Which type of vitamin B12 is best–cyanocobalamin, methylcobalamin, or hydroxycobalamin?

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I have followed you for years and purchase your tapes. Met you in Ann Arbor at the food co- op. Is it true Cyanocobalamin b12 ( which you recommend for us as vegans) turns into cyanide and the best b12 to take is hydroxycobalamin?Per Raymond Francis MIT scientist. That’s what his website shows anyway. His comments were it is man made , not natural, and not well utilized. What is absorbed is turn into cyanide. Could you please clarify, help.

David Tunison / Originally asked on Vegan epidemic

Answer:

Let me guess: Mr. Francis sells hydroxycobalamin supplements?

It’s like the whole coral calcium scam. Calcium is cheap as chalk–in fact it is chalk! So how are you going to bilk people out of lots of money? You sell some sort of special calcium. Same with B12 supplements.

B12 is so cheap to produce that supplement manufacturers try to come up with all sorts of fancy ways to “add value” to products so they can charge $30 a bottle. Unless you’re a smoker, have kidney failure, or base your diet around cassava root, cyanocobalamin should be fine. That’s what I take!

Image credit: epSos.de / Flickr

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  • http://www.facebook.com/joe.bourguignon Joe Bourguignon

    But, is cyanocobalamin from animal sources? In another video, you mention B12 supplements for ~$2/year, was that a vegan B12 supplement? Methylcobalamin claims to be vegan, are there cheap sources for it? Not asking you to recommend a retailer specifically but I just wanted clarification… Thanks so much for the wonderful source of FACTUAL information! Keep up the great work! :)

    • Toxins

      Here are Dr. Greger’s current b12 recommendations
      http://www.scribd.com/doc/64850131/Dr-Michael-Greger-s-2011-Optimum-Nutrition-Recommendations-ENGLISH

      Twin lab offers good, cheap sublingual b12 tablets and thats what I use.

      • beccadoggie10

        This is terrific and concise information to have. Thank you!!!

    • beccadoggie10

      Some 40 years ago, I used to consume Kal brand nutritional yeast for vitamin B-12. But, I wasn’t vegan at the time. I consumed it because it helped me quit smoking — cold turkey; I also fed it to my dog when I was making my her pet food. She did better on homemade pet food with nutrients added than I commercial pet food and that was before they were genetically engineering pet foods! The veterinarian, Richard H. Pitcairn recommended Kal brand, which I bought at a local health food store.

      I now take Bluebonnet Earth Sweet Chewable Vitamin B-6, B-12 plus Folic Acid. I was looking for a vitamin B-12 that was 1000 mcg. So many have 5,000 or more, which I did not want. I’ve also read in the Nutrition Almanac that vitamins should not be taken alone because they can deplete other vitamins in the body. And, in addition, one of the physicians who subscribe to this list, suggested this Earth Sweet Chewable Vitamin B12 for me, when I went vegan.

      Thus far, I’ve had no problem and it certainly makes me feel better.

      • visitor2013

        Bricker Labs has a liquid B12 with 1000mcg and it tastes great.

  • Susan

    Does cassava root and derived products such as tapioca offer health benefits?

  • http://www.facebook.com/rippelhans Hans Rippel

    I would still like to know, leaving prices aside, which is better: cyanocobalamin or methylcobalamin?

  • Fidel Castrati

    Dr. Greger, you aren’t concerned that people who don’t eat as super-healthy as you might not have the ability to unload the cyanide in cyanocobalamin in order to utilize cobalamin? My concern is that for many, cyanocobalamin is too stable a molecule in which the cyanide is not that easily released. Can you dig up some science on the mechanism by which the body detoxes cyanocobalamin and how involved that process is?

    The video at http://bit.ly/toxic-b12 says that cyanocobalamin can actually LOWER
    true b12 levels. Yes, the guy is selling a drink mix with hydroxycobalamin, but i still sense there is some degree of truth in what he’s saying. That is, for some, and more than you might expect, cyanocobalamin might actually be unsatisfactory of even harmful. After all, it is not the way humans have been getting b12 up until very recently in terms of the overall human timeline.

    • Colin P. Müller

      “Yes, the guy is selling a drink mix with hydroxycobalamin”

      That’s really all that needs to be said. I don’t listen to anybody who spouts unproven theories about vitamins, especially if they’re trying to push their lame product on me.

    • Nate Morey

      There is no evidence suggesting it lowers b12 levels, total scam is my theory. That said the levels of cyanide in this vitamin are so small that as he said, unless your already smoking it would do nothing at all. you would have to eat a smll bottle full to get a single cigarettes worth, and that is not recommended anyways. your body needs an increadibly small amount of b12 size wise, so though it has this toxin it wont effect you.

      • Vegan Minstrel

        Aren’t we all smoking to some extent? That is, there are poisons in our air from car exhaust, etc. I don’t want a known poison attached to my vitamin on top of that. I have a feeling one of Dr. Greger’s future videos will refer to a study showing why the bio-active forms of B12 are better for us than cyanide-B12.

  • Deanna

    Dr Greger. Thank you for all of your info / sharing. Regarding B12 recommendations, you say that the Cyanocobalamin should be fine. I wanted to double to see if you feel this is true for Vegans..because 2 Vegan sources I have communicated with recommend the methylcobalamin form of B12 b/c it is the natural form. Could you please share your thoughts, advice. (Would there be a negative to taking the Methylcobalamin form over the Cyanocobalamin form)? Thankyou!

    • http://nutritionfacts.org/ Michael Greger M.D.

      We don’t have as much data (in terms of proper dosing and efficacy) on preventing/reversing B12 deficiency in vegans with any other form that cyanocobalamin. Until there is I’m less comfortable recommending it.

  • mikeysbro

    I just read this small paragraph on cyanocobalamin and it does not clarify if cyancobalmin is toxic as reported. Furthermore, it is still unclear how the cyanocobalmin found in nutritional yeast is made.

  • EJ

    Methylcobalamin versus Cyanocobalamin http://www.apiindia.org/medicine_update_2013/chap139.pdf

    • Jacob

      That article says to take “Cobalimin” and not Methylcobalamin, but Cobalimin is a general term for all forms of Vitamin B12 according to wikipedia. Is it referring to Hydroxocobalimin?

  • Colin P. Müller

    Nearly every source I’ve seen that says
    methylcobalamin is the best is also trying to sell a product.

    • Adam

      I’ve found it to be better. I’ve felt nothing of of cyanocobalamin, even at high doses taken over a long duration. Methylcobalamin, which is NOT expensive ($4.99 for 60 tabs (2,500 mcg
      dose per capsule over at Swanson) is a much more bio-available choice.

  • tanji

    You said that cyanocobalamin b12 was the best unless you are a smoker……..if someone is a smoker, should they not take it?

    • myke

      really. for such a broad population you might figure to tell why smoker’s are advised against it…

  • Adam

    I can’t even believe this is up for debate. Most physicians will tell you that B-12 is poorly absorbed because it’s destroyed by gastric juices. I’ve known several physicians who recommend B-12 injections as the most effective way to make use of B-12. In most cases, I’ve found them to be right. I was sluggish and tired, and my intake of cyanobobalamin was more than the average bear. I felt nothing. About two weeks into a methylcobalamin-containing supplement, I noticed a huge difference that has been sustained. Dr. Greger’s dismissive nature on this matter puts me off.

    • http://www.DonForresterMD.com/ Don Forrester MD

      Once you understand the biochemistry involved avoiding Vitamin B12 deficiency and treating Pernicious Anemia(PA) via the oral route becomes straightforward. In my clinical experience I have never had to resort to injections if you use high dose oral medications in the case of PA an autoimmune disorder where the body stops producing intrinsic factor which helps is necessary for the active phase of B12 absorption. See Dr. Greger’s 5 video’s on B12 beginning on February 3 2012. Using injections can be useful in the initial treatment of B12 deficiency. It is important to work with your physicians but there is ample literature to support oral therapy. In addition to PA there are certain inborn errors of metabolism that would require injection. Methylcobalamin may offer a theoretical advantage over cyanocobalamin but it is more expensive… if you go to the website referenced by Toxins it is 14 times more expensive. Cyanide is present in foods so our bodies are equipped to eliminate it. The total amount consumed is important. I am not a physician who believes that “Vit B12″ is destroyed by gastric acid. As a clinical matter the use of acid blocking agents and antacids can contribute to Vitamin B12 deficiency. All this said there are individual differences and if methylcobalamin works better for you then cyanocobolamin I would certainly go that route. You need to work with your physician(s) to work out what works for you.

      • Adam

        I hold the personal believe that cyanocobalamin is cheap for a reason. It’s synthetic garbage. Even you conceded that its bioavailability can be trivial. Who cares about cost when it’s your health and well-being on the line? It’s like all the people who gripe about the cost of eating healthy. It’s still cheaper than chemotherapy.

        Right now I’m paying $15.99 to have 60 days worth of a B complex that contains methylcobalamin and also contains medium-chain triglycerides. I can’t imagine that $8 a month is beyond the reach of most health conscious people

      • Adam

        And I just checked Swanson Vitamins and found you can by their brand of methylcobalamin for $4.99 for 60 tabs (2,500 mcg
        dose per capsule). You consider that expensive? You consider that TWELVE times more expensive than the cheap and inferior cyanocobalamin?

      • Veganrunner

        Hi Dr. don,

        Something that hasn’t been mentioned is what is in the supplements. I had a hard time finding a B12 that didn’t have sorbitol. I went through a bout of IBS with stomach cramps and diarrhea. Once I eliminated the sorbitol it cleared up. The B12 I finally found was methylcobalamin drops. (thank you Brian) Have you found patients with this issue with the sorbitol?

  • Optimus

    I think the point for not just vegans but for anyone who is health conscious is to choose healthier foods and to remove as many synthetic products from your body as possible. It maybe fine for others to take in Cyanide if they choose, more power to them… but lets not take away all our healthy choices simply because its cheaper…Has everyone gone mad with the money bug….If its not naturally found in my body why put it in there?……
    Cyanocobalamin when digested becomes methylcobalamin then leaves the cyanide behind.. although at none toxic levels, but can bioaccumulate….
    Methylcobalamin is a very good and benificial source of B-12 although a bit more expensive..but it can be synthisized by chemically processing Cyanocobalamin..
    they just mimic human digestion..this way you can get B-12.. still get a good price and not get the cyanide…
    Hydroxocobalamin is natural.. and is the very best form of b-12 and very expensive… not only do you get the neurological benefits.. there are molecules in it that bond with cyanide in the body and allows it to be removed through urination..so just like all natural products it detoxifies..and does not toxify the body

    • myke

      where are your sources?

  • http://diabetesdigest.com/ NATURE MADE VITAMINS

    With this in mind, we can check out the various nature made vitamins that could possibly give us the exact vitamins that we may be lacking in. These natural vitamins can boost our immune systems, give us our Daily IU of Vitamins A, C, D plus B complex and other vitamins that we could need.

  • Jason Smart

    If you have MTHFR which up to 80% of the United States has, you have to take the co-enymated (enzyme activated) methylcobalamin

    • Holly

      could you please post a reference?

  • Lauren Vita

    If you have the genetic mutation mthfr, any b12 other than methylated turn into cyanide. My son has this ans we give him methylated b shots.

  • superape

    My mom’s only got one kidney left that only works for 30% but I got her into taking this form of B12. Should she stop taking it and start using another one?

  • superape

    Can someone please answer my question? I´m a bit worried now and I really don’t know who else I can ask this. Thank you :)

    • JacquieRN

      Hi superape. Since kidney disease can result from several causes, the type and amount of B12 should be closely monitored by her MD. I say that not to dodge your question but since people with kidney disease have limited kidney function, taking high doses might allow unhealthy levels of the vitamins to remain in the blood.

      • superape

        Thank you very much for answering my question Jacquie! I told her that maybe she needs to take another type of B12 and she´s going to ask her nephrologist. I will also tell her to ask him about the right amount ’cause I told her to take 1000 mcg a day as she is 66 years of age. Really thought I was doing the right thing for her… Thanks again! It’s much appreciated :)

        • JacquieRN

          My pleasure!

  • edvilla24

    Thank you Dr. Greger ..muah!

  • ioana

    Hi Dr. Greger,

    I have been vegan for the last 2,5 years. Two month ago I decided to take a daily dose of B12 (methylcobalamina spray) to supplement my nutrient intake.

    I noticed that my lips have become chapped and dry and for the last 3 weeks an acne like rash is bothering me.

    Do you think these could be the result of overdosing with B12? Or that I show an intolerance to the product?

    Wikipedia says B12 overdose could lead to acne-like rushes:

    http://en.wikipedia.org/wiki/Vitamin#Side-effects

    Thanks.

    • Paul’s Stuff

      Hi Ioana,

      I don’t know how much B-12 you are taking but the body only requires 5 micrograms a day. That’s right micrograms not milligrams. Nobody makes dosages that small. So if you just take one pill a month of any brand you are getting all you need. And that assumes you are a strict vegan and have been for at least three years. If you are eating any meat at all you probably don’t need to supplement your B-12. My source on this is Dr McDougall.

  • Kristine

    What if you are a smoker? Which is best to take then? And does it help?

  • Mari

    Hola Dr. Greger. I would like to know your thoughts about B12-cyanocobalamin injections (1000mcg). Is it true that it is a better way to make sure you are absorbing the vitamin?

    I already started taking it. One inyection a day per one week, one a week during one month and one per month to mantein the levels.

    I didnt find anything about inyections in your videos or webside and really would like to know what you think about it. Thank you for everything. Greetings from Spain!

  • April Egan

    Our unless you strive for an actual healthy lifestyle! Cyancobalamin being the most widely used form dies not make it the safest form. I seek nothing. I am a SAHM mother of two that actually researches what I put in my body and in that of my family. There is plenty of information from various sources, including the encyclopedia, concerning cyancobalamin. It does not occur in nature, and for me that’s the biggest red flag there is. The fact that a medical professional would actually recommend cyancobalamin over other safer, more natural forms disturbs me greatly. Do your research- there’s a reason why ‘side effects’ are listed for cyancobalamin and not for other forms.

    • healthy Doc

      methyl cobalamin is ‘ready-to-eat’ by the body. Other forms need to be first transported to the liver to have the CH-4 (methyl group) added, then released so it is ‘bio-available’.

      • bub

        Actually Hydroxycobalamin is the most bio-available form, as Methylcobalamin gets converted to Hydroxycobalamin in the body, though the Methyl component is needed for multiple reactions within the body anyway (ie: it is good, not a waste product). Also, for those with too much cyanide in the body, Hydroxycobalamin will combine with cyanide molecules, and allow it to be excreted via the kidneys. Thus, it is used in cyanide poisoning cases.

        Many people with heavy metals in their bodies, and other toxins that over tax the liver, cannot easily convert Cyanocobalamin to Methycobalamin, so the Methyl version is preferred. It is also preferred over Cyanocobalamin if you are wishing to follow studies showing that doses of 10000mcg are required to get the higher energy results desired, as well as for those with low B12.
        At higher doses, Cyano version would give you significant levels of Cyanide which would further tax your liver, and is poison, period.

        Hydroxycobalamin is best intravenously (in terms of bio-availability), but needs an anesthetic administered with it, as it “burns.”

        Overall, from a cost and health perspective, orally, methylcobalamin is probably the ticket, and if sublingual, has been shown in studies to be just as effective as shots of B12. It can be bought at most Sams and Costco’s at the most affordable prices I could find readily available anywhere for high-dose Methylcobalamin.
        I can also state that it has proven nearly miraculous results for me with seasonal allergy relief. Check out B-12 and how it naturally suppresses immuno-over-response, if you have bad upper-respiratory allergies…not a permanent “cure,” but lowered my spring allergic reactions to nearly nada.

  • disqus_3BrONUAJno

    I assume you also take the potentially poisonous folic acid instead of a more bioavailable form of folate that won’t potentially build up in your bloodstream like homocysteine, causing the same problems? Cyanocobalamin is about as bioavailable as the iron in nails, since your body has to strip the cyano-complex off and add the methyl to use it.
    Do us all a favor and chew on some nails…

  • Joel Santos

    Hi Dr greger, the cheapest b12 supplement I could find already has b1, b2, b3, b6, c and calcium pantothenate in it. Is that okay? It costs around 2 cents per tablet

    • Vee

      Just wondering where you found them for that price. Very interested….and are they working for you?

  • Michael

    I think everyone should read the following website that compares the three types of B12 in a succinct, but very informative fashion. My conclusion has been that methylcobalamin is the best choice for many reasons, including that it is a methylating agent, decreases homocysteine, and does not deplete glutathione as both other forms can. But toxicity is also a major concern. Cyanocobalimin is inferior when it comes to absorption, toxicity, GSH depletion, dependence on intrinsic factor, and more. This article is very well referenced.