WHY B-12 IS A MUST!! (AND ALL THE OTHER VIT'S)

My apologies.  I thought you were saying that you posted twice, but received no repsonse. 

ETA: Since I see that you have been taken oral B12 and are planning to change to shots & sublingual, I wanted to let you know why B12 cannot be absorbed orally.

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.

No need to apologize, I'm sure I must have worded my statement wrong. I'm working on this migraine right now that has me seeing blurry, mixing up my words and messing up my thoughts. Seems like I'm going to go through the same misery I went through two weeks ago when I had a migraine for a week. I'm probably like the least confrontational person you will ever meet, I come here for help and advice and appreciate every single bit including yours and everyone elses. So once again thank you very much! :)

And thanks for that little bit of info. I have been looking into vit b12 all day and now I see that it being the level that it is might be causing me symptoms that I never even thought had anything to do with a vitamin. I've been having all this "brain farts"(as I lovingly call them, lol) for a while now that I thought just had to do with my exhaustion from the anemia(the b12 is probably helping me feel that way too so it's probably a double whammy for me). Like I will find myself driving and missing exits and forgetting where I was going or why but I just thought it was normal, that I was just tired. I don't know if it has anything to do with the vitamin b12 too but I seem to have all these twitches. On my legs and arms, sometimes violent but most often than not subtle.

I just feel so stupid because I was careless with my vits. Thinking that just a multivitamin and some B pills and calcium chewables were going to keep me in tip top shape. I honestly thought I was doing well. I feel that if my previous insurance hadn't dropped me and I hadn't missed my two year follow up app and had been able to make Dr appts I would've known this was going on and would've been able to do something about it sooner. Unfortunately it is what it is now and I just have to fix it now while I have the insurance that I have now. I won't make excuses though and I will take full responsiblity if any non-reversible damage has been done, I just pray to God that it is not the case.

Thank you :)

Your symptoms sound eerily similar to Tanya & Debra's.  I would try to get the B12 levels drawn sooner than your appointment in 3 weeks, though, if you can.  And start with the sublingual ASAP.

And I looked back at your post.  YOU were fine, I just misunderstood.

Good luck and I am glad you are being proactive now.

Sharyn - I'm so confused with the following:  Where it says b12 can't be absorbed orally !! But then in the 2nd paragraph - it says sublingual.   I consider that the same thing......are the pills under the tongue okay to do or the liquid form under the tongue (which is what I used to do) but then READ in an OH magazine that that form was not absorbed for us RNYers. 
Can you help me differentiate this.  I have started 2 mos ago - getting b12 shots and this month - got a bcomplex & b12 combo shot the other day !!   :)     Lets just say - that I got a lot of housework done today in 2 -3 hours !!  lol 
ETA: Since I see that you have been taken oral B12 and are planning to change to shots & sublingual, I wanted to let you know why B12 cannot be absorbed orally.

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.

Phyllis, when you take B12 (or anything else) sublingually, it is absorbed through the mucus membrane that lines the bottom of the mouth.  It doesn't matter whether it is a sublingual pill or liquid.  I take the liquid and my last B12 levels were 1082.

I haven't read all the replies so someone probably answered you already but 220 is way to low for us as post-ops.  I think most labs still show 200 as the bottom of normal, but that is for someone with a normal digestive track.  IMO it's too low for a normal, I believe labs will be moving this number up soon, some may already.

My B-12 runs in the 1200-1700 range and I want it there.  Under no cir****tance do I want mine below 1000.  B-12 can be depleted quickly, so I'm glad you are seeing your surgeon.  Don't let them push you off, demand injections if you aren't properly  absorbing the sublingual.

BTW, how much sublingual B-12 are you taking, and how often?

We never want to see B12 levels below 800. Many cases of brain damage at 400! I know current labs show 200-900, but I've seen too many like you, sadly. Lives blown apart. All for a simple, cheap vitamin. The other thing is rickets, vit D. I hope you're on daily B12 shots. If you're not and no one will give them, PM me. And thousands of units of dry D3.
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These two paragraphs from the first article referenced below are so compelling that I want to include them here, as a reference for everyone who has ever faced a doctor that claims a level of 200 is "fine".
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Various authors have documented the psychotic (Hart/ McCurdy) , depressive (MacCallum), and consecutive affective and psychotic conditions in the same patient (Verbanck/ LeBon). Drs Levitt and Joffe, working at the Clarke Institute of Psychiatry in Toronto (where I trained, years earlier), published a report about vitamin B12 deficiency causing the psychotic form of depression, in the British Journal of Psychiatry in 1988 (Levitt/ Joffe). They also reviewed the medical literature and found that psychotic depression is more often caused by B12 deficiency than by any other known or unknown cause.
This fact is hardly ever borne in mind when psychiatrists confront a case of psychotic depression and, when they do think of it and order a serum B12 level, they will more often than not still miss the deficiency because the lab "normal range" is so low that their patient's B12 level almost always appears to be in the "normal range".

At least six neurological and psychiatric papers, in top medical journals, have shown that the normal range should be regarded as at least 500-1,300 pg/ml (rather than 200-1,100), since the cerebrospinal fluid level can be deficient when the serum level drops below 500, and neuropsychiatric symptoms often occur at serum levels between 200 and 500 pg/ml (VanTiggelen et al, Lindenbaum et al, Mitsuyama/Kogoh, Nijst et al, Ikeda et al, Regland). As for the still held misconception that the neuropsychiatric effects of B12 deficiency are always accompanied by a macrocytic anemia, it is humbling to know that this notion was already debunked in 1905 (Langdon)! Since then, many papers have stressed this point, including those by Strachan and Henderson (1965), Evans et al (1983) and Lindenbaum et al (1988).
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> http://www.johndommissemd.com/b12.html
> http://www.veganhealth.org/b12/formula
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l
> ist_uids=824083&dopt=Abstract
> http://www.vitacost.com/science/hn/Supp/Vitamin_B12.htm#Deficiency-Sym
> ptoms
>
> First two are the best, and quite solid at that.

If i remember correctly the levels as stated on the lab reports say 200-1000 so doctors often say your fine.....BUT....the fine print on the reports say that a level of under 400 has been associated with mental problems like dementia.  I had a reading of 300 and something and had to demand b-12 shots.  I planned to take one a week for a month but after 2 my levels were over 1000.  I try to keep my levels close to 1000.  Recently I learned I should be checking Vitamin D and Ferretin.  So again I insisted these labs be drawn.  I was very deficient in both.  I ask the over fifty forum for advice and was advised to take dry vit D3 50,000 IU 5 days a wee****il replenished then 50,000 IU once a week thereafter.  In a month my D was normal.  My ferretin is another story.  I started taking an iron chewable once a day and retesting showed it still low.  My doctor told me to take 3 a day.  Not likeing that.  Once is constapating enough, three has me running to the drug store for fiber and other remedies.  I will retest in a month and I sure hope the ferretin is ok.  I have labs done regularly and I have never shown anemia.  It wasn't until I forced the issue with the ferretin that I knew I was low.  My pcp was not concerned.  A hemotologist said even if my labs were not showing anemia if the ferretin was low I was anemic.  I have no "savings account" for my body to draw from.  I now make sure I take a couple of B-12 sublinguals everyday, my vitamin D in addition to whatever is in my multi or calcium, and the dreaded iron. This is not convenient.  You can't take iron and calcium together.  Iron needs C to absorb.  Calcium needs D to absorb.  Yada yada yada.  But it is necessary.  I have a schedule posted to my refrigerator to remind me when to take what.  From now on my labs will include tests for B-12, D, Ferretin, and A.  I am also considering a bone density test since blood calcium is no indicator of whether your bones are absorbing it or not.    This is nothing to mess with your life could depend on it.  good luck.

Thanks for the post again. I have read your story before, and sorry you have to go through all you have.

hello i just read your post i havent read your profile.... but this just happened to me...i am almost 5 years out from a revision and 11 years out from my first surgery.... i thought i was doing great and didnt need the vitamins so i stopped taking them...

a few weeks ago a friend thought i was having a stroke lost my vision, my memory, the use of my left arm and leg.... i got my vision back but the memory is the hardest.... i havent been driving because i forget where i am going .... i have to ask ramon a friend of mine about trips we took together when he spoke for OH and look at pictures.... i still have the numbness in the face and sometimes the arm goes there again...

i am now having a b12 shot weekly and an iron infusion every 4 weeks.... i take my vitamins daily.... i am too young to have to depend on someone to take care of me....

i try to stress to newbies starting out this is a decision for life...if you can learn from my mistakes please do... i will use myself as the example...i didnt do what i knew i should be doing and now i am paying... who knows if i will have a job when the doctor releases me....

i knew it was not a stroke... my heart didnt hurt... i just had all the symptoms.....

please post your story on your local board and the grad board and every where you can....

people thing they can just have the surgery and thats it....once they lose their weight.... that is not it this is for life....

my b-12 was at a 200 should be over 900 or higher.... sharyn is a nurse i highly recommend anyone taking her advice when it comes to numbers....

good luck in the future...