Dr Hive: What do you think about range of B 12 levels?

[Laurie4b]

The range for normal B12 that the US uses is lower than for some other countries. Minimum in Japan, for instance is 500. US minimum is 123. I have read clinical info that looks like even in the US, some practitioners consider less than 350 to be borderline deficient and that symptoms can arise in that range. 

 

What do you know about this? 

 

 

If you supplement B12 either because you don't eat meat, have a digestive issue, are older, etc, what form/brand do you use and at what dosage? 

 

 

Thanks!

[Kim in Appalachia]

I had been around 300 a little while back, so I started to include red meat (I had stopped eating red meat) at least once a week or every two weeks, and I also started taking B12 from Costco. It's the kind that dissolves under the tongue.  I just had my levels tested again and they were above 600.

 

I don't know anything about the differences between US and other countries' standards.     

 

[hornblower]

I'm vegan & I take 1000mcg once a week when I remember. I also take a mutli pretty regularly & drink fortified soy milk. 

I use Jack Norris's recommendations (& Virginia Messina's in Vegan for Her). 

Norris's website article is probably the best & most thorough in terms of recommendations & guidelines: http://www.veganhealth.org/articles/vitaminb12

Also, meat analogues in Canada are fortified but this is not always the case in the US. 

I was just tested as part of a regular check up so I can do dig out the ranges on my lab results. 

[Laurie4b]

I'm vegan & I take 1000mcg once a week when I remember. I also take a mutli pretty regularly & drink fortified soy milk. 

 

I use Jack Norris's recommendations (& Virginia Messina's in Vegan for Her). 

 

Norris's website article is probably the best & most thorough in terms of recommendations & guidelines: http://www.veganhealth.org/articles/vitaminb12

 

Also, meat analogues in Canada are fortified but this is not always the case in the US. 

 

I was just tested as part of a regular check up so I can do dig out the ranges on my lab results. 

 

I'd be interested in learning what is regarded as a normal range in Canada!

[Soror]

The US has messed up lab values for lots of things, it seems they want us to get to half dead before acknowledging a problem.  I've been trying to get mine to the upper 25% of the range for awhile. 

 

This is what I have been taking after reading good reviews in different places- 

http://www.amazon.com/Source-Naturals-Coenzymate-Complex-Tablets/dp/B000GFPD2Y/ref=pd_sim_121_1?ie=UTF8&dpID=41w3cUrMwbL&dpSrc=sims&preST=_AC_UL160_SR86%2C160_&refRID=1BEWDPFWJH9GYW4ZAZCX

 

I just ordered a new folate that is especially for MTHFR defect as I have it and haven't been able to tolerate other MTHFR b's so I'm hoping this will help this will finally get my levels up to optimal.

[gardenmom5]

I use NOW methylcobalamin (most bioavailable) sublingual 1000mcg.

 

Injection into fat is most absorbable.

Edited March 30, 2016 by gardenmom5

[hornblower]

ok, here is mine: 

B12: 677 

range: 156-698 pmol/L 
 

 

Note: New Methodology effective January 13, 2016
(Roche - Electrochemiluminescence)

Interpretation:
Serum B12 [Probability of symptomatic deficiency]

<75 pmol/L high
75-150 pmol/L moderate
150-220 pmol/L low
>220 pmol/L rare
Clinically significant B12 deficiency may occur
with B12 levels in the normal range, particularly
in elderly patients."

 

 

[shawthorne44]

B12 is one of the vitamins that your body tops off and then discards the rest.   So, I have some powdered B grouping vitamin that I take once every blue moon that has a bunch.   I don't particularly care what various governments say.  

[gardenmom5]

The US has messed up lab values for lots of things, it seems they want us to get to half dead before acknowledging a problem. I've been trying to get mine to the upper 25% of the range for awhile.

 

This is what I have been taking after reading good reviews in different places-

http://www.amazon.com/Source-Naturals-Coenzymate-Complex-Tablets/dp/B000GFPD2Y/ref=pd_sim_121_1?ie=UTF8&dpID=41w3cUrMwbL&dpSrc=sims&preST=_AC_UL160_SR86%2C160_&refRID=1BEWDPFWJH9GYW4ZAZCX

 

I just ordered a new folate that is especially for MTHFR defect as I have it and haven't been able to tolerate other MTHFR b's so I'm hoping this will help this will finally get my levels up to optimal.

Do you use Thorne mthf? It's highly rec'd by NDs, and I like it better than deplin- which is the rx form.

[Soror]

Do you use Thorne mthf? It's highly rec'd by NDs, and I like it better than deplin- which is the rx form.

I just ordered one from Thorne that a friend has had good luck with. I did ok with the Source Naturals one before getting my levels decent but for some reason I've just been taking a half a dose- I should know better, especially being hypo and not absorbing very well. I hate having to take vitamins but it isn't an option evidently.

[hornblower]

I take Cyano because it's readily avail (& Jack Norris says it's fine to take  :D ) 

if you go with methyl, some indications are that you'd need a higher dose http://jacknorrisrd.com/what-b12-supplement-should-i-take/

[hornblower]

B12 is one of the vitamins that your body tops off and then discards the rest.   So, I have some powdered B grouping vitamin that I take once every blue moon that has a bunch.   I don't particularly care what various governments say.  

 

I get what you're saying but if you're vegetarian or vegan or have pernicious anemia or other absorption issues 

 

or 

 

if you're over 50 

 

odds are overwhelming you need to supplement b12 more conscientiously to avoid neurological issues. 

[umsami]

I supplement due to digestive issues (well, missing a good portion of my stomach...thus intrinsic factor which helps with absorption.)  I've been using TwinLab B12 dots or sublingual cherry flavored B12s I buy at Costco for years.    Today at Costco I tried ZipFizz, and I'd use that if it was cheaper. :)

[StaceyinLA]

I haven't looked into it much personally, but I do know that my mom's hematologist told us that you start to lose mental function when B12 is too low, and, though you can raise the levels of B12 and improve what you have left of function, you will not regain anything that was lost.

 

He also said that after a certain age we stop absorbing it from food and supplements and if it gets low, would need injections.

[cjzimmer1]

my lab lists the normal range as 213 -816 pg/ml.  My doctor likes to see results that are well above midline or higher.  Last fall I was lowish and so she had me add 1000 per day.  I goofed and bought the wrong dosage so I am currently taking 2000 every other day.  My most recent number was 830 ( so slightly high) however, she didn't want me to reduce my dosage because she felt I would drop too low.  She felt this was a vitamin that was fine to be high on.

[Laurie4b]

my lab lists the normal range as 213 -816 pg/ml.  My doctor likes to see results that are well above midline or higher.  Last fall I was lowish and so she had me add 1000 per day.  I goofed and bought the wrong dosage so I am currently taking 2000 every other day.  My most recent number was 830 ( so slightly high) however, she didn't want me to reduce my dosage because she felt I would drop too low.  She felt this was a vitamin that was fine to be high on.

 

Curious---is your doctor a functional medicine doctor or a traditional practitioner? I am just wondering whether traditional docs ever concern themselves with a B12 reading that is low but in the normal range. 

[cjzimmer1]

Curious---is your doctor a functional medicine doctor or a traditional practitioner? I am just wondering whether traditional docs ever concern themselves with a B12 reading that is low but in the normal range. 

 

I'm not sure what functional medicine doctor is.  I haven't heard that term before.  But she started as a traditional medicine doctor, however she has had numorous health issues in her life and has moved to a more holistic type of medicine.  She doesn't look at just numbers she looks at the whole person.  For instance I take high doses of Vitamin D.  It ends up putting me well over the top of the range.  After some research I did, I discovered that when my D is below about 80 (and the top of the range is only 95), I have sleep issues.  We played with my supplimentation and done many follow up labs and yes my sleep problems clearly coinside with my Vitamin D level.  So her response is well normal is less than 95 but we know that doesn't work for you so do what makes you feel best.  She now mostly specializes in natural hormone therapies but I'm one of her leftover patients from when she did family practice stuff.

[Soror]

/OT

 I discovered that when my D is below about 80 (and the top of the range is only 95), I have sleep issues.  We played with my supplimentation and done many follow up labs and yes my sleep problems clearly coinside with my Vitamin D level.  So her response is well normal is less than 95 but we know that doesn't work for you so do what makes you feel best.  

I figured this out for me too! After noticing a correlation between d supplementation and sleep I looked it up and found some studies that show that optimal range for sleep is 80+. Now, it isn't the only thing that affects my sleep but a big factor.

[gardenmom5]

I just ordered one from Thorne that a friend has had good luck with. I did ok with the Source Naturals one before getting my levels decent but for some reason I've just been taking a half a dose- I should know better, especially being hypo and not absorbing very well. I hate having to take vitamins but it isn't an option evidently.

there are different  forms of methylfolate, so you want be pay attention to particular form.

optimum level varies from person to person - and is affected by how well your methylation cycle is working. if it's  subpar, your tolerance will be lower (even though you have a higher need) 

dudeling is on 15 mgs.  (he ND wanted to get him up to 30 to see how he responded, but he was topping out at 21mg for tolerance.  I dropped him down to 15 because he does very well at that point.  I'm currently doing 8.5mg . . . I've not tolerated it well, but am hoping to be able to increase my dose.)

 

ETA: . . .. Thorne is considered the 'gold standard' for mthf.  deplin is the rx form - and apparently, I'm  not the only one who felt like it was a step backwards when I went on it.

thorne mthf comes in 1mg and 5mg capsules.  deplin is rx only, and comes in 7.5 and 15mg.  I wouldn't trust any otc brand claiming to have a rx dose otc.

I'm fortunate to have a compounding pharmacy that found out where thorne gets their mthf, and that's what they use in their rx capsule. . . .for a lot less. . . .  I felt a positive difference when I switched from the deplin. (same dose.)

my ND said she'd been looking for years for a rx that was the same quality as the thorne.

 

I take Cyano because it's readily avail (& Jack Norris says it's fine to take   :D ) 

 

if you go with methyl, some indications are that you'd need a higher dose http://jacknorrisrd.com/what-b12-supplement-should-i-take/

 

those with a mthf mutation don't do as well on cynao -- their bodies can't convert it adequately.  they do better with methylcobalamin - which is the most bioavailable form.

 

I get what you're saying but if you're vegetarian or vegan or have pernicious anemia or other absorption issues 

 

or 

 

if you're over 50 

 

odds are overwhelming you need to supplement b12 more conscientiously to avoid neurological issues. 

 

or you've had your gallbladder out . . .

Edited March 31, 2016 by gardenmom5

[jenn-]

I am below the level of normal in other countries and my dr. had me start taking an OTC b12, with no suggestions of what brand or amount.  About the same time, I discovered I am homo for MTFHR gene so research lead me to using methyl b12.  Unfortunately, I didn't handle it well at all (yeah, found out I'm also homo for the gene that says methyl=bad). I've had to stop for now, but have an appointment with my hematologist in a couple of weeks and I will get her suggestions.

[gardenmom5]

I am below the level of normal in other countries and my dr. had me start taking an OTC b12, with no suggestions of what brand or amount.  About the same time, I discovered I am homo for MTFHR gene so research lead me to using methyl b12.  Unfortunately, I didn't handle it well at all (yeah, found out I'm also homo for the gene that says methyl=bad). I've had to stop for now, but have an appointment with my hematologist in a couple of weeks and I will get her suggestions.

 

if you have access to a naturopathic doc who does a lot with mthf - I would urge you to go there. few - VERY few, allopaths are familiar enough with mthf to actually be competent to treat a patient with it.

 

 I'm  also homozygous for mthf - and the way my DO treated me made me worse.  she knew enough to test for the gene, but wasn't unaware of all the other nuances that can  come with the mutation.  (she was following the protocols of another allopath.)  I've been dealing with a side effect of  too much (15mg) too fast (immediately.  no ramping at all.) ever since.

 

the only otc mthf you should trust is thorne (it also tends to get better response than the rx deplin) - and start small.  very small.  allopaths tend to rx 15mg off  the bat.  never, ever,  ever . . . . start with 1mg. wait at least a week before adding.  I'm at 8.5. . . and it's questionable if  I will still be at 8.5 in a week or two.  it's taken me two years to get to  this dose, and I've had to drop back down several times.)

[Corraleno]

I am below the level of normal in other countries and my dr. had me start taking an OTC b12, with no suggestions of what brand or amount.  About the same time, I discovered I am homo for MTFHR gene so research lead me to using methyl b12.  Unfortunately, I didn't handle it well at all (yeah, found out I'm also homo for the gene that says methyl=bad). I've had to stop for now, but have an appointment with my hematologist in a couple of weeks and I will get her suggestions.

 

I couldn't take methylcobalamin either, so I switched to hydroxocobalamin, which is what Dr Lynch (MTHFR.net) recommends for people with mutations that make the methyl form a poor choice. I haven't had any trouble with the hydroxo form (other than expense!). 

[Soror]

I just got in my Thorne L5 Folate- 1mg, fingers crossed and all that- I'm taking it alongside my b12 complex that has worked well for me.

 

I guess I need to read more about the various types and MTHFR, it is obvious that there is till a lot I don't know. I tried Lynch's b12 lozenges, that were supposed to be good for MTHFR but I could not tolerate even 1/4th at a time, I hadn't read about the hydoxo form, I've read on Lynch's website multiple times, I'm not sure how I missed that- I might have to try that version after I run out of my current pills. 

[jenn-]

if you have access to a naturopathic doc who does a lot with mthf - I would urge you to go there. few - VERY few, allopaths are familiar enough with mthf to actually be competent to treat a patient with it.

 

 I'm  also homozygous for mthf - and the way my DO treated me made me worse.  she knew enough to test for the gene, but wasn't unaware of all the other nuances that can  come with the mutation.  (she was following the protocols of another allopath.)  I've been dealing with a side effect of  too much (15mg) too fast (immediately.  no ramping at all.) ever since.

 

the only otc mthf you should trust is thorne (it also tends to get better response than the rx deplin) - and start small.  very small.  allopaths tend to rx 15mg off  the bat.  never, ever,  ever . . . . start with 1mg. wait at least a week before adding.  I'm at 8.5. . . and it's questionable if  I will still be at 8.5 in a week or two.  it's taken me two years to get to  this dose, and I've had to drop back down several times.)

 

I'm not even sure how to look up a naturopathic doc.  I seriously doubt there is one nearby.  I'm going to give the hematologist a go with it as the appointment is so close.  I have no choice but to go with her for other reasons that she is monitoring.

[MIch elle]

I thought I had MS because of the tingling in my arms & legs for several weeks.  My doctor (regular MD) checked my serum B12 and it was normal but low.  I had B shots for a few weeks then have been orally supplementing ever since (3 yrs).

 

I use NOW brand Co-Enzyme B Complex along with NOW Eve Multi-vitamin.  I had my gallbladder out 8 yrs ago.

[ktgrok]

if you have access to a naturopathic doc who does a lot with mthf - I would urge you to go there. few - VERY few, allopaths are familiar enough with mthf to actually be competent to treat a patient with it.

 

 I'm  also homozygous for mthf - and the way my DO treated me made me worse.  she knew enough to test for the gene, but wasn't unaware of all the other nuances that can  come with the mutation.  (she was following the protocols of another allopath.)  I've been dealing with a side effect of  too much (15mg) too fast (immediately.  no ramping at all.) ever since.

 

the only otc mthf you should trust is thorne (it also tends to get better response than the rx deplin) - and start small.  very small.  allopaths tend to rx 15mg off  the bat.  never, ever,  ever . . . . start with 1mg. wait at least a week before adding.  I'm at 8.5. . . and it's questionable if  I will still be at 8.5 in a week or two.  it's taken me two years to get to  this dose, and I've had to drop back down several times.)

 

That seems like such a high amount to me...the normal amount for regular supplementation is usually about 400-800mcg, so less than 1mg. Why would a person need or want to take 15mg???  I get the MTHFR thing, I'm heterozygous for one of the mutations, and that regular folic acid wouldn't be converted. But if you are taking a form that you CAN absorb and utilize, why on earth so much?

 

I've got the seeking health sublingual that is a combo of methylfolate and methylated B12, and that is MUCH lower. 

[gardenmom5]

That seems like such a high amount to me...the normal amount for regular supplementation is usually about 400-800mcg, so less than 1mg. Why would a person need or want to take 15mg???  I get the MTHFR thing, I'm heterozygous for one of the mutations, and that regular folic acid wouldn't be converted. But if you are taking a form that you CAN absorb and utilize, why on earth so much?

 

I've got the seeking health sublingual that is a combo of methylfolate and methylated B12, and that is MUCH lower. 

 

depends upon if you're talking about b12 - or mthf.  they're not the same thing.

 

optimum amounts vary from person to person.   iow: I take rec's with a grain of salt.   the acid test is what works.

I prefer thorne mthf (pricey), but have also used the rx deplin.

 

dudeling is heterozygous -  he's on 15mg mthf. that's about optimum for him. if he's much lower, his function goes backwards.  and people who dont' know we've been playing with his dosage notice.  

 

1ds (at least hetero) is currently taking 10mg of mthf.  he can feel a huge difference between 5mg - 10mgs. he's at 15mg and the ND wants him at 20mg when he comes in later this month.

 

dd (homo) is finally listening to me, and after many many different drs each with their own tx plan, is finally feeling better. she was over last night to tell me.  she's currently at 12mg.

 

for me - mthf is also a big deal.  plus I'm hoping it will forestall health problems that have affected at least three generations in my mother's family.  I'm  finding I do better on the thorne quality over the rx deplin.  (my ND found a compounding pharmacy that gets their mthf from the same place as thorne, for less.  yes, I can tell the difference.)

 

for the b12 sublingual - we only do 1mg.  (1000mcg)  the ND prefers the injection into fat.  (slower absorption).   I also get b12 methylcobalamin in my b-complex and multi.

 

oh- and I will not buy anything off of dr glick's site.   he's local, I've heard him speak.  he's pulled together a lot of research (as have others), and such, but . . . I feel like he's putting too much emphasis on selling his own products. it feels like a conflict of interest.

 

I rely upon my son's, and my own ND, for what works best for my family's health.  (bastyr is local. the ND community here is very familiar with mthf.)

[ktgrok]

Right...I'm talking about methylfolate. (MTHFR is the gene, not the vitamin, according to my understanding.) Those with a mutation in the MTHFR gene can't convert foilc acid to methylfolate. So they need methylfolate instead. I get that part. What I'm not understanding is where the large dosage comes from. Someone without a mutation at MTHFR would usually take about 800 mcg of folic acid a day according to the RDA. So by that logic a person with MTHFR mutations would need to take about the same amount, but in the L-Methylfolate form. If they are taking the proper form, that they can absorb and utilize, why would they need to take 15-20 times higher a dose than the RDA? I'm not quite understanding that part.  Are there any studies, or info you could point me to that says more is better, or why such a high does would be advisable?

 

 

[texasmama]

Curious---is your doctor a functional medicine doctor or a traditional practitioner? I am just wondering whether traditional docs ever concern themselves with a B12 reading that is low but in the normal range.

My B12 was in the low normal range in the 300's, and I was half-dead. No kidding. They don't call it pernicious for nothing. With a family hx of pernicious anemia and serious symptoms, my family doc gave me a script. I've been on self-injected cyano for a decade now.

[texasmama]

I haven't looked into it much personally, but I do know that my mom's hematologist told us that you start to lose mental function when B12 is too low, and, though you can raise the levels of B12 and improve what you have left of function, you will not regain anything that was lost.

 

He also said that after a certain age we stop absorbing it from food and supplements and if it gets low, would need injections.

My low B12 affected my cognitive function quite a lot, but I regained functioning once I was supplemented via injection.

[Soror]

My B12 was in the low normal range in the 300's, and I was half-dead. No kidding. They don't call it pernicious for nothing. With a family hx of pernicious anemia and serious symptoms, my family doc gave me a script. I've been on self-injected cyano for a decade now.

I was really struggling last week especially after my period- I'm curious to see what my b levels test at- I'd guess from my symptoms I'm low on b's, iron and thyroid but even without upping my thyroid I already feel much more human upping my b's and iron. I got chased by the police(speeding) and didn't realize it(for I don't know how long)- I've not let myself drive since then. Numbness, fatigue, nausea, dizziness- a whole lot of not fun. 

[ktgrok]

I do feel best with my B12 way up at the top of the range. It's a decided difference. 

[texasmama]

I was really struggling last week especially after my period- I'm curious to see what my b levels test at- I'd guess from my symptoms I'm low on b's, iron and thyroid but even without upping my thyroid I already feel much more human upping my b's and iron. I got chased by the police(speeding) and didn't realize it(for I don't know how long)- I've not let myself drive since then. Numbness, fatigue, nausea, dizziness- a whole lot of not fun. 

:grouphug:   I hope you feel better soon.

[gardenmom5]

Right...I'm talking about methylfolate. (MTHFR is the gene, not the vitamin, according to my understanding.) Those with a mutation in the MTHFR gene can't convert foilc acid to methylfolate. So they need methylfolate instead. I get that part. What I'm not understanding is where the large dosage comes from. Someone without a mutation at MTHFR would usually take about 800 mcg of folic acid a day according to the RDA. So by that logic a person with MTHFR mutations would need to take about the same amount, but in the L-Methylfolate form. If they are taking the proper form, that they can absorb and utilize, why would they need to take 15-20 times higher a dose than the RDA? I'm not quite understanding that part.  Are there any studies, or info you could point me to that says more is better, or why such a high does would be advisable?

 

I just lost a very long post.  I.  am. not. a. happy. camper. . . .thunk.

okay - long post now shorter.

 

usrda should be taken with a grain of salt.  it should be remembered it is a bare-bones minimum (and sometimes not remotely realistic for health and well-being.)

e.g. vitamin d.  usrda is 400IUs.  that will prevent rickets.  (which is why they set a rda of vit-d in the first place). rickets is a risk at a d3 level of 7 or lower. . . . . . baseline vitamin d3 (not specified by rda, but the only form that will build long-term stores) is now 50  significantly higher than a rickets risk factor..  d3 is being reclassified as a hormone for a number of reasons, not least of which is how many body systems it's been found to be essential for optimum function.  my own allopath now rec'd 1000IUs (2 1/2 X rda) after years of taking as much as 4000Ius daily - my d3 level is still below 50.   I now take 5000IUs.of a higher quality vitamin    the oil used as a delivery method matters.

 

mthfr - methyltetrahydrofolatereductase.  = enzyme. 

mthf = vitamin/specific form of folate

677 and 1298 - genes that dictate how the body uses mthf.  affects methylation cycle and everything downstream from that.

 

the naturopaths around here - who do a lot with mthf - look at what is the optimum  dose for a patients health and well-being..   someone who is having mthf related issues needs more than someone who doesn't.  someone with no issues, can take a higher dose - but their body will just excrete the uneeded excess. for someone with issues - it will make an enormous difference to how they feel and function.

 

just like with thyroid (something I'm currently wrestling with and over which I just left my allopath.).  there have been many recent threads, and posts of the optimum thyroid hormone chart.  (something to which allopaths don't treat).  there's the minimum  that drs are comfortable with rx (which can leave patients still feeling hypo and their dr telling them "you're numbers are fine".) - then there's "optimum". . . . and we can feel functional.

 

same with mthf.  adequate/optimum amounts make us functional - and that can be many many times the usrda.

[ktgrok]

@Gardenmom, thank you that makes sense. 

 

I do feel better with more than the minimum B vitamins, and better on certain forms, so I get where you are coming from. I think comparing it to D helped. (I take about 4,500 iu a day I think. More if I remember to take my fish oil, that also has some D in it. And I'm taking about 1.5mg methyfolate and about the same of methylcobalamin. Which seems to work. If I take less I notice it by mid afternoon.