B12 Overload

On November 25, 2009, in Water Solubles, by Andrea
Here doggy doggy doggy...

Here doggy doggy doggy...

Those that have been reading some of my posts for awhile may remember my cautions against overloading on B12.  Generally of which I get “poo-poo”d at because “B-12 is safe, doncha know cause my doctor told me so and you’re just some idiot on the interwebz.”

And for the most part, I’ve kept my mouth shut.  Until now.  I have articles.  And quotes.

It’s important to note a few things –

1) the difference between an overdose and toxicity (or in this case, overload)

  • overdose is when you take something one time and it’s soooo very much that it completely kills off body systems and you cannot handle it and your systems fail, generally leading to death — think taking an entire bottle of tylenol at once
  • toxicity, or overload is a gradual dosing of high-dose medication that stresses the body until a point in which the body gives up — think taking the maximum dosage of tylenol (4mg) a day for a year – at some point, the liver will fail

2) B12 is made of cobalt.  Cobalt.  Do you realize what cobalt IS?  It’s a heavy freaking metal.  Something that many of us postops are injecting into our bodies even weekly because we can’t get it to stick.  A heavy metal.  Hell, I inject it into my doggy once every 2 weeks (yeah, you’d think he had WLS as well – and yes, that is his dose up there in the picture.. see his name?).  Some forms are actually molecules of cobalt and cyanide.  Mmm… cyanideYummy.  Now tell me that B12 is completely safe and harmless to take all willy nilly.

3) Postops are exhibiting disorders and diseases that docs haven’t seen in quite some time.  Beri-beri, a deficiency of thiamin, used to be quite uncommon.  Now, it’s becoming common enough postop RNY that it’s got a new name for us — bari-beri.  Great, eh?  And I’ve received more than a few PM’s on OH asking about rectifying Scurvy..  Scurvy?  Really?  I thought that went away when people stopped sailing the ocean blue?  No?  So the idea that we could possibly be overmedicating ourselves, especially given some docs who don’t believe in doing lab draws after the 3rd year for vitamins (Hi Iris, remember that lecture in Atlanta?  Wasn’t that a blast?  I sure thought it was.) but yet still give their patients the shots?  Well who knows what blood levels are coming up?

Nothing really surprises me much anymore.  Well, lab-wise.  I think someone 10 years out on 2 flintstones and 2 tums and my-idea-of-perfect labs would do it — but that’s about it.

So yeah — nothing is perfect in super-human quantities.  Sure, RNY’ers have the guts of 90-year olds (the older people get, the less IF they have) so they can’t break apart the B12 properly and get the benefit of it.  I get that.  I mean, I have this configuration my own self.  I understand.  But there’s a point in which too much is, well, too much.  What is that level?  Well, my WLS nut in Greenville, NC says it’s over 2000.  This guy says it’s over 3000.  These guys?  Well, they don’t even have a clue… Their side-step answer?

The upper limit of safety for vitamin B12 has not been determined due to lack of data substantiating adverse effects at high intakes. The Food and Nutrition Board of the Institute of Medicine recommends that vitamin B12 should be consumed only from food sources to prevent intake of potentially toxic levels.

Yeah, that’s helpful.  Thanks, guys.  I’ll be sure to stuff a stocking for you.

But regardless — people, and these are people with little letters after their names, folks — not just me — people are saying that B12 in excess is not necessarily a great thing.  Especially with that whole JAMA deal that came out last week

So!  You want to know what overloading on B12 can do?  Well, hey, I have that right here!

Acu-Cell Nutrition gives us some bright info (where is that sarcasm font I asked for?):

Some uninformed practitioners believe that there is no overdose possible with Vitamin B12, however
5-10% of the population presents with above-normal levels of Vit B12, so if injections are erroneously
given, they can trigger a number of adverse symptoms that may include coronary artery spasms with
chest pains, numbness or pain down their right arm, and/or TIA-like symptoms with tingling / numbness
on the right side of the face.
There is also a risk of hypokalemia, pulmonary edema, peripheral vascular thrombosis, optic nerve
atrophy for someone with Leber’s disease, and others.  Risks from intranasal use of Vitamin B12
include glossitis, headache, sore throat, rhinitis, and feeling of “pins and needles.”  Individuals suffering
from Mitral Valve Prolapse (MVP) are also vulnerable to experience a worsening, or an acute flare-up
of MVP symptoms following a Vitamin B12 shot if not indicated.

Even without having had any Vitamin B12 injections, individuals who run naturally high Vitamin B12
and cobalt levels (which may include patients with mitral valve prolapse), tend to frequently suffer from
tachycardia, panic-anxiety attacks, or angina-like chest pains, that may be accompanied by numbness
and tingling in the face or extremities.
In contrast to cellular measurements, blood tests for cobalt or Vitamin B12 levels (including the Schilling
test) are not only very unreliable, but at times alarmingly wrong, subjecting patients to improper therapy,
or routinely misdiagnosing them as Psychiatric Cases, when in fact correcting their abnormal cobalt,
Vitamin B12 and nickel status (or ratios) could resolve the problem.

And then this (and I hesitate only because the references got nixed and I HATE that, but it has a valid point concerning the cyanide):

Dr. Dommisse prefers hydroxycobalamin to cyanocobalamin. A person taking the latter might over a period of years accumulate a toxic amount of cyanide and possibly damage vision. Methylcobalamin, according to one source, might be risky for schizophrenic patients.

And last, but not least — something that all RNY’ers really want to read as a possible side effect to high B12 levels:

Case Study involving Elevated Vitamin B 12 Levels
We present a second case study concerning a thirty-year old woman (in 1999) whose blood parameters were monitored for unrelated matters but strikingly presented repetitive high vitamin B12 levels without any related supplementation neither from the vitamin itself, nor through vitamin B complexes / multivitamin formulas.

The original data from our records follows [NOTE: All results for vitamin B12 are expressed in pg/ml and the normal range provided by the Belgian laboratory is 200pg/ml to 900pg/ml, even if the lower limit could be considered as too low to be compatible with optimal health].

The five first measurements, from February 1999 to April 2000, were quite consistently fluctuating around 2500pg/ml (respectively 2796pg/ml on 6/2/99, 2355pg/ml on 19/4/99, 2572pg/ml on 30/7/99, 2697pg/ml on 7/3/2000 and 2325pg/ml on 17/4/00), which is much too high! At the time, the patient’s blood had to be monitored in relation to a drug-based anti-epileptic treatment. However, the young woman was not complaining about her digestive system, even if she occasionally mentioned some severe but transitory abdominal cramps.

Her digestive problems started during the summer season in 2000, with IBS like symptoms, bloating, diarrhoea and excruciating pain in the belly. She was examined thoroughly and the gastroenterologist initially suspected Crohn’s disease due to the presence of mucosal ulcerations in the proximal small intestine. During that period of major clinical deterioration, blood vitamin B12 level increased even further as seen from two measurements performed on 25/08/00 (3220pg/ml) and on 28/11/00 (3221pg/ml). Then, she refused to take the corticoids prescribed by the specialist and went on a natural treatment based on diet modifications (exclusion of high IgG foods, in her case: dairy products, beef, bananas and black pepper), supplements (according to her biological results in blood and in 24-hour urine), antimicrobial herbs (such as grapefruit seed extracts) and probiotics.

She didn’t improve dramatically, but slowly started to complain less within a few weeks, then was feeling slightly better in March 2001 and significantly better when she came back five months later, in August 2001. Very interestingly, vitamin B12 blood levels started to decrease to 2740pg/ml on 24/3/01 and then down to 2132pg/ml on 22/08/01. In fact, the last result provided her lowest blood value since the beginning of the study. In September 2001, we then asked the gastroenterologist to perform a new endoscopy, in order to dismiss the diagnosis of Crohn’s disease and make sure that we were not harming her by not giving the prescribed drugs. The digestive exploration was then considered as normal, besides some “non specific mucosal inflammation”.

So the case was much less worrying and it took about seven months before she consulted again, in March 2003. She was symptom-free, finally expressing a much better digestive capacity since she was on this diet, even though she hadn’t renewed her supplements for a while. The cramps had disappeared and her blood reading for the vitamin B12 was 1001pg/ml on 26/3/02, almost back to the normal range. She definitely reached and stayed within the normal range on further checks with 726pg/ml on 31/08/02, 677npg/ml on 21/5/03 and finally 516pg/ml on 15/5/04. The last time, she was still symptom-free, but also dairy-free. She might have to consider taking vitamin B12 supplements one day in the future, but that’s another story…

There is other anectdotal evidence that shows that B12 can be overloaded and we should watch our levels  — but hey, I’ve just been beating this drum for a year or so now..

Monin Sugar Free Dark Chocolate Sauce

On November 18, 2009, in Reviews, by Andrea
Mm.. chocolate?

Mm.. chocolate?

I have to admit — I’ve had this before I bought it.

In Books-A-Million’s cafe’s Joe Mugg’s, they sell a Sugar Free Cafe’ Mocha using this product.  At first, I thought — WTH, I’ll try it.  It will suck, but I’ll give it a shot.  The barista let me put a little on my finger to let me try it.. which was a shock because I was expecting it to be some of the runny syrups that everyone uses in their coffees (including me, yes).. but no, this is the consistency of Hershey’s syrup.  But sugar-free?  What?  No, it would taste like rubber, right?  It would suck, right?


No, it didn’t.

So I had a skinny mocha made with this.  Shared with Sam, who also really liked it.  It was good.  Had another one, at a later date.  It was still really good.  Had to order.  Thus I did.  Here it is.

The consistency is just like Hershey’s syrup.  No, not kidding.





Gave some to my parents who are in town visiting and they agree.  Husband and grandparents all agree this tastes like Hershey’s — none could really tell it was sugar free unless they looked at packaging (well, they knew I was mega-excited, so that was a major clue).  Thoughts are already popping through my little brain as it sits on my counter, with pump installed.

And yes, don’t worry — cause I bought the 64 ounce container.  Why buy 16oz when for just a fraction more you can get 4x as much?!?

Okay, so the downfall — and yeah, of course it had to have one — is that the first ingredient is malitol.  For many postops, this is an evil evil sugar alcohol.  It’s hard on the gut, can cause tear-causing gas, a rift in your relationships (personal, professional, offend random people in elevators…, etc.  I’m lucky — I have to practically inject the crap to have much effect — but for others it should practically be taken with iron to help keep things moving.  So if you’re particularly sensitive, then hey, take it with your ferrous sulfate (and that rusty metal pipe for your iron).  Of course, I only plan on using a small bit in my coffee to add a touch of flavor, but that’s just me.



Serving size: 1/2 fl oz (15 mL)
Amount per serving
Calories 40 Calories from Fat 0
% Daily Value*
Total Fat 0g 0%
Saturated Fat 0g 0%
Cholesterol 0mg 0%
Sodium 18mg 1%
Total Carbohydrates 12g 4%
Dietary Fiber g 2%
Sugars 0g
Protein g
Vitamin A 0% Vitamin C 0%
Calcium 0% Iron 3%
Allergen Information
contains: milk
*Percent Daily Values (DV) are based on a 2,000 calorie diet.

INGREDIENTS: maltitol syrup, water, cocoa powder (processed with alkali), modified food starch, chocolate liquor, natural flavors, contains 0.5% or less of the following: sucralose, salt, citric acid, potassium sorbate (a preservative), coffee extract, mono- & diglycerides, xanthan gum, acesulfame k

So yeah, I lurve it.  I will be adding it to my coffee for a special treat — and have some other ideas to think about.  Hey Eggface, maybe you could come up with some ideas?

Cheaper to get directly through the Monin site ($16 for 64oz, $3 for the pump, plus shipping) — but available also from Amazon.

Bariatric surgery IS an ANSWER…

On November 18, 2009, in General Nutrition, by Andrea

So there’s a new report out yesterday that projects 103 million Americans will be obese by 2018 — that’s 43%  — up from 31% in 2008.  That’s quite an increase, and imagine the costs associated with the co-morbidities that are associated with obesity..

Mr. Thorpe concluded that the prevalence of obesity is growing faster than that of any other public health condition in the country’s history. Health care costs related to obesity — which is associated with conditions like hypertension and diabetes — would total $344 billion in 2018, or more than one in five dollars spent on health care, if the trends continue. If the obesity rate were held to its current level, the country would save nearly $200 billion a year by 2018, according to the study.

So while reading this little article — and thanks Eggface for linking it up — I remembered an article I read last year – this one right here that called Bariatric surgery “cost effective” !!  Heya, this might be an answer!

The cost of the most common type of weight-loss surgery, which typically runs between $17,000 and $26,000, is offset within two to four years by medical cost savings, according to a new study.

The findings, published in the September issue of the American Journal of Managed Care, may increase pressure on health-insurance companies to cover gastric bypass surgery. Some insurance plans specifically exclude weight-loss surgery, despite medical evidence of its effectiveness as a treatment not just for obesity, but also for related conditions including diabetes, high blood pressure and sleep apnea.

“The most cost-effective treatment for obesity is bariatric surgery. If you do that, within two to four years, you will get your money back,” said the study’s lead author, Pierre-Yves Crémieux, a health economist and principal at Analysis Group Inc., an economic consulting firm in Boston. “We have identified the break-even point for insurers,” he added.

So maybe, just maybe we can get people to listen?  Fixing obesity with a gut-rerouting can be a cost-effective solution.  I don’t advocate it for everyone — those who won’t take care of themselves, follow the vitamin regimen, etc. shouldn’t get sliced and diced.  I know, hard to weed out the crazies.  But here, here is a way to help cut health care costs that people are bitching about in the country.  Rather than tell those of us who have the surgery that we shouldn’t do this, doctors should help us and learn more about it, and hey, maybe even educate more patients about it to help save lives.

Well, a girl can dream, right?

B12 and increased cancer risk?

On November 17, 2009, in General Nutrition, Water Solubles, by Andrea

It’s Tuesday.  Tuesday is a day that I work one of my real jobs.  You know, one that pays actual money that helps feed the younglings, keeps the bank from taking away the home, etc.  So I almost missed (yeah, right!) the flurry that JAMA kinda started within a few of the WLS circles about B12 and folate increasing cancer risk.  In fact, there were a few articles.. one here, and another here..

Actually, no, I couldn’t have missed it.  I think I got 2 or 3 emails.  Plus Beth posted about it on her FB and Twitter.  I’m sure it will be everywhere tomorrow.

So yeah, I read the article.  Sorry, it’s locked down and I am too broke to afford getting in trouble by breaking copyrights.  I’m adventurous, but not that adventurous.  You’re welcome to read the free abstract here.  The conclusion from the abstract is thus:

Results During study treatment, median serum folate concentration increased more than 6-fold among participants given folic acid. After a median 39 months of treatment and an additional 38 months of posttrial observational follow-up, 341 participants (10.0%) who received folic acid plus vitamin B12 vs 288 participants (8.4%) who did not receive such treatment were diagnosed with cancer (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03-1.41; P = .02). A total of 136 (4.0%) who received folic acid plus vitamin B12 vs 100 (2.9%) who did not receive such treatment died from cancer (HR, 1.38; 95% CI, 1.07-1.79; P = .01). A total of 548 patients (16.1%) who received folic acid plus vitamin B12 vs 473 (13.8%) who did not receive such treatment died from any cause (HR, 1.18; 95% CI, 1.04-1.33; P = .01). Results were mainly driven by increased lung cancer incidence in participants who received folic acid plus vitamin B12. Vitamin B6 treatment was not associated with any significant effects.

Now, I have to tell you, I read the article.  And while I’m not an expert — and will never claim to ever be an expert cause God only knows how many emails I’d get then — it seems that the correlation is based on blood serum values for folate and cobalamin (B12) rather than the actual taking of the supplements.  I mean, actually I think a trained monkey could figure this out, although you’d have to read the entire article to get that because the abstracts aren’t giving it to you — gotta love scare journalism.  So for those of you injecting yourself weekly with B12 because your numbers suck — I’d not worry too much, although the numbers that correlated in the study are below what many of us postops look for as “ideal”.

In the folic acid groups, median serum folate increased from 3.9 to 27.5 ng/mL and serum cobalamin from 477 to 761 during the intervention.  In the vitamin B6 groups, median plasma pyridoxal 5′ phosphate (the active form of vitamin B6) increased from 8.2 to 75.4 ng/mL.

These can be scary numbers given that many docs see a “normal” B12 reference range as 200-600, folate as >5, and B6 from 5-30.  Some of these are not really off the mark too much.

Admittedly, there are several questions raised; many of the patients who developed lung cancer used to smoke – could this have caused a change in outcome?  Norway does not enrich their bread like the US does to avoid birth defects – could a massive dosage increase of these vitamins have made a difference?  I mean, these were massive differences compared to what we in the US are used to just by having a sandwich.

Because use of vitamin supplements was modest (23%) at trial entry and there is no folic acid fortification in foods in Norway, baseline serum folate levels were lower than in populations from areas where use of vitamin supplements is more widespread and fortification is voluntary or mandatory.  The intervention dose of 0.8 mg/d of folic acid was 4 to 6 times higher than the average dose delivered by the mandatory fortification in the United States and twice the recommended daily allowance.  Still the intervention dose was below the tolerable upper intake level of 1mg/d as set by the US Institute of Medicine. Our findings are therefore relevant across folic acid intake readily obtained from consumption of fortified foods and dietary supplements.

Yeah.  Vitamins and these.  I’m kinda screwed.

Come to mama..

Come to mama..

(If you didn’t know, these are chock full of B-vites — in fact, think of them as a slightly carbonated, caffeinated b-complex!)

I’m still not convinced that postops need to worry too much about this right now — especially given our predisposition to dropping B-vitamin levels anyway.  I think a known problem (especially that whole coma and death thing?  SOOO very inconvenient..) versus a possible one is something we should avoid at all costs — and hey, given these numbers, I should have been dead two years ago already.

More evidence for D

On November 17, 2009, in Fat Solubles, by Andrea

Via CNN.com

About time people are getting the message.  Vitamin D has been linked to everything from lowering cancer risk, stroke, heart disease, hypertension, auto-immune disorders, diabetes, and depression.

A few notables..

In the first study, May and her colleagues measured blood levels of vitamin D in 8,680 people age 50 or older who had been diagnosed with heart disease, stroke, or another type of cardiovascular disease. vitamin D levels above 30 nanograms per milliliter of blood (ng/mL) were considered normal, levels between 15 and 30 ng/mL were low, and those 15 ng/mL and below were deemed very low.

Among those with very low levels of vitamin D, 32 percent were depressed, as were 25 percent of the people with low levels, and 21 percent of those with normal levels. This trend was seen even among individuals with no history of depression.

In the second study, which looked at 27,686 people age 50 or older with no history of cardiovascular disease, May and her colleagues found that, compared to individuals with normal levels of the vitamin, people with very low levels of vitamin D were 77 percent more likely to die, 45 percent more likely to develop heart disease, and 78 percent more likely to have a stroke during the study, which lasted for more than a year. They also had double the risk of heart failure.

Holick advocates raising the daily limit to 10,000 IU. Many researchers agree and have suggested that the toxic level of vitamin D is closer to 10,000 IU/day.

Keep in mind that 10,000 IU / day number is for normies.. not for those with designer guts.

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