Pernicious Anaemia Society
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b12 levels normal but ive read they are actually quite low

hi everyone, been looking at some blood test results that my dr said was normal but ive actuall read my b12 is actuall quite low.

the level is 224.

my symptoms over the past year have been extreme fatigue, blurry vision, vertigo ( started a month or so ago) , very dry skin,itchy dry scalp, upper back pain, insomnia, palapatations and anxiety. i just feel so unwell and its really getting me down.

i must also mention i have been a pescetarian for the last 2 years

does this sound like b12 deficiency? what can i do ?

13 Replies

What was the 'normal' range for the test you took? It's quite likely that you just sneak into the 'normal' range. Of course, that range isn't fixed for different people. Indeed, many suffer from a deficiency with levels higher than the bottom of the 'normal' range.

The experts recommend treating the symptoms rather than the numbers. Get my summary document that includes references to what those experts say -

Then go to the Pernicious Anaemia web site and download their symptom checklist pernicious-anaemia-society....

Take both along to the doctor and ask for a course of B12 loading doses. It can't do any harm and, if they work, your doctor will have been saved a lot of hassle.

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it was 211 so i am fairly close to the low level



Perhaps you could read a copy of Martyn Hooper's book "What You Need to Know About Pernicious Anaemia and Vitamin B12 Deficiency" I gave a copy of this book to my GPs.

Other b12 UK websites

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Hi ozzyosbo

"Vitamin B-12, or Cobalamin, is the largest and most complex vitamin currently known to man. A slight deficiency of vitamin B-12 can lead to anemia, fatigue, mania, and depression, while a long term deficiency can cause permanent damage to the brain and central nervous system. Vitamin B12 can only be manufactured by bacteria and can only be found naturally in animal products, however, synthetic forms are widely available and added to many foods like cereals. Vitamin B12 can be consumed in large doses because excess is excreted by the body or stored in the liver for use when supplies are scarce. Stores of B12 can last for up to a year."

I'm not a medically qualified person but your pescetarian diet may partly be the cause of your low B12 although some "sea foods" such as clams, crabs, mackerel and tuna are high in B12, Eggs, cheese, some breakfast cereals and Marmite also contain B12.

Do you know what your folate (B9) level is as this is needed to help process the B12?

As others on here will say your doctor may prescribe you a course of injections if you cannot boost your intake from your diet.

I wish you well for the future.

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Hiya my folate level is 7.6 is that low too? clivealive


Hi ozzyosbo it depends on the range from to,

The range on my Folate test was from 3.10 to 20.50ng/ml with my level at 18.2ng/ml so if your ranges are similar your level at 7.6 is not very high.

Personally I supplement with a 400μg folic acid tablet each day which can be bought over the counter at any chemist.

Folate is sourced from things like green vegetables (cabbage, sprouts, broccoli etc) and it can also be found added into some breakfast cereals.

Hope this helps

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Hi level was 261 ( 192 Pmol) and was told it was fine. I had a postal Active b12 test and referred for an MMA at St Thomas and diagnosed with a functional b12 deficiency at blood and tissue level. I'd have needed to be under 130 for my Dr to acknowledge it as a problem! I've been ill for 17 years with ME and have a major amount of the symptoms for b12 deficiency, but it's been a battle! I can give you more details about the Active b12 test if you wish, it was very reasonable at £30 and the result finally convinced my Dr!

Keep on with your quest for good health, don't be put off, you know how you feel...

Best :)


Yes please :)


Hello Jo, could you please send me details of the postal Active b12 test. Could you let me know if it's a pin prick of blood that I can do at home or do I need to get a "test tube" of blood.

Thanks :)


Hi Toroto, have put a reply at the bottom with ozzyosbo, hope you find it...:)


id like this also Jo5454


Hi ozzyosbo and Totoro

The Active b12 is available from St Thomas NHS hosp, London £18 if u attend, £30 via post. It needs a referral from your Dr ( mine took bit of persuading, but agreed when I wrote to him in end). Blood needs to be taken end of the day ( had mine at 4.30 for 5.15 post).

Will add contact number on end. Quite simple process, they email u for some info, u receive a container/ envelope ( your dr needs to supply blood test tube) then post back with your signed referral, making sure your name, dob, sex, date/ time of test and NHS number on the tube of blood. My first one was rejected due to insufficient labelling, so had to pay and redo again. Results go back to your dr approx 2 weeks NOTE request a printout, I was told mine were fine and only found out via printout! Mistakes happen...

Active b12 needs to be between 25-70 to be referred for MMA ( no extra cost). This needs to be between 0-280, higher indicates b12 def. high MMA can also be indicator of thyroid, kidney, bacterial overgrowth, but if accompanied with lower serum and active b12 results, taken as b12 def.

To give u eg. My blood test at dr was 261 which I converted to 192 Pmol. It's said active b12 is 10-30% of this which equalised 19-57, so I thought I'd potentially need MMA test, which I did. My active was 27, then MMA was 708, very high.

I chose this way, rather than a pinprick because it was via NHS hosp and very reasonable at £30 and thought it would carry weight with my dr. If needed. Had I have hit a brick wall with getting referral, maybe I'd have tried the pinprick first, but would've been more costly and not sure it would have got me any further? But doctors vary so I'd suggest trying as hard as you can to get the referral! Also very cheap way of getting MMA if your active is lower, it usually costs £96 at St Thomas if ordered as a single test, and much higher it seems, elsewhere.

They also offer a homocysteine test which is another indicator of b12 def, but the sample needs to be spun, and my dr couldn't do this. Prob available at local hosp? I've since found out it measures a different enzyme in relation to b12, but also raised in folate and b6 deficiency, so not deemed quite so specific to b12 ? I personally struggled enough to get the one test in relation to how ill I was feeling, but in hindsight it could have proved valuable too, just seemed like too much to sort at the time!:)

I was lucky and this worked for me, but keep open minded with results if you go ahead and they don't prove to be low. Plenty have had higher active b12 results, it seems, and still improved taking b12. There seems to be alsorts of problems in getting accurate tests and being diagnosed and they'll no doubt find there are many ways of being b12 def in the future, that require diff methods to show this!

The current method via the Drs isn't reliable and they are supposed to go by symptoms, not much evidence this happens though. Then the ranges are set too low as well, no wonder so many are having difficulties.

Any other questions, feel free to ask, I'm fairly new, had a loading dose March/ April and still learning loads...keep on with your quest for better health, know it's not at all easy when you feel so poorly, but there's plenty of support to be found on here, don't know what I'd have done without it...take care :)

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