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.
B12 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.
Kelly
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.
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.
I am pre-surgery, currently awaiting surgery date notification, and have met with my Surgeon. He mentioned that I am to take a B12 supplement (preferably sublingual) once per week. But when I read about B12 both online and the bottles themselves in the store, the instructions say to take them daily.
What do you all do? Weekly or daily? and also, what strength of B12 do you take both pre and post surgery? I've seen them ranging from 50mg up to 2500mg. I am currently within the B12 appropriate range right now (maybe a little on the lower side).
I'm just curious as to what other patients take.
Sian 
"If you can imagine it, you can achieve it. If you can dream it, you can become it."
Surgery Date 8/25/2011
Highest Weight 310lbs - Current Weight 154lbs - Goal Weight 175lbs
Now, I do B12 shots. Often you can do those just once a month but mine was low and so far I've been doing them once a week. I am thinking of cutting back to every other week, though.
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.
For me, I think it will be easier if I know I'm taking the same pills every day, so the 500mg sublingual might be the way to go for me. When I start throwing once a week or once a month items in there, I'm worried I might forget, or delay taking it and cause more bad then good.
I'll have to do a search on more of your vitamin discussion threads. Sounds like they will be extremely helpful for me.
Thanks again =)
Sian
"If you can imagine it, you can achieve it. If you can dream it, you can become it."
Surgery Date 8/25/2011
Highest Weight 310lbs - Current Weight 154lbs - Goal Weight 175lbs
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.
Thank you for posting this. I don't know whether it is lack of B-12 or insomnia that makes me fatigued and ready to go to bed at 7pm at night. I have my liquid B-12 right at the kitchen sink, but rarely take it anymore. I am going to take it every day and see if that helps.
Is there a specific website or reading material that you suggest to get more of this information on B-12. I am coming up on my yearly checkup and would like to see what my bloodwork shows.
Thank you again!
Ann
If you haven't been taking the B12 regularly, you're probably low. Get it checked, get the specific number so you can decide how much you need to suppliment.
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.
