Pernicious Anaemia Society
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Active B12 results, suggestions on B12 sublingual and multi-vits dosage

Hey everyone,

Well I have now completed my investigation into my B12.

So my results:

Serum B12: 182 ng/l (180-1000) and a few weeks later 202 ng/l,

Homocysteine: 9.9 mmol/l

MMA: 0.25 umol/l

Active B12: 30 pmol/L (25.1-165)

According to 'Could it be B12?' <200 ng/l as "severe B12 deficiency". I think the homocysteine is a little high, but both MMA and Active B12 place me in the 'borderline' category I think.

So I started on sublingual B12 (Jarrows) two days ago and have been actually taking 2x 5000mcg a day. One in the morning and one in the evening to try and build up reserves. How long do you think I should continue on this dose?

I've also started on a good wholefood multi-vitamin containing 400mcg of L-Methylfolate, the B vitamins and lots of other things. It takes two tablets to get the amounts on the label, should I just take them both at the same time, or split them apart? Does it matter taking them the same time as the B12?

Appreciate any thoughts/advice! Thanks.

5 Replies

Hi whitenoise,

It will help me if you put the ref ranges used for "normal" by the labs that gave you those results as different labs use different ranges. But it does look like you are in the grey area with all your results and it would be better if you could get your GP to see the results and test firstly serum folate (as a def in folate can cause a raised homocysteine), secondly it would be far better if you were treated for a B12 def at tissue level, meaning normal procedure of 6 B12 injections every other day then o0nto maintenance B12 injections for life, than what you do now, trying not licenced over the counter B12 preparations that may or not help you.

I hope you appreciate my reply, I think its better to not self medicate until you have a firm diagnosis, and if that means waiting 3-4 months then that is worth it in the end.

At a certain time my Daughter's active B12 was 28 pmol/L (lab range 35 - 141), Active B12 concentrations under 25 pmol/L suggests B12 def, vitamin B12 can not be excluded if Active B12 (holo TC) concentration is inbetween 25-35pmol/L. Her serum B12 at that time was 230 ( lab ref range used for normal serum B12 161-531 ng/L = 119 - 392 pmol/ L), because of her result her blood sample was referred for mathylmalonic acid (MMA) analysis , MMA was above the upper limit which suggests functional vitamin B12 def at tissue level. She is now on B12c injections for life. A much better diagnosis than trying to do things with sublingual B12 , they did nothing for me and did not raise my serum B12 at all.

Kind regards,



Hey Marre, thanks for your reply. Unfortunately I don't know the reference ranges for some of the tests, but I've added the Active B12 range now.

The GP did test folate around the same time of the first B12 test, I think it was 5ug/l, again no range I'm afraid. Sadly there is no point in bringing the results to the GP since he has already told me on two occasions that I don't have B12 problems, and basically that's the end of that.

I still think that my low B12, Vit D and potential hypothryoid issues are connected to my mercury amalgam fillings. At the moment I can't afford to have those done, so I hoping by taking the B12 sublingual, and the multi-vitamin, it is building up (or helping to offset the losses) in my system, ready for when they can be removed.


Its very difficult to say much with out ref ranges, but all your results look on the low side, just none obviously shouting deficiency. If you really think your GP (or an other one/new one) will not help you, then you can but try with the B12 lozenges and see how you go, its not that you can overdose on B12, its just a very expensive way of treating a B12 def.

Re: "mercury amalgam fillings", I am not sure they cause a B12 def, but we all are different and perhaps it may make a difference. Both my two kids on B12 do not have any fillings, I do..we all still have a problem with B12. Still I know to little about vit D and or thyroid to have an opinion on mercury fillings having an influence. It is expensive to remove them, that is all I know.

Wishing you good luck, hope it gives you the improvement you hope for!

Kind regards,



What makes you think it's due to fillings? That is very, very, very unlikely. If they were leaking mercury then you'd have a lot more things to worry about that a non-existent effect on B12 (like methylation of mercury by methylcobalamin to produce highly toxic methyl mercury).

Instead of self-diagnosing from t'interwebs you really need to get a firm diagnosis from a doctor. Have you been tested for H. pylori? Have you been tested for the presence of anti-IF (Intrinsic Factor) antibodies?


Ive been reading about sublingual supplements and have seen some of your posts and as you seem very knowledgeable i wonder if you could offer some info on my situation?

Im recently diagnosed with inflammatory bowel disease and started treatment with steroids 2 months ago. I still have many outstanding symptoms including chronic fatigue,weakness, achiness and dizziness that having been getting worse the past year or so and 24/7 pins and needles in both hands, arms, feet, legs and neck that started 6 months ago.

In March my total serum b12 was 434.

2 weeks ago my gp here in spain decided to start me on b12 injections (cyanocobalamin .) She has not prescribed a loading dose. So far i have had 1 injection and cancelled my dose this week because i have been in touch with Denise Oblein and my private UK GP and have arranged to have the active b12 test w/c 7th Dec which will be 5 weeks after the injection ive already had.

I realise that having already started the injections that the result maybe affected but feel it is worth doing.... (i didnt know about the test until after i had had the first injection.)

So, i wonder if you have an opinion on my situation so far and also whether you can advise on whether further supplementation is worthwhile via sublngual/nasal sprays etc once i restart the jabs. And if so which type of b12...

My concern is that if i am actually b12 deficient that my gp has not prescribed sufficient dosage to make a difference especially given my neuro problems. She has also referred me to a neurologist.

Many thanks.


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