Got the bloodwork back on the B12

[Erin]

Well, the nurse just called me back from my doctor's office. Told me what my B12 and folic acid levels are.

B12 is 562 and the folic is 6.2.

The nurse was saying I didnt have to do B12 shots...I told her I still wanted them, seeing as how I've got MS and B12 helps nerves and I'd like to give my nerves a little boost.

Plus I found out something about my family's genes that could have something to do with the MS. I dont know if I have the particular gene that was mentioned, but just in case I want to do the B12. One of my other relatives started B12 shots last night, and because of whatever the genetic thing is, I'd kind of like to have the extra B12 in my system. I'm going to ask my doctor about the gene (once I figure out what it is)

It's really weird how just before I start taking B12, another relative starts doing the same shots. It's just a weird coincidence and makes me want to investigate it more.

[BBS1951]

Insist that she let you do the Urine MMA test, which is more sensitive than the blood B12 test.

[MS Bites]

Why the shots and not sublingual B12?

(especially until MMA is done)

[MomtoM]

I read that the sublingual is more effective too. Maybe you could try that, Erin. It is a lot cheaper. You don't have ins. right? Maybe it would ease the financial strain.
Deb

[Erin]

I have insurance. Just a HUGE deductible.

[elizabeth]

Oh, Erin - Go for the sublingual B-12. It's just as effective and MUCH cheaper than the shots, plus you don't have to get stuck. If your deductible is high, you might as well save the $$$, especialloy if you have not hit it by the end of the year. Here we are in NOVEMBER after all!

:) Elizabeth

[Matthew's Mom]

Oh, Erin - Go for the sublingual B-12. It's just as effective and MUCH cheaper than the shots, plus you don't have to get stuck.

Ditto !!!!!!!!!!!

Pam

[lady_express_44]

Everything I've read says that normal bodies normally require very little B12, and that it is easy to get this vitamin from natural sources, like, dairy, fish, meat and animal organs.

Apparently, the operation of vitamin b12 is also dependent on us having sufficient quantities of other vitamins in our bodies too . . . so we should really be trying to get a "balanced diet" to help avoid vitamin b12 deficiency.

If a person has a deficiency, why wouldn't we first try to change our overall diet to see if this makes a difference?

Erin, do you have a link to what is "normal" B12 levels? I couldn't find anything on the net that says whether "562" is high or low or otherwise.

Cherie

[Erin]

I know the normal range is between 200 and 900 for B12.

I dont eat the greatest foods in the world, and because of how my mom is (little brain damaged from a brain concussion in the mid-1950s) it's difficult to eat correctly. My mom always wants to go out to eat. If we try to stay home to eat she becomes very....difficult (the word I wanted to use started with a "B" and probably would get * (starred out) instead of showing up as the word)

If my dad or I try to put our foot down and say no, we're eating at home, we're on the wrong end of a temper tantrum. She had one friday. Tossed her walker and purse halfway across the room and then fell down and hurt her wrist. She's really been having a lot of tantrums lately.

So, when I do get to eat at home, I've been trying to eat the healthier foods rather than the junky stuff. I just think I need to help the vitamins along for a while right now. I've got prenatal vitamins to take, and I just basically want to give the B12 a little boost for a few months. I can afford some shots for awhile, and then I'll probably just take the prenatal vitamins on their own after that.

I dont mind needles that much anymore. I just dont look when someone wants to stab me with a needle, and I dont actually watch myself giving myself a shot. Nice thing about the autoject is that I dont have to look other than deciding where to shoot up.

[snack]

I don't have a link but my lab report mentions the same 200-900 range

[Matthew's Mom]

Erin,
Off topic of the B12.

Right now I am more concerned about your Mom. With the brain damage you mention and increased "tantrums" sounds like she needs a complete workup including a neuropsyche exam etc. Even if she's had one in the past with the increase in "tantrums" could be a medical issue going on that needs to be addressed.

And please don't take this wrong, but as you are an adult, you cannot blame your Mom for your eating habits. Of course as children we eat what is put on our plates (well maybe not spinach:) )

Pam

[Erin]

My dad keeps saying he's going to get her a psych exam, but he hasnt yet.

A couple of weeks ago, she was getting an epidural for her back pain at the pain clinic. The doctor screwed up and accidentally injected into the the area around the spinal cord instead of the spot he was supposed to inject. So, he injected her again where he was supposed to inject her.

About a minute or two later she was complaining of the worst headache of her life and her blood pressure spiked up to 241/99! My dad said the doctor got almost a whole syringe of the pain meds that were supposed to go into the epidural spot to injected into the area around the spine (subdural space?????)

Her BP was seriously high for about 45 minutes. My dad, who works at the same hospital came in, and we were watching her and the IV bag they hung. After awhile she was complaining she had to use the bathroom. (2 bags of lactated ringers will do that) and it was weird, after she went to the bathroom her blood pressure started to come down, and the headache went away.

It's been since then that she's been having the really bad tantrums. I'm wondering if something in her head popped during the high blood pressures and they just didnt notice it. She's totally unreasonable at times.

[mmcc53]

I read that the sublingual is more effective too. Maybe you could try that, Erin. It is a lot cheaper. You don't have ins. right? Maybe it would ease the financial strain.
Deb

I don't understand why people think the B12 shots are expensive. $9.99 (without insurance) covers several months worth of shots at doing them every 2 weeks. Can't get much cheaper than that! Syriges are so cheap they are almost free.

[lady_express_44]

I don't understand why people think the B12 shots are expensive. $9.99 (without insurance) covers several months worth of shots at doing them every 2 weeks. Can't get much cheaper than that! Syriges are so cheap they are almost free.

Wow, that's a great price!

Erin, my step-son (who lived with his mother) was 240lbs at 12 yrs old, but he was 6'3" tall too . . . so that didn't seem too bad. I insisted he have his cholesterol checked though, because of his unhealthy diet, and it was "dangerously high".

His mother cooked every night, but his diet was still very unhealthy. My ex often took him out for dinner (it was too far to bring him home to our house when he had him), and it was NO problem finding healthy foods to eat when they were out; salads, rice, vegetables, low fat meats, etc..

If your parents are doing fast food though, you can always just let them go out and you can stay home and cook for yourself. Healthy eating (especially when we have a disease such as this) seems to be important regardless of our b12 levels.

Cherie

[Erin]

My mom eats worse than I do. When I want to stay home, it's to make a good meal with a couple of green veggies and some meat of some sort with a little bread or something...and I want to try and get my mom to eat it.

She lives on store brand bakery cookies. She's got this weird obsession with cookies. She doesnt eat lunch, even if I offer to make it for her (but she'll ask me to take her to BK or McD's) I'm lucky if we can go to the Bagel Bin (wonderful local kosher bagel store that has good soups and sandwiches too...and no, I'm not jewish, but I LOVE Jewish food!! I wish they had hamentoshen cookies this time of year)

My grandmother had alzheimers, and I suspect that my aunt who was taking care of her was not feeding her very well. G-ma would come over to my other aunt's house (across the street from me) and she'd be disoriented and not very cooperative until my aunt would make her a good meal. As soon as my G-ma would eat the food, she'd be more alert and cooperative, and she'd know who we were. She had some diabetes and I think that my other aunt was not very good at keeping up G-ma's blood sugar.

About the same thing happens (not to the same extent) with my mother. If she's hungry, she starts getting mad, and the hungrier she gets, the worse she acts...but, she wont tell us she's hungry, and if we ask her what she wants, she says "nothing". If we're home, my dad just makes some food and hands it to my mom and usually she'll eat it. If we're out somewhere, we'll try to find a restaurant, but my mom will shoot down any suggestions we want to do.

I'm a bit scared of my mom, because we dont know when she'll go off on us. I guess she rapid cycles her moods...she can be giggling one minute and then saying "I wish I'd die" the next minute.

She's been this way (altho not that bad when I was younger) pretty much my entire life. My dad did a GREAT job of shielding me and my sister from my mom's screaming. I didnt realize she was nuts until I was a teenager. (not her fault that she's nuts, I blame the drunk jerk who crashed into her car when she was 17 and put her into a 5 week coma)

[mmcc53]

My mom eats worse than I do. When I want to stay home, it's to make a good meal with a couple of green veggies and some meat of some sort with a little bread or something...and I want to try and get my mom to eat it.
You are not likely to get your mother to change her eating habits at this point. Leave her alone and worry about feeding yourself, unless the eating habits are DIRECTLY causing a problem - like she has diabetes.

She lives on store brand bakery cookies. She's got this weird obsession with cookies. She doesnt eat lunch, even if I offer to make it for her (but she'll ask me to take her to BK or McD's)
While I think you should leave her alone, that doesn't mean you should enable her either. Just don't take her.

I'm lucky if we can go to the Bagel Bin (wonderful local kosher bagel store that has good soups and sandwiches too...and no, I'm not jewish, but I LOVE Jewish food!! I wish they had hamentoshen cookies this time of year) Then go! If your mother wants to come, take her, but if not, go alone and leave her at home.

My grandmother had alzheimers, and I suspect that my aunt who was taking care of her was not feeding her very well. G-ma would come over to my other aunt's house (across the street from me) and she'd be disoriented and not very cooperative until my aunt would make her a good meal. As soon as my G-ma would eat the food, she'd be more alert and cooperative, and she'd know who we were. She had some diabetes and I think that my other aunt was not very good at keeping up G-ma's blood sugar.

About the same thing happens (not to the same extent) with my mother. If she's hungry, she starts getting mad, and the hungrier she gets, the worse she acts...but, she wont tell us she's hungry, and if we ask her what she wants, she says "nothing". If we're home, my dad just makes some food and hands it to my mom and usually she'll eat it. If we're out somewhere, we'll try to find a restaurant, but my mom will shoot down any suggestions we want to do.
Has your mother been tested for diabetes or other blood sugar problems? Its a little unclear - is your mother physically disabled so that she can't feed herself, go shopping etc.? If so, then you and your dad have control over what she eats. If not, then, again, leave her alone and let her make her own food choices.

I'm a bit scared of my mom, because we dont know when she'll go off on us. I guess she rapid cycles her moods...she can be giggling one minute and then saying "I wish I'd die" the next minute. Are you physically afraid of her? If so, you need immediate help. If you mean you don't like her moods being inflicted on you, then either get her a mental evaluation or stop catering to them. If she is nasty, go away or go to your room and close the door. If you don't have a lock, then get one.

She's been this way (altho not that bad when I was younger) pretty much my entire life. My dad did a GREAT job of shielding me and my sister from my mom's screaming. I didnt realize she was nuts until I was a teenager. (not her fault that she's nuts, I blame the drunk jerk who crashed into her car when she was 17 and put her into a 5 week coma) That may be - but your father and she married, presumably afte she was 17, so if that was the cause of her problems, your father chose to marry her inspite of them.

I am assuming from everything you have posted that you are an adult. Time to be one. If she is crazy get her help. If your Dad won't do it, then either learn to deal with it, or move out of your parents' house.

This is no way to live. At a minimum, get yourself help if you can't help yourself.

[Cat Dancer]

All your kind words to Erin...I hope you all realize that Erin is not a child, but a woman of 38 years old. Probably old enough to live on her own.

[Matthew's Mom]

Erin,
You have alot going on, not only with your health but your Mom's.

Maybe pick up the phone tommorrow and let your Mom's doctor know whats going on. That way he will know what might be causing her behavior issues, and he can order the appropriate testing. Why your Dad hasn't don't so....? And your Dad being a nurse........?

From your description of your Mom it sounds like she could possibly be bipolar?

Could be she just needs the right medication to control mood swings.

Really think she needs a good workup, blood tests for diabetes, tyhroid etc.

Is your Mom seeing a psychologist? When someone says "I wish I'd die" it should never be taken lightly. This is serious, you have to get some help for her.

As you know stress is never good with MS.

By helping your Mom you will be helping yourself.

I will be praying for the both of you.

Pam

[jcc]

Erin, I'm happy to hear you plan to increase your B12, whether by shots or oral methods. I would aim to keep a B12 level in the upper 25% of range, especially for anyone with neurological issues. And, as has been mentioned by others, the MMA is a more sensitive test.

Most problems with low B12 levels has nothing to do with dietary intake. While true that strict vegetarians may have a dietary lack of B12, this is not commonly the problem. The most common cause of B12 deficiency is pernicious anemia, an autoimmune disease where one lacks intrinsic factor needed to process B12. Other metabolic problems can be at fault. Other common causes are malabsorptive issues (celiac disease, gluten sensitivity, Crohn's, etc...), or medications usage like acid blockers; metformin and others. Increased dietary intake will not help in most of these cases, although in celiac disease, once the gut is healed, nutritional deficiency may self correct.

I am all for a well balanced whole foods diet, though! That should always come first, but unfortunately, it isn't always enough to do the trick. Erin, having another family member who requires B12 shots is a good reason to be sure you are getting the B12. It does run in families.

I skimmed this thread very quickly, but saw mention of Alzheimers. I have some info collected on B12 deficiency and Cognitive Decline/ Alzheimers... so thought I'd drop it in!

Vitamin B12 deficiency can cause a dementia that is similiar to Alzheimer's Disease.


High-dose vitamin B12 for at-home prevention and reversal of Alzheimer's disease and other diseases (http://findarticles.com/p/articles/mi_m0ISW/is_274/ai_n16359687) - Townsend Letter May 2006

Familial Alzheimer's disease and vitamin B12 deficiency (http://findarticles.com/p/articles/mi_m2459/is_n4_v23/ai_15657868/pg_1) - Age and Ageing July 1994


Vitamin B12: Suprising New Findings (http://www.lef.org/magazine/mag2000/dec2000_report_b12_1.html)- LE Magazine Dec 2000
Quote:
B12-deficiency can cause a dementia that looks exactly like Alzheimer’s disease. And Alzheimer’s disease itself is characterized by brain deficiencies of both vitamin B12 and the methylating factor, S-adenosylmethionine (SAMe). A new study from Germany correlates B12 deficiency in Alzheimer’s patients with two personality changes—irritability and disturbed behavior.

Relation of Higher Folate Intake to Lower Risk of Alzheimer Disease in the Elderly
http://archneur.ama-assn.org/cgi/con...stract/64/1/86 (http://archneur.ama-assn.org/cgi/content/abstract/64/1/86)


Nutrtional Healing on Dementia/Alzheimers:
http://www.nutritional-healing.com.a...FAlzheimer%27s (http://www.nutritional-healing.com.au/content/condition.php?condition=Dementia%2FAlzheimer%27s)


PubMed abstracts:

It was possible to detect, both in patients with MCI (1.5% and in patients with dementia (3.5%, a non-significant difference), abnormal metabolic values, indicating poorly controlled diabetes, renal failure, hyponatremia, folate or vitamin B12 deficiency and hyperthyroidism, which correction led to clinical improvement. The majority (62.5% of these alterations were previously unknown.
Journal of Alzheimer's Disease
The use of laboratory tests in patients with Mild Cognitive Impairment. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16988482&query_hl=4&itool=pubmed_docsum) PMID: 16988482 Nov 2006

Depending on the biochemical criterion that is used, 5% to more than 20% of older adults have marginal or frank vitamin B12 deficiency.
What is an adequate dose of oral vitamin B12 in older people with poor vitamin B12 status? (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16958314&query_hl=4&itool=pubmed_docsum)
PMID: 16958314 Aug 2006

Clinical relevance of low serum vitamin B12 concentrations in older people: the Banbury B12 study. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16709605&query_hl=8&itool=pubmed_docsum) PMID: 16709605 July 2006

These findings suggest that cobalamin deficiency may cause a reversible dementia in elderly patients. This dementia may be differentiated from that of Alzheimer's disease by a thorough neuropsychological evaluation.
Neuropsychology of vitamin B12 deficiency in elderly dementia patients and control subjects. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15681626&query_hl=1&itool=pubmed_docsum) PMID: 15681626 March 2005

Depression, B12 deficiency, and hypothyroidism should be screened for and treated in patients with dementia.
A synopsis of the practice parameters on dementia from the american academy of neurology on the diagnosis of dementia. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16553467&query_hl=1&itool=pubmed_docsum) PMID: 16553467 Jan 2004

Cara

[lady_express_44]

The most common cause of B12 deficiency is pernicious anemia, an autoimmune disease where one lacks intrinsic factor needed to process B12. Other metabolic problems can be at fault. Other common causes are malabsorptive issues (celiac disease, gluten sensitivity, Crohn's, etc...), or medications usage like acid blockers; metformin and others. Increased dietary intake will not help in most of these cases, although in celiac disease, once the gut is healed, nutritional deficiency may self correct.


Thanks for that all of that information on B12, Cara. Over the years there have been a number of people who've visited the forum that were ultimately dx with a B12 deficiency. I guess the symptoms can be very similar to ours, especially for those with a severe lack of this vitamin.

Erin has MS though, so I would suggest that this "normal range" result is probably the proof she needs to put her mind at ease that they've at least dx her with the correct disease. :)

As well, Erin's test showed that she DOESN'T have a B12 deficiency, and there is currently no indication that there is underlying problem effecting her ability to process B12 adequately. In fact, she is on the high end of the normal range even WITHOUT maintaining a decent diet . . . so I would still suggest that all she needs is to add a few more of those foods into her diet (if the goal was to get her into the upper 25% range).

Even though this is a cheap vitamin (by itself), it is also recommended that folic acid is added at the same time. I'm not sure if that will increase the price too (or if it is included with the shots), but IMHO, ANY additional money spent treating this disease should be scrutinized. This is ESPECIALLY true if we do not have an income, or we are financially dependant on family members to pay for our health care.

Cherie

[mmcc53]

...The most common cause of B12 deficiency is pernicious anemia, an autoimmune disease where one lacks intrinsic factor needed to process B12...

I assumed I probably had pernicious anemia when I found out I had a B12 deficiency because my grandmother had it. In fact a blood test can determine that. I did not and was told that while B12 defficiency is common in those with automimmune disease, that pernicious anemia is NOT the main cause.

...Erin has MS though, so I would suggest that this "normal range" result is probably the proof she needs to put her mind at ease that they've at least dx her with the correct disease. :)

As well, Erin's test showed that she DOESN'T have a B12 deficiency, and there is currently no indication that there is underlying problem effecting her ability to process B12 adequately. In fact, she is on the high end of the normal range even WITHOUT maintaining a decent diet
Cherie

I agree with Cherie: the range is in the higher end of normal and is not likely to be causing your problems. My doc said he prefers to have it comfortably above the midline of normal in patients who have shown a defficiency, but if it is already there, why do anything?

More of something that is fine and neccessary is not always a good thing. If you start Vitamin supplements, then be sure you are not shortchanging other vitamins, and be sure to take folic acid. It sounds more like a reasonable diet and maybe a multi-vitamin would be sensible.

There are pleny of other vitamins, minerals, etc. which need to be maintained and sometimes increased which can specifically help with MS-type symtoms:

Calcium, potassium (don't buy supplements - eat bananas, celery, OJ), magnesium, and selenium (overdosing can be poisonous) are great for cramps/spasticity.

Avoid zinc unless sick with a cold - it boosts the immune system which is not good for MSers.

Vitamin D as has been pointed out repeatedly should be taken, and every relative of someone with MS or another autoimmune disease should be taking it too, as part of a multi-vitamin (more effective than just alone). Centrum silver apparently contains the correct dose.

There was a major study showing that those who took multi-vitamins with vitamin D had a much lower rate of developing MS - a HUGE difference from those who didn't. Since there is a genetic component to MS and other autoimmune diseases be SURE that every single child related to you is taking the vitamins religiously. Best thing you'll ever do for them - cut their chances of following in your footsteps.

[Matthew's Mom]

Vitamin D as has been pointed out repeatedly should be taken, and every relative of someone with MS or another autoimmune disease should be taking it too, as part of a multi-vitamin (more effective than just alone). Centrum silver apparently contains the correct dose.


Thanks for this important info, was wondering what vitamin to tell my kids to get.

Pam

[Erin]

Erin has MS though, so I would suggest that this "normal range" result is probably the proof she needs to put her mind at ease that they've at least dx her with the correct disease. :)



I'm still in a bit of denial about the MS. I'm fairly sure that I have it, which is why I make a good effort at remembering to take the C shot every day, but I still have enough lingering doubt that it's something else that I want to investigate other things for a little while longer. So, no...my mind isnt quite at ease yet.

And for the people who asked if I was adding other vitamins (folic acid) while taking B12. Yes. I'm taking a prenatal vitamin that the doctor suggested. I want to try the B12 to see if any of the neurological problems will get better, but I'm getting the shots and taking the prenatals to try to help my body get healthy enough to have a kid someday.

I'm not planning on a kid all that soon, but I'm thinking that the earlier I get into the habit of taking the vitamins and trying to get the body healthy enough for making babies, the better it'll be. I'm just hoping that the B12 (and any of the other vitamins) will help the neurological symptoms too.

[jcc]

There really are many many causes for B12 deficiency. I think my doctor was presumptious about deciding what caused my B12 deficiency. Because I have autoimmune thryoid disease, she presumed it was pernicious anemia. I requested follow up blood tests (anti-intrinsic factor; anti-parietal cell) which were both negative, although they say they are negative in up to 25% of those with PA. I had a GI who ordered the Schilling test, but the lab came back saying they no longer used it (year 1999). To be honest, I have no conclusive explanation for why my B12 was low. My PCP said, "some people just are". I guess she's right. I think achlorydia is as good of a guess as any. I knew someone who had a tapeworm that was found to cause the B12 deficiency :eek:.

My guess is as more and more other causes of B12 deficiency are recognzied (medications, celiac disease, etc).... the percentage thought to be caused by Pernicious Anemia will come down. And, most doctors don't give a hoot WHY, they just simply treat it. I think it is good to know why, but it would be cost prohibitive to actually test for all of these possiblities.



http://www.emedicine.com/neuro/topic439.htm
Causes: Inadequate vitamin B-12 absorption is the major pathomechanism and may result from several factors.
Intrinsic factor deficiency

PA accounts for 75% of cases of vitamin B-12 deficiency. It is an autoimmune attack on gastric IF. Antibodies are present in 70% of patients. They may block the formation of the cobalamin-IF complex or block its binding with cublin. Other antibodies are directed at parietal cell hydrogen-potassium adenosine triphosphatase (ATPase).

Juvenile PA results from inability to secrete IF. Secretion of hydrogen ions and the gastric mucosa are normal. Transmittance is autosomal recessive inheritance of abnormal GIF on chromosome arm 11q13.

Destruction of gastric mucosa can occur from gastrectomy or Helicobacter pylori infection. A Turkish study found endoscopic evidence of H pylori infection in more than 50% of vitamin B-12–deficient patients. Antibiotics alone eradicated H pylori in 31 patients, with resolution of vitamin B-12 deficiency.
Deficient vitamin B-12 intake: Intake may be inadequate because of strict vegetarianism (rare), breastfeeding of infants by vegan mothers, alcoholism, or following dietary fads.
Disorders of terminal ileum: Tropical sprue, celiac disease, enteritis, exudative enteropathy, intestinal resection, Whipple disease, ileal tuberculosis, and cublin gene mutation on chromosome arm 10p12.1 in the region designated MGA 1, which affects binding of the cobalamin-IF complex to intestinal mucosa (Imerslünd-Grasbeck syndrome), are disorders that affect the terminal ileum.
Competition for cobalamin: Competition for cobalamin may occur in blind loop syndrome or with fish tapeworm (Diphyllobothrium latum).
Abnormalities related to protein digestion related to achlorhydria: Abnormalities include atrophic gastritis, pancreatic deficiency, proton pump inhibitor use, and Zollinger-Ellison syndrome, in which the acidic pH of the distal small intestine does not allow the cobalamin-IF complex to bind with cublin.
Medications: Medications include colchicine, neomycin, and p-aminosalicylic acid.
Transport protein abnormality: Abnormalities include transcobalamin II deficiency (autosomal recessive inheritance of an abnormal TCN2 gene on chromosome arm 22q11.2-qter resulting in failure to absorb and transport cobalamin) and deficiency of R-binder cobalamin enzyme.
Disorders of intracellular cobalamin metabolism: These disorders result in methylmalonic aciduria and homocystinuria in infants.

Isolated methylmalonic aciduria
Cbl A is due to deficiency of mitochondrial cobalamin reductase resulting in deficiency of adenosylcobalamin.
Cbl B is due to deficiency of adenosylcobalamin transferase resulting in deficiency of adenosylcobalamin.

Methylmalonic aciduria and homocystinuria
Cbl C is a combined deficiency of methylmalonyl CoA mutase and homocysteine:methyltetrahydrofolate methyltransferase. Patients have prominent neurologic features and megaloblastic anemia.
Cbl D is a deficiency of cobalamin reductase. Patients have prominent neurologic features.
Cbl F is a defect in lysosomal release of cobalamin.

Isolated homocystinuria
Cbl E is due to a defect in methionine synthase reductase located on chromosome arm 5p15.3-p15.2.
Cbl G is due to a defect in methyltetrahydrofolate homocysteine methyltransferase located on chromosome arm 1q43.
Increased vitamin B-12 requirement: Requirement is increased in hyperthyroidism and alpha thalassemia.
Other causes

In AIDS, vitamin B-12 deficiency is not infrequent. Although the exact etiology remains obscure, it is likely a multimodal process involving poor nutrition, chronic diarrhea, ileal dysfunction, and exudative enteropathy. Low vitamin B-12 levels may be more common in late than in early HIV disease.

NO exposure can occur iatrogenically (ie, anesthesia) or through abuse ("whippets").

[jcc]

This mentions a few additional causes that aren't in the first.


http://www.emedicine.com/med/topic1799.htm#target3

Causes: An increased incidence of pernicious anemia in families suggests a hereditary component to the disease. Patients with pernicious anemia have an increased incidence of autoimmune disorders and thyroid disease, suggesting that an immunological component to the disease exists. Children who develop Cbl deficiency usually have a hereditary disorder, and the etiology of their Cbl deficiency is different from the etiology observed in classic pernicious anemia.
Congenital pernicious anemia is a hereditary disorder in which an absence of IF occurs without gastric atrophy. Other gastric disorders that cause Cbl deficiency are gastrectomy, gastric stapling, and bypass procedures for obesity and extensive infiltrative disease of the gastric mucosa. Usually, these disorders are associated with a decreased ability to mobilize Cbl from food rather than a malabsorption of Cbl. Thus, a patient with these disorders may exhibit a normal finding on Schilling test (stage I).
Pancreatic insufficiency can produce Cbl deficiency. Nonspecific R binders chelate Cbl in the stomach, making it unavailable for binding to IF. Pancreatic proteases degrade the R binders and release the Cbl so that it can bind IF. The Cbl-IF complex is formed so that it can bind ileal receptors that enable uptake by absorptive cells. Thus, patients with chronic pancreatitis may have impaired absorption of Cbl.
Cbl deficiency is reported in the Zollinger-Ellison syndrome. The mechanism is believed to be due to the acidic pH of the distal small intestine such that the Cbl-IF complex cannot effectively bind the ileal receptors.
Disorders of the ileum cause Cbl deficiency due to loss of the ileal receptors for the Cbl-IF complex. Thus, surgical loss of the ileum or diseases such as tropical sprue, regional enteritis, ulcerative colitis, and ileal lymphoma interfere with Cbl absorption.
Genetic defects of the ileal receptors for IF (ie, Imerslünd-Grasbeck syndrome) and hereditary transcobalamin I (TC I) deficiency produce Cbl deficiency from birth and are usually discovered early in life.
Many drugs impair Cbl uptake in the ileum but rarely are a cause of symptomatic vitamin B-12 deficiency because they are not taken long enough to deplete body stores of Cbl (eg, nitrous oxide, cholestyramine, para-aminosalicylic acid, neomycin, metformin, phenformin, colchicine).
The clinical manifestations of inherited defects of Cbl transport and metabolism are usually observed in infancy and childhood. Thus, they are discussed only briefly in this article.
Three hereditary disorders affect absorption and transport of Cbl, and another 7 alter cellular use and coenzyme production (see Image 2 (http://www.emedicine.com/med/topic1799.htm#target2)).

The 3 disorders of absorption and transport are TC II deficiency and deficiencies of either IF or IF receptors. These defects produce developmental delay and a megaloblastic anemia, which can be alleviated with pharmacological doses of Cbl. Serum Cbl values are decreased in the IF abnormalities but may be within the reference range in TC II deficiency.

The abnormalities of cellular use can be detected by the presence or absence of methylmalonic aciduria and homocystinuria. The presence of only methylmalonic aciduria indicates a block in conversion of methylmalonic CoA to succinyl CoA and results in either a genetic deficit in the methylmalonyl CoA mutase that catalyzes the reaction or a defect in synthesis of its CoA Cbl (Cbl A and Cbl B).

The presence of only homocystinuria results either from poor binding of Cbl to methionine synthase (Cbl E) or from producing methylcobalamin from Cbl and S adenosylmethionine (Cbl G). This results in a reduction in methionine synthesis, with pronounced homocystinemia and homocystinuria.

Methylmalonic aciduria and homocystinuria occur when the metabolic defect impairs reduction of Cbl III to Cbl II (Cbl C, Cbl D, Cbl F). This reaction is essential for formation of both methylmalonic acid and homocystinuria.

Early detection of these rare disorders is important because most patients respond favorably to large doses of Cbl. However, some of these disorders are less responsive than others, and delayed diagnosis and treatment are less efficacious.
Abnormalities in the intestinal lumen may produce Cbl deficiency. Individuals with blind intestinal loops, stricture, and large diverticula may develop bacterial overgrowth, which sequesters dietary Cbl for their metabolic needs. Tapeworm infestation with Diphyllobothrium latum occurs from eating poorly cooked lake fish that are infected and causes Cbl deficiency because the parasites have a high requirement for Cbl.

[mmcc53]

jcc,

I expect some of the answer is that lots of people wit autoimmune disease do not have just a crystal clear "one." The doc told me that B12 defficiency is much more common in people with autoimmune diseases.

I am betting that eventually it will turn out to all be related. Pernicious anemia would be the logical answer for me - 1 of every 3 adults descended from my paternal grandmother (who had pernicious anemia) has one or more autoimmune disease. That's a pretty damning case of genetic problems, and many of the people have more than one disease. I think at last count there are 9 different autoimmune diseases (some are repeaters - 3 have MS, etc.)

My daugher has some sort of "whole body autoimmune disease which apparently cannot be characterized as one or more specifically in spite of an incredible number of tests and time in hospitals. It is appears to be some combination of vasculitis, MS, Chrohn's and ulcerative colitis.

I guess what I am saying is that while "pernicious anemia" may not be exactly why we MSers have a high rate of B-12 defficiency, but those nasty little T-cells that attack us are probably not as specifically directed at only one target in the body.

[Ted Hutchinson]

IVitamin D as has been pointed out repeatedly should be taken, and every relative of someone with MS or another autoimmune disease should be taking it too, as part of a multi-vitamin (more effective than just alone). Centrum silver apparently contains the correct dose.

There was a major study showing that those who took multi-vitamins with vitamin D had a much lower rate of developing MS - a HUGE difference from those who didn't. Since there is a genetic component to MS and other autoimmune diseases be SURE that every single child related to you is taking the vitamins religiously. Best thing you'll ever do for them - cut their chances of following in your footsteps.This does not appear to me to be correct.
Centrum silver ingredients are listed here (http://www.drugstore.com/qxp72901_333181_sespider/centrum_silver/multivitamin_and_mineral_for_adults_50_tablets.htm ) and from this you can see they contain only 400 IU Vitamin D this is 100% the official RDA but we know from The urgent need to recommend an intake of vitamin D that is effective (http://www.ajcn.org/cgi/content/full/85/3/649) there isn't a vitamin d expert in the world who thinks that is an adequate amount. An adult requires 4000iu/daily just to meet their daily needs and in winter you simply cannot achieve that from food sources or multimineral/vitamin tablets.

What is worse is that if you scroll down the Centrum Silver ingredients list you will see they use Ergocalciferol (Vit. D), The case against ergocalciferol (vitamin D2) as a vitamin supplement (http://www.ajcn.org/cgi/content/full/84/4/694) shows us in detail why D2 should NEVER be used. It is not reliable, many people do not utilise it at all, and it is not as effective having only at best a third of the impact of Cholecalciferol D3.

Similarly the B12 experts here will be able to tell you why Centrum Silvers Cyanocobalamin (Vit. B12) should not be relied on. You can get RELIABLE information about the vitamins/supplements that have a scientific basis for their use in MS from DirectMS.org (http://www.direct-ms.org/supplements.html) for children 50% of those suggested levels would be fine. But there is no point in taking supplements in forms the body does not utilise well. Therefore you must check that Vitamin D is Cholecalciferol D3 and the only form of B12 that is worth taking is MethylCobalamin with both these supplements the safety margin, that is the amount over the current RDA and the levels known to cause adverse events is so huge that you really do not have to worry about it.

40,000iu/daily of D3 is needed for MANY MONTHS before adverse events have been recorded. 4000iu/d is only a tenth of that amount and less than half the 10,000iu/d that is proposed as the safe upper limit. 400iu/d will raise status only by 9nmol/l or 3.6ng/mL as most people have a winter status of 40nmol/l raising that by 9nmol/l is trivial when the minimum level to be aimed for is 80nmol/l to maximise calcium uptake and reduce colon cancer incidence 72%. People taking only the RDA of Vitamin D remain vitamin d deficient. Mothers taking prenatal vitamins that include vitamin d remain vitamin d deficient and give birth to vitamin d deficient babies and their breast milk does NOT contain any vitamin d.