Anyone else have a B12 deficiency?

[luvwinnie]

Found out I do and my neuro said to take 1000 mcg daily. My friend gets shots because she cannot absorb b12 apparently. I guess if the oral form does not work shots will be next for me. Wondering what others do.

 

[MickeySP]

I do, and I take a large dose sublingual daily. I did have to have 2 shots initailly because my B12 was almost non-existent.

 

[joyjoy]

I do. I did a series of shots - 1 per day for 5 days, then 1 per week for a month, then 1 every two weeks for 3 months. I take the oral supplement now. Doctors do not agree on whether the shots work or not. I've heard opionions for and against. Also, I had to get a letter from my dr. saying I had a type of anemia that required the shots, otherwise my insurance would not pay for them as they are currently considered experimental.

Good luck.

 

[LovableGluttons]

I get an iron infusion every couple of years when my counts get too low. I tried the supplements sublingually and intramuscularly and they were ineffective on my anemia.

 

[perdidobay]

I do. I complained to my doctor at my physical back in Feb that I was always tired, he checked thyroid and B12 levels with bloodwork. My B12 was in the very low end, so he suggested suppliments. I started with regular tablets, then read as you age you lose the ability to absorb B12 through the lining of your stomach. (that fit me I guess since I eat plenty of meat). Now I take sublingual tablets. And I sometimes get a B12 shot from my pharmacy every so often. In the 6 months I have taken them, I have more energy, my fingernails are in much better shape, ie: no more splitting and cracking.
I also used to get zapping pains in my side that I don't have anymore. I had pain in my hands and feet like they were falling asleep that I don't get anymore.

 

[luvwinnie]

Thanks, everyone. I don't eat much meat, so this could be the cause...we'll see.

 

[golfgal]

I do. I complained to my doctor at my physical back in Feb that I was always tired, he checked thyroid and B12 levels with bloodwork. My B12 was in the very low end, so he suggested suppliments. I started with regular tablets, then read as you age you lose the ability to absorb B12 through the lining of your stomach. (that fit me I guess since I eat plenty of meat). Now I take sublingual tablets. And I sometimes get a B12 shot from my pharmacy every so often. In the 6 months I have taken them, I have more energy, my fingernails are in much better shape, ie: no more splitting and cracking.
I also used to get zapping pains in my side that I don't have anymore. I had pain in my hands and feet like they were falling asleep that I don't get anymore.

Wow, I think I should get my B12 checked. I have a lot of these symptoms.

 

[NHdisneylover]

Yes. My B-12 level was all the way down to 12 when I fianlly had a doctor who realized what the symptoms probably meant (before that I had 6 years and 5 doctors telling me everything was "just anxiety" Anyway, even with the levels having dropped so dangerously low 1000 mcg of B-12 orally per day brought them up very quickly (and most of my issues went away; I had a small amount of permanent nerve damage from being undiagnosed for so long).
Now i can maintain a decent level by taking 500 mcg a day--but we test to make sure it is not sliding every 6 months.

 

[luvmarypoppins]

I do. I complained to my doctor at my physical back in Feb that I was always tired, he checked thyroid and B12 levels with bloodwork. My B12 was in the very low end, so he suggested suppliments. I started with regular tablets, then read as you age you lose the ability to absorb B12 through the lining of your stomach. (that fit me I guess since I eat plenty of meat). Now I take sublingual tablets. And I sometimes get a B12 shot from my pharmacy every so often. In the 6 months I have taken them, I have more energy, my fingernails are in much better shape, ie: no more splitting and cracking.
I also used to get zapping pains in my side that I don't have anymore. I had pain in my hands and feet like they were falling asleep that I don't get anymore.

Can you just describe what the "zapping" pain felt like? I told my dr. that I felt like I was a voodoo doll and someone kept sticking pins into me and then it was followed by itching. These pains were anywhere and everywhere, no specific place and usually were between 7-11 pm.

He told me he thought I had "allergies". Well it turned out I had severe anemia,needed 3 blood transufsions, my b12 was non existent and then throw in he couldnt figure out I had cancer too. I had a few shots last year. I think I need to have him do a blood test just to check it and be sure its o.k. now.

 

[disfan07]

I have severe B12 deficiency. My B12 level was essentially non-existent when they tested me. I believe that my neuro said my B12 level was 6. I am on the 5th month of weekly B12 injections. My levels are still not high enough for them to have me take oral B12 instead. We tried oral about 2 months ago and my levels began dropping again. We are hoping that I will be able to go off of the injections my the end of the year.

My neuro thinks I have permanant nerve damage because of this. We only found out because I was having decreased feeling in my lower body especially my feet. I am having an EMG and nerve conduction study in a few weeks to see just how bad the damage is but they dont think it's reversable

They found absolutely no reason for such a severe deficiency (no anemia, no celiac, no malabsorption problems, and i do eat meat).

 

[mommasita]

I do. Was diagnosed with Pernicious Anemia, at dangerous levels.

The vitamins did nothing for me. I could not break them down.

At first I was on monthly injections, and now it is every 2 weeks. My numbers are still low, but not dangerously low. I have bloodwork every 6 weeks, to make sure all is ok.

I also have some permanent nerve damage. Damage that is already done, can not be restored, but it is can halt any more from happening.

Some of my symptoms were burning in my arms/legs. The only way I could describe it was as if someone took a match and lit my skin on fire. I dropped a lot of things, due to nerve damage. A few days after the shot I feel like I have more energy. It lasts a few days only, but sure feels great.

This is a test that should be done IMHO with regular bloodwork.

 

[perdidobay]

Can you just describe what the "zapping" pain felt like? I told my dr. that I felt like I was a voodoo doll and someone kept sticking pins into me and then it was followed by itching. These pains were anywhere and everywhere, no specific place and usually were between 7-11 pm.

He told me he thought I had "allergies". Well it turned out I had severe anemia,needed 3 blood transufsions, my b12 was non existent and then throw in he couldnt figure out I had cancer too. I had a few shots last year. I think I need to have him do a blood test just to check it and be sure its o.k. now.

Your description of being a voodoo doll and someone sticking pins in you was exactly what I was feeling. They would come out of nowhere, mostly in my side, but occasionaly in other spots.

If I were you I'd have your B12 levels checked again!

 

[perdidobay]

Article from Wikipedia that lists some symptoms

Vitamin B12 deficiency
From Wikipedia, the free encyclopedia



Vitamin B12 deficiency is a reduction in vitamin B12 from inadequate dietary intake or impaired absorption. The condition is commonly asymptomatic, but can also present as anemia characterized by enlarged blood corpuscles with characteristic changes in neutrophils, known as megaloblastic anemia.

In serious cases deficiency can potentially cause severe and irreversible damage to the nervous system, including subacute combined degeneration of spinal cord.

The anemia is thought to be due to problems in DNA synthesis, specifically in the synthesis of thymine, which is dependent on products of the MTR reaction. Other blood cell types such as white blood cells and platelets are often also low. Bone marrow examination may show megaloblastic hemopoiesis. The anemia responds completely to vitamin B12; the neurological symptoms (if any) respond partly or completely, depending on prior severity and duration.

Contents [hide]
1 Signs and symptoms
2 Causes
3 Diagnosis
4 Treatment
4.1 Natural food sources of B12
5 Epidemiology
6 References

[edit] Signs and symptoms
Early and even fairly pronounced deficiency does not always cause distinct or specific symptoms. Common early symptoms are tiredness, a decreased mental work capacity, weakened concentration and memory, and irritability and depression.

Sleep disturbances may occur, because B12 may be involved in the regulation of the sleep wake cycle by the pineal gland (through melatonin).[1]

Neurological signs of B12 deficiency, which can occur with or without anemia, include sensory disturbances (due to damage to peripheral nerves caused by demyelination) and irreversible nerve cell death. Symptoms include numbness and/or tingling of the extremities, altered proprioception, impaired sense of smell, loss of appetite (anorexia), disturbed coordination and, if not treated in time, an ataxic gait especially in the dark when there is less visual reference.[2] In extreme cases, B12 deficiency can lead to a syndrome known as subacute combined degeneration of spinal cord.

B12 deficiency can also cause symptoms of mania, psychosis, fatigue, memory impairment, irritability, depression and personality changes.[2][3][4][5]

B12 status may be associated with the onset and course of Alzheimer's disease. Some studies have found no relationship,[6] while several recent studies[7][8][9] indicate a relationship between B12, homocysteine, and Alzheimer's. B12 status is routinely measured at the time of Alzheimer's diagnosis, and there is some indication that ongoing measurements may be useful to detect the development of a severe deficiency.[10] In addition to checking serum B12, checking the levels of other compounds (particularly methylmalonic acid) may be necessary to accurately detect a deficiency state, because serum levels do not necessarily correlate with efficient utilization of B12.

Studies showing a relationship between clinical depression levels and deficient B12 blood levels in elderly people are documented in the clinical literature.[11][12]

Bipolar disorder appears to genetically co-segregate with the hereditary B12-deficiency disorder pernicious anemia.[13][14]

Science Daily reported that "a deficiency of B-vitamins may cause vascular cognitive impairment, according to a new study by the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University." Aron Troen, PhD, said that: "The vascular changes occurred in the absence of neurotoxic or degenerative changes. Metabolic impairments induced by a diet deficient in three B-vitamins — folate, B12 and B6 — caused cognitive dysfunction and reductions in brain capillary length and density in our mouse model."[15][16][17][18]

The following symptoms have been recorded, beginning with those perhaps most likely to be indicative of B12 deficiency.

1. Itchy or tingling tongue. The tongue suddenly itches from time to time without warning. This occurs on the edge of the tongue, along one side or the other or at the tip. Some individuals experience stinging, pain, or tingling instead of itching.

2. White spots in the skin, resulting from melanin becoming absent in the area. These often occur on the outside of the forearm, but may occur in other places. The longer these spots are there, the whiter they get. As time goes by, the spots become very dry and flaky to the extent that small raw spots of skin may be exposed.

3. Sharp stabbing, tingling pain in the palm of one or both hands. This occurs suddenly and for no apparent reason in a spot directly below the ring finger, approximately where the first palm crease is. If B12 deficiency is not treated, a tingling pain may begin to occur along the outside edge of the hand, starting from the wrist. This pain occurs when the wrist is extended.

4. Sores at the corners of the mouth, sometimes extending along the edge of the lip. These are raw spots, not blisters, and they tend to come and go.

5. Nerve shock in the side of the body. It can be felt coming on a few seconds before it hits, and then it hits almost like a mild but deep electric shock and quickly subsides. It can occur at the side of either hip or on either side of the upper body, along the ribs. It can occur consecutively in at least two or three locations, one right after the other.

6. Shortness of breath, but without chest pain. This can occur when walking just a few yards.

7. Hemifacial (one side of the face) spasm usually manifesting in the eye. Can occur in multiple spots on the face such as the lip, nose, eyelids, and eyebrow.

8. Facial pain, usually on only one side of the face at a time. This pain varies so much that it would be difficult to describe all the possibilities. This can present as a dull pain in the cheek bone right underneath an eye, or a sharp shooting pain across the forehead, sometimes coming downward from the scalp to the edge of the nose by the eye.

9. Tingling along the back of one or both thighs, starting at the hips and shooting downward.

10. Memory loss and/or disorientation.

11. Migraine headaches. These may be preceded by a temporary blind spot in the center of the field of vision, usually lasting about ten minutes, and sometimes followed by facial pain under the eyes. After the blind spot vanishes, there may be zigzag streaks through the vision that may last up to hours. Even in the same person, there may be extreme variations in the headaches themselves. They may be quite severe with nausea or they may be virtually nonexistent.

Migraines of most individuals have causes other than B12 deficiency, but migraines of certain individuals diminish or stop completely after they are treated for B12 deficiency.

12. Irritability and/or depression and/or personality changes.

[edit] Causes
Inadequate dietary intake of vitamin B12. As the vitamin B12 occurs naturally only in animal products (eggs, meat, milk); a vegan diet can produce a deficiency unless one uses supplements or eats enriched food.[19][20]
Selective impaired absorption of vitamin B12 due to intrinsic factor deficiency. This may depend on loss of gastric parietal cells in chronic atrophic gastritis (in which case, the resulting megaloblastic anemia takes the name of "pernicious anemia"), or on wide surgical resection of stomach (such as in bariatric surgery), or on rare hereditary causes of impaired synthesis of intrinsic factor. Celiac disease may also cause impaired absorption of this vitamin.
Impaired absorption of vitamin B12 in the setting of a more generalized malabsorption or maldigestion syndrome. This includes any form of structural damage or wide surgical resection of the terminal ileum (the principal site of vitamin B12 absorption), forms of achlorhydria (including that artificially induced by drugs such as proton pump inhibitors), as well as bacterial overgrowth (such as in blind loop syndrome).
Surgical removal of the small bowel (for example in crohn's disease) such that the patient presents with short bowel syndrome and is unable to produce vitamin B12. This can be treated with regular injections of vitamin B12.
Chronic intestinal infestation by the fish tapeworm Diphyllobothrium, that competes for vitamin B12, seizing it for its own use and therefore leaving insufficient amount for the host organism. This is mostly confined to Scandinavia and parts of Eastern Europe (for example, in preparers of gefilte fish, who would acquire the tapeworm by nibbling bits of fish before it was cooked while making the Eastern European delicacy).[citation needed]
The diabetes medication metformin may interfere with B12 dietary absorption.[21]
Hereditary causes such as severe MTHFR deficiency, homocystinuria, and transcobalamin deficiency.
Some studies have shown that giardiasis, or similar parasite should be considered as a cause of Vitamin B12 deficiency, this a result of the problems caused within the intestinal absorption system.[22]
Chronic alcohol abuse
[edit] Diagnosis
Serum B12 levels are often low in B12 deficiency, but if other features of B12 deficiency are present with normal B12 then the diagnosis must not be discounted. One possible explanation for normal B12 levels in B12 deficiency is antibody interference in people with high titres of intrinsic factor antibody.[23] Some researchers propose that the current standard norms of vitamin B12 levels are too low.[24] In Japan, the lowest acceptable level for vitamin B12 in blood has been raised from about 200 pg/ml (145 pM) to 550 pg/ml (400 pM).[25]

There is confusion in units of B12 deficiency when given by various labs in various countries. Where units are presented as pg/liter, or pg/L, they are likely in error.[citation needed] Where they are presented as pg/mL or pmol/L, they are likely correct. The ranges for these two units are similar, since the molecular weight of B12 is approximately 1000, the difference between mL and L. Thus: 550 pg/mL = 400 pmol/L.

Serum Homocysteine and Methylmalonic acid levels are considered more reliable indicators of B12 deficiency than the concentration of B12 in blood, see for example research at the St. Louis University.[26] The levels of these substances are high in B12 deficiency and can be helpful if the diagnosis is unclear. Approximately 10% of patients with vitamin B12 levels between 200–400pg/l will have a vitamin B12 deficiency on the basis of elevated levels of homocysteine and methylmalonic acid.[citation needed]

Routine monitoring of methylmalonic acid levels in urine is an option for people who may not be getting enough dietary B12, as a rise in methylmalonic acid levels may be an early indication of deficiency.[27]

If nervous system damage is suspected, B12 analysis in cerebrospinal fluid can also be helpful, though such an invasive test would be applicable only after unrevealing blood testing.[28]

The Schilling test can play a role in the diagnosis.

[edit] Treatment
B12 can be supplemented in healthy subjects by oral pill; sublingual pill, liquid, or strip; intranasal spray; or by injection. B12 is available singly or in combination with other supplements. B12 supplements are available in forms including cyanocobalamin, hydroxocobalamin, methylcobalamin, and adenosylcobalamin (sometimes called "cobamamide" or "dibencozide"). Oral treatments involve giving 250 µg to 1 mg of B12 daily.[29]

Vitamin B12 can be given as intramuscular or subcutaneous injections of hydroxycobalamin, methylcobalamin, or cyanocobalamin. Body stores (in the liver) are partly repleted with half a dozen injections in the first couple of weeks (full repletion of liver stores requires about 20 injections) and then maintenance with monthly injections throughout the life of the patient. Vitamin B12 can also be easily self-administered by injection by the patient, using the same fine-gauge needles and syringes used for self-administration of insulin.

B12 has traditionally been given parenterally (by injection) to ensure absorption. However, oral replacement is now an accepted route, as it has become increasingly appreciated that sufficient quantities of B12 are absorbed when large doses are given. This absorption does not rely on the presence of intrinsic factor or an intact ileum. Generally 1 to 2 mg daily is required as a large dose [3]. By contrast, the typical Western diet contains 5–7 µg of B12 (Food and Drug Administration (FDA) Daily Value [30]). It has been appreciated since the 1960s that B12 deficiency in adults resulting from malabsorption (including loss of intrinsic factor) can be treated with oral B12 supplements when given in sufficient doses. When given in oral doses ranging from 0.1–2 mg daily, B12 can be absorbed in a pathway that does not require an intact ileum or intrinsic factor. In two studies, oral treatment with 2 mg per day was as effective as monthly 1 mg injections.[31][32]

Hypokalemia, an excessive low potassium level in the blood, is anecdotally reported as a complication of vitamin B12 repletion after deficiency. Excessive quantities of potassium are used by newly growing and dividing hematopoeitic cells, depleting circulating stores of the mineral.

Recently, claims have been made that other routes of B12 administration, such as intranasal and sublingual routes of administration, are superior to the simple swallowed pill. Although the intranasal route is are effective at increasing B12 levels, there have been no direct comparisons to show that they are any more effective than simple swallowed megadose tablets (1 to 2 mg). In particular, the sublingual route, in which B12 is presumably or supposedly absorbed more directly under the tongue, has not proven to be necessary, though there are a number of lozenges, pills, and even a lollipop designed for sublingual absorption. A 2003 study found no significant difference in absorption for serum levels from oral vs. sublingual delivery of 500 µg (micrograms) of cobalamin,[33] although the study measured only serum levels as opposed to tissue levels, which is more reflective of B12 levels. Sublingual methods of replacement may be effective only because of the typically high doses (500 micrograms), which are swallowed, not because of placement of the tablet. As noted below, such very high doses of oral B12 may be effective as treatments, even if gastro-intestinal tract absorption is impaired by gastric atrophy (pernicious anemia).

[edit] Natural food sources of B12
Vitamin B12 can be found in animal products, including fish, meat, poultry, eggs, milk, and milk products and fortified breakfast cereals. However, B12 is first made by yeasts and microorganisms and thus, animal products are not the only reliable source.[34] One half chicken breast, provides some 0.3 µg per serving or 6% of your daily value (DV), 3 ounces of beef, 2.4 µg, or 40% of your DV, one slice of liver 47.9 µg or 780% of your DV, and 3 ounces of molluscs 84.1 µg, or 1,400% of your DV, while one egg provides 0.6 µg or 10% of your DV. Other sources include fortified nutritional yeast, fortified soy milks, and fortified energy bars.

[edit] Epidemiology
Recent research indicates that B12 deficiency is far more widespread than formerly believed. A large study in the US found that 39 percent of studied group of 3,000 had low values.[35] This study at Tufts University used the B12 concentration 258 pmol/l (= 350 pg/mL) as a criterion of "low level". However, a recent research[citation needed] has found that B12 deficiency may occur at a much higher B12 concentration (500–600 pg/mL). On this basis Mitsuyama and Kogoh [25] proposed 550 pg/mL, and Tiggelen et al.[36] proposed 600 pg/mL. Against this background, there are reasons to believe that B12 deficiency is present in a far greater proportion of the population than 39% as reported by Tufts University.

In the developing world the deficiency is very widespread, with significant levels of deficiency in Africa, India, and South and Central America. This is due to low intakes of animal products, particularly among the poor.[37] The increased bacterial load due to poor sanitation, unprocessed/unsterilized food, or other sources of dietary contamination could also lead to pathogen-related malabsorption issues.

B12 deficiency is even more common in the elderly.[37] This is because B12 absorption decreases greatly in the presence of atrophic gastritis, which is common in the elderly.

B12 deficiency is common among vegetarians and vegans who do not take B12 supplements. In vegans the risk is very high because none of their natural food sources contain B12. One American study found blood levels below normal in 92 % of vegans, 64 % of lactovegetarians, 47 % of lacto-ovo vegetarians who did not supplement their diet with B12.[38] The study applied the old normal values, so in reality a considerably greater proportion may have been deficient. On the other hand, one must take into account that the study was conducted in 1982 with a group taking no vitamin supplements: today soy drinks are often fortified with vitamin B12.

 

[disneyluv4]

I take a shot every month. If I am late getting it I sure know it, my energy level gets really low.

 

[joyjoy]

I forgot to mention that yes, I am a vegetarian.

 

[golfgal]

Is there any problem with getting too much B12, say you start taking it and you find out later you don't need it. Does the excess wash out like Vit C does?

 

[mommasita]

Is there any problem with getting too much B12, say you start taking it and you find out later you don't need it. Does the excess wash out like Vit C does?

I am not sure if it washes out, but my DR's say that you can not have TOO much. I don't know if this is because my numbers remain 'low' but not as dangerous as they were. At one point I was having the injections weekly, and asked if was dangerous if my levels were to rise TOO high, and that was my answer.

A hematologist is the best way to go.

 

[MrsToad]

I am not sure if it washes out, but my DR's say that you can not have TOO much. I don't know if this is because my numbers remain 'low' but not as dangerous as they were. At one point I was having the injections weekly, and asked if was dangerous if my levels were to rise TOO high, and that was my answer.

A hematologist is the best way to go.

When my levels were determined to be way too low, my hematologist also said that there really isn't a level that is too high. I had 7 injections over 3 weeks, then started taking 2500 units sublingual every day. It's been a little over a year now, and my levels are stable at a bit above what the blood work paperwork showed as "normal."

 

[LovableGluttons]

If you continue to be anemic even on supplements, please see a hematologist

Getting the iron dextran infusions also callef InFed, truly changed me. What a relief! No more doctors trying transfusions of blood products which never worked anyway.

 

[luvwinnie]

Thanks, everyone. I've never been anemic. Just low B12.