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.

It’s not uncommon for people to end up needing more B12 than the ASMBS recommends starting with, though.  So we gotta watch our labs.

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.

Thanks for posting this.  I had B12 deficiency diagnosed prior to my surgery.  It was just about 250, and my feet were tingling.  I took multivitamins, and also ate whole grains, so it was a surprise to me.  I started feeling much better, since I started on the B12  I would recommend testing for people who don't have surgery, since there are potentially permanent effects.

I agree with you, I recommend everyone get their B12 and vitamin D checked whether they had WLS or not.

Kelly, my NUT said we are to use the sublingual B-12 2500mcg - 3000mcg per week. She said we did not need any more than that.

By the way, looking at my lab results from when I was in the hospital it says I have 554 for B-12 and that normal is between 254-1320. In your opinion is that good or on the low side?

Do you agree?

I'm really feeling concerned about my NUT. She is also one of those that said that drinking soda will stretch my pouch, soooooooooo lol.

Wynter

How often?

Kelly, I was not through with my post and accidently hit Submit. It's all there now. Thanks!

It's on the low side.  Around 550, people generally start getting tired and depressed.

The amount she told you, 2500 - 3000 mcg once a week, is in line with the ASMBS guidelines.  If I were in your position, though, I would take more since your level is kinda low.

my b12 is 900and something. i take sublingual liquid b vitamin complex EVERY DAY.

my vitamin d is well above the "normal" range. i take dry d3 50,000 IU EVERY DAY (i get it from vitalady)

this works for me.

downside, my ferritin is 7. i hate taking my iron cuz i can't poop when i do. working on that. hemoglobin and hematocrit is normal.

ETA:

b12 931 (High by 'normal' standards)
vit d 140 (High by 'normal' standards)
folate greater than 20 (H)
b1 153 (normal range)

Have you tried Proferrin? I take 3-4 per day and so far it seems to be keeping my ferritin up since my infusion. It contains magnesium oxide an mag citrate which have helped tremendously with bowel movements.

I have not, but I will definitely check it out.