Questions from a person new to B12 deficiency...

Hi everyone,

I have been reading through lots of your posts, and you seem to give each other wonderful advice and support! I wonder if anyone can answer a couple of questions so I can understand how B12 deficiency works...

1. When you say that with folate and B12 a surplus of one masks a deficiency of the other, do you mean that you're not likely to get macrocytosis if you are lacking in B12 but have plenty of folate? Or do you mean that you won't have so many symptoms of B12 deficiency (e.g. neuropathy, fatigue etc) if you are lacking B12 but have plenty of folate? Does that make sense?

2. Also, I have just started b12 tablets as I thought my B12 deficiency may be diet related, but the more I read about it I'm not sure. I'm having a repeat blood test in 6 weeks to see if my levels have gone up, if they have can I assume that it was diet related after all? I'm a bit confused about the active vs inactive B12. If I have PA will I absorb ANY of the B12 from the tablets? I'm a bit worried that by taking tablets I might mask underlying deficiency on the repeat blood test.

Just to explain the background to this, I recently had blood tests showing low B12. I had been to my Dr for heart palpatations, and the first blood test came back as B12 154, ferritin and folate were within the normal range (sorry I don't have the exact figures). A month later B12 had gone up to 183, all other blood work within the normal range (no macrocytosis, negative for IF antibodies) . I put this down to 1. That month I had made an effort to eat fish every day (am pescatarian, used to eat fish 2/3 times per week but didn't think I needed to worry about B12 as also had plenty of dairy and eggs). 2. the first test result I was mid cycle in my contraceptive pill, the second one was in my week off ( don't know quite the degree of difference that might make- anyone?).

Anyway, after discussing B12 injections with Dr, I decided to try B12 tablets, as from the above I thought maybe it's a dietary deficiency, didn't want to have injections if it was not neccessary, and he seemed to be quite reassured that there was no macrocytosis and that there were no neuro symptoms (though now I am reading up on it more have had tiredness and "odd sensations" on and off for years but has never been severe so assumed everyone does!).

Now I'm starting to question my decision! Perhaps have been reading up too much about it, then again I would rather take charge of my health now than regret it later.

Thanks in advance for any answers you may have for a confused person!

[Galixie]

"you're not likely to get macrocytosis if you are lacking in B12 but have plenty of folate"

Yes, that one. You could still experience symptoms of deficiency but the blood markers of macrocytic anemia would not show up on tests. It is possible to become B12 deficient and not have macrocytic anemia show up. Even though it is considered a defining characteristic of the disease, macrocytosis is really just one symptom and not everyone has it.

The tablets might work for you, or they might not. It would be a good idea to start a log of your symptoms so that you can gauge how effective the tablets are. If your test result has not increased by hundreds of points and/or you still have the symptoms you were experiencing at the beginning, then it would be a good idea to ask about injections. The bottom line is that the whole picture is important, not just the number on the next test result.

[Hidden in reply to Galixie]

Thanks Galaxie, that seems like very good advice. I started a symptom diary yesterday so will see how it goes.

[Gambit62 Administrator]

Although contraceptive pill can interfere with B12 absorption the variation in the two tests is actually in the realms of the accuracy of the assay methods so much more likely to be that. I don't think the week off would have made the difference but that's just a feeling rather than an in depth knowledge.

Do you eat dairy as well as fish? and do you eat eggs. To be honest it sounds unlikely that the deficiency is due to diet as fish is actually quite a good source of B12.

Macrocytosis isn't present in around 25% of patients first presenting with B12 deficiency

[Hidden in reply to Gambit62]

Thanks Gambit, so the tests could just vary due to range of error rather than anything else. Yes I do eat dairy and eggs, always assumed I have quite a balanced diet so didn't think I needed to worry about B12. I'm going to follow Galaxie's advice and see what happens