00:00Are you tired all the time?
00:02Do you find yourself being a little forgetful sometimes?
00:06So you decide to check it out with your doctor,
00:09just to be certain everything is okay.
00:12And everything is A-OK, including your vitamin B12.
00:18But wait a minute.
00:20Could you still be vitamin B12 deficient?
00:24Your doctor told you your B12 level was normal.
00:28He showed you the report.
00:30You could see for yourself that it is normal.
00:33So what could be the disconnect here?
00:36Pay close attention and I'll walk you through a scenario
00:39that clinicians encounter across the country
00:41in medical facilities and clinics.
00:44Vitamin B12, you see, is a co-factor.
00:49Your level stores a remarkable amount of vitamin B12,
00:53often enough to keep you going for several years.
00:57That is why vitamin B12 deficiency doesn't just happen overnight.
01:04You don't just wake up one morning and say,
01:07oh, my memory isn't like it used to be.
01:10I must be vitamin B12 deficient.
01:13And that's what makes it tricky.
01:16B12 deficiency can develop gradually.
01:20And the symptoms, the serum B12 concentration,
01:24and changes in the blood count do not necessarily appear at the same time.
01:31During this critical period, if deficiency is developing,
01:36your memory, blood cells, and nervous system can gradually begin to suffer.
01:42And here's the worst part.
01:45Neurologic damage from B12 deficiency can often improve when it's caught early.
01:51But if severe deficiency goes untreated for too long,
01:56that damage may become permanent.
01:59Here's something even stranger.
02:02Researchers took samples from 300 healthy people
02:06and measured the B12 using three commonly used laboratory systems.
02:12And here's what they found.
02:13With Roche, the normal range was from 190 to 678,
02:18picograms per milliliter.
02:20With Siemens, it was 181 to 562.
02:24With Beckman, it was 110 to 562.
02:29Same vitamin, same group of people,
02:33different laboratory methods,
02:35different reference ranges.
02:37So what counts as a normal B12
02:39can depend on what machine your laboratory uses.
02:44But that's only half of the story.
02:47There's another reason that B12 numbers can sometimes fool you.
02:52Vitamin B12 helps the body convert homocysteine to methionine.
02:57It also helps the body convert methylmalonic coenzyme A
03:02to succinylcholinezyme A.
03:04When B12 is deficient,
03:07both of these reactions can become impaired.
03:10And when those B12-deficient reactions slow down,
03:16methylmalonic acid and homocysteine can begin to rise.
03:20But that gives us something very useful.
03:25It gives us biochemical clues that B12 isn't doing its job properly.
03:31And here's the part most people don't realize.
03:35The vitamin B12 level we measure in the blood does not always perfectly reflect the vitamin B12 levels in the
03:42tissues.
03:43The B12 on your laboratory report is total B12 circulating in the blood.
03:50It is not a direct measurement of how much usable B12 is actually inside your cells.
03:58So your lab report can show a normal serum vitamin B12 level and your tissues can be telling a completely
04:06different story.
04:07What's the solution?
04:10How do you protect yourself from the devastating effects of vitamin B12 deficiency?
04:15If you have any of the symptoms of B12 deficiency and your B12 level is somewhere in that borderline zone,
04:24roughly 180 to 350,
04:27150, don't just look at the word normal printed beside it.
04:32That may be a situation where your doctor needs to consider another marker,
04:39particularly methylmalonic acid, MMA, and sometimes homocysteine.
04:45As I mentioned before, these can rise when your tissue vitamin B12 is low.
04:51And sometimes those markers can be high even when your serum B12 is borderline or occasionally still within the normal
05:01range.
05:02Remember, normal is not always normal on a vitamin B12 report.
05:08I hope you found this video useful.
05:10If you did, like and share the video with your friends and family.
05:14You can support this channel by subscribing.
05:16Until the next video, stay healthy and stay safe.
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