Which tests are correct?

[buriedinbooks]

Which tests should be requested to determine accurate B12, Vit D, Thyroid, and Coritsol levels? Want to make sure I request the right ones...so tired of hurting all the time:(

[rose]

You have been taking B12, correct? If you have been taking it and have a B12 serum test from before, a B12 serum test now should give you some idea where you are in relation to that. It does not tell what the level is in your tissues, but with previous testing and knowing whether you have taken it, how much and when, a pretty good guess can be made.

Please tell me what your situation is: not taken it; taken it; taking it currently; etc.

rose

[annelb]

According to this paper, there is no perfect test. Dr. Solomon writes that "High-done cobalamin therapy may improve neurologic function even in the abscence of cobalamin deficiency."
Anne

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16814909&query_hl=10&itool=pubmed_docsum


Blood Rev. 2006 Jun 29; [Epub ahead of print]Click here to read Links
Disorders of cobalamin (Vitamin B12) metabolism: Emerging concepts in pathophysiology, diagnosis and treatment.

* Solomon LR.

Section of Hematology, Department of Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520, United Kingdom.

Although cobalamin (vitamin B12) was isolated almost 60 years ago, its biochemical, physiologic and neurologic effects remain incompletely defined. New observations suggest renal regulation of cobalamin metabolism; actions of cobalamin on nucleic acid and protein function; and a role for cobalamin in cytokine and growth factor regulation. Clinically, no gold standard has emerged for the diagnosis of cobalamin deficiency. Moreover, cobalamin resistance may occur in diabetes, renal insufficiency and advanced age, leading to functional cobalamin deficiency despite adequate cobalamin nutriture. Finally, high-dose cobalamin therapy may have salutary pharmacologic effects on neurologic function in a variety of disorders. Many studies lacked appropriate control groups. However, at this time, therapeutic trials with pharmacologic doses of cobalamin are suggested when findings consistent with cobalamin deficiency are present regardless of the results of diagnostic tests. While oral cobalamin immediate-release is adequate for many patients, its effectiveness in reversing neurologic abnormalities has yet to be established.

PMID: 16814909 [PubMed - as supplied by publisher]

[rose]

That's right. There is so much more to learn. Proper testing is much better than the old, but unfortunately proper testing is not done by most doctors.

Some who know a lot more about B12 than most suggest to every patient with symptoms that they should take at least 1000 mcg B12 per day. And those who know of methylcobalamin suggest it.

Much has been learned since this was published, but oral B12 has been shown effective for neurological problems in many for many, many years. The people studied in this case apparently were not damaged as severely as some, so recovered quickly.

BTW Stabler SP; Lindenbaum J have concentrated on B12 for a long time, and have appeared in better medical textbook chapters, etc. for years.

Oral was first seen to be effective over 30 years ago. And, of course that, and the test below, was with cyanocobalamin. Methylcobalamin helps even more people.


Effective treatment of cobalamin deficiency with oral cobalamin.
Kuzminski AM - Blood - 1998 Aug 15; 92(4): 1191-8

From NIH/NLM MEDLINE, HealthSTAR


Publication Type:
Clinical Trial; Journal Article; Randomized Controlled Trial

Author Affiliation:
Division of General Internal Medicine, Bassett Healthcare, Cooperstown, NY, USA.
Authors:
Kuzminski AM; Del Giacco EJ; Allen RH; Stabler SP; Lindenbaum J

Abstract:

Because cobalamin deficiency is routinely treated with parenteral cobalamin [B12 shots], we investigated the efficacy of oral therapy. We randomly assigned 38 newly diagnosed cobalamin deficient patients to receive cyanocobalamin as either 1 mg intramuscularly on days 1, 3, 7, 10, 14, 21, 30, 60, and 90 or 2 mg orally on a daily basis for 120 days. Therapeutic effectiveness was evaluated by measuring hematologic and neurologic improvement and changes in serum levels of cobalamin (normal, 200 to 900 pg/mL) methylmalonic acid (normal, 73 to 271 nmol/L), and homocysteine (normal, 5.1 to 13.9 micromol/L).

...

Correction of hematologic and neurologic abnormalities was prompt and indistinguishable between the 2 groups.
...

The higher serum cobalamin and lower serum methylmalonic acid levels at 4 months posttreatment in the oral group versus the parenteral group were significant, with P < .0005 and P < .05, respectively. In cobalamin deficiency, 2 mg of cyanocobalamin administered orally on a daily basis was as effective as 1 mg administered intramuscularly on a monthly basis and may be superior.

[buriedinbooks]

Thank you for the information. I currently take 1000 mcg Methyl B and a B Complex daily.

[rose]

If you want tests to see whether you are being affected by the two most common causes of B12 malabsorption, antibodies to parietal cells and intrinsic factor are the thing. One or the other of those catch most cases, not 100%, but most.

Of course, there are other causes, but those are the common ones.

A B12 test result should be very high, having taken that dose for a substantial period of time, even if you malabsorb badly.

Regarding the vitamin D, put vitamin D and Dr. Mercola into a Google search and you will be walked through that information. One of his links will tell you the tests.

Best wishes,

rose