PPIs and B12 Deficiency? - Help Needed
 

Hello, all you lovely people. :p

Story short: after several months of high-dose PPIs and H2 blockers and an onset of sudden, inexplicable neurological symptoms, I put two and two together, and am wondering if supplementing with B-12 might help. I figure I've got nothing to lose.

I'm currently waiting on test results, so I don't know my current level. A few questions, though:

a) How much B12 is safe per day?
b) It's near-impossible for me to get off the acid-blockers at the moment, so what would be the easiest form to absorb in someone with very low stomach acid? Sublingual?
c) Should I take the B12 spaced apart from the acid blockers?

Thank you. :D

I don't know about your third question. Many people in the Peripheral Neuropathy forum (self included) take as much as 5000 mcg of methylcobalamin (sublingual) per day. It should be taken on an empty stomach, about an hour before eating any food.

Doc

And, in answer to the third question--
 

--yes--B12, preferably methylcobalamin, sublingual or otherwise, should be taken apart from any food of other supplements or medications, in order to optimize passive absorprtion ability--the cobalamin molecule is the largest our body regularly uses and it is very easy to interfere with its absorption.

I take mine at least two hours after eating or at least one hour before, and far apart from any other supplements.

Yes, you can take whatever you want. However, if you would like to know if B12 is low and causing your symptoms you need to be tested before you start. It can be useful to know where you are in the scheme of things.

Naturally in the body, our liver stores up to 5 yrs worth of extra, and so in normal people, a few months of acid blocking drug use or other depleting drug, will not harm you. But if you are initially not absorbing it, from food or have been depleting it with drugs for years, then yes, you could have no backup left.

As people age, they make less acid, and then less B12 is absorbed. If you have autoimmune disease, it may have attacked your parietal cells that make instrinsic factor, and you may have pernicious anemia. Other malabsorption may occur in Crohn's patients, or those with gluten intolerance.

People who are very low in testing, can start at 5mg a day of active B12-- called methylcobalamin -- each morning on an empty stomach. People not really low, can start at 1mg a day.

One test that offers a "hint" as to low B12, before real anemia hits (usually late in low B12 patients), is an elevated MCV --mean corpuscular volume-- in the CBC tests. Although many doctors ignore this, it can point to a need for further testing, either using serum B12 level or MMA level.

Sublingual is not necessary. Oral works fine as long as you take it on an empty stomach.

This is a link to my informational B12 thread:
http://neurotalk.psychcentral.com/thread85103.html

Methyl form is not commonly seen in local stores.
But many online places have it for very little cost:
iherb.com
vitacost
Swanson's
Puritan's Pride

It works out to pennies a day. B12 has no upper limit set for safety because it has not shown toxicity in any studies yet.
High dose oral is only absorbed 10% or less per dose.
Studies done without regard to food, have been in the 10microgram absorption range for 1000mcg swallowed.
Here is a post with two good links in it:
http://neurotalk.psychcentral.com/thread85103.html

Please take a look.