Tuesday, July 3, 2012

Migraine and B12 Status: What Your Doctor Doesn't Tell You

Think a little vitamin won't have any bearing on your Migraines?  You might be surprised at the right answer to this question...

Finding out I had a long standing B12 deficiency and correcting that issue was paramount to my chronic Migraine improvement.

This research points to the fact that identifying a B12 deficiency can be difficult.  Most doctors who think to test B12 will not know how to do it properly, and many patients with deficiency problems will be missed as a result.

B12 testing itself is insufficient.
  1. To learn your B12 status, 3 tests must be performed.  B12 should be above 400 for neurological health.  Numbers below 400 result in neurologic damage which can be permanent if not caught and treated early.
  2. Methylmalonic Acid.  This test may be high in B12 deficient states and is much more sensitive in reflecting the actual status of the patient.
  3. Homocysteine.  This test can be high in B12 and Folic Acid deficiencies.  High homocysteine has been found in a larger percent of Migraineurs than control groups.  
If homocysteine and methylmalonic acid are both high, it is usually B12 deficiency, especially if B12 testing is below 400.  

If homocysteine alone is raised, this usually indicates a folic acid deficiency. 

In my case, I had been tested in the mid 1990's and even earlier.  Results of B12 testing came back in the 100's - a very good reason for me to be notified of a problem and treated.  Because I was not notified nor treated, it is very likely at this point, that my damage is not going to improve.  The numbness in hands and feet as well as other areas have not gone away in several years of supplementation.  My cognition definitely improved, but I will likely always have problems I have largely learned to work around, but nevertheless am discouraged by.  

Research showed deficiency led to decreased brain size and other complications.  B12 deficiency is often seen in the elderly and mis-identified as dementia.  Sad, since this condition is very treatable.  

Next, learn why we can become deficient in B12 and how to treat it...

Source: C.C. Tangney, PhD; N.T. Aggarwal, MD; H. Li, MS; R.S. Wilson, PhD; C. DeCarli, MD; D.A. Evans, MD and M.C. Morris, ScD. "Vitamin B12, cognition, and brain MRI measures; A cross-sectional examination." The journal Neurology. Copyright © 2011 by AAN Enterprises, Inc.


jamie said...

seems like for a lot of these critters, the testing isn't good enough... what does that say about the companies producing the tests, and the specificity needed to actually influence someone's life... (including insurance implications, but don't get me started on that...)

<--is growth hormone deficient, but in order for BCBS to even touch the issue, have to have test replicated. To do so, I need a prior auth. It's not a severe deficit, but I wonder what changes would come with correcting it...

Ellen Schnakenberg said...


There are a couple of problems here.

To begin with, the United States labs won't flag a low B12 level until it is so low that frank anemia occurs. By that point, neurological damage has already happened. Change those protocols and it might not be as important to have the other testing done as a simple B12 level would be more likely to be sufficient to tell the tale.

Methylmalonic acid and homocysteine are part of the methylation process, of which B12 is the keymaster. When these levels are off, even in the face of the US substandard *normal* B12 lab value (which in truth is not normal at all) it shows that there is a problem happening that isn't being caught by the B12 test. This happens because B12 is stored in the liver for up to 5 years. It takes a long time of illness or malabsorption to deplete these stores. As the depletion occurs, it will be seen in the homocysteine and methylmalonic acid levels first, telling your doctor there is a problem... IF he is smart enough to know how to test them.

The problem with insurance companies tends to be that they don't want to pay for the homocysteine or methylmalonic acid testing because the B12 test was *normal*. I always suggest patients ask their physicians for all 3 at the same time to help keep this from happening.

Additionally, the problem with physicians themselves is that they don't get enough training in the importance of this particular vitamin to the body. What little they get is not emphasized, so is often forgotten. If you are a neurologist you might remember that a B12 test isn't sufficient because US values are too low, however most are also taught that the US has the greatest medical system in the world, so if labs don't flag low B12 it must be because it really isn't low. Right?!

Make any sense at all??