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Subklinisk vitamin B12-mangel
er en tilstand hvor det foreligger milde biokjemiske tegn på B12-mangel, men ikke kliniske symptomer som megaloblastisk anemi eller nevropati.
Helsekonsekvensene, og effekten av B12-tilskudd ved denne tilstanden, er ukjent. Dermed er det ingen klare retningslinjer for hvorvidt subklinisk B12-mangel skal behandles.
Subklinisk mangel på B12 er en tilstand hvor det foreligger milde biokjemiske forstyrrelser, som økninger i MMA og Hcy, men ingen/svake symptomer på mangel. Årsaken til tilstanden er ukjent, men det har vært foreslått at det skyldes at B12 ikke frigjøres fra proteiner i maten og dermed blir utilgjengelig for absorpsjon i ileum.
Subklinisk mangel er langt mer vanlig enn klinisk mangel, og i følge Carmel har 10-25 % i den eldre befolkningen denne tilstanden.
Ettersom subklinisk mangel sjelden skyldes malabsorpsjon, er det mindre sannsynlig at tilstanden utvikler seg til klinisk mangel.
Diagnosen avhenger kun av biomarkører, og ettersom alle markørene har sine svakheter, blir diagnostiseringen av subklinisk B12-mangel utfordrende.
Man vet lite om helseeffektene av subklinisk B12-mangel, og dermed er det heller ingen klare retningslinjer for hvorvidt eller hvordan man skal behandle tilstanden.
Artikler om B12 behandling
Vitamin B12 deficiency from the perspective of a practicing Abstract
B12 deficiency is the leading cause of megaloblastic anemia, and although more common in the elderly, can occur at any age. Clinical disease caused by B12 deficiency usually connotes severe deficiency, resulting from a failure of the gastric or ileal phase of physiological B12 absorption, best exemplified by the autoimmune disease pernicious anemia. There are many other causes of B12deficiency, which range from severe to mild. Mild deficiency usually results from failure to render food B12 bioavailable or from dietary inadequacy. Although rarely resulting in megaloblastic anemia, mild deficiency may be associated with neurocognitive and other consequences. B12 deficiency is best diagnosed using a combination of tests because none alone is completely reliable. The features of B12 deficiency are variable and may be atypical. Timely diagnosis is important, and treatment is gratifying. Failure to diagnose B12 deficiency can have dire consequences, usually neurological. This review is written from the perspective of a practicing hematologist.
Treatment with high dose vitamin B12 been shown to be safe for more than 50 years Artikkel som avskriver at høye doser B12 kan være farlig. Det har blitt brukt doser som er 5000 ganger sterkere på folk som har blitt røykskadet i mange mange år.)
Les mer, trykk her:
Guidelines for the diagnosis and treatment of cobalamin and folate disorders
Vinod Devalia Malcolm S. Hamilton Anne M. Molloy on behalf ofthe British Committee for Standards in Haematology
Retningslinjer for diagnostisering av B12- og B9-mangel.
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Testing av vibrasjonsfølelsen. Krev alltid at denne skal taes ved nevrologiske symptomer. Det er en billig, pålitelig og viktig test der man kan fange opp nevropati tidlig
Engelsk side om nesten alt du trenger å vite om B12-mangel. Legg merke til at du kan velge språk når du først kommer inn på siden.
Les mer, trykk her:
Influence of Treatment Parameters on Symptom Relief in Individuals with Vitamin B12 Deficiency
Findings: B12 injections were associated with greater mean symptom improvement than oral supplements. However, the combination of injections and additional oral cobalamin resulted in the greatest improvement. There were no differences observed for the form of cobalamin used. Compared to daily (DLY) or weekly (WKLY) injections, monthly (MNTH) or every two to three month (MNTH+) injections were associated with less symptom improvement. While additional oral B12 improved the effectiveness of daily, weekly and monthly injections, it was insufficient to 'rescue' the ineffectiveness of MNTH+ injections. Lastly, folate intake, but not iron, was associated with greater symptom improvement.
Conclusions: Patient' symptom reports suggest that oral supplements are not as effective as B12 injections. This is in contrast to previous work that relied primarily on biomarker change as a proxy for effectiveness, suggesting more research is necessary. The frequency of injections perceived as most effective by patients was far in excess of that often prescribed, suggesting under-treatment may be occurring. Taken together, further investigation with more definitive tests and the inclusion of patient reports is necessary.
