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In this article, we will look at what to do with high B-12 levels. For instance we will look at what approaches you can take to find out:
How you can think about what's going on in your body to create high B-12 levels?
Whether or not you actually have excess B-12? Should you be checking your white blood cells, kidneys, liver etc. What test should you to be doing?
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The first thing you want to look at when you have high B-12 levels is to find out why you have high B-12 to begin with. In previous 2 articles;What Does A High B-12 level Mean?
Causes of High B-12 Without Supplementation
we discussed this in some detail. Still it is essential to find this out before you go on and start planning what to do about it. One of the problems with finding out you have high B-12 is that the serum B-12 test gives limited information. It is not the best at showing your true functional B-12 status. In other words, sometimes your tissues and cells do not have enough B-12 and it does not match the results of the high serum test.
This may seem strange that your tissues do not have enough B-12 but the B-12 blood test shows that you are high in B-12. However, you will get a get an appreciation for this as the article progresses. The main point for now is that the serum B-12 test is not the best way to understand your B-12 status. Neither are some of the functional tests like methylmalonic acid and homocysteine.
If you do have adequate B-12 levels, how do you know that there are not other problems with your white blood cells, with your kidneys, liver, etc? How do you know this is not a signal that's something deeper is going on with your tissues?
The first thing I recommend you do if you have a high B-12 level, is find out if your cells are getting adequate B-12 levels to begin with. To do this, you want to run two tests called methylmalonic acid and homocysteine. If these two test are normal (and the serum test is high) then you could likely assume that you do have adequate B-12 levels. By normal, for simplicity sake, we can use the lab reference range for normal. So if normal, then you do have adequate B-12 levels. Keep in mind that there can be problems with these tests too, but all in all, if normal there is adequate B-12.
Another way to look at this is to distinguish if you do or do not have B-12 deficiency symptoms, regardless if you have adequate B-12 level per lab values. If you have symptoms of B-12 deficiency and your methylmalonic acid and homocysteine levels are high, then it's clear you want to treat for B-12 deficiency. However, you still should dig deeper, try to find out why the B-12 level high and make sure that there's nothing more going on. On the other hand, if your homocysteine and methylmalonic are low (or normal) but you still have B12 deficiency symptoms, you may still want to treat for B12 deficiency. There are various ways to go about that. However, in the case that your labs are showing normal homocysteine and methylmalonic acid, then use more caution using B-12 and focus more on finding the cause (see below). The main reason for this distinction is that the symptoms of b-12 deficiency can have many different causes.In the first case you have elevated B-12, high homocysteine, high methylmalonic acid with B-12 symptoms. Here you will be you're treating for B-12 deficiency. In addition you want to make sure your white blood cells, your liver, your kidneys are al normal. This could be done through some simple standard labs called a CBC and Chemistry panel. If it's way outside the range, then there may be a problem there and you need to look a little closer. If it all looks looks fine then probably there's nothing going on with these organs and tissues currently. Regardless if it looks fine now, you should still be following a doctor and still looking at these tests on a regular basis. While the levels could be normal now they may become abnormal later.
If all tests are normal and you avoid extra B-12 supplements for 6 months, you could start supplementing with B-12. For both these scenarios, there are other test you can do to possibly uncover another layer of information. There is a test called holotranscobalamin.