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..