Topics like this one sound quacky, so let's set the matter straight from the start:

If you do not like getting shots of B-12, you should be aware that intranasal absorption is the next best thing. Oral administration of B-12 is largely ineffective. This goes for so-called sublingual B-12 supplements as well.

VITAMIN B-12, unlike other B vitamins, is stored in muscle and other organs of the body. A little B-12 goes a long way, what is stored lasts a long time, and it may take YEARS to deplete your body’s reserves. But sooner or later, usually later (after age 40), not only do poor eating habits catch up with us, but we also lose the ability to efficiently absorb what B-12 we do get from food.

COBALAMIN is the proper name for vitamin B-12. It is a really huge molecule (C 63, H 90, O 14, P, Co). The "Co" is for the one cobalt atom at its core. B-12 is obtained mostly, but not exclusively, by eating animal products such as dairy and meat. If you therefore think that you have to eat meat to get your B-12, consider this: Where do grass-and-grain-eating cattle get THEIR vitamin B-12? From synthesis by microorganisms in their gastrointestinal tract, that's where. And such synthesis in vegetarian animals is so tremendous that their milk and flesh is OUR source of B-12. But it all actually came from their bacteria.

Yes, B-12 is also synthesized in the human GI tract, but not reliably enough for most people. Such synthesis as occurs may be enhanced by a good vegetarian diet that favors an internal population of beneficial, B-12 making bacteria.

But with our diets, we will need more than they can provide. Nutritional yeast, fermented soy foods such as tempeh, and sprouts (according to some sources) are vegetarian sources of dietary B-12.

But there still is a physiological hurdle to cross.

Absorption of dietary B-12 takes place in the very last part of the small intestine, right before the colon. Absorption requires a biochemical helper molecule called “intrinsic factor,” which is a glycoprotein normally secreted by cells lining your stomach. Strong stomach hydrochloric acid is also required to split up this huge molecule. (That's why a weak acid like vitamin C (ascorbic acid) is harmless to B-12, persistent myths to the contrary).

Incidentally, even sublingual (under-the-tongue) B-12 supplements are probably ineffective because the cobalamin molecule is too large to diffuse through the mucosa of the mouth.

And if your body no longer makes intrinsic factor like it should, you cannot absorb oral B-12 supplements very well, either.

The end result can be pernicious anemia, which is more than the classical inability to make enough hemoglobin for your red blood cells. Pernicious anemia also results in a sore mouth and tongue, assorted burning and tingling sensations (paresthesia), and eventually neurologic damage. I think Meniere’s, and dementia symptoms mistaken for Alzheimer’s disease, might be a manifestation of this.

While there is a urine test for B-12 deficiency (the "isotope-dilution assay for urinary methylmalonic acid"), to get it right it is necessary to measure the cerebrospinal fluid, not the blood, to get accurate B-12 readings. If you are not a Spinal Tap fan, consider a simple, non-invasive therapeutic trial of B-12. This is so inexpensive and safe that it would be difficult to deny it to anyone. I would suggest your doctor try a 1,000 microgram (mcg) injection at least once a week. Compared to the US RDA of only about 3 mcg, that dose may appear rather hefty. But given the miserable nature of Meniere’s, erring on the high side may be preferable to unnecessarily delaying recovery. And l know of no side effects whatsoever to B-12 overdose.

If you do not like the idea of getting shots of B-12, you should be aware that intra-nasal (that is, by way of the nose) absorption is the next best thing. It sounds pretty weird, as duly promised at the beginning of this section, but it is an efficient delivery method for large-sized molecules whether you like the sound of it or not.

Your nose has two choices:

1) Buy ready-to-use, over-the-counter B-12 gel, which you will occasionally find for sale in a pharmacy or health food store. Some products come in individual disposable packets. These are pricey.

2) Make your own B-12 intra-nasal supplement. It is cheap, easy and best done behind closed doors. Obtain your doctor’s OK before trying this procedure. Take any B-12 tablet (between 100 to 1,000 mcg) and grind it into a powder between two tablespoons. Add water, just a few drops at a time, to make a soft paste. With a “Q-Tip,” its generic equivalent, or your clean pinkie finger, gently swab the paste inside your nose up to a comfortable level. Do not push; use no force whatsoever. The excipients (tableting ingredients) are more likely to bother your schnoz than the B-12 is. If it irritates you, try using less, or a different brand of tablet. I’d try this two times a week for a month or two.

Feel free to quit at any time, and get B-12 shots instead. Once in a great while, doctors (such as “Children’s Doctor” Lendon H. Smith, M.D.) will even teach you how to give yourself your B-12 shots, but that remains a singularly rare event.

Hence this nose news.


In Sanskrit, tulsi means literally "the incomparable one" and has been revered since ancient times. Tulsi, the holy basil, is said to have grown at the site of Christ’s crucifixion and is associated with St. Basil’s feast.