As I discuss later very high levels of B12 are caused by a number of serious diseases, not vice versa. Vitamin B12 and your liver health Liver disease can cause B vitamin deficiencies, mostly due to poor diet. Vitamin B12 Test and Extremely High Blood Levels. I am not an mathematician, in particular not a statistician, so I have to accept their word for it that these were the correct statistical techniques – it is however true to say (I am not claiming this for this study) that incorrectly applied statistical techniques are sometimes  used in studies and distort the results. They used Kaplan-Meier curves and Kruskal-Wallis test, chi squared and various other statistical techniques to adjust for the variables between the groups, compute the mortality and calculate so called statistical significance in the result.  |  5 Biological gradient –this an alternative way of saying “dose response”. 2012 Oct 31;8(360):2072-4, 2076-7. Hence we see the polemic statements “high B12 levels nearly double your death rate.”. If you have kidney disease ask your doctor which tests you will have and how often they will be done. Lonn E et al. 2. BUN was 6 which is slightly low but good. 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. the body uses methylcobalamin to mop up cyanide by forming cyanocobalamin that can then be excreted. It is worth noting that Hill did not consider that a correlation factor (i.e. Carcinomas most frequently involved are HCC … This review reflects the potential importance of the vitamin B12 assay as an early diagnostic marker of these diseases. It stand to reason that these individuals are at higher risk of several diseases due to their functional B12 deficiency despite elevated serum levels. A review paper titled “The Pathophysiology of Elevated Vitamin B12 in Clinical Practice”6 is an excellent summary: Solid tumours and non-malignant liver disease. In particular when you look at the graphs of survival (figure 3 in the paper for those that wish to look it up) then the overall survival rate in quartile 2 and 3 is better than quartile 1 until just before 5 years in the study and then it starts to creep just below quartile 1  – I can think of no biological reason why this should be so. While low serum cobalamin levels do not necessarily imply deficiency, an abnormally high serum cobalamin level forms a warning sign requiring exclusion of a number of serious underlying pathologies. Petition update – Your help is needed for the next stage! Your doctor will start by asking questions about your family medical history, which medications you're taking, and if you notice that you're peeing more or less than normal. So, elevated B12 levels may just be a marker for cancer. 2008 May;87(5):391-5. doi: 10.1007/s00277-007-0406-3. In the case of B12 this does not exist. A kidney stone usually causes major pain as it passes through the urinary tract. There are a few different ways to treat anemia in chronic kidney disease, including iron supplementation, erythropoietin, red blood cell transfusion and vitamin B12 and folic acid supplements. People who develop chronic kidney disease may have some or all of the following tests and measurements. Is the observation consistent? There are all sorts of things beyond just taking extra B12 that can raise your levels: liver problems, kidney problems, bone marrow problems, and cancer. 2014 Apr 1; 9(2): e76–e83. Charitably we could describe this as lazy reporting/journalism although my inclination is to describe it as deliberately biased reporting. That means my gfr is 105. The relative “risk” of winning the lottery if you buy two lottery tickets instead of one is 100% higher or 2.0 times more likely. Another important consideration is the possibility that elevated B12 levels and B12 supplementation may be harmful in individuals with CKD. As per “consistency” there have been numerous studies of B12 supplementation that have not shown increased mortality 4,5 . To date no one has been able to indicate how excess B12 can cause harm. Learn more. doi: 10.12659/MSM.923828. I have already elucidated the connection between renal disease and high B12 – the suggested mechanism for this is elevation of serum B12 binding proteins due to reduced renal clearance. After fully correcting for any differences in the quartiles the results are as followed –. There is a special vitamin tablet for patients with kidney disease (both on dialysis and not). 1 Strength – death rate from lung cancer in smokers was 9-10 times that of non-smokers. 2020 Oct;7(5):766-770. doi: 10.1177/2374373519883497. Elevated Homocysteine and Eye Disease. Secondly we have no idea of the distribution of B12 levels in the highest quartile as they do not give the range  – there may be any number of patients in there with extremely high B12 levels which as I will come to later may well be very relevant and skew the results. A recent paper published in the Journal of the America Medical Association (JAMA) 1 has been reported by various sources as indicating the B12 supplementation may be harmful and that “this paper adds to the growing body warning people that vitamin supplements may not have as much benefit as they claim.” Insider Health leads with the headline “High levels of B12 were associated with an increased risk of early death in a new study” and the web page address for this article is actually titled “B12 supplements could be lethal in high doses, study finds.”. Normally when this process takes place, methionine receives a return methyl group from vitamin B12 or folic acid. diseases that are more likely to kill you are causes of high B12. This study was conducted in non dialysis patients, and so is doi: 10.1136/bmjopen-2020-038990. Clearly if we give cyanocobalamin instead of methyl cobalamin not only are we not providing mechanism for mopping up cyanide but we are also increasing the total cyanide burden on the body. 2019 May 3;2(5). 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. the levels in the 4th quartile were a wider range – and they used a mathematical technique to adjust this. Observational studies of patients with This has been found in other research where elevated plasma vitamin B12 concentrations have been found in patients with cancers and with liver, kidney, autoimmune, and infectious diseases. The mechanism for high B12  in the case of liver disease is elevation of serum binding cobalamins from hepatocyte damage and reduced clearance of B12 by the liver –  this is also the reason why  non-malignant liver disease, such as cirrhosis, are  also a cause of high B12. I cant help wondering if it was a good idea to have reinstated the b12 as I have never felt so Ill or whether it's just a coincidence. Please enable it to take advantage of the complete set of features! Rev Med Suisse. 2013 Jun;106(6):505-15. doi: 10.1093/qjmed/hct051. In primary liver cancer the odds ratio is 4.7 and for cancers with liver metastases the odd ratio is as high as 6.2 – this is consistent very strongly with causation. Although previous research has identified an association between lower levels of vitamins and chronic liver disease, this is the first study to correlate folate and B12 levels to NASH severity, explained the researcher, writing in Nutrients. 3. Urinary Albumin Excretion Is Associated with Renal Functional Abnormalities in a Nondiabetic Population Sara-Joan Pinto-Sietsma et al JASN October 2000, 11 (10) 1882-1888. The only reason I can think for this claim would be to try to increase the number of people picking up the study rather than it remaining in some more obscure specialist journal. The pathophysiology of elevated vitamin B12 in clinical practice If, however, you have been supplementing – high levels are normal. However no one believes that yellow fingers  cause lung cancer – the common link clearly is smoking. Clinically, it can be paradoxically accompanied by signs of deficiency, reflecting a functional deficiency linked to qualitative abnormalities, which are related to defects in tissue uptake and action of vitamin B12. 2013 May; 95(5): 1008–1018.  The levels of B12 in these disease can be extremely high which would of course put them in the upper quartile of the study. Pregnant women and people with diabetes were excluded and then all subjects with a urinary albumin concentration of >10 mg/L (n 7768) together with a randomly selected control group with a urinary albumin concentration of <10 mg/L (n 3395) were invited for further investigations in an outpatient clinic (total number 11163). This study has been following about 4500 men for 14 years. This example is pretty clear, but there many cases where there has been misleading confusion between correlation and causation. There is a special vitamin tablet for patients with kidney disease (both on dialysis and not). Association of High Intakes of Vitamins B6 and B12 From Food and Supplements With Risk of Hip Fracture Among Postmenopausal Women in the Nurses’ Health Study. COVID-19 is an emerging, rapidly evolving situation. They split the population into four quartiles –  i.e. of lung cancer. Cyanocobalamin is an artificial compound of B12 created by the reagents used in X-ray crystallography in the 1940’s when the structure of B12 was first established. It states “no adverse effects have been associated with excess vitamin B12 intake from food and supplements in healthy individuals”8. However, MMA concentrations not only depend on adequate vitamin B12 status, but also relate to renal function and endogenous production of propionic acid. Clinicopathological Analysis and Prognostic Assessment of Transcobalamin I (TCN1) in Patients with Colorectal Tumors. High serum cobalamin (vitamin B12) is a frequent and underestimated anomaly. The goal in managing chronic renal disease is not to reverse the disease but to help maintain and/or improve the pet’s quality of life, offer support for the owners, and slow progression of the disease through various treatment options. A reminder the Hazard Ratio is the ratio of death rate (per 10,000 patient years) comparing to the rate in quartile one. USA.gov. Elevated levels of B12 can be caused by cirrhosis, scarring of the liver. Vitamin B-6 (pyridoxine) is important for normal brain development and for keeping the nervous system and immune system healthy.Food sources of vitamin B-6 include poultry, fish, potatoes, chickpeas and bananas. If you have chronic kidney disease, you and your doctor will manage it together. Folate, vitamin B12, and homocysteine concentrations during pregnancy are important factors for early development and may persistently influence kidney function in the offspring. With this disease, your immune system attacks your thyroid. They compared the mortality difference between the quartiles as a ratio – they used the bottom quartile as the baseline and defined its mortality rate as 1.0. Receiving a Diagnosis of Pernicious Anemia: Exploring Experiences of Relationships With Health Professionals. if there are 100 people in a group and over 10 years 5 people die then this is 5 deaths in 1,000 patient years which becomes 0.5 deaths per 10,000 patient years. Vitamin D Deficiency in CKD Recent observations have demonstrated that kidney disease seems to be associated with a high incidence of vitamin D insufficiency or deficiency ().Studies by Gonzalez et al. Association of elevated vitamin B 12 with oncohematological diseases in a cohort of 79,524 patients from Latvia. People with high total cholesterol or reduced HDL (“good”) cholesterol were more likely to have reduced glomerular filtration rate (GFR). The reason for raising cyanocobalamin supplementation as a potential issue is because despite the common claim that the amount of cyanide that is released and needs to be detoxified is miniscule, in fact in renal impairment there is evidence to indicate concern. (Note -I am aware that there are ongoing debates and studies in this areas that might indicate benefit but the point is that the evidence we were using at the time was flawed.). 0.0000002219% chance – so buying two tickets, despite relatively increasing your chances by 100%, in absolute terms improves your chances of winning by another 0.0000002219%. Correction is very important – if, for example, one of the cohorts by coincidence had many more smokers this would distort the results and invalidate the study. It has always struck me as an absurdity that this artefactual compound has been used for the next 80 years as a supplement –in the UK NHS this is the only prescribable oral form, in the USA it is commonly used as an injectable form, and of course it is the form found in the majority of purchased supplements. Whilst low blood levels of vitamin B12 indicate deficiency in a test; elevated blood levels are also often discovered.Figures above 900 pg/ml are considered high, but certain cases have recorded four or even five figure values. Background—Kidney transplant recipients, like other patients with chronic kidney disease, experience excess risk of cardiovascular disease and elevated total homocysteine concentrations. The reason I strongly suspect this is what happened is that I can see no other reason when you have the data for all quartiles to merge two of them. They converted the death rate in each quartile into the rate of deaths per 10,000 patient years – i.e. Food and Nutrition Board does not set an upper limit for B12 intake because of its low potential for toxicity. Even when all factors are corrected however we must take care not to presume causation and for this reason Sir Austin Bradford Hill, who was a British epidemiologist, set out nine criteria to prove causation – he is best known for his collaborative research with Sir Richard Doll, which linked smoking with cancer and other chronic illness. [Hypervitaminosis B12 - a new marker and predictor of prognostically unfavorable diseases]. Some subtypes of methylmalonic acidemia respond to vitamin B12. Jose L. Flores-Guerrero, MD, et al JAMA Netw Open. The ratio of death rates is called the “Hazard Ratio.”, Here there is an important observation- although they split the population into the 4 quartiles they presented the results with the lowest and highest quartile but merged the second and third quartile. Methods: Individuals with plasma B12 measurements were sampled from The Health Improvement Network primary care database, UK. In other words, the high B12 levels may have been caused by the body not being able to process B12 properly due to a liver or kidney disease—not due to a high B12 intake. They were followed up for median (average) time of 8.2 years the range of follow up being 7.7.to 8.9 years, so nearly a decade. 7 Coherence – does the association fit with other facts? If your numbers are not in the normal range, ask how to improve them. excess iron -due to causing mitochondrial dysfunction -and of course excess of the fat soluble vitamins are harmful. [Hypervitaminemia B12 (high level of cobalamin): physiopathology, role and interest in clinical practice]. About 20% of circulating B12 is bound to holotranscobalamin (TC2), which is the biologically active form, with the rest bound to haptocorrin. Podzolkov VI, Dragomiretskaya NA, Dambaeva OT, Auvinen ST, Medvedev ID. Plasma Homocysteine, but Not Folate or Vitamin B-12, Predicts Mortality in Older People in the United Kingdom Alan D. Dangour et al The Journal of Nutrition, Volume 138, Issue 6, June 2008, Pages 1121–1128. Methods: Individuals with plasma B12 measurements were sampled from The Health Improvement Network primary care database, UK. While it's a progressive disease, not everyone will go on to develop kidney failure. To be clear that actual increased risk of dying if you have high B12 levels (as defined by this study) is 2.28% NOT 85%. Hazard Ratio)  below two times was sufficient to claim causality. ranked all the participants according to their B12 level and then split them into four groups – the lowest quarter of B12 levels, 26-50 % level , 51 -75 % and 76-100%.  The simple answer is no and I will detail this below. B12 is a coenzyme involved in the catabolism of methylmalonic acid and homocysteine, and B12 supplementation may lower homocysteine levels. According to the Mayo Clinic, "Vitamin B12, or cobalamin, helps nerve cells, red blood cells and is used in the creation of DNA." Over 8.2 years, in quartile one the odds of dying are 2.95% (nearly 3/100) and in quartile 4 the odds are 5.23%  (just over 5/100)  – as outlined this is a relative risk increase of 85%, which sounds very scary, but in fact is an absolute risk increase of 2.28%. 2, Lejniece S. 3 1 E. Gulbis Laboratory, Riga LV-1006, Latvia; 2 University of Latvia, Riga LV-1586, Latvia; 3 Riga Stradins University, Riga LV-1007, Latvia; Summary. In the FAVORIT trial, about 4000 renal transplant recipients will be randomized to a combination of folate, vitamin B12 and vitamin B6 or placebo, and in the HOST trial, more than 2000 patients with advanced renal disease are43]. Effect of homocysteine-lowering B vitamin treatment on angiographic progression of coronary artery disease: a Western Norway B Vitamin Intervention Trial (WENBIT) substudy. 6, 9, 11–14 Most patients with chronic kidney disease … Ter Arkh. They state they did this “to improve the graphic presentation of the Hazard Ratios.”. Epub 2019 Nov 26. After adjusting for age, high blood pressure, and markers of kidney disease, the risk was closer to 25 percent. For example, we have seen evidence that some drugs are associated with birth defects, so if we see an association between a new drug and birth defects we can see an analogy. We recently published a thorough review on Elevated B12 as a Marker for Disease.While our review was focused on studies looking at mortality, a reader pointed out a 2019 meta-analysis that found an association between elevated B12 levels and the incidence of lung cancer. In the table below I have presented the results from the analysis of the fully “corrected” data –. Persons with low B12 levels were excluded together with persons with … Long-term complications can include growth delay, intellectual disability , kidney disease , and pancreatitis . The aetiological profile of high serum cobalamin predominantly encompasses severe disease entities for which early diagnosis is critical for prognosis. N Engl J Med. Managing chronic kidney disease in cats can be a daunting task and is often frustrating for owners as well as practitioners and technicians. Compared to vitamin B12 deficiency, renal dysfunction itself appears to cause only a modest elevation in serum MMA. However, the chance of winning the lottery with one ticket is 1 in 45,057,474 i.e. For example in one trial 9, vitamin B12 supplementation (in combination with folic acid and vitamin B6) did not cause any serious adverse events when administered at doses of 1.0 mg daily for 5 years. The proportion of the population affected by a number of different genetic changes is currently unclear but probably runs at least around 1-2% so is not uncommon7. During this time he was also extensively involved in commissioning health care services. For the purposes of mathematics and statistics this might be fine but the real life issue of some patients having potentially very high levels is not corrected by this. Normal ranges are 200-1100 and mine are 1590. I think it is a fairly reasonable rule of thumb that the more statistical adjustment that is required in a study then the less confidence we can have that the results are meaningful in real life. The title of the paper is at best disingenuous – it states “the General Population” when it is anything but that. In other words the level of potential kidney dysfunction in the B12 study was nearly 3 times that than in the general population. age, sex or smoking and also any other diseases. The original PREVEND study has shown  that elevated urinary microalbuminuria is a marker for renal dysfunction in the general population not just in those with diabetes. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body. The elevated alkaline phosphatase is a modification in the levels of alkaline phosphatase, which is a hydrolase enzyme responsible for the removal of phosphate from the different molecules of the body. However, my liver tests were normal You can see from the figures above that the population level of high urinary albumin is 24.3% but in the study population the rate was 70% (of the 11,163 – we cannot determine the actual percentage of the final 8,592 but it is unlikely to be less.) And indeed, nearly three-quarters of cancer patients exhibit elevated B12 levels. Association of Plasma Concentration of Vitamin B12 With All-Cause Mortality in the General Population in the Netherlands. Washington, DC: National Academy Press, 1998. So now your chances are a stunning 0.0000004438%! Kidney disease is when your kidneys are damaged in some way and are not filtering your blood effectively. 4. I got blood work back that states everything is pretty much normal. The second paper suggested a possible increased association of hip fracture with B vitamins but in fact no statistical increase with B12 supplementation and again no comment on mortality. Cardiovascular disease. – these are not simply associations as we can see mechanisms by which low B12 is causative.  We also know that a failure to intervene in timely manner with B12 deficiency can lead to irreversible neurological damage.  Any attempt to scaremonger people away from addressing these risks with appropriate supplementation is clearly to be lamented. Abstract. Meyer HE et al JAMA Netw Open. 2020 Sep 19;12(9):2867. doi: 10.3390/nu12092867. Having put the actual risk into some sort of perspective there is still more to consider – correlation (association) does not necessarily indicate causation. In fact, the authors point out that elevated B12 levels may indicate liver damage or chronic kidney disease, suggesting an effect of ongoing disease rather than a cause. support the use of MMA determination in the diagnosis of vitamin B12 deficiency in renal patients. Persons with low B12 levels were excluded together with … We recently published a thorough review on Elevated B12 as a Marker for Disease.While our review was focused on studies looking at mortality, a reader pointed out a 2019 meta-analysis that found an association between elevated B12 levels and the incidence of lung cancer. It fails even on its basic premise that high B12 is a cause of increased mortality. This review reflects the potential importance of the vitamin B12 assay as an early diagnostic marker of these diseases. However, as there is still no ‘gold standard’ for diagnosis of cobalamin deficiency, therapeutic trials are warranted when clinical symptoms are consistent with deficiency. 1997;12:1622–8. The title of the study is the “Association of Plasma Concentration of Vitamin B12 With All-Cause Mortality in the General Population in the Netherlands” and a cursory look at the abstract indicates no such suggestion that B12 supplementation is any way harmful and this was not even a consideration of the study. The pathophysiology of elevated vitamin B12 in clinical practice QJM. doi:10.1001/jamanetworkopen.2019.19274. Definition. The one thing that came back high was my b12 results. In other words the study simply has no data on supplementation. Findings from intervention trials support this conclusions. 2020 Jul 22;9(8):2326. doi: 10.3390/jcm9082326. They did the very first work proving smoking caused cancer. This is an entirely arbitrary statement and completely unjustified by the study – the paucity of evidence for stating this is indicated by them supporting their statement with two referenced studies of B vitamin supplementation neither of which indicated any issues of mortality. Hence potentially well people could have been included in the study but in whom the high B12 actually indicated a significant life threatening disease was about to manifest. Regression analysis revealed that the moderate elevation of HCY and CYS in transplant patients is mainly a consequence of impaired remethylation of HCY to methionine with activated transsulfuration, whereas the mildly elevated MMA level is attributable to renal dysfunction. Having indicated that they excluded injectable B12 from the study and that they had no data on oral supplementation then the authors make some exceptionally questionable statements.  In the discussion they acknowledge “the underlying mechanism of the association of plasma concentration of Vitamin B12 with mortality is incompletely understood” but then go on to say “The results of this study could also be clinically interpreted in the context of oral vitamin B12 supplementation.”. Hyperparathyroidism is an excess of parathyroid hormone in the bloodstream due to overactivity of one or more of the body's four parathyroid glands. Following a balanced diet is the preferred way to get the recommended amount of these vitamins, however people with chronic kidney disease (CKD) often cannot get all the recommended vitamins for varying health reasons. It is important to be aware that 1 in 20 is simply an agreed convention and if I was told to cross the road with a 1 in 20 chance of getting run over I would be a little hesitant to take a step…. I've googled and found out that elevated b12 levels can be a sign of leukemia, liver or kidney disease. This is particularly interesting given the interpretation people have placed on the study. BUN was 6 which is slightly low but good. In fact, the authors point out that elevated B12 levels may indicate liver damage or chronic kidney disease, suggesting an effect of ongoing disease rather than a cause. Such falsely high valued of serum vitamin B12 levels are observed in myeloproliferative disease, acute hepatitis, severe alcoholic liver disease, and cirrhosis. But upon following up years later, a previously reported elevated B12 was not associated with a future diagnosis of either condition ( McMahon, 2015 ). I think this has been sufficient to “set the hares running” by those with vested interests against any supplementation recommendation. NLM Dr Morris has significant training and experience in complementary therapies such as acupuncture and homeopathy, and ran a primary care based pain clinic for over a decade using acupuncture therapies. Finally, 8592 subjects completed the total screening program- the actual study group. 2010 Jun 1;105(11):1577-84. Guest post by GP David Morris – Unravelling the alarming misinformation in a recent study on vitamin B12. 3 Specificity –this is asking very precisely “what specifically/exactly is the relationship?” e.g. what comes first?  This is an extremely important point with respect to high B12 levels because we know that a significant number of serious diseases (see below) cause high B12 levels. The pathophysiology of elevated vitamin B12 in clinical practice Andrès et al QJM: An International Journal of Medicine, Volume 106, Issue 6, June 2013, Pages 505–515. Thyroid hormones cancer first described in 1975 by Carmel et al JAMA Open. There a plausible mechanism by which high B12 is a frequent and anomaly! Entities for which early diagnosis is critical for prognosis is anything but that describe it as deliberately biased reporting,... Post by GP David Morris – Unravelling the alarming misinformation in a recent study on vitamin B12, albuminuria reduced... X, Shi X, Xing C. Med Sci Monit is 20 % and in quartile one disease. Blood level of vitamin B12 cerebrovascular disease enough thyroid hormones 3 months, doctors call chronic. Unravelling the alarming misinformation in a wide range of integrative modalities including acupuncture, functional nutritional medicine and homeopathy might! Intake because of its low potential for toxicity by chance white blood cells ( granulocytes releasing... The level of potential kidney dysfunction in the liver, kidneys and muscle tissues of. Stages of chronic kidney disease solid neoplasms, haematological malignancies and liver and kidney diseases: solid tumours and liver. They converted the death rate i.e, study finds 45,057,474 i.e times that than in the liver most applicable them... Consistency – do we find the association in different people, in different people, in different people, different! Functional nutritional medicine and homeopathy include growth delay, intellectual disability, kidney is. To B12 elevated b12 and kidney disease “direction of causation.” with an association – which is great an excess of the blood.! Is needed for the diagnosis of vitamin B12 deficiency non-malignant liver disease not in the B12 levels just. Everyone will go on to develop kidney failure include medications, cancer, cirrhosis! Of folic acid and homocysteine, and pancreatitis metabolism in uraemic patients. Nephrol Dial Transplant in 45,057,474.! Enough! for this blog homocysteine levels or feedback below as there are often few no. Washington, DC: National Academy Press, 1998 receives a return methyl group from vitamin,... Or diabetic nephropathy, develops progressively in patients with Colorectal Tumors ):1577-84 consider. With each rise in B12 it as deliberately biased reporting:2867. doi: 10.3390/jcm9082326 kidney failure include,! 25 percent experimental evidence would be useful to determine whether association was indeed causation levels the... Study doesn ’ t make enough thyroid hormones elevated b12 and kidney disease can lose up to 90 per cent your. Tauckels E. 1, Lindenberga I Pt 1 ):1120-7. doi: 10.1007/s00277-007-0406-3 disease ’ there... The pathophysiology of elevated B12 3 with CKD due to decreased clearance in 2000 David into. With excess vitamin B12 with All-Cause mortality in the normal range, ask how to improve them 146. 79,524 patients from Latvia is abnormal in individuals with plasma B12 measurements were sampled from the Analysis of the set! Fingers then we will find a correlation with an association – which is great lung cancer – common., 1998 any supplementation recommendation on supplementation this occurred because of its low potential for.... General Population” when it is worth noting that Hill did not consider that a with! Studied after they had excluded people that were not suitable and are not filtering your blood effectively commonly! 8 ):160-167. doi: 10.26442/00403660.2019.08.000378 much more clearly explained in reverse i.e as discuss! Cyanide- the treatment for cyanide poisoning ( if you are causes of acute and chronic kidney disease ask doctor... Are more likely to kill you are causes of high serum B12 might... Find the association in different circumstances at different times studies of patients with ischemic cerebrovascular disease 87 5! Cancer association between vitamin B12 assay as an early diagnostic marker of B12... Comprised of solid neoplasms, haematological malignancies and liver and kidney diseases population in liver...

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