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What Does A High B12 Level Mean?

In this post we're going to talk about why you might have high b12 levels, what does high b12 level mean,  and is a high b12 level dangerous.  There are three main scenarios that I'm going to discuss. I will briefly mention them here:

  • Number one is improper testing numbers 
  • Two is has to do with cell membranes and transportation
  • Three has to do with liver disease  

If you want to find out a little bit more details on what each of these mean and why it could be contributing to your high B12 levels keep reading. 


So we want to answer the question what does a high b12 level mean and is it dangerous?  First off it's not really dangerous to have high b12 level in and of itself.  The more important thing is what the high b12 suggests about your physiology and how your body works. In this blog we will discuss the three things that most likely are causing it to be high.  These are the most common that I see in my practice. 


High Vitamin B12 Level From Testing

Scenario number one has to do with how we test for B12.  When you are getting your B12 tested, it is typically a serum B12 level that is being tested.  What this test is looking at, is the amount of B12 in the liquid part of your blood (verses the cells).  The test reference range goes from about three hundred fifty to one thousand.  If you are taking B12 on a regular basis and it’s absorbing into your body, this supplementation will raise the serum B12 levels. The serum levels of B12 will spike in the initial hours after the vitamin is taken (again assuming it is absorbed well) then level off as it is distributed throughout your body.  So if you take the B12 when you are close to the test you will see a higher level than what is reflective of body and cellular storage.  The whole point of testing it to get an accurate understanding of cellular storage and utilization. 

For this reason, it is suggested that you give a couple days washout period before you test.  I typically tell patients to wait up to five days.  It may be appropriate to wait longer to see what's going on, if you have a really high b12 level.

For instance, if your B12 level is consistently high even after avoiding vitamin B12 for 1-2 weeks, you may want to avoid for an additional three weeks and see what happens.  This is more true when you have not taken any B12 for a long period of time or you have only been on it for a short period of time.  So if you have been off of b12 for a really long time and you're still getting a spike, then see scenario number two and three.  

blood test for vitamin b12 

The other thing to think about with testing is with people getting B12 shots.  These will raise your levels a lot more than just an oral tablet.  The other variables to consider are the milligram dose of your tablet and the injection.  As far as testing when you get an injection, you should wait at least one week and up to 2 weeks for your washout period.  Then how often you're getting that injection will dictate what the likely rise will be.  I am seeing them as high as two to three thousand on the high end and as low as one hundred.  In terms of testing B12 with injections you should give a washout period. 

This serum test is really the only test available through standard labs for B12 specifically. There are no intracellular B12 test like there are with other vitamins and minerals.  I also wanted to mention that there are other vitamins and supplements that can interfere with the serum B12 assay, specifically Biotin.  If you are taking Biotin you want to make sure you're not taking any Biotin in close proximity to the B12 test.  

So that is scenario one. In proper testing can lead to high B12 levels.  In the case that this is the reason, for your high B12 level, then there is really nothing else to worry about.  The high level itself isn't really problematic.  The higher B12 may not be helping you as much as you think, but it's not a problem.  Some people just need to run at higher B12 level to get it into all their tissues and cells. 


High Vitamin B12 Level From Cell Membranes

Reason number two for why your B12 is high relates to cell membranes and transportation of B12.  Most vitamins and nutrients are transported to the cells via transport proteins.  They deliver the nutrients to the outer part of the cell called the cell membrane.  As it related to this, one reason your B12 level is really high, is from inadequate B12 transportation and or inadequate cell membrane function.


Find Out Why Your B12 Shots Are Not Working


For both of these problems, there are genetic variants that can predispose a person to this problem.  With low levels of carrier protein the serum B12 levels rise but it cannot get into the cells which will lead to poor distribution throughout your body.  The same thing happens when there are poor or fragile cell membranes.  

Once the B12 arrives at the cell it has to get transported inside and through cell membranes.  If your cell membranes are fragile or poorly repaired, the B12 (and other nutrients) has trouble getting into the cell. This also leads to higher B12 levels in the serum because it's basically just floating in the serum.  Eventually it will get excreted out of the body but it's not actually getting into the tissues the way that it should.  

The carrier protein that can be genetically altered is called TCN which stands for transcobalamin.  The one for cell membranes is PEMT which stands for phosphatidylethanolamine methyl-transferase enzyme. Alterations in this enzyme lead to decrease phospholipid production and instability or poor production of cell membranes. 

Both of those scenarios can lead to higher B12 levels. However, I usually think about these problems when there is high B12 and you are not actually taking extra B12 in the form of vitamin or supplement. 


High B12 Level From Liver Disease

The third scenario that can contribute to this high B12 level has to do with liver disease.  The liver problems that can cause this vary from things like viral hepatitis to alcohol induced hepatitis.  These inflammatory states in the liver limit it's ability to many of the liver's products.  One of these products is choline.  Choline is an essential part of our cell membranes.   As noted in scenario number two, poor cell membranes can lead to high B12 levels. Because much of the choline and the cell membranes are produced in the liver, a compromised liver leads to compromised cell membranes. So when you have hepatitis or problems with your liver, this can lead to high B12 levels.  

Now that doesn't necessarily mean that everyone with high B12 levels has liver problems.  It also is not the case that every one with liver problems will have high B12 levels.  Still if you have high B12 levels you probably should have a look at your liver if you have not already.  If you are consuming alcohol on a regular basis, you can get a simple liver enzyme blood test to rule that out or rule that in.  

The above information should give you a better understanding of what it means when you have high B12 levels and whether or not it is dangerous.  If you want a customized look at your B12 levels or specific health situation click on the link below. 


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