B12 levels

When first diagnosed with B12 deficency almost 10 years ago, my level was <100. I started weekly and then monthly injections until my levels were up in 900 -1000 range. They were that high for a number of years.  Unfortunately I relocated and had to change Dr.'s.  I have been extremely fatigued to the point thatI am on SS disability because I am not longer able to work.  

In June, 2004 my B12 was checked and the level was 198.  I was not told my level was so low until I asked for report.  Later that month, it was checked by another Dr. and it was 227.  Both Dr's say that the low result was because I am due for my monthly injection.

Since I have been having significant fatigue, memory loss, etc.  I feel that  the Dr. should have increased my B-12 as soon as my level got so low.

1)How much B12 can you realistically lose in a month? I understand that it took 4-5 years for my level to get to <100 so how can my level drop so signicantly in one month?  I feel that  my low B12 is not a result of being due for an  injection as both of these Dr's state. What range  should I be at in light of my extreme fatigue?

Thank you -

[Kevin Pho, MD]

B12 deficiency is normally due to inadequate absorption from gastric disease or pernicious anemia.  Pernicious anemia is due to an immune attack on intrinsic factor (which helps absorb the B12).  Pancreatic disease, H Pylori, gastritis, as well as malabsorption are other diseases that can lead to b12 deficiency.  

If you are still having low b12 levels, you may consider further evaluation as to the cause.  This may include an upper endoscopy to look for gastritis and H Pylori (which is a bacteria associated with inflammation or ulcers).  

As for the proper range, I would say that being in the normal range should rule out b12 deficiency as a cause for the fatigue.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[twiggy1234]

A related discussion, b12 was started.