QUESTION: 49 year old F diagnosed a few years ago with Peripheral Spondyloarthritis. She is currently taking Naproxen 220mg BID, Sulfasalazine 2500mg QD, Fexofenadine 60mg, CoQ10 100mg, B12/folate 1000mcg/800mcg, Milk Thistle, Turmeric, Vitamin D, Probiotic, MSM, and Ligatone. Her PCP found that she was anemic (RBC: 3.94, Hgb: 11.9, Hct: 34.9%, and WBC: 4.6). I tested Iron (76), Ferritin (25), Folate (23.1), and Vitamin B12 (>1500), homocysteine (6.7)and am waiting on MMA but am concerned about her elevated B12. Her liver enzymes and kidney markers are normal. No elevation of Eos. I haven’t tested MTHFR or other SNPs yet. Any other thoughts?
ANSWER: Great question. Common issue and the bottom lines are:
Blood tests for B12 are only useful if LOW, elevation can mean SO many things that it is totally useless except as a starting point.
B-12 elevation can be the following (and other things too):
– MTHFR or methyl cycle issues
– Supplementation
– Non fasting non B12 avoidance blood sample (7 days no B12)
– Active cancer
– Cancer treatment
– Liver metabolism issues (non Liver disease
– Liver disease
– kidney disease
– Absolutely nothing
And: The test is so poor because the B12 test looks at ALL isomers of B12 and so may be showing the active and MANY non active forms of B12 which is why in some “high B12 on the labs” folks they are actually deficient in the useful forms of B12.
Work the rest of the case, do full methyl cycle and other areas genomics, and use the B12 lab as the least helpful test in the universe without other confirmation of the above causes of elevation.