First b-12 shot

After an earlier post by someone with vitamin deficiency issues and Vitalady's subsequent response, I looked at my past b-12.  It went from 1200 before surgery to 300 a couple months ago.  I have been just out of it lately and decided to go to the doctor this week...just the primary not surgeon(too long to wait).  He drew blood for all sorts of tests since I am a year out and said he would give me the b-12 that day.  He said it wouldn't hurt to have too much either way.  He suspects it's only gone down from the 300 anyway.   Well, I had it and feel a lot better. It's not like an adreniline rush like I had hoped...but I do not feel like napping at 3pm and since I can make it through the day without napping, I am sleeping better at night.  Better all around.  He thinks weekly shots will be good for awhile, but we won't get the labs bac****il Monday.   Thanks guys....everyone's questions help! Rachael

Wow. I am totally impressed. A PCP who knows 300 is too low and offered to give a shot without you begging? And THEN, he knows weekly will be right? That's almost to good to be true!

Thing is, you want your level to be over 800, so whatever frequency works.

I do weekly and barely even reach 800. My dh does 'em and holds about 1500. So not fair.

Here's a quick WHY on B12. It's a lot of info I wrote many years ago, but you're mostly interested in WHY, which is the first paragraph or so.

This is how B-12 doesn't work for us. Extracted from food, it formerly passed into the lower stomach, acid and enzyme ****tail, mingled with the intrinsic factor and from there went through the duodenum and down the jejunum, etc and distributes itself accordingly. Got no acid/enzymes, got no duodenum, got no jejunum. Can't mingle the B-12 with the intrinsic factor. Can eat B-12 all day and swallow it but it sits forever at the bus stop waiting for the bus, which never comes.

Dots are supposedly absorbed via the mucous membrane of the mouth. The Nascobal (Rx) nasal spray works on the same theory. Never seen the Nascobal work for anyone long term. The dots do work but, in theory, they cannot. No intrinsic factor. In theory, B-12 naturally decreases in everyone after age 50.

Excerpted from Earl Mindell's Vitamin Bible (bearing in mind that he is talking to people who have the use of their stomachs and access to intrinsic factor, which does not apply to RNY people):

Water soluble and effective in very small doses
Commonly known as the "red vitamin," also cyanocobalamin
Cyanocobalamin is the commercial available form of vitamin B-12 used in vitamin pills
Measured in micrograms (mcg)
The only vitamin that contains essential mineral elements
Not well assimilated through the stomach
A diet low in B-12 and high in folic acids (such as a vegetarian diet) often hides a vitamin B-12 deficiency.

A properly functioning thyroid gland helps B-12 absorption. Symptoms of B-12 deficiency may take more than five years to appear after body stores have been depleted. In the human diet, vitamin B-12 is supplied primarily animal products, since plant foods (with minor exceptions) don't contain it.

What it can do for you:

Form and regenerate red blood cells, thereby preventing anemia
Promote growth and increase appetite in children
Increase energy
Maintain a healthy nervous system
Properly utilize fats, carbohydrates and protein
Relieve irritability
Improve concentration, memory and balance
Deficiency: pernicious anemia
Best natural sources:

Liver
Beef
Pork
Eggs
Milk
Cheese
Kidney
Supplements:

Because B-12 is not absorbed well through the stomach, (Earl Mindell) recommends the sublingual form of the vitamin (and another one we cannot use).

Toxicity:

There have been no cases reported of vitamin B-12 toxicity, even on megadose regimens.

Enemies:

Acids and alkalies
Water
Sunlight
Alcohol
Estrogen
Sleeping pills
If you are a vegetarian and have excluded eggs and dairy products from your diet, then you need B-12 supplementation. (This would also apply to those who cannot digest these or mix them with intrinsic factor - people with the lower stomach out of the system). If you drink a lot, B-12 is an important supplement for you. Combined with folic acid, B-12 can be a most effective revitalize. Surprisingly heavy protein consumers may also need extra amounts of the vitamin, which works synergistically with almost all other B vitamins, as well as vitamins A, E and C. Elderly people (another reference reads "over 50") frequently have difficulty absorbing vitamin B-12 and require supplementation by injection. Women may find B-12 helpful, as part of a B complex, during and just prior to menstruation.

Combining symptoms mentioned:

Body odor
Heart palpitations
Menstrual problems

Mouth sores and cracks
Vaginal itching

Well, I didn't exactly ask.  I said my B-12 was low and steadily getting lower from the surgery and that I was just not able to make it through the day without naps and I wanted to try this since it isn't going to hurt me.  He did the labs and said he'd give me the shot right then.  Who knows what he will say when the labs come back, but he is usually agreeable if I tell him I want something...especially if it can't hurt me.  He's never said no when I go in prepared and tell him what I want.  I guess that's good in just about all cases.   Thanks for passing along the info.  If we don't have access to the intrinsic factor how does the shot work?  I had been taking the pill Foltrin with iron, b-12 and intrinsic factor, does that work? Thanks Rachael

foltrin is Triniscon, and no, not especially. It's nice that it has some IF in it, which would boost a normal person. But we've got NOTHING. It's good for someone who is just aging and has LESS IF, but we have none.

When I was ready for shots, I told my PCP and he said, "But it's not that low" and I said, "No intrinsic factor, never going to have it, never going to get any better and I don't want to FEEL sick." So, he did. Was a little nervous at first and tested before each shot, but fast fwd to today and he has read the "800 is low" study and didn't bat an eye when I said I wanted rx for weekly shots. Whew. I'd been using the veterinary product I can get on line w/o the rx, sinced I wanted more shots than he did. Now we're on the same page, tho. I still am using up my vet stuff, since I paid for it. Perfectly good B complex in there.

But I prefer the rx. No matter how you buy the B12 "juice", it's CHEAP. Even if ins does not pay. I paid $7 for a 30 shot vial at Costco (no ins), but I did have to have na Rx.

Yeah, I was excited to see how cheap it is compared to the sublingal.  I have a mail order option on prescription insurance and a ninety day supply of one shot a week is only $3.50.  I suppose the syringes will cost something as well.  Do you have a link to the "800 is low" study or anything on bariatric patients and b-12 that says the 300 is low enough?  I want to come in with ammo whatever the lab results are. thanks Rachael

try www.jefferspets.com you want the 3ml 25g 1". They're about $13 for 100 OR www.calvetsupply.com . They go back 'n forth with pricing as to who's better.

And yes, my Rx one is just under $3 also, for 12 vials (once/wk). But I HATE those little 1ml vials! Hard to load! But that's what my insurance provides. So, Igot a new rx and bought the 30 shot vial at Costco for $7, cash pay.

I was, like so many, afraid of needles, both end! But now we just give each other our shots Sat. night and that's it.

I haven't seen how the patch works at all yet. I know the Nascobal hasn't worked for one single person I'v known. "Worked" meaning held the levels over 400, for example.

You'd have to email me privately and maybe I can find the link on the 800 study. I'm not particurlarly good at grabbing stuff in my "brain" and bringing it over here. Im' good at forwarding stuff, tho. LOL

Michelle, I was on your site this morning and it prompted me to try one of the samples I ordered awhile back from you, the Nectar twisted Cherry.  It was great.  I think I need to get back to the shakes because I am starting to crave sweets.  I never did pre-surgery, as I was a salt fiend, but I don't think I am getting enough protein in.  I am eating enough of it, meat sits well, but I wonder how much I am actaully taking in.   What I was wondering was, where did the Davinci SF Chai Tea syrup go?  It's my fav.   Thanks Rachael

I'm a chocolate girl, myself. Not overly crazy about cherries in little fruit balls OR liquids. LOL Yes! sweets cravings can sometimes be subdued with protein, as long as you don't add sugars to it (milk, juice, fruit). And it's true that low protein will first manfest as sweet cravings. Weird, huh? When the traditional source of protein is meat, which is not sweet!

For a proximal, I figure they get about 30% of eaten protein, less of iron, calcium, A, D, E, zinc. No B12 at all, of course.

The Chai is there. They all got new labels so harder to spot.

Excellent advice as usual, Michelle. I'm able to keep mine in range with sublingual B12 (the "dots"). I'm not sure how they work but they do, so I'm thankful for that. I have a friend (non WLS patient) who has been given patches by her doc. What do you know about those? Seems like it could be a good option for those of us who don't want the shots or who, in my case, have a hard time getting in to see someone regularly (I'm a nurse, work nights, and have a crazy schedule that varies from week to week). I'm curious as to what you, or anyone else, knows about the patches and if they're a viable option for us. Thanks, Vickie

Oops, answered the patch question in one of the ones above.

How do the sublinguals work? They are absorbed via the mucous membrane of the mouth, like sugar and alcohol. So, they don't need the IF to bind in order to be absorbed in the intestine. Since the whole gut system is bypassed when they are sublingual, our bodies' inability to process it correctly becomes moot.

Now, if you SWALLOW your B12 pill, liquid, sublingual, it's just as lost as the hunk of liver you know you love. LOL Once you drop it into the gut, it HAS to have IF to be of any use and since it can't get to the IF, it's a big waste of $$$.

If ppl go down in B12 and are faraid of shots, we can try the 10,000 units of cyancobalamin (the one you think of when you think B12) OR 5,000 units of methylcobalamin, which is the better(read: more $), "final" form of B12. THE methyl is the one that the body recognizes, so the cyan has to be able to convert to that.

Lots of ppl opt for the pricier methyl form just so they get IT ALL. LOL But like we all agree, the shots are way, way, way cheaper.