Since we've been talking about B12...

here's why it so important to remember to take it.  Nik.  And anybody else.

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 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.

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 nasal spray, but it 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.

B12 deficiency 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 Kelly, You know my left hand has been tingling for the last month.  I always figured that I was just resting it wrong... Now I wonder if it is an indicator of something else. 

Oh you are preaching to the choir. I've been taking it and all my vitamins religiously since that "word losing" incident. That scared the crap outta me. My NUT things my long term memory loss may be a function of either low b12 specifically or low overall b vitamins but she said often that doesn't show up on labs. My doc advised me on how to change up my regimen and it's interesting because the last week or so I haven't been so forgetful.

The reason some B vitamins often don't show up on labs is because docs often do not order those labs.  If your doc writes an order for it, the phlebotomist will draw the blood for it, the lab will do the test, and it will show up on your lab report.

My partner has that word losing thing kind of a lot.  I was teasing him for a while that he was developing early Alzheimer's but I'm actually worried now that there is something wrong with him.  I actually made him get his B12 tested, along with his vitamin D, maybe 18 months ago.  His B12 was around 700 so not low enough to be causing that.  But he now takes a B12 supplement so his level should be above 1000 now.

No my NUT specifically said when she orders those labs the results aren't commensurate with the symptoms patients are describing. So they'll have levels well above the baseline but will have the symptoms of deficiency.

I don't know enough about vitamins to know why that would be. She doesn't seem to know either but she said she's seeing it more and more.

Oh, I see what you mean.  And you know what?  I think I might know why that is, at least with some vitamins!

An OH member that works in a lab recently explained to me how labs come up with their "normal ranges."  What they do is test a fairly small number of people, often some of their employees, that are presumed to be in good health.  Whatever numbers they get, they average them out and that's where their normal range comes from.

Now, with some vitamins, like vitamin D, almost everyone in the U.S. has levels that are low enough to put them at increased risk for osteoporosis and heart disease and all that stuff.  And there is research that shows that your level needs to be at least 80 in order to reduce those risks for you.  But labs don't pay any attention to any research like that when determining their normal range - they only pay attention to the levels in the small sample of people they tested.

And apparently B12 deficiency is more common than many medical professionals seem to believe it is, because they came up with a really low range for that one too, based on the levels of the people they tested.  So your B12 can be low enough to cause nerve damage in your hands and feet but apparently there are enough other people out there with B12 that low too, so the labs list it as normal.

My B12 was at 1680 at my 3 1/2 month check up.  Eventhough the results said high, my doc was happy with it.  I do have a question though that I've been wondering for some time.... What is intrinsic factor?  Does it have an effect on any other vitamins?

It's a protein made by the lining of your stomach.  But since we only have a tiny pouch now, I guess there's not a lot of the lining in there to make it.  As far as I know it does not affect other vitamins.