From the Guidelines
Elevated vitamin B12 levels are often associated with symptoms such as acne, rosacea, itching, and rashes on the skin, as well as headaches, dizziness, anxiety, restlessness, or difficulty concentrating, although the evidence provided does not directly support these claims, and instead focuses on the treatment and prevention of vitamin B12 deficiency 1. The provided evidence primarily discusses the prevention and treatment of vitamin B12 deficiency, particularly in patients undergoing bariatric surgery or with inflammatory bowel disease.
- The British Obesity and Metabolic Surgery Society guidelines recommend treating vitamin B12 deficiency immediately and seeking urgent specialist advice from a neurologist and haematologist if there is possible neurological involvement 1.
- The guidelines also recommend hydroxocobalamin 1 mg intramuscularly on alternate days until there is no further improvement, then hydroxocobalamin 1 mg intramuscularly every 2 months for people with neurological involvement, and hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks for people without neurological involvement 1.
- Additionally, the evidence suggests that vitamin B12 absorption decreases post-bariatric surgery due to changes in hydrochloric acid production and reduced availability of intrinsic factor, and that routine vitamin B12 supplements are required after certain types of bariatric surgery to prevent deficits 1. However, it is essential to note that the provided evidence does not directly address the symptoms associated with elevated vitamin B12 levels.
- In clinical practice, it is crucial to consider that elevated B12 levels may be a sign of an underlying condition, such as liver disease, kidney disease, certain blood disorders, or some types of cancer, rather than a primary problem caused by excessive supplementation 1.
- Therefore, if you have unexplained elevated B12 levels, you should consult with a healthcare provider to determine the underlying cause rather than simply trying to lower your B12 intake, and treatment will typically focus on addressing the underlying condition rather than the B12 level itself.
From the Research
Symptoms Associated with Elevated Vitamin B12 Levels
Elevated Vitamin B12 levels, also known as hypervitaminosis B12 or hypercobalaminemia, can be associated with various symptoms and diseases. Some of the symptoms and conditions linked to high Vitamin B12 levels include:
- Solid neoplasia (primary or metastatic) and acute or chronic hematological diseases 2
- Liver disorders, such as chronic liver disease, which can lead to falsely elevated Vitamin B12 levels due to increased excretion of Vitamin B12 into the serum from the liver 3
- Monoclonal gammapathy of undetermined significance, renal failure, and inflammatory or autoimmune diseases 2
- Excess Vitamin B12 intake, which can cause symptoms such as acne, palpitations, anxiety, akathisia, facial ruddiness, headache, and insomnia 4
- Transient hematological disorders, including neutrophilia and secondary eosinophilia 2
Disease Entities Associated with Hypervitaminemia B12
Hypervitaminemia B12 can be a marker for various disease entities, including:
- Hemoblastosis, which is a type of blood cancer 5
- Liver and kidney diseases, which can lead to increased levels of Vitamin B12 in the serum 5
- Chronic liver disease, which can be associated with falsely elevated Vitamin B12 levels and can be used as a severity and prognostic marker 3
Clinical Implications of Hypervitaminemia B12
The clinical implications of hypervitaminemia B12 can be significant, and it is essential to investigate the underlying cause of elevated Vitamin B12 levels. Some of the clinical implications include: