I had part of my stomach removed, so I need to get a vitamin B-12 shot every month. Recently, I saw an advertisement for B-12 microlozenges that dissolve under the tongue. Can I take that instead of the shot?

L.P.

As you point out, patients who've had surgery to remove their stomachs vitamin B-12 shots to maintain adequate levels of this vitamin in their bodies. The reason is that the stomach normally produces a protein required for the absorption of B-12 from dietary sources. Loss of this protein, due to removal of the stomach, leads to an inability of the digestive system to absorb B-12 in the last part of the small intestine, the ileum. Although the body stores about a three-year supply of B-12 in the liver, eventually this will get used up. B-12 deficiency can lead to anemia and neurologic dysfunction.

It is true that many preparations of various vitamins and minerals are available. These include certain nasal formulas and under-the-tongue (sublingual) lozenges. Although these may be adequate for vitamin supplementation in most people, these preparations would still not provide enough B-12 for someone who has had his or her stomach removed. This is because B-12 is not absorbed from the mouth or nose. It is only absorbed in the ileum, as previously described, so B-12 from the supplements still requires the specific protein made by the stomach for absorption. At this time, the monthly B-12 shots are the recommended way to replete stores of this vitamin people who've had part of their stomach removed.