Q: My doctor had done a blood test and found that my vit B12 level is 161 pg/ml only against the required. range of 270-970. He also did another test to know if blocking AB is positive. He told me that I have lost the ability to absorb B12 through digestion and have to only take vit B12 by injection. I saw a lot of web sites for sub-lingual B12 in Google and also saw one TV ad for a tablet Trivita in US. Do you think these sub-ligual tablets really get absorbed through under the tongue. I have not taken B12 shot since 3 months and already started feeling the numbness more frequently now. Hence looking forward to your advice.

A:Deficiency of vitamin B12 &/or folic acid results in a form of anaemia called megaloblastic anaemia. The usual cause of deficiency is either dietary deficiency or a failure to effectively absorb B12 from the intestine. Vitamin B12 absorption requires the secretion of a glycoprotein called intrinsic factor (IF) from the cells lining the stomach and this B12-intrinsic factor complex is then absorbed in the ileum (part of the small intestine) in the presence of calcium. Certain people are unable to produce intrinsic factor and the subsequent pernicious anaemia is treated with injections of B12. This is an auto immune disease. The immune system normally makes antibodies to attack bacteria, viruses and other ‘foreign’ agents but in an auto immune disease, the immune system makes antibodies against part(s) of the body. In pernicious anaemia, antibodies are formed against intrinsic factor, or against the cells in the stomach which make it. This stops intrinsic factor from attaching to vitamin B12, and so the vitamin cannot be absorbed into the body. It is thought that something triggers the immune system to make antibodies against intrinsic factor but this trigger is not known. Individuals with pernicious anaemia have to take lifelong supplemental vitamin B12. You will observe on the web that this drug has not been evaluated by the US Food and Drug Administration (FDA) and it is not intended to diagnose, treat, cure, or prevent any disease. Till date, the accepted treatment in case antibodies are present to IF, is injectable vitamin B12. Please do not neglect this and take the treatment as prescribed by your physician.