Help with B12 and folate results. - Pernicious Anaemi...

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Help with B12 and folate results.

Whisky1956 profile image
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Hi there, I recently had a blood test as I am hypothyroid and was wondering if you think my B12 and folate levels need me to talk again with my GP.

Serum folate 4.7 (4.8-19.0) abnormal

B12 312 (189-883)

I read the PAS symptom list and it could have been written about me! I really don't know much about B12 deficiency but am trying to find out. I am a 58 yr old female btw!

Thanks for your help.

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Gambit62 profile image
Gambit62Administrator

Your folate is very low - which isn't going to help with B12.

B12 deficiency is generally a result of an absorption problem. The mechanism by which most B12 is absorbed (99%) is rather complex - special binding agent and specialised cells in the ileum.

B12 is stored in the liver and recycled - released through bile through the ileum where it is reabsorbed - which means that a deficiency can take years or even decades to manifest itself after an absorption problem starts - but it tends to get quicker towards the end as the recycling mechanism becomes ever more inefficient and the absorption gets worse.

Causes of absorption problems include:

-an autoimmune response that attaches either the binding agent (intrinsic factor) or the cells that do the absorption (parietal cells) - this is PA in the strict sense

- lowering of acidity levels in the gut as you get older

- drug interactions - ironically many of the drugs are given to treat what could be early signs of a developing deficiency

- gastric surgery affecting the ileum

- genetic abnormalities affecting the ileum.

Given your age lowering acidity levels sounds like the most likely cause though you can actually drive yourself mad trying to get to a precise cause - though the treatment is the same - finding another route in for B12 that doesn't involve the ileum.

Your results - whilst in the normal range are certainly in that grey area where significant numbers of people are symptomatic. However, doctors tend to be quite unaware that this grey area exists and despite guidance to the contrary have a tendency to treat on the basis sof test results which is really bad news if there is neurological involvement.

Not sure where you are based - if UK then the BCSH guidelines may come in handy when talking to your GP about B12D - summary is particularly relevant as is the intro to B12 and section C on B12

bcshguidelines.com/document...

It is best to avoid supplementation until you have a proper diagnosis but it can be a battle so would totally understand if you decided you wanted to try supplementation. If you try an oral solution you need to be taking doses over 1mg a day - which floods the gut in the hope that enough gets through to replace some of what is lost - but injections are the usual treatment - there are also sublingual tablets, sprays and nasal sprays ... as well as skin patches that you don't need prescriptions for (you do for the injections ... though even there you can source from outside the UK).

It is important that a folate deficiency in the presence of strong clinical indications of a B12 deficiency is not treated on its own as it can mask some of the B12 symptoms (relating to anaemia) and result in neurological damage being left too long. If you have cliniical signs of B12D then you need to be treated for both folate and B12 ... and ideally you need to keep your folate in the top part of the range.

You may also find that other minerals and vitamins are low - vitD is a common one so probably worth getting a full analysis done if possible.

And, as you have a thyroid problem - treatment with B12 can affect the levels of thyroid medication that you need - so things need to be monitored carefully.

Sleepybunny profile image
Sleepybunny

Hi,

I found it helpful to ring the PAS. They are sympathetic and a good source of info.

You can leave a message and they will get back to you.

pernicious-anaemia-society.... Head office: 01656 769 717

These websites are good sources of info.

b12deficiency.info/

b12d.org

Useful books

Could It be B12 by sally pacholok

Pernicious Anaemia; The Forgotten Disease by Martyn Hooper

Living with Pernicious Anaemia by Martyn Hooper

Your B12 result, although normal range is certainly at a level where many people are symptomatic. Recent articles recommend that symptomatic patients are treated even if blood tests are normal or negative.

As well as the BCSH Cobalamin and Folate guidelines that Gambit mentions, it might be helpful to look at the following;

ukneqas-haematinics.org.uk/...

This makes the point that symptomatic patients should be treated to avoid neuro damage.

bmj.com/content/349/bmj.g5226

Have a look at the summary points.

Have you had your ferritin( iron) checked and a full blood count test recently?

Whisky1956 profile image
Whisky1956 in reply to Sleepybunny

Thank you for your replies. I think that I shall talk to my GP about the results and see what he has to say.

Polaris profile image
Polaris

A good description of the thyroid-brain-gut and B12 connection:

"Hashimoto's Healing- Facebook post by Dr Marc Ryan:

"Anyone who has lived with Hashimoto's knows that this is so much more than a thyroid problem. The biggest axis of trouble is often found in the thyroid-brain-gut connection. And one common problem that causes this is leaky gut or intestinal permeability. Many researchers believe that this is ground zero for autoimmune disease. It is the place that autoimmune disease is born and the place that makes it get worse and worse. And when things get worse in the gut, problems in the thyroid and brain often follow. In this post, I wanted to shed light on some little known but very helpful enzymes called brush border enzymes.

Brush Border

The small intestines are the place where leaky gut often happens.

And the walls of the small intestines are lined with tiny little hair like protrusions called microvilli. On a regular microscope they kind of look like a tiny, fuzzy paint brush. This fuzzy appearance is why they came up with the term "brush border" to describe them.

Where Absorption Happens

This is the place where absorption happens.

And many people with Hashimoto's suffer from deficiencies of important vitamins and nutrients (like vitamin D, vitamin B12 and B6, zinc, selenium, magnesium, iron, etc.)

One of the reasons for this is the breakdown of these brush borders.

Foods high in lectins or other inflammatory substances (like gluten, and other grains, beans and nightshades) can actually cause these brush borders to get crushed and destroyed. The microvilli (little hairs) that make up the brush border have enzymes for this final part of digestion anchored into their membrane as membrane proteins.

These enzymes are found near to the transporters that will then allow absorption of digested nutrients.

Brush Border Enzymes

Brush border enzymes amylase, cellulase and invertase can be effective in digesting carbohydrates, proteins, and fats without causing irritation and digestion of the intestinal walls. One problem with using large quantities of pancreatic enzymes (which are commonly found in digestive enzyme formulas) is that they may actually irritate and digest the intestinal walls.

The theory about the reason for this is that they help break down proteins and your intestinal walls are made of proteins.

If you have leaky gut, which many of us do, these proteins are exposed.

And these digestive enzymes don't know which proteins to digest and which ones to not digest. They break down all of them.

If you are using digestive enzymes, you should be cautious about which kind you are using. Because, if you have leaky gut, you may actually make it worse by using the wrong kinds. Brush border enzymes don't do this. They are safe, well tolerated and can be a good tool in healing these tiny little paintbrushes."

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