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 tests should you to be doing?
- What things should you be looking at over time?
- What can you do to get the numbers down?
This is what we will discuss and answer.
If this interest you keep reading, we're going to discuss the details.
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 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 something deeper is going on with your tissues?
What To Do With High B-12 Levels Step 1
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 is high and make sure that there's nothing more going on (see below).
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.
What To Do With High B-12 Levels Labs
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. Now we can just say that the normals on these on the lab reference range should be close to what we would consider normal. 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.
In another case you have elevated B-12, low or normal homocysteine, low or normal methylmalonic acid with B-12 symptoms. Here you will follow the same steps as above and continue to avoid extra B-12. If all tests are normal (except the elevated B12) and you avoid extra B-12 supplements for 6 months, you could start supplementing with B-12 after this period.
What To Do With High B-12 Levels Holotranscobalamin
For both these above scenarios, there are other test you can do to possibly uncover another layer of information. There is a test called holotranscobalamin. It's my understanding that this test is very expensive and not something that all labs can do. It is mainly done in Europe and UK. So you may be able to get the test done depending on where you are at and what kind of health conditions you have going on. Holotranscobalamin test is basically looking for all of the transcobalamin proteins in your blood. There are three different types of these proteins. There is TCN 1, TCN 2 and TCN 3. The TCN 2 is the one that actually takes the B-12 and puts it into the cell. The TCN 1 and TCN 3 do not. So if your body is making more of these (TCN1 and TCN 3) as a whole then you will not be able to get that B-12 into the cell because most of its getting bound up. Your B-12 is bound up by the other two (TCN1 and TCN 3). When this happens your TCN 2 does not have any B-12 to actually bind to and pull into the cell. Some of it will get in but less of it will because there is so much of the other binding proteins.
We see similar types of binding issues in medicine with hormones, for instance. When this happens there is less bioavailable B-12 or hormones to bring into the cells. So if you're homocysteine and methylmalonic acid are normal you would move on and test for some of these same things looking at white blood cells the kidney function and maybe even holotranscobalamin. It would be nice to be able to just run this test in all scenarios but the cost and availability of the test preclude it.
If you do the holotranscobalamin test and it is normal (within reference range), then it rules out any increased production of the TCN1 and TCN3 by the white blood cells. If you do the holotranscobalamin test and it is low , then this tells you your body is not making these TCN binding proteins adequately. This is likely a genetic cause. In this case it would be highly probably that you also have high homocysteine and/or methylmalonic acid. The reason being the B12 cannot get into the cell.
Another option if all the lab studies are normally is watch and wait to see if the B-12 levels normalizes. Within a reasonable amount of time, the B-12 level should be coming down. For instance, if you are avoiding B-12 for 6 months and maybe even 3 months it should be coming down and into normal ranges.
What to Do with High B12 Levels Mast Cells
It is the white blood cells, specifically the granulocyte type of white blood cells like eosinophils that can and do produce higher amounts of these transcobalamin proteins. The granulocytes will produce more of the TCN 3 and TCN 1 specifically. This is a problem as outlined above. Higher levels of eosinophils is commonly seen in people with high allergies, histamine intolerance, or mast cell activation syndrome. These functional issues may not show up as an overt problem in the CBC and chemistry screening tests noted above.
The mast cell issue has a lot of possible sources. Typically this is coming from something going on in the intestines (not always) with increased immune system and allergy type symptoms. We also call this atopic syndrome and manifests as eczema, allergies, and asthma. If these symptoms are occurring in you, it could be part of what's going on.
Even if you have these atopic type symptoms, it is still recommend to make sure you get some of these other tests done. Make sure there's nothing major going on like your CBC, your chemistry and in some cases the holotranscobalamin. What can you do to reduce these transcobalamin proteins and improve the overall cellular uptake of your of your B-12?
How To Improve High B12 Levels
Mast Cell Activation Syndrome is a condition of excess inflammation and histamine production. People with this often have many different symptoms crossing many different systems. It also has many varied causes or triggers. You should try to find out what is triggering the immune system and where is the overall inflammation occurring in your body. There are a lot of things 
that can excessively stimulate the mast cells (see below). In a general sense you can look at this condition as a pro-inflammatory process. Even though you may have normal inflammation levels through direct assay, sed rate and CRP, there still may be increased inflammatory response.
To resolve this issues you want to adopt more of an anti-inflammatory approach as you try to uncover the source of this inflammation. Some options include high levels of iron, increased microbial toxins like LPS or other chronic infections (EBV, digestive bugs, Lyme). These are tests that are generally done in injunction with a medical professional. These are not really things you can sort through without a doctor's help. It takes a lot of different testing, monitoring, and clinical insight. This should give you some ideas and directions you can go in though.
The other thing with regard to cell membranes is the absorption though them. The channel that the transcobalamin and B-12 go through is an electromagnetic field. This field can be altered when your cell membranes are damaged or not is not repaired properly. Inflammation and poor antioxidant status can be a trigger for this poor repair. There are several tests you can do to look at antioxidant status like organic acid test, for instance. If your antioxidant status is low especially in the lipid part, like vitamin E and glutathione, then you're not able to counteract the inflammation occurring in the cell membrane. When the membrane is being organized to allow for the transcobalamin plus B-12 to go through, there may be a block. The channel or the receptor isn't organized in quite the right configuration. As a result, things are not funneling through the channel as easily. So if everything looks fine with your white blood cells, kidneys, liver, etc then consider looking at and treating for inflammation, Mast Cell Activation Syndrome, and or depleted cell membranes and antioxidants. Here are some links to products to consider for lowering your high b12 levels.
1. Fatty acid cell membrane support
If there's any doubt, you always want to see a hematologist because they have other tests, clinical insight, and things they can do like bone marrow biopsies to really make sure there's nothing deeper going on.
Check out the other article that goes into more detail on some of the causes of high b12. Hopefully that was helpful and giving you a deeper understanding of what could be going on with your body when you have high B-12 levels.
