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B12/Folate Question

post #1 of 16
1/6/11 at 6:09am
Thread Starter 
My little IBD pal Franklin can't seem to keep his B12 level high enough. His last level was 185. I think it's supposed to be closer to 900. His folate level is high. We have tried a couple of rounds of weekly B12 supplementation and this barely gets him into the acceptable range.

The vet says that low B12 and high folate usually indicates a bacterial overgrowth the digestive tract. One further indication of bacterial overgrowth is failure to respond to medication. This is not the case with Franklin. His symptoms disappeared with the first dose of prednisolone and he has been steadily gaining weight. My vet is going to speak with a vet that specializes in bacterial overgrowth before treating with antibiotics.

I'm just wondering if anyone has had a similar experience or experience with chronic B12 deficiency.

Kyle
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post #2 of 16
1/6/11 at 12:23pm
I'd just like to ask you, by weekly B 12 supplementation, are you talking about injections or something else?
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post #3 of 16
1/6/11 at 12:44pm
Thread Starter 
Yes, he has received 2 courses of 4 weekly injections. the courses were 6 months apart.
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post #4 of 16
1/6/11 at 1:02pm
Thank you! Just one more question. Did you take him to the vet for the injections, or did you give the injections at home?
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post #5 of 16
1/6/11 at 1:15pm
I get them at the vet but I know some allow it at home..

B12 is a great thing for many things though I use it alot in my animals never for this issue
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post #6 of 16
1/6/11 at 2:12pm
I get them from the vet and give them at home.

I asked Kyle where the injections were administered because when used at home it's extremely important to protect the vial or individual syringes from light at all times. (Not a concern when the injections are given at the vet.)
I wanted to make sure B12 possibly exposed to light was not part of their problem.
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post #7 of 16
1/6/11 at 2:16pm
Originally posted by KyleW

Quote:
The vet says that low B12 and high folate usually indicates a bacterial overgrowth the digestive tract. One further indication of bacterial overgrowth is failure to respond to medication. This is not the case with Franklin. His symptoms disappeared with the first dose of prednisolone and he has been steadily gaining weight. My vet is going to speak with a vet that specializes in bacterial overgrowth before treating with antibiotics.
Kyle, there is some info in this article
http://www.battlab.com/tli.htm
that might be important to you. Please be sure to discuss it with your vet.

Quote:
Increased folate and/or decreased cobalamin can be indicative of small intestinal bacterial overgrowth (SIBO), also known as “antibiotic-responsive enteropathyâ€. SIBO is a particularly common cause of cobalamin deficiency in dogs, large numbers of bacteria in the proximal small intestine binding and internalising cobalamin so that it is unavailable for uptake in the distal SI. These bacteria may also synthesise large amounts of folate which is then absorbed in the proximal small intestine. However, while an increased serum folate concentration alone may be suggestive, this does not provide definitive evidence of SIBO.
SIBO is not typically a clinical syndrome in the cat, but potentially intestinal bacteria could bind B12 and contribute to a low serum B12. However, provided pancreatic insufficiency (EPI) has been eliminated, low serum cobalamin is most likely to be indicative of small intestinal disease (including inflammatory bowel disease and lymphosarcoma) in the cat.

Exocrine pancreatic insufficiency (EPI) can also have major effects on these vitamins, particularly cobalamin, and it is essential to eliminate EPI by assay of cTLI or fTLI before interpretation of abnormal results. Understanding how EPI can result in cobalamin deficiency depends on knowledge of the key role of the pancreas in the physiology of cobalamin uptake in dogs and cats illustrated here:

Cobalamin is a very large molecule that cannot cross the intestinal epithelial barrier without help from a specific cobalamin-binding protein called “intrinsic factor†(IF). A second site on intrinsic factor subsequently binds to specific receptors present only on the surface of ileal epithelial cells. This binding induces cell-mediated endocytosis of the IF-cobalamin complex and hence transport of cobalamin into the blood.

IF is synthesised by the stomach in most mammals including humans. However, the pancreas is an important site of IF synthesis in the dog, and is the sole site of IF synthesis in the cat. Pancreatic proteases also degrade non-specific R proteins from the stomach which would otherwise bind cobalamin and prevent binding to IF. Interference with production of pancreatic IF and pancreatic proteases in EPI can therefore result in cobalamin deficiency in dogs and particularly severe cobalamin deficiency in cats.
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post #8 of 16
1/6/11 at 2:58pm
Thread Starter 
My vet's first thought was bacterial overgrowth. and he is still thinking along those lines. One thing that would rule it out is that with sibo Franklin should not have responded to the prednisolone. But he did, beautifully. i gave the injections at home and they were not exposed to direct sunlight.

My vet is going to consult with a specilist and we will proceed from there.
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post #9 of 16
1/6/11 at 3:52pm
Quote:
i gave the injections at home and they were not exposed to direct sunlight.
Are you saying they were not kept in a completely dark place (closet or drawer) at all times?
If so, that could have caused a problem, the injections could have lost potency. B12 is very sensitive to light.

When I pick up my injections the hospital pharmacist puts the syringes in an envelope to protect them from light right away. Then I put the envelope in my purse, making sure no light can get to it on my way home. Then it goes into a closet into an area where no light can get to it even when the door is opened. (I do the same thing if I get a vial.)

If the injections you were giving were exposed to light, you might want to try a few fresh ones before you do anything else to see if storing them differently makes any difference. No way to tell but in my mind it would be worth a try.
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post #10 of 16
1/6/11 at 5:54pm
Quote:
Originally Posted by Violet View Post
I get them from the vet and give them at home.

I asked Kyle where the injections were administered because when used at home it's extremely important to protect the vial or individual syringes from light at all times. (Not a concern when the injections are given at the vet.)
I wanted to make sure B12 possibly exposed to light was not part of their problem.
My vet does it for me for a few reasons...

DUMB ? to both of you are the syringes white or opaque? this is off the light issue which honestly one would think all of us over elementary school would know

Where does the pharmacist/vet store them is another ? to ask ... If they do not make them up in front of you
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post #11 of 16
1/7/11 at 3:35am
When it comes to storing B12 I've been taught to store it away from light, in a dark place. It makes sense to me.
Overly cautious maybe, but I do this even with a vial.
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post #12 of 16
1/7/11 at 10:56am
Quote:
Originally Posted by Violet View Post
When it comes to storing B12 I've been taught to store it away from light, in a dark place. It makes sense to me.
Overly cautious maybe, but I do this even with a vial.
I do not think your being overly cautious at all... Honestly, All water soluble vitamins should be cared for in that manner.. This is why many of the "better" companies use brown bottles.
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post #13 of 16
1/7/11 at 12:12pm
Quote:
This is why many of the "better" companies use brown bottles.
Yes. And since I store those brown bottles in a dark place too.....sigh............

However, it's interesting that the Doctors Foster and Smith web site
http://www.drsfostersmith.com/produc...m?pcatid=10630
for instance shows a brown bottle, yet it still recommends
Quote:
Store at room temperature. Protect from light and freezing. Keep out of reach of children and pets.
It doesn't say that with a brown bottle protecting from light is an unnecessary precaution.
I know, I know, you don't have to say anything.........lol........
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post #14 of 16
1/7/11 at 2:50pm
Quote:
Originally Posted by Violet View Post
Yes. And since I store those brown bottles in a dark place too.....sigh............

However, it's interesting that the Doctors Foster and Smith web site
http://www.drsfostersmith.com/produc...m?pcatid=10630
for instance shows a brown bottle, yet it still recommends

It doesn't say that with a brown bottle protecting from light is an unnecessary precaution.
I know, I know, you don't have to say anything.........lol........
Oh I also did not say it was a cure all more of it being added protection.. and in many studies done on that subject the results IMHO came back inconclusive and only a truly non absorbing bottle does not need the protection( though guess where ALL my bottles are ).. Brown , clear or otherwise... Of course some will say just the keep out of reach of kids and pets would = a cabinet and they may not understand the light thing at all...

Of course you little dig that is well funny to anyone reading... could be avoided by ACTUALLY having read WHAT I really wrote
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post #15 of 16
1/7/11 at 4:43pm
Trust me, there was no little dig. Can't imagine what reason I could have possibly had for doing something like that and no such thought even crossed my mind. I was having fun with words and making fun of my own overly cautious, fussy ways. Peace?
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post #16 of 16
1/7/11 at 5:36pm
Quote:
Originally Posted by Violet View Post
Trust me, there was no little dig. Can't imagine what reason I could have possibly had for doing something like that and no such thought even crossed my mind. I was having fun with words and making fun of my own overly cautious, fussy ways. Peace?
OOOOPPPPPSSSS
Sorry .. Mis understood... having fun is a GREAT thing.... Takes big CHill pill
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