For ASTHMA, vitamin B12 is a mainstay for easing wheezing, tight chest, and mucus secretion, with a specific role in improving shortness of breath. Asthma can rapidly improve while taking vitamin B12 and can continue to steadily get better when taken over the long term. It is especially effective for people whose asthma is aggravated by sulfites. Having inadequate B12 levels can ultimately impair oxygen delivery, and this helps illustrate why patients with low B12 serum levels often have poorly controlled asthma.

What is vitamin B12 and why is a deficiency so common?

Vitamin B12, or cobalamin, is a water-soluble vitamin that is needed in the metabolism of every cell of the human body. It is the largest and most structurally complicated of the B vitamins. Vitamin B12 is required for red blood cell formation and maturation, for nerve function and heart health, and it restores critical DNA synthesis and activity in every cell. Evidence from the Framingham Offspring Study suggests that the prevalence of vitamin B12 deficiency might be greater than previously assumed. This study found that the percentage of participants in three age groups (age 26-49 years, 50-64 years, 65 years and older) with deficient blood levels of vitamin B12 was similar, ranging between 39% with low levels and 17% with extremely low levels.¹   

Vitamin B12 can be low within cells for years before there is a measurable serum deficiency. In our clinic, we check blood B12 levels routinely, and we find that maybe 30 to 50% of people have insufficient levels. Additionally, modern diets are typically saturated with highly processed foods, which can aggravate B12 deficiencies. Vegans and vegetarians receive little or no vitamin B12 in their diets. We often test vitamin B12 for new patients, as this has powerful asthma-relieving benefits and is commonly low in people with asthma and in the general population. We like to see blood levels between 900 to 1,200 pg/mL.

Many people have a dietary B12 deficiency, as it is only abundant in red meats, organ meats like liver, and eggs, and these foods are limited in many people’s diets. Neither fungi, plants, nor animals can make vitamin B12 themselves. Plus, absorption of vitamin B12 is fraught with hurdles: in the stomach, vitamin B12 needs a protein called Intrinsic Factor to absorb, and sufficient acid to release it from protein foods. Then it travels all the way to the far end of the small intestine (terminal ileum) to cross into the bloodstream. Any stomach disorders, low acid output or acid-blocking drugs, or conditions like pernicious anemia where Intrinsic Factor is lacking, can prevent B12 absorption, as can intestinal inflammation such as Crohn’s disease if a damaged terminal ileum cannot take up vitamin B12.

The old-fashioned solution for deficiency was to administer vitamin B12 injections, but now that is rarely needed as dissolving vitamin B12 under the tongue is highly effective and well-absorbed as long as the formulation and dose are sufficient. Taking a sublingual dose bypasses the digestive tract and guarantees easy entry into the body by directly entering the blood vessels around the tongue. Studies as early as 1998 validate correct oral treatment to be equally effective as injections. They concluded that in cobalamin deficiency, 2,000mcg of cyanocobalamin administered orally daily is as effective and may be superior for raising blood B12 levels compared with 1,000mcg administered intramuscularly on a monthly basis.²

The role of vitamin B12 in asthma

For decades, vitamin B12 has been a well-recognized remedy for asthma in many clinical settings. It contributes to naturally expanding the bronchi and lung airways, leading to reduced wheezing, less shortness of breath, and better exercise capacity even for gentle activities like walking. It also helps to reduce bronchospasm, which is sudden narrowing of the air passages, in reaction to allergens such as pollen or animal dander or allergenic foods such as peanuts. Over time, vitamin B12 contributes to airway remodeling with bronchi that continue to stay more widely open.

Vitamin B12 is also recognized clinically to reduce mucus production, with smaller volumes of sputum, and a looser consistency so that the airways feel less clogged for patients and breathing deeply becomes easier. If a patient encounters one of their trigger allergens such as pollen, dust, mites or an irritant food, vitamin B12 can also lower mucus secretion in this situation.

In addition, vitamin B12 has gentle anti-inflammatory and antioxidant actions, lowering the inflammation reaction that could otherwise exacerbate asthma, and protecting the lungs from oxidative injury.

Our patient’s experience with vitamin B12 and asthma

In our clinic, many of our patients have excellent results with sublingual vitamin B12 that dissolves gradually in about 15 minutes under the tongue. They describe fewer asthma attacks, less phlegm and chest tightness, and improved breathing capacity with resulting better stamina. We measure their blood B12 levels beforehand and often see a big increase within 6 to 8 weeks. We recommend a lozenge formulation with only natural flavorings. It is best taken in the morning or afternoon as it may cause a quick energy boost. Ideally, we like to use a vitamin B12 that is combined and balanced with an ample amount of folic acid, which should be included in a patient’s overall supplement intake to make sure that a folic acid deficiency is not masked.

Recommendation: Vitamin B-12 (as cyanocobalamin) 2,500 to 5,000mcg, dissolved slowly under the tongue, in the morning or early afternoon, once daily, or as directed by your healthcare provider. It is unrelated to food and does not matter if a meal has been eaten, as B12 circumvents the stomach to absorb into veins around the tongue. Folic acid 400 to 800mcg daily should also be ingested either with B12 or in a multivitamin or B-vitamin formula.

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