Numbness & Tingling in my leg

LIke I listed in my other post, B1 and B12 deficiency are very serious.  We need to be supplementing these from day one and then monitoring these vitamins in our blood with frequent blood tests to avoid serious deficiencies.

B1 - I started out deficient at about 4 months out and was taking 300mg daily from that point on and still do.  My levels are a bit high now but that is fine, must better than too low. We just pee out the excess.  Not enough can cause nerve damage and for a long period of time can cause us to lose feeling in our legs and feet - ultimately losing the ability to walk.  This can be avoided by supplementing and testing.  I have only seen this a few times with postops that just felt the need to take supplements post op werent needed and it wasnt until they were hospitalized with severe complications including the inabilty to walk did they realize what they had done.

B12  = I had B12 deficiency for over 15 years long before my gastric bypass and was taking B12 shots 3 times per week since then.  I also had Chronic fatigue syndrome and needed extra high B12 levels to keep my energy levels up, so the shots helped.  Having high B12 levels dont have any adverse affect, you just pee out the excess just like B1 - they are both water soluable vitamins.  They are only dangerous when too low causing deficiency and nerve damage if too long.

You really need to get your labs checked.  First I would call your surgeon and ask for your old ones to be sent to you via Fax - if wont do that then ask for them to be mailed.  You have every right to see your labs and have copies.  they are your records.  Dont give up, insist.  If they still wont do it - call your PCP and ask them to call and get them.  They cant refuse another doctor.  Then make an appointment with your PCP and sit down and go over them with him or her.  Then get a copy and bring them here and either post them on these boards for us to review with you or if you would like, PM me and I will go over them with you.  You really need to get on a proper regimine but you need to know your levels first.

I tend to think you  may be missing more things - as far as the copper - please dont supplement until you know if you are deficient.  Yes, it can cause a deficiency causing some of your symptoms but if it isnt your problem and you take it anyway, you can become toxic and that will only cause even worse problems.  You need to have both Copper and Ceruloplasmin taken together because there is a combination of the that mean totally different results.  I have to look it up again but it is really important that they are dont together.  One combination means deficiency and theother means toxicity.

You should also be taking calcium citrate 1500-2000mg per day, multivitamin 2 times per day (no iron in it - centrum silver is a great choice - chewables if your like are good too) but make sure they have selenium in them,   vitamin D3 - should be Dry D3 - again based on labs but almost everyone by 1 year out is vitamin D deficient if they havent been supplementing properly up til now - we are all pretty much prior to surgery.  The best option is Dry D3 from vitalady,com called D3-5 and D3-50, either 5,000 or 50,000 unit capsules - most need to start on 10,000 units daily or 50,000 units per week and then adjust up - many needing more.  Carbonyl iron with vitamin C - I do hope you have been taking this also from the start = vitalady.com has a great choice called tender irons - 60mg each capsule with 400mg of vitamin C ta-ke  many takes between 3-5 per day at bedtime with great results.

The B1 I talked about above -this is the dosing range my NUT gave me - From day one, every one takes 100mg per day and then if your ranges change to a different range as follows,

range for B1 is 9-44  (below 9 to 15 - 300mg per day) 
                                     (from 16 to 35 - 200mg per day)
                                     (from 36 and over 100mg per day)


Even if your range gets better with supplementation, dont drop your dose.  You need to continue at the dose you were put on or your level will drop again.  The most I ever did was cut from 7 days per week to 5 days per week/  There is no danger in a high level, it is actually a good thing.

Your B12 - you mentioned you have been taking a B12 shot once per month - that is probably a good part of your problem along with no vitamin B1 for a year.  The normal starting dose for B12 is 1000mcg of a sublingual B12 or a monthly injection but a good majority by 3 months if not 6 months needs to increase there doses to 2500mg daily or injections 2 times per month and many even weekly - a few more than weekly like myself but monthly is very rare post op after the first few months.  We just need alot more than the average person.

People that havent had WLS need levels of 200-900 and we need levels of 1200-1800 or even higher so in order to get levels that high, you need alot more B12.  If my levels are less than 1000, I can hardly get out of bed.    I know exactly when to ask for B12 level when not due. I can tell.

If you need the complete list of labs, I can send it to you.

I do hope this helps

I have this in my left leg on the outside of the calf to the top of the foot... PA said it has nothing to do with the surgery and suggests a neurologist - but I am 11 months out and it just started about 3 months ago. It's frustrating. Kelly, do you know how much B1 and copper we need/should take?

I know, I had asked her about getting labs done earlier & she said that we have stores for 6 months & then tells me it might be a deficiency & I was like ok if that's the case why aren't you checking my labs? Lol I was passing B12 oral tabs whole in the toilet & have since switched to the sublinguals the past 2 weeks, so maybe that could be it. Not sure. All I know is it hurts when I walk & is numb to the touch. I will have to contact them again.

If you were taking B12 tablets since your surgery and have only been on sublinguals for the past 2weeks, I can almost guarantee you are deficiencient in B12.  Didnt anyone tell you before you surgery that you needed either a sublingual or an injection post op??  if not, that really urks me that surgeons and NUTs dont give proper supplement advice and then wont due labs and wonder when they finally due the labs after 6 months or a year, they find deficiencies?  It really pissed me off.

First off, we dont have stores for 6 months - especially if you dont take the proper supplements - we malabsorb severely from day 1.  My surgeon doesnt start us on iron until 5 weeks out when we can swallow pills unless you are deficient preop - my levels were really good and within 5 weeks, I was already deficient - it happens that fast.  I got on iron immediately and it was corrected but if labs werent done at 5 weeks and if they waited until 6 months, I would have been a mess.

B12 is even more malabsorbed - we cant absorb anything in a tablet that you swallow - we no longer have intrinsic factor needed to absorb it, so if you dont take a sublingual 1000mcg daily or an injection monthly minimum and most need alot more than that - you will be deficient and then most increase based on first set of labs which should be by 3 months out - minimum.

If you are having the symptoms you are having - please get  a B12 and B1 test immediately and please start taking high levels of both to make sure because if you have a deficiency of either one for too long - it can become permanent - I have seen people that left it too long, end up unable to walk and if you are already having trouble, you need to stop it fast.

Do you take any vitamin B1?  You should be taking a minimum of 100mg per day - capsule preferably - avoid terrible taste and also to absorb it better but the tablets will work.  If you havent been taking it at all, I would recommend taking 200-300mg per day until you get  your lab results - there is no danger in taking too much but severe danger in not taking enough - that is the dose for a deficiency.

B12 - how much did you start to take in a sublingual?  If you are severely deficiencient which I think you are - you are going to need injections but in the meantime - you can take  high dose sublinguals - like 2500mg per day - some take 5000mcg per day for 1 week and then go on the 2500mcg per day from then on.  This gets it up quicly and then it will continue to rise and then maintain.  You want your level to be up atleast 1200-1800 and can go up even higher but if less than 500, you can be at risk for nerve damage.

Please dont put off the blood tests - get to your PCP as soon as possible to get them done. - it is really serious.

My NUT & Surgeon both said before & after that I could take oral B12 & when I had passed it in the toilet they told me to switch to sublinguals. Currently I'm taking 1 500mcg B12 sublingual a day, so I guess I need to increase that quite a bit, surgeon never said anything about increasing it. & I do get B1 in my multi but its only 80mg. I'm pretty sure its nerve damage in that leg also. It is painful & numb to the touch. They acted like it wasn't a big deal, which I found kind of alarming. Not only have I been passing the B12, but my calcium citrate pills as well. I have since started taking calcium citrate chews from Bariatric Advantage. I was also very concerned about them not taking labs until 6 months out too. I don't want to wait that long to find out I'm deficient in something or a few things. That will make me very angry. Thanks for posting, I really appreciate your concern. I have read the ordeal you went through in one of your posts in the past  & am glad that you were able to make it through all of that & are here to help direct us that are new to this journey.

I am really sorry you are having so much trouble with your surgeon and NUT. Unfortunately that is why it is so important to interview them prior to your surgery to see exactly what there program is all about. You then need to make sure you meet with each person individually - the surgeon and ask tons of questions - people come on here all the time asking what questions theyshould ask, then see the NUT for a consult to goover your eating program including preop and post op and then a detailed consult to go over all the post op labs. I got a book with all the information and also got a test to make sure I understood everything and then anything I didnt understand, the NUT went over personally.

If you aren't able to get what you need from the NUT from your program, you might want to find another NUT in your area or from another WLS program that could help you. Many Endocrinologists offices have great Nutritionists that are very knowledgeable in WLS and also in keeping blood sugars in tact. They deal with diets high in protein and low sugars all the time.

I have one question for you - you mentioned you had surgery on May 10th - what was that because in your picture it says your surgery was in February???

As far as your labs go, you shouldnt wait until 6 months especially with the problems you are having - it is essential you get them done now!!!!!!!!!!!! Many post ops, get them done by there PCP;s when there surgeons wont do them often enough and you are a prime candidate for that. Here is a complete list of labs that should be done every 3 months for the first year then after that it is controversial on how often you need them - some get them yearly which I think is crazy - some get them every 6 months which is still too long for me but pretty much the norm - I still get them every 3 months and I am 3 1/2 years out.

CBC, Comprehesive Metabolic Panel, Iron, TIBC, Iron Sat %, Ferritin, B12, Folate, Vitamin D ( 25 Hydroxy), Phosporus, Calcium, PTH, Vitamin A, Vitamin E, Vitamin K, Lipid Panel, Zinc, Magnesium, Selenium, Copper, Vitamin B1 (Whole Blood), B6, B2, B3, TSH, T4 and T3, HemA1C, cortisol and DHEA.
(not everyone needs B2, B3, cortisol and DHEA)

As far as all the supplements you should be taking - I gather from what you wrote that you werent given the proper the information on any of this = so if you need this, I hope it helps = if you already have this = just ignore it but I just hope I can help you = you mentioned a problem with calcium also)

Here goes:

Multi vitamins - 2 times per day - you want to take one without iron = centrum silver is an idea multi and if you like or need chewables, they make a great one and they taste really good ones, I use them. They have everything you need in a multi and you take a seperate iron supplement.

Calcium citrate - minimum 1500-2000mg per day in 3-4 daily doses no more than 650mg at a time. Each dose must be atleast 2 hours apart and atleast 2-4 hours apart from any iron or thyroid medication. It sounds complicated but it really isnt that bad - I will give you a sample day below for you. Your bariatric calciums are perfect - I use them too - you can either take the lozenges 3-4 times per day or the chewies - 2 of them 3-4 times per day but you need to get a calcium, vitamin D - 25 hydroxy, PTH and phosphorus level to really know what is going on with your bones and to know if you need more calcium or if you are taking too much - just a simple calcium level isnt enough to tell. You need to know if the calcium is leaking from your bones and into your blood.  There are alot of factors that figure in. Again this needs to figure in since pain in the legs can also be linked to lack of calcium but not necessarily the numbness

vitamin D = atleast 75% of the population are vitamin D deficient and need mega doses of vitamin D. Mega dosing is 50,000 units 2-3 times per week or 10,000 -20,000 units daily but without a vitamin D level, you cant really know what to take. The safest dose to start on without knowing your level would be around 10,000 units per day. You can get Dry D3 which is what we need to absorb vitamin D at vitalady.com by BioTech technologies = it comes in either 5,000 units or 50,000 units = the 5,000 units are called D3-5 and you would take 2 per day.  Once you get your labs done, it would be much easier to know a better dosing for you.

Iron = since we dont take iron in a multi, we need to take it separately.  We need to take a special type of iron and more than the average person.  We need to take either Carbonyl iron with vitamin C or heme iron..  Many doctors recommend ferrous irons but we dont have enough acid in our pouches to absorb it, the same reason for calcium citrate vs. calcium carbonate.   After WLS, especially an RNY, we have very little acid and with a PPI - we have even less -practically none which helps in our digestion and reduces heartburn and less risk for ulcers.  The best first choice is carbonyl iron with vitamin C - it is highly absorbable, easy on the stomach, doesnt cause constipation and it is cheap.  You can also get this at vitalady.com called Tender irons - they are capsules with 60mg of carbonyl iron each with the necessary vitamin C in each one - 400mg of vitamin C.  Depending on your iron and ferritin levels determine how many of these you take at a time which are best to be taken at bedtime on an empty stomach - they also cant be taken within 2 - 4 hours of any calcium or thyroid medication.   My surgeon starts patients on 120mg per day - 2 of these per day and then we adjust from there based on our labs.  These work really well.

B12 - we need to take sublinguals  or injections since we no longer have the intrinsic factor needed to absorb the B12 by mouth.  The minimum daily dose is 1000mcg per day from day 1 and preferably 1 month prior to surgery to start to get your levels up a bit.  I was taking B12 shots for 12 years prior to my RNY and had great levels then and still do most of the time - they fluctuate.  You want optimal levels - normal for non-post ops is 200-900 which they are finding in the medical community is way too low and are trying to changing it to atleast 400-500 at the bottom which we have already figured out in the Weight loss community.  If you go below 500, you are at risk for nerve damage and if it stays there for any length of time, it can become permanent and also lead to severe cognitive problems - they have found that many alzeimers patients have vitamin B12 defiency and well as dementia patients.  it is really important to keep B12 levels as high as possible.  I try to keep mine around 2000 whenever possible.  There is no danger in being high - you actually just pee out the excess. 

Being you have such severe symptoms of B12 deficiency - you should really take atleast 2500mcg daily and you might want to take 2 per day for 1 week.  This will really give you good start and thent eh 2500mcg will continue to bring the levels up to where they need to be.  Once you are on the 2500mcg, YOU NEED TO GET LABS DONE after 2 months.  GET TO YOUR PCP to make sure it is working.

B1 - It sounds like you could also have B1 deficiency which is also very serious with the same symptoms of B12 deficiency.  If you havent been taking any B1 other than your multi up until now, then it is likely that is the case.   You need to be taking 100mg per day from day one and multis dont have enough.  Some people take an extra B complex with B1 which is okay for the B1 (if it has 100ng B1 (thiamine) but then it has too much B6 because it can become toxic and most people have very high levels from B complexes.  Being you havent taken any since surgery - I would recommend taking 200-300mg daily to get your levels up.  High B1 levels are fine, you just pee out the excess - I actually try to get my levels high.  You want your levels to be at the top of the range or over the top.  



These are the basics = if you get any cramps or spasms in your legs - this is very common and can be due to a few things - not enough potassium, calcium or magnesium.  If it is severe, immediate blood tests are needed and you can always go to the ER to get it done - low Potassium is very dangerous and although at first causes severe cramping in the calves and legs, it can then lead to hearbeat  irregularites.  If it is only slightly low, you can just eat  a small banana a day or other high potassium foods if you can tolerate it.  If it is calcium - you need the blood tests I listed above to determine if you are too low in calcium = if so, you need to increase your calcium - you could be leaking calcium from your bones and into your blood. 

For magnesium is used for 3 reasons: to help us absorb calcium  (magnesium citrate capsules), magnesium oxide to to help with constipaton and magnesium gluconate to hellp absorb calcium.:


anything else depends on your labs.

I hope this helps

Thanks for all the great information. I will definitely have to make some adjustments. My surgery on May 10th was exploratory surgery & they found 3 internal hernias & cleaned out some adhesions on my colon.

It is amazing how so many of us get these same complications.  You are actually lucky that your internal hernia's didnt cause any more problems.  I wont go into alot of details because it will take me an hour to type it - I need to put it in my blog one day  - but anyway - In Oct of 2010 - I had terrible abdominal pains and got constipated.  By time I got to my gastro doctor - I had to be rushed into emergency surgery with my RNY surgeon an hour away.  I had a bowel obstruction, internal hernia, intuseption (SP???) and my bowels were all twisted again   I lost a large part of my colon adn small part of my small intestines.

I was in the hospital for 2 months with 4 surgeries and my recovery basically took a year.



Earlier I had exploratory where I had my intestines all kinked up with 4 sets of adhesions.  I felt so much better after surgery.

I have had a really rough time but I have lost all my weight - at times I even lost too much weight and had to gain some back

I am glad that you are doing better after your .surgery = now just make sure you are vigilant about your supplements.  Sometimes after bowel obstructions, our malabsorbtion can get worse and we have to take more supplements adn be more careful about what we eat.

I wish you the best and if you ever have any questions, feel free to PM me.

Question: Would low B levels be the reason I have low to no energy & am tired all the time? I have read the long version of what happened to you in someone else's post awhile ago & that was scary. I'm glad you made it out ok. I will take  your advice & bump up my vitamins, I definitely do not want to be deficient in anything or have permanent damage. Again thanks for your care & concern.

I see the wording got messed up, just hit reply and you wlll be able to read it properly.

Low to no energy can be due to a few things - it can be from B12 deficiency , low iron/ferritin - iron deficiency,folate deficiency - another form of anemia, severe vitamin D deficiency along with not enough calcium can also lead to problems with your bones.

It can also be hypothryoid. I dont know if you had a thyroid problem preop which many of us do and if so, this needs to be checked very often postop because it fluctuates a great deal postop. Some people need more Synthroid and some people need less. It needs to be checked every 3 months - no questions asked. If a change in dose is made, it is supposed to be rechecked in 6 weeks to make sure the new dose is working. I have had my dose change 7 times in the 3 1/2 years since my surgery - I now take 2 different thyroid drugs - synthroid and cytomel. I am going to my Endocrinologist tomorrow for a sonogram of my thyroid to make sure my nodules havent changed and there arent any new ones.


Unfortunately severe low energy can be several things but it is important to find out what it is. The only way to find out is with bloodwork for Vitamin D-25hydroxy, iron, iron sat%, ferritin, CBC, comprehensive metabolic panel, B vitamins - B1, B12, B6, Folate, PTH, TSH, T3 Total, Free T3, Total T4, Free T4

I know this is very overwhelming but something is definitely wrong and you need to find someone that is willing to take the time to spend with you and figure it out. If your surgeon's office wont, try your PCP - if your PCP wont, then maybe you need a new PCP that is willing to give you the time and care that you need as a gastric bypass patient. You are going to need someone that is going to do your labs post op and many times more often than your surgeon is going to want to do them. Many times surgeons push the labs off to PCP's after a period of time and tell us only to come back if a problem or yearly to let them know how we are doing. A good PCP with some understanding is vital for us.

For me, I have my Endocrinologist that has about 50-75 WLS patients and also has a NUT that specializes in the diets needed for both diabetes, preop WLS, post op WLS and also reactive hypoglycemia. I used her preop but if I ever need her, she will be there for me. So, far I have my Endo who I see every 6 weeks or so and she does all my labs. She is very thorough and if I want her to do anything extra, she is always willing to do it.