Do I need B12 injections?

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Plumster
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Do I need B12 injections?

Post by Plumster »

I have all the signs of B12 deficiency: tired, fuzzy thinking, achy muscles, occasionally dizzy, blurry vision, tingling in hands and legs, occasionally constipated, spooning nails. I believe I've had these symptoms off and on for years, long before I became vegan last summer (2017). I supplement with hydroxo B12 about 2000-3000 mcg daily. I do eat fish occasionally. I am homozygous (GG) for MTRR A66G, which causes poor B12 methylation and raises homocysteine. My February 2018 lab tests were:

Homocysteine: 9.9
B12: 1523 pg/ml (normal range 232-1245)
Platelets 148 (normal range 150-450 k/cu mm)

My doctor concluded that B12 looks good and recommended that I take iron 25 mg daily because of my platelets. I have not taken iron supplements. I try to get iron from dark leafy greens together with vitamin C, chocolate, etc.

In March 2018, I took the Nutreval test, which showed that my B12 is borderline and I was also low on B2 and zinc and magnesium. So I added magnesium, zinc, and B2 and B6 and several of the other Bs and have been taking them daily since March. Some of the results from the Nutreval, which I don't claim to understand, but know they concern B12:

Methylmalonic Acid: 1.9 (normal range is 1.9 or lower)
Tricosanoic Acid: 0.19 (normal range is 0.12-0.18 wt %)
Pentadecanoic Acid: 0.06 (normal range is 0.07-0.15 wt %)

Because of my homocysteine, my doctor wants me to take methylfolate, but in addition to being COMT (met, met), I haven't done this because my B12 is in fact lower than my folate on my Nutreval. I asked her about my B12, and she said, just take more of it. So here I am, now taking 4000-5000 mcg of Hydroxo B12 or Hydroxo-Adenosyl B12. My deficiency symptoms got worse when I switched to swallowing capsules rather than taken the B12 sublingually. I am now experimenting with drops. But I am really frustrated by this constant borderline status of my B12. Do you think I can get to a normal level by supplementing at home? Or do I need B12 injections? What should I do about my MTRR?
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Stavia
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Re: Do I need B12 injections?

Post by Stavia »

Plumster your symptoms are very non specific and nail spooning is an iron deficiency sign. Your B12 levels are good and virtually excludes deficiency to be causing your symptoms.

This is not specific medical advice, just my thoughts on looking at your symptoms and labs. My recommendation is to discuss with your doctor.
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Re: Do I need B12 injections?

Post by Plumster »

Thank you, Stavia. That calms me to know. It was/is becoming a stressor for me--perhaps unnecessarily so.

The question then is whether I should actually take iron supplements, as my doctor recommends. I haven't because here are my lab results from February 2018:

My iron levels were 129 (normal range 37-145 mcg/dl)
My ferritin levels were 14 (normal range for women premenopausal 7-283 ng/mL)
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Re: Do I need B12 injections?

Post by SusanJ »

Many moving parts to lowering homocysteine.

You might want to go back to sublingual B12. Studies show it is absorbed better than capsules, especially if you have gut issues.

You might want to dial back the chocolate - Lynch says that more that 1 TBS of cocoa a day will decrease MTRR's activity even more.

Are you supplementing choline? If not, you might want to add that in because you are mostly vegetarian. Lack of choline also puts extra stress on the methylation cycle.

Any reason as to why you're taking hydroxy versus methyl B12?
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Re: Do I need B12 injections?

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Many moving parts to lowering homocysteine.

You might want to go back to sublingual B12. Studies show it is absorbed better than capsules, especially if you have gut issues.

You might want to dial back the chocolate - Lynch says that more that 1 TBS of cocoa a day will decrease MTRR's activity even more.

Are you supplementing choline? If not, you might want to add that in because you are mostly vegetarian. Lack of choline also puts extra stress on the methylation cycle.

Any reason as to why you're taking hydroxy versus methyl B12?
Thank you so much for your thoughts. Yes, I'm back to sublingual. They work better in all respects, except for the health of my teeth. :)
Regarding chocolate, oh that's interesting. I had no idea. I was wondering how much cocoa was too much for me.
Today I am starting sunflower lecithin and creatine, thanks to your earlier post. I'm very glad you suggested this.
I'm not taking methyl B12, even though I know it's best for MTRR, because Amy Yasko told me that my COMT V158M (AA) and COMT H62H (TT) tolerate hydroxo and adeno the best.
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Re: Do I need B12 injections?

Post by slacker »

Plumster wrote: My iron levels were 129 (normal range 37-145 mcg/dl)
My ferritin levels were 14 (normal range for women premenopausal 7-283 ng/mL)
Then there's the question about "normal" versus "ideal" levels of ferritin. Here's a rather long thread on Ferritin; the title was chosen based on an article about cerebral spinal fluid levels of ferritin, but there is a lot of conversation on serum ferritin, both too high and too low. You may find it of interest.
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Re: Do I need B12 injections?

Post by Stavia »

Plumster your ferritin is lowish, but not a worry as such IMO. If I had a patient who was suffering from fatigue or restless legs, I would supplement it up to about 40. If my patient felt well I would leave it alone.
(This is not medical advice, discuss with your own doctor)
Mine personally naturally runs at about 80ish.

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Plumster
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Re: Do I need B12 injections?

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If I had a patient who was suffering from fatigue or restless legs, I would supplement it up to about 40. If my patient felt well I would leave it alone.
This is probably a silly question, but can you raise ferritin without raising iron levels? As far as I have understood, ferritin is about iron storage and wouldn't the storage have to be higher because circulating iron is higher? When my doctor recommended iron 25mg daily, my AD/Diabetes danger radar went off.

I am familiar with restless legs from a few years ago (from unwanted pregnancy), not anymore, except a little tingling as mentioned above, which I had attributed to B12 levels. Fatigue is also arguable. I can't discern if it's just that I want more energy (because who doesn't?) or if I actually need more. (I am likely low dopamine.)

Thanks for the link, Slacker!
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Re: Do I need B12 injections?

Post by Stavia »

Plumster ferritin is a maker of total body iron stores. Serum iron is much more complicated, it doesnt necessarily go up or down according to iron stores.
25mg iron daily is a tiny dose. A normal daily dose for iron deficiency is 300 to 400mg a day.

Why is your ferritin low? Heavy periods? Vegetarian? Coeliac?

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Plumster
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Re: Do I need B12 injections?

Post by Plumster »

Why is your ferritin low? Heavy periods? Vegetarian? Coeliac?
I am vegan. That's probably why. My periods can sometimes last a long time; other times not come at all. I'm 48.
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