Re: Possible B12 Deficiency

[Guest guest]

First is there any statin use. Statin intolerance will cause this problem. Just

because you are within normal range does not mean you are not deficient. RDIs

are based on a bell curve to prevent frank deficiency in about 80-85% of the

population. You may be an outlier and need to be at a higher level then the

minimum to prevent problems. The shots will take a couple of weeks to work. You

can also buy Vitamin B12 dots for under the tongue. Things that will affect

vitamin B12 absorption are stomach acid suppression and bile acid suppression. I

have been down both roads so I am off all statins, questeran and omniprozol. So

I eat less fat and now take fish oil daily. But I am no longer falling down or

tipping into the wall when I walk. Another kind of off the wall though is

Vitamin D3, it does a lot of things in our bodies.

Good Luck

Jackie Chase RD

Dillingham AK

> Hi Everyone....I just received the following from a former student of mine.

Neuro is not my area of expertise. Can anyone help?? Thanks so very much!

>

> Sheerin, RD

> Traverse City, MI

>

> " I have been having some odd neuro stuff going on since summer (or before now

that I really think about it), mainly postural imbalance and gait and just

feeling REALLY " off, " not sure how else to describe, but bad enough that I don't

know if I'll go back to nursing school this semester or not. Well, long story

short (if that is possible)- been shuffled all over- internist, neurologist,

ENT, and about to go to (University Med Center) for a vestibular work up and

today the neurologist declares that she is fairly certain that my problem is a

B12 deficiency. My MRI is negative and I show some signs of peripheral

neuropathy very consistent with this and my other symptoms fit the bill- my

level was 200, which is low, but in the normal range (I think 200-700 is the

range), anyway the neuro feels that anything below 400 generally is accompanied

by neuro symptoms. She sent me back to my internist for shots and said he should

do some lab work to check intrinsic factor (something like that) to determine if

I am just deficient or have an absorption problem. I am sort of a vegetarian but

NOT a vegan, or even close, I eat plenty of dairy and always have. The internist

doesn't buy it, still thinks it is my ear (ENT says it is neuro), says my level

is fine but will try a shot once a month for a couple of months to see what

happens (but don't get my hopes up, I can tell he doesn't buy it at all). Also I

am thinking 1000 B12 once a month isn't enough to build my levels much and was

wondering what you thought. Sound likely? Ever dealt with this? (other than the

elderly or the alcoholics?) How much do I need and how quickly do you think I

might see improvement IF there is any relationship? "

>

>

[Guest guest]

I'm not sure if this will help, but she is about 40 and I would guess her BMI is

on the low end of normal.....19-20. She exercises a lot and teaches yoga. I do

not think she has an eating disorder, but she has only been a student, not a

client, so cannot say for sure. I believe she would confide in me if she did

have eating issues....she is quite honest and forthcoming and we got to know

each other quite well while she was my student. So....do you think excessive

exercise could be a factor??

Re: Possible B12 Deficiency

No matter how young this person is, be certain the neuro r/o Parkinson's

disease. - ne

> Hi Everyone....I just received the following from a former student of

> mine. Neuro is not my area of expertise. Can anyone help?? Thanks

> so very much!

>

> Sheerin, RD Traverse City, MI

>

> " I have been having some odd neuro stuff going on since summer (or

> before now that I really think about it), mainly postural imbalance

> and gait and just feeling REALLY " off, " not sure how else to

> describe, but bad enough that I don't know if I'll go back to nursing

> school this semester or not. Well, long story short (if that is

> possible)- been shuffled all over- internist, neurologist, ENT, and

> about to go to (University Med Center) for a vestibular work up and

> today the neurologist declares that she is fairly certain that my

> problem is a B12 deficiency. My MRI is negative and I show some

> signs of peripheral neuropathy very consistent with this and my other

> symptoms fit the bill- my level was 200, which is low, but in the

> normal range (I think 200-700 is the range), anyway the neuro feels

> that anything below 400 generally is accompanied by neuro symptoms.

> She sent me back to my internist for shots and said he should do some

> lab work to check intrinsic factor (something like that) to determine

> if I am just deficient or have an absorption problem. I am sort of a

> vegetarian but NOT a vegan, or even close, I eat plenty of dairy and

> always have. The internist doesn't buy it, still thinks it is my

> ear (ENT says it is neuro), says my level is fine but will try a shot

> once a month for a couple of months to see what happens (but don't

> get my hopes up, I can tell he doesn't buy it at all). Also I am

> thinking 1000 B12 once a month isn't enough to build my levels much

> and was wondering what you thought. Sound likely? Ever dealt with

> this? (other than the elderly or the alcoholics?) How much do I need

> and how quickly do you think I might see improvement IF there is any

> relationship? "

[Guest guest]

very interesting and valuable point!

Merav Levi, RD, MS, CDNA dietitian, not the food police.

http://www.linkedin.com/in/meravlevi

" Life is not measured by the number of breath you take, but by the moments that

take your breath away. " - Carlin " People don't forget the truth, they just

become better in lying " (Revolutionary Road)

To: rd-usa

From: fivestar@...

Date: Sun, 9 Jan 2011 08:39:51 -0600

Subject: Re: Possible B12 Deficiency

No matter how young this person is, be certain the neuro r/o Parkinson's

disease. - ne

> Hi Everyone....I just received the following from a former student of

> mine. Neuro is not my area of expertise. Can anyone help?? Thanks

> so very much!

>

> Sheerin, RD Traverse City, MI

>

> " I have been having some odd neuro stuff going on since summer (or

> before now that I really think about it), mainly postural imbalance

> and gait and just feeling REALLY " off, " not sure how else to

> describe, but bad enough that I don't know if I'll go back to nursing

> school this semester or not. Well, long story short (if that is

> possible)- been shuffled all over- internist, neurologist, ENT, and

> about to go to (University Med Center) for a vestibular work up and

> today the neurologist declares that she is fairly certain that my

> problem is a B12 deficiency. My MRI is negative and I show some

> signs of peripheral neuropathy very consistent with this and my other

> symptoms fit the bill- my level was 200, which is low, but in the

> normal range (I think 200-700 is the range), anyway the neuro feels

> that anything below 400 generally is accompanied by neuro symptoms.

> She sent me back to my internist for shots and said he should do some

> lab work to check intrinsic factor (something like that) to determine

> if I am just deficient or have an absorption problem. I am sort of a

> vegetarian but NOT a vegan, or even close, I eat plenty of dairy and

> always have. The internist doesn't buy it, still thinks it is my

> ear (ENT says it is neuro), says my level is fine but will try a shot

> once a month for a couple of months to see what happens (but don't

> get my hopes up, I can tell he doesn't buy it at all). Also I am

> thinking 1000 B12 once a month isn't enough to build my levels much

> and was wondering what you thought. Sound likely? Ever dealt with

> this? (other than the elderly or the alcoholics?) How much do I need

> and how quickly do you think I might see improvement IF there is any

> relationship? "

[Guest guest]

Magnesium deficiency causes muscle weakness and balance / frequent falling. It

is commonly known in the dairy industry as grass staggers. A large dairy intake

or other calcium supplements and foods can add up to poor magnesium absorption.

Sweating would also increase losses as would use of acidic beverages or

diuretics. I would encourage her to try easing back on dairy and tofu and

increase nuts and seeds and other beans and chocolate for more magnesium. And if

she wants to try B12 on her own the sub-lingual tablets are very absorbable. I

was using them daily for a while but stopped when my next labs for it were quite

high.

from: Section of Pediatric Nephrology,Rush University Medical Center, Chicago,

Illinois, USA author: Farahnak Assadi..

Hypomagnesemia: An Evidence-Based Approach to Clinical Cases. Iranian Journal of

Kidney Diseases, North America, 411 01 2010.

The prominent organ systems associated with magnesium deficiency are the

cardiovascular and neuromuscular . 3 1 Manifestations o f hypomagnesemia may

include muscle weakness, positive Chevostek sign and Trousseau sign, tetany, and

generalized seizures as may be seen with hypocalcemia.32 The most

life-threatening cardiovascular effect of hypomagnesemia is ventricular

arrhythmia.31

TREATMENT

Patients with mild to moderate deficiency (1.2 mg/dL to 1.7 mg/dL) should be

treated with diet or oral magnesium supplements.3 Symptomatic patients should

receive 3 g to 4 g (24 mEq to 32 mEq) of intravenous magnesium sulfate slowly

over 12 to 24 hours.3 This dose can be repeated as necessary to maintain serum

magnesium level above 1.2 mg/dL. Rapid intravenous push administration raises

the serum magnesium concentration above physiologic levels, causing a large

percent of magnesium to be excreted in the urine. Establishment of adequate

kidney function is required before administering any magnesium supplementation.

Patients with renal insufficiency should receive 25% to 50% of the initial dose

recommended for patients with normal kidney function.

Case 2

A 16-year-old girl complained of easy fatigability and generalized muscle

weakness. Her history was otherwise unrevealing, and she denied vomiting or the

use of any medications. Physical examination revealed a thin anxious girl with a

normal blood pressure. Her examination was otherwise unremarkable. Her serum

sodium was 141 mEq/L; potassium, 2.1 mEq/L; chloride, 85 mEq/L; bicarbonate, 45

mEq/L; calcium, 9.5 mg/dL (reference range, 8.5 mg/dL to 10.3 mg/dL); phosphate,

3.2 mg/dL (reference range, 2.8 mg/dL to 4.5 mg/dL); magnesium, 1.2 mg/dL

(reference range, 1.8 mg/dL to 2.3 mg/dL); and albumin, 4.6 g/dL (reference

range, 3.5 g/dL to 5.0 g/dL).

Question 1. Which of the following statements is true (select all that apply)?

(a). Hypokalemia can alter the renal handling of magnesium and cause

hypomagnesemia.

(. Hypomagnesemia can alter the renal handling of potassium and cause

hypokalemia.

©. Both statements are true.

(d). Neither statement is true.

The answer is b. Magnesium is required for adequate renal handling of potassium.

Hypomagnesemia can cause hypokalemia because of the increased urinary loss of

potassium, likely by opening potassium channels in the thick ascending loop of

Henle.29 This may become apparent when hypokalemia persists despite potassium

supplementation.

R Vajda, R.D.

________________________________

To: rd-usa

Sent: Sun, January 9, 2011 11:03:08 AM

Subject: Re: Possible B12 Deficiency

I'm not sure if this will help, but she is about 40 and I would guess her BMI is

on the low end of normal.....19-20. She exercises a lot and teaches yoga. I do

not think she has an eating disorder, but she has only been a student, not a

client, so cannot say for sure. I believe she would confide in me if she did

have eating issues....she is quite honest and forthcoming and we got to know

each other quite well while she was my student. So....do you think excessive

exercise could be a factor??

Re: Possible B12 Deficiency

No matter how young this person is, be certain the neuro r/o Parkinson's

disease. - ne

> Hi Everyone....I just received the following from a former student of

> mine. Neuro is not my area of expertise. Can anyone help?? Thanks

> so very much!

>

> Sheerin, RD Traverse City, MI

>

> " I have been having some odd neuro stuff going on since summer (or

> before now that I really think about it), mainly postural imbalance

> and gait and just feeling REALLY " off, " not sure how else to

> describe, but bad enough that I don't know if I'll go back to nursing

> school this semester or not. Well, long story short (if that is

> possible)- been shuffled all over- internist, neurologist, ENT, and

> about to go to (University Med Center) for a vestibular work up and

> today the neurologist declares that she is fairly certain that my

> problem is a B12 deficiency. My MRI is negative and I show some

> signs of peripheral neuropathy very consistent with this and my other

> symptoms fit the bill- my level was 200, which is low, but in the

> normal range (I think 200-700 is the range), anyway the neuro feels

> that anything below 400 generally is accompanied by neuro symptoms.

> She sent me back to my internist for shots and said he should do some

> lab work to check intrinsic factor (something like that) to determine

> if I am just deficient or have an absorption problem. I am sort of a

> vegetarian but NOT a vegan, or even close, I eat plenty of dairy and

> always have. The internist doesn't buy it, still thinks it is my

> ear (ENT says it is neuro), says my level is fine but will try a shot

> once a month for a couple of months to see what happens (but don't

> get my hopes up, I can tell he doesn't buy it at all). Also I am

> thinking 1000 B12 once a month isn't enough to build my levels much

> and was wondering what you thought. Sound likely? Ever dealt with

> this? (other than the elderly or the alcoholics?) How much do I need

> and how quickly do you think I might see improvement IF there is any

> relationship? "

[Guest guest]

I have attached two articles on magnesium to go with my other email. The St

Louis University one recommends 400-500 mg Magnesium supplement in the am and pm

for chronic deficiency/loss patients - I actually take that much - and it helps

- migraines & fibromyalgia pain. After reading his article during a PMS week I

added a noon one occasionally when I was feeling too irritable.

R Vajda, R.D.

________________________________

To: rd-usa

Sent: Fri, January 7, 2011 5:53:16 PM

Subject: Possible B12 Deficiency

Hi Everyone....I just received the following from a former student of mine.

Neuro is not my area of expertise. Can anyone help?? Thanks so very much!

Sheerin, RD

Traverse City, MI

" I have been having some odd neuro stuff going on since summer (or before now

that I really think about it), mainly postural imbalance and gait and just

feeling REALLY " off, " not sure how else to describe, but bad enough that I don't

know if I'll go back to nursing school this semester or not. Well, long story

short (if that is possible)- been shuffled all over- internist, neurologist,

ENT, and about to go to (University Med Center) for a vestibular work up and

today the neurologist declares that she is fairly certain that my problem is a

B12 deficiency. My MRI is negative and I show some signs of peripheral

neuropathy very consistent with this and my other symptoms fit the bill- my

level was 200, which is low, but in the normal range (I think 200-700 is the

range), anyway the neuro feels that anything below 400 generally is accompanied

by neuro symptoms. She sent me back to my internist for shots and said he should

do some lab work to check intrinsic factor (something like that) to determine if

I am just deficient or have an absorption problem. I am sort of a vegetarian

but NOT a vegan, or even close, I eat plenty of dairy and always have. The

internist doesn't buy it, still thinks it is my ear (ENT says it is neuro),

says my level is fine but will try a shot once a month for a couple of months to

see what happens (but don't get my hopes up, I can tell he doesn't buy it at

all). Also I am thinking 1000 B12 once a month isn't enough to build my levels

much and was wondering what you thought. Sound likely? Ever dealt with this?

(other than the elderly or the alcoholics?) How much do I need and how quickly

do you think I might see improvement IF there is any relationship? "

[Guest guest]

I have attached two articles on magnesium to go with my other email. The St

Louis University one recommends 400-500 mg Magnesium supplement in the am and pm

for chronic deficiency/loss patients - I actually take that much - and it helps

- migraines & fibromyalgia pain. After reading his article during a PMS week I

added a noon one occasionally when I was feeling too irritable.

R Vajda, R.D.

________________________________

To: rd-usa

Sent: Fri, January 7, 2011 5:53:16 PM

Subject: Possible B12 Deficiency

Hi Everyone....I just received the following from a former student of mine.

Neuro is not my area of expertise. Can anyone help?? Thanks so very much!

Sheerin, RD

Traverse City, MI

" I have been having some odd neuro stuff going on since summer (or before now

that I really think about it), mainly postural imbalance and gait and just

feeling REALLY " off, " not sure how else to describe, but bad enough that I don't

know if I'll go back to nursing school this semester or not. Well, long story

short (if that is possible)- been shuffled all over- internist, neurologist,

ENT, and about to go to (University Med Center) for a vestibular work up and

today the neurologist declares that she is fairly certain that my problem is a

B12 deficiency. My MRI is negative and I show some signs of peripheral

neuropathy very consistent with this and my other symptoms fit the bill- my

level was 200, which is low, but in the normal range (I think 200-700 is the

range), anyway the neuro feels that anything below 400 generally is accompanied

by neuro symptoms. She sent me back to my internist for shots and said he should

do some lab work to check intrinsic factor (something like that) to determine if

I am just deficient or have an absorption problem. I am sort of a vegetarian

but NOT a vegan, or even close, I eat plenty of dairy and always have. The

internist doesn't buy it, still thinks it is my ear (ENT says it is neuro),

says my level is fine but will try a shot once a month for a couple of months to

see what happens (but don't get my hopes up, I can tell he doesn't buy it at

all). Also I am thinking 1000 B12 once a month isn't enough to build my levels

much and was wondering what you thought. Sound likely? Ever dealt with this?

(other than the elderly or the alcoholics?) How much do I need and how quickly

do you think I might see improvement IF there is any relationship? "