Pernicious Anaemia Society
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Help with B12 and folate

Hi been sent here by Thyroid U.K. For advice on B12 and folate. Been recently diagnosed with hypothyroidism and been given levothyroxine. Also folic acid 5mg and cholecalciferol 50000. My B12 results are 262 pg/mL(197-771.0) and folate level <2.0ng/mL (3.9-26.8). I'm having symptoms of B12 deficiency even though my levels are in the normal range but on the low side. Any advice gratefully received

4 Replies

Many of the symptoms of low B12 are also associated with low folate - like yours. I suggest supplementing with 400 - 800 ug a day and see what happens.


as fbirder says - suggest you try to rule out low folate as the reason for your symptoms first and then return to B12 if the folate supplements given by your doctor don't resolve the problem - no need for any supplementation above that your GP has already given you.

Do you know if you had macrocytosis - larger rounder red blood cells than normal - this is will take a few months to clear - classic symptom of folate deficiency.

Your B12 is in the grey range but it is actually quite difficult to get a proper diagnosis - in part because interpreting tests is very difficult. It gets even more difficult if you supplement with high levels of B12.

This assumes that your diet includes good amounts of B12 and that you aren't a vegan/eat very little meat/fish/dairy/egg. If you are a vegan then would advise that you take a supermarket B12 supplement to make sure that you are getting enough B12.

Absorption problems are more likely to lead to B12 deficiency than diet - supplementing with a supermarket supplement would not have a significant impact on an absorption problem because it severely reduces your ability to absorb B12 to a fraction of what it would be.

Another thing to think about is how quickly your symptoms came on - though the overlap with folate may make this difficult. The symptoms of B12 deficiencies generally develop very slowly whereas folate deficiency symptoms come on relatively quickly.

If the folate hasn't made any impact in a couple of months then come back for support in getting your GP to look seriously at B12 - and in the meantime familiarise yourself with the materials in the pinned posts.


Thanks for the advice will give folate supplements a chance to work. I don't eat eggs as they make my throat seize up, limited dairy, fish and red meat. My symptoms have come on slowly feeling physically and mentally slower and slower Then just felt like I was going to stop


It does sound as if your diet isn't very rich in B12. The body is very efficient at using B12 and stores good quantities in the liver with the result that even a dietary deficiency can take years to develop. Suggest that you look seriously at how much B12 you are getting from your diet - there are a lot of sites that will give you the B12 content of various foods - and see if you can up the content from your diet - or start supplementing with a general B12 supplement containing 5-50mcg or so of B12. This isn't a dose that will have any material impact if you have an absorption problem so wouldn't affect further testing if you have an absorption problem but should be sufficient to ensure that you are getting enough B12 if diet is the problem.

Please do double check this advice with your GP/pharmacist though


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