TBI's and B12 Deficiencies
 

So, I found out 4 weeks ago that I am borderline B-12 deficient after having a series of "spells" (possibly absent seizures, but have not been officially diagnosed yet) and asking to have my blood work checked to see if something else could be going on. My B12 score was 246. I have been getting the B12 shots weekly for the past 4 weeks and I am beginning the monthly shots here at home. I saw my nueropshycologist this morning who told me that patients with TBI's often become B12 deficient and that there is a correlation between the two. I am trying to find out more information about the correlation. Does anyone know anything about this or have any information they could share with me on the subject?

ALSO... Has anyone else out there experienced "seizure like" symptoms from a B-12 deficiency? It starts with sudden and extreme nausea that lasts for a minute or less than comes a wave of extreme lightheaded/dizzy/foggy feeling that can last a minute or much longer. Then comes a tingly sensation down the top of my arms and into my fingers and sometimes my lips. Next comes the daydreaming and I get very lethargic. Following that I get a bad headache and pain in the base of my skull and the back of my neck feels like I pulled a muscle. The whole thing lasts from sometimes 10 to 30 minutes and I will sometimes get several of these episodes in a single day. I also get ticking (tremors) on the upper RT side of my body and head sometimes too during them and some rapid eye-blinking. When I have a full day of these I feel lightheaded 24/7 for several days after this. Does this sound familiar to anyone?

Mad Knitter,

Welcome to NeuroTalk.

B-12 deficiency is common with brain injuries as it is needed for myelin sheath repair. Folic acid is also needed in extra amounts. It is also needed to maintain the blood brain barrier. A blood level of about 1000 for B-12 and greater than 20 for folate is suggested for injured brains.

The shots are great to get levels up but there are different forms of B-12. Sub-lingual drops can be a good source. You also want appropriate D3 and a full complement of all the B's such as a B-50 or B-100 Complex. Check out the Vitamins... thread. I'll top post it so you can find it easily.

Another common thing with TBI is upper neck injuries, specifically at the C-1 (atlas) to occiput (base of the skull). You should try icing this area as often as possible throughout the day. 15 minutes on, 30 minutes off. Do it especially when you are symptomatic. You can make a flexible ice pack with a zip lock baggie with one part rubbing (isopropyl) alcohol and three parts water. Make a few so you can alternate them in the freezer as you use them. Wrap them in a thin towel to take away the extreme cold.

The vitamin regimen and icing should make a difference within a week or two.

My best to you.

There are many causes of low B12. One common cause today is the chronic use of acid blocking heartburn drugs. These drugs reduce acid in the stomach, which then interferes with absorption of nutrients that require acid.

These are:
B12
folic acid
calcium
magnesium
iron
zinc
and some trace minerals.

Because of this effect B12 deficiency is more common than it ever was! Some studies suggest 40% of Americans may be low.

B12 (from cyanocobalamin) and folic acid are not active in the body. They need to be converted once absorbed to their active methyl forms. This step can fail if you inherited damaged methylation genes. Estimates today are that 10-30% of Americans cannot methylate these two crucial B vitamins.
This is called MTHFR polymorphism. Luckily there are OTC versions of them available at very reasonable prices so you can correct this problem easily. Methylcobalamin and methylfolate are their names. Methylfolate is sometimes called Metafolin.
Not easily found locally but online they are now available from many quality discount sources, like iherb.com, Puritan's Pride, Amazon and Swanson's to name a few.

The methylB12 needs to be taken on an empty stomach, and daily use can be as effective as injections. This is my B12 thread, with medical information explaining:
http://neurotalk.psychcentral.com/thread85103.html

MethylB12 is a cofactor in the synthesis of melatonin. For people with insomnia, this is a critical thing to understand, as it suggests methylation failure. Most doctors do not know this yet, because they do not keep up with new research.
You could use cyano every day, and if you cannot methylate it and change it to the active form, it will NOT do anything for you.
Taking oral is as effective as shots, and there are studies to prove that. So do read the link I gave and especially the links listed there that explain this so you can improve your status quickly. MethylB12 crosses the blood brain barrier, into the central nervous system, and is dependant on the gradient concentration in the serum. If blood serum is low, then little can enter the brain. So keeping your blood levels high, insures that the brain will have enough.

Eventually low B12 will lead to degeneration of the spinal cord, and paralysis, blindness and death if not treated.
http://en.wikipedia.org/wiki/Subacut...of_spinal_cord

It is quite possible that low B12 creates further difficulties for TBI patients, than for normals. Since it is so common, and doctors continue to follow outdated lab ranges for testing, patients in the US continue to deteriorate. The new low today is 400pg/ml. But doctors continue to accept "normal" in ranges below that, even in the face of deterioration of the patient!

That is why you need to be proactive on this subject and find out your lab results and medicate yourself if necessary.
If you are one of the 40% who are already low in B12, you are not going to HEAL a brain injury very well...and in fact you are already deteriorating from THAT before you even had the injury.

On the thread I gave you are links to medical papers illustrating that absorption of oral B12 is effective, if done properly. Presence of food in the intestine will block the micrograms needed for passive absorption (when intrinsic factor fails, due to damage to the stomach cells producing it, or when acid is removed from the stomach with heartburn drugs. Acid is necessary to enable absorption of B12 orally and from food). So it is critical to take oral B12 supplements on an EMPTY STOMACH, for best absorption.

Therefore you must learn how your body works, and work with it and not against it, to supply B12 on a daily basis to heal and maintain your nervous system. This will cost you pennies a day and is just about the least expensive insurance you can provide for yourself.

I'm looking at my Trader Joe's B 100. Only 100 mcg's of B12 - will get some more! - but 100 mg's each of thiamine, riboflavin, niacin, B6, pantothenic acid, and calcium. 400 mcg's of folate, and 100 mcg's of biotin. What values are recommended?

That probably has folic acid in it. Methylfolate is only in a very few OTC complexes today.

Folic acid is not active in the body until methylated --which can commonly fail.

Folic acid or methylfolate should not be taken if you suspect B12 deficiency...it can mask neuro symptoms, leading to a false sense of security, and neuro damage can result. This is why 1mg or more folic acid requires a doctor's prescription. With the fortification of US foods, folic acid is typically not deficient in Americans today.

This is why testing is important.

Let me give you a visual image to help explain this.
Imagine a large stadium like you see on football games on TV.
Typically they have 100,000 people or more in them.
Taking the lowest known % of people who CANNOT convert cyanocobalamin and folic acid to their active forms in the body, which is 10%.... 10,000 of those people could be non-methylators!
They are destined for serious problems if not discovered.

We have tests for DNA to determine your methylation ability, now that do not require a doctor even!

https://www.23andme.com/

The price is coming down, and becoming more available to the public
every day.

I was blood tested for B-12, folate, and D3 while taking my regimen. I used the test to confirm that my regimen was providing adequate amounts.

Getting a blood test while fasting from B-12, etc provides valuable information about how well B-12 is utilized but the blood work with the B-12, etc regimen allows us to understand if our supplement goals are being achieved.

Please let me explain how blood testing works.

First off the B12 blood level, may be misleading. It only measures what is floating around in the blood. If the B12 is not being consumed in the various tissues because it is not active, then it will appear normal or even high in the blood.

The MMA test, however, shows if B12 is actually WORKING.
This compound requires active B12 to remove it from our systems as it becomes toxic when high.
http://labtestsonline.org/understand...s/mma/tab/test

So if the MMA comes out high in testing, that shows that something is wrong with B12 in that person.

Another test to show if B12 is working, is homocysteine. This compound elevates when B12, folate, and activated B6 are not present in adequate amounts. These 3 vitamins are cofactors to methylate homocysteine to SAMe. The methyl groups are added to homocysteine , which becomes SAMe (s-adenosyl methionine) which then carries that methyl group to the liver, joints and nervous system where the various neurotransmitters are manufactured. So if homocysteine is elevated, then one needs to look at these cofactors.

The methylation chemistry is rather new. And the DNA testing also within the last decade or so. And the methylcobalamin is relatively new too. All within the last 10 yrs.

Why spend money on the older forms of these critical vitamins, when the activated ones, are available for about the same cost?

The basic screening for low B12 using serum testing, is only one tool. People may test above 400pg/ml today, and still need the supplements.
Here is an important link to Dr. C. Snow's article which explains this:
http://neurotalk.psychcentral.com/post698522-70.html

Other countries are way ahead of us about this subject.
Japan and India have had serious issues with B12 deficiency, and one can see that they treat B12 deficiency more aggressively than in the US. However, our labs in US still report low values as "normal"... that is below the new recommended low of 400pg/ml. And doctors continue to tell patients who are low that they are "normal", and the damage and suffering continue.

edit to add: There is a new test, called the transcobalamin test.
This is not yet available in all labs, and is expensive. But it is supposed to be the "best". I haven't done it yet, myself tho.
http://www.questdiagnostics.com/test...28&labCode=SJC

A hint of developing B12 problems can be seen in a CBC test which is
pretty routine at most doctors. (the tests above have to be requested specially).
This is the MCV or mean corpuscular volume. This test will elevate or hover around the upper range when B12 is becoming scarce. Often doctors completely ignore this result, and that is a shame because it
can point to a need for further testing. It measures the size of the cells in a given volume of blood and when B12 is not working the red cells are defective and larger than usual.

mrsD,

It would be great if you could post a simple list of the tests and the good and bad ranges of the results.

I have though about asking to start a Sticky for Nutrition, vitamins, supplements, hormones, meds and blood related issues. It would be great to have this all in one place. The existing Stickies have too much to find the Nutrition........ posts. It would also be good to direct discussion to the main forum so the important information does not get lost.

All the B12 info is already at PN here on the stickies.

There are so many discussions about B12 on NT, just about every forum at one time or other.

For B12 you need 400pg/ml or more. Anything less is problematic. The lab ranges reported for the serum test, are still outdated in the US.

Everyone is welcome to come to PN and read and ask questions there.

What is PN ?

What sticky thread ?

Dr Snows information is too intense for many with PCS.
We need the information in a just the basic facts format.
Your previous B-12 post is also too intense.

PN= Peripheral Neuropathy
Posters on PD, MG, MS, RSD, Bipolar and other forums all use
methylB12 successfully here. If you think my posts are intense you
should read the PD (Parkinson's) forum where technical posts are
the norm.

I cannot help it if the information is "too intense". I water it down and simplify quite a bit for this format on NT.

I bolded the part of Dr. Snow's paper, pertinent to giving extra B12 for those who tested in the borderline low range. It is 2 sentences long. Reading outloud so that one can HEAR the words instead of seeing them, often helps. Having someone read the posts to them, may also help. Auditory functioning can be easier for people with cognitive problems, than visual sometimes.

I put links up for those who want to delve more deeply into a subject.
I also think the internet is not trustworthy and provide the links as proof of medical studies and medically acceptable content.

Many people may have to read some information more than once. Or in batches. I have to do that sometimes myself.

The link to my sticky on PN is in this thread.

I recently started taking 2500 mcg of B-12/day. Is this too high? Should I be cutting these tablets in half and taking them?

No. No need to change the dose. Only about 13 mcg gets absorbed ideally from 1000mcg dose. Ideally means taking it alone on an empty stomach and no food after for about an hour.

If you worry however, anyway, you can take it every other day.
But if you eat with it or near taking it ...don't count on much being absorbed.

Vit B12 has no upper limit of dosing.

Taking 2 of your GNC vitamins at a time, however may be problematic depending on the formula. Those are designed for one a day use unless the label says the formula is for 2 or more tablets at a time. (some vitamins get too large to swallow so they make them multiple dose in that case.)

mrsD,

Why do you need to take B-12 on an empty stomach is you can get it into the blood stream taking it before or after a meal ?

I take about 400 mcgs after breakfast and my blood levels are 970 pcgs/mL

My focus is keeping the continuity of taking it day after day so with half-life considerations, there is a continuous amount in the blood stream.

I have found that continuity is more important with all of the vitamins and supplements. My father was big on the timing and such but I would never get all of my regimen done if I had to space them out so much. Twice a day is enough for me.

Mrs D,

In some of my studies in the past I recall that supplementing B12 sublingually was a better avenue for absorption; does that hold true, or have the tablets/capsules been protective enough to protect their passage thru the Stomach acids now for later absorption in the GI tract?

Mark, you may have intact intrinsic factor functions.

There is a finite amount of intrinsic factor secreted in the stomach with food intake. It will enable absorption of B12 from food sources (which is about 1-2mcg/meal) when it works well.

The empty stomach for supplements is for PASSIVE absorption when intrinsic factor fails. It used to be thought that nothing could be absorbed without intrinsic factor activity but now that has been disproven.

With time and aging people develop low acid in the stomach. This is called achlorhydria. In fact in the early 20th century, pharmacies actually dispensed hydrochloric acid to be diluted in water, for this condition. Studies show about 30% of people 50 and over may have this lack of acid. When this happens naturally or because of using heartburn medicine too often and too much... the stomach cannot break up protein that contains the B12 properly, and so it does not attach to the instrinsic factor and is not absorbed, in the intestine.

Autoimmune issues/disease or hereditary genetic failures in the intrinsic factor production also occur. When this happens in younger people they cannot absorb B12 from food either.

Poor diet (vegan lifestyle or not eating protein)
Autoimmune disease
Chronic use of heartburn acid blocking drugs or metformin
Celiac disease or other malabsorption like Crohn's disease,etc

All will result in low B12 absorption.

The high dose supplements are designed to bypass intrinsic factor and when given very high like 1000mcg/day or more, a few micrograms will get passively absorbed into the body we know now. Presence of food will be a physical block to that process which is very delicate. B12 only gets in thru a short area of the small intestine. We know from studies that presence of food impairs microgram dependent drug absorption too.. Levothyroxine must be taken on an empty stomach, and so also for digoxin. Presence of fiberous food...like grains, bran, veggies, are the worst because the micrograms are lost in the fiber.

This table shows how much B12 was absorbed during a study under different conditions. The PA (pernicious anemia column illustrates the upper limit for intrinsic factor itself.).
http://www.ncbi.nlm.nih.gov/pmc/arti...able/T1/#TF1-4
you will see at 500mcg --your dose-- 9 mcg was measured in this study. This study, gave on an empty stomach. 9mcg is about twice the RDA for B12. So if you take yours daily every day, you will end up with good levels, over time.

Notice on that table link... that PA patients, who consumed 1000mcg B12 orally were almost equal to the non PA patients.
This demonstrates that at this high intake level, that PASSIVE absorption is working even in the pernicious anemia patients (who have no intrinsic factor). This is why oral supplements have to be high dose to work for EVERYONE.

Now this does not take into consideration those using cyano vs methyl. That is another problem. Cyano is not active biologically and if people have genetic DNA errors preventing methylation...then the cyano will not work in the body. This factor is separate from the intrinsic factor failures. It is only about a decade old, and was discovered as the genome was decoded. This is why I only recommend active Methyl B12...because we cannot see inside people to know what their genetic situation is.

This link gives a diagram on how B12 is broken down from protein, attached to intrinsic factor, and then absorbed in the intestine. This is a complex situation and even many doctors do not understand it. This link was made for doctors...for their CME (continuing education).
Figure 2.
http://www.aafp.org/afp/2003/0301/p979.html

Today methyl B12 is pennies a day. I just learned that Costco now offers it . It works out to 6 cents a tablet. Why use anything else, when this is so available and is the type the body actually uses?

Dr. Snow (whose link I gave you before also), mentions in his research that some people with fairly "normal" blood levels, of B12 still had neurological impairments, and giving a higher dose worked for them. His opinion is that some people just need more.
Now that may reflect an error in Transcobalamin transport, and that is rather new still, and tests are just coming out for that factor. Low levels in transporting it around the body, may be serious for some. In fact you could test high, and still not be getting B12 delivered to tissue sites. It is thought that low transcobalamin can be bypassed with mega dosing. And that this error is probably genetic also.

So Mark in your case, you might be lucky that you have the genes to handle B12 metabolism. But without an MMA test you really do not know if you are utilizing what is being measured.
You could just have lots of cyano floating around. So it would not cost you much to switch to methylcobalamin at this time, and use 1000mcg daily. 6 cents a day from Costco.
http://www.costco.com/webber-natural....11659799.html
and:
http://www.costco.com/.product.10002...rySiloedViewCP

Also Walgreen's is now offering methylcobalamin on their website and in some stores. The fact that this is FINALLY making its way to consumers is a very good thing!

Our bodies are very complicated. VERY. It is not really a matter of just taking a pill anymore.

MrsD,

NM, your answer to Mark above is what I was referring to, thanks........... not really the stomach acids per se.

Thanks again.

Can't tell you how many 'go rounds' I had with my Supervising Physicians in checking MMA and Homocysteine studies, along with B12, and folates, in the 80's-90's, before they finally started recognizing them as valid studies for anemias.

Thanks.

Yes, 1 serving of the GNC multivitamin is two pills. So I was going to take one with breakfast and one with lunch, and then take all my other vitamins with breakfast (D3, B-100 complex, fish oil). THe B-12 I am taking as soon as I wake up before I get into shower to allow some time before breakfast.