Have Any Opinions About B12...?

[Kim27]

I recently had some bloodwork done and my doctor emailed me to tell me that everything looks good CBC, Hemogram, Vitamin A level, and even my TTG continues to fall (started at 186, after 5 weeks gluten-free was 65, and now 4 months gluten-free she said it is a "weak positive" (haven't gotten the exact number yet) I'm assuming that means somewhere between 20-30 (less than 20 is normal). However she told me that my B12 is on the low-ish side. It's 186 (ref range 175-852). She suggested I start getting B12 injections for awhile. It's surprising this came back low as I have had a multitude of vitamin/mineral levels checked and everything has been fine (Zinc, Vitamin A, Vitamin D, etc). From what I've been reading most labs consider <200 to be low and I've also read that it takes awhile for B12 to show up low on the blood tests, so that once it's low on the labs, then it's really low and depleted. I also read that it leads to anemia when low and my other labs were all normal (including checking for iron/anemia). I think of B12 injections as something elderly people have to do (that's the only people I've known to get injections and it's common in older people). I'm 27. What do you all think of my number? Why would she advice injections instead of pills? Any thoughts?

[kayo]

Injection is the best way to get those levels up. You can get a higher dose in injection form than you can in a vitamin you take orally. I had B12 injections in my young 30's well before all my GI/non-celiac issues cropped up. It's one of those things that those of us with autoimmune illnesses have to keep an eye on.

[mushroom]

Your levels are low and I would also take the injections. I did, and I only need them every three months now - I can't do the sublinguals.

[gary'sgirl]

Your levels are low and I would also take the injections. I did, and I only need them every three months now - I can't do the sublinguals.

Mushroom,

I'm curious... why can't you take the sublinguals?

[RiceGuy]

IMHO, your level is not just low, but very low. I've read that the body cannot assimilate more than about 5-6mg of vitamin B12 per day. So although the shots may get the serum level up more quickly, I don't know if it's just putting a bunch in circulation, until the body can actually assimilate it. Can't hurt however, except perhaps the ouch from the needle.

If you don't want to take the needle (cannot blame you), the sublingual tablet/lozenge type is what I'd recommend, of the methylcobalamin form. This kind requires no conversion by the liver, thus is more readily available to the body. Take 3-5mg per day. Source Naturals makes methylcobalamin in 1mg and 5mg potencies. There is no known level of overdose for vitamin B12.

[mushroom]

Mushroom,

I'm curious... why can't you take the sublinguals?

I break out in acne-type rash all over my face (never had acne my whole life before )

[Kim27]

IMHO, your level is not just low, but very low. I've read that the body cannot assimilate more than about 5-6mg of vitamin B12 per day. So although the shots may get the serum level up more quickly, I don't know if it's just putting a bunch in circulation, until the body can actually assimilate it. Can't hurt however, except perhaps the ouch from the needle.

If you don't want to take the needle (cannot blame you), the sublingual tablet/lozenge type is what I'd recommend, of the methylcobalamin form. This kind requires no conversion by the liver, thus is more readily available to the body. Take 3-5mg per day. Source Naturals makes methylcobalamin in 1mg and 5mg potencies. There is no known level of overdose for vitamin B12.

Is that OTC? What if I did both? Overkill? Too much? Or good combination of quickness (injection) and stability (pills)?

[RiceGuy]

Is that OTC? What if I did both? Overkill? Too much? Or good combination of quickness (injection) and stability (pills)?

The methylcobalamin is an ordinary vitamin supplement, which you might find at a health store/vitamin shop. I order it on line.

Taking both the injections and sublingual at the same time seems like overkill to me. I haven't seen any articles comparing the effectiveness of the two, but I can't imagine the shots not working just as well if not better. The injections just aren't necessary for maintaining levels, for most people. I suppose you could get a shot or two, then start the sublingual, and perhaps your next blood test will show you don't need to keep taking the shots. That would suggest the sublingual is being effective.

[cassP]

your levels r way too low- i would take the advice of all the posters above.

your question about anemia- B12 depletion leads to "Pernicious Anemia" which doesnt involve your Iron levels but your B12 levels.

and it's quite possible to have your other vitamin levels be ok- but not your B12. B12 requires your stomach to be working right- the right amount of stomach acid & intrinsic factor... that's why the injections will help you so much- because your stomach & digestive tract are still healing- and the injection will bypass all of that & get you back on track.

after your levels are up, and your body is healed, then eating the right foods may be enough- but definitely listen to everybody here- you should aim to get your levels above 6 or 700

i dont know if my sister in law has celiac or not- but her B12 tested at 211 and she was going numb in her hands and her feet, irregular heartbeat, etc... she's been getting shots & feels much better

[Skylark]

There is fairly recent research showing that typical B12 supplements (not even sublingual) are effective in reversing B12 deficiency. Only people with pernicious anemia who have intrinsic factor problems actually need shots, although they do work consistently for anyone. Doctors are still using injections because it's well-studied, they know how to administer the injections, and there are no compliance issues with people remembering to take pills. It would be reasonable to talk to doctor about trying a pill or sublingual and being retested in a couple months.

There is a lot of glib "you can't overdose on B12" nonsense floating around the Internet. Yes, you can overdose on B12. It does take a lot of B12 to cause problems, but you don't want to be eating the stuff like candy. Basically, do something sane like either getting shots or a supplement but not both. B12 megadoses have been associated with kidney damage, heart problems, neurologic problems and leukemia.

[gf-soph]

Your dr may be proactive about the B12 as it can cause neurological damage when it's low. I know then when I am below 200 I feel extremely unwell, and I'm under 300 I can feel it as I feel generally unwell. I got to 88 at one point, and was having resting tremors in my feet, as well as weird out of body sensations, i would fall over when standing still - it was scary.

It is possible to have pernicious anemia, where you body doesn't produce intrinsic factor, which is needed to absorb B12 from food. This is more common in older people, but it can happen at any age. I have heard that people with this condition can absorb some of the sublingual tablets, but perhaps not the B12 in your food. I would request the blood test for intrinsic factor from your GP, at least that way you know if you can absorb the food from your diet.

Speaking personally, as I get so unwell from low B12 I have had a lot of injections. I started taking the sublingual B12 to see if I could keep my levels up without, but I am in the unusual position where my B12 seems to dive by hundered of points within weeks, so I am still getting occasional injections. My dr is hopeful that as my health improves I will be able to go without, but I am not there yet.

You could try a single course of B12 injections to get your levels back up, then go on to the sublinguals and see if you can maintain the levels for a few months. I can understand wanting to avoid injections long term, but unless you lack intrinsic factor you shouldn't need injections long term.

[ravenwoodglass]

There is fairly recent research showing that typical B12 supplements (not even sublingual) are effective in reversing B12 deficiency. Only people with pernicious anemia who have intrinsic factor problems actually need shots, although they do work consistently for anyone.

The problem with this research is that the same area that produces the intrinsic factor is the area that is damaged in us before we have healed. I do agree that once we have healed a regular supplement is fine but while we still have villi damage the regular pills are not going to be absorbed.

I also agree and have read research that our levels can be too high which is why, as with any supplements, we should get our levels checked periodically. I get my B12 checked when I get my yearly checkup. At my last checkup my levels were to high, they were around 1,500 and should be 1,000 or so or less. I simply dropped my sublingual at that point and now just use regular supplements. It took over 6 years of sublingual daily use to get that point though. Also many don't realize that taking a vitamin with folate can cause a false higher reading on the B12 so I discontinue my supplements with folate for a couple weeks before I get my levels checked.

[RiceGuy]

your levels r way too low- i would take the advice of all the posters above.

your question about anemia- B12 depletion leads to "Pernicious Anemia" which doesnt involve your Iron levels but your B12 levels.

and it's quite possible to have your other vitamin levels be ok- but not your B12. B12 requires your stomach to be working right- the right amount of stomach acid & intrinsic factor... that's why the injections will help you so much- because your stomach & digestive tract are still healing- and the injection will bypass all of that & get you back on track.

after your levels are up, and your body is healed, then eating the right foods may be enough- but definitely listen to everybody here- you should aim to get your levels above 6 or 700

i dont know if my sister in law has celiac or not- but her B12 tested at 211 and she was going numb in her hands and her feet, irregular heartbeat, etc... she's been getting shots & feels much better

Just to be clear, Intrinsic Factor is needed to begin the digestive process of B12 from food. Pernicious Anemia is when the stomach no longer produces adequate levels of Intrinsic Factor. This condition can develop from long-term use of antacids, and probably other things. But Pernicious Anemia does not develop from low B12. It's the other way around. That is, Pernicious Anemia can cause B12 deficiency.

There is fairly recent research showing that typical B12 supplements (not even sublingual) are effective in reversing B12 deficiency. Only people with pernicious anemia who have intrinsic factor problems actually need shots, although they do work consistently for anyone. Doctors are still using injections because it's well-studied, they know how to administer the injections, and there are no compliance issues with people remembering to take pills. It would be reasonable to talk to doctor about trying a pill or sublingual and being retested in a couple months.

There is a lot of glib "you can't overdose on B12" nonsense floating around the Internet. Yes, you can overdose on B12. It does take a lot of B12 to cause problems, but you don't want to be eating the stuff like candy. Basically, do something sane like either getting shots or a supplement but not both. B12 megadoses have been associated with kidney damage, heart problems, neurologic problems and leukemia.

Please post a link to a reliable source of information to back up the idea of B12 overdose. I've searched and found nothing to indicate what you've stated about high doses of B12 causing problems. Not even a single article on PubMed. I did however, find Open Original Shared Link.

Perhaps what a person can overdose on is the other stuff in the pills. For instance, the cheaper B12 supplements are often cyanocobalamin, which has cyanide as the co-enzyme. I don't doubt that one could ingest enough of that to cause a problem. That's why I always recommend methylcobalamin, as it is an active form, and can readily be assimilated, requiring no digestive breakdown, nor conversion by the liver. This is important, as it means that a sublingual methylcobalamin supplement can be absorbed directly into the bloodstream, bypassing the digestive system, and therefore get around Pernicious Anemia. And that's why it can work in place of the injections, as long as its absorption through the soft tissue under the tongue is adequate.

I do agree that one shouldn't need to take both injections and a sublingual. And since the body cannot assimilate more than about 5-6mg per day anyway, it doesn't seem to make sense to take much more than that. Unless, I suppose, if one somehow determined that only a small percentage of the sublingual was getting absorbed. The body's rate of assimilation is probably why there aren't very many sublingual B12 supplements with more than around 5mg.

[Kim27]

Thank you everyone for your responses! You all are obviously far more educated on the subject than I am. I am seeing my doc this Friday, so I'll see what she says. I'm hoping I'll have a lot more energy after I get this deficiency fixed. Do any of you think that this deficiency could be involved in a half-numb big toe on my left foot and also possibly the cause of extremely achy legs when I lay down...? Those are 2 things that have been bothering me a lot lately.

[RiceGuy]

Do any of you think that this deficiency could be involved in a half-numb big toe on my left foot and also possibly the cause of extremely achy legs when I lay down...? Those are 2 things that have been bothering me a lot lately.

There is quite a bit of info on the role of B12 in nerve health. So I'd say those symptoms could very likely be related to B12 deficiency. Although there are probably other things which can be involved, given your test results, it would not surprise me if those issues resolve once the deficiency has been taken care of.

[RiceGuy]

I break out in acne-type rash all over my face (never had acne my whole life before )

Interesting. Was it a tablet/lozenge, or a liquid? Was it methylcobalamin, or some other form? I'm wondering if perhaps the reaction might have been due to some other ingredient in the supplement.

[mushroom]

Interesting. Was it a tablet/lozenge, or a liquid? Was it methylcobalamin, or some other form? I'm wondering if perhaps the reaction might have been due to some other ingredient in the supplement.

RiceGuy, we actually had this conversation a while ago now. It was a Solgar methylcobalamin sublingual. I was afraid it might have been the mannitol and delayed taking Humira shots (which contain mannitol) until I could test that theory - turns out it wasn't

[RiceGuy]

RiceGuy, we actually had this conversation a while ago now. It was a Solgar methylcobalamin sublingual. I was afraid it might have been the mannitol and delayed taking Humira shots (which contain mannitol) until I could test that theory - turns out it wasn't

OK. I thought I recalled a conversation of this sort, but wasn't sure whom it was with. I wonder why a shot would contain a sugar-alcohol? A weak preservative perhaps? Weird.

[cassP]

OK. I thought I recalled a conversation of this sort, but wasn't sure whom it was with. I wonder why a shot would contain a sugar-alcohol? A weak preservative perhaps? Weird.

i have reactions to sugar alcohols too

i totally believe in the benefit of the B12 injection- but i was very upset to find out that the last one i got had ALUMINUM in it . i think there are some without tho

[kayo]

Humira shots (which contain mannitol)

That's quite odd! Why would they put sugar alcohol in Humira? It's not like you'd be drinking it. Must be a preservative. I take Enbrel and wonder if it too contains sugar. (Humira and Enbrel are like the Coke and Pepsi of RA meds)

I have issues with fructose, fructans, sugars and I'm on a FODMAP diet. I never thought to check my meds for mannitol or sorbitol. It never occurred to me it could be in an injectible.

Well, sure enough Enbrel in the 25mg doses contains: 40 mg mannitol &

10 mg sucrose. That's the one I took for years until recently. The one I take now (50mg pen applicator) contains; 1% sucrose. No mannitol.

I'll be damned.

I wonder if injecting myself with mannitol for oh, 7+ years caused or contributed to my GI issues.

Thank you Mushroom for mentioning the mannitol in Humira!