How to know if you B12 status is sufficient.

Hello, my name is Stelios Pantazis, I am a doctor specializing in Medical Nutrition and
in metabolic disorders and today I would like to talk about B12.
And in fact for the levels of B12 that are ideal for the blood and how we could examine that, as well,
after many questions I have received on the subject through the channel, but also from customers
coming to the my office. Before I get started I would like to ask you if you find the content
interesting to press the like button, share it with people who will find it interesting,
and use the comments to suggest topics for the next videos.
So let's get started on vitamin B12.
First of all, B12 is a vitamin that is relatively difficult to absorb. And why do I say that?
Because a factor needs to be produced in the right amount in the stomach, and its absorption
occurs at the end of small intestine, a place where several germs often develop
sometimes coming from the colon and this often leads to difficulties
in the absorption of B12. And that's why we can say that in people over 40, 1 in 4 do not
have adequate levels of B12 in their blood. Of course, the issue is also how the blood levels are determined.
And that's what we're going to talk about today.
But before I get started, let me say again that the test we use to measure B12 measures B12 in blood and
not in the cells, so you can't know if the B12 in the cells is sufficient only from measuring B12 in blood.
Measuring something in the blood is like seeing the streets of a city and trying to assess how many
cars exist in the city.
Such are the results we get from a blood test. You will not see how many cars are parked in the houses etc.
Considering these limitations, it's a bit difficult to draw
absolute lines and to say that this is okay, this is not okay.
What is certain, however, is that if someone has more than 350 vitamin B12 in their blood, they can
be quite sure that the levels in their cells are sufficient.
Also, those under 200 should be pretty sure there is a problem.
The B12 in their blood is low.
They have to make some decisions and take some measures.
There is a large part of the population that exists in the gray zone between 200-350.
Let's say there is someone with an answer between 200 and 350.
What can one do?
The simplest solution is to start taking dietary supplements with B12, the ones you will find
at the pharmacy, the simplest, the most economical and take 3 times a week.
He will notice anyway that the doses in the pills in relation to the
recommendations is up to 1000 times more, so most likely taking
a tablet 3 times a week, Monday-Wednesday-Friday, for a few weeks is enough to
notice significant increase.
If one does not see significant increase, one should look the reason.
And we'll get to that in a moment.
Another, more scientific approach, if you will, is to try to find out if a measurement in the
200-350 zone is enough for his body.
One may do the following: take folic acid for a few weeks, 3-4 or even 6,
and after this time to measure homocysteine.
Homocysteine ​​is a blood test that can be done when there is
lack of folic acid or B12. So, taking folic acid, we ensure that it is not deficient in
folic acid and then measure homocysteine. If we see that homocysteine ​​is low then it means that
B12 is not sufficient and must take B12 supplements.
Of course, anyone could ask me why do we have to do all these?
The good thing is that we will have an extra piece of information, homocysteine, which is important.
If the homocysteine ​​test is below 15, the labs consider it normal, although the truth
is that optimally it should be below 10.
That is, answers between 10-15, although they are acceptable, they certainly are not ideal.
After taking B12 dietary supplements we should examine if
B12 increases.
If it increases, it means that absorption is okay. If it doesn't, then one should definitely try to find
why B12 isn't increased.
In this case we refer to dietary supplements taken orally. Not injections.
In this case we are specific about oral intake of supplementation.
So someone gets B12 tablets, B12 doesn't go up, they have to go through an
investigation with the help of a doctor. The specialist that will help is a gastroenterologist because the 2 more
common causes of poor absorption of vitamin B12 well require gastroscopy.
These are atrophic gastritis and pernicious anemia.
The first is relatively common, the second is less common. Both can
be diagnosed with gastroscopy, so we have to start with this examination.
For the 3rd most common cause, which is inflammatory bowel disease, ie Crohn's disease and
ulcerative colitis and another intestinal condition called celiac disease, there is a little more difficult
to diagnose for inflammatory bowel disease, ie Crohn's disease and ulcerative colitis,
a colonoscopy is usually sufficient. But we have to be aware that lesions don't always apear in colonoscopy.