<<Disclaimer: Verify this information before applying it to your situation.>>

I have been treating myself for hypochlorhydria for about the last 4 months
or so, taking betaine HCl, digestive enzymes, probiotics, a potent
multivitamin/mineral supplement, plus additional vitamin E and vitamin C.
I have been showing gradual and steady improvement in health until the week
prior to this week, when I had a recurrance of general bowel distress and
heavy fatigue.  Fatigue has remained a problem throughout the last 4
months.  I thought I was adequately covered in the "B" vitamins with my
multivitamin supplement, but then, having read Dr. Jonathan V.
Wright's "Why Stomach Acid Is Good For You" and a library copy of "Dr.
Wright's Guide to Healing With Nutrition", I thought maybe vitamin B12
injections might be needed.  A web search on B12 injections brought up
articles indicating that sufficient amounts of vitamin B12 can be absorbed
from high doses of oral vitamin B12 supplements to meet one's daily needs.
I also found references to "sublingual" B12 used by vegetarians.  Finally,
I found an actual study on the effectiveness of sublingual B12 compared to
B12 injections.

Sublingual (under tongue) vitamin B12 oral supplementation appears to be
just as effective in treating B12 deficiency as intramuscular injections:

http://www.aarogya.com/specialities/hematology/news.asp

This study is published in The Lancet:

"Delpre G, Stark P, Niv Y. Sublingual therapy for cobalamin deficiency as
an alternative to oral and parenteral cobalamin supplementation.  Lancet
1999; 354: 740-41"

Some other earlier articles on oral B12 versus B12 injections are:

http://www.tldp.com/issue/11_00/gaby_b12.html

http://www.lef.org/magazine/mag99/aug99-report3.html

For the last week I have been taking sublingual Twinlab B-12 Dots, 500 mcg,
under the tongue twice daily, before breakfast and before dinner.  I was
somewhat skeptical and didn't expect to see any results for at least 2 or 3
weeks.  However, almost immediately after the first supplemention, my bowel
distress diminished to the point of feeling closer to normal than I have
felt in years, and I am feeling much less fatigued... and this occurring
after a previous week of feeling quite rotten.  Still skeptical, I have to
eliminate coincidence as a factor.  However, for the last 5 days I continue
to feel as well.  I'm very encouraged, but I want to see if this continues
through the next few weeks and if I get even better.

I searched the web for the best deal on sublingual B12 supplements.  I came
up with "NOW Sublingual B-12, 1000 mcg B-12 plus 100 mcg Folic Acid, 250
lozenges".  I ordered a couple of bottles of these from an online discount
vitamin store for only $8.03 per bottle.  Much cheaper than injections and
no prescription or doctor visits required:

http://www.nowfoods.com/product_catalog/catalog.asp?
showdetail=733739004680&stats=no

In fact, if you don't like lozenges, NOW even has a "spray" form of B-12
supplement:

http://www.nowfoods.com/product_catalog/catalog.asp?
showdetail=733739039101&stats=no

(You may have to "cut and paste" the above web addresses together on one
line.)

Vitamin B12 deficiency often occurs with hypochlorhydria (low stomach
acid).  Hydrochloric acid (HCl) is needed to absorb vitamin B12.  HCl is
produced by the parietal cells of the stomach lining.  The parietal cells
also produce a protein called "intrinsic factor".  Vitamin B12 binds to
intrinsic factor to form a complex which can then be taken up by the
mucosal cells of the small intestine to be absorbed into the circulation.
Through aging, disease, surgery, or chemicals (such as antacids), the
parietal cells may be damaged or reduced in number and/or function, thereby
leaving the individual deficient in both HCl and intrinsic factor.

With low HCl, B12 cannot be extracted and absorbed from food.  And if
intrinsic factor is deficient, B12 cannot be absorbed into the circulation
via the digestive tract, even if B12 is present from oral supplementation.
So hypochlorhydria often leads to B12 deficiency.  Fatigue is often the
first sign of B12 deficiency.  Bowel distress and other symptoms can
occur.  Eventually neurological problems develop.

A description of the above in medical terms can be found at:

http://www.bcm.tmc.edu/neurol/challeng/pat18/summary.html

Some other useful articles on B12 include:

http://www.gnc.com/health_notes/Concern/Vitamin_B12_Deficiency.htm

http://www.healthy.net/asp/templates/Article.asp?Id=1924

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