Epub 2021 Jul 2. By using this Site you agree to the following, By using this Site you agree to the following, Need relief - not sure what is going on - std or autoimmune, Had IV Infusion for possible MS, test results unclear, The Best IOL for 2022 RXSight Light Adjusted Lens, Will refractive surgery such as LASIK keep me out of glasses all my life. Nutrients. Autoimmune Diseases: Signs, Symptoms, and Complications - Verywell Health 2019 Aug 15;91(8):160-167. doi: 10.26442/00403660.2019.08.000378. As noted above, sometimes people are actually deficient in B-12. Google Scholar. Keywords: Autoimmune Metaplastic Atrophic Gastritis - Merck Manuals Professional 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. The site is secure. Correspondence to 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. Vitamin B12 helps the body replace nerve cells in the spine and additionally also reduce inflammation, a common cause of chronic back pain. contributed to interpretation of data and critically revised the manuscript for important intellectual content. These disease states result in an increased production of white blood cells including Granulocytes. All Rights Reserved. Without advertising income, we can't keep making this site awesome for you. Strength of the association of elevated vitamin B12 and solid cancers: An adjusted case-control study. Inflammation. 2014 Southwest Integrative Medicine. Raffick AR Bowen, Janet K Dale, Margaret Brown, Steven K Drake, Tarsilla Moura, Kennichi Dowdell, Alan T Remaley, Thomas A Fleisher, Glen L Hortin, Ebba Nexo, Stephen E Straus, V. Koneti Rao; Significantly Elevated Vitamin B12 Levels in Autoimmune Lymphoproliferative Syndrome (ALPS), a Rare Lymphoproliferative Disorder with Apoptosis Defect. So double-check you are not getting B-12 from various sources that you are not aware. SDS-PAGE and western blot analysis revealed the presence of HC in lymphocyte lysates of ALPS but not apparently healthy controls. These are disease of the bone marrow where the white blood cells come from. Arendt, J. F. H., Srensen, H. T., Horsfall, L. J. The study population included patients with at least two plasma B12 measurements without already known elevated-B12-related causes. 6 Degrees of Vitamin B12- B12 Deficiency and Autoimmune Disease The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. (Video) Diet That Tackles Symptoms of Autoimmune Diseases. & Lindemans, J. Hyperhomocysteinemia and functional cobalamin deficiency due to granulocytosis-induced alterations in the cobalamin-binding protein. Simonsen, K. et al. 28, 814821 (2019). The risk of solid cancer seems insufficient to systematically perform these invasive and expansive investigations in case of incidental discovery of elevated B12. 40, 11201127 (2011). B-12 uses three different carrier proteins to do this TCN 1, TCN 2, and TCN 3. Autoimmune metaplastic atrophic gastritis is an inherited autoimmune disease that attacks parietal cells, resulting in hypochlorhydria and decreased production of intrinsic factor. HHS Vulnerability Disclosure, Help The diagnosis of ALPS is based on clinical findings, laboratory findings, and identification of mutations in genes, such as FAS, that affect the programmed destruction of cells (apoptosis). J. 49, 10961102 (2014). Gimsing, P. Cobalamin metabolism in chronic myelogenous leukemia. Symptoms. Most people with vitamin B12 or folate deficiency anaemia have underdeveloped red blood cells . In this study, we limited the analyses to cancers occurring within 60months following B12 measurement, because it appeared to be difficult to establish the causal link between a subclinical solid cancer and an elevated plasma B12 beyond a period of 5years32,33,34,35. These control patients defined the NN (normal/normal) group. These are typical labs that are done in a general screening called CBC and Chem panel. Treatments. . Many times kidney disease is affected by inflammation and poor antioxidant capacity. Elevated B12 - General - Sjogren's Syndrome Support Brousselle, A. et al. You are using a browser version with limited support for CSS. They build public awareness of the disease and are a driving force behind research to improve patients' lives. Indeed, the frequency of incident diagnoses of chronic liver diseases (32/144, 22.2%) and myeloid blood malignancies (25/144, 17.4%) in the EE group also confirmed the interest in screening these pathologies in case of persistent elevated B125,18,19. Separate from kidney disease, inflammation can be another cause for elevated B-12 levels. To avoid this, we included the sex of patients as a variable of adjustment in the survival model and, finally, sex did not significantly influence the occurrence of cancer at 60months. BMJ Case Rep. 2022 Jan 13;15(1):e247660. contracts here. I also high MCH. Podzolkov VI, Dragomiretskaya NA, Dambaeva OT, Auvinen ST, Medvedev ID. Vitamin B 12 is an essential micronutrient that plays a fundamental role in cell division and one-carbon metabolism. Increased vitamin B12 levels are associated with mortality in critically ill medical patients. Epub 2012 Nov 25. van der Wal HH, Comin-Colet J, Klip IT, Enjuanes C, Grote Beverborg N, Voors AA, Banasiak W, van Veldhuisen DJ, Bruguera J, Ponikowski P, Jankowska EA, van der Meer P. Heart. There is no consensus on the definition of high or elevated B12. High B12 levels are found in many myloproliferative disease. In the case of incidental finding of elevated B12, the relevance of an active search for solid cancer necessitating invasive and expensive examinations remains debated5,18,19. 3. It is noteworthy that most of diagnosed neoplastic diseases were previously unknown and at a non-metastatic stage. A doctor may use the results of a vitamin B-12 test to help form their diagnosis. Search for other works by this author on: Thank you for submitting a comment on this article. High B-12 levels could be an epiphenomenon or related to a deeper issue with B-12 transportation. Biochem. ADS 9, 474 (2020). Arendt, J. F. B., Pedersen, L., Nexo, E. & Srensen, H. T. Elevated plasma vitamin B12 levels as a marker for cancer: A population-based cohort study. Remacha AF, Sard MP, Canals C, Queralt JM, Zapico E, Remacha J, Carrascosa C. Ann Hematol. The two major types of lymphocytes are B cells and T cells, which are derived from pluripotent hematopoietic stem cells in the bone marrow.https://en.wikipedia.org wiki Lymphoproliferative_disordersLymphoproliferative disorders - Wikipedia with Apoptosis Defect. Chem. 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. Serum Vitamin B12 was increased in 1186 (81.2%) patients, mainly middle-aged males, with sepsis, multiorgan failure, and higher 30-day mortality (all p < 0.01). So solid tumors are a cause of high B12 due to increased release of stored B12 and decreased uptake. All conditions may show elevated concentrations of B12 transport proteins. By submitting a comment you agree to abide by our Terms and Community Guidelines. Clin. Marsey October 5, 2018, 9:31pm 1. 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. Basophils account for less than 3% of the circulating white blood cells (0 to . This is why most often when you have an elevated B-12 level show up on your lab, it is ignored, pushed to the side. High IgA and B12 - Autoimmune Disorders - MedHelp High B-12 levels may indicate liver disease, diabetes, or another condition. In patients with three or more B12 measurements and at least one B121000ng/L, T1 was selected as the first test with B121000ng/L. Even though the title is "cause of high B-12 without supplementation," my experience helping people figure this out, they are taking B-12. Vitamin B 12 in serum is bound to two proteins, haptocorrin (HC) and transcobalamin (TC). The Status of Oxidative Stress in Patients with Alcohol Dependence: A Meta-Analysis. Clin. , All content found on the AutoimmuneSisters.com Website, including: text, images, audio, or other formats were created for informational purposes only. Vitamin B 12 also plays an important role in hematopoiesis and maintaining the integrity of the nervous system. In this study, characteristic of patients with serum vitamin B12 levels higher than 2500 pmol/L (high B12) were studied. Inflammation in the tail-end of your small intestine, called Ileitis, can have numerous causes. Careers. We therefore hypothesized that acute conditions could have temporarily raised the B12 level. & Petersen, I. Elevated vitamin B12 levels and cancer risk in UK primary care: A THIN database cohort study. Provided by the Springer Nature SharedIt content-sharing initiative. Non-cancerous swelling of the lymph nodes (lymphadenopathy) that lasts for more than six months, Autoimmune disease, especially against blood cells, Family history of ALPS or ALPS-like features. The hazard ratios (HR) were presented with a confidence interval of 95%. The mean age of patients in this subgroup was 46.6 years. Please check for further notifications by email. 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. Kingma TJ, Bascoy S, Altaf MD, Surampudy A, Chaudhry B. Cureus. Cancer-free survival in the 3 groups. While spleen enlargement can be severe in children with ALPS,splenic rupture is very rare. It also is normal for lymph nodes to change somewhat in size, shape, or feel over time. Epub 2007 Nov 9. Lambert, D. et al. hope this video was helpful in giving you a deeper understanding of the causes of elevated B-12 level without supplementation. The analyses were carried out using GRAPHPAD Prism v6.01 (GRAPHPAD SOFTWARE, La Jolla, CA, USA) and R software (version 3.5.1, R-project.org, Vienna, Austria). Before we get into this, we have to take first things first. . Research on the use of vitamin B-12 for specific activities and conditions shows: Heart and blood vessel disease. Autoimmune diseases, such as celiac disease, type 1 diabetes, . Jaundice , which is the yellowing of the skin and eyes. The proportional hazard assumption was checked with 2 different methods: graphically by plotting the log(minuslog) curves and by studying the interaction with time. On the contrary, we think that certain cancers would be, directly or indirectly, responsible for B12 elevation. Rev. Hematologic disorders like . government site. Dis. 17, 1 (2017). We assessed the prevalence of vitamin B12 deficiency in patients with AITD and whether their evaluation may be simplified by measuring fasting gastrin levels. This site needs JavaScript to work properly. As noted Granulocytes have an affinity for producing the TCN 1 and TCN3 and not so much of the TCN 2. Disclosures: No relevant conflicts of interest to declare. Vitamin B12 or folate deficiency anaemia occurs when a lack of either of these vitamins affects the body's ability to produce fully functioning red blood cells. Solid cancers represent one of the main diagnoses found in patients with unexplained and persistent elevated B12. An elevated B12 is generally defined as a level higher than the upper limit of the normal range, around 1000100ng/L (73873.8pmol/L)2,3,4. When I was initially hospitalised in 2014, I showed a reading of 1353 (with 200-900 being the normal . It is needed to absorb vitamin B 12. Paradoxically, hypercobalaminaemia can be associated with a functional B12 deficiency. In some people, high levels of B12 may cause gastrointestinal problems such as bloating and diarrhea. Pregnant and breastfeeding women may also need to be especially mindful of B12 levels. The chemical name for B-12 is cobalamin and it has to be bound to a carrier protein to move through the blood and more importantly into the cell. 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. The B12 measurements were centralized in the biochemistry laboratory of Angers University Hospital. These particular transport proteins are made more commonly in certain cell lines like the granulocytes, a type of white blood cell. 2013 Apr;92(4):527-31. doi: 10.1007/s00277-012-1634-8. An official website of the United States government. doi: 10.7759/cureus.31936. Anemia occurs when the body destroys its own red blood cells,causingweakness and fatigue. Clin Chem. Blood concentrations of vitamins B1, B6, B12, C and D and folate in palliative care patients: Results of a cross-sectional study. 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. Med. The https:// ensures that you are connecting to the I have also been on metformin 12 years and know that can lead to b12 deficiency. Prevalence of high B12 was evaluated during a 10-month period. Jo. What causes high vitamin B12 levels without supplements? The information in the article is based a research paper that can be found here (, The causes of high B-12 levels without supplementation are numerous. One of the main causes of increased vitamin B12 with liver disease is release . Abnormally elevated B12 has been attributed many causes [5,6], e.g., myeloid blood malignancies [7,8,9], acute or chronic liver diseases [10,11,12], chronic kidney failure, autoimmune or inflammatory diseases [3], and Gaucher disease [13]. This supports the presence of undiagnosed subclinical cancer rather than a hypothetical role of the elevated B12 in the development of cancer. FOIA Prevalence of high B12 was 1.3%. 5, 2 (2016). Indeed, vitamin B12 is the cofactor of methionine synthase, which is implicated in methylation reaction and in the synthesis of purine bases29,30, and these functions are crucial in tumor-initiating cells and cell proliferation30,31. Ter Arkh. 196 likes, 10 comments - CultivateElevate (@cultivateelevate) on Instagram: "We talk about Soy and why it should be avoided. We compared the cancer-free survival during 60months between the groups after adjustment for the other elevated-B12-related causes in a survival competing risk model. Med. Would you like email updates of new search results? No consensus exists concerning a diagnostic strategy in case of incidental finding of elevated B125,18,19. The prognostic nature of elevated B12 in solid cancers suggested the question of a possible link with the tumor mass or the capacity for proliferation20. A. We know that where there is one autoimmune disease, others can be present. Can autoimmune diseases cause high B12? Elevated levels of serum cobalamin may be a sign of a serious, even life-threatening, disease. (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. & Baker, E. R. Cobalamin (vitamin B12) and holotranscobalamin changes in plasma and liver tissue in alcoholics with liver disease. The pathophysiology of elevated vitamin B12 in clinical practice. Blood 2008; 112 (11): 4898. doi: https://doi.org/10.1182/blood.V112.11.4898.4898. What Do High B12 Levels Mean? - PA Relief People with severely low levels of B12 may need more shots in the beginning. Haematologica 91, 394396 (2006). 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. The second hypothesis is that of the release of haptocorrins by the granulocytic cells involved in the anti-tumor response. & Thachil, J. Vitamin B12 deficiency: A 21st century perspective. PubMed 2012 Oct 31;8(360):2072-4, 2076-7. In studies evaluating the association between solid cancer and elevated B12, a single measurement was sufficient to define an elevated B12 level1,16,17. showed that the SIR of cancers was higher within the year following B12 measurement than in subsequent years16. The plasma vitamin B12 (B12) measurement is mainly conducted to detect vitamin B12 deficiency, but the incidental finding of elevated B12 is not uncommon1,2. Seijo, L. M. et al. Is high vitamin B12 status a cause of lung cancer? Researchers had previously believed that vitamin B-12, when combined with folic acid (vitamin B-9) and vitamin B-6, might prevent diseases of the heart and blood vessels by reducing the levels of an amino acid in the blood (homocysteine). The aetiological profile of high serum cobalamin predominantly encompasses severe disease entities for which early diagnosis is critical for prognosis. The authors declare no competing interests. Med. 9 Best Vitamin B12 Supplements in 2023, According to Health Experts High serum concentration of cobalamin is a common but underestimated finding. 2015 Feb;101(4):302-10. doi: 10.1136/heartjnl-2014-306022. J. Inborn Errors Metab. Bowen RA, Drake SK, Vanjani R, Huey ED, Grafman J, Horne MK 3rd. Combined cobalamin and iron deficiency anemia: a diagnostic approach using a model based on age and homocysteine assessment. What stocks should I buy in a bear market? These particular transport proteins are made more commonly in certain cell lines like the granulocytes, a type of white blood cell. This raises the question of the potential interest in repeating investigations 1year later. These may include: Fatigue. Sometimes, these enlarged lymph nodes are confused with cancer of the lymph gland, or lymphoma. J. Some people with autoimmune diseases may get a negative test result for ANA but positive result for other antibodies. So if you are finding high B-12 levels and elevated methylmalonic acid, you would want to supplement with B-12 until that methylmalonic acid goes down. Arendt, J. F. H., Farkas, D. K., Pedersen, L., Nexo, E. & Srensen, H. T. Elevated plasma vitamin B12 levels and cancer prognosis: A population-based cohort study. Follow-up was limited at 60months. These results could help to select patients in whom the screening for solid cancers would be of interest. In the meantime, to ensure continued support, we are displaying the site without styles This study included patients aged 18years and over, admitted to Angers University Hospital between January 2007 and May 2015. 51, 545 (2013). What autoimmune diseases cause high B12 levels? Vitamin B-12 - Mayo Clinic The most common rise in immunoglobulin levels is polyclonal, and due to immune system activity caused by infection or autoimmune diseases. Moreover, thyroid disease is often caused by autoimmune disease (Hashimoto's thyroiditis). 8600 Rockville Pike 31, 5359 (2012). Geoffrey Urbanski. The categorical data were presented as absolute values and as percentages and were compared using Chi-squared test. 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. 44, 203221 (2016). 2023 Cryptoguiding. Vollbracht C, Gndling PW, Kraft K, Friesecke I. J Int Med Res. Now this doesn't necessarily explain the elevated B-12 levels but it does explain how one can be deficient in B-12 in the presence of higher serum B-12 levels. The aetiology of hypercobalaminaemia includes excess vitamin B12 intake, solid neoplasms, haematological malignancies, liver disease, renal failure and autoimmune diseases. The quantitative data were presented in medians and quartiles and compared using a Student t test or an ANOVA. 24. 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. Coll. Patients with identified elevated-B12-related causes including a solid cancer before/at T1 were excluded. I have every symptom of b12 deficiency--sensory neuropathy, fatigue, cold extremeties, paleness. Experts have also found high levels of homocysteine in people with coronary heart disease and stroke. Eur. Chiche, L. et al. The mechanism of elevated B12 in case of solid cancer is poorly understood5,6,20. Arshad, M. et al. In the absence of B121000ng/L, T1 was randomly selected between the first and the penultimate B12 measurement. What vitamin Am I lacking if my joints hurt? Among the causes of elevated B12, incident myeloid blood malignancies and chronic liver diseases were more frequent in the EE group (p<0.001 and p<0.001, respectively). Methods: What should I study to work in blockchain? Copyright 2023 by American Society of Hematology, https://doi.org/10.1182/blood.V112.11.4898.4898, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, 5-methyltetrahydrofolate-homocysteine s-methyltransferase. ALPS is a rare autoimmune disease in children resulting from defective lymphocyte apoptosis and is characterized by lymphoproliferation, peripheral accumulation of DNT cells (double-negative T cells; TCR alpha/beta +, CD3+ CD4 CD8), often leading to autoimmune multilineage cytopenias. So what is actually causing the high B-12 levels? So how does B-12 get into the cell? Unable to load your collection due to an error, Unable to load your delegates due to an error. I do have Hashimotos and have been on medication for years but had a relapse recently when all these symptoms appeared (TSH was 10). The 344 patients in the NN group were randomly selected from the 7,889 patients with plasma B12<1000ng/L at T1 and T2. 19, 13571360 (1973). Solid cancers were defined as non-hematological malignancies. In patients with repeatedly high B12 levels, ICs were detected in approximately 25% of samples. 14, 343357 (2019). Nat. Your immune system's response affects your body's ability to absorb vitamin B12. High B12, High Folate, High MCH and b12 deficiency symptoms Federal government websites often end in .gov or .mil. Doctors may perform additional blood tests to help diagnose ALPS. In a previous video we talked about What Does A High B-12 Level Mean and some things to think about with that. What does it mean if your B12 is too high? Uptake of cobalamin and markers of cobalamin status: a longitudinal study of healthy pregnant women. A . & Nexo, E. Unexpected high plasma cobalamin/Proposal for a diagnostic strategy. The study population included 688 patients with a median age of 79 [6486] years. Minimally Invasive Surg. What happens when vitamin B12 is very high? 11, 110 (2011). $25 at Amazon. Vitamin B12 in serum is bound to two proteins, haptocorrin (HC) and transcobalamin (TC). The exact function of this HC-bound vitamin B12 is unknown (holo-HC), but it is believed to be biologically unavailable to most cells. The pathophysiology of elevated vitamin B12 in clinical practice Samples with high B12 were incubated with polyethylene glycol (PEG) and a new measurement of vitamin B12 was carried out using the supernatant. 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. 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. We offer this Site AS IS and without any warranties. Additionally, an increase in serum vitamin B12 can indicate lymphoproliferation in the form of ALPS caused by mutations in the FAS gene (ALPS-FAS). Slider with three articles shown per slide. High levels of these substances in your body are a sign of pernicious anemia. They sometimes just are not aware of it. doi: 10.1002/pul2.12173. Reviews: 88% of readers found this page helpful, Address: Suite 835 34136 Adrian Mountains, Floydton, UT 81036, Hobby: Skimboarding, Photography, Roller skating, Knife making, Paintball, Embroidery, Gunsmithing. Keep reading on to find . Hampered vitamin B12 metabolism in gaucher disease?. Results: 2022 Sep 28;11(10):1919. doi: 10.3390/antiox11101919. Andres, E., Serraj, K., Zhu, J. However, a falsely normal or high value of vitamin B12 in the blood may occur if antibodies interfere with the test. 11, 715 (2013). What is it called when a prisoner goes back to jail? The persistence of elevated B12 was associated with a high incidence of solid cancer at 60months, in contrast to a transient B12 elevation. Green, R. et al. 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. Elevated plasma vitamin B12 concentrations are independent predictors of in-hospital mortality in adult patients at nutritional risk. 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. pathophysiology of elevated vitamin B12 in clinical practice An elevated B12 level was defined as1000ng/L1,4,24,25,26. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. How Much Water Do You Really Need Each Day? 2. https://www.westonaprice.org/soy-alert . Bookshelf Causes Of High B12 Without Supplementation, In this article we will discuss the causes of high B-12without supplementation. Lab. 2020 Oct 9;18(1):307. doi: 10.1186/s12916-020-01771-y. 2022 Nov 27;14(11):e31936. GP60 Clinical utility of elevated vitamin B12 levels with a 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. An official website of the United States government. Significantly Elevated Vitamin B12 Levels in Autoimmune Lymphoproliferative Syndrome (ALPS), a Rare Lymphoproliferative DisorderLymphoproliferative DisorderLymphoproliferative disorders are a set of disorders characterized by the abnormal proliferation of lymphocytes into a monoclonal lymphocytosis. All patient records have been fully reviewed. 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. When you have inflammation or damage to the cell membranes the transport mechanisms that allow the TCN 1 to take the B-12 through the cell membrane may be altered.
high b12 levels and autoimmune disease
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