DEAR DR. ROACH: I am a new reader to your column; as such, I thought I would ask you a question that I have never seen asked or addressed in similar newspaper health columns.

I am in my early 40s. I am active and generally healthy. That being said, I have GERD, but I have successfully been treating it with a daily dose of 20 mg of omeprazole for the past 10 years. Last year, I read that omeprazole can inhibit the body’s ability to absorb vitamin B-12. I had my B-12 level checked to see if I was deficient. I wasn’t. In fact, my B-12 blood level was about 30 points higher than the “normal” range, which as I recall topped out at 900 mg/dl.

My primary-care physician said, “There’s nothing to worry about.” A GI doctor said that he wasn’t concerned either.

Because everything I’ve read on the subject indicates that excessive levels of B-12 could be an indicator of other disorders, I’m scared. Should I see a hematologist for further testing? — C.R.

ANSWER: The “normal” range for a given laboratory result is based on the range that is found in healthy individuals. Almost all characteristics you can think of — height, weight, blood pressure — have a range of values. The “normal” is defined as where 95 percent of healthy people will fall. That means that 5 percent of healthy people will be outside the range, even though there is nothing wrong with them. That almost certainly is what is happening with you.

Omeprazole and drugs like it do cause a slight, probably insignificant drop in B-12 levels. However, true B-12 deficiency from these medications hasn’t been seen.

It is true that diseases associated with destruction of liver or white blood cells can cause these cells to release their B-12 into the blood. When I have seen this, the B-12 level was in the several-thousand range, and there were many other blood abnormalities. I think it’s very unlikely that anything like that is going on with you.

The booklet on heartburn explains GERD, a common disorder. Readers can obtain a copy by writing: Dr. Roach — No. 501, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR ROACH: I’m a diabetic, and three weeks ago I had my appendix removed. The surgeon said it was very large and had attached itself to my liver. I know the liver plays a big part in blood sugar control. Since then, my blood sugar has fallen by 50 percent. My insulin dose has gone from 100 units per day to 15-20. The surgeon thought I could have had a low-grade infection for some time, causing problems. What do you think? — G.R.

ANSWER: I think your surgeon is exactly right. A chronic infection can cause a big increase in your insulin needs, and the only way to restore it is to cure the infection. The only way to cure a chronic, smoldering appendicitis, or abscess around the appendix, is to get rid of it. A sudden increase in insulin needs can mean a hidden infection.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters or mail questions to P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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