B12, how high is high enough?

I'm 5 years post, and recovering from severe pernicious anemia. I Have been taking weekly b12 injections for 45 weeks now, plus I had a 2,225 mg IV iron infusion.   I had my b12 checked this week and was sure they would take me down to monthly injections but noooooo...   My level was 917 and they said it STILL isn't high enough!  Any idea why they would want it higher before I slow down the injections??

You're born at around 2,000. Most recent studies show 800 is the new "low". Be thankful that your docs want you up there! Most docs don't know about that study and are happy if you're at 200!! Brain and nerve damage can occur at 400.

Thanks MIchelle!  I needed to know that. Damage at 400... and My b12 was down to 25!

OH
MY
GOSH

Yes, I suspect some damage was done. I often wonder about my own, since my low was 330. In those days (2000), my PCP was nervous about shots on a person under 50. But I said to him, "Gastric bypass? No INTRINSIC FACTOR? Never will be. It can only get worse from here. I don't want to feel bad, so can we shoot before I do?" Once I reminded him about the Intrinsic Factor, he came back to life and started shots. But at first, he had me come back and test before he'd shoot again. We played around with that (OK!! I'm a huge fan of tests!) and then he just let me do it my way, pretty much. But the 800 study came out last year so when we had our annual thing, he just wrote 'em and now we have plenty for weekly.

Before that, we used a combo of the Rx we got PLUS and injectable B complex we get on line. We shoot ourselves. His office taught us how to do it.

Please note that while B12 comes in red meat (and some other things), even if we ate plenty (we don't), it still has to go into the old stomach to mate with the Intrinsic Factor. I know it sounds like an adjective, but it is a chemical most ppl make until they are over 50, when it begins to subside. Some ppl never make enough, but not usually found out. For example, my DIL had a shortage at age 31 before she had WLS. If she had not been working up for WLS, it would not have been found for 20 yrs or until she exhibited symptoms!! Anyway, IF the B12 food source had mated with the IF, it would then have to have been routed past the duodenum, which is the primary B12 absorption station. And the food does not go there. BYPASSED.

So, dietary B12 is not useful to us. The only way we get it is sublingually or via shots. Subs will work for some ppl, holding them at 2000 levels for years and for some, it's the same as nothing at all. Personally, I prefer shots. WAY cheaper and I'm not good with chewables or lozenges of any kinds. Never liked hard candy, either.

You are also the fair skin type, which is genetically known for the old fashioned pernicious anemia. I'm curoius if you have ever seen anyone with dark hair and skin who has a b12 deficiency? My PCP refused to give me monthly b12 injections which were suggested by my WLS dr.  She seemed to act like it was her own personal supply.  When I got my results of my "Demanded" blood work she gave me ONE.....  ONE!  100cc shot of B12 and called it a day.   I called my WLS surgeon and faxed them my blood work and he immediately ordered 7 shots in 2 weeks, and two shots a week for a month. Now I'm still on 1 a week almost a year later.   OH.. plus two pints of blood! My symptoms were constant thrush, vomiting, leg cramps, restless legs, alzheimers symptoms, depression, a hollow ringing in my ears, etc... etc... My wls Dr suggested I fire my Dr for neglect and never look back.  I did! OH... and another thing... Dry Mouth... Now I'm having around 10,000 in dental repair to my teeth from it.  I can't stress enough.. LAB WORK.. LAB work!! I'd your pcp wont do it.. find one that will!

Well, you have to remember what I do, so yes, I've seen ppl disabled by rickets (osteomalacia--vit D deficiency); beri beri (thiamin-B1); Pernicious anemia (B12); iron anemia; vit A deficiency (night blindness, inability to heal) and on down the list I'm always tossing around.
protein
iron
calcium
A, D, E
zinc
B1
B12

Those are the malabsorbed vites, tho the reason for malabsorption isn't the same from element to element, since the B12 issue is the IF.

Sooooooo, where is your vit D? If you have dental issues, calcium and vit D are major players here. I've heard it said that our not drinking after meals is what it's about, but that would be cavities, not shattered or crumbling teeth.

For me, I was on daily shots in 2005, including folic acid (that stuff stings!) and my level was only 919 ! I mean, with the beautiful iron I enjoy and good folic, why is my B12 so lazy? no idea here. So, I went back to weekly and level remains around 700.

I can't tell you how gllad I am that you have docs who get it. So many do not, and see the low levels, give one shot and call it good. As can be said with many deficiencies we will always fight. So many get ONE vit D per week, X weeks, then stop. ??? The problem is FOR LIFE, so the fix has to be FOR LIFE. It's not hard to prevent it, but it's hard to FIX it.

Due for annual thing again here shortly, so be interesting so see what PCP says. Surgeons are still thinking anything over 500 is too high, so we do not discuss B12. LOL

I'm not sure where my Vit D is, THe hematologist did some test to see if my saliva was working right, He said it was normal, so it has to be the dry mouth. These are surface cavaties on the outer sides of my teeth.  My dentist said that dry mouth can ruin a mouth full of teeth in no time at all. He took 13 viles of blood.  I'm not sure what else when into those IV's when I was so out of it.  Thank goodness I'm able to function again.  And Keeping Tabs! I think my WLS surgeon is a GOD...  After my wls he gave me his cell phone number to call if i needed ANYTHING.

How can your WLS be god when mine is? LOLOL

Funny how we elevate the guy(s) who save our lives, huh?

Still, as good at most of it as my guys are, they just don't have it all inthe nutrition. As it is, our local U still puts 'em on the street with mullti vites, if that. Even tho (!!!) their own WLSdept has published articles on vit D that suggest 1000 IU of vit D3 FOR NORMIES, but the same docs put their WLS out the door with NONE!

But then, I can't really think of any WLS programs (but our own docs) who start people on preventative courses of the whole range of vites, tweaking up or down as time goes on. It is far, far the norm to wait until the deficiecies are fairly serious before addressing them. but even more common is not testing the full range, then these guys can look you straight in the eye and tell you they do not have those deficiencies with their surgery. Well, THEY don't, but YOU do. See?

Marketing is a wonderful thing, as long you realize that WE are the marketing tools.

That is very interesting that B12 should be around 800.  I just had my labs done and although most everything was in the "normal" range for lab values, I've been wondering if they are where they really should be.  I am a nurse and have access to a University Medical library, so was wondering if you can direct me to some specific research studies or journals that I could get to read.  Especially the one that you refered to earlier about the B12.  I'm trying to educate myself as much as possible about this but sometimes I don't know were to even start.  When I go to talk to my doctor, I want to make sure I have specific scientific info to back me up, not just "I read on the internet. . ." Thanks, Jennifer

OK, here is a cut 'n paste of one, maybe more. Will cut 'n paste as I find 'em.

Various authors have documented the psychotic (Hart/ McCurdy) , depressive (MacCallum), and consecutive affective and psychotic conditions in the same patient (Verbanck/ LeBon). Drs Levitt and Joffe, working at the Clarke Institute of Psychiatry in Toronto (where I trained, years earlier), published a report about vitamin B12 deficiency causing the psychotic form of depression, in the British Journal of Psychiatry in 1988 (Levitt/ Joffe). They also reviewed the medical literature and found that psychotic depression is more often caused by B12 deficiency than by any other known or unknown cause.
This fact is hardly ever borne in mind when psychiatrists confront a case of psychotic depression and, when they do think of it and order a serum B12 level, they will more often than not still miss the deficiency because the lab "normal range" is so low that their patient's B12 level almost always appears to be in the "normal range".

At least six neurological and psychiatric papers, in top medical journals, have shown that the normal range should be regarded as at least 500-1,300 pg/ml (rather than 200-1,100), since the cerebrospinal fluid level can be deficient when the serum level drops below 500, and neuropsychiatric symptoms often occur at serum levels between 200 and 500 pg/ml (VanTiggelen et al, Lindenbaum et al, Mitsuyama/Kogoh, Nijst et al, Ikeda et al, Regland). As for the still held misconception that the neuropsychiatric effects of B12 deficiency are always accompanied by a macrocytic anemia, it is humbling to know that this notion was already debunked in 1905 (Langdon)! Since then, many papers have stressed this point, including those by Strachan and Henderson (1965), Evans et al (1983) and Lindenbaum et al (1988).
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http://www.johndommissemd.com/b12.html

http://www.veganhealth.org/b12/formula
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&l ist_uids=824083&dopt=Abstract
http://www.vitacost.com/science/hn/Supp/Vitamin_B12.htm#Deficiency-Sym ptoms

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Vitamin B-12 Deficiency after Gastric Bypass
Title
Vitamin B-12 deficiency after gastric surgery for obesity.
Author
Rhode BM; Arseneau P; Cooper BA; Katz M; Gilfix BM; MacLean LD
Address
Department of Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
Source
Am J Clin Nutr, 1996 Jan, 63:1, 103-9
Abstract
Low serum vitamin B-12 concentrations after gastric bypass (GB) surgery for obesity were observed in 11 of 28 patients without detectable impairment of crystalline vitamin B-12 absorption. This was observed in 2 of 19 patients with vertical banded gastroplasty (VBG). In contrast, protein-bound vitamin B-12 absorption was markedly impaired, as demonstrated in eight of these patients after GB (n = 7) and VBG (n = 1). Correction of this impaired absorption occurred when protein-bound vitamin B-12 was incubated with an enzyme mixture before consumption. Simultaneous ingestion of the enzyme mixture with protein-bound vitamin B-12 did not improve absorption of the vitamin. In a separate experiment, 10 patients with a normal result from the Schilling test failed to correct low serum vitamin B-12 concentrations with a quantity of oral crystalline vitamin B-12 equal to the recommended dietary allowance of 2 micrograms, taken twice daily for 3 mo. Serum total homocysteine values declined during this interval. An oral daily dose of 350 micrograms crystalline vitamin B-12 raised the average serum vitamin B-12 concentration to an amount greater than the lower reference limit. A dose > 350 micrograms/d was required to raise all patients' vitamin B-12 concentrations above this concentration rather than just above the population mean. We conclude that because concentrations of oral crystalline vitamin B-12 were required to normalize serum vitamin B-12 concentrations, that a mechanism other than formation of a vitamin B-12 intrinsic factor complex is responsible for crystalline vitamin B-12 absorption after GB for obesity.
Language of Publication
English
Unique Identifier
96112783