B12 Five years after WLS

Question
I had RNY Gastric Bypass in 2003.  I am concerned regarding the decline in my B12 scores over the years.  I have had the following B12 lab reports over the five years:(presurgery)807,(post surgery)919,527,(started OTC supplements)1008,1203,1472,1321,(stopped OTC supplements due to rashes)878,742,759,744,755,519,661,794,485.  The last one was taken Feb. 3 of this year. I did take OTC B12 supplements (about a year out from surgery), which raised my level quite high and caused me to have a body rash.  My weight loss surgeon told me to discontinue them at that time.  However, although my recent levels are "normal", I feel they indicate a continuous decline and that perhaps I should be taking action.  Could you give advice on what to do?  

Answer
Dear Pat,

After Gastric Bypass, I consider it important to keep your B12 levels above 500 to prevent nerve damage. I know the bottom range for labs is often much lower, but the range between 200 and 450 is not very accurate, so staying higher is safer.

You should NEVER be off B12 after gastric bypass.  While it is true that for some vitamins (like B6 or A) that high levels are bad, they are meaningless with B12 - it is non-toxic at infinitely high doses in humans.  Per current guidelines, you should be on a sublingual B12 of at least 350 mcg (most people used 500 to 1000mcg) daily for life.  An alternative is a weekly nasal spray or monthly injection (both by prescription from your doctor.

Please let me know if you need more information.

In Health,

Dr. Jacques

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