First, why do we need to supplement B-12?
From Bariatric Times, Micronutrient and Macronutrient Needs in Roux-en-Y Gastric Bypass Patients:
B12. Cobalamin (B12) plays an important role in creating cellular energy and hemoglobin production. The route of absorption for B12 is unique and complex. The Roux-en-Y procedure puts patients at risk for B12 deficiency for several reasons. The use of proton pump inhibitors, common for ulcer prevention in RYGB, inhibits absorption of B12 because of the decrease in HCl acid. Decreased stomach function, decreased intake, and malabsorption due to loss of intrinsic factor (IF) also contribute to the risk of B12 deficiency.
There is also an increase in physiologic demand for B12 during rapid weight loss. A deficiency may not be seen until several months of low intake and/or absorption because, unlike most water-soluble vitamins, B12 is stored and recycled in certain organs in the body.
Symptoms of deficiency are generally neurological in nature, including numbness and tingling of extremities, difficulty walking, memory loss and disorientation.
Because of the possibility of a masked deficiency with folate or a folate deficiency causing a falsely low serum B12, it is recommended that homocysteine and monomethylamine (MMA) be tested as well.3 When both homocysteine and MMA are high, supplementation of both B12 and folate is indicated. If homocysteine is normal, but MMA is high, B12 supplementation is indicated. If homocysteine is elevated and MMA is normal, this is an indication for folate levels to be tested. Recommended treatment for B12 deficiency is 2,000mcg sublingual B12 daily for 2 to 4 weeks or intramuscular injections (IM) 1000mcg daily for 1 to 2 weeks. Though the RDA for B12 is 2mcg and the daily reference value (DRV) is 6mcg, an easily found and inexpensive dose available in drug stores is 500 to 1,000 mcg. This is likely the driving force for the commonly recommended maintenance dose of 500 to 1,000mcg per week via effective absorption route (i.e., sublingual tablet, nasal gel, or B12 patch) or 1,000mcg IM once a month. If labs values have not corrected themselves after 2 to 3 months, a repeat course of therapy may be indicated.
Permanent damage from B12 deficiency can occur if treatment is initiated too late.*
Selective impaired absorption of vitamin B12 due to intrinsic factor deficiency. This may depend on loss of gastric parietal cells in chronic atrophic gastritis (in which case, the resulting megaloblastic anaemia takes the name of "pernicious anaemia"), or on wide surgical resection of stomach (such as in bariatric surgery), or on rare hereditary causes of impaired synthesis of intrinsic factor.
(*Yeah, about that? No comment. I have shown lots of these problems.)
Wait, what You don't think you need to supplement? Read this, Wikipedia:
Early and even fairly pronounced deficiency does not always cause distinct or specific symptoms. Common early symptoms are tiredness or a decreased mental work capacity, decreased concentration and decreased memory, irritability and depression.
Sleep disturbances may occur, because B12 may be involved in the regulation of the sleep wake cycle by the pineal gland (through melatonin).
Neurological signs of B12 deficiency, which can occur without anemia, include sensory disturbances due to damage to peripheral nerves caused by demyelination and irreversible nerve cell death. Symptoms include numbness, tingling of the extremities, disturbed coordination and, if not treated in time, an ataxic gait, a syndrome known as subacute combined degeneration of spinal cord.
Recent studies have devalued a possible connection between B12 deficiency and Alzheimer's dementia, and such a correlation is unlikely as of June 2007.
Low vitamin B12 level in old people may develop into brain atrophy or shrinkage, associated with Alzheimer's disease and impaired cognitive function. Anna Vogiatzoglou, MSc, University of Oxford, in a study published in Neurology journal, said: "Many factors that affect brain health are thought to be out of our control, but this study suggests that simply adjusting our diets to get more vitamin B12 through eating meat, fish, fortified cereals, or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory." Professor David Smith, of the Oxford Project to Investigate Memory and Ageing, said: "This study adds another dimension to our understanding of the effects of B vitamins on the brain - the rate of shrinkage of the brain as we age may be partly influenced by what we eat.This study suggests that consuming more vitamin B12 through eating meat, fish, fortified cereals or milk as part of a balanced diet might help protect the brain. Liver and shellfish are particularly rich sources of B12. Vitamin B12 deficiency is a common problem among elderly people in the UK and has been linked to declining memory and dementia."
Science Daily reported that "a deficiency of B-vitamins may cause vascular cognitive impairment, according to a new study by the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University." Aron Troen, PhD, said that: "The vascular changes occurred in the absence of neurotoxic or degenerative changes. Metabolic impairments induced by a diet deficient in three B-vitamins -folate, B12 and B6- caused cognitive dysfunction and reductions in brain capillary length and density in our mouse model."
Sorry about that. I'm over it.
About Celebrate's particular blend of B12 supplementation.
It's 1,000 mcg of B12 and 200 mcg of Folic acid, in a sorbitol, sucralose and STEVIA! sweetened sublingual (under your tongue, kids) pill. Why so many sweeteners? Because, have you tasted drugstore big box brand B-12 supps? Those are not a pleasant experience, and something you will soon stop doing if you realize how bitter and nasty they are, finding yourself deficient soon enough.
Gastric Bypass / Sleeve Gastrectomy / Duodenal Switch
Daily Dosage = 1 tablet
Delivering 1000 mcg of vitamin B-12 and 200 mcg, this great tasting sublingual tablet will ensure that you are receiving proper levels of this critical vitamin. Each bottle contains 90 sublingual tablets.
While the majority of patients that are taking our multivitamin will not need an additional sublingual, there will be a small percentage of patients that require higher levels. Since vitamin B-12 is water soluble, any excess will simply be excreted by your body.
Good to know, you cannot OD on B12, you just pee it out. Heh. Which is good for me, since I get B12 injected currently in my ARM, and I would rather not, but was too deficient not to have it stuck in me. Maybe later I can revert back to just sublingual supplementation.
The Celebrate pills are very small and go right under your tongue.
They are a super sweet cherry flavor and you have zero excuses not to be able to tolerate this unless you have a serious aversion to sweet cherry flavor? They begin dissolving upon hitting your saliva.
I like that these pills don't leave any grit. The more generic brands left grit under my tongue, never dissolving entirely and I was left with a rock to spit out.
The principle behind sublingual administration is simple. When a chemical comes in contact with the mucous membrane beneath the tongue, or buccal mucosa, it diffuses through it. Because the connective tissue beneath the epithelium contains a profusion of capillaries, the substance then diffuses into them and enters the venous circulation. In contrast, substances absorbed in the intestines are subject to "first pass metabolism" in the liver before entering the general circulation.
Sublingual administration has certain advantages over oral administration. Being more direct, it is often faster, and it ensures that the substance will risk degradation only by salivary enzymes before entering the bloodstream, whereas orally administered drugs must survive passage through the hostile environment of the gastrointestinal tract, which risks degrading them, either by stomach acid or bile, or by the many enzymes therein, such as monoamine oxidase (MAO). Furthermore, after absorption from the gastrointestinal tract, such drugs must pass to the liver, where they may be extensively altered; this is known as the first pass effect of drug metabolism. Due to the digestive activity of the stomach and intestines and the solubility of the GI tract, the oral route is unsuitable for certain substances, such as salvinorin A.
For those of us with a bypassed small intestine, it's imperative that the B12 hit the bloodstream at some point. For me, it's going into my veins directly right now, and ALSO under my tongue.
- Product - Celebrate Bariatric Supplements B-12 Sublingual Dietary Supplement
- Purchased - Sample from Celebrate for review purposes, www.celebratevitamins.com
- Price - $15.95 for a 90 day supply
- Pros - Tasty, small, smooth, sweet, keeps your brain from shrinking.
- Cons - Only available online.
- Rating - Pouchworthy, MM.