Causes of vitamin B12 deficiency include inadequate ingestion from chronic alcoholism, chronic malnutrition and strict vegetarianism; inadequate absorption due to atrophic gastritis, gastrectomy, small intestinal bacterial overgrowth, intestinal resection, malabsorption, Crohn’s disease, chronic pancreatitis, and Helicobacter pylori gastritis; inadequate utilization of vitamin B12 due to medications, transcobalamin-II deficiency, and anti-vitamin B12 analogues; inadequate stores of vitamin B12 due to advanced liver disease; drug interactions relating to malabsorption due to metformin, antibiotics, phenytoin, colchicine, para-aminosalicylic acid, and cholestyramine; metabolic inactivation due to vitamin C and nitrous oxide; and food-cobalamin malabsorption due to proton pump inhibitors and H2 receptor blockers. The pathway for gastrointestinal absorption of cobalamin in the oral cavity and stomach occurs through R protein secretion by salivary glands and gastric mucosa. In the stomach, cobalamin is separated from food by acid and peptic activity. This liberates cobalamin and binds it to R protein, forming the cobalamin-R complex. Intrinsic factor is secreted by the parietal cells. In the duodenum, the cobalamin-R complex is digested by pancreatic enzymes/alkalinity, which frees the cobalamin. The free cobalamin binds to intrinsic factor in the alkaline medium. The cobalamin-intrinsic factor moves down to the terminal ileum. In the terminal ileum, the cobalamin-intrinsic factor complex binds to specific receptors on the mucosal brush border. In the mucosal cells, the cobalamin-intrinsic factor complex bound to receptor undergoes pinocytosis. The intrinsic factor is degraded, and cobalamin is transferred to transcobalamin-II and released into the circulation as holo transcobalamin. There are two cobalamin-dependent pathways. The first pathway involves the conversion of homocysteine to methionine. The vitamin B12-dependent enzyme is methionine synthase, with the coenzyme being methylcobalamin. When there is not enough vitamin B12, there is increased homocysteine. In the second pathway, methylmalonyl CoA is converted to succinyl CoA. The enzyme for this is methylmalonyl CoA mutase, and the coenzyme is adenosylcobalamin. If there is a vitamin B12 deficiency, there is increased methylmalonic acid. Laboratory features of cobalamin deficiency include anemia, thrombocytopenia, elevated mean corpuscular volume, leukopenia, low or normal reticulocyte count, macroovalocytosis, hypersegmented neutrophils, anisocytosis, poikilocytosis, hypercellular bone marrow, increased myeloid/erythroid ratio, abundance of stainable iron in bone marrow, nuclear-cytoplasmic asynchrony, decreased megakaryocytes with abnormal morphology, reduced serum vitamin B12, increased methylmalonic acid and homocysteine, decreased holo transcobalamin-II, increased unconjugated bilirubin and increased lactate dehydrogenase enzyme. Also, false low levels of serum vitamin B12 may be due to folate deficiency, progressive multiple myeloma, use of oral contraceptive pills, multiple myeloma and excessive vitamin C intake. False normal vitamin B12 levels may occur in active liver disease, lymphoma, alcoholism, intestinal bacterial overgrowth and myeloproliferative disorders. At the age of 50, if serum cobalamin levels are >400 pg/ml, screen every 5 years. If serum vitamin B12 levels are 100-400 pg/ml, consider performing methylmalonic acid and homocysteine evaluations. If serum vitamin B12 levels are <100 pg/ml, treat for deficiency. In individuals who are =65 years of age, screen annually. Therapeutic options for treating vitamin B12 deficiency include intramuscular injections at 100-1,000 mcg every 1-3 months, oral intake at 500-2,000 mcg/day, sublingual forms at 2,000 mcg/day, and intranasal administration at 500 mcg weekly.</p>Unfortunately, getting the B-12 vitamin your body needs is not easy. The shots can be painful and expensive. Additionally, your ability to absorb the B vitamins from food and oral pills decreases as you age. Sublingual B-12, sublingual method simply means that you put a great tasting, quick dissolving tablet under your tongue where it can speed the vitamins directly into your bloodstream. This helps your body get the maximum absorption of the vitamin B nutrients into your system—effective as the shot and without the pain.   Neither a placebo, nor a caffeine-type stimulant,  Sublingual B-12, gives you the increased energy and stamina you need to do the things you want to do.
 

1) Regain the energy of your youth .

2) Free yourself of daily stress and anxiety.

3) Live a happier, more productive life.

4) Most people notice the positive effects the very first week!