Q. I was told I was deficient in vitamin B12. Is taking a sublingual vitamin B12 supplement better than a regular B12 tablet?

A. There are many ways to treat a vitamin B12 deficiency. B12 pills can be swallowed or taken in sublingual form, meaning they are dissolved under the tongue. Other treatments include diet, nasal gels and injections. The best method depends on the cause of the deficiency, severity and your age.

If your diet is low in vitamin B12, either increasing your food intake of B12 or taking an oral B12 tablet should be sufficient. B12 is found in meats, chicken, fish, pork, eggs and dairy products. Since B12 is only naturally found in foods of animal origin, vegans need to eat foods that have the vitamin added or take a supplement.

Stomach acid is needed to remove B12 from food so it can be absorbed in the intestines. Most people who develop a deficiency have a stomach or intestinal disorder that limits their ability to absorb vitamin B12.

B12 supplements don't need stomach acid for absorption. Sublingual pills are absorbed directly into the bloodstream, bypassing the digestive system completely. They may be a good option for some individuals.

Groups who may produce less than optimal stomach acid include the elderly, folks who take medicines that decrease acid production and folks who have undergone gastric bypass surgery. It is unclear from research whether sublingual pills work better than traditional oral B12 tablets in elderly folks. Sublingual B12 is generally recommended for folks who've had gastric bypass surgery. After the surgery, stomach acid is virtually eliminated.

A severe B12 deficiency can lead to pernicious anemia, a disorder in which your body destroys cells in the stomach that help you absorb B12. If you've been diagnosed with this condition, you may want to check with your doctor if sublingual pills could be used as an alternative to B12 injections.

Some signs of B12 deficiency include fatigue, confusion, memory loss and numbness or tingling in your hands or feet. Many of these symptoms can be caused by medical conditions other than vitamin B12 deficiency. If your blood levels of B12 are low, your doctor can perform a test that measures your ability to absorb B12. This will help determine the most appropriate treatment.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.