Vitamin B12 in South Africa: forms, risk and Clicks labels

Clicks sells vitamin B12 tablets as a complementary medicine. The Essentials page is marked S0 and describes the nutrient's ordinary roles: red blood cells, the nervous system, metabolism, the immune system, and tiredness. That language sits near the low-risk health-supplement wording SAHPRA allows while products remain unregistered. It is not a claim that the tablet treats anaemia. The Expert page names methylcobalamin and folic acid and does not state the micrograms of B12. The row says the amount is missing.

SAHPRA, the Advertising Regulatory Board, and injections

SAHPRA's complementary-medicine page explains Category D and the low-risk boundary: general health enhancement, maintenance, or minor symptoms, not treatment of a named disease. The Advertising Regulatory Board is the advertising forum. In the UK that injection is prescription only, and in the US the NIH describes it as a prescription medicine. South African readers should assume an injection is a clinician's decision until a local schedule page is checked. This article does not offer one.

The forms, without a winner

Vitamin B12 is a group of compounds called cobalamins. The NIH Office of Dietary Supplements fact sheet says methylcobalamin and 5-deoxyadenosylcobalamin are the forms used in metabolism. Hydroxocobalamin and cyanocobalamin become active after the body converts them. Supplements are often cyanocobalamin. Methylcobalamin, adenosylcobalamin and hydroxocobalamin are also used. The same fact sheet says there is no evidence that absorption differs by form. At a dose under about 1–2 micrograms, absorption is about half, because intrinsic factor can still carry it. At 500 micrograms absorption is about 2%, and at 1,000 micrograms about 1.3%. A 1,000 microgram tablet is not 1,000 times more useful than a few micrograms from food. Most of it passes through.

Injections are a different product. The NIH fact sheet says cyanocobalamin and hydroxocobalamin can be given by injection as a prescription medicine, usually into muscle, when someone cannot absorb B12, including pernicious anaemia. The NHS page on hydroxocobalamin says it is only available on prescription. The NHS treatment page says UK injections use hydroxocobalamin rather than cyanocobalamin because it stays in the body longer. NICE's clinical knowledge summary describes hydroxocobalamin 1 mg by intramuscular injection for deficiency that is not fixed by diet, and it also describes oral cyanocobalamin for diet-related deficiency. A shop tablet is not that injection. Clinics that sell B12 shots without a prescription relationship are outside what these pages describe.

Who is more likely to run short

The NIH fact sheet is blunt about food. Natural B12 is in animal foods. Vegans, who eat no animal products, and vegetarians who eat little, have a higher risk of deficiency unless they use fortified foods or a supplement. Breastfed infants of vegan mothers can become deficient early, and that deficiency can injure the developing nervous system. That is a reason for clinical care, not for a parent to guess a dose from this article.

Older adults are the other large group. Depending on the definition, the fact sheet cites deficiency rates in community-dwelling older adults from 3% to 43%, especially when atrophic gastritis reduces stomach acid and intrinsic factor. Pernicious anaemia is an autoimmune cause of intrinsic-factor failure. The NHS says it is the most common cause of B12 deficiency anaemia in the UK, and it is not a diet problem. People who have had stomach or intestinal surgery, and some people with coeliac disease, can also absorb too little.

Two common medicines interfere with absorption from food. The NIH fact sheet names proton pump inhibitors, such as omeprazole and lansoprazole, and H2 blockers, because they reduce stomach acid. It also names metformin, used for prediabetes and diabetes, as a drug that can lower serum B12. People on those medicines should ask the prescriber about monitoring. A high-strength shop tablet is not a substitute for that conversation, and it is not a reason to stop the medicine.

The US recommended dietary allowance for adults, from the same fact sheet, is 2.4 micrograms a day, 2.6 in pregnancy and 2.8 while lactating. The daily value used on US labels is 2.4 micrograms. The NHS treatment page does say that people who struggle to get B12 from diet, including vegan diets, may be advised to take tablets long term, and that diet-related deficiency may instead be treated with a hydroxocobalamin injection twice a year. Non-diet deficiency, once treated, is usually an injection every two to three months for life, with neurology cases referred to haematology.

What is established, and what the trials do not show

It is established that the body needs B12 to make red blood cells and to maintain the nervous system, and that deficiency can cause megaloblastic anaemia and neurological symptoms, including numbness, which can occur without anaemia. The NIH fact sheet says symptoms can take years to appear because the body stores about 1 to 5 milligrams. It is also established, in ordinary nutrition science, that people who do not eat animal foods need a fortified food or a supplement. Those are not marketing claims. They are why vitamin B12 has authorised health claims in Great Britain at all.

The authorised British wordings, as copied on the register compilation (described there as the register of 19 May 2026), include: vitamin B12 contributes to normal energy-yielding metabolism; to normal functioning of the nervous system; to normal homocysteine metabolism; to normal psychological function; to normal red blood cell formation; to the normal function of the immune system; to the reduction of tiredness and fatigue; and it has a role in the process of cell division. Each claim has a condition of use. The food has to be at least a source of vitamin B12. Check the register before relying on a paraphrase. A claim about tiredness is not a claim that a 1,000 microgram tablet treats chronic fatigue, and it is not a claim about mood disorder.

Cognitive decline is the tempting extra. The NIH fact sheet says observational studies disagree, and randomised trials have not shown that B12, alone or with folic acid and B6, improves cognition in older adults with or without dementia. That is a negative finding worth keeping. Energy claims on a label are the authorised nutrient wording, or a US structure/function line. They are not evidence that a person who is not deficient will feel different.

On treatment, the fact sheet summarises a 2018 Cochrane review of three small trials, 153 people, comparing 1,000–2,000 microgram oral doses with intramuscular B12. The evidence was low quality, and oral high doses normalised serum B12 about as well as injections in those trials. NICE still describes injections for people with neurological involvement and for many non-diet causes. High-dose oral B12 is a clinical option in that guidance, not a product to start without a clinician.

Safety and interactions

The NIH fact sheet says the Food and Nutrition Board did not set an upper limit, because of low toxicity, and that the body does not store an unlimited excess. That is not a dare to take the highest number in the shop. Folic acid can mask the blood picture of B12 deficiency while nerve damage continues. The NHS says a GP checks B12 before starting folic acid for folate-deficiency anaemia for that reason. Metformin and acid-reducing drugs, already mentioned, are the interactions that change B12 status. Injections have their own side effects. The NHS hydroxocobalamin page lists pain at the injection site, nausea, diarrhoea, headache, dizziness, and rare anaphylaxis. Call 999, on that NHS page, if you think you are having anaphylaxis after an injection. Shop tablets do not carry that injection risk. They also do not treat the causes that need an injection.

Vegans, older adults, and people taking metformin or a proton pump inhibitor are the groups to take to a clinician, not to a bigger tablet by default. Folic acid on the Expert product is a reason to be careful: the NHS warns that folic acid can improve the blood picture and hide B12 deficiency. We are not saying this Clicks product will do that. We are saying the combination is a reason to know your B12 status. Call 10177 for an ambulance, or 112 from a mobile phone. An HPCSA-registered doctor or a pharmacist is the right person for a deficiency. The practitioner directory on this edition is empty until a real registration is checked.

Dis-Chem's brand index showed a Gold Vitamin B12 60-tablet price. Two Clicks rows are what met the rule.