Stuff to Know About B12

poet_kelly
on 1/15/12 12:10 am - OH

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 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.
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.

View more of my photos at ObesityHelp.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.

 

WhoIWantToBe *.
on 1/15/12 12:26 am
RNY on 01/10/12
 Thank you for this.

I really appreciate you, Kelly.  I've learned a LOT from you.
Jessica A.
on 1/15/12 12:46 am - Auburn, AL
 If the recommendation is 350-500 mcg per day for a sublingual and with the absorbtion issue, do you think my 2500 mcg sublingual is effective?  I only take it once a week but my multi also includes 100 mcg which I take daily.  I just had my labs drawn and am waiting for my copy to come in the mail.  I will be interested to see what my level is at now.
   
poet_kelly
on 1/15/12 12:49 am - OH
Yeah, that's about the same as taking 350 mcg a day.  You may  need more or may not.  See what your labs tell you.

You're not gonna absorb the B12 in your multi because of the lack of intrinsic factor in your pouch.

View more of my photos at ObesityHelp.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.

 

GoldiesGirl
on 1/15/12 1:47 am
After reading this info, I'm wondering if I'm taking too much B12.  I will admit I've been a little bit laissez faire with my vitamin regime because my surgeon has a vitamin package they recommend, and I just buy them all in 30-day increments.  I am due for updated labs for my 6-month appointment in late March.

Pre-op, I did have a bit of a B12 deficiency.  I would get weekly shots, then just took the sublingual, then fell out of the habit altogether.  After reading some posts here, I started taking my B12 sublingual again.  I take it twice/day.  It's 2500mcg.  Without having labs to base anything off of, am I taking too much?  Or am I hurting anything to take it twice a day?  I don't know where I got the idea to take it twice, perhaps because the directions say to take one/day, and I figured with my internal setup it wouldn't hurt to double it.

I aprpeciate any thoughts.  Thanks!!
        
poet_kelly
on 1/15/12 1:56 am - OH
That's probably more than you need, although it's hard to take too much.  What happens is, since it's a water soluble vitamin, you just pee out any extra.  But why take more than you need when it just means you have to buy more and then have expensive pee?

than again, not knowing your numbers, it's hard to say if it is too much.  I guess your options are A) call your doc and ask him/her to order a B12 test for you now instead of waiting two more months, B) keep taking what you're taking and then adjust as needed when you get labs done, or C) cut that down to once a day and adjust as needed when you get labs done.

View more of my photos at ObesityHelp.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.

 

Kaysmommy
on 1/15/12 1:53 am - Silver City, NM
Thats exactly why I got the shot last week.  I found myself avoiding the sublinguals, because I hated taking them.  Because of you great knowledgeable peeps on OH I knew I needed it for sure.  So now once a month I will give myself the shot.  My surgeons nurse was concerned when I said Ill do them myself, but I assured here after doing IVF to get pregnant the shots were the easy part.  

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poet_kelly
on 1/15/12 1:58 am - OH
I wonder why she was so concerned.  Lots of people do their own B12 shots.  It's easy.  At first I had my partner give me mine because I was squeamish about sticking myself, but I got over that and can do them myself now.

View more of my photos at ObesityHelp.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.

 

TysCandi
on 1/15/12 2:27 am
RNY on 12/14/11 with

Kelly can I take my b12 sublinqual with my calcium?

    
 
HW: 326  SW: 312  GW:140

        
Bettisima
on 1/15/12 2:41 am
I am not Kelly, but the answer is yes. Iron is the 'weak' vitamin that needs to be taken separately from others. But you can take your b12 with any of your vits.
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