B12 and Crohn’s

If you have Crohn’s disease, it probably affects your ileum, and you’ve probably learned that you are at risk of vitamin B12 deficiency.  If this is news to you, take a moment to read up. I used to take B12 shots which were effective, but when I leaned that they contained aluminum I sought out a metal-free alternative.

The challenge with B12 is that if your ileum is damaged or removed you simply cannot absorb B12 through diet or vitamin pills and have no choice but to find another delivery method. The lack of sufficient B12 can be problematic and potentially serious if not addressed. Talk to your doctor and read this.

I’ve found a few alternative delivery methods for B12 supplements: injections, nasal spray, sublingual and topical cream. I can’t give you any insider experience with the nasal spray or topical cream, but if you google for “b12 nasal spray”, you’ll find what you need. B12 topical cream is a little harder to find. Google will return many B12 creams for eczema, but I suspect they wouldn’t work as needed. I did find some at Coastal Compounding and you could always speak to your local compounding pharmacy.

My recent experiment in alternative B12 supplementation was to use Pure Encapsulations B12 liquid as a sublingual. I used it for one year as my sole B12 supplement, taking a single 1ml, 1000mcg dose every other day. I recently had my yearly checkup and my blood work showed a B12 level of 439 on a normal scale of 180-914. For context, I’ll tell you that I weigh 170 pounds and consider myself to be moderately active.

Being the eagle-eyed reader that you are, you’ve probably already discovered that Pure Encapsulation B12 liquid contains stevia. You also know that stevia is illegal as a sweetener. But did you know that Elaine allowed it in “miniscule amounts” in supplements? I know that this isn’t ideal, but for me the trade off between aluminum in the shots and stevia in the B12 was acceptable. I have found another B12 liquid that appears to be 100% legal, but at three times the cost of the Pure, I haven’t given it a try.

labeling on Pure B12 liquid

In her BTVC book, Elaine recommends bringing B12 levels up to a “high normal” (pg 65, eleventh printing). You’ll have to discuss this with your doctor and spend some time with blood work and experimentation to discover what it takes to get you there. If you dig around the web a bit, you will find that the “normal range” for B12 is somewhat subjective as different sources cite different normal ranges. As far as I can tell, no upper limit for B12 has been established due to it’s low risk for toxicity. It appears that excess B12, that is B12 that your body cannot use, is simply excreted. Don’t get crazy with it though.

As always, talk with your doctor before altering your treatment to avoid unintended consequences or complications.

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21 Responses to “B12 and Crohn’s”

  1. 1 Eva January 8, 2010 at 11:18 am

    re sublingual spray for B12:
    Hi Paul, My daughter (32) was diagnosed with Crohn’s February ’09 and has been on the SCD regime for about 10 months. Her gastro doctor actually called her stupid when she refused Prednisone and said she wanted to investigate other alternatives. We discovered SCD pretty quickly and she follows it 100% and is doing great – no more blood and pain. Anyway we use a B12 sublingual spray that we get online from Dr. Mercola’s website. We live in Northern Canada so a lot of our SCD products (almond flour and supplements) have to be purchased online and I spend a fair amount of time researching for her. Here are the ingredients: B12 (cyanocabalmin), purified water, vegetable glycerin, citric acid, potassium sorbate, natural spearment flavour. All legal.
    Thanks for your posts – you and the other online SCDer’s have provided support and inspiration for us as we sometimes feel a little isolated up here.
    Peace and health,
    Eva P.

    • 2 Paul Stocker January 9, 2010 at 3:43 pm

      Hi Eva,

      I understand why most doctors don’t understand our choice of SCD, but that kind of derogatory comment is shocking. I’m sorry she had to endure that.

      I’m glad to hear that she doing well.

      Thanks for the info. Do you know what the “natural spearmint flavour” actually is? When I see words like “natural” and “flavour” in ingredients listings, I treat them as suspect because just about anything can be described as “natural” and the scope of “flavour” is even broader. If you want to be 100% sure that the product is 100% legal, you may want to find out exactly what that natural spearmint flavour is.

      Thanks for reading and commenting. I’m glad to hear from people as then I know I’m not talking in a vacuum and I’m happy to be able to help.


  2. 3 Eva January 18, 2010 at 10:39 pm


    Thanks for the direction about ‘natural’ flavors. Yikes! Can’t believe I missed that one.

    I’ll let my daughter know so she can make an informed decision about continuing it. I’ve contacted the vendor to get more info and will let you know. She has been using it for about 3 weeks and hasn’t had a reaction but, it’s sublingual so it may not affect her gut as quickly.

    She’s out of town for a week on a real estate course but we skype regularly. Traveling can be tricky but she found an extended stay hotel with full kitchens so she won’t suffer from lack of a fresh Yonana muffin!


    • 4 Paul Stocker January 19, 2010 at 11:02 am


      I know, there’s a lot to watch. I’ve been doing this SCD thing for 5 years and am still learning.

      Thank you. That would be great to know what the manufacturer says. Sometimes it can be hard to tell if something is affecting you. It’s good to keep in mind in case she begins to have problems that are unexplainable otherwise

      Those kitchens really help out and seem to make eating less expensive. My wife and I like the Staybridge Suites. Congrats to you daughter for keeping SCD while traveling – it can be a challenge.

      P.S. I’ve been trying to email you directly as well, but Gmail tells me your account doesn’t exsist.

  3. 5 Eva January 21, 2010 at 7:52 am

    Hi Paul,
    I corrected my email address – it will work now.
    The makers of the B12 spray (Mercola) replied to my inquiry about the ‘Natural Spearmint Flavor.’ They say it is steam distilled from organic spearmint with no additives used in the process.
    I let my daughter know and she’s going to continue for now. Like you she was getting b12 shots from her naturopath but stopped because of the aluminum.
    She seems to be tolerating the spray but she won’t make any other changes for a couple of weeks to make sure.
    She’s doing great on her real estate course but looking forward to coming home this weekend.
    Thanks again Paul for your blog. We look forward to your monthly posts (not to mention your recipes!) It’s good to know that we’re not alone on this most interesting journey.

    Eva P.

  4. 7 Marian March 17, 2010 at 2:29 pm

    Hi Paul,
    I noticed that the Pure B-12 liguid you use has B-12 in the form of methylcobalamin. The form Eva’s daughter is using (which I’m considering trying — I currently give myself shots) is cyanocabalmin. Any idea what the difference is and which is better?

    • 8 Paul Stocker March 17, 2010 at 4:26 pm


      In researching the cyano VS methyl forms of cobalamin, I discovered just how complex the issue is and how much of the topic was outside my grasp. Having said that, my limited understanding is that methylcobalamin is immediately available to your body unlike cyanocobalimin which must be converted to the methyl form for use by your body.

      Assuming the wikipedia article on cyanocobalamin is accurate, cyanocobalamin is converted to methylcobalamin in the body by the process of “equilibration, as cyanocobalamin slowly loses its cyanide in surroundings that contain no cyanide”. I’m no scientist, but I like the idea of avoiding those bits of cyanide.


  5. 9 Anonymous May 14, 2010 at 9:23 am

    Hi there,
    Just found your web site and have found it informative. I do have suffered with Crohns and all of its ugliness for 35 years.

    I have taken B-12 injecton since 1980 and in 1999 I started having short memory problems. I found out that my brain was B complex deficient. As soon as we compounded the B complex in with my B-12 injection my memory came back and has been fine since. However in the last few years I do have been using a sublinginal B12/Complex and do fine unless under a lot of stress. Then I will use the injection. Hope this will help someone else.

    • 10 Paul Stocker May 16, 2010 at 7:15 am


      Thank you for taking the time to share. Having more information is always better. It’s so different then when I grew up. I didn’t know anyone else with Crohn’s then, but now with the internet it’s relatively easy to benefit from other’s experiences.


  6. 11 jgirl July 20, 2010 at 4:30 pm

    Just a note of caution around the sodium benzoate 😉 definately one to research and thumbs up on the methylcobalamin vs other.

  7. 12 Tia March 18, 2012 at 2:28 pm

    Hi,tried to find methylcobalamin for shots, after doing research on cyan and methy forms.Dr’s & Pharmacy only have cyan form. So I’m taking Cyan 1000mcg per 1 Mil shot, two times a Month.I’m taking B12 for peripheral neuropahy,essential hand tremors and fatigue.The shots do help some,but I worry about the aluminum, which is 625mcg per shot. I have B12 sublingual,1100mcg with B6 &Folic Acid in Methylcobalamin form from a well know vitamin store.I use this B12, in between the shots. I’m a senior and otherwise healthy.Also I have only one kidney, due to cancer.Am I doing this the right way. What do you recommend.Should I take a B12 Complex,too.

    • 13 Paul Stocker March 20, 2012 at 9:17 am


      I must confess that my understanding of B12 is rudimentary at best and I don’t understand nearly enough to make a recommendation in your case. All that I understood regarding B12 at that time I put into the post.


  8. 14 Kris July 14, 2013 at 11:05 pm

    “Douglas Labs – Methylcobalamin Liquid 30ml” now appears to contain modified ingredients – instead of the stevia, it now has ‘natural cherry flavor.’

    Since “cherries” are SCD legal, it’s.. safe-ish right?

    • 15 Paul Stocker July 15, 2013 at 10:44 am


      Strictly speaking, any product that contains a “flavor” is suspect and may contain illegals. The stevia in the image on this post is illegal as well, but I consider it acceptable risk for my situation given the amount. So you are right, it may be safe or it may not be. Keep that in mind if you use it.


  9. 16 marie September 2, 2013 at 12:10 pm

    Will you share what brand this is of vitamin B encapsulated liquid is?

  10. 18 Chris May 29, 2015 at 12:27 pm

    Not sure if this helps or if you are interested but I recently heard about a new oral prescription alternative to the injections called Eligen B12. I recently read that it works even if you don’t have intrinsic factor (so even if you don’t have normal gut absorption). This would mean no more shots! Apparently it came out a month or two ago. Has anyone heard of it or tried it??

  11. 21 Kate December 20, 2017 at 8:12 am

    This post is helpful! Thanks Paul

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