I am taking a multivitamin, a vitamin C and a vitamin D.
I would really like to hear the rundown on all this stuff.
I only started the D and C recently.

I don't know her, so can't comment on her clinical skills. No, I am trying to understand why such errors occur.

I don't think B12 deficiency is a zebra, but I think rare presentations of it are.

From what you say, yours wasn't a rare presentation.

And it sounds like there was no good reason for her to miss this for such a long time.

I agree that physicians (and people in general) have misconceptions.
We try to correct them as we learn, but I am sure we all have some.

As to physicians and patients working as a team, I think you know my opinion regarding that.

Celeste and Steph, There are metabolic pathways in the body. For example, when I didn't have enough B12, my homocysteine increased. When I got enough of it, it decreased.

If you have B12 without enough folic acid, you can get a folic acid deficiency. And vice versa. It's the same kind of biochemical pathway reaction.

Some people can get too much B12. It's rare but if you have any concerns, you can talk to an internist about it.

Some multivitamins have too much of certain B's, such as B6. Too much B6 can be bad for anyone with nerve issues, like a neuropathy. Mrs. D. is very knowledgeable about all of this stuff.

When you take vitamin D, you should have it with calcium and magnesium. It's not absolutely necessary but those vitamins work well together.

When you take iron, Vitamin C helps to absorb it. If you take Vitamin C with calcium, you can keep the calcium from being absorbed. So there are certain vitamins that, as singular supplements, are better to take at different times.

Is this making sense?

On the issue of too much B12 in your blood, it's kind of like having a glucose test after eating a chocolate sundae. Your glucose would probably be through the roof. My B12 is always high because I supplement on a daily basis.

If you have symptoms of a B12 deficiency, you should be off of B12 to get an accurate reading. Or a smart doctor can order homocysteine and/or methylmalonic acid, which are often high when you are not getting enough B12 to your tissues. It's not always the case during a deficiency though.

The kind of B12 I take - and have to take - is sublingual (literally meaning "under the tongue") B12. It is put under the tongue and absorbed directly into the bloodstream. Not unlike nitroglycerin. I can't absorb it well through the GI tract.

B12 is stored in the liver as cyanocobalamin. In order for your body to use it, the liver converts it into methylcobalamin. Some people do have a liver problem that causes a low B12 but it's more rare. The type of sublingual B12 I take is methylcobalamin. B12 shots are cyanocobalamin and still have to be converted by the liver before the body uses it. My B12 was not going up much at all on the shots but did on the sublingual. My symptoms weren't improving either.

When you take B12, some is used by the body, some is stored and the rest is urinated out. When you take sublingual B12, it's about the same thing but the body gets more of it immediately.

I could drone on and on because I did a lot of research on it. A woman named Rose did too but she is no longer here on the forums, which is unfortunate. Sublingual B12 can also help after you have any peripheral nerve damage, like after birth, surgery, injury or when you have shingles. It helps to heal the nerves more quickly. Also, when people get Bells Palsy, the combo of Pred and B12 help resolve it more quickly too (based on studies).

As far as multivitamins, I take children's chewables. Yeah, that's right. I can split the amounts up during the day and then I don't get too much of ones like B6, which makes my neuropathy very unhappy. And they absorb better for me.

I get my supplements at www.iherb.com because they have discounts and free shipping past a certain amount. They have good brands and good service.

If you guys have more questions, it might be a great idea to start a new post. It's amazing how many people want to have the best nutrition they can. I like to get as much as I can from good, organic, whole FOOD!

Alice, Yes, I'm very appreciative of how you work with your patients. The fact that you don't feel well, struggle daily with all sorts of issues and still have time to respond - especially when I'm challenging you and vice versa - is beyond admirable. You know how much I respect you!

Annie

Thanks Annie,

I would love to know more about the nutrition/nutritional supplements you and others are taking.

I think it is a great idea to start a new thread on that.

Yes, I am very interested too in what vitamin, change in diet and supplements everyone takes and do they think it helps. I read an article a few years ago about research at the University where I work that discussed why some individuals carry the genetic markers for a disease but do not get the disease. They hypothesized that many people may carry the genetic marker but only 70% or so get the disease because of genetic expression. And the genetic expression was due to environmental factors such as air, water, nutrition and even the effect of stress changing the chemical composition in our blood. Makes sense to me.

Kathie