In a large study of smokers (almost 30,000 people), lower initial vitamin B12 levels were associated with a 5.8-fold higher risk of getting stomach cancer (gastric carcinoma). appear in the cerebrospinal fluid below 550, 30-50% of B12 deficiency patients (measured by true, low active-B12 levels) will have ‘normal’ total-B12 levels of 150-300, assessment of B12 status by serum B12 levels is insufficient, many people with traditionally normal levels of 300-400 do have high active-B12 levels, excrete significantly more uMMA than those without damage, can predict one’s path toward permanent neurological impairments, Healthy nervous system & disease prevention in the elderly, In most countries, the low range of what’s considered normal B12 blood levels is way too low (100-250), often missing desperately deficient folks. She spent 4 years reviewing the scientific literature on supplements, lab tests and other areas of health sciences. It’s possible that B12 affects methylation, and, therefore, the activity of certain cancer-related genes [140]. Serum MMA levels may also be high in patients with thyroid disease or bacterial overgrowth in the small intestine. Levels differ slightly between labs, due to differences in techniques, equipment, and chemicals. First, keep in mind that the total-B12 blood level test doesn’t tell us nearly as much as people think it does. But a normal level of vitamin B12 in your bloodstream is generally between 190 and 950 picograms per milliliter (pg/mL . Vitamin B12 deficiency can impair motor function (e.g. Methyl B12 is needed as a co-factor to convert homocysteine back into methionine. We’ll have a look at this study from Turkey, which measures vitamin B12 levels by age (0 to 24 year-olds). An elevated B12 is generally defined as a level higher than the upper limit of the normal range, around 1000 ± 100 ng/L (738 ± 73.8 pmol/L) 2, 3, 4. What Abnormal Results Mean The Schilling test helps determine etiology. We charge as little as $3. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Blood vitamin B12 levels don’t necessarily reflect dietary intake and may result from issues such as liver damage. Vitamin B12 deficiency is a common cause of megaloblastic anemia, various neuropsychiatric symptoms, and other clinical manifestations. In a meta-analysis of studies of over 1.2 million people, every 10 μg/d increase in vitamin B12 intake lowered the risk of pancreatic cancer by 27% [135]. He informed me that the normal range for B12 in the Japanese Health system is considered above 500 pmol/L. Goldman-Cecil Medicine. If you buy through links on this page, we may earn a small commission Here’s our process. In two studies (over 9,000 people), supplementing with folic acid + vitamin B12 increased cancer risk [138, 139]. • Use OR to account for alternate terms Older adults with a vitamin B12 level less than 100 pg/mL (74 pmol/L) may also have symptoms. • Use “ “ for phrases Deficiency causes megaloblastic anemia (indistinguishable from that due to vitamin... read more as a cause of megaloblastic anemia; folate supplementation can mask vitamin B12 deficiency and may alleviate megaloblastic anemia but allow the neurologic deficits to progress or even accelerate. Copyright © 2023 American Academy of Family Physicians. A large-scale study looked at 5,000 lung cancer-control pairs and reviewed genetic data of 29k cancer patients and 56k healthy people. The result ranges vary from one laboratory to another, so it is important to discuss the results and their meaning with a doctor. Natural or biologically active forms (hydroxocobalamin, methylcobalamin, and adenosylcobalamin) are a better option than synthetic cyanocobalamin. In a single study with approximately 700 people aged 85+, women (but not men) with initially higher vitamin B12 levels had an increased risk of dying from any cause and from heart disease [124]. Complete blood count (CBC) and vitamin B12 and folate levels, Sometimes methylmalonic acid levels or Schilling test. We include products we think are useful for our readers. To establish that the product manufacturers addressed safety and efficacy standards, we: We do the research so you can find trusted products for your health and wellness. Our science team must pass long technical science tests, difficult logical reasoning and reading comprehension tests. A possible explanation for the link between vitamin B12 and depression is that vitamin B12 is required for the production of SAM-e (S-adenosylmethionine). Neither active vitamin B12 nor MMA is reliable in people with damaged kidneys [33, 34].Normal Range. So . Usually, excess vitamin B12 is removed in the urine. No prescription needed. Inadequate absorption may occur in blind loop syndrome (with overgrowth of bacteria Small Intestinal Bacterial Overgrowth (SIBO) Small intestinal bacterial overgrowth can result from alterations in intestinal anatomy or gastrointestinal motility, or lack of gastric acid secretion. They can also increase the likelihood of anemia. Megaloblastic anemias. Frustrated by the lack of good information and tools, Joe decided to embark on a learning journey to decode his DNA and track his biomarkers in search of better health. Taking blood from some people may be more difficult than from others. Based on the data from the studies by Bor et al.13 and Pentieva et al.14 as well as on the target concentrations for total serum vitamin B 12 (>221 pmol L −1), holo‐TC (≥40 pmol L −1), MMA (<270 nmol L −1), and homocysteine (<12 µmol L −1), the estimated value for the vitamin B 12 intake is 4.0 µg d −1 for men and women within . Similarly, in another meta-analysis of 17 studies and over 10,000 people, higher total and dietary vitamin B12 intake were associated with lower colon cancer risk [136]. A vitamin B-12 level test checks the amount of vitamin B-12 in the blood or urine to gauge the body’s overall vitamin B-12 stores. The four main intestinal cestode pathogens of humans are Taenia saginata ( beef tapeworm) Taenia solium ( pork tapeworm) Hymenolepis... read more ; in these cases, bacteria or parasites use ingested vitamin B12 so that less is available for absorption. In a study of 78 people with nerve pain, 83% improved with vitamin B12 treatment. The richest sources of vitamin B12 are animal products such as meat, fish, and dairy [8, 9]. The association remained even >10 years after blood collection. Normal value ranges may vary slightly among different laboratories. Vitamin B12 or B9 (commonly called folate) deficiency anaemia occurs when a lack of vitamin B12 or folate causes the body to produce abnormally large red blood cells that cannot function properly. The trusted provider of medical information since 1899, Dietary vitamin B12 deficiency usually results from inadequate absorption, but deficiency can develop in vegans who do not take vitamin supplements. holotranscobalamin (holoTC) Research suggests that MMA and holoTC may be more accurate at reading low B-12 levels because they represent active B-12. Cobalamin, cyanocobalamin Units of measurement pmol/L, pg/mL, pg/dL, pg/100mL, pg%, pg/L, ng/L Nutritional and macrocytic anemias can be caused by a deficiency of vitamin B 12. The earlier you begin treatment, the more likely you are to avoid damage. Similarly, in over 476,000 people without cancer or vitamin B12 prescriptions (injections), high B12 levels (> 1,200 pmol/L) were linked to a higher incidence of cancer [120]. Inadequate vitamin B12 intake is possible in vegans but is otherwise unlikely. Unless dietary vitamin B12 is obviously inadequate, serum gastrin levels or autoantibodies to intrinsic factor may be measured; sensitivity and specificity of these tests may be poor. Hypercobalaminemia can yield clinical signs indicating functional and qualitative vitamin B12 deficiency. Tissue deficiency and macrocytic indexes may precede the development of anemia. Vitamins, trace minerals, and other micronutrients. Values of less than 160 pg/mL (118 pmol/L) are a possible sign of a vitamin B12 deficiency. People with vitamin B12 deficiency can have neurological symptoms and/or damage without anemia (lack of red blood cells). Total B12 vs. In fact, a healthy person can store up to 3 – 6 years’ worth of vitamin B12 in their liver. In some cases, despite being elevated the body can’t use vitamin B12 effectively, in which case people can experience functional vitamin B12 deficiency [118]. However, rather than being a contributing factor, in this case, low vitamin B12 may be a consequence of stomach inflammation, which precedes stomach cancer and decreases B12 absorption [104]. A nasal gel preparation of vitamin B12 is available at a higher price. In a study of 181 demented adults, 25% were vitamin B12-deficient. It may also be high in pregnant women or infants suffering from a rare genetic disease called methylmalonic acidemia. Enterohepatic reabsorption helps retain vitamin B12. Fortified foods, such as cereals and nutritional yeast, are plant-based alternatives…, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. Free worldwide shipping. Common sources of B12 include animal products such as red meat, fish, poultry, yogurt, and milk. Two studies found a link between low vitamin B12 and Alzheimer’s disease. Subclinical vitamin B12 deficiency refers to serum levels above 148 pmol/L and the thresholds defining vitamin B12 adequacy are still debated. Patients who have had bariatric surgery should receive 1 mg of oral vitamin B12 per day indefinitely. I Googled this and this was confirmed. 7th ed. Alcohol consumption can reduce B12. Anemia Megaloblastic Macrocytic Anemias Megaloblastic anemias result most often from deficiencies of vitamin B12 and folate. Patient information: A handout on this topic is available at https://familydoctor.org/vitamin-b-12. Vitamin B-12 is an essential nutrient that plays a vital role in overall health. Although low vitamin B12 has many negative health consequences, high B12 has also been linked to health risks. Bei welchen Symptomen Vitamin B12 messen? No association was found in men [101]. However, researchers recognize an inverse relationship between adverse outcomes and serum B12 (even at "normal" levels). None of these strategies should ever be done in place of what your doctor recommends or prescribes! Last medically reviewed on January 15, 2020, Many vitamin B-12 supplements contain much more of the vitamin than the body needs. High serum folate levels can mask the symptoms of vitamin B-12 deficiency and make its neurological symptoms worse. How prevalent is vitamin B12 deficiencyamong vegetarians? Is there any reason for you to be worried? A study suggests that calcium supplements may improve B12 absorption in diabetics taking metformin [109]. In most countries, the observed normal values of vitamin B12 – in both children and adults, males and females – are anywhere from 100 to 1400pg/ml. If you’re deficient, your doctor will likely prescribe vitamin B12 supplements or vitamin B12 shots [107, 108]. 100% pure methyl B12. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. The normal range for vitamin B12 (total) is between 200 - 1100 ng/L (nanograms per liter), 200 - 1100 pg/mL (picograms per milliliter), or 148 - 811 pmol/L (picomoles per liter).. MMA levels can also be used to monitor the response to treatment. Read on to learn more about testing B-12 levels and what the test results mean. This condition can lead to vitamin deficiencies... read more ) or fish tapeworm infestation Overview of Tapeworm Infections Tapeworms (cestodes) are flat, parasitic worms. What are the optimal B12 levels for females? It has a short life and drops much faster than total vitamin B12 when your B12 supplies start running low. Some common drugs can lower vitamin B12 levels, including: Mild, subclinical deficiency affects between 2.5% and 26% of the general population (depending on the cut-off) [64]. For this reason, some experts claim that active B12 is an earlier and more sensitive indicator of vitamin B12 deficiency [30]. ROBERT C. LANGAN, MD, FAAFP, AND ANDREW J. GOODBRED, MD. This is as confirmatory as a vitamin B12 deficiency test can get. Treatment Vitamin B 12 deficiency can be treated with intramuscular injections of cyanocobalamin or oral vitamin B 12 therapy. Vitamin B12 normally breaks down methylmalonic acid (MMA), which builds up only when B12 is low. If you have normal B12 values, but high homocysteine levels, this may point to a deficiency or problem utilizing methyl B12. In over 77k people, B12 supplement use (but not multivitamins) was associated with a 40% increase in lung cancer risk among men, but not women. cirrhosis or hepatitis) [, Myeloproliferative disorders (diseases of the bone marrow and blood), such as hypereosinophilic syndrome, polycythemia vera, or leukemia [, Help create a more hospitable environment for gut flora and the “good”. Gut issues and certain prescription medications can also impair B12 absorption and lower blood levels of this vitamin. This is usually not of concern as vitamin B12 is not considered toxic. Our team thoroughly researches and evaluates the recommendations we make on our site. (See also Overview of Vitamins Overview of Vitamins Vitamins may be Fat soluble (vitamins A, D, E, and K) Water soluble (B vitamins and vitamin C) The B vitamins include biotin, folate, niacin, pantothenic acid, riboflavin (B2), thiamin (B1)... read more .). Multivitamins seem to work better than B12 supplements in isolation. Although hematologic abnormalities are usually corrected within 6 weeks (reticulocyte count should improve within 1 week), resolution of neurologic symptoms may take much longer. The most important thing is to work with your doctor to find out what’s causing your low vitamin B12 levels and to treat any underlying conditions. General physical symptoms of vitamin B12 deficiency can include: Feeling very tired or weak. Do not stop any medicine before talking to your provider. Many point only to an association, not causation. Adverse outcomes include an increase in homocysteine and methylmalonic acid as serum B12 drops below 542 pg/mL (400 pmol/L). A doctor may use the results of a vitamin B-12 test to help form their diagnosis. All Rights Reserved. Can diet and exercise reverse prediabetes? You should not eat or drink for about 6 to 8 hours before the test. Our goal is to not have a single piece of inaccurate information on this website. No research has yet found any side effects from taking too much…, Vitamin B12 supports the health of blood and nerve cells, but some people's bodies are unable to absorb it. Smoking (nicotine) can also lower B12 levels and should be avoided [57]. The following groups of people are more likely than others to experience low vitamin B-12 levels: Doctors usually use a blood test to check vitamin B-12 status, but home urine tests are also available. The Schilling test is useful only if diagnosing intrinsic factor deficiency is important, as in classic pernicious anemia. Intrinsic factor is a substance in the stomach that binds to vitamin B-12 so that the body can absorb it. Veins and arteries vary in size from one person to another and from one side of the body to the other. Malabsorption can affect macronutrients (eg, proteins, carbohydrates, fats)... read more , AIDS Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection results from 1 of 2 similar retroviruses (HIV-1 and HIV-2) that destroy CD4+ lymphocytes and impair cell-mediated immunity, increasing risk of certain... read more , use of certain drugs (eg, antacids, metformin), repeated exposure to nitrous oxide, and a genetic disorder causing malabsorption in the ileum (Imerslund-Graesbeck syndrome). The pathophysiology of elevated vitamin B12 in clinical practice. Vitamin B12 Deficiency – Are You At Risk? If malabsorption Overview of Malabsorption Malabsorption is inadequate assimilation of dietary substances due to defects in digestion, absorption, or transport. For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml. She believes that SelfHacked has the best science that is also layperson-friendly on the web. Initial laboratory assessment should include a complete blood count and serum vitamin B12 level. Certain medicines may affect the results of this test. Long-term vitamin B12 and folate use (several weeks to years) may prevent depression from coming back in those in recovery while also preventing depression in those at risk. This can occur when the stomach makes less of the substance the body needs to properly absorb vitamin B12. The vitamin B-12 level test checks how much vitamin B-12 is in the body. [2] Learn more about the MSD Manuals and our commitment to, Vitamin Deficiency, Dependency, and Toxicity, autoimmune metaplastic atrophic gastritis. The result ranges vary from one . Some studies suggest that higher dietary B12 is beneficial. Deficiency should be confirmed by checking the level of a substance in the blood called . The US Institute of Medicine deficiency cut-off for B12 deficiency is set at 203 pg/mL (150 pmol/L). They are continually monitored by our internal peer-review process and if we see anyone making material science errors, we don't let them write for us again. Some labs use different measurements or may test different samples. Inadequate vitamin B12 absorption is the most common cause of deficiency (see table ). Signs and symptoms of deficiency include: Infants with vitamin B-12 deficiency may fail to thrive. According to other studies, the potential benefits of B12 supplementation may extend to all people suffering from depression or those at an increased risk, regardless of sex. For some people, high doses of vitamin B-12 supplements may improve B-12 status. Philadelphia, PA: Elsevier; 2020:chap 155. Patients with levels of > 600 pmol/L were 2 times less likely to survive than those with levels within 200 – 600 pmol/L [130]. Causes of vitamin B12 deficiency include: An increased vitamin B12 level is uncommon. However, if your uMMA levels are high, you probably suffer from B12 deficiency. In this case, a doctor may recommend…, MCHC levels are measured as part of a standard complete blood count (CBC). If your tests consistently show elevated levels of B12 even after stopping supplement use, work with your doctor to find out what’s causing your high B12 levels and to treat any underlying conditions. Higher blood vitamin B12 was associated with higher lung cancer risk. Pernicious anemia is a form of megaloblastic anemia caused by poor vitamin B12 absorption. Folate (. They include measuring the following: Serum methylmalonic acid (MMA) levels: An elevated MMA level supports vitamin B12 deficiency but may be due to renal failure. Vitamin B12 helps converting methylmalonyl-CoA, one of the forms of MMA, into succinyl-CoA. Your health care provider will tell you if you need to stop taking any medicines. When clinical judgment suggests vitamin B12 deficiency but the vitamin B12 level is low-normal (200 to 350 pg/mL [145 to 260 pmol/L]) or hematologic indexes are normal, other tests can be done. Screening average-risk adults for vitamin B12 deficiency is not recommended. If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please leave a comment or contact us at support@selfdecode.com.