What Can I Expect From B12 Testing? Part 1

Migraine is not a disease that can be diagnosed by positive lab tests or images. Yet. Although we can actually test for specific genes responsible for certain Migraine types and markers involved in others, in clinical practice, Migraine is essentially a diagnosis of exclusion. Physicians listen to your symptoms which narrow the possible diagnoses to include Migraine, then order tests for you that will rule out other often treatable conditions for which we can test.

One of those treatable conditions that can influence your Migraine attacks and your neurological health is called B12 deficiency.

What is B12 deficiency?

B12 is also known as cobalamin. It is a water soluble vitamin that can only be found naturally in animal products. Unlike other water soluble vitamins in which excess is shed from the body as waste products, vitamin B12 is stored in the liver. Humans cannot manufacture B12 on their own. B12 is necessary for a major body function called the Methylation Process which is responsible for many chemical conversions needed for life. Part of B12’s job is to maintain your neurological health. This includes the maintenance of the myelin sheath that surrounds each and every nerve in the body. B12 deficiency may lead to neurological damage that may become permanent. Damaging low levels of B12 may go undetected for years because liver stores take years to become depleted. B12 deficiency symptoms are not very specific and often difficult to diagnose without testing. This deficiency has been estimated to be present in one in four people (1). B12 deficiency used to be fatal, however we now have ways to treat the deficiency that did not exist just a few generations ago.

There are two basic types of B12 deficiency:

  1. Pernicious Anemia is an autoimmune condition that results in decreased ability to absorb B12 in the digestive system. Antibodies attack specialized cells in the digestive system that secrete Intrinsic Factor which is required to carry B12 from the small intestine to your blood supply and to the liver where it is stored.
  2. B12 deficiency (non-autoimmune) is a condition that occurs because either B12 consumption is too low or the body is unable either to absorb B12 or store it.

What are the tests I need?

B12 testing is done with a combination of these three specialized blood tests (2):

  • Vitamin B12, Serum (Cobalamin). This test requires .3 — 1cc serum in a screw cap vial which needs to be protected from light. This test will usually be transported in a cooler packed with cold packs to keep it cool. If hemolysis occurs (blood cells are not intact usually due to lab error) a re-draw will be required. The sample may be refrigerated for up to 7 days. After arrival the sample may be put on hold until there are sufficient numbers of samples to do in a batch. Results are available from most laboratories a day after the test is completed.
  • Homocysteine (nutritional and congenital). This test requires 1.1 — 2.7 cc serum preferably collected in a red topped tube. After the blood is placed in the tube it is either refrigerated or put in an ice water bath to cool and wait until the blood clots. After clotting it is centrifuged asap. If transportation is needed, it is transported in a screw topped tube with cold packs to the lab. After arrival the sample may be put on hold until there are sufficient numbers of samples to do in a batch. If hemolysis occurs (blood cells are not intact usually due to lab error) a re-draw will be required. The specimen is stable for 4 days at room temperature, 7 days refrigerated, 6 months frozen. Levels are increased in B12 deficiency and Folic Acid deficiency.
  • Methylmalonic Acid GC/MS/MS. This test requires 1.1 — 2.7 cc serum preferably collected in a red topped tube. After the blood is placed in the tube it is either refrigerated or put in an ice water bath to cool and wait until the blood clots. After clotting it is centrifuged asap. If transportation is needed, it is transported in a screw topped tube with cold packs to the lab. After arrival the sample may be put on hold until there are sufficient numbers of samples to do in a batch. If hemolysis occurs (blood cells are not intact usually due to lab error) a re-draw will be required. The specimen is stable for 4 days at room temperature, 7 days refrigerated, 6 months frozen. Levels are increased in B12 deficiency but not Folic Acid deficiency.

Next: How are the tests performed, and what do my results mean?

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Comments

View Comments (2)
  • taralane
    6 years ago

    Hi Ellen –
    This was a really great article, and I am taking notes so when I finally get the app’t with the new migraine specialist I am trying to get in to see (in record time) this will be on the list.

    In the meantime, does it hurt or help to take 1 B12 bilingual pill a day (50 mg I think or it may be 10mg; whatever they usually come in is what I have). Docs are often reluctant when I ask them to screen for all these trace minerals, B Vitamins, except for Calcium of course, which I stopped taking when my stomach started acting up again.

    Is it better to see an endocrinologist for this kind of thing, or your standard PCP and bring the blood test results with you to your migraine doc app’t? I am so confused about things at the moment, especially with all the publicity about “gluten free diets”

    I am now being advised by well meaning friends to go on that diet and everything will go away – or at least all my gastrointestinal problems will go away, if not my migraines. Sometimes I just hate the way the media over-reports these diet things as if they are a cure all for everyone!

  • Ellen Schnakenberg author
    6 years ago

    Taking a supplement will cover up the problem if one exists, unless you have pernicious anemia in which taking a supplement will not help orally, but sublingually may cover the problem and may leave you still searching for a trigger that is no longer there. That said, if you can get your numbers up, you have fixed the trouble and that is a good thing and may help the trigger if it exists. It depends upon what your goals are here.

    As to getting these tests done, you can order your own testing for these elements. However, doing that will not be covered by insurance. Still, if you find your doctor refusing, it is an option to consider.

    Usually I suggest that patients ask their doctor for these tests because they are facing difficulty identifying triggers and need to rule this one out. In that case, often going to the doctor and stating that fact: “I would like to run this test because I would like to rule this deficiency out as a possible trigger” often gets them to agree.

    Unfortunately doctors are often used to having patients show up asking for ridiculous testing that is unnecessary at that point in their treatment/management. It’s usually something someone picked up on the internet and are suddenly *sure* they have the condition. If you look relatively healthy, doctors are often reluctant at best to test for these deficiencies thinking erroneously that a patient who is deficient will look sick. That is what happened to me. It was only when I told him that I felt I needed to rule it out as a possible complication or trigger before giving up that he finally relented, and that was not without a fight.

    As to which doctor to see for this testing, any of them can order it. A neurologist or headache specialist will be most familiar with the connection between low levels and Migraine, as well as hopefully aware that your level for B12 needs to be at least 400 for neurological safety. That said, now that you know what to look for, just getting the test is the toughest part. Once you have your results, you can then take them to your neuro or HA specialist for action.

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