is published on his website: htp://www.hcgobesity.org/hcg_obesity.pdf

hCG doesn’t get absorbed through sublingual, bucal, oral, or GI routes because it is too big in size.
–hCG is composed of 237 amino acids and has a mass of 36,700 daltons.
–The maximum size for “sublingual absorpton” of a peptde hormone is only 300 daltons. (Intranasal dosing can be up to 2,000 daltons)
–In comparison, Insulin has 51 amino acids and weighs only 5,700 daltons.
–ORAL HCG IS NOT ABSORBED!

•Dr. Beluscio admits, “oral hCG cannot be detected in plasma”
http://hcgdietinfo.com/hcgdietforum...-read-about-dalton-size-ugh-46510/index2.html

Tang L and Meibohm M. “Pharmacokinetcs of peptdes and proteins” in Pharmacokinetcs and Pharmacodynamics of Biotech Drugs: Principles and Case Studies in Drug Development (Bernd Meibohm, Editor). 2007. Wiley-VCH. Weinheim, Germany. ISBN-13: 978-3527314089. pps. 17- 44.

I want to see an authoritative source on this idea that there is a 300 dalton limit on molecules absorbed sublingually before I believe it.

 

[colinmb]

It's so hard to know what to do. I've been closely following Freddd. But can’t go on destroying tooth enamel with ‘sublingual’ ET-B12s. Fredd argues sublingual superior to just about everything else, including injections. I hesitate to dismiss any of Fredd’s findings and yet maybe - as CFS_for_19_years suggests – while it appears to me (and Fredd) that we’re getting effective sublingual absorption, it's illusory as in fact we’re getting effective GI absorption (enhanced by a steady dribble from the mouth over a period of up to 2 hours). Some are even questioning the viability of GI absorption. All I know for sure is that the B12 is getting absorbed somehow, as B12 serum tests are very high – so the only question for me is whether it’s coming through via the sublingual or the GI route. I wish I knew. Tempted to switch to swallowing the B12s in several bits spread over 2 hours and see what happens; only reluctance is that Anna (PWME - my daughter) is in a good rhythm, keeping the various factors in balance as she steadily increases dosages, and I hate to throw the whole thing off course by making what could be a fundamental change (which, if Fredd is right, will involve a substantial reduction in her serum B12). I won’t feel patronised if anyone has any advice!

Separately, re the nasal spray, I suppose again because I’ve been following Fredd who has strong views on methyl vs hydroxo (and the ET methylcobalamin has been working for Anna), I’m reluctant to switch to hydroxocobalamin. (A lesser factor in my consideration would be that I’m in the UK and I’m sitting on 6 months’ supply of ET-B12 as I import it in bulk from Vitacost USA in order to minimise shipping costs. But while I’d quite like to use this stock, I’ll throw it out if necessary in order to continue healing without ruining teeth.)

 

[Hip]

@colinmb
I was looking at the ingredients of Enzymatic Therapy B12, which are listed as: "fructose, mannitol, cellulose, magnesium stearate, and natural flavor."

I am wondering what they mean by "natural flavor", and whether this might actually be citric acid, which is often used as a flavoring. I don't think the other ingredients are going to harm the enamel. Fructose and mannitol are used in foods and sweets, and if they were a major contributor to tooth enamel erosion, people that ate a packet of sweets each day would all soon have this enamel erosion problem. If the Enzymatic Therapy B12 tablets have a bit of a tangy taste, then that indicates an acid content.

What you might consider doing is crushing down the tablets into powder, adding a pinch of bicarbonate of soda to neutralize the acid, and then putting a few drops of water on the powder to turn it into a paste. Then using your forefinger, dab up the paste and transfer it to the mouth. That may prevent any acid content from damaging the tooth enamel.

When I used B12 tablets, I would always crush the tablet into powder, and then rub this B12 powder all over the mucous membranes of my mouth using my forefinger — ie, placing it not just on the sublingual membranes, but also the large areas of mucous membranes inside the cheeks and on the gums. That way, with a larger surface area, you get much better absorption.

 

[colinmb]

Thanks Hip. I don't think the flavouring is citric acid - the tablets aren't at all tangy anyway - just overwhelmingly sweet. The trouble with crushing them before use would be that they would dissolve and be swallowed in no time at all - Anna is able to retain them behind her lips for as long as she does (2 hours) because they are pretty hard and take that long to disintegrate in that position. As I understand it (largely from Fredd, but subject to all the doubts and contradictions which I'm struggling with), it's critical to prolong as much as possible the exposure time, and so rubbing on crushed tablets wouldn't be a great idea. (In any case there's still the unresolved question as to whether these things can be absorbed at all in the mouth.)

 

[Hip]

One thing to consider, @colinmb, is that when holding a B12 tablet behind the lips, the contact surface area will only be around the size of the tablet — let's say 1 cm squared.

Now the oral mucous membranes have a total surface area of around 100 cm2. So when you crush the tablet into powder and spread this powder across all the oral mucous membranes, you are getting 100 times the absorption rate compared to the tablet.

Thus if you were able to hold this B12 powder on your oral mucous membranes for just 1 minute, that may be equivalent to 100 minutes of holding a tablet behind the lips.

That's why I think using all the oral mucous membranes in this way may be a better approach.


I am skeptical of the claim that the oral mucous membranes do not absorb B12. Especially because it has been shown that B12 gets absorbed in ordinary skin. That's the basis of the B12 skin patches you can buy. If the skin can absorb B12, I think we might assume the oral mucous membranes can too.

 

[colinmb]

I rather like that thought, Hip. Though it does lead to other questions! You think the whole of the mucosa has similar capacity for useful B12 absorption? This idea I have that the inside upper lip is more much more effective than elsewhere - true or false? Well supposing it's false, and taking your figure of 100cm2, and for the sake of the illustration, let's say the patient has been retaining the tablets under the lip for 100 minutes... Is 100cm2 for 1 minute as beneficial as 1cm for 100 minutes? Is a large - but brief - kick as good as a modest but prolonged exposure? Maybe these things are unknown - I do like your suggestion and I think I'll put the doubts aside and try it. I'd hesitate less if it only we had a good short-term way of gauging the effects of such changes.

 

[Hip]

@colinmb
Certainly it would nice if we had a method of measuring B12 absorption into the blood. I suppose the nearest thing we have to this is relying on people who can feel a strong and immediate response to B12, in terms of effects on their symptoms. These people would be good at gauging various methods of administration.

In my case, although B12 helped me a little a few years ago, I no longer seem to get any benefits or effects from it (even from B12 injections), so I don't take it anymore, except occasionally, just to ensure I don't develop a B12 deficiency.

Regarding the relative effectiveness of B12 absorption from the various areas of the mouth, that is an interesting question. I notice if I feel the oral membranes with my finger, the sublingual membranes feel smoother than the membranes on the inside of my cheeks, which have more of a "matt" finish, suggesting a slightly different makeup.


By the way, when I spread B12 powder with my forefinger across my oral mucous membranes, I tend to do this in a gentle massaging sort of action for a minute or so, on the assumption that massaging with my finger will help to push the B12 into the skin.

 

[PennyIA]

This is interesting. I do think there's been some pernicious anemia studies around solubles vs other delivery methods... but I wonder how many of them are having issues with stomach proteins vs. MTHFR genes vs. other reasons they need it. So, it's hard to say.

I do know that with mega doses of sub lingual I got the best response (20 mg per day) and it lasted for quite a while... but it was before I identified as MTHFR. And I was still missing *something*... and of course, am hoping methylation treatment ends up being the something. Adding methylfolate got me to another level of improvement, Thyroid treatment brought that up yet another level. But I still have crashes. And when I crash, I reset and have to build my treatment back up.

I wish methylcobalamin as a liquid was more stable - as I understand we'd have to have pretty careful safeguards in place to keep liquid methylcobalamin from converting to hydroxycobalamin before injections.... wouldn't the nasal spray have the same instability?

For me? At this point, I care less about what studies tell me than I do about what my own fairly-minor-self-experimentation does. Since I have an issue with higher doses of citric acid and after about 20 minutes my sub lingual starts to feel like it's burning my lip... I'm betting it's tied to the longer exposure to the citric acid. At work, it'd be difficult for me to crush the tablet and massage it into my cheek with a finger tip.

So, right now, I'm trying this. Stick it under my lip until it starts to burn. Once it burns I chomp on it with my teeth until it's pretty small chunks, and use my tongue to massage it into my cheek. If I still feel the boost, why not? If it seems to make it less effective? I'll revert to trying to relocate it to another place between teeth and gums after the burn until I use up my current supply, then try to find one without citric acid.

FWIW (I'm not worried about tooth erosion... I'm already in dentures thanks to teeth that have never had any mineral density to start with).

 

[Hip]

For anyone who wants a very interesting alternative to sublingual B12, have a look at the following thread that uses a very simple vaporization method so that you can inhale B12 methylcobalamin vapor directly into the lungs, and thus into the bloodstream:

Methylcobalamin Inhalation Therapy

 

[physicsstudent13]

I definitely feel the Jarrow's 5000mcg slmB12 is much more potent I fall asleep after taking it where I had no reaction with puritan's pride that I bought on Amazon.
I'm curious if you can even take the Jarrow's and inject it to get better absorption but I think the inhalation or intra nasal might be better options. My b12 was dangerously low 8 years ago and my endo did nothing and lied to me and then I was put on metformin and had a parasitic worm infection which all lowered my b12 even lower
I also tried 2 bottles of piping rock mb12 and got almost no reaction from it.

 

[dannybex]

With all due respect to Fred, I personally wonder if it's necessary for everyone to have to hold the sublingual in their mouths for so long. The Jarrow has citric acid in it, which as mentioned many times on this thread could cause the erosion.

On the flip side, folate, especially as a mouthwash has been shown in studies to improve gum issues, so perhaps a balancing act is in order. ???

 

[PeterPositive]

With all due respect to Fred, I personally wonder if it's necessary for everyone to have to hold the sublingual in their mouths for so long. The Jarrow has citric acid in it, which as mentioned many times on this thread could cause the erosion.

Personally I don't.
I've tried and did not find major benefits, possibly not even minor ones. I use Enzymatic Therapy M-B12 and more recently Source Naturals 5mg which are more convenient (since I need ~10mg).
Stick under the tongue, they last approx 20-25min, they I brush my teeth.

If you don't want the citric acid (which I am trying to avoid) try the Source Naturals tablets, they work pretty well, no acids.

On the flip side, folate, especially as a mouthwash has been shown in studies to improve gum issues, so perhaps a balancing act is in order. ???

Interesting, I didn't know.
Are there mouthwashes with folate? Actual methylfolate?