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.
B12deficiency 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.
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.
B12deficiency 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.
Sublinguals and the patch do not require a prescription. The nasal spray and shots do.
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.
Sublinguals you can find in lots of store or you can order online. I don't use them so I'm not sure of the price range but I don't think they are too much.
The patch I've never seen in stores. I think you have to order online. I used it for a while and ordered mine from Healthy Habits. It's been a while so I can't remember how much it was but it was more than sublingual, I'm pretty sure.
If you have insurance that covers prescription drugs, it probably covers the nasal spray. You should be able to fill the script at any pharmacy. What it would cost would depend on your copay. If you don't have any insurance that covers, my guess is that it might be expensive but I'm not sure.
You can fill a prescription for the shots at any pharmacy, too. Again, your insurance will dictate the cost to you. I only had a $2.50 copay for the actual B12 but my insurance won't cover the syringes so I had to pay for that myself. It was cheap though. I think I spend about $20 on a box of 100.
The patch I've never seen in stores. I think you have to order online. I used it for a while and ordered mine from Healthy Habits. It's been a while so I can't remember how much it was but it was more than sublingual, I'm pretty sure.
If you have insurance that covers prescription drugs, it probably covers the nasal spray. You should be able to fill the script at any pharmacy. What it would cost would depend on your copay. If you don't have any insurance that covers, my guess is that it might be expensive but I'm not sure.
You can fill a prescription for the shots at any pharmacy, too. Again, your insurance will dictate the cost to you. I only had a $2.50 copay for the actual B12 but my insurance won't cover the syringes so I had to pay for that myself. It was cheap though. I think I spend about $20 on a box of 100.
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.
I take B12 sublinguals that are 5000mcg (yes, 5000), dissolve quickly, have a very mild berry flavor, and are cheap ($10 for 60). Because the dose is high, I only have to take it once a week (and my B12 is consistently right at about 1000).
They are from Twinlabs and are available at Vitamin Shoppe and Kroger:
www.vitaminshoppe.com/store/en/browse/sku_detail.jsp
There is also a 500 mcg version which is 100 tablets (they call them "dots") for $8.50.
Beware the Bariatric Advantage B12s. Not only are they much more expensive than most brands, but they take FOREVER to dissolve (and I thought they were very rough under the tongue). The Celebrate cherry flavored ones taste really good (to me, anyway), but they are also quite expensive so I stick with the Twinlabs since it is working great for me and I only have to take it once a week.
Lora
They are from Twinlabs and are available at Vitamin Shoppe and Kroger:
www.vitaminshoppe.com/store/en/browse/sku_detail.jsp
There is also a 500 mcg version which is 100 tablets (they call them "dots") for $8.50.
Beware the Bariatric Advantage B12s. Not only are they much more expensive than most brands, but they take FOREVER to dissolve (and I thought they were very rough under the tongue). The Celebrate cherry flavored ones taste really good (to me, anyway), but they are also quite expensive so I stick with the Twinlabs since it is working great for me and I only have to take it once a week.
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
Hi thanks for the information I had just had my labs done and my b12 was 2000 so I think I need to cutt back on the shot I had taken it twice last month so I am cutting back to one time a month. I had to get my family doctor to do my lab work because my RNY doctor didnt check anything his nurse said he doesn't do lab work unless you are having issues. I told you about that before you gave me the labs that you have run and I got my doctor to run it. I wanted to thank you for that as well.
HW 286 SW 266 CW 180
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