The Iron Maiden – Vitamin B12

Vitamin B12 is another important element in the production of a healthy blood supply. When discussing the components of hemoglobin production I often use the analogy of a brick wall.

Vitamin B12 (stone mason) converts iron (bricks) into hemoglobin (brick wall) 

Vitamin B12 is a water soluble vitamin, and as such it is believed to be safe to have elevated levels, however recent literature suggests that this is not true. Elevated B12 levels can lead to a phenomena referred to as “Vitamin B12 Syndrome”. In Vitamin B12 Syndrome, elevated Vitamin B12 levels convert all available iron into hemoglobin. Extremely high Vitamin B12 levels may actually deplete iron stores resulting in the development of the early stages of iron deficiency and an abnormally high hemoglobin. In an atmosphere where many health care professionals will not consider iron deficiency until there is a significant drop in hemoglobin, it is possible to have debilitating symptoms of iron deficiency go undiagnosed because the hemoglobin is normal range or high. A normal Vitamin B12 level is _______, however patients with malabsorption issues (post bariatric, intestinal resections etc.) should maintain a Vitamin B12 range between 300 and 400 because this population is more prone to Vitamin B12 syndrome .

Absorption of Vitamin B12 requires Intrinsic Factor. Intrinsic factor is secreted from the greater curvature of the stomach. Members of our community who have had a sleeve or duodenal switch no longer have the greater curvature of their stomachs, therefore they have no secretion surface for intrinsic factor. It is difficult to know how much of the greater curvature of the stomach has been utilized in the creation of the gastric pouch in the bypass patient, therefore it is difficult to know how much if any of the intrinsic factor secretory surface remains. It is recommended that bariatric patients use injectable or sublingual Vitamin B12 supplementation. 

Recent literature suggests that in the absence of significant gastric esophageal reflux disease (GERD), sublingual Vitamin B12 is as effective as injectable Vitamin B12. Significant GERD is defined as taking the maximum dosage of stomach acid reducing medications and still requiring “Over the Counter” (OTC) antacids (aka Tums). It is my opinion that sublingual Vitamin B12 is better than injectable Vitamin B12 because: there are no significant peaks and valleys in serum B12 levels; you are not risking a portal of infection by puncturing your skin; you are not risking the development of scar tissue from repeated injections and you do not have to fit in a monthly appointment to get your vitamin B12 injection. 

If you are one of the few that must have injectable Vitamin B12, you should monitor you Vitamin B12 on a regular basis, to avoid the development of Vitamin B12 syndrome; and consider increasing your oral iron by 1 dose for 7-10 after your injection, so that elevated vitamin B12 levels do not deplete your iron stores. 

Recommended Vitamin B12 Supplementation is 1000 MUG sublingual every second day or 500 every day. 

**Jamison Vitamin B12 strips are not sublingual Vitamin B12. It says right on the box that it is oral Vitamin B12. 

Leona "Oknee" Dove

Leona "Oknee" Dove

With my background as a registered nurse consultant in patient blood management at a Toronto community hospital, in combination with my own personal health struggles, I am an advocate for the early diagnosis and treatment for iron deficiency.