It is important to take supplements or at least check levels regularly so that supplementation is not delayed. It is better to take just B12 instead of B complex since all the other B vitamins should be available in a healthy diet. There are two kinds of vitamin B12 – methylcobalamin and cyanocobalamin. Methylcobalamin is the kind which is used by our body. Our bodies cannot efficiently use cyanocobalamin. Spirulina and Chlorella contain cyanocobalamin and not methylcobalamin, and hence are not good sources of vitamin B12. Some vitamin B complex supplements also contain cyanocobalamin rather than methylcobalamin, therefore it’s important always to check the source of vitamin B12.

Tablets

There are many preparations available in India. Nurokind 500 mcg is a good option. While taking daily doses we can expect the levels to rise by about 100 pg/ml monthly and when not taking any supplement we can expect the fall in levels by about 100 pg/ml monthly. These are average values and may differ in individuals. Take one tablet daily initially when the deficiency is detected. Once your blood levels reach desired values take one tablet 2-3 times every week for life to maintain levels. In case you are not vegan and your B12 levels are low, it means you are not absorbing B12. In this case, oral supplements can be tried and if not suitable turn to injections.

Suggested oral dosage – methylcobalamin 250 – 500 mcg daily till the levels are 400 pg/ml or more after which it should be taken 2-3 times per week lifelong. In case levels do not rise, injections are suggested. It is best to have levels around 400 pg/mL.

Important note: oral vitamin B12 should not be taken as cyanocobalamin, but rather only methylcobalamin, and the dose should not be more than 500 mcg/day. This is already a high dose, given that the recommended daily allowance is 2.4 mcg/day. Excess vitamin B12 will be thrown out in the urine and so would be a load on the kidneys. There are many supplements that provide 1000 – 2000 mcg. These should never be taken.

Injections

Vitamin B 12 injections should be taken if the deficiency is very severe, or if oral doses are not being absorbed or are unsuitable for any other reason. Injections should be given to you by a doctor in a clinic after a test dose is given the first time.

Injection Eldervit from Elder Company is recommended. It comes as a combi pack of two vials. No.1. vial contains vitamin B12, 2500mcg with Folic acid 0.7mg, and Niacinamide 12 mg. No.2 vial contains Vitamin C, 150 mg. No. 1 vial can be taken as it is or mixed with No. 2 vial. Mixed is better for the absorption of vitamin B12. About 10 injections may be required initially in one month depending upon the severity of deficiency. Later one injection every two months is good as a maintenance dose.

Injection Vitcofol contains B12 and Folic acid. Take a total of 2 vials (each vial 10 ml) in the following way: Take 2 ml twice a week of Vitcofol for 15 days. After that, 2 ml each week. This should be enough to lift the B12 levels. The second vial would last for one month and one week. This injection might be slightly painful for some.

Injection Methylcobalamin contains only vitamin B12 but is in the same dosage as the Vitcofol injection and comes in similar-sized vials of 10 ml each. This can be taken in exactly the same way as you would take Vitcofol. This injection is not painful.