Oral vitamin sprays

…perfect for people with swallowing issues

Did you know that certain vitamins are now available to buy as an oral “spray” (also called a “buccal spray”)?  These oral sprays are a novel distribution method and may be preferred over standard liquid vitamins being administered by dropper, pipette or spoon for those with dysphagia (or people without dysphagia who dislike taking tablets).  At present, oral sprays are available for: Vitamin D, Vitamin B12 and a multivitamin.

In a spirit of “investigation,” I bought a Vitamin D spray to see what it was like. It came as a 15 mL spray pump and dispensed a “mist” of less than 0.25 mL.  I had some control over where I could direct the spray in my mouth – eg. inside the cheek, directly on the tongue or into the mouth generally.  The brand I tried had a pleasant peppermint flavour and I only needed 1 spray per day to get more than 100% of my requirements for vitamin D.  Some colleagues I spoke with (who don’t have dysphagia) said their compliance with spray vitamins is better because they don’t have to go to the effort of getting a glass of water to take their tablets.

So what’s the evidence?

Vitamin D

I found two randomised studies specifically testing the absorption of vitamin D spray compared to vitamin D capsules(1,2) and in both cases,  the oral spray was absorbed as good or better, than the capsules.  How can this be?  A vitamin D oral spray disperses the product over various membranes in the mouth (buccal, sublingual and palatal membranes) which allows the vitamins to passively absorb into the blood stream.  This study specifically looked at using the spray vitamins for people with ulcerative colitis, Crohn’s disease and steatorrhea and found that reduced intestinal absorption in these individuals meant they were absorbing less vitamin D from their capsules as well.  The oral spray, on the other hand, completely bypasses the intestinal tract and allowed for more of the vitamin D to be absorbed.

B12

I found two studies which looked at sublingual tablets (dissolved under the tongue) compared to either oral tablets or vitamin B12 injections, and all three methods were equally effective at increasing vitamin B12 levels.(3,4). I could not find any study which compared a vitamin B12 oral spray with an oral tablet.

Multivitamins

I could not find any studies which compared the absorption of an oral spray multivitamin with a multivitamin tablet.

My advice?

I am happy to recommend the vitamin D oral spray at present. If the person using the spray has dysphagia, please check with their Speech and Language Therapist to make sure it is appropriate. Vitamin D deficiency is common in the UK and people with brain injuries and neurological conditions need to make sure they are getting enough.  The Scientific Committee on Nutrition recommends that everyone in the UK aged 4 years and above, get 10 micrograms (400 IU) of vitamin D per day. It is extremely difficult to get sufficient levels of vitamin D from food alone. You can get some vitamin D from exposing your skin to the sunlight between late March and October in the UK, but clothing, sunscreen, skin pigmentation and cloud cover will all reduce vitamin D production in the skin.  People who spend much of their time indoors, or who are very vigilant about wearing sunscreen when they go outside, are probably not getting enough vitamin D and should consult their GP or dietitian about taking a supplement.

As for the vitamin B12 spray, there is insufficient evidence at present to promote its use.  If you want to use it, my advice is to get your blood levels checked before and 1 month after using it to see if it is having the desired effect.

For multivitamin sprays, there is also insufficient evidence for me to promote them at present. I also have concerns that the current multivitamin sprays on the market only include vitamins and are lacking in important minerals such as zinc and iron.  If someone’s diet is not nutritionally adequate, it makes more sense for me to recommend a multi-vitamin and mineral supplements which provide ALL of the nutrients a person needs, instead of recommending something which is incomplete. I also wonder if the required 4-8 “sprays” per day of the multivitamin may reduce compliance slightly.

If you need advice on whether or not you need a vitamin or mineral supplements (or want a review of the supplements you are already taking), please get in touch with me at info@specialistnutritionrehab.co.uk.

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