Putative B12 deficiency

[hammerheart]

Being on an omnivorous diet and regularly supplementing with B vitamins, I was being a bit quite curious where my levels would land at, so I pulled cobalamin in the most recent bw I had.

Because of the above, I was a bit dismayed to discover I have borderline levels - 254 pg/ml (187 pmol/l) over a lower range of 200. By modern standards, this already shows moderate deficiency.

Going a tad backwards in time, I did pull B12 two yrs ago, levels scored at 700 but I had been taking 1000mcg methyl-B12 tablet for about three months prior to bloodwork. From there on, I stopped those and relied on regular B vitamins complex.

Considering both supplementation and dietary intake from animal protein I should have been able to maintain average levels. It seems rather abnormal to me that such fall in levels occurred in a relatively short frame of time. Occording to medical literature, the liver should store about three-to-five years worth of B12 if intake stops. It's like I've been assimilating nothing.

I readily started IM cyano injections but I believe I do need to do further testing to understand what might be going on.

Possible causes for selective B12 malabsorption include atrophic gastritis (due to lack of IF), small bowel pathology (celiac sprue, IBD), and SIBO (small intestine bacterial overgrowth).

I checked antibodies for coeliac disease a while ago and came out negative. I feel I can exclude Chron's (though some family members have it) and other forms of IBD because symptoms of inflammation would be easily discernable and I got none.

Athrophic gastric can be autoimmune in origin and has higher incidence in hashimoto's patients (I'm one). I should have already looked for IF and parietal cells antibodies long ago, positivity isn't sufficient for diagnosis but might point in the right direction.

If these came out negative, I sense I should rather look into SIBO and perhaps run a trial of normix (rifaximin). Bacterial overgrowth in the small bowel might also well explain why Iron status too is at stale despite supplementation.


This is a good informative page about the functions of B12 in the body:

Vitamin B12 | Linus Pauling Institute | Oregon State University


The major enzyme families requiring cobalamin as co-enzyme are MS (methionine synthase) and MCM (Methylmalonyl-CoA mutase).

Methionine synthase catalyzes the recycling of homocysteine into methionine and MCM converts MMA (Methylmalonic acid) into Succinyl-CoA. Thus, tissue-level deficiency will lead to accumulation of these metabolites in the blood and can be used as markers of "true" B12 deficiency. This is very important to know because, according to modern research, this can be present despite normal, "in range" cobalamin levels, and can help with early diagnosis.


For the average public, I found this to be a good informative site: B12 Deficiency : Welcome


All in all I'm glad I've detected this issue early, I suspect I might have developed serious issues in the months ahead if I didn't correct this now. Being also affected by a genetic, benign "disease" that causes microcytic erythrocytosis (small red cells but higher in number), plus supplementing with folate/iron and with TRT supporting hematopoiesis it would have been quite hard to develop pernicious anaemia, the most prominent (and clinical) feature of B12 deficiency characterized by larger-than-normal red blood cells, reduced counts and haemoglobin, that means, the whole thing would have been perfectly masked and unrecognizable...

[Mr.BB]

Very informative as always!

Have you taken any antibiotics lately?

[hammerheart]

Just a brief three days course of Azithromicyn early in December as prophylaxis for the tooth avulsion.

[Marsoc]

Being on an omnivorous diet and regularly supplementing with B vitamins, I was being a bit quite curious where my levels would land at, so I pulled cobalamin in the most recent bw I had.

Because of the above, I was a bit dismayed to discover I have borderline levels - 254 pg/ml (187 pmol/l) over a lower range of 200. By modern standards, this already shows moderate deficiency.

Going a tad backwards in time, I did pull B12 two yrs ago, levels scored at 700 but I had been taking 1000mcg methyl-B12 tablet for about three months prior to bloodwork. From there on, I stopped those and relied on regular B vitamins complex.

Considering both supplementation and dietary intake from animal protein I should have been able to maintain average levels. It seems rather abnormal to me that such fall in levels occurred in a relatively short frame of time. Occording to medical literature, the liver should store about three-to-five years worth of B12 if intake stops. It's like I've been assimilating nothing.

I readily started IM cyano injections but I believe I do need to do further testing to understand what might be going on.

Possible causes for selective B12 malabsorption include atrophic gastritis (due to lack of IF), small bowel pathology (celiac sprue, IBD), and SIBO (small intestine bacterial overgrowth).

I checked antibodies for coeliac disease a while ago and came out negative. I feel I can exclude Chron's (though some family members have it) and other forms of IBD because symptoms of inflammation would be easily discernable and I got none.

Athrophic gastric can be autoimmune in origin and has higher incidence in hashimoto's patients (I'm one). I should have already looked for IF and parietal cells antibodies long ago, positivity isn't sufficient for diagnosis but might point in the right direction.

If these came out negative, I sense I should rather look into SIBO and perhaps run a trial of normix (rifaximin). Bacterial overgrowth in the small bowel might also well explain why Iron status too is at stale despite supplementation.


This is a good informative page about the functions of B12 in the body:

Vitamin B12 | Linus Pauling Institute | Oregon State University


The major enzyme families requiring cobalamin as co-enzyme are MS (methionine synthase) and MCM (Methylmalonyl-CoA mutase).

Methionine synthase catalyzes the recycling of homocysteine into methionine and MCM converts MMA (Methylmalonic acid) into Succinyl-CoA. Thus, tissue-level deficiency will lead to accumulation of these metabolites in the blood and can be used as markers of "true" B12 deficiency. This is very important to know because, according to modern research, this can be present despite normal, "in range" cobalamin levels, and can help with early diagnosis.


For the average public, I found this to be a good informative site: B12 Deficiency : Welcome


All in all I'm glad I've detected this issue early, I suspect I might have developed serious issues in the months ahead if I didn't correct this now. Being also affected by a genetic, benign "disease" that causes microcytic erythrocytosis (small red cells but higher in number), plus supplementing with folate/iron and with TRT supporting hematopoiesis it would have been quite hard to develop pernicious anaemia, the most prominent (and clinical) feature of B12 deficiency characterized by larger-than-normal red blood cells, reduced counts and haemoglobin, that means, the whole thing would have been perfectly masked and unrecognizable...

Thought b12 wasn't available due to the formation of cyanide in the blood from it. Found in pits of apricots I think..it was researched as a form of cancer treatment. Is it not available to purchase?

[Quester]

I'm taking Lipo-Mino-Mix from Olympia Pharmacy (legit Florida compounding pharmacy), prescribed by my TRT doctor.

Active Ingredients:
Pyridoxine (B6): Promotes red blood cell
production and converts food to energy.
Methionine: Helps break down sugars &
carbohydrates and convert to energy.
Inositol: Converts food to energy.
Choline: Healthy nerve cells, cuts muscle
recovery time, helps convert fat to energy
Methylcobalamin: Energy, healthy nerve cells.
Carnitine: Building block for proteins, helps body
burn fat as fuel
Thiamine (B1): Improves immune system, helps
convert fat and carbohydrates into energy
Riboflavin (B2): Increases metabolism, supports
immune system
Valine: Suppresses appetite

[hammerheart]

Thought b12 wasn't available due to the formation of cyanide in the blood from it. Found in pits of apricots I think..it was researched as a form of cancer treatment. Is it not available to purchase?

We ingest some cyanide everyday from food, fruit pits might contain hazardous amounts yet I don't know of anyone eating them...

Yes it's available to purchase (on prescription) worldwide. It's vital to ppl with pernicious anaemia. The cyanide released from cyanocobalamin is too small to pose any harm even with IM/IV administration.

Gear sources also stock it. Imo a great addiction to control the elevation in homocysteine that might come with cycling (study).

I'm taking Lipo-Mino-Mix from Olympia Pharmacy (legit Florida compounding pharmacy), prescribed by my TRT doctor.

Active Ingredients:

What a bunch. IM B12 alone it's fine for selective malabsorption. I supplement regularly with (almost) everything essential needed for physiologic functioning: B vitamins, C, D, omega-3 fatty acids, Fe, Zn, and selenium. The rest I'm sure it's well covered by diet.

[Charlie6]

Being on an omnivorous diet and regularly supplementing with B vitamins, I was being a bit quite curious where my levels would land at, so I pulled cobalamin in the most recent bw I had.

Because of the above, I was a bit dismayed to discover I have borderline levels - 254 pg/ml (187 pmol/l) over a lower range of 200. By modern standards, this already shows moderate deficiency.

Going a tad backwards in time, I did pull B12 two yrs ago, levels scored at 700 but I had been taking 1000mcg methyl-B12 tablet for about three months prior to bloodwork. From there on, I stopped those and relied on regular B vitamins complex.

Considering both supplementation and dietary intake from animal protein I should have been able to maintain average levels. It seems rather abnormal to me that such fall in levels occurred in a relatively short frame of time. Occording to medical literature, the liver should store about three-to-five years worth of B12 if intake stops. It's like I've been assimilating nothing.

I readily started IM cyano injections but I believe I do need to do further testing to understand what might be going on.

Possible causes for selective B12 malabsorption include atrophic gastritis (due to lack of IF), small bowel pathology (celiac sprue, IBD), and SIBO (small intestine bacterial overgrowth).

I checked antibodies for coeliac disease a while ago and came out negative. I feel I can exclude Chron's (though some family members have it) and other forms of IBD because symptoms of inflammation would be easily discernable and I got none.

Athrophic gastric can be autoimmune in origin and has higher incidence in hashimoto's patients (I'm one). I should have already looked for IF and parietal cells antibodies long ago, positivity isn't sufficient for diagnosis but might point in the right direction.

If these came out negative, I sense I should rather look into SIBO and perhaps run a trial of normix (rifaximin). Bacterial overgrowth in the small bowel might also well explain why Iron status too is at stale despite supplementation.

This is a good informative page about the functions of B12 in the body:

Vitamin B12 | Linus Pauling Institute | Oregon State University

The major enzyme families requiring cobalamin as co-enzyme are MS (methionine synthase) and MCM (Methylmalonyl-CoA mutase).

Methionine synthase catalyzes the recycling of homocysteine into methionine and MCM converts MMA (Methylmalonic acid) into Succinyl-CoA. Thus, tissue-level deficiency will lead to accumulation of these metabolites in the blood and can be used as markers of "true" B12 deficiency. This is very important to know because, according to modern research, this can be present despite normal, "in range" cobalamin levels, and can help with early diagnosis.

For the average public, I found this to be a good informative site: B12 Deficiency : Welcome

All in all I'm glad I've detected this issue early, I suspect I might have developed serious issues in the months ahead if I didn't correct this now. Being also affected by a genetic, benign "disease" that causes microcytic erythrocytosis (small red cells but higher in number), plus supplementing with folate/iron and with TRT supporting hematopoiesis it would have been quite hard to develop pernicious anaemia, the most prominent (and clinical) feature of B12 deficiency characterized by larger-than-normal red blood cells, reduced counts and haemoglobin, that means, the whole thing would have been perfectly masked and unrecognizable...

I took a nutrition class recently and my prof mentioned that the methyl b tabs are the absolute best for absorption. You mentioned a switch from that to B comp so I'm wondering if that might account for the slump. But also, you don't seem to be deficient as you claim.. You just dropped in level but you're still in range.

[hammerheart]

I took a nutrition class recently and my prof mentioned that the methyl b tabs are the absolute best for absorption. You mentioned a switch from that to B comp so I'm wondering if that might account for the slump. But also, you don't seem to be deficient as you claim.. You just dropped in level but you're still in range.

Large oral doses (1000-2000mcg) of cyano will work as well. There is nothing special to methyl-B12 in the regards of absorption, however it might offer advantages being a biologically active form of cobalamin.

I never claimed to be deficient, the title speaks for itself, what I said is that when levels are borderline you need to look at homocysteine and methymalonic acid in order to understand what is going on intracellularly. Without further testing, we cannot have a clear idea of what is going on.

About ranges, I guess it's like Test - at 250 ng/ml you might be "in range" (varying between labs even), but...

[Quester]

Tabs and injections both bypass the digestive system. The digestive system will not absorb B-12 (and, I think, other water soluble vitamins) if our body has enough. Thus, ingesting B-12 will do nothing if we already have enough.

[hammerheart]

Today I got some bloodwork results, not mine but grandma's.

She got a very complicated health situation - decades of poorly managed diabetes, stage IV kidney failure, rheumatic and autoimmune disorders, psychiatric disability, etc.

Considering my own experience with B12 and familiarity (I believe I somewhat inherited thyroiditis from her) I went to her GP and asked , among multiple things as she's feeling very unwell lately and has literally skin coming off from fingertips, to check her vitamin status.

It turns out, she has extremely poor levels of B12 (86 pg/ml) despite no evidence of megaloblastosis from CBC, as folate status is actually good (I guess thanks to Mediterranean diet), and this can prevent the red blood cells from developing macrocytosis to some extent.

Now it will be hard to convince her doctor a 100% RDI of B12 won't solve the problem. I have 1/4th of her years yet supplementation plus diet high in B12 wasn't enough to keep adequate B12 status for me.

Damn GPs and their careless attitude about patient problems and needs. What if I didn't ask to check her B12? Not even her neurologist (apparently a major authority here) did. What further suffering would have she had to endure?

[hollowedzeus]

Borders on neglect sometimes i think based on some of my families experiences...

Hope she gets things sorted soon.

[Obs]

Today I got some bloodwork results, not mine but grandma's.

She got a very complicated health situation - decades of poorly managed diabetes, stage IV kidney failure, rheumatic and autoimmune disorders, psychiatric disability, etc.

Considering my own experience with B12 and familiarity (I believe I somewhat inherited thyroiditis from her) I went to her GP and asked , among multiple things as she's feeling very unwell lately and has literally skin coming off from fingertips, to check her vitamin status.

It turns out, she has extremely poor levels of B12 (86 pg/ml) despite no evidence of megaloblastosis from CBC, as folate status is actually good (I guess thanks to Mediterranean diet), and this can prevent the red blood cells from developing macrocytosis to some extent.

Now it will be hard to convince her doctor a 100% RDI of B12 won't solve the problem. I have 1/4th of her years yet supplementation plus diet high in B12 wasn't enough to keep adequate B12 status for me.

Damn GPs and their careless attitude about patient problems and needs. What if I didn't ask to check her B12? Not even her neurologist (apparently a major authority here) did. What further suffering would have she had to endure?

Most docs are "passed the exam docs".
Even specialists usually don't go over anyone with a fine tooth comb they just reach for a brush and give a once over, usually giving a generalized diagnosis off basic symptoms.
Most are either too dumb or lazy to give individualized diagnosis or treatment by looking at the health of the persons blood levels for any domino effect root causes.
I have seen some retarded diagnosis!

Two instances in particular made me lose a lot of faith in doctors.

Good catch bizzaro! You would make an excellent doctor!

[Obs]

Oooooohh! My favorite is when someone goes to a general practitioner here and they explain their symptoms and the doctor is literally typing the symptoms into webmd!
That is just sickening!
"Well Timmy, Google says you may have aids"

[hammerheart]

GP put her on B12 injections straight away and she's finally commencing to feel better. Her anxiety and tremors are much less noticeable.

[DocToxin8]

Tabs and injections both bypass the digestive system. The digestive system will not absorb B-12 (and, I think, other water soluble vitamins) if our body has enough. Thus, ingesting B-12 will do nothing if we already have enough.

Not that simple.
But if f.ex vit c status is high,the body will excrete it faster.
B12 is a little special since it needs intrinsic factor/IF to be absorbed.
Hence why some people have difficulty getting enough even with oral megadoses. Injections don't require IF though.

All water soluble vitamins can be taken in a bit of an excess without any harm.

Be wary of doctors, they make mistakes.
And nowadays they make even more,
cause they are so tired of patients spewing out info they found on Google that they won't take the ones who do know their shit seriously.

[hammerheart]

Aging alone can be a factor in impaired secretion of IF, I thus believe a B12 panel (serum and erythrocyte folate, cobalamin and homocysteine) should be a fundamental part of geriatric evaluation, yet it's still enormously underlooked today still, even in the setting of neurologic and psychiatric symptoms.

[TRA]

Thought b12 wasn't available due to the formation of cyanide in the blood from it. Found in pits of apricots I think..it was researched as a form of cancer treatment. Is it not available to purchase?

You're thinking of B17, which is what some people call Laetrile or amygdalin, from the apricot pit, and yes, it can be toxic.

B12 is found mostly in red meats and does have a cyanide but the body can easily handle the small amount from it during metabolism.