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Irishmom4
Regular Member


Date Joined Sep 2008
Total Posts : 457
   Posted 7/21/2010 2:18 PM (GMT -7)   
I recently had my labs done and my B-12 was 194. The lab report indicates it is low, but my doc didn't mention it.  Should I look into taking supplements. I already take folic acid and a multi vitamin.
Thanks for your help.
 
Elizabeth
Dx'd with Crohns 1984
Polycystic kidney disease in 1996
Bowel Resection surgery 2006, Now on Asacol,  Imuran, Folic acid, and Enalapril.
 


NiceCupOfTea
Veteran Member


Date Joined Jan 2010
Total Posts : 8545
   Posted 7/21/2010 2:57 PM (GMT -7)   
Crikey. You made the same thread I had been thinking of making, except my B12 is slightly higher (224). My GP told me cheerily that it was "fine", so I'm not sure what to do about it. I'm interested in seeing other people's replies.

njmom
Veteran Member


Date Joined Apr 2006
Total Posts : 1884
   Posted 7/21/2010 5:40 PM (GMT -7)   
B12 deficiency is common in Crohn's because the terminal ileum is often unable to effectively absorb it. General guidelines are that anything below 300 is presumed deficient. The B12 level should be at least 400, but the best level is 500 and higher.
 
You can get a B12 shot to ensure it is boosted right away. You could then follow up with B12 oral supplements of at least 500, and then have another blood test taken after a month or so to see how high your B12 is. Everybody is different - my daughter's B12 tends to increase quite a bit right after a shot, and then steadily go down to where she needs another shot in a month or six weeks - she takes oral 1000 B12 a day, but it goes down, anyway. Not unusual for Crohn's.
 
You might find that no amount of oral B12 will do the job, so you might need monthly shots for life.  
 
The following link shows that you are most likely definitely NOT B12 deficient ONLY if your B12 is above 400.  http://www.aafp.org/afp/2003/0301/p979.html
 
The following article defines B12 deficiency as "clinical" response to therapy - by this standard, it finds that 40% of patients at 100-200 are deficient and 50% at less than 100 are deficient. These are pretty high odds of deficiency, so your goal should be to be higher than 400 to ensure you are not deficient, since B12 is critical to so many functions.  
 
"Opinions differ as to the optimal laboratory cutpoint for the serum vitamin B12 test, due in part to the insidious onset and slow progression of the disorder and limitations of current assays. Research studies and clinical laboratories have tended to dichotomize low values at 200 picograms per milliliter(pg/mL).18,66-67   Stabler and Allen note the following range of serum cobalamin levels among patients with a clinically confirmed B12 deficiency (defined as those who “have objective clinical responses to appropriate therapy”):  less than 100 pg/mL, approximately 50%; 100 to 200 pg/mL, approximately 40%; 200 to 350 pg/mL, approximately 10%; and more than 350 pg/mL, approximately 0.1% to 1%.7"
 

NiceCupOfTea
Veteran Member


Date Joined Jan 2010
Total Posts : 8545
   Posted 7/21/2010 6:34 PM (GMT -7)   
400-500? And my doctor thought 224 was fine?!

I'll never get B12 shots if my B12 level has been recorded as "normal". The thing with me is, I should get loads of B12 from my diet: eat eggs, red meat, milk, etc. And I still have my terminal ileum intact, if diseased. But my B12 level seems to be quite low. I had mild disease for the first few years, so it could have taken many years for my B12 stores to have become depleted.

Meh. Guess I'll have to go the sublingual route if I want to supplement. Thank you for the detailed post and links, njmom - I'll bookmark those articles.

lamb61
Veteran Member


Date Joined Jan 2005
Total Posts : 1718
   Posted 7/22/2010 3:56 AM (GMT -7)   
That isn't acceptable level. Mine just dropped down again to 278, it didn't even take the dr. office 6 hours after the bloodwork to call and tell me I need to do another 4 week bolus and see if it comes back up. I don't think we've ever gotten it back up over 400 but I'm going to push for more frequent shots, currently I only do 1 per month.
 


Irishmom4
Regular Member


Date Joined Sep 2008
Total Posts : 457
   Posted 7/22/2010 4:52 AM (GMT -7)   
I will call my GI today. I can't believe my doctor didn't mention it when I was in there two days ago. I am quickly losing confidence in both my doctors.
Dx'd with Crohns 1984
Polycystic kidney disease in 1996
Bowel Resection surgery 2006, Now on Asacol,  Imuran, Folic acid, and Enalapril.
 


njmom
Veteran Member


Date Joined Apr 2006
Total Posts : 1884
   Posted 7/22/2010 10:01 AM (GMT -7)   
Docs can easily be fooled by the lab reports because they are used to thinking things are fine if the lab says the level is "normal." But in the case of B12, "normal" does not mean "healthy" and it does not mean you are not B12 deficient. Patients with B12 of 100-200 are in the "normal" range, but about 50% of these patients are B12 deficient.
 
The typical B12 test is not designed to rule out B12 deficiency, but only to say what is "normal."  One of the links I supplied goes to the American Family Physician document, which suggests that, if you have a B12 level of 100-400, you can be further tested to rule out deficiency. These tests are the "serum methalmalonic" and "homocysteine levels." If either level is elevated, you are definitely deficient.
 
But in the US, endocrinologists don't bother with the additional tests. It makes sense to suspect anybody with less than 300 is deficient, and needs a shot to quickly build up the B12. And then to follow up with lab work to make sure the levels have risen enough. The problem is, either you are deficient or not. There is no such thing as a little deficient when it comes to B12. My daghter has never had surgery, has no symptoms, has no scar tissue, but just cannot absorb enough B12 through the oral route. 
 
The oral route is worth trying, but even if it works, the body can only absorb a miniscule amount, at a time, of the supplement. This is why docs tend to go for the shot if B12 is lower than 300, to quickly boost B12, rather than risk the harm that can be done by B12 deficiency. 
 
So the shot might make sense at least initially...I don't have Crohn's and my own B12 was 239 (I worked night and day and didn't eat right.), so I got the shot and have been able to maintain via the oral route. Maybe this will work for you...the only way to know for sure is trial and error, and following up with labs to check what is and isn't working.
 
 

Post Edited (njmom) : 7/22/2010 11:04:28 AM (GMT-6)

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