Discussions By Condition: I cannot get a diagnosis.

vitamin b12 problem

Posted In: I cannot get a diagnosis. 2 Replies
  • Posted By: robertam
  • October 31, 2008
  • 03:15 AM

i am 5 1/2 years out after having a gastric bypass, my B12 has been decreeasing over time even tho i take sl tabs 2xday. 11-07 it was 330. 6-08 it was 235 in 9-08 it was 214. my doctor doesn't want to treat it because "its not below 200" i have been have problems with insomnia, restless legs, twitching in my legs at night, tingling in my arms and hands. headaches (everyday), depression and severe irritatibity. my doctor tested my hgb in june is was 9.2 so we increased my iron tabs to four times a day, but of course constipation and hemmorrhoids became a problem. I also increased my b12 to 3 sl tabs 2xday. in sept my hgb was up to 10.2 my b12 was at 218. i am always tired, even when i wake up in the am. my doctor seems to think the headaches are from tension in my neck, he gave me valium to relax those muscles and help me sleep. i still dont sleep well. at the end os sept i requested another test for the b12 level. suddenly it was at 715. I am a RN, i figured a mistake had occured, because i hadn't shanged anything else(only added an orange each morning) so i asked to repeat the test.. two weeks later tests showed my b12 at 535, hemocystine was 8, the MMA was 1.2, in aug my ferritin was 1; tibc unsat = 456; transferin % 5%; tibc 481; iron 25. my doctor thinks all is going to be ok. I know i have used up my iron and b12 stores and am not eager to wait for unreversalbe effect of low b12. to complicate all this a bit more i am 49y and tring to get thru menopause, my periods have increase to 1x2weeks. whichdoesn't help. i am not sure what the normal range is for mma, what i read it depends on age, sex and toher info. would the increase of sl b12 mess the mma and hemocystine results up, so they don't show vit b12 def? should i change doctors to one who will give me injections without as much hassel? have any suggestions?:rolleyes:

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2 Replies:

  • If you're an RN, go to Medline and search the following: b12 deficiency gastric bypass www.pubmed.gov
    aquila 1,263 Replies
    • November 4, 2008
    • 08:15 PM
    • 0
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  • Okay, I'm having just a bit of difficulty in following your posting. First of all, I'm not certain what you're referring to by "unreversable effects" of low B12. The only irreversible effects of B12 conditions are wherein the practitioner attempts to treat it with folate, which can cause nerve degeneration. B12 deficiency in of itself does not constitute irreversible circumstances, only inappropriate treatment. Secondly, unless your labs are indicating signs of megaloblastic anemia, then low B12 values do not constitute deficiency or indicate pathological circumstances. The need to treat it would purely be elective. In other words, the need to check MMA and homocysteine would only be appropriate if symptoms of B12 deficiency(not a plasma level) were evident. These tests have no diagnostic value otherwise. Realize that an elevated methylmalonic acid level is not a pure indicator of cobalamin deficiency and can be seen in kidney dysfunction and other disorders. Homosysteine can be elevated if general inflammation is present in the body. Both are better predictors of tissue levels rather than plasma levels as well. Normal range for MMA is, depending upon the lab naturally, somewhere between .08 to .56. The factor relative to your bypass may well involve levels of instrinsic factor necessary to process cobalamin. If you are taking any type of PPI for GI discomfort of any type, then in the presence of a bypass, therapeutic agents like these can bring about a B12 deficiency more frequently than in those without gastric bypass. Low acidity equates with decreased instrinsic factor. Having said all of that, you can certainly locate another primary care physician who would be less concerned about giving you B12 IM. It's not necessarily a risk but you should take into account my comments that stand in contrast to your opinions regarding your B12 status. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • November 4, 2008
    • 11:50 PM
    • 0
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