about B12.  Since I just finished my B12 shot.

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 “in range" for B12. This used to confuse 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 didn’t get how labs can say that’s normal.  Then someone explained to me that the “reference ranges" listed on lab reports are NOT “normal" ranges or the ranges recommended for good health.  Instead, they are just the “average range" found in a number of test subjects.

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.

Does your doctor give you injections or do you have a supply of them that you can do yourself ( as like a prescription)???

I do them myself.  A doc has to write a prescription, which you can fill at any pharmacy.  They are very easy to do.  For a long time I had my partner do them because I felt uncomfortable sticking myself (although I have a cat I give insulin shots to every day and that does not bother me at all, somehow sticking myself is different).  But I finally got over it and it's actually very easy and it does not hurt.  I could go to my PCP's office to get them but that would be a pain and much more expensive than doing them myself.

Kelly,
I used to give myself injections when I had gestational diabetes.  I found those injections very easy but don't the b12 ones have to be injected into the muscle?  Where to you do yours?  Thigh?  Is it the same needle as an insulin needle?  I'm considering since my insurance isn't covering b12 nasal spray as well as it used to.  Can't afford 100 bucks a month for that.  Thanks

Some people say B12 should be given IM but others say sub-q is also OK.  I asked my PCP and she said she has always given them sub-q.  So that's what I do.  My needle is very skinny.  I'm not sure if it's the same as an insulin needed or not.  The pharmacist told me it's the type of needle many people use for allergy shots.  I do them in my thigh or belly.  When my partner gives them to me, he usually does them in my upper arm.

awesome.I will definitely look into that. My doctor shouldnt have a problem with it. That eliminates one extra thing a day. Thanks!!

If my next labs don't shoot up, I'm going to look into nasal spray or shots.  I doubled my dose (500 mcg to 1000 sublingual), and my levels still fell.  It's not horrible (700s), but I'd like it a little higher.

Thanks Kelly! I really appreciate all the info you share with us!

Friday is my B12 day, too.  Friday seems to be a good day to remember for some reason...

 I did mine on Saturday.  I am shooting for the 1st of each month.  I have never had to give myself shots of any kind but am giving myself a B12 shot and its very easy and doesn't even hurt.  I was shown on my thigh where there is a big muscles so i take the shot on every other thigh each month. Much easier than taking a pill.  My prescription plan covers the shot and the needles..