[rose]

I don't have time to hang around, but one of those unethical marketers (in my opinion) has again been brought to my attention.

If it seems the product you are considering is being marketed as a new kind of B12 that will get through when others won't, and the word "sublingual" is being thrown around as if it is the magic key, I suggest you get a different product.

TV advertising, high price, automatic shipping are not good signs in my opinion. Some of the better brands won't even use the word "sublingual" on their B12 products because B12 is a large molecule and because the large (1000 mcg or more at a time) dose has been known for many years to treat even severe malabsorption. And that dose of methylcobalamin is even better.

rose

[shiney sue]

wow Rose i remember,and I was fooled years ago Thank you..Sue

[Mcharris]

I know you R busy - but.............

I order and take the methyl sublingual from LEF

would you be saying these are of no real benefit as opposed to any other type I can buy that are not specifically sublingual?

Appreciate your comment

Clare (THANKS) Tassie

[mrsD]

are really just swallowed.. There is no difference. Except you should do
your dose on an empty stomach...that way the B12 can be absorbed better.

I chew mine up and swallow.

[darlindeb25]

So, Mrs D. you don't sit with that stupid pill under your tongue, waiting for it to disolve? Sometimes I get bored and chew it up too. And here I thought I was cheating. It's ok to do that huh?

[mrsD]

don't think the sublinguals absorb much.

The whole technology for sublingual is very small. You notice there are
not many things available that way. Nicotine and nitroglycerin are the basic
only ones.

OTC products like we see for B12 don't have to provide bioavailability data
to sell them. Because B12 is a huge molecule, and the mouth surface is small,
I don't expect much gets in that way. I think most is dissolved in the saliva and swallowed. So just see that you take it on an empty stomach for best results.

I think the "sublingual" selling point is to make B12 seem more spiffy, increase patient believeability.

You know many decades ago there were buccal testosterone tablets for men.
They didn't work and were taken off the market.
We don't see other drugs that have minute doses used under the tongue.
Birth control pills for example.
Nitro is under the tongue for immediate angina treatment, but is very short acting and has side effects (it bypasses the liver that way). There are oral forms for longer duration. B12 doesn't need to bypass the liver, (this is called first pass--everything from the GI tract goes thru the liver first ) because the liver is where B12 is stored and converted. Studies have shown that oral swallow gives the same benefits. So I think the sublingual is just a marketing ploy to look "spiffy".

[jarrett622]

You might want to google sublingual medication. I was surprised at what came up. There are a good number of meds given in this way. For example:
http://www.nlm.nih.gov/medlineplus/d...r/a605002.html

And this one too:
http://bja.oxfordjournals.org/cgi/co...tract/55/8/761

Found this last one (above) interesting just from a clinical standpoint.

This one I didn't know about either. They give allergy meds this way too and it works better than taking them orally.

http://www.webmd.com/allergies/news/...-without-shots

One study I came across stated that giving meds this way even fairly large molecules are absorbed. They didn't give many examples and the article was quite technical really. And it focused on the buccal mucosa as the delivery system....
http://www.ualberta.ca/~csps/JPPS1(1...ccalreview.htm

I'd like to see more info specifically about B-12. I've been hearing about the sublingual form for quite sometime. Just wish I could remember *where* I heard it or saw it!

I *did* find an article that stated: ...no difference in efficacy between the two methods of vitamin complex delivery.

http://www.medscape.com/medline/abstract/17109579

A very interesting discussion! Thank you!

[mrsD]

articles about delivery systems. This is a part of the pharmaceutical industry.

However, very few if any come down to the daily use level, of everyone.

Benzos have been used to control nausea in some people on chemo by using them under the tongue. A true sublingual dosage form does not exist for them however, and they taste pretty bad used straight. Drug abusers know this trick, too. But we don't see benzos commonly used this way at all. If one does a drug under the tongue, the dose changes radically.
For example a typical nitro subling is 1/150gr or .4mg...the orals are 2.5mg, 6mg and 9mg. The DOSE has to be changed, since first pass is avoided. If B12 were to follow the micro dosing that sublingual DRUGS use, we would NOT see 1000mcg doses of B12, we'd see 2 or 4 micrograms instead. The 1000 times overdose for subling B12 suggests to me that experience has shown that a megadose is needed for it, because it is in reality swallowed with the saliva.

I did forget Levsin sublingual, which can be used to abort a gall bladder attack.
But still that is not a common product either. It is also an alkaloid like nicotine.
Buprenorphine cannot be used orally, and neither can fentanyl. So they have buccal (suckers) or subling. Sometimes morphine concentrate is given as drops under the tongue too. (Cancer patients who need opiates for pain, often cannot swallow.)

The fact remains that sublingual doses are not common. If this mode were reliable, we'd see lots more. My personal opinion is that the time element, or the standardization of dosing cannot be controlled with sublingual. So for now we only have items that give obvious results being used this way (rescue meds) Nitro gives a rapid vasodilation that can be felt (including pounding headache). Nicotine gives craving relief. But to expect a drug with no feedback like hormones, blood pressue or other critical things, is to expect every patient to use the subling/buccal exactly correctly. And this will never happen. People are unreliable. Their mouths all differ, they have irritation levels all different, etc.

Immunotherapy --which is placing ALLERGENS (not drugs) under the tongue is relying on minute absorption to desensitize. The mouth is the first place to react to allergens. Seafood and nut allergies will swell the tongue and throat in a snap for those allergic to them. In fact it is quite amazing that we are not all allergic to MORE things thru this system. So that also points to limited mouth absorption. Otherwise we'd be reacting far more commonly than really happens. The fact that we can eat and drink usually with impunity shows us how the mouth resists assault in most cases.

[nide44]

Either way, we all agree that the cyano form of B12 is not optimal.
The METHYL-cobalamin is the one that is most helpful, right?
I take 2000-5000mcg sublingual, every day,
thanks to Rose's advice....years ago..

[jarrett622]

That was a very good explanation and cleared up a lot of the questions I had that remained unanswered about that kind of dosing.

That's one of the best things about this board: I've learned more here than I could have anywhere else.