Stuff to Know About B12
Tonight's public service announcement:
After RNY, we need to take a B12 supplement. Since part of our small intestine has been bypassed we won’t absorb B12 as well as we used to, but even more concerning is the fact that we need something called intrinsic factor in order to absorb B12 and we have very little of that in our new pouch. Therefore we will absorb very little B12 that we swallow. That includes B12 in food we eat and B12 in a multivitamin. Doesn’t matter if it’s a multi that we swallow whole or a chewable or a liquid. If we swallow it, we won’t absorb much of the B12 in it.
So we need a B12 supplement that we don’t swallow, and there are several to choose from. There are sublinguals that dissolve under the tongue, there is a patch you stick behind your ear, there is a nasal spray, and there are injections. Most people will absorb any of these equally well so it’s just a matter of personal preference. Sublinguals and injections are cheap. The nice thing about injections is most people only need them once a month. The nasal spray is just once a week but you need a prescription for it and depending on your insurance coverage it might be costly. The patch is convenient and most people just need one a week, but it’s kind of costly.
If you use a sublingual, the ASMBS recommends 350-500 mcg per day. If you use injections, they recommend 1000 mcg once a month. The ASMBS doesn’t address the patch or nasal spray, but the patch contains 1000 mcg and is normally used once a week, while the nasal spray contains 500 mcg and is normally used once a week. The reason the doses seem very different is because the B12 is absorbed differently depending on how you take it.
B12 is supposed to be pretty rare in the general population, but I kind of question that. Many people go their entire life without ever getting their B12 tested, so how would they know if they were deficient? Also, many labs and health care professionals use ridiculously low values as a “normal range," which I’ll talk about in just a moment. Regardless, it’s not rare in RNY folks.
Most labs and health care professionals consider anything from 211-911 to be “normal" for B12. This confuses me greatly. Studies show that when B12 drops below 550, people start experiencing things like depression, fatigue, difficulty concentrating, and problems with short-term memory. When it drops below 400, they start having numbness and tingling in the hands and feet. That’s because they are developing nerve damage. And that nerve damage is often permanent. Never goes away. They can start taking more B12 and get their level up and prevent further damage, but they will probably feel like their hands and feet are falling asleep for the rest of their lives. So I don’t get how labs can say that’s normal.
It’s also not bad for your B12 to be over 911. There is some question about whether or not there is such a thing as B12 toxicity. Some sources say yes, some say no. If there is, it would only occur when your B12 is very high, probably over 2000. And it’s probably not very dangerous if your B12 does get over 2000. It will not cause permanent nerve damage or anything like that. Still, if your B12 is close to 2000, it probably makes sense to cut back on your supplement. I would suggest cutting back slowly, though, and watching your labs carefully because you really don’t want to get too low.
When you get labs done, it’s important to make sure you get the actual number. Don’t take your doc’s word for it that it’s OK. Docs often tell people their B12 is normal when it’s 300 or lower, when they could be developing permanent nerve damage.
After RNY, we need to take a B12 supplement. Since part of our small intestine has been bypassed we won’t absorb B12 as well as we used to, but even more concerning is the fact that we need something called intrinsic factor in order to absorb B12 and we have very little of that in our new pouch. Therefore we will absorb very little B12 that we swallow. That includes B12 in food we eat and B12 in a multivitamin. Doesn’t matter if it’s a multi that we swallow whole or a chewable or a liquid. If we swallow it, we won’t absorb much of the B12 in it.
So we need a B12 supplement that we don’t swallow, and there are several to choose from. There are sublinguals that dissolve under the tongue, there is a patch you stick behind your ear, there is a nasal spray, and there are injections. Most people will absorb any of these equally well so it’s just a matter of personal preference. Sublinguals and injections are cheap. The nice thing about injections is most people only need them once a month. The nasal spray is just once a week but you need a prescription for it and depending on your insurance coverage it might be costly. The patch is convenient and most people just need one a week, but it’s kind of costly.
If you use a sublingual, the ASMBS recommends 350-500 mcg per day. If you use injections, they recommend 1000 mcg once a month. The ASMBS doesn’t address the patch or nasal spray, but the patch contains 1000 mcg and is normally used once a week, while the nasal spray contains 500 mcg and is normally used once a week. The reason the doses seem very different is because the B12 is absorbed differently depending on how you take it.
B12 is supposed to be pretty rare in the general population, but I kind of question that. Many people go their entire life without ever getting their B12 tested, so how would they know if they were deficient? Also, many labs and health care professionals use ridiculously low values as a “normal range," which I’ll talk about in just a moment. Regardless, it’s not rare in RNY folks.
Most labs and health care professionals consider anything from 211-911 to be “normal" for B12. This confuses me greatly. Studies show that when B12 drops below 550, people start experiencing things like depression, fatigue, difficulty concentrating, and problems with short-term memory. When it drops below 400, they start having numbness and tingling in the hands and feet. That’s because they are developing nerve damage. And that nerve damage is often permanent. Never goes away. They can start taking more B12 and get their level up and prevent further damage, but they will probably feel like their hands and feet are falling asleep for the rest of their lives. So I don’t get how labs can say that’s normal.
It’s also not bad for your B12 to be over 911. There is some question about whether or not there is such a thing as B12 toxicity. Some sources say yes, some say no. If there is, it would only occur when your B12 is very high, probably over 2000. And it’s probably not very dangerous if your B12 does get over 2000. It will not cause permanent nerve damage or anything like that. Still, if your B12 is close to 2000, it probably makes sense to cut back on your supplement. I would suggest cutting back slowly, though, and watching your labs carefully because you really don’t want to get too low.
When you get labs done, it’s important to make sure you get the actual number. Don’t take your doc’s word for it that it’s OK. Docs often tell people their B12 is normal when it’s 300 or lower, when they could be developing permanent nerve damage.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
thanks for posting this Kelly. I had my labs tested last month, and I was told my b12 was VERY high, and it was at 1140 (if I'm remembering correctly). My PCM told me to cut back on my suppliments (1 every other day)...now of course I'm wondering if I should have listened.
"I can do all things through Christ, who strengthens me" Phil 4:13
Don't but back. 1140 is not very high, it's beautiful.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
Good stuff Kelly. One thing. You said you doubt the rarity of b12 because folks go their whole lives without getting tested so how can they know if they are deficient.
Yes...and when they get old they get senile, which may very well be the result of a b12 deficiency. My grandfather eventually developed Alzheimer's but when WE first thought he had it, he was tested and had a severe b12 deficiency.
With the rate of older people having cognitive problems, it isn't very hard ro me to believe that b12 deficiency could be very widespread among humans.
Yes...and when they get old they get senile, which may very well be the result of a b12 deficiency. My grandfather eventually developed Alzheimer's but when WE first thought he had it, he was tested and had a severe b12 deficiency.
With the rate of older people having cognitive problems, it isn't very hard ro me to believe that b12 deficiency could be very widespread among humans.
So your extremities falling asleep is a sign of a b12 defiecency? for the past month my hands and feet have been falling asleep very easily and when i asked my surgeon he said he wasnt concerned....but i think ill make an apt with my pcp and ask her to do labs. Thanks Kelly this is oneof the many reasons i love this place!
Yes, that's a sign of B12 deficiency. Now, it's not the only thing that can cause it. If you're getting labs done to look for a cause, get B1 and copper, too. But other things, like a pinched nerve, could be at fault. But B12 is probably the most likely. And it's sure easy to check.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
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