B-12...Hunting for more info, passing on what I had...

saw this question on the Main Board recently, and thought it might have value here as well. Please add "All you Know" to the thread. Info, what your doc recommends, personal experience, etc... "RNY Post-Op, taking the sub-lingual B-12 but recently switched to "regular" oral tablets. Is this a mistake?" ------------------------------------------ Yep, That would be a "Big Ole" Mistake. B-12 deficiency is one of the "Top Four" long-term complications for folks who have had RNY. Vitamin B 12- Cyanocobalamin It is a water-soluble hematopoietic vitamin. (means it’s necessary for manufacture of red blood cells) It occurs in meats and animal products. I have seen posts (by 'vitalady' and a couple of others) that claim Methylcobalamin form of B12 is best, but I don’t find that to be "pushed" by Docs in General Only those who sell this more expensive form. (Not ‘voting,’ just indifferent and slightly skeptical opinion. wish I knew more.) To be absorbed by the intestine, B-12 MUST combine with intrinsic factor, and its metabolism is interconnected with that of folic acid. If you’ve had a Gastric Bypass (RNY) the "intrinsic factor" in your old stomach, doesn’t have the ample opportunity to bind with the B-12 in the digestive tract until after the food has passed most of the receptor sites in the illeum which would normally absorb it. So, B-12 in food? Or the B-12 found in "regular pills?" is unavailable to RNY Post-ops. One "almost exception" in regards to food is calves liver. B-12 Trivia-- (Calves Liver, eaten in large enough quantities, has shown to have such a high concentration of B 12 that even people who lack the adequate intrinsic factor have absorbed enough vitamin B 12 to prevent pernicious anemia.) Vitamin B-12 is necessary for the growth and replication of all body cells and the functioning of the nervous system. [Here’s why B-12 is SO Important]… If you get a B-12 deficiency, it can quickly manifest as a case of pernicious anemia, which can quickly result in Peripheral neuropathy, (nerve damage) in the extremities. Pernicious Anemia, like other types of Anemia is an insufficient supply of red blood cells needed to carry oxygen through the body. The name "pernicious" was attached to this particular type because prior to the discovery of the cause and treatment with B-12 supplements, this type of anemia was fatal. The Peripheral Neuropathy is actually more of an issue today, even with the less ‘vicious’ name. Once you get this ‘tingling and aching’ in the feet, legs, fingers, etc. (Peripheral neuropathy ) Even when you restore B-12 levels, much of the nerve damage is done and will not ‘go away’ completely once you start taking B-12 again. In this case an ounce of prevention is worth much much more than a pound of cure. B-12 is absorbed differently than most vitamins due to that "combination with intrinsic factor" issue. Some docs think B12 can be too high. (from what people have reported as "straight from their doc’s mouth…") Other don't worry about "high" including mine. My Bariatric Doc and my PCP both have said- "high - we like it high". Mine registers just between 1800 and 2000 and they are both fine with that. Lab values for B12 are weird. Somewhere from 200-900 pg/ml  or 1100 pg/ml (picograms per milliliter) [(depending on the study)] are considered "normal".  Values of less than 100 pg/ml show a deficiency of vitamin B12. People with this level of deficiency are likely to have or develop symptoms.

BUT-... permanent neurological damage can happen in the 200s and 300s even though that is considered "low-end normal" because "Normal" is based on cardiac implications and not nerve problems. The World Health Organization upped the minimum B12 level for the "world" up to 460 in the past year or so but that doesn't dictate the U.S. The most common number I have heard tossed around by Docs at seminars is that post-ops are better in the 800+ range just to be safe. The most effective way of absorbing vitamin B12 after a gastric bypass is with monthly (or twice-monthly) vitamin B12 injections, but this is not absolutely necessary unless you have a deficiency already. The recommended daily allowance is 6 mcg, but that is the amount that is to be absorbed. A higher dose is needed when taken by mouth. (sub-lingual) Which ever method you choose to take Vitamin B12, you must take it daily for the rest of your life. Some people prefer getting a B12 shot once or twice a month from their PCP, or self-injection. B-12~Self-Injection-Info Others greatly prefer B12 lozenges or sub-lingual (under the tongue) B12 tablets. With these forms, the B12 is absorbed into your bloodstream through the mucus membranes your mouth. Typical amounts in supplements range from - 500 mcg to 5000 mcg. A 500 mcg or 1,000 mcg supplement daily is sufficient. If you get the 5000 mcg strength, 1 per week may be sufficient. You can find these at most places that sell vitamins. For info concerning B-12 deficiency? and some helpful informative links for B-12- http://www.umm.edu/altmed/articles/vitamin-b12-000332.htm (Thanks Paul! AAwesome site) This site lists "possible interactions" with B-12 supplements- Antibiotics, Anti-Ulcer meds, Metformin, etc… "Normal" just plain oral B-12 pill? Might as well throw it in the toilet and save yourself the time. Although ‘Some’ will be absorbed, It will not be adequate to prevent nutritional complications if you’ve had RNY. Best Wishes- Dx