Source: Saint Louis University

Date: 2004-11-05

Usual Test For Vitamin Deficiency Can Mislead Doctors
ST. LOUIS -- A test that generally is used to measure the amount of vitamin B12 in the body is not sensitive enough to detect a deficiency of the vitamin, which has been linked to several neurological conditions, according to Saint Louis University research. The findings were presented this month at a meeting of the American Neurological Association.

"B12 deficiency is associated with dementia, peripheral neuropathy and spinal cord disease," says Florian Thomas, M.D., Ph.D., associate professor of neurology at Saint Louis University School of Medicine and a researcher on the project.

"While it occurs at any age, B12 deficiency is more common in the elderly, may affect some vegetarians and their newborns, can be provoked by laughing gas anesthesia and also by a unique form of recreational drug use. Importantly, it is very easy to treat by taking one pill per day for life. We need to do a better job of detecting the problem."

Thomas and his Saint Louis University colleagues, Laurence J. Kinsella, M.D., associate professor of neurology, and Jamie T. Haas, M.D., a neurology resident, found that the standard test for B12 deficiency -- measuring its blood level -- may be too insensitive.

The scientists found that of 34 patients who had normal levels of B12, 26 had elevated levels of methylmalonic acid (MMA), which indicated B12 deficiency.

They are urging doctors who suspect their patients lack the vitamin to also test for levels of MMA, a natural compound in the body that increases when B12 is lacking.

"The usual way of diagnosing B12 deficiency may be inadequate because it underestimates the frequency of the problem, which is present in up to 20 percent of the elderly," Thomas says. "The problem is eminently treatable at pennies a day."

Dr. Kinsella has had a longstanding interest in B12 deficiency and its relationship to nitrous oxide, a general anesthetic in common use in dental offices and hospital operating rooms. A B12 deficiency can be caused by nitrous oxide, also known as laughing gas, by inhibiting the action of B12 when tissue stores are low.

"This becomes a public health problem in the elderly undergoing surgery or dental work who may have undiagnosed and untreated B12 deficiencies. It also occurs among dental personnel and others who repeatedly abuse nitrous oxide for its euphoric effects," he says.

Rest of the article here: http://www.sciencedaily.com/releases/2004/10/041030213126.htm

This article doesn't mention the other important test which is the Homocysteine Blood test in conjunction with a B12 level.

I found this article in a thread on a LBD forum. I'm going to post the link to the thread. The woman that posted it gives interesting details of her own experience with B12 deficiency which I found interesting. I think it's also good that she can give a very clear picture of what happened to her, what she felt and experienced, as opposed to our LO's, who more often than not, can't really tell us what's happening with them.

Here's the link to the thread:
http://brain.hastypastry.net/forums/showthread.php?t=45492

Cathy

Hi' I have been doing ssome reading on this since my regular Doctor has retired and my new thinks my body is storing its b-12 shots and says my level is to hgh now....i never herd this before i have been getting the shot for about 6 to 7 yrs and go sometimes once a week till all of a sidden my doc now says sorrynomore for u .....i went insane i was sleepy and forgetful, i was irratable ect....i now see a diffrent doc who gives me the shot it helps with some fibromyaligapain and some arthritic pain...mostly it makes me wanna move....i have yet to figure why all my oher doctors say i have pernius anemiesa except this other one that says abnormal red cells and to high level of b-12 other symptoms of diffent are sore tounge and thirsty tummy thibgs ct...imsure u all know what would like to know has anypnne ever heard of to much lormarlin1@hotmail.com u can email me if yu want thankx...lori

Ces, this is a very interesting article, one I want to print.SnowLynne , my hubby takes B12 for the same type of anemia.Once a month.The first test given to my mother was for B12.Also Va tested my hudband when he came under the IN home care.

I have Pernisious Anemia & had it for years before It was dx.I have Neuropathy from It.I get the B 12 Inj monthly.

What I didn't say was that I have no Intrinsic factor in my stomach so my body does not make it's own B 12...........

This message has been edited. Last edited by: SnowyLynne,

hello i am 44 yr old mom of 3 and have been taking my injestions for b-12 for about 1 yr now, when i can help with them , not real regular to be honest. By the time i found out what was wrong i lost a good deal of feeling in my feet after all the neg M>S tests,It makes me sad to see myself falling apart i have some neuropathic problems already and 3 small children, my skin is more sensitive then it should be also, my memory is terrrible. I had surgery 3 weeks and i cant hold a thought to save my life, i was told it could be a combo of vicidan and going under and being behind on my shots( i cant stick myself yet)any body have any info that may help me i am kind of depressed about being a mess, and i wonder what will follow, i cant take the cold at all now either and the doctors call it fibromyasia,it seems to be more of my legs being weak and and achey after the long day, i just cant stand. Is anybody else like this? I am afraid,how am i going to be at 60 or 70? jody

Vitamin B12 Deficiency

Vitamin B12 (cobalamin) deficiency, whether related to nutritional or gastrointestinal disorders, remains an important cause of neurologic complaints. The deficiency may present with a variety of manifestations, including effects on any aspect of the nervous system. Unfortunately, vitamin B12 deficiency may present a diagnostic challenge in that serum cobalamin levels may be normal. Thus, the detection of elevated methylmalonic acid (MMA) may add sensitivity to the diagnosis.

Haas and collaborators[8] evaluated cobalamin and MMA levels in patients with a neurologic cobalamin deficiency syndrome. Both levels were measured in 37 patients before replacement treatment. In all, 34 patients (91.9%) had normal cobalamin levels (> 200) and 44.7% had levels > 300. Of the 34 patients with normal cobalamin levels, 26 (76.5%) had abnormal, elevated MMA (> 243 nmol/L). Another study by Rao and colleagues[9] showed that MMA was of especially high yield in patients with cobalamin levels below 300. These studies underscore the need to carefully consider the possibility of cobalamin deficiency and the sensitivity added by measuring MMA.

Medscape article

Ces, thank you for that bit of information.Very helpful , indeed

Getting the B12 level is good. But one of the main points of this article is that the level of B12, alone, just doesn't give you a real picture. The B12 level alone is relative, nonspecific, not really meaningful. It's getting a B12 level along WITH an MMA level, (methylmalonic Acid) and Homocysteine that gives a full picture. It's in conjuction with these 2 tests, that a B12 level becomes meaningful and gives a real picture of the situation. MMA and homocysteine are not included in regular chemistries. They need to be ordered specifically.

The very first test our doctor did on my mother was the B12 and her electrolytes.Did a urine test and tested for congestion.I am hearing more and more how the pet scan is being denied because of the cost.So we are denied answers because of cost affective testing.My mother would have benefited from this test.In life we never got the true answers because of cost and in death because of the cost of an autopsy

this site was so interesting ..now i know why my husbands b-12 was checked..thank u so much audrey

Ces, They keep a close check on my husband at the VA.T

Hi May,
Have hubby's B12 levels been checked since he's been on replacement? It can also be taken sublingual, that's a tablet under the tongue, quick dissolving.

Hi Lynne,
Have your thyroid functions and pernicious anemia been treated and followed up regularly?

Cathy

Ces, excellent site.

Ces , very good information.My husband gets a vitimin b 12 shot once a month.They said his low levels contributed to his anemis which contributed to dementia.Thanks to the nutse from the VA I was informed and they were concerned enough to start the shots.No one ever considered this before .

I was dx with hypothyroidism & Pernisioua Anemeia just prior to dx of Alzheimetr's........

Related, some news, some not so new

Research Ties Vitamin B12 And Folate Deficiencies With Alzheimer's Disease
http://www.sciencedaily.com/releases/2001/05/010508083559.htm

Moderately High Homocysteine Tied To Stroke, Alzheimer’s Risk
http://www.sciencedaily.com/releases/2002/10/021004064826.htm

Homocysteine: A Possible Risk Factor For Alzheimer's Disease
http://www.sciencedaily.com/releases/1998/05/980504125421.htm

Low Vitamin B12 Is Associated With Poorer Memory In Older People With High Risk For Alzheimer's
http://www.sciencedaily.com/releases/2004/04/040405085355.htm

Cathy