Dr's opinions on b12 published in BmJ

[Steap]

Twould seem that some doctors do get it

bmj.com/content/349/bmj.g52...

[pugdogs10]

So interesting that I printed it ( yes all of it ) to continue reading later. Thanks Steap.

[Steap]

Cyanocobalamin is cobalt attached to a cyanide molecule .

It's harmless in nearly every situation except in someone with a rare hereditary eye condition where cyanide can worsen damage to their optic nerve. (It's called lebers disease).

Lots of foods such as fruits and nuts and even drinking water in some places contain cyanide.

The amounts in the food and cyano are so small it's not worth worrying about.

[humanbean]

To deal with constipation when taking iron supplements, take high dose vitamin C - about 500mg - 1000mg per dose of iron. If that still leaves you with constipation take more. If you end up with diarrhoea take less.

If you need iron, avoiding it because of constipation is nuts.

[humanbean]

P.S. prescription-strength iron tablets are available in many pharmacies in the UK without prescription. It is up to the pharmacist's discretion whether they sell it or not. They are also available online.

[humanbean]

I imagine the result of 110 is in g/L - it usually is. If you convert that to g/dL your result is 11.0.

According to this page :

patient.info/doctor/iron-de...

The World Health Organization defines anaemia as:[1]

Haemoglobin (Hb) <13 g/dL in men over 15 years old.

Hb <12 g/dL in non-pregnant women over 15 years old.

Hb <12 g/dL in children aged 12-14 years.

So you are suffering from iron-deficiency anaemia and should be taking iron.

If your doctor had prescribed he would have prescribed according to what it says on this page from the BNF :

evidence.nhs.uk/formulary/b...

When I was very low in iron I was prescribed ferrous fumarate 210mg in boxes of 84, which is enough for one dose, three times a day for 28 days. If you struggled to tolerate it there are other choices.

Ferrous fumarate 210mg contains about 69mg pure iron per pill.

waltonpharmacy.co.uk/images...

Ferrous sulfate 200mg contains about 60mg pure iron per pill.

waltonpharmacy.co.uk/images...

Ferrous gluconate 300mg containing 35mg pure iron per pill.

dontblushpharmacy.com/media...

Ferrous bisglycinate (also called iron bisglycinate) containing 20mg - 30mg pure iron depending on brand.

The maximum amount of pure iron I took, and I would consider this to be the most anyone should take, was 207mg pure iron in a day.

Iron should be taken with vitamin C as described in my previous post, to maximise absorption and reduce constipation.

If you don't get on with the stronger supplements try the ones with lower iron content.

Altrnatively, if you eat meat, eating liver a couple of times a week will increase your iron levels too. Some people find this is more successful than supplements.

Remember that iron is poisonous in overdose so regular testing is essential. You can do a finger-prick test :

medichecks.com/iron-tests/i...

And get suggestions on optimal levels here (or ask on the forum):

rt3-adrenals.org/Iron_test_...

Another document on the subject of iron can be found here, written by helvella.

dropbox.com/sh/3waycnbzhywi...

The one you need shows up on the second row with the incomplete name "helvella iron ...pdf". Just click on it and save it.

[JGBH in reply to humanbean]

Thanks for comprehensive information on iron deficiency anaemia and various iron supplementation humanbean.

[humanbean]

14mg won't get your levels up this side of the apolcalypse. 14mg is the daily standard requirement for iron for healthy people, not those who have a large deficit to make up. You should read the patient information leaflet for whatever you buy.

If you have trouble finding one perhaps you could let us know.

[JGBH]

Hi Steap,

Thank you so much for this most interesting link. I may print it out and give it to my useless GP on my next visit. Perhaps all B12 deficient patients could so that?

[Polaris]

I'm so sorry you're feeling so unwell delicious21. I've started SI after experiencing neurological problems - tingling tongue, fingers, toes, and have been injecting every other day for about three weeks now. It's so Important to nip these in the bud to avoid permanent damage 🙁

I'm already noticing a huge improvement with fatigue, dizziness, concentration, blurry eyes. No problem with potassium - making sure I have avocado, bananas, sweet potatoes, yoghurt, etc. - all have high levels of potassium.

[jillcur39]

thank you so much for posting this link- lets hope our gps read it too.

[Frodo]

Thanks, Steap , this (the top response by Karen Thompson) does seem to answer the question everyone has been asking of how the treatment levels were originally set and why.

I wonder if Tracey Witty has seen it - I think she was trying to find out.

[humanbean]

Any iron supplement will tell you the amount of iron in each pill or tablet.

The highest dose of iron that is prescribed (that I know of) is ferrous fumarate 210mg, which is prescribed at the rate of 1 pill, three times a day. That is a total of 207mg of pure iron per day.

So, whichever supplement you take, make sure that you don't exceed 207mg (or thereabouts) per day.

evidence.nhs.uk/formulary/b...

For dosing info you need to look at the Sub-sections for the various supplements at the bottom of the page in the above link. So, click on the substance name, then click on the name again at the bottom of the next page. You are looking for the therapeutic dose, NOT the prophylactic dose.

[humanbean]

Steap Sorry I took your thread off-topic above. Thanks for the link to the article. If you want to read the entire article, not just the abstract, you can find it here :

sci-hub.cc/http://www.bmj.c...

Since sci-hub gets driven off the internet on a regular basis (because it allows people to download full papers of scientific research for free), and has to change its web address, I would suggest that you download a copy while you have the chance.

[Steap in reply to humanbean]

Thank you

[Poppet11 in reply to humanbean]

So nice to see the Sci-hub site being given a bit of exposure too. They are quite right - research papers should be available to all. Biggest pain of my job is not being able to access relevant research papers because they are stuck behind a paywall!

[fbirder in reply to Poppet11]

Any job I've had (since my Saturday job in Tesco) had required full access to journals, which was paid for by my employer.

I also had full access when I was a student with the OU.

After I retired from working I signed up to do a short course with the OU, that allowed my to buy a lot of student version software for ridiculously low prices. It also gave me full access to their library.

Their short courses have changed (you no longer get academic credit for them) so you may not get full library access. But if it's that important then £160 a year might well be worth it. Plus you get to study some interesting stuff.

Oh, ******* ******** book arrives tomorrow.

[Poppet11 in reply to fbirder]

You do get full access usually with most degrees, I know I got it.

I get access with the BMJ because I'm a peer reviewer. But the Sci-hub makes a very good point and is doing a brilliant job of kicking up a stink with all research papers. Jama is particularly frustrating!

What is your opinion of the clinical review?

[fbirder in reply to Poppet11]

I was highly impressed with the BMJ review article. So such so that it is one of the main sources I use in my B12 summary document (in the linked posts).

[Poppet11 in reply to fbirder]

Yes, but I meant a specific point that they make?

I tell you the reason that I ask;

because they point out some issues in there, that resolve many of the questions still being asked on this board today - and no one is giving these answers - and I wondered why?

...and just as an afterthought... are you linking direct to the article in the BMJ itself?

[fbirder in reply to Poppet11]

Like I said, I regularly point people at that paper, as do several others. It's also in the pinned posts. So I disagree that 'no one is giving these answers'.

[Poppet11 in reply to fbirder]

Yes, but which bits?

What answers?

I'm just going to come back to you on this because I've just clicked on the 'pinned link.'

It's my post from over 2 years ago and there is no link in it. The only link is to the Murphy and Minot video.

Remind me again, exactly how are you promoting this very important clinical review?

[fbirder in reply to Poppet11]

I'm not sure what you clicked on.

On the home page for the PAS fora, over on the right-hand side (or the bottom on a mobile device) is a box that says 'Pinned Posts'. The third of those contains a link to the summary document.

[Poppet11 in reply to fbirder]

I clicked on the pinned post for it. And it led to my post.

Right; the 'summary' document - do you mean 'abstract summary'?

And what sections of the complete clinical review do you personally find particularly relevant or that you were 'impressed' by?

If I might suggest, when this book shows up that you've ordered, flip straight to the section on Cognitive Dissonance.

[fbirder in reply to Poppet11]

Please read what I wrote.

Go to the home page for the PAS forum.

Look for the box that says 'Pinned Posts'.

Click on the third link.

That will open a post with lots of infor from Stichting Tekort, and various other sources. The last link is to the summary document of which I speak.

[Poppet11 in reply to fbirder]

Can we take it that you haven't read the Hunt Clinical review in full?

[fbirder in reply to Poppet11]

Can we take it that you haven't bothered to read a word I've written.

Here the simple version

healthunlocked.com/pasoc/po...

[Poppet11 in reply to fbirder]

I know where the linked posts are. There is a link in here to the full research paper - not a summary. What I want to know is, have you read it?

It's not a trick question, it's an excellent review, as reflected by the clinician's comments on it, and the many relevant points - I just wondered which one you were most impressed by?

[fbirder in reply to Poppet11]

If you actually bother to read that summary you will see that I have extracted what I believe to be the more relevant points in that paper.

Now, while I am exceptionally talented, even I would find it difficult to extract important bits from a paper without having read the paper!

[Steap]

I've never met someone yet that I though was stupid. We each have knowledge that others can benefit from.

[Frodo]

Thank you Karen (Poppet11 ), that's very interesting and informative.

It's hard to comprehend why anyone would reject this kind of information providing it's based in fact, which I assume it is. Especially as it seems "nobody knows" the medical basis for the current treatment regime, frequent dismissal of symptoms and reliance on fairly inaccurate tests. The book appears very informative - I've looked at the available preview. The preview doesn't show a list of sources, but presumably there is one and they can be verified? Thanks again.

[Polaris]

Yum - nearly through one pot of Rachael's yogurt - another in the fridge 😍

I'm on a g/f diet so know how you feel about the same food every day

[Frodo]

Well explained, thank you!

[Poppet11]

At the bottom of the Responses section on the BMJ Clinical Review, and I'll risk 'reasonable use' on a quote, who says:

'This review raises enough clinical questions to be quite genuinely alarming.'

Opening line, last post on that page:

bmj.com/content/349/bmj.g52...

That's a doctor. One of the kind that patients here can never get to understand the situation. And that's why this review needs to be read, comprehended and linked anywhere and everywhere.