[Fogbrain]

First, Many thanks to Rose! Your efforts have much educated me.

Latest labs showed serum potassium at 5.6 mmol/L, a tenth of a point over this labs' age dependent reference range. All other chemistries, liver, kidneys show very good results. I did not have a serum B12 pulled on this pass.

So, I have been experiencing some classic B12 malabsorbtion symptoms; the most prominent being burning foot-soles with a lovely bright red color. All the other symptomology I had been blowing off, as I'm so accustomed to weird stuff as a survivor of multiple brain injury. Increased fatigue, PN, achy muscles, etc..

What caught my attention on one of Rose's posts somewhere was something about potassium stores being drawn down when B12 is being utilised. Am I being too simplistic to wonder about my B12 malabsorbing if my potassium is high, with no other apparent issues?

Only other thing that comes to mind re: potassium would be adrenal/aldosterone insufficiency.

But my gut tells me that B12 and probably B6 are problematic.

Any feedback gratefully welcomed, and thanks from a long time lurker for all your previous help.

Jeff

[med_help]

Fogbrian,

question on your comment - "So, I have been experiencing some classic B12 malabsorbtion symptoms; the most prominent being burning foot-soles with a lovely bright red color."

Just to clarify "burning foot-soles" means B-12 deficiency or B-12 malabsorption symptom?

I had taken my wife to another endo. for a second opinion as she is also severely malabsorbing.Will let you know if anything interesting comes out from test results or doctor talk.

[rose]

Thanks Jeff. I'm glad you've come out of the shadows to post.

The potassium level would vary from time to time and individual to individual, and the "normal" range just means that a larger percentage of people thought to be healthy are within that range. And it may relate to a good dietary (and/or supplement) potassium intake.

Also, he period of time the body draws on potassium heavily is quite short.

Bottom line: I don't think your potassium result proves anything in regard to a possible need for B12.

Regarding med's question about the burning feet. That is not a typical symptom, but even the "classic" symptoms are not really typical----the fact that they are thought to be causes even more people to go undiagnosed. People are damaged by B12 deficiency in so many different ways that it amazes researchers.

Anyway, it's good to cover the possibility!

rose

[Fogbrain]

Saw my primary Dr. today and what an awakening!

He was not at all surprised on the burning feet, combined with the rest of the symptoms, that I most probably have a deficiency of B12. He advised me to continue the sublingual methylcobalamin (1000mcg) and to call him in sixty days with a report of how I'm doing, stating that if I feel no improvement, we would be checking methylmalonic acid, and antibodies to intrinsic factor and parietal cells.

As to the potassium, he said he would need to go to his books to answer the question I asked here, then went on to state that if the orthostatic dizziness persisted he would be keen to do some tests on cortisol levels and other corticosteroids. I seem to have a family practice Dr. who truly is on top of this and, yeah, I am amazed!

I've only been on the methyl B for (Jarrow) six days and I know this will be an up and down process. I'm digging in for the long haul.

[Fogbrain]

Med Help: The burning soles could also have been an indicator of a copper or iron problem if my wacky memory serves me true. But in this case I beleive the B12 deficiency to be both relative and absolute, meaning I malabsorb (probably due to stress and metabolic issues), and I aso could be needing more in my diet alone.

Here's hopes that your wife is well attended to and gets satisfactory results.

Jeff

[Fogbrain]

Rose:

Many thanks for your input!

I've read enough of your postings on both BT forums to have an inkling of the price you've paid for your knowledge. Great website you have, too! You inspire me to do better. Bless you for that.

Jeff

[rose]

Jeff,

I appreciate your understanding words. That means a lot to me.

If you malabsorb, eating more food with B12 in it will do no good (unless you like huge amounts of liver every day ).

If your MMA is high after taking 1000 mcg B12 daily for weeks, either your B12 was so depleted that your MMA was much higher before, or you should consider a kidney problem.

1000 - 2000 mcg oral B12 daily is the textbook (well edited) dose for people who lack intrinsic factor or may be heading that way.

It's wonderful that you have a doctor who cares enough to look into potassium and to bother with exploring reasons for your suspected B12 deficiency. Most doctors wouldn't even know to check parietal cells and intrinsic factor antibodies if they did care to look into it.

Be clear though, in case the doctor isn't. What you are taking is treatment for malabsorption, even severe malabsorption of absent intrinsic factor.

Best wishes, and I hope to see you around here more.

rose

[rose]

An afterthought: have you had a ferritin test?

If not, it would be a good idea. Much better than the usual iron tests, and it is very important to know what your iron-store status is. Too high or too low is a problem.

rose

[Fogbrain]

Originally Posted by rose

Jeff,

I appreciate your understanding words. That means a lot to me.

If you malabsorb, eating more food with B12 in it will do no good (unless you like huge amounts of liver every day ).

If your MMA is high after taking 1000 mcg B12 daily for weeks, either your B12 was so depleted that your MMA was much higher before, or you should consider a kidney problem.

1000 - 2000 mcg oral B12 daily is the textbook (well edited) dose for people who lack intrinsic factor or may be heading that way.

It's wonderful that you have a doctor who cares enough to look into potassium and to bother with exploring reasons for your suspected B12 deficiency. Most doctors wouldn't even know to check parietal cells and intrinsic factor antibodies if they did care to look into it.

Be clear though, in case the doctor isn't. What you are taking is treatment for malabsorption, even severe malabsorption of absent intrinsic factor.

Best wishes, and I hope to see you around here more.

rose

Rose:
Understood about diet. No liver on my plate in any amount!

The Dr. and I are both clear that the treatment is for malabsorbtion. The short list of symptoms I gave him combined with his physical exam was convincing for him. He also did distinguish for me that I'm not experiencing true peripheral neuropathy so much as some parasthesias.

Meanwhile, I note an increase in fatigue following that mid-morning dose of B12, which tells me the body would like to rest and repair. I get a decent rebound in energy mid-afternoon, but I'm frugal about how I expend my energy as I know there's a ways to go before I am repaired and replenished. As I said, I'm in it for the long haul, and I've been through enough brain injuries to know how to wait and be patient while the body does its thing.

As to iron/ferritin: Serum iron was 113 in a reference range of 40 - 155. As I'm considering ordering another full chem panel (I want a re-read on that potassium) I will pull a ferritin level for good measure.

Thank you for everything.

Jeff

[rose]

Jeff,

You're very welcome.

I'm glad you will be getting a ferritin. Don't let them talk you out of it. The other iron indicators can be smack down the middle of the "normal" range in some people while iron stores are way off.

The neuropathy thing is semantics. Abnormal function of peripheral nerves is neuropathy, and parasthesis is abnormal function. Most docs mean that it isn't diabetic, CMT, etc. If it is due to B12 deficiency, it is systemic neuropathy (stemming from peripheral nervous system or central nervous system) just the same.

There is research indicating that low iron can also contribute to abnormal sensation in the legs. It is unlikely that a male is low in iron, but not impossible. It will be interesting to see what your ferritin result is.

It's unusual for such immediate responses to B12 doses, but I have seen a few others report it. Sounds good.

rose