I was recently rummaging around on the Internet looking for evidence of a possible connection between gout and vitamin B12 supplementation.
I came across the following information relating to the cautious use of vitamin B12 supplements (oral and injectable) where there are specific pre-existing health conditions.
I hasten to add that this does not mean that B12 is any less safe than it's ever been...it just means that where there is a specific pre-existing health condition, additional monitoring and a consideration of any potential impact on that condition might be required (for instance, B12 increases the production of red blood cells so in the case of blood disorders, additional caution and monitoring might be advisable).
I'm not so sure many (if any) doctors will be aware of this...unless we tell them 😄.
And of course pre-existing medical would be subject to routine monitoring anyway...but your GP or specialist may not be aware of the potential cautions when having B12 treatment.
Glad you are back on internet. Thanks for link re: caution with pre-existing conditions.
It just occurred to me that GP first should establish cause for overproduction of RBCs before agreeing to B12 injections (if ever!). I also use PPI, have done so for decades because of reflux problems. Would welcome feedback on that.
Hi JGBH. Hmm...not quite that simple. High RBC's can be caused by something as simple as dehydration. A high RBC count would have to be viewed in relation to all other blood tests and investigations as on its own, it could be quite meaningless.
And if there was a pre-existing condition as per those indicated in the link, then there would be other clinical evidence to support a diagnosis.
I think the main imperative would be to treat with B12 (we all know what happens without treatment) but simultaneously take into account any pre-existing conditions - and monitor accordingly. Whilst, of course, ruling out any other unidentified medical conditions. Or at least that's how it should work...in an ideal medical world 😄
About the PPI's - yes these are known to interfere with the absorption of vitamin B12.
Thanks Foggyme. Re: dehydration. I drink a lot of water and herbal teas (red bush) as well as ordinary and green tea since have been diagnosed with vaso vagal syncope over a year ago. Will have to push for further investigation... am dreading it.
I'm glad someone hadn't "cautiously" told me all this 45 years ago as then I might have opted for the raw liver three times a day diet instead of the injections and then I'd not have been "clivealive" at 75 today
Two thoughts: firstly possible contraindications may well be what puts doctors off testing for and prescribing B12, as they might need to do other tests and checks, potassium should probably be tested in everyone for example. They should probably do tests to rule out other conditions, and causes for low B12 as well and go through the patient's notes: time factor.
As a GP said to me when I asked for some CVD tests: "Ha ha. We can't test everybody for this!"
Secondly I don't understand the reasoning behind the following (below) - I would have thought that if B12 was deficient for the reasons listed (not sure about ACE inhibitors) that would be an indication that injections were needed? Because those things would be causing or contributing to B12 deficiency? So why would caution be necessary?
Quote: "Use CAUTIOUSLY in people taking the following agents, as they have been associated with reduced absorption or reduced serum levels of vitamin B12: ACE inhibitors, acetylsalicylic acid (aspirin), alcohol, antibiotics...etc ... metformin, nicotine, nitrous oxide, oral contraceptives... etc"
Hi Frodo. Not so sure that it's the potential contraindications that put GP's off, since many will be completely unaware of them.
Think it's more likely to be that GP's have so little understanding of B12 deficency y that they have no idea how they should be diagnosing or treating the condition.
In terms of potassium...yes, of course they should test...but again, I suspect that many don't know this.
With reference to long term pre-existing conditions - well these should be monitored routinely anyway, and factoring in B12 treatment and any potentially impacts on those conditions should simply be a matter of an 'awareness' that certain changes / impacts could occur....and watching out for these during the usual monitoring process. Again, not so sure doctors have this level of awareness. (Whether the routine monitoring takes place is perhaps sometimes debatable - but that's a different matter 😖).
In terms of caution being necessary when B12 deficency is drug induced: I take this to mean that if the causative agent (the drug) is removed or changed, then the B12 deficiency will resolve as a matter of course (though B12 injections may be needed initially to get B12 levels up). So, exercise caution by not putting those effected in this way on a lifetime regime of B12 injections...which may not be needed. 😄
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