I’ve been reading the posts about vitamin b12 and restenosis. I’m looking for good recent research but can’t find any. Anyone got a link?

[Ewloe]

I’m on b12 injections. I’ve been on a PPI long term which can reduce your absorption of b12. I have 1 stent now and so far have continued with the injections. I’ve seen a 2004 report and read it’s controversial. This report didn’t look at b12 supplements alone. Any suggestions about where to get some research please. As I gather it’s controversial among cardiologists even.

[gilreid1]

If you cardiologist or GP prescribed treatment then subsequent test would have shown any problems and they would change accordingly?What further reports do you require. No one else has you case notes

[Milkfairy Heart Star]

I suggest you discuss your concerns with your Cardiologist or GP.

Vitamin B12 is very important in maintaining health.

nhs.uk/conditions/vitamin-b...

[nellie237]

That's an interesting question Ewloe. I also tried to do some research on BVits and heart issues last year, (ie low levels = high homocysteine) but I was more interested in Folate (which I'd discovered had been low for years), and I didn't get very far either. WebMD have a Norwegian study article in 2008, which basically states that if you have cardiovascular problems then BVits don't improve outcomes, and another in 2010 from Japan which recommends increasing intake of BVit rich foods.

I have not seen/read any warnings re B12 supplementation, although there are for high levels of folate or B6.

webmd.com/heart-disease/new....

webmd.com/heart-disease/new...

I had a coeliac dx last year, and is often the case low/deficient on Iron, Folate, B12 & Vit D. My experience was that GP's are reluctant to test (I did some reading on coeliac, and had to ask for these tests 2 months after dx), and sometimes reluctant to prescribe eg My Vit D result was 22 nmol/L, which NICE recommend should be treated with loading doses........yet, I had to speak to the Surgery 3 times to obtain a prescription. During the 1st call I was advised 'normal', the 2nd to take 1,000iu per day (which I went away and found was a 'maintenance' dose, the 3rd conversation was me advising the GP that NICE recommends 20,000iu X 2 per wk for 7 wks.

Also on PPI's for years. Are you aware that NICE recommends testing Magnesium if on PPI's. I'd never had mine tested in the 13 yrs I was taking them.

"Monitoring of patient parameters

Measurement of serum-magnesium concentrations should be considered before and during prolonged treatment with a proton pump inhibitor, especially when used with other drugs that cause hypomagnesaemia or with digoxin."

bnf.nice.org.uk/drug/lansop...

Last year I also got online access to my blood results. What an eye opener that was.

NB I had a HA & stent in 2012.

[MountainGoat52 in reply to nellie237]

From my blood test results I can see clearly what happened when I had my heart attack and so started on medication. I can also see the result of the statin I take and also how vitamin B controls my homocysteine level, though I have to request the test for homocysteine as my GP practice does not really acknowledge the relevance of homocysteine in respect of coronary artery disease.

My latest blood test was recorded with the phrase "abnormal, but expected". It prompted me to write to the GP and I will be speaking to the practice about this today. Without access to test results, I would be oblivious of this apparent abnormality.

[Phil_London in reply to MountainGoat52]

I have been monitoring the comments over the last few days with interest as I had NSTEMI and one stent fitted in May 2019 and have tried to follow all guide lines on changed life style and food intake, I have as part of all these changes been taking for the last 6 months multi vits, only due to a couple of minor points in my blood tests where levels were slightly out but considered acceptable. Part of the Multivits are B1, B6 and B12, I had never been advised or asked to avoid vitamin supplements and I do drive my cardiologist mad I am sure with minor questions on so many health questions and queries, this being the next one!! I have read reports in favour of and against, some reports are very old and some are more about bare metal stents, where I have DES. I have read only one dated this year asking for more trails and puts questions around your individual starting point on blood tests, but overall says maybe avoid, but it's very difficult as a non medical expert to understand all pros and cons. I can find that one and share it.

[nellie237 in reply to Phil_London]

Hi Phil,

I am no expert, but I know that you have to be careful with B6, and some multi-vits may have more than recommended.

"Do not take more than 10mg of vitamin B6 a day in supplements unless advised to by a doctor"

nhs.uk/conditions/vitamins-...

Also calcium supplements are not generally advised for heart patients.....there is quite a lot of good info about this out there.

[MountainGoat52 in reply to Phil_London]

Well, I'm rather amazed at how some of the studies relating the efficacy of Vitamin B are deemed to prove anything. Some are based on other studies so are secondhand information and just the manipulation of data. Others appear to be valid in that they use placebos as something to set a baseline against as part of the study, yet there is usually no control of diet for those participating, no method of evaluating previous health issues, etc. I suspect many are little more than 'jobs for the boys'.

I am happy that the pathologist at the local hospital established homocysteine as a likely factor contributing to my heart attack. Evidently it was not the only factor. The recommendation was to take Vitamin B which I have done since 2019. No mention has ever been made about the possibility of it affecting my stents.

My homocysteine level has dropped from 14.5 to around 12 sInce I took Vitamin B. As this is at the top of the normal range, I would naturally prefer it to be lower. I was not tested this year, so I don't know whether the level is being maintained. However, today I was advised that I could not have further tests as I was taking the Vitamin B supplement.... now what sort of logic I that?

[nellie237 in reply to MountainGoat52]

Hi GWP,

"I have to request the test for homocysteine as my GP practice does not really acknowledge the relevance of homocysteine in respect of coronary artery disease." Wow, I'm very impressed that you manage to get your GP to test this. I expect that most GP's don't acknowledge it because unless anaemic they are not permitted to prescribe BVits...........plus, if they advise that you should take B12/Folate then they've really got to monitor it. I told my GP that I was going to start taking a B Complex, and the response was "That's a good idea", but he would never have suggested it.

With regard to B12/Folate/Vit D/Iron, the NHS policy is only prescribe if deficient/anaemic, then re-test in xx weeks, and send patient on their way, until said patient comes back feeling like death warmed up again.........rinse repeat. I'm sure this policy must have implications for all sorts of health problems aside from raised homocysteine as we've been discussing.

I haven't asked for homocysteine testing because I doubt my GP is allowed to request it........and those that get blood drawn at GP Surgeries will be immediately excluded because it has to go straight into the path lab. Maybe I will ask.

I'm so sorry your result was abnormal. Please let me know how you get on. x

[MountainGoat52 in reply to nellie237]

Well, the abnormality turned out to be in my higher tha normal creatinine level resulting from a fall that damaged my kidney in 2010. The level is stable, so my GP is not worried.

With regards to homocysteine testing, I requested it last year and the blood test was done at the local hospital. This year I requested it to ensure that the level was not rising and although the blood test was done at the hospital, my homocysteine was not tested. Today the GP advised me that I could not have the test as I am taking Vitamin B..... yes, but I need to know whether the reduction is being maintained. I suspect that it is all down to the cost. So what do I do.... increase the dose I take to ensure the level is kept down?

[nellie237 in reply to MountainGoat52]

Gosh, that must have been a very nasty fall.

I believe that it is quite an expensive test. The cheapest private test I've seen is Medichecks at about £150, and only in London. I go to my local hospital for all my blood tests and where they have a path lab, but I doubt they have the ability/kit to run this test.

I had AKI (acute kidney injury due to bp meds) a couple of months after the coeliac dx. My eGFR dropped from 85 to 29 in about 10 days. You can imagine I was a bit concerned about homocysteine levels, what with the already deficient B12/Folate...it must have been sky high. The AKI leeched my iron & RBC's too. At this point neither I, nor my GP had any idea whether my kidneys would recover or not, and I asked him to test erythropoietin (produced in the kidneys, prompts bone marrow to produce red blood cells).. his response was "That's synthetic....cyclists use it to enhance performance". When I corrected him..........he couldn't access a request for it anyway. I'm guessing you can only get it tested at a renal unit.

I think in your shoes I'd keep taking the BVits, regularly monitor B12 & Folate levels, and keep a very close eye on your kidneys.

[MountainGoat52 in reply to nellie237]

Yes indeed, that's my thinking.... keep on taking the pills! I'm not too worried about the stent issue as I've had a bypass around the stents and the clinicians that reviewed my medication at the time of my op said to keep taking the vit B. The only question is how much?... the ones I'm taking have 200 micrograms of folic acid which has brought my homocysteine down from 14.5 to 12, but that's still at the very top of the normal range and last year it had risen to 12.4, hence why I wanted a test this year to see if it was still on the rise. By the way, they don't normally test my folate and B12 levels, so I'm in the dark about those figures as well. A private test might be my only option.

With regards to my kidney, it was a freak accident. I fell over an exercise bike that was awaiting repair in the garage and I fell onto the concrete floor, twisting myself to avoid something that was being stored in the garage. An ultrasound revealed that I had a swollen kidney, but no blockage. The damage is permanent. My eGFR is stable around 50 and creatinine level of 126.... hence "abnormal, but expected".

I'm sorry to hear of all that you have gone through with your health. These things aren't easy to deal with, but I find being pro-active helps.

[nellie237 in reply to MountainGoat52]

I'd try and get the GP to test folate if you can, and whilst at it B12 & Iron too. I'm hypothyroid, and lots on the thyroid forum get basic vits/iron etc., tested with postal finger prick tests at accredited labs............but if something fails its usually the folate. Some order the postal kit, and arrange a local blood draw, either NHS/private which adds about £30 to the cost.

Worth bearing in mind............ I've had to have quite a few NHS blood tests over the past year, and if I've wanted to test something else using a postal kit, I've asked the phlebotomist to draw a bit more blood for it. They haven't minded at all. I take them chocolates, because I am very grateful for their help.

I take 400mcg in my B Complex, but I only take one every other day. I don't know if I'm taking enough......yet. I had to have a break from taking them for a few months because I was having some gut problems, but I'm back on the case, and due for testing in August.

I'm so sorry that your kidney damage is permanent. My last eGFR was up to 77, so I think I was very lucky. By-pass surgery is particularly scary. I remember calmly waiting outside the cath-lab for the stent, the Consultant came out to see me, and explained that if he couldn't place the stent, I would need a by-pass, at which point I replied "OK, now I'm going to ask for that sedation that was offered." 😅

Being pro-active definitely helps.

[MountainGoat52 in reply to nellie237]

My visit to the cath lab was rather bizarre. I was blue-lighted to the hospital and wheeled straight in. I'm not sure why, but I was asked whether I could get myself off the trolley onto the table... a quick shuffle and I moved over. Bearing in mind I was having a heart attack at the time, the fact that I was obviously fit and otherwise well, must have made them think I was capable. After the angioplasty I got myself back onto a trolley and less than half an hour after arriving at the hospital was sat up in recovery having a sandwich. It was all over so quickly, I didn't have time to worry about anything.

I was really surprised when I had my bypass to be invited to get onto the operating table unassisted. I even had a chat with the surgeon before being anaesthetised. After the operation I had excellent care and was consulted at every stage and all my medication was duscussed and agreed. I think all this helped me recover quickly without any mental hangups. Yet when I get back to being under the care of my GP practice, there is a "me and them" mentality which doesn't sit well with me.

As regards the dose of folic acid to lower homocysteine, I found a chart on the Web which indicated that for my level of homocysteine I should be on 800mcg. Then when the homocysteine level drops, a lower dose is required. Quite how this can be managed in practice I don't know. It seems that 200mcg per day is a holding dose when you are well within the normal range. So maybe I need a blast of 800mcg for a period, followed by 400mcg, then back to 200mcg. Exactly when these changes are required, who knows.... I think I'll lick my finger and stick it in the air to see which way the wind is blowing. 😀