A family member (70 yr old female) recently started taking B-12 5mg methylcobalamin tablets in an effort to increase their B-12 levels. Before starting to take the B-12 tablets they had symptoms that included the following:

1. Daily fatigue
2. Light-headed when standing up
3. Forgetfulness/Memory issues (mixing up names, forgetting directions, etc)
4. Low appetite
5. Always feeling cold

It has now been 3 weeks since she started taking the daily 5mg tablet and during that 3 weeks some of her symptoms have seem to worsen.

1. Her daily fatigue has gotten worse
2. Her memory seems to have gotten worse (forgetting family members' names, not remembering things that happened a day or two ago, thinking that family members who are dead are still alive, etc)

When starting B-12 treatment does symptoms tend to get worse before they get better or is something else causing this?

Do you have a reference number for her blood levels? Or did you just do this on your own?

The elderly are prone to thyroid changes too...and many of the symptoms you list could be hypothyroid as well. That needs to be checked out.

Sometimes the elderly get so low, they need injections very frequently. Every day for a week, then once a week, then depending on the blood levels, a less frequent schedule.

If the oral absorption is too slow to fix a process of deterioration, then the deterioration continues, in spite of the oral supplement. Remember only a tiny fraction of the dose is absorbed orally if taken correctly --on an empty stomach.
13mcg out of 1000mcg/tablet. Daily injections would be much faster compared to this.

Concerning her B-12 levels she has not had a test to find out exactly what her levels are. Every year in February a local hometown pharmacy offers a service where individuals can come in and pay to get a full blood test to check the most common things. This past February (2014) we had the test done on her (it doesn't check for B-12 but it did do a full profile on the thyroid) and all of here thyroid numbers (TSH, T4, T3, Free Thyroxine) were in the middle of the normal ranges. Every year that she has had this test for the past 8 years her thyroid numbers have always been normal. This test did check for Vitamin D and on that she was low 38.9 (range 32.0 to 100.0). As a result of that she is now taking D3 supplements to get that value up.

As a result of a botched medical procedure, about 12 years ago, she now refuses to go to any doctor because she thinks they will mess something up. After doing research on all her symptoms it kept coming back to the possibility of B-12 deficiency. I thought that since B-12 is not toxic I would start here on 5mg and hope that it would help. But, over the past 3 weeks she has become more tired and her memory has become worse. She doesnt seem to know what day it is and sometimes she doesnt even recognize some of her family members.

I am sorry that this is happening. But I don't think the B12 is the issue. I do think she needs to be seen. If it is low B12, the oral form is too slow at this point. Once fixed with aggressive injections, one could maintain with oral. But something else could be going on too.

The elderly can get low potassium, diabetes, Alzheimer's, kidney failure, and all sorts of other things that give similar symptoms.

I think a visit to a doctor, is in order now.

Well after talking to a few friends who have taken B-12 for energy when working out a few recommended a place in a nearby town that gives B-12 injections. I checked them out and they have offices statewide and one service they offer is B-12 injections but it appears that they use either Cyanocobalamin or Hydroxocobalamin. I thought that maybe I could tell her that I was getting tired lately and I know that she is tired lately and we could go together to get B-12 shots so that she feels more comfortable about it.

But since they only use those two forms of B-12 would either work as injections since it is not the methylcobalamin type?

The hydroxocobalamin is an activated form. Use that one.
You don't know if she is methylating or not, so, I'd avoid the cyano form for now.

But I have to warn you, if she continues to show deterioration, even with the injections you need to have her seen by a doctor.

Thanks for all the info.

I spoke with her today and she mentioned that when she woke up this morning she felt so hungry that she was eating whatever she could grab for breakfast that didn't take long to cook or prepare. Usually over the past few months she has had little appetite but seems like her appetite might be getting somewhat better.

I do remember reading an article a few weeks ago about people who start methylcolbamamin can get very low potassium levels since the body is creating new blood cells that need that potassium. And that low potassium levels can cause a lot of symptoms.

Currently she is taking:

5mg Methylcob tablet (by itself)

Coconut Oil
Multivitamin
D3 softgel
Calcium tablet

I think I might add some potassium supplements to that.

I also remember reading about folate and some supplement called B-Right. If I also incorporate that supplement is it alright to take that separate with a meal or should it be taken with the Methylcob on an empty stomach?

The low potassium occurs only in those with severe anemia.
The B12 jumpstarts the bone marrow to make new red cells and they rob the body of potassium for a brief time. This stops when the red cells reach a normal level. Severe anemia is one of the last signs of low B12. Neurological symptoms and peripheral nerve damage often precede anemia.

There are types of kidney tubular acidosis that waste potassium thru the urine. There are also types of kidney disease that cause potassium to accumulate. Also the elderly can bleed from the colon if they have cancer there. I know an elderly woman who started bleeding internally from cancer and became very anemic and weak. It was the first sign of her colon cancer.

Low potassium can occur when people stop eating properly.
It is best to get potassium from high potassium foods. Even V8 juice is high in potassium.

The elderly are prone to all sorts of imbalances..and guessing is just not safe.

If and when you seek a doctor stop the B12 for at least 5 days before, so the test will be more accurate.

I still think seeing a doctor at this point is the best solution.

Since she is adamant about not wanting to go to the doctor I spoke with the place where we go each year to get her general blood test and they gave me names of places that the test for B12 could be ordered and done directly instead of through the doctor. Maybe that away I can get the test and no for sure and then convince her to go to the doctor.

My question is i am noticing that there are several different B-12 tests.
One is called a B12 blood panel that test B12 and folic acid. Then there is the MMA test that can either be done by blood or urine.

So which of these test are the best? And for the MMA is urine or blood better?

Also while looking online about these tests I read that if someone has been supplementing with B12 then it will skew the tests and not make them accurate. It even said that you got to wait about a month of taking no B12 supplements before being tested to make sure the test is accurate. Is that true? She has been taking B12 5000mcg supplements for the past 3 weeks so how long should I wait before getting the tests so they are not skewed?

Yes, the B12 test will reflect some increase from 3 weeks use.

You won't know what it was before supplementation. Stopping for 5-7 days before the test will remove some excessive values from the supplement, but the result is likely to be higher than before any was used.

The MMA test will reflect if the B12 present is being utilized properly. When B12 cannot work (say it is cyano form only), then MMA builds up in the blood to a high value.

Sometimes people with low B12 show high folate levels. This is called the methyl trap...and that is why they are both tested.
This information is mostly used by hematologists to provide information for the treatment of the various types of anemia.

In a 70 yr old, there are complicating factors:
http://www.cdc.gov/ncbddd/b12/detection.html