Question of B-12....

Well hello to all,

Haven't posted since Moby Dick was a minnow but I am alive and well in San Marcos, look for ya Northerns to send some rain down our way!

Quick question: I read that B-12 has to be taken by injection, sublimial, or nasal spray.. I have gummy tabs that I love, as they go down so wonderful! I take them on an empty stomach to that I believe they must be absorbed?? No? Yes?

Also wanted to comment that I have lost 33 lbs (surgery date March 31). Due to a hernia, that was fixed during surgery but ripped back open and is now the size of a grapefruit, right over my new lil pouch! I can put my hand on it and feel the food go thru; how gross is that! But, after surgery I got double pnumonia and was in ICU for a wk.. so therefore my surgery WON'T do the hernia repair until the end of July.. I just have to live with it, and because of that I am unable to exercise, other that normal housework and yardwork. So, 33 lbs probably isn't as great as it would be if I was exercising but am doing the best I can under the cir****tances.

Well, just wanted to let ya all know I was alive and well, relatively speaking.

Cheers to all, and happy losing!

Carole, I'm adding Sharyn's comment on B-12 for you.  She can explain this easier than I can, I'm sure if she's available today she'll respond in more detail if you need it.

After RNY, B12 MUST be taken in injection, sublingual, or nasal inhalant form.  It requires binding to an enzyme called intrinsic factor (IF) in order to be absorbed.  IF is secreted in the part of the stomach that was bypassed.  Therefore it is inaccessible to the RNY patient.

Carole....I wasa just thinking about you yesterday and about not seeing you post.    I was about to look up your phone number to call ya.   LOL   So glad that you are doing well all except for that hernia.   Oh....I think 33 lbs is wonderful !!!!    You are doing really well.   I didn't loose my weight really quickly either.     Hang in there...it will come off.    Please post more often....we miss ya !!!

Hugs and blessings ~~~ Vivian

Hi Carole!

Congratulations on your weight loss!

I wrote this a while back regarding anemia that resulted because of a lack of the vitamin B12.  I thought I'd leave it in tact so that you can also see what may happen if you do not supplement with the proper B12 for YOUR body.  I hope this helps!


http://en.wikipedia.org/wiki/Pernicious_anemia

http://www.nlm.nih.gov/medlineplus/ency/article/000569.htm

http://www.nhlbi.nih.gov/health/dci/Diseases/prnanmia/prnanm ia_what.html

http://www.umm.edu/blood/aneper.htm

If you go to google and run a search on "Pernicious anemia" you will find a world of information.  As always, use the most reputable medical sites.

First, since you are post WLS, we KNOW without question or testing that you lack the ability to possess the intrinsic factor that allows the body to absorb B12.  The part of your intestines where B12 absorption occurs has been completely bypassed so you will never again absorb B12 by food alone or by a typical vitamin that contains B12.   You must supplement with the proper B12 for US.  Some post op patients are successful with the B12 sublingual tablets.  These tablets, if you notice, has a dosage of usually 2500 which is over 40,000 (fourty thousand) percent of the RDA.  It is believed that some post op patients are able to have success with this treatment because the B12 dosage is so high that the body is *forced* to accept some of the component that is introduced into the body.  Under normal cir****tances, the actual RDA of B12 is typically easily achieved through diet unless one has a physical disorder that prevents the body from producing the intrinsic factor that binds with B12 so that it is absorbed or as is the case when a portion of the bowel is bypassed as it is in the post-op gastric bypass patient.

Conclusion:  Post-OP WLS patients who have had a portion of their intestines bypasses canNOT absorb B12 through food or regular vitamins.  They MUST supplement B12 either by sublingual tablets, injection, nasal spray, or more recently a patch.

In addition:

Aside from the research I did on what causes PA, I also studied the treatment of PA along with lab tests, readings, studies, means, etc.  My PCP didn't agree with the research I had regarding treating the anemia.  It's important to remember that doctors (especially PCPs) cannot possibly keep up with all the current information on disease/illness/etc. and treatment.  To do so, he'd never be able to see patients!  Also, they are "general" doctors and not "specialists".  The best treatment for any blood disorder will obviously come from a Hemotologist (though he can't know it all either! LOL)  Anyway, my PCP wanted to take a much more conservative approach (injections once per month) which I believed would not help my stores quickly enough and it would therefore take me longer to recover and feel better.  I had to "encourage" a better treatment plan than what he wanted but I got what I wanted and it has worked.  The suggested treatments vary - some physicians think oral / sublingual B12 is sufficient and it may be for some but I felt like trying that hadn't worked for me.  It does take 2 years for the liver to become depleted of its B12 stores which is why we start to see PA in WLS patients around the 2 year mark.  The concensus regarding treatment of PA in post op WLS patients seems to be B12 injections which can be sufficient done subq rather than muscular.  The dosage and administration should be at the minimum 1000 mcg injections sub-q every day for three days, then once per week for 4-5 weeks, and then monthly for life.  Levels should be checked after treatment begins at 1 month, 3 months, 6 months and then yearly.  HOWEVER, looking further, I found a more aggressive initial treatment seemingly more acceptable to those suffering from PA because they felt better faster and the body replinishes its stores faster.  This treatment would be 1000 mcg dosage(s) injection sub q every day for one week / seven days, then twice a week for 4 - 6 weeks and then monthly for life.  I ended up doing 1000 mcg injection sub-q for four days, then twice a week for 4  weeks and then once per week for 2 weeks and I'm now seeing how far I can get before I start to suffer from the tinlging extremeties.  It was also helpful for me to "split" my dosage such as 500 mcg every other day (after the initial daily dosages) and then split 50/50 for the remainding weeks.  After 7 weeks of my personalized treatment plan my B12 went up 425 points to 870.  To me, it's amazing that my range was still under 1000 after all of treatment I received.  However, it should be kept in mind that B12 is water soluable and there is no upper limit (a limit whereby the FDA warns to no go over).  There are definite consequences to mega dosing even with water soluable vitamins that do not have an UL.  I initially suffered from a particlar type of lesion (that looks remarkably like a pimple but isn't) on the face, neck, chest and back; however, it did subside when dosage decreased and compared to the pay off - it was a minor inconvience at best.  It should also be noted that vitamin and iron levels should be considered by patient.  The "normal range" is a highly broad range determined by a particular mean (group of patients/people).  You and your doctor should work together to determine what is the best level for you!   I also believe this regarding a whole host of other blood test(ing) and treatment(s).  I also learned that high doses of Vitamin C can affect the number of the level of your B12 at a higher range -- meaning large doses of vitamin C can push the B12 reading/number higher than the patients true level ---- so that this should also be a mindful part of the treatment plan.  My surgeon wants my B12 level over 1000 and I've just reached 870 so not too much farther to go!  

I hope this information is beneficial to you as well as others!

Update as of 07/12/2007:  I haven't had blood work lately but have an appointment to recheck in late August.  The longest I have gone since the inception of treatment without tingling is 21 days.  Months later, I have not yet been able to reach the "once a month injection" goal.  I suspect, however, that this is obtainable and in the near future.  I have taken the prescription iron faithfully so I do expect to see *some* increase in my ferritin level (iron stores) which were exactly at the minimum on my last set of labwork.  Because my B12 level were recovering and my H&H levels were good (and I have a conservative Hemotologist), iron fusions were not ordered.  I am feeling better as well though may days are on and off -- good days and bad days and I never know which it will be!!! 

*added from written post on 07/13/2007

**** I have the following information posted on my profile -- it was written after literally hours of research of medical journals, etc. and I have posted website for informative reading as well.  For me, I believe that my B12 may have been on the *low* side for "me* prior to surgery which would explain some symptoms from which I suffered prior to WLS but couldn't seem to conquer.  *I* believe it to be a shame that physicians don't look me for low B12 levels more often as raising B12 levels in many people who were even in the *normal range* yet suffering from *unexplained* physical, psychological, mental, and emotional symptoms have experienced dramatic life changes after raising B12 levels.  *I* suspect that many people are improperly diagnoses because B12 is *overlooked.*   Also, as a side note, typically anyone over 50 (irregardless of gastric bypass) begin to not produce less of the intrinsic factor (IF) in order to properly absorb B12.  It is (in my opinion) of benefit for the over 50 patient to mindful of this medical *fact.*  Low levels of B12 have now been linked to Alzheimer's disease -- though once the diagnosis of AD is made, it's too late to treat it with B12; therefore, it is *safe* to conclude by many studies that B12 should be evaluated and potentially supplemented by the over 50 age group.


This is a *****oppy but unfortunately I don't have time to organize it better right now!  I apologize for that!  I hope you find the information you need and/or you now have an idea of where and how to research the importance of not just B12 for ALL vitamins.  (I promote a high quality B-Complex so that B1 and B6 are also included as they are also extremely important to the nervous system!)

Good luck!