Stuff to Know About B12
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.
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.
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.
Some of us may have a problem even with B12 subligual - even when taken daily in large dosages. I never could get my B12 above 600 even when i was taking 3000-5000 mcg 4--6 times a week. My body would just not absorb it and stored it properly.
I decided to start injections. Initially I was on 1000 mcg once a month, then increased to 2 x a month, then increased to once a week. With once a week for a few months now - my last blood work show app 800.. That was after one week 1000mcg injection.
To make sure your blood work is accurate - do not take B12 (any form) 2 -5 days before the test. So you can really see how well your body is managing the B12.
Hala. RNY 5/14/2008; Happy At Goal =HAG
"I can eat or do anything I want to - as long as I am willing to deal with the consequences"
"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."
I've always taken 2000-3500 mcg a day since surgery (rarely missing this vitamin). I've had my PCP (old one and new one both) tell me I was wasting money taking so much since my numbers have always been between 1500-1900 consistantly. My response is always it's cheap, and I want my numbers to stay right there.
Proximal RNY Lap - 02/21/05
9 years committed ~ 100% EWL and Maintaining
www.dazzlinglashesandbeyond.com
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.
For injections, you need a prescription. You can go to your doctor's office to get them, or get a prescription and get the needles and B12 at any drug store and do the shots yourself. That might sound kinda scary but it's really really easy and much more convenient than a trip to the doctor. For me it's cheaper too - my insurance copay for meds is much lower than my copay for a visit to the doc.
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.
