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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