How to Dig Deeper for Your True B12 Status

May 3rd, 2016 by admin

Do you feel run down, yet all of your lab tests are “normal”?

When a person complains of fatigue, the first place practitioners tend to look is iron and B12, but more so iron. If your iron levels are normal, and your B12 level is also within the normal range, your doc may scratch her head. Here’s the thing—when iron levels are normal, you should also have your ferritin (iron storage) levels checked and know that the optimal range is between 70 & 90,which is different from the standard reference range.

When B12 levels are normal, you need also to know how to dig deeper, and that’s what I want to focus on here today.

{Of course, there are others avenues to pursue as well when fatigue is an issue, such as thyroid, and most of the time, the digging is not deep enough here, either. Stay tuned for a future post on how to correctly assess your thyroid function.}

The normal range for B12 is 110-1500 pg/mL. That’s a very wide range, no? Believe me, this has been called into question. That said, many labs show the cut off to be around 900 pg/mL. I have clients show me their lab work, and we often find that their B12 level is in the lower end of normal. Studies show that blood, or serum  B12,  is not a good indicator of TISSUE B12, and they also show that a significant amount of people with serum B12 levels below the upper quartile of the serum B12 range, are symptomatic for B12 deficiency.

What are the symptoms?
Parasthesia (tingling, “pins and needles” sensation caused by nerve damage),peripheral neuropathy (weakness, pain or numbness in the hands and feet, caused by nerve damage), megaloblastic anemia, pancytopenia (shortage of all types of blood cells), irritability/personality change, mild memory impairment/dementia, depression, psychosis, fatigue, and possible increased cardiovascular risk.
That’s a wide range of symptoms. If you click the link above for the definition of pancytopenia, you’ll notice that pancytopenia is often treated with drugs, rather than investigating B12 status or even trial supplementation.

Back to determining whether you have a B12 deficiency or not…
Studies show that methylmalonic acid (MMA), either serum or urine, is a better indicator of B12 deficiency, versus serum B12 (see the reference list below my signature). So, if you have a low-normal B12 level, ask for either a serum or urine MMA level. If the result is higher than the normal range, you are B12-deficient.

Elevated homocysteine levels can also be an indicator of B12 deficiency, and this has to do with how well you are able to methylate, or activate, not only B12, but folate as well. Elevated homocysteine levels increase inflammation in the artery walls, and should be addressed by supplementing with methylated B12 and folate, as well as Vitamin B6 and Riboflavin.  The therapeutic goal of supplementation in this case, is to get elevated homocysteine levels down to 7 umol/L or less.

By the way, you can expect that your doctor may not be in support of the above recommendation, and/or may not be willing to order a homocysteine level for you, due to insurance regulations.  In this case, you can still have your doctor order the test, but you must be willing to pay for it out of pocket. It’s well worth knowing, so I would encourage you to have it run. If you cannot get your doc to run the test for you, you may go through Direct Labs

Recently, an elderly family member who was visiting, had been complaining of tingling and numbness in his hands and feet. He’s an avid walker and had had to cut back on his walking, due to these issues. He had his levels of B12 and folate tested upon returning back to his home country, and sure enough, they were both low.

Also of note, he had had 23 & Me genetic testing done a few years back. Just a couple of weeks ago, I took his results and had them analyzed for additional information, through a tool that I am now using in my practice. Sure enough, he has lots of Single Nucleotide Polymorphisms (SNP’s), which are genetic coding variations, that put him at high risk on several fronts for becoming depleted in Vitamins B12, B6 and Folate. Most of his SNP’s are associated with decreased ability to methylate, which basically means that he is not able convert his B Vitamins into their active forms for proper use. Methylation is a critical step in neurotransmitter pathways (think mental health/memory), cardiovascular-related pathways and DNA repair (think cancer prevention), so it can benefit each of us to know how well we are set up for this.

My concern for this family member, although he is now supplementing and his levels are no longer low, is that he is not currently supplementing with methylated B12 and folate. Due to the SNP’s that he has,  I would also want to make sure that he has his Vitamin B6 level tested, and that he is taking the best form of B6, which is Pyridoxal 5′-Phosphate. His B12 levels are now around 600, which is pretty good. At the same time, his folate levels are well above the normal range. He is under the impression (likely from his doctor) that this is a good thing; however, what I see, is that he has a lot of folate that is not being methylated and used properly, hence the extremely high levels in his blood. This is most likely due to the fact that he is supplementing with folic acid and not a methylated form of folate.

So you see, it’s not enough to simply identify deficiencies and insufficiencies, although that’s certainly further than most people get. You must supplement with the right FORM of the nutrient(s) in question, and it’s ideal to know how your genetics impact your needs for certain nutrients.

If your B12 levels are “normal”, and you still feel run down, please dig deeper. If you need support in that, I would love to be a member of your healthcare team! For more information on how we can work together, check out the options on my website. I have gone from having just ONE program option, to THREE. If you appreciate that you need help with your health, want to dig much deeper than your doc is willing or able to dig, and/or just want an expert Functional Nutrition advocate on your team, I trust you’ll find an option that suits you.

I hope this serves you well. Here’s to wellness BEYOND the status quo!

Be well,
Angie