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Dr. Bob is Robert Hsiung, MD,
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Posted by Cairo on January 28, 2005, at 11:13:07
We just received lab results on my teenager who has been complaining of fatigue. SMAC, thyroid, folic acid, vit. E, ANA, lead, and iron indices came back normal. Only things that stood out were ferritin being low normal (20 ng/ml) and B-12 being high (1456 pg/ml; normal=211-911). Could high B-12 mean anything? I searched on Google and found only a few sites than even mention B-12 overdose with the following symptoms:
"Can cause folic acid-related anemia if low,
numbness or tingling in right arm or right side
of face, anxieties, panic-anxiety attacks, heart
palpitations, hyperthyroid, optic nerve atrophy
(in someone with Leber's disease), insomnia,
may worsen symptoms of mitral valve prolapse"The anxiety, panic, and insomnia stood out as she has these.
She takes a B-50 supplement. Should I be concerned about the high B-12 level in terms of toxicity? Or could it indicate something else such as reduced B-12 in the CNS (it not crossing the BBB and serum levels go up)?
Cairo
Posted by tealady on January 28, 2005, at 16:37:38
In reply to Re: B-12 level too high? Larry Hoover, posted by Cairo on January 28, 2005, at 11:13:07
> We just received lab results on my teenager who has been complaining of fatigue. SMAC, thyroid, folic acid, vit. E, ANA, lead, and iron indices came back normal. Only things that stood out were ferritin being low normal (20 ng/ml) and B-12 being high (1456 pg/ml; normal=211-911). Could high B-12 mean anything? I searched on Google and found only a few sites than even mention B-12 overdose with the following symptoms:
>
> "Can cause folic acid-related anemia if low,
> numbness or tingling in right arm or right side
> of face, anxieties, panic-anxiety attacks, heart
> palpitations, hyperthyroid, optic nerve atrophy
> (in someone with Leber's disease), insomnia,
> may worsen symptoms of mitral valve prolapse"
>
> The anxiety, panic, and insomnia stood out as she has these.
>
> She takes a B-50 supplement. Should I be concerned about the high B-12 level in terms of toxicity? Or could it indicate something else such as reduced B-12 in the CNS (it not crossing the BBB and serum levels go up)?
>
> CairoHi,
First what's SMAC?
Also what were the thyroid levels and ranges? It's good to keep them for the future too if there really are ideal as a base reference. The figures will give an idea of hyperthyroid tendencies or not.(one of the symptoms you listed as too high B12). I know low B12 and hypothyroid go together often.Most people on a B12 forum I used to visit would find that level acceptable. Quite a few had levels up to 2000. However if the B50 contains cyanocobalamin(s?) form, I think with those results it would be better to cut to a B25 (cut the tablet in half or take 1/2 cap). I really don't like the cyanide bit of that one.
Most females find a B25 is a high enough level of B's for long term supplementation.
At a young age she obviously absorbbs b12 well and really doesn't need any supps. I know its hard to find a B vit without the B12 though.I suspect that somehow b12 and folate (folic acid) may "balance" somehow in ours bodies. They both lower homocysteine.
My (and my Mum's) red cell folate (on a blood test) is over range ..and B12 lowish.
Perhaps high B12 levels tend to lower the folate levels also?
I can se how a too high B supp could cause insomnia. I'd have thought maybe the B5 especially.
Doubt if the BBB- B12 stuff is known. However considering the size of our brains compared to the rest of our body , I doubt if any problems there would significantly raise the B12 level in the res of our body. Also nerves are throughout our body and if symptoms of panic and anxiety are the concern, then if it was the B12 ..it must be crossing the BBB? I wouldn't worry about this point myself.However some of us ( well me anyway) develop symptoms of anxiety with too high a B3 intake..and yet B3 is often a remedy for anxiety.
Acne with fish oil etc may be low too a B5 level, but too high will wire you up.If you are concerned, why not stop the supp for a couple of weeks for starters and se if any symptoms decline.
B12 will stay in the body for months.Her ferritin is too low for comfor and at that level could cause anxiety symptoms, especuially when taking a B50 supp which (I suspect) could increase the anxiety when ferritin is that low.
Ideally ferritn should be around 50ish..so maybe stop the B50 for a couple of weeks and take some iron supps with meals and a little VitC (or preferably an orange or something with VitC in it).
It could take a few months to raise ferritin levels to optimal. Low ferritin can cause anxiety type symptoms, fatigue, panic type symptoms.IMO more is not always better with some supps, especially the B's. I know how they affect me.
Jan
Posted by Cairo on January 29, 2005, at 7:39:00
In reply to Re: B-12 level too high? Larry Hoover » Cairo, posted by tealady on January 28, 2005, at 16:37:38
Thanks, Jan!
SMAC is a chemistry screening panel consisting of usually 12-20 different tests. I think the newer term is CMP (complete metabolic panel). It includes sodium, potassium, calcium, total serum protein, bilirubin, lipid panel, etc. Every thing looked OK except her BUN/creatinine was slightly elevated which is not unusual if she didn't drink anything before the test (dehydration will cause BUN to go up).
I agree with you that we need to supplement iron, low iron stores being a source of fatigue without overt iron deficiency. I personally think her low ferritin might be due to a sluggish thyroid caused by a hypoactive HPA axis which is part and parcel of some kinds of depression/anxiety.
Actually she doesn't have insomnia as much as delayed sleep onset. I have just the opposite. Anyways, she has always had a sleep shift since she was born, so I don't think this is due to B-vitamin administration. Not that it might not exacerbate the problem, so I'll keep an eye on this, per your suggestion. She has ADD/ADHD and dysthymia and sleep is disordered in those.
She also seemed to suddenly develop poor appetite which we treated with magnesium supplements and that definitely seemed to help as her appetite has picked up a bit. I'm thinking of changing the magnesium malate and Krebs cycle chelates that we alternate it with (it's a variety of minerals with citrate/fumerate/malate/succinate/alpha ketoglutarate salts) to magnesium taurate to see if that will help her anxiety. Or maybe I should just use taurine by itself at first to see if that is what is helping. What do you think?
I also have her on 1200mg EPA and 800mg DHA per day (Carlson brand). Do you think that is enough EPA? The capsules are SO big and taking 4 a day is just about all she can handle as she doesn't like big pills and gags all the time. But she said she now prefers Carlsons to Coromega (the orange flavored emulsion); I don't know why she stopped liking Coromega, but she is particular about taste and texture.
I appreciate your comment about B3 and anxiety. While she developed social anxiety before any high dose B vitamins, it may contribute.
Thank you for sharing your experience and your kind help. You are very knowledgeable.
Cairo
> Most females find a B25 is a high enough level >of B's for long term supplementation.
> At a young age she obviously absorbbs b12 well and really doesn't need any supps. I know its hard to find a B vit without the B12 though.
>
> I suspect that somehow b12 and folate (folic acid) may "balance" somehow in ours bodies. They both lower homocysteine.
> My (and my Mum's) red cell folate (on a blood test) is over range ..and B12 lowish.
> Perhaps high B12 levels tend to lower the folate levels also?
> I can se how a too high B supp could cause insomnia. I'd have thought maybe the B5 especially.
> Doubt if the BBB- B12 stuff is known. However considering the size of our brains compared to the rest of our body , I doubt if any problems there would significantly raise the B12 level in the res of our body. Also nerves are throughout our body and if symptoms of panic and anxiety are the concern, then if it was the B12 ..it must be crossing the BBB? I wouldn't worry about this point myself.
> However some of us ( well me anyway) develop symptoms of anxiety with too high a B3 intake..and yet B3 is often a remedy for anxiety.
> Acne with fish oil etc may be low too a B5 level, but too high will wire you up.
> If you are concerned, why not stop the supp for a couple of weeks for starters and se if any symptoms decline.
> B12 will stay in the body for months.
> Her ferritin is too low for comfor and at that level could cause anxiety symptoms, especuially when taking a B50 supp which (I suspect) could increase the anxiety when ferritin is that low.
> Ideally ferritn should be around 50ish..so maybe stop the B50 for a couple of weeks and take some iron supps with meals and a little VitC (or preferably an orange or something with VitC in it).
> It could take a few months to raise ferritin levels to optimal. Low ferritin can cause anxiety type symptoms, fatigue, panic type symptoms.
> IMO more is not always better with some supps, especially the B's. I know how they affect me.> Jan
Posted by Larry Hoover on February 14, 2005, at 16:17:53
In reply to Re: B-12 level too high? Larry Hoover, posted by Cairo on January 28, 2005, at 11:13:07
> We just received lab results on my teenager who has been complaining of fatigue. SMAC, thyroid, folic acid, vit. E, ANA, lead, and iron indices came back normal. Only things that stood out were ferritin being low normal (20 ng/ml) and B-12 being high (1456 pg/ml; normal=211-911). Could high B-12 mean anything? I searched on Google and found only a few sites than even mention B-12 overdose with the following symptoms:
>
> "Can cause folic acid-related anemia if low,
> numbness or tingling in right arm or right side
> of face, anxieties, panic-anxiety attacks, heart
> palpitations, hyperthyroid, optic nerve atrophy
> (in someone with Leber's disease), insomnia,
> may worsen symptoms of mitral valve prolapse"
>
> The anxiety, panic, and insomnia stood out as she has these.
>
> She takes a B-50 supplement. Should I be concerned about the high B-12 level in terms of toxicity? Or could it indicate something else such as reduced B-12 in the CNS (it not crossing the BBB and serum levels go up)?
>
> CairoVitamin B12 has no established toxic threshold. There is no evidence that there even is one. I'd also suspect that the "normal" values might better be expressed as "typical", which may or may not be "optimal". Extra B12 in the blood serves as an especially efficient scavenger for the potent oxidant peroxynitrite, so I'd say this B12 level is a positive finding, not an adverse one. The ferritin level is worth efforts to increase, though.
Lar
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