My favorite articles talk about 500-550 being the B12 levels at which loss of memory, dementia, and lethargy can be caused. The articles talk about B12 deficient people with gastritis and celiac disease, and each suggests cobalamin, B12 therapy.
Doctors concluded that levels of serum vitamin B-12 concentrations currently considered normal in the United States may be too low and should be reassessed. It is for this reason that I don’t include a vitamin B12 levels chart on this page. All of the charts I have seen show very low vitamin B12 levels as normal.
Charts showing B12 levels by age can be particularly misleading. Older people have lower levels of vitamin B12 not because that is normal and good, but because that is the result of a life in which stress and other factors have lowered their vitamin B12 levels to such a point that what is seen as age related illness was bound to occur. Had those same people understood that a higher vitamin B12 level could be easily achieved, with accompanying improved health, they most likely would have used methylcobalamin, the form of vitamin B12 our bodies use.
MOLNYCKE, SWEDEN. Swedish researchers have discovered that many older people are deficient in vitamin B-12. Their study involved 368 men and women aged 75 years or older. Analysis of blood serum showed that 11 per cent of the participants were deficient in cobalamin (vitamin B-12). The researchers point out that a vitamin B-12 deficiency has been linked to neuropsychiatric disorders such as memory loss and dementia. The researchers discovered several cases of gastritis (inflammation of the lining of the stomach) and two cases of celiac disease among patients with low serum values of cobalamin. They conclude that routine screening for a vitamin B-12 deficiency is justified in the case of older people.
In a separate letter to the Journal of the American Geriatrics Society doctors from the Union Memorial Hospital in Baltimore report on a case of vitamin B-12 deficiency. The patient, an 85-year-old man, had developed progressive memory loss and lethargy over a two-year period. Although his serum level of vitamin B-12 was within the currently accepted range, the doctors decided to proceed with vitamin B-12 therapy. The patient received an intramuscular injection of 1000 micrograms of vitamin B-12 for three consecutive days, then 1000 micrograms weekly for a month, and then one injection every month. By the fifth injection his mental status has vastly improved and his lethargy had completely vanished.
The doctors conclude that the levels of serum vitamin B-12 concentrations currently considered normal in the United States may be too low and should be reassessed. The lower limit of 200 pg/mL is based on the level which causes abnormalities in the blood (pernicious anemia). In contrast the lower limit in Japan and some European countries is 500-550 pg/mL and is based on the level which causes mental manifestations such as dementia and memory loss. The doctors suggest that a trial of vitamin B-12 therapy is warranted in patients with borderline cobalamin serum levels as it is effective and inexpensive.
Eggersten, Robert, et al. Prevalence and diagnosis of cobalamin deficiency in older people, Journal of the American Geriatrics Society; Vol. 44, Nol. 10, October 1996, pp. 1273-74.
Goodman, Mark, et al. Are U.S. lower normal B-12 limits too low? Journal of the American Geriatrics Society, Vol. 44, No. 10, October 1996, pp. 1274-75.
Normal B12 range in various countries
The reference range for vitamin B12 in different countries varies. In fact, reference values may vary markedly among populations and cultures. One reason for this is that diet varies significantly. The laboratories of any particular country are expected to investigate values in relation to their population and determine their own reference ranges.
Although the research quoted above says that some European countries have a low normal for vitamin B12 of 500-550, like Japan, Google has not helped me find which countries those are.
Low normal for B12 in England
The low normal for vitamin B12 in England has been as low as 150. At that level some patients had hair loss that was diagnosed as Alopecia and said to be a permanent disorder. However, when the very same patients were given vitamin B12 injections their hair grew back and accompanying depression went away.
Not everyone rejoiced, however. The doctor who prescribed vitamin B12 instead of drugs came under fire from orthodox medicine.
Inside Out – Dr. Chandy and B12 is worth watching for the view it gives of patient experience vs medical professionals’ opinion.
Doctors and General Practitioners (GPs) in England are advised that the ‘normal’ reference range of serum B12 in blood tests is between 180-1132 pmol/mL and that only deficiency needs to be treated. This often translates into denial of treatment for nerve disorders which are known to be related to low levels of vitamin B12. In fact some research articles say that although a patient’s vitamin B12 was raised to a normal level the nerve issue did not resolve.
Dr. Chandy’s approach differed in that he treated until the patient regained a much higher level of health. He treated based on visible health results, rather than achieving a particular blood test “score”.
I found that when I had to rely on US doctors for an injectable cobalamin prescription they did not take my reports of how the injections helped me as meaningful and my begging often fell on deaf ears. It was only when I discovered that Methylcobalamin lozenges work as well as injections that I was able to maintain higher levels of health for myself.
In England doctors generally treat vitamin B12 deficiency by intramuscular (IM) injection, and no more than once every three months.
It is hopeful, however, that recent research from Oxford University has suggested that 300 pmol/mL might be a more accurate lower limit than 180. And, there is some suggestion that 500 pmol/mL might be an even more accurate lower required limit.
“Normal” B12 range in different countries
Australia ~ Australia’s reference range for vitamin B12 is 135-650 pmol/L. Clinical cases have shown that B12 deficiency symptoms can be seen even when the B12 level in blood is within that reference range. In fact, signs and symptoms of B12 deficiency appear to start when plasma B12 levels are ‘normal’.
Canada ~ Sufficient vitamin B12 levels are those greater than or equal to Health Canada’s recommendation of 148 pmol/L. In a recent email from a Canadian I was told the range is 138 to 652. She wrote, “The report (requested by my doctor), was from my blood samples, taken and analyzed by LifeLabs Medical Laboratories in Milton, Ontario (1/2 hour west of Toronto, Canada).”
Germany ~ German research states that if the total vitamin B12 concentration is in the lower reference range, 156 to 400 pmol/L, then vitamin B12 deficiency cannot be ruled out; and, clinical signs of vitamin B12 deficiency can be seen in persons with vitamin B12 concentrations lower than 156 pmol/L.
Japan ~ Japan raised its B12 reference range to 500 – 1300 Pmol in the 1980s.
Korea ~ A 2010 study showed the average Korean centenarian’s serum vitamin B12 concentration to be 393.2 pg/mL in males and 405.5 pg/mL in females despite a lifelong diet of mainly grains and vegetables. Testing discovered B12 in fermented-soybean products. For instance, traditional home-made soybean-fermented foods such as Doenjang, Chungkookjang, and Gochujang were found to contain higher amounts of vitamin B12 than commercial factory-made products. Home-made Doenjang is a “slow food” taking at least 10 months for preparation and fermented by multiple microorganisms found in nature. The commercial, factory product takes only 3-4 months and is fermented by inoculated microorganisms under strict conditions. Due to the needs of space, time, and labor and the smell during preparations and storage of Doenjang, commercial Doenjang is increasingly popular, particularly with younger generations in urban areas. However, most Koreans in rural areas still make it themselves and consume it year round. The Korean centenarians in the study were consuming the traditional home-made fermented foods. Next is the fact that most Koreans eat Kimchi, a vegetable-fermented food, at almost every meal. Cabbage Kimchi is the most popular. It is made of salted Chinese cabbage, red pepper, garlic, fermented fish sauce or/and fermented small fish, green onion, ginger, starch, and some other optional vegetables and generally fermented for a few days, but sometimes for a few months in low temperature. It has been reported that the vitamin B12 content of Kimchi is derived from the fermented fish sauce rather than newly produced during fermentation. It is to be noted that generally, Korean centenarians do not consume supplements, and there are few vitamin B12 fortified foods in Korea. Some edible algae and seaweed, including laver, contain large amounts of vitamin B12 though there is debate regarding bioavailability of vitamin B12 in seaweeds. Be that as it may, the high consumption of dried seaweeds would still be partly responsible for the normal status of the vitamin B12. Discovery of Novel Sources of Vitamin B12 in Traditional Korean Foods from Nutritional Surveys of Centenarians, Chung Shil Kwak, Mee Sook Lee, Se In Oh, and Sang Chul Park, 2010.
Netherlands ~ Serum vitamin B12 level cut-off 145 pmol/L. A cut-off level is the point which segregates a result as being either positive or negative.
Pakistan ~ Lower limit of serum vitamin B12 in healthy individuals varies from 150 to 300 pg/ml and the upper limit from 635 to 925 pg/nil7,8.
Poland ~ Normal range: 180-900
Russia ~B12/Cobalamin lack begins at a level less than 200 (<200 ng/l). Cobalamin deficiency is 150 ng/l or lower.
Sweden ~ Sweden accepts a low vitamin B12 level of 152 as normal. Sweden’s standard laboratory range for vitamin B12 is 152–568 pmol l.
Turkey ~ Normal reference levels obtained for vitamin B12: 127-606 pg/mL for girls, 127-576 pg/mL for boys, and 127-590 pg/mL for the entire study group.
Uganda ~ A study seeking to establish vitamin B12 reference values for young Ugandan adults, to be used as baseline information, found a range of 117–1158 pg/ml. This range was then adjusted “to the 2.5th to 97.5th percentile” where it read as 152 to 1029 pg/ml. These results were considered as showing no borderline deficiency or deficiency and were considered comparable to values obtained in Germany of 191 – 663 pg/ml and the USA of 211 – 946 pg/ml.
United States ~ Normal values are 200 to 900 picograms per milliliter (pg/mL).
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or may test different samples. Talk to your provider about what your specific test results mean.
Labs are quick to say “What Abnormal Results Mean” and answer, “Values of less than 200 pg/mL are a possible sign of a vitamin B12 deficiency. People with this deficiency are likely to have or develop symptoms.”
High-dose B12 prevents Alzheimer’s Disease
Townsend Letter for Doctors and Patients – May, 2006
by Joseph G. Hattersley
It is interesting to consider what proportion of Alzheimer’s Dementia (AD) may result from under-nutrition, (1) especially when it seems that there may be an easy, low-cost, perfectly safe, nutritional way that may allow people to avoid a miserable illness that many people consider worse than death. Some people might say, “That’s too good to be true!” In fact, an at-home nutritional program, using a lot of vitamin B12 may indeed prevent and virtually eliminate AD. An early launch of the treatment soon after first warning symptoms start could even turn off the process.
Confusion, difficulty concentrating, loss of memory, marked changes in personality that can lead to outbursts of violence, hallucinations, wandering away, and early death all characterize Alzheimer’s dementia. An estimated 2.3 million Americans now have AD. Prevalence doubles every five years after the age of 60, increasing from one percent among those 60 to 64 up to 40% among those aged 85 years and older.
Let’s start with a little background. Mammals, including humans, are born with serum levels of vitamin B12 at about 2,000 pg/ml. The level declines throughout human life owing to practices common in Western societies. Below 550 to 600 pg/ml, deficiencies start to appear in the cerebrospinal fluid. US clinical laboratories regard 200 pg/ml as the lower range of normal.
“Most cases of Alzheimer’s dementia are actually missed B12 deficiency cases, because of the too-low normal range for B12,” wrote John V. Dommisse, MD in 1991 in Medical Hypotheses. Dommisse, who practices medicine in Tucson, Arizona, has confirmed that Alzheimer’s disease appears to result from too-low serum vitamin B12, and repletion of the vitamin succeeds despite other risk factors. Repleting B12 can reverse 75% of B12 deficiency dementias when the condition is discovered early enough.
Other aspects of the therapy should be noted: The neurological and cerebral manifestations of B12 deficiency require dosages larger, and extending over a longer time, than to those needed to reverse hematologic effects. B12 therapy appears to be perfectly safe; in other words, the risk of overdose is virtually nil. Patients of Dr. H.L. Newbold in New York City injected themselves three times daily with triple-strength doses of B12 (9,000 ug/micrograms/per day) indefinitely. Their serum B12 levels reached 200,000 pg/ml (100 times the normal level found in newborn babies and higher), but none had any significant side effects.
Vitamin B12 can prevent major birth defects
By Will Dunham – Mon Mar 2, 12:02 am ET
WASHINGTON (Reuters) – Before becoming pregnant, women need to get enough vitamin B12 in addition to folic acid to cut their risk of having a baby with a serious birth defect of the brain and spinal cord, researchers said on Monday.
Irish women with the lowest vitamin B12 levels were five times more likely to have a baby with a neural tube defect than those with the highest levels, the researchers wrote in the journal Pediatrics.
Neural tube defects can lead to lifelong disability or death. The two most common ones are spina bifida, in which the spinal cord and back bones do not form properly, and anencephaly, a fatal condition in which the brain and skull bones do not develop normally.
Dr. James Mills of the U.S. National Institutes of Health, one of the researchers, said the study showed that vitamin B12 deficiency was a risk factor for neural tube defects independent of folic acid, another B vitamin.
Many women now know of the importance of folic acid and there has been a drop in neural tube defects.
Mills said he hopes that awareness of the similar role of vitamin B12 can reduce neural tube defects further…
“An absolutely critical point is that women have to consider this before they become pregnant because once they realize they are pregnant it’s likely to be too late,” Mills, a researcher in the NIH’s National Institute of Child Health and Human Development, said in a telephone interview.
The developmental events involved in these birth defects occur in the first four weeks of pregnancy, Mills said.
Mills urged women who do not eat meat or dairy products to be particularly aware of the need to get enough vitamin B12.
He had similar advice for women with an intestinal disorder such as inflammatory bowel disease that may prevent them from absorbing sufficient amounts of the vitamin.
The study involved almost 1,200 women in Ireland who gave blood samples during early pregnancy, which were analyzed to determine vitamin B12 levels.
The women in the lowest 25% of vitamin B12 levels were five times more likely than those in the highest 25% to have had a baby with a neural tube defect.
The researchers suggested that women have vitamin B12 levels above 300 nanograms per liter before getting pregnant.
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