Falling B12

[linda65]

In August 2012 my B12 level was 1075. In October 2014 it was 409. I have many symptoms including pins and needles in hands and feet, tinnitus and disturbed vision. Also palpitations. I have UAT and am on T3 only. What should I ask my GP to test please. He cannot explain why my B12 has fallen. Many thanks

[Hidden]

Hi,

Some people do not seem to store much of the injected B12, and like I will never get near the 1000 mark, but other (B) vitamins can help so its good to take a multi vitamin. All needs to be in balance and giving loads of one (B12) can mean there is not enough of others, many vitamins (and minerals) need each other to be taken up and or converted, is how I understand it. You are sure you are not deficient in folate (serum folate) and or iron (serum ferritin), they can give the symptoms described if low; all has been tested? Also its not uncommon to have to alter thyroid meds once on B12 treatment, I'm not able to go into detail though, do not know enough about thyroid issues, do not know what UAT is,

I hope this helps a bit,

Kind regards,

Marre.

[Gambit62 Administrator]

Your B12 levels are probably falling because you have an absorption problem (as I presume you have ruled out lack of B12 in your diet). B12 is stored in the liver so it can take a very long time for B12 in serum to drop and for symptoms to start to manifest.

Presume as not mentioned that your folate levels are good - body needs folate to absorb B12 so if folate is a problem then would be good to sort that out.

Causes could be

a) pernicious anaemia proper - autoimmune response that either destroys intrinsic factor or destroys the parietal cells in the illeum hence affecting the mechanism by which the body absorbs most of its B12

Unfortunately autoimmune problems tend to come in groups so fact that you have thyroid problems increases chances that PA could be a factor

b) gastric surgery affecting the illeum

c) drug interactions - including antiacids, metformin etc - not sure where you can get a definitive list but it might be worth checking whether any drugs you are taking are known to suppress absorption of B12 and look for some alternatives

d) changes in acidity levels in the gut as you get older (gets lower)

You could ask your GP to test for IFA but the test is notoriously unreliable.

In terms of investigating further whether B12 is a problem MMA in urine and homocysteine levels can help to clarify - both are waste products that build up if the body is not metabolising B12 - but also needs to be interpreted in context of folate levels - as folate is also needed to metabolise and use B12

At 409 your levels are moving into the grey area where significant numbers of people show strong clinical signs of deficiency. Recommendation in UK is to treat on the basis of symptoms - as a lot of your symptoms are neurological that is particularly important.

cks.nice.org.uk/anaemia-b12...

[linda65 in reply to Gambit62]

Thanks for your help. My Folate in Aug 2014 was 2.6(1.8-18.3) and my Ferritin was 72.9(10-204) I have also had Polymyalgia which is autoimmune with my Underactive thyroid and my grandmother had PA!

[Gambit62 Administrator in reply to linda65]

PA tends to run in families so that it is worth mentioning your grandmother to GP (if not done already).

Hope GP agrees to start treating you for B12 and hope that it helps to sort things out.

[linda65 in reply to Gambit62]

Thanks. I will bang his desk x