Pernicious Anaemia Society
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B12 levels

Hello I'm just wondering if anyone can tell me as I have just had my first ever result from B12 serum test and folate .My B12 result was number 381 and my folate was 22. Can anyone tell me if this is normal levels? I do supplement sometimes but don't know if it makes a different I don't feel much different;


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Could you provide the unit and ranges.

Both will be in the normal ranges. However, the serum B12 test is problematic when used as a single marker because people vary a lot so comparing an individual to an average doesn't necessarily work.

Do you have any symptoms of B12 deficiency?


Do you have any other conditions - eg thyroid?


hi yes the ranges for B12 in my country australia the unit ranges is 135-650 and for folate greater than 7.So I'm 381 for B12 which is in normal range and normal for folate too at 22. I have slight off reading for thyroid at .4.74.I don't know why that is.I feel ok.I have injections every 2 months I feel ok after just sleep.a bit better nothing major changes>I dont know if I'm deficient or not.Anyone can advise?


you say you have injections - does that mean you are being treated already for B12 absorption problems - bit of context that could totally change the answer to the question you asked as normal range certainly doesn't apply after you have started treatment with B12 injections - you need to go on symptoms.

what is happening about your off thyroid reading. There is another forum you might be able to help more with thyroid issues - get that sorted out as the symptoms overlap with B12 deficiency.


381 is ok or not?


are you being treated for B12 deficiency - you mention injections but you don't say what is being injected.


Also, how long after your injection was the B12 test done?

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the unit was pmol/L


About 2 months after last injection I was tested.thanks.So I don't know if number 381 if low good or high.I sometimes get pins and needles. Also is general nervousness a a sign of B12 deficiency?B vitamins. I do injections every 2 months plus started on oral suplement


If you are currently being treated with B12 shots then 381 is a potentially low result as the normal ranges applied aren't applicable to after treatment has started - and I am still not clear if you are being treated for B12 deficiency - and there isn't a normalised range for people who are being treated with B12 and it would mean even less than the serum B12 result because the variation would be even greater. After treatment starts you need to go on symptoms - you say you feel okay so that implies that your B12 levels aren't causing you an issue.

Symptoms not scores that are important.


Ok thanks.I always thought numbers were important however I have always had very minor pins and needles in my hands and feet but not extreme only.mild.I just I would try injections plus oral supplements to see if it helps or does anything for me. I feel not a great deal of difference I just sleep a bit better after having treatment although one thing I noticed after injection or orals is that I feel abit of tightness and pressure a little sore around the kidney area.Not sure why.Any thoughts.My thyroid reading is 4.74.I don't know if that is ok or not.Thank you


I started treatment on my own decision.Not because my Doc told me too or anything

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I don't know if I have any absorption issue or not.I don't know as I can't see inside my stomach.Does general nervousness mean anything related to B12 orB vitamins deficiency?


Please be aware that the members of this forum are not medically qualified and that HU is not a substititute for professional medical advice. Whilst members of this forum may be more aware of guidelines, treatment options etc related to B12 deficiency than the average GP we are not experts by any means in other conditions. You really need to find a doctor that you can work with.

To get a base line for serum B12 you would need to stop supplementing any B12 for at least 3 and probably nearer 6 months.

If your B12 was tested by the doctor in the past then you can get copies of your blood tests to see what the problem is.

Probably the most clear cut test for PA - the most likely cause of B12 deficiency is to have the levels of gastrin in your blood measured - they will be sky high if you have PA.

Other possible causes of absorption problems include coeliacs, crohn's, a whole raft of drug interactions, h pylori infection, tapeworms. H. pylori and tapeworm are treatable.

Anxiety is a potential symptom of a B12 deficiency, or a folate deficiency - though your results above certainly don't imply a folate deficiency. However, they can also be caused by a lot of other things.


thank you


Personally, knowing where I have been and the symptoms I have now: I would get your B12 up as high as at least the top of the range which is 700 in UK.

Japan far less heart disease and alzheimers normal range is 500-1300.

Psychiatrist/ author/functional nutrition approach treatment, using SPECT scans to look at the functionality of his patients brain, Dr Daniel Amen, states always be top of the class when it comes to B12

Lack of/low B12 is insidious. The damage caused to, particularly your brain and heart is not noticeable until the damage is bad enough to make symptoms noticeable. By the you have such damage to your brain that it is a long haul back and levels of 1000+ are needed before healing can commence.

My B12 6yrs ago, first time ever tested was 191. My GP told me that my B12 level was fine. No it wasn't! 191 was the absolute bottom of the range unknown to me, but normal for the GP because in range (UK now raised to min of 197, typical pathetic UK) Later when I realised as I had obtained print outs and learned about B12 from listening to Dr Amen speak, I started to supplement. but like you, on and off. I still hadn't realised the importance and was stupidly pleased when I got my levels up to 500

But this year with levels of 4-500+ I started with bad symptoms. The B12 deficiency charity told me that if my levels were 191 in 2011 that I would have been too low and falling to that level for at least 10yrs before. And all that time plus the next 6yrs to bring us to today damage will have been occurring and that I urgently need to address this, stop the damage and get levels up high to heal!

Folate needs to be a good level. B12 uses folate to become useable in the body. Folate levels will fluctuate anyway with what you eat daily and if you supplement. You should monitor folate when get tested for B12 to ensure that it doesn't go very high consistently as that is an indicator that B12 is not using folate and therefore not being converted to get into the cells to be be useable buy the body. Your folate seems fine

If your GP is is happy to test. Homocysteine blood test is a good indicator that B12 is being converted well and used. During the methylation cycle, B12 converts cysteine back into methionine. So if your Homocysteine is high - above 9 then you may have a problem with this cycle. Homocysteine levels should ideally be 5/6 or 7 if higher you need to bring down, it is an indicator all is not well on the future alzheimers front. Obviously this would be the case re brain function is reliant on B12. B12 supplementation + B vitamin complex of all Bvitamins + other supplements are advised (google) to bring homocysteine down. For Homocysteine blood test, blood needs to be drawn at your local hospital as needs to get to the lab within the hour. You need to ring the hospital to confirm their labs do (not all do, so find one that does) Obv all your blood tests can be taken at the hospital at the same time, easier than GP as don't need an appointment at the dept in the hospital, just a queue system. I always fast and have taken early morning.

Hope this helps:)


Also, pins and needles in hands and feet means damage is happening.


Ok thanks for that. Well at the moment I' supplementing with methly sublingual tablets several times a week 1000 mcg plus injections every two months.I hope this is enough to increase. I was getting injections every month but switched from the cheap cyano injection to more expensive methyl B. I hope I'm doing enough will it take time to raise my level or is it slow? Is the methly better than cyano ? Can it get too high?I'm in Australia. Is injections better received? Or oral tablets just as good.What are your thought?


I really don't know if slow to increase or not as I am trying to increase - others may know timescales? But presume everyone different

I am in UK and cannot get injections or help from our health system the NHS as they see my B12 level as too high. I have bad symptoms but they conveniently ignore that and their own guidelines!

So I am having to take sublingual tablets. I take Jarrow methyl 5000mcg (as recommended by someone on here and noteably Chris Kresser: functional clinician whom I trust, check out his website/podcasts for info)

I take one per day but I have taken another in the night if wake in a pool of sweat, with burning limbs and burning mouth/tongue/lips/gums etc.

I am just about to have a B12 blood test next week, so I am hoping my levels will have increased. I haven't taken any tablets for 2 weeks+ before the test - not that this will help really - folks say 6 months without supplementation is the only way to get a true result.

But, it will show my level in blood with supplementation and not the recently taken tablet, so best I can do.

My symptoms haven't gone away in 4 months of taking. But the way I see it, they aren't going to if have to get up to 1000 before any healing is even going to start taking place.

I am working in the dark with no medical help.

I have read that methyl form is better than cyano - ( the cyanide which is less than an apple pip however, I believe) But the methyl can be absorbed whereas the cyano has to be converted by the body to the methyl form. But then all forms Adenosyl too, have to be converted by the body to be useable by the cell.

My levels have raised in previous yrs, once I had realised I was deficient, when I then started supplementing orally, a little on and off, So I presume that I don't have absorption problems. As said before my levels raised from 191 to 500+ and then ignorantly thought that was OK. I was 400+ when symptoms started

I am not sure how, if there are no antibodies to prevent absorption issues how blood levels with a good diet get so low as to become deficient.

Coeliac/gluten issues can damage the small intestinal villi (responsible for absorption) partially in early stages of coeliac. So not optimum absorption but some would be absorbed because the villi are not all affected at the same time. But that doesn't apply to me as I don't consume gluten grains, and because of ensure an optimum nutritionally focused diet.

I would say that with ruling out intrinsic factor and paretial cell antibodies, Gluten/coeliac damage to villi then an unbalanced microbiome could also be an issue. As beneficial bacteria in the intestines are responsible for releasing B12 from food eaten and for making many vitamins including B12.

So consequently a good diet including a good probiotic as well as supplementing B12 and a B vitamin complex would help.

Ruling out gluten issues (method to be certain is to remove grains from diet for a few months as testing is usually expensive or often a waste of time = 70% false negatives. There are approx 60 gluten proteins and in the UK they NHS test for 2, which explains that unless damage has become extensive they cannot diagnose and even then the national health systems are only looking for intestinal issues and not NCGS (non coeliac gluten sensitivity) the name target being the brain and so similar symptoms to B12 deficiency in the brain = the tingling/nervous system issues.

A low fat diet that has been pushed on us for 40yrs is not optimum for brain health either. High percentage of brain is made up of fat and fatty membranes such as myelin sheaths which protect your nerves. So just incase you are using bottles of polyunsaturated oils still? Remove them. Eat natural fats, bright yellow butter from herds feeding pastured on grass for the butyrate (which the beneficial gut bacteria also produce) natural saturated oils such as coconut oil (really beneficial for the brain which is dependant on fat, and monounsaturated olive oil. Avocados and healthy free range eggs. Eggs particularly for the choline - necessary for cleansing the liver. Wild Fish/seafood for omega 3's (not farmed - as their diet is full of toxins and omega 6's)

All of the above can help support the brain (well are necessary for optimum brain health and if require healing) But B12 is essential, and essential up high. Many people's levels I have seen on forum sites and on here are at 2000+ The Japanese range as said is 500-1300 so getting into the 1000's should be really fine. That's what I am aiming for.

Look at this website link re the different types of B12 re your methyl /cyano question. Quite informative


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