Pernicious Anaemia Society
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GP visit following B12 retest

You may recall I had a low B12 of 129 (range 180-914). I stopped taking reflux meds but after 6 weeks the B12 had only risen to 143 which is clearly deficient. I went to see the GP today armed with all sorts of info but, as usual, I was squashed into submission. I asked for B12 injections but he refused on the grounds that my Hb was higher than it has been for years so I am not anaemic. My folates and ferratin are in the "normal" range but both are at the lower end.

He did prescribe me 50mcg B12 twice daily making a daily total of only 100mcg. In between getting the latest test and getting a GP appointment I have started taking 5000mcg daily of Solgar B12. Now what do I do? At the next test the B12 will have risen and the stupid GP will assume it is the meagre amount he is giving me.

Also the Solgar B12 is Methylcobalamin whereas the B12 from the GP is Cyanocobalamin? What is the difference? I am sure I have read somewhere on this site that the better than the C.......

Your thoughts would be appreciated.

7 Replies

As you say, by taking the sublinguals your B12 levels will almost certainly rise, meaning you will probably never get the GP to agree to injections.

However, if the levels rise high enough to alleviate your symptoms then that won't be a problem. You will have found your solution to your problem.

As for methylcobalamin vs cyanocobalamin there's virtually no difference. Certainly not once they get into the cells.


As you say Megluka, your B12 is still v. low and I notice you also have Hashimoto's.

These helpful links might help persuade your GP to do more tests to establish whether you have an absorption problem, in which case, cyanocobalamin tablets will be useless and you will need injections.

With (templates for writing to your doctor.

Latest BMJ research document, with useful summary in case GP will not read the whole thing.



PS Coincidentally, looking for something else, I came across this research:

"There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients."


Thank you Polaris. I know that so why doesn't the GP with years of training and experience know that too!

I have been out with friends tonight and have had a chat about all this. I have decided to stop taking the higher dose of B12 meds and stick to his lower dose for the next three months. If the higher greatly increases the B12 level then the GP would think that everything is hunky dory when it is not. I have low Vit D, folates and ferretin as well as the low B12 which, to me, points to absorption problems.

If my levels are still low after three months when I will have been taking ACV, gone gluten free and taking Kefir, then that surely will point to absorption problems and the GP will have to do something. At the moment he is quoting the NHS guidelines as he knows them!!

Meanwhile after about six weeks I will do another complete thyroid test with Medichecks as that checks B12, folate and ferretin too


It's so good you're able to talk things through with friends as it must be so frustrating not to be taken seriously by GP.

The connection with Hashimoto's (HT) seems so important with many of us having the gastric problems associated with it. The link already given above ***( highlights this connection with PA :

"Similarly, autoimmune gastritis is a chronic inflammatory disease involving gastric body and fundus, with the progressive reduction and/or disappearance of the native gastric glands that are sometimes replaced by intestinal or pyloric epithelium (metaplasia) (3). The natural history of HT is the progressive reduction of thyroid function till overt hypothyroidism (24) with a rate of progression of 2–4% per year (23), while that of gastric atrophy features the progressive reduction, till disappearance, of parietal cells, leading to reduced or absent acid production (3, 22).

These alterations interfere with absorption of essential nutrients leading, at first, to iron-deficient anemia, followed by PA if the self-injurious process involves the IFA (13). Increased risk of developing neuroendocrine tumors and gastric adenocarcinoma is also associated with the severity of damage of gastric mucosa (22)."


Good luck - I hope this will help convince GP but, if not, I wouldn't go too long without treatment. I personally found Jarrows 5000 mcg SL tablets worked well for a while but I've resorted to SI after two viruses left me with neurological symptoms.

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Sorry, I am not awake yet....what do you mean by Sl


On this forum, Self Injection.

(Afraid I always tend to think Stress Incontinence... :-( )

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