From the Guidelines
A vitamin B12 level of 237 pg/mL is considered low and requires immediate treatment to prevent neurological complications and anemia. According to the British Obesity and Metabolic Surgery Society guidelines 1, vitamin B12 deficiency should be treated immediately, especially if there is possible neurological involvement. For patients with vitamin B12 deficiency and no neurological involvement, hydroxocobalamin 1 mg intramuscularly should be administered three times a week for 2 weeks, followed by maintenance treatment with 1 mg intramuscularly every 2–3 months for life 1. Some key points to consider in treatment include:
- Checking for underlying causes of deficiency, such as pernicious anemia or malabsorption
- Monitoring treatment effectiveness by rechecking B12 levels after 1-3 months and assessing symptom improvement
- Considering dietary changes to include more B12-rich foods like meat, fish, eggs, and dairy products
- Being aware of medications that may affect folic acid levels, such as anticonvulsants, sulfasalazine, and methotrexate 1 It is essential to treat vitamin B12 deficiency promptly to prevent long-term complications and ensure optimal patient outcomes.
From the Research
Treatment for B12 Level of 237
- The treatment for a B12 level of 237 is not explicitly stated in the provided studies, as the normal range for vitamin B12 levels can vary depending on the laboratory and the individual's overall health 2.
- However, according to the study published in the American Family Physician, oral administration of high-dose vitamin B12 (1 to 2 mg daily) is as effective as intramuscular administration for correcting anemia and neurologic symptoms 2.
- Another study published in Clinical Therapeutics found that an oral formulation of 5-mg cyanocobalamin containing 100-mg SNAC, an absorption enhancer, provided significantly improved bioavailability and a significant decrease in T(max) for B12 in a small study of normal healthy subjects compared with a commercially available 5-mg cyanocobalamin oral formulation 3.
Bioavailability of Vitamin B12
- The bioavailability of vitamin B12 is dose dependent, and at a low dose that approximates the normal daily requirement, the mean bioavailability is 46.2% 4.
- Parenteral replenishment of the vitamin B12 store in deficient individuals prior to the measurement resulted in a 1.9-fold increase in bioavailability 4.
- A study published in the Journal of the American Geriatrics Society found that cyanocobalamin supplementation of 50 microg but not 10 microg daily produced a significant increase in serum vitamin B12 5.
Forms of Vitamin B12 Supplements
- There are several forms of vitamin B12 supplements available, including methylcobalamin, adenosylcobalamin, hydroxycobalamin, and cyanocobalamin 6.
- The study found that all supplemental or food-derived B12 forms are reduced to a core cobalamin molecule, which converts to the intracellular active forms: MeCbl and AdCbl, in a ratio not influenced by the form of B12 ingested 6.
- Supplementing with any of the nature bioidentical forms of B12 (MeCbl, OHCbl, and/or AdCbl) is preferred instead of the use of CNCbl, owing to their superior bioavailability and safety 6.