started my B12 loading dose yesterday (yay!) and have 6 in total lined up.
I've read a few threads round here which mention vitD, potassium, folate etc and I want to really be clear what effect B12 has on metabolism of these other minerals/vits
I'm low on vitD anyway so am already supplementing. Doc has put in a reminder to get it checked again in a few weeks to make sure the supplements are doing enough. So that's in hand.
However, do I need to keep an eye on the other two? My folate is about 6.7 which is at the low end, and I know B12 and folate are linked and you shouldn't treat folate first. Since I'm now being treated for B12, shall I start on the folate supps I've got, or wait a bit longer?
Re potassium - should I start eating bananas right now (I don't like bananas, actually, so if there are other good sources please shout! I'm not sure if potassium as a supplement is a good idea or not).
I will eat bananas if I have to, and lord love him my partner is downstairs making banana muffins right now as I can most definitely eat those but I can't expect him to be baking every day.
I mean, I can, but I suspect he'd give me a hard stare if I suggested it
I have a good diet in general, to be honest, so it may be I'm already eating enough potassium rich stuff but it might need a boost, I just don't know.
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I take vitamin B complex, high dose D3 and a multivitamin. At the beginning I took a lot more but gradually reduced it to the 3 pills. I haven't noticed any difference and I'm saving a fortune.
B12 can eat up some nutrients, especially iron and folate, as these are needed for blood formation and increased blood production can use these up and thus, uncover a deficiency in these. This happens especially in the initial few weeks, as the body will stop producing extra blood once the blood levels normalize.
Potassium is generally not an issue, as we get plenty of potassium from foods and its deficiency is also rare, except in certain situations like diarrhoea, or due to certain medicines, but it doesn't hurt to eat potassium rich foods during this time.
Iron and folate are especially needed, so watch out for these and may need supplementation. Take 1-5mg of folate till you are in the higher levels and yes, you can start supplementing as soon as you start your B12 supplementation. Also make sure ferritin is high, else supplement.
If VitD is low, take at least 4000IU/day or 60,000IU/week for 2-3 months, after which it can be reduced a bit.
Take a good B-complex tablet that has all the B vitamins, as the B-vitamins act together. This may not be needed though, as generally, we get all the B vitamins from food and you may not be deficient (for me, it does not make any difference), but may want to do so for some time till things stabilize.
Also, check your thyroid levels, if not already checked, as this is one common cause of B12 deficiency.
As am111 says, ensure you've good levels - my folate and iron were too low and that cost me dearly in terms of my health. Long forgotten iron deficiency that reared it's ugly head was the worst thing.
Please could you educate me on how much b12 is in a loading dose? I SI daily but didn't start with a loading dose and keep meaning to find out how much it is. Thanks!
Start on folate very soon or your levels will likely drop more, especially if you inject frequently. My B12/iron specialist said it needs to be at 15-20 ideally.
Coconut water's a better source of potassium than bananas. Ground flaxseed's good too.
Ground flaxseed is an excellent source of the essential Omega-3 fatty acid ALA (Alpha-Linolenic Acid). Two tablespoons should cover the requirement. I make sure these are in my breakfast mix
ALA can be converted to the long-chain Omega-3's (EPA and DHA) but conversion can be poor so its best to also get these directly (Algal EPA/DHA is available).
The urban myth that Bananas are an excellent source of Potassium dies hard. A banana typically has about 10% of the Potassium RDA. Not bad but not amazing. However it has 20% of the B6 RDA. So when you think of Bananas think of B6, not Potassium!
Legumes of all kinds (lentils, beans etc) are among the best sources of Potassium and completely destroy Bananas. Spinach and Avocados are also excellent sources. This calculator shows a handy list of some of the top sources:
The potassium obsession (I had it too, and really bad tbh!) is due to the rare possibility of hypokalemia (dangerously low potassium levels in the blood) in early B12 treatment but this is only a possibility if you were anemic as the increased production of red blood cells makes a demand on the bodys potassium stores. No anemia == no need to get excited about Potassium.
Just eat a generally good diet (read my profile text for tips on this) and you should be fine. Its difficult to find high dose potassium supplements and this is for good reason as potassium is an electrolyte and must be maintained in a tight range in the blood. High dose supplements could upset that and send you to the ER. And correcting hypokalemia has enough gotchas that I'm not sure I would trust my fate to the medics in my local ER to do it safely😅.
Iron can also be an issue due to the replacement of the defective red blood cells so good to keep an eye on ferritin or an iron panel if needed. Every other day supplementation is better than daily to raise iron levels if you need to (too much iron ramps up inflammation and decreases iron absorption).
You should definetely maintain adequate folate, usually a 400mcg per day dose is recommended but if you're gobbling fruit and veg like they're going out of style (as I do) you can get as much as 1mg of folate from the diet (that 2.5x the RDA and at the tolerable upper limit 😆) So supplement if you need it, or can't absorb enough - 400mcg is widely recognised as safe. I am probably an anomaly here but I regret not dropping my folate supplementation sooner as it seemed like I started improving a lot once I did 🤣 (could be coincidental timing).
Vitamin D has no direct metabolic relationship with B12 but it can't hurt to get it into a good range. Maintenance would be around 1000IU in summertime, 2000IU over the winter but if you're overweight add 1000IU and over 70 add another 1000IU. Absorption problems might increase needs further, just go by blood tests. 4,000IU is the tolerable upper limit and can be safely taken in order to raise a low result. If you're seriously deficient you might be prescribed higher doses and I would take your doctors advice on that. Be aware that daily doses are more effective than massive weekly or monthly doses to raise levels, even though massive "bolus" doses are often prescribed weekly/monthly to correct deficiency. Think about how the body would get Vitamin D normally - a good amount from the sun everyday, not a blast of blinding sunlight once a month and then 29 days of darkness!
The 2 other vitamins that are most closely linked to B12 in metabolism are B2 (Riboflavin) and B6 (pyridoxin). An RDA level B-Complex or some fortified nutritional yeast can help meet intakes here. Individual supplements are possible but are often super high dose and not really intended long-term. High dose B2 will give you flourescent yellow pee and is no cause for panic, its just your body getting rid of the excess (the phenomenon is not harmful but is a hint that you dont need to take that much).
If taking B6, the active form (P5P/PLP - Pyridoxal-5-Phosphate) is highly preferred since this form does not seem to have been linked with neuropathy in large doses but I would still be careful not to exceed the upper limit of 12.5mg a day.
If you dont eat plenty of fruits and veggies, then Magnesium is a good, safe supplement , up to 200mg but as above you can get more than enough from a good diet so its not strictly necessary.
Here are a few additional leftfield tips about supplementation, that, if I was in early B12 deficiency treatment I would be trying:
Creatine 5g daily. Creatine gives you ATP, the battery/energy currency of cells. As anyone who had a B12 deficiency knows, energy is good to have and you won't reach 5g even from gobbling steaks all day (which would introduce its own set of problems).
Taurine 500mg daily. In animal models, B12 deficiency creates a secondary Taurine deficiency. This can affect bone health, but again this is in animal model. Nevertheless Taurine is very safe so it cant hurt to get 500mg as a booster to help get Taurine levels back up quickly.
Soya Lecithin, 1 or two teaspoons. This is a big one especially in early stages if neuropathy is present. It can help provide some of the myelin sheath repair materials.
"Phosphatidylcholines (also called lecithin) are an abundant phospholipid found in myelin"
...
"Also, phosphatidylcholines are precursors for the synthesis of other important classes of signaling and structural phospholipids, the sphingomyelin, which share the same head group, and the phosphatidylinositols and their phosphorylated forms, which all are critical to PNS myelination"
B12 Institute released a research paper which hypothesized that "early treatment decline" might be partly caused by excess formaldehyde. This is by no means proven but its one of the few scientific hypothesis out there at the moment which tries to explain this phenomenon.
One of their recommendations was to support Glutathione production. This can be done by supplementing around 1g of Glycine with 1g of NAC (N-Acetyl Cysteine). This should hopefully rev up production of Glutathione, the body's "master antioxidant", which in theory might help to counteract the damage as the processes now running better due to B12 starting to sort out all the damage incurred by the B12 deficiency.
Betaine(Tri-Methyl Glycine) is another easy choice at from 500mg to 1g a day. This will help to recycle homocystine to methionine independently of the B12-related processes.
EPA/DHA - Aim for about 1 gram of combined EPA/DHA to exceed requirements. Liquid supplements are usually needed for this rather than tablets.
Usual disclaimer : I am not medically trained and please consult your doctor or registered dietician if you have any questions or concerns about taking any of the above or if you have any other conditions which might affect the safety of supplementing them.
oh this is so helpful. I still have a review to come with the haemotologist and since he’ll have the results in front of him I’ll be able to ask him really precise questions now.
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