High B12 levels are found in many myloproliferative disease. The association between elevated B12 and solid cancers was demonstrated by two population-based studies: a B12>800pmol/L (1084ng/L) was associated with a diagnosis of cancer in the following year with a Standardized Incidence Ratio of 6.3 [95% CI 5.76.9] in a Danish cohort16, and a B12 between 800 and 1000pmol/L (10841355ng/L) was associated with an Incidence Rate Ratio of 2.9 [95% CI 2.43.5] in a British cohort17. Ermens AA, Vlasveld LT, van Marion-Kievit JA, Lensen CJ, Lindemans J. Ned Tijdschr Geneeskd. What vitamin Am I lacking if my joints hurt? The persistence of elevated B12 was associated with a high incidence of solid cancer at 60months, in contrast to a transient B12 elevation. We assessed the prevalence of vitamin B12 deficiency in patients with AITD and whether their evaluation may be simplified by measuring fasting gastrin levels. The alpha risk was 5%. How do I send cardless cash with capitec? However, this would identically impact the 3 groups. Indeed, few studies analyzed the incidence of solid cancers following the incidental finding of elevated B12 and no studies linked elevated B12 to solid cancer after adjusting for other causes of elevated B12. Use of vitamin B12 in patients with elevated serum homocysteine levels and cardiovascular disease does not reduce the risk of myocardial infarction or stroke, or alter cognitive decline. What can I invest 20 dollars in to make money? Elevated B12 has been associated with various diseases 1,5,6: liver diseases 7,8,9,10, myeloid blood malignancies 10,11,12,13, chronic renal failure 3,14, autoimmune or inflammatory diseases 3 . CAS Pernicious anemia is an autoimmune condition that happens when your immune system produces antibodies that attack cells in the mucosal lining of your stomach and nerve cells. Results: Twenty six patients with ferritin levels between 10,000-15,000 ng/ml were identified. This can lead to elevated B-12 levels due to poor uptake of B-12 in the liver cells. This is how inflammation starts and is perpetuated. Incident solid cancer was diagnosed in 30/144 (20.8%) patients in the EE group, 12/200 (6.0%) in the EN group and 13/344 (3.8%) in the NN group (p<0.001). Karin Amrein, Mario Scherkl, Oliver Malle, Arash Shirvani, Tyler Arek Kalajian, Michael F. Holick, Armin Zittermann, Heiner K. Berthold & Stefan Pilz, Astrid Lipplaa, Ricardo Fernandes, Pippa G. Corrie, Deirdre K. Tobias, Aditi Hazra, Samia Mora, Visalini Nair-Shalliker, Albert Bang, David P. Smith, M. Rebecca Heiner-Fokkema, Ineke J. Riphagen, Wilhelmina H. A. de Jong, Agustina A. M. B. Hastuti, Marta Costas-Rodrguez, Frank Vanhaecke, Scientific Reports Autoimmune thyroid disease, also called Hashimoto's disease, is an autoimmune disease that causes hypothyroidism, or an underactive thyroid gland. In the absence of B121000ng/L, T1 was randomly selected between the first and the penultimate B12 measurement. As a pilot study, 26 frozen samples with high B12 were evaluated for changes in vitamin B12 after PEG. NCI CPTC Antibody Characterization Program. The proportional hazard assumption was checked with 2 different methods: graphically by plotting the log(minuslog) curves and by studying the interaction with time. Causes Of High B12 Without Supplementation, In this article we will discuss the causes of high B-12without supplementation. The major clinical symptoms of ALPS result from lymphoproliferation, or the excessive production of a type of white blood cell called a lymphocyte, and autoimmune destruction of blood cells. Vitamin D supplements may treat joint pain in some people who have a vitamin D deficiency. To date, the mechanism of the elevated vitamin B12 concentrations in ALPS patients has not been determined and we sought to explore the source of elevated vitamin B12. Functional cobalamin deficiency can thus occur at any serum level. High blood B12 levels can occur in liver conditions such as cirrhosis and hepatitis. Hinkel J, Schmitt J, Wurm M, Rosenbaum-Fabian S, Schwab KO, Jacobsen DW, Spiekerkoetter U, Fedosov SN, Hannibal L, Grnert SC. The aetiological profile of high serum cobalamin predominantly encompasses severe disease entities for which early diagnosis is critical for prognosis. Patients gave informed consent. High B-12 levels could be an epiphenomenon or related to a deeper issue with B-12 transportation. 2019 Aug 15;91(8):160-167. doi: 10.26442/00403660.2019.08.000378. Strength of the association of elevated vitamin B12 and solid cancers: An adjusted case-control study. 2014 Southwest Integrative Medicine. BMC Nephrol. Presse Med. 2021 Sep;1(1):2. doi: 10.20517/mtod.2021.02. Please enable it to take advantage of the complete set of features! The risk of solid cancer seems insufficient to systematically perform these invasive and expansive investigations in case of incidental discovery of elevated B12. Vitamin B 12 and its binding proteins in hepatocellular carcinoma and chronic liver diseases. Vitamin B 12 in serum is bound to two proteins, haptocorrin (HC) and transcobalamin (TC). The .gov means its official. Of these patients, 10/26 (38%) had elevated ferritin levels secondary to liver disease, 7/26 (27%) malignancy/infection, 6/26 (23%) malignancy alone, 1/26 (4%) autoimmune disease, and 1/26 (4% . High serum vitamin B12 concentrations have been observed in patients with ALPS studied at NIH Clinical Center. One of them is called methylmalonic acid and the other one is called homocysteine. The B12 normal range for healthy adults is between 160 to 950 picograms per milliliter (pg/mL). A . Patients in our study were hospitalized, so the results need to be confirmed in an outpatient population. An unexplained elevated B12 level should be confirmed later by a second measurement, which could help to identify patients in whom the screening for solid cancers would be of interest. Minimally Invasive Surg. Anemia occurs when the body destroys its own red blood cells,causingweakness and fatigue. Google Scholar. The tests were carried out on an immunoanalytical system ADVIA Centaur (SIEMENS HEALTHCARE DIAGNOSTICS Inc. Tarrytown, NY, USA) with ADVIA Centaur VB12 reagents. The quantitative data were presented in medians and quartiles and compared using a Student t test or an ANOVA. doi: 10.1002/pul2.12173. Vitamin B 12 is an essential micronutrient that plays a fundamental role in cell division and one-carbon metabolism. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. Assessment of the serum levels of hemoglobin, ferritin, and vitamin B12 in a sample of Iranian population with morbid obesity. In this study, characteristic of patients with serum vitamin B12 levels higher than 2500 pmol/L (high B12) were studied. The study population included 688 patients with a median age of 79 [6486] years. The objective of this study was to evaluate the proportion of incident solid cancers in patients with persistent elevated B12 level, compared to patients without elevated B12 and to patients with non-persistent elevated B12. Your homocysteine and methylmalonic acid (MMA) levels. The .gov means its official. Serefhanoglu S, Aydogdu I, Kekilli E, Ilhan A, Kuku I. Ann Hematol. The incidence of solid cancers in the EE group argues for checking the persistence of B12 elevation to justify investigations in case of incidental finding of B12 elevation. Inflammation is very nonspecific but various cases of autoimmune disease, like lupus etc have been described as causing elevated B-12 levels. Vitamin B12 binds with transcobalamin (TC) II. Glomerulonephritis (inflammation of the kidneys). (Video) Cause of High B12 Level Without Supplementation, (Video) Autoimmune Issues & Mental Health: Understanding the Interactions, (Video) Autoimmunity causing B12 Deficiency, (Video) Causes of Vitamin B12 Deficiency | In-Depth Overview including Medications, Diseases & Fish Tapeworm, (Video) Understanding Pernicious Anaemia (B12 Deficiency), (Video) Woman Believed She Was Going to Die Due to B12 Deficiency Symptoms | This Morning. The influence of covariate (including age, sex, and all the elevated-B12-related causes) on the occurrence of solid cancer was evaluated with a survival competing risk model (package cmprsk from R) with the death as the competing risk. Careers. 25. (Video) What Does It Really Mean If You Have High B12 Levels? The first thing to consider and rule out is solid tumors as they can cause elevated B-12 levels. Orphanet J Rare Dis. Such changes are usually not indicative oflymphoma. 9. Have been feeling generally unwell for quite a few years with a lot of joint pain,been suggested it could be fibromyalgia. While spleen enlargement can be severe in children with ALPS,splenic rupture is very rare. The most common rise in immunoglobulin levels is polyclonal, and due to immune system activity caused by infection or autoimmune diseases. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Br. It is caused by one of the following: Lack of intrinsic factor. Serraj, K., Mecili, M., Housni, I. Lab. Geriatrics. Consequences include atrophic gastritis, B12 malabsorption, and, frequently, pernicious anemia. Cancer Epidemiol. High or supraphysiological serum B12 levels without supplementation have been associated with many pathological conditions including renal failure, haematological disorders, cancer, and hepatic or autoimmune diseases. Significance of elevated cobalamin (vitamin B12) levels in blood. sharing sensitive information, make sure youre on a federal J. Natl. Samples with high B12 were incubated with polyethylene glycol (PEG) and a new measurement of vitamin B12 was carried out using the supernatant. This one will focus on steps to take, labs to do etc. The goal of treatment is to increase your vitamin B12 level: Treatment involves a shot of vitamin B12 once a month. Why vitamin B12 deficiency should be managed aggressively. PubMed 2022 Oct 25;14(21):4476. doi: 10.3390/nu14214476. Even though the title is "cause of high B-12 without supplementation," my experience helping people figure this out, they are taking B-12. Results from 26 frozen samples and from a prospective study (28 cases) showed that undergoing vitamin B12 treatment was the main cause of high B12. Hepatitis and Hepatocellular Carcinoma can also lead to increase release of B-12 from the cells being damaged. and transmitted securely. HHS Vulnerability Disclosure, Help Thrombocytopenia occurs when the body attacks and destroys blood components called platelets. Zhao, L., Wei, Y., Song, A. Methods: Serum B12 levels was measured in 115 patients with AITD (7 men . Uptake of cobalamin and markers of cobalamin status: a longitudinal study of healthy pregnant women. The Status of Oxidative Stress in Patients with Alcohol Dependence: A Meta-Analysis. What autoimmune diseases cause high B12 levels? I do have Hashimotos and have been on medication for years but had a relapse recently when all these symptoms appeared (TSH was 10). Why is a vitamin B-12 level test useful? Doctors may perform additional blood tests to help diagnose ALPS. What should I study to work in blockchain? What level of B12 is dangerously high? MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. Persistent elevation of plasma vitamin B12 is strongly associated with solid cancer, https://doi.org/10.1038/s41598-021-92945-y. Vitamin B12 is an essential micronutrient that plays a fundamental role in cell division and one-carbon metabolism. The remainder of vitamin B12 is bound to TC (holo-TC). ALPS-related autoimmunity uncommonly targets organs, leading to rare complications such as. 8600 Rockville Pike Chem. Arendt, J. F. H., Srensen, H. T., Horsfall, L. J. Alcoholic liver disease is an example of a liver condition associated with high vitamin B12. Compared with the reference NN group, the EE group was associated with the occurrence of solid cancers with or without metastases (p<0.001 and p<0.001, respectively), contrary to the EN group (p=0.56 and p=0.38, respectively). Scand. . 26. All patient records have been fully reviewed. Article [Hypervitaminosis B12 - a new marker and predictor of prognostically unfavorable diseases]. In contrast, people with ALPS often have abnormally low levels of HDL (high density lipoprotein) and total cholesterol. As noted Granulocytes have an affinity for producing the TCN 1 and TCN3 and not so much of the TCN 2. Nat. There is no consensus on the definition of high or elevated B12. Most commonly it would be liver tumors, hepatocellular carcinoma in particular. Which company is going to merge with Tata Steel? Levels of Vitamin B12 detected in these patients range from 742 to 35365 pmol/L (median: 2489 pmol/L; mean: 4123 pmol/L; reference interval: 162708 pmol/L) among 137 patients compiled for this study (Vitamin B12: 1pmol/L=1.355 pg/mL). eCollection 2022 Nov. Kwant CT, van der Horst FAL, Bogaard HJ, de Man FS, Vonk Noordegraaf A. Pulm Circ. Basophils are a type of white blood cell that have some role in immune surveillance (such as detecting and destroying very early cancers) and wound repair. High levels of these substances in your body are a sign of pernicious anemia. Biomark. 9, 474 (2020). The swollen lymph nodes in the neck, armpit, and groin are usually the most noticeable symptoms of the disease. This symptom is one of the early warning indicators of Vitamin B12 overdose. How Much Water Do You Really Need Each Day? 1. Complications. Prev. Before A list of national and international resources and hotlines to help connect you to needed health and medical services. As you will see below look at some of the problems that can come up with the transcobalamin transport proteins and various diseases that can cause elevated B-12 when you're not supplementing with B-12. Interne 29, 187194 (2008). hope this video was helpful in giving you a deeper understanding of the causes of elevated B-12 level without supplementation. These disease states result in an increased production of white blood cells including Granulocytes. What vitamin Am I lacking if my joints hurt? As noted Granulocytes have an affinity for producing the TCN 1 and TCN3 and not so much of the TCN 2. This type of B 12 deficiency anemia is called pernicious anemia. & Lindemans, J. Hyperhomocysteinemia and functional cobalamin deficiency due to granulocytosis-induced alterations in the cobalamin-binding protein. Res. 196 likes, 10 comments - CultivateElevate (@cultivateelevate) on Instagram: "We talk about Soy and why it should be avoided. What happens when vitamin B12 is very high? Now in a previous video we talked about how liver disease and cell membrane issues can be implicated in elevated B-12 levels. Most people with vitamin B12 or folate deficiency anaemia have underdeveloped red blood cells . In our study, an increased risk of cancer was associated with patients having a persistent elevated B12 (group EE) but not with those showing transient elevated B12 (group EN). Methionine is a metabolic dependency of tumor-initiating cells. What autoimmune diseases cause high B12 levels? 25, 825837 (2019). In other words, about 1 in 5 patients will develop ALPS lymphoma by the time they are 40. FOIA PubMed Central https://www.westonaprice.org/soy-alert . Med. T2 was the test immediately following T1 with at least 1month between T1 and T2. The patients with elevated plasma B12 at first measurement were split into 2 groups, according to the presence (EE group, n=144) or the absence (EN group, n=200) of persistent elevated plasma B12 at second measurement. Oncol. Autoimmune metaplastic atrophic gastritis is an inherited autoimmune disease that attacks parietal cells, resulting in hypochlorhydria and decreased production of intrinsic factor. The higher proportion of men in the EE group could have biased the risk of incident cancer, since men are more exposed to environmental risk factors36. 28, 814821 (2019). As a result, there is more binding of the B-12 but less of it is getting taken up into the cells because it's all bound by non-functional transport proteins. As noted above, sometimes people are actually deficient in B-12. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Google Scholar. Vitamin B12 helps the body replace nerve cells in the spine and additionally also reduce inflammation, a common cause of chronic back pain. Med. Trring, M. L., Frydenberg, M., Hansen, R. P., Olesen, F. & Vedsted, P. Evidence of increasing mortality with longer diagnostic intervals for five common cancers: A cohort study in primary care. Association study between genome-wide significant variants of vitamin B12 metabolism and gastric cancer in a han Chinese population: Unexpected Role of Vitamin B12 Metabolism Genes. Zibold J, von Livonius B, Kolarova H, Rudolph G, Priglinger CS, Klopstock T, Catarino CB. It's also rich in protein, which is good for cellular repair. However, total and holo-TC levels (1210 pmol/L; reference interval: 5001500 pmol/L and 143 pmol/L; reference interval: >40 pmol/L, respectively) were not elevated in ALPS patients. ADS We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Alcoholic cirrhosis and cobalamin metabolism. Events only referred to solid cancers and not to blood malignancies. Arendt, J. F. B. This site needs JavaScript to work properly. CAS Int. People who have low levels of vitamin D often have joint pain. Vitamin B 12 also plays an important role in hematopoiesis and maintaining the integrity of the nervous system. Whiteman, D. C. & Wilson, L. F. The fractions of cancer attributable to modifiable factors: A global review. Hannibal, L. et al. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Vitamin B12, or cobalamin, is often associated with energy, but this nutrient is necessary for many vital processes in the human body. Green, R. et al. An elevated B12 level was defined as1000ng/L1,4,24,25,26. Clin. The occurrence of solid cancers in 20.8% of patients in the EE group could justify careful clinical surveillance and raises the question of carrying out complementary investigations. Sometimes, these enlarged lymph nodes are confused with cancer of the lymph gland, or lymphoma. & Li, Y. Control patients were randomly selected among those with B12<1000ng/L at T1 and T2, with a ratio 1:1, matching for sex, age and the number of B12 measurements (2, 3,4) during the study period. The categorical data were presented as absolute values and as percentages and were compared using Chi-squared test. What does it mean if your B12 is too high? Search for other works by this author on: Thank you for submitting a comment on this article. There were 256/688 men (37.2%), and the median time from T1 to the last hospitalization or consultation was 3.2 [1.55.2] years. This study included patients aged 18years and over, admitted to Angers University Hospital between January 2007 and May 2015. Immune complexes; pernicious anemia; transcobalamin; vitamin B12. Elevated plasma vitamin B12 has been associated with solid cancers, based on a single B12 measurement. To obtain Greibe, E. et al. Cancer 116, 14991504 (2017). 11, 715 (2013). With liver cancer some of the liver cells are damaged as a result the liver cell are are not expressing as many B-12 receptors. A low level of vitamin B12 in the blood indicates pernicious anemia. Arthritis, one of the leading causes of joint pain can also be worsened due to deficiency of Vitamin B12. These are disease of the bone marrow where the white blood cells come from. Clin. ISSN 2045-2322 (online). The B12 measurements were centralized in the biochemistry laboratory of Angers University Hospital. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 44, 203221 (2016). Uveitis (inflammation of the iris in the eye). Therefore, malabsorption of vitamin B-12 is quite likely to occur in patients with CD. They sometimes just are not aware of it. Clin. If someone has been on any form of a supplement containing B12, it can leave the serum levels of B12 elevated for a long time afterwards. Additionally, an increase in serum vitamin B12 can indicate lymphoproliferation in the form of ALPS caused by mutations in the FAS gene (ALPS-FAS). Dizziness. Unauthorized use of these marks is strictly prohibited. On the contrary, we think that certain cancers would be, directly or indirectly, responsible for B12 elevation. All Rights Reserved. What is the biggest northern pike ever caught in the United States? Sviri, S. et al. What stocks should I buy in a bear market? However, ICs were detected in 10 frozen samples and in seven cases (25%) of the prospective study, respectively. Cancer 49, 21872198 (2013). An association between elevated B12 and solid cancers has been demonstrated by two population-based cohort studies16,17 and persists after adjustment for the other elevated-B12-related causes1. Epub 2021 Jul 2. The https:// ensures that you are connecting to the The first hypothesis consists in the secretion of a tumor mediator increasing the bioavailability of vitamin B12, promoting the synthesis of nucleic acids by cancer cells. 17, 235238 (1998). Prevalence of high B12 was 1.3%. Can autoimmune diseases cause high B12? High or supraphysiological serum B12 levels without supplementation have been associated with many pathological conditions including renal failure, haematological disorders, cancer, and hepatic or autoimmune diseases. Your comment will be reviewed and published at the journal's discretion. 17, 1 (2017). Reduce the amount of animal-derived foods that appear in your diet, as they contain vitamin B12. Therefore the B-12 justcirculates and never gets into the cells. Vlasveld, L. T., Bos, G. M. J., Ermens, A. Thrombocytopenia can lead to nosebleeds, gum bleeds, and bruises. We applied the strengthening the reporting of observational studies in epidemiology (STROBE) statement to observational studies. Cancer Epidemiol. Thus, doctors should monitor patients with ALPS for symptoms of lymphoma, such as night sweats, fever, fatigue, weight loss, loss of appetite, and sudden lymph node enlargement. PMC McMahon, G. M. et al. Pregnant and breastfeeding women may also need to be especially mindful of B12 levels. https://doi.org/10.1038/s41598-021-92945-y, DOI: https://doi.org/10.1038/s41598-021-92945-y. The pathophysiology of elevated vitamin B12 in clinical practice. At least one cause of elevated B12 was diagnosed in the follow-up of 75/144 (52.1%) patients in the EE group, 34/200 (17.0%) in the EN group, and 38/448 (11.0%) in the NN group (p<0.001, Table 1). This part of the small intestine is where vitamin B 12 is absorbed. Between January 2007 and May 2015, 9,198 patients underwent at least 2 measurements of B12 in our center, excluding the intensive care and maternity units. [Hypervitaminemia B12 (high level of cobalamin): physiopathology, role and interest in clinical practice]. 40, 158165 (2016). 5, 232640981769235 (2017). Nutrients 9, 1 (2016). We cannot exclude that the elevated B12 level may have prompted some physicians to look for underlying cancer in patients of the EE and EN groups, but this limitation is imbalanced by the prolonged follow-up (3.2 [1.55.2] years in the whole population, with a longer follow-up in the NN group), which could have enabled detection of cancers that have not been actively searched initially. Conditions that can increase B12 level include: Liver disease (such as cirrhosis or hepatitis) Myeloproliferative disorders (for example, polycythemia vera and chronic myelogenous leukemia). Increased vitamin B12 serum may be due to: Didn't find the answer you were looking for? , All content found on the AutoimmuneSisters.com Website, including: text, images, audio, or other formats were created for informational purposes only. Treatments. NIAID scientists also found that people with ALPS-FAS tend to have much higher B12 levels than do healthy people without this condition. 4, 5 All conditions may show elevated concentrations of B12 transport proteins. Andres, E., Serraj, K., Zhu, J. Bookshelf This still can be the cause of high B-12 without supplementation but there could be other, more serious, reasons for this as well. official website and that any information you provide is encrypted We anticipated this bias using a survival competing risk model with the death as the competing risk. In any case of persistently elevated B-12 levels, you should be explored the other things noted above with preliminary labs to make sure you don't have problems with your white blood cells, kidneys, liver, etc. (Video) Diet That Tackles Symptoms of Autoimmune Diseases. We collected the incident elevated-B12-related causes, including solid cancers, which appeared within 60months following T1, and their date of occurrence. Radio- and enzyme immunoassays, size-exclusion chromatography, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), western blot, and flow cytometry techniques were used to identify and quantitate the source of the elevated vitamin B12 concentrations in peripheral blood specimens from ALPS patients and controls. This condition may not cause symptoms in the early stages. 19, 13571360 (1973). Clipboard, Search History, and several other advanced features are temporarily unavailable. Pernicious anemia is an autoimmune condition in which the body can't absorb vitamin B12 correctly. The mean age of patients in this subgroup was 46.6 years. Scientific Reports (Sci Rep) In studies evaluating the association between solid cancer and elevated B12, a single measurement was sufficient to define an elevated B12 level1,16,17. [Therapeutic and clinical implications of elevated levels of vitamin B12]. A codified approach is needed to determine the potential indications of a search for high serum cobalamin and the practical clinical strategy to adopt upon discovery of elevated cobalamin levels. Shipton, M. J. Is high vitamin B12 status a cause of lung cancer?. Before we get into this, we have to take first things first. Lacombe, V., Chabrun, F., Lacout, C. et al. Some causes can be explored with simple investigations (blood count, renal function evaluation, liver cytolysis and cholestasis parameters, and liver echography) but solid cancer exploration often requires imaging or endoscopic examinations. Moreover, a prospective study was carried out during three consecutive months. Further studies are needed to elucidate the mechanism for the increased synthesis and secretion of HC from lymphocytes of ALPS patients, but altered cytokine profiles, including increased interleukin-10 levels in ALPS may contribute. 21. 51, 545 (2013). So how does B-12 get into the cell? Both of which would be elevated in the presence of B-12 deficiency. & Baker, E. R. Cobalamin (vitamin B12) and holotranscobalamin changes in plasma and liver tissue in alcoholics with liver disease. In some people, high levels of B12 may cause gastrointestinal problems such as bloating and diarrhea. spokane police scanner codes, garden kneeler on wheels, fear of closing eyes in shower,
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