I understand that B12 should be present in your blood, and you should ingest so much per day to replace the little you lose or use. What I don't understand is many people's need to have B12 injected every day or other day or even every month, when their serum B12 blood test shows a B12 level sometimes at over a thousand. My own most recent blood test showed an increase from 178 to over 450 in a month just using sublingual tablets.
I understand that of the 1000ug I was taking each day I might only absorb a very few percentage points. On my most recent test of 452 there was a note written under saying that I now had enough reserves for two years which I find reassuring. But am I either wrong or right in thinking the more B12 the better I will feel? Apparently I have enough in my body for two years, yet I still feel many of the symptoms I had before but, thankfully not every day. Which is why I would like to know why many on this site self inject every day or so, and how can it benefit them?
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serum B12 tells you about the amount of B12 in your blood - it doesn't tell you whether your cells have enough B12 and I really don't know how anyone can use it to tell you how much B12 you have stored in your liver - that would require other test and I'm not sure what they actually are.
If you have an absorption problem then that also impairs your ability to access any stores of B12 in your liver because releasing it relies on the same mechanism - in the ileum - that is stopping you absorbing B12 from your food.
Some people react to high levels of B12 in serum in a way that makes the process that allows the B12 to go from blood to cell a lot less efficient - meaning that very little actually gets into their cells - unless their serum B12 levels are very high - like needing a lot of water behind a dam for enough to trickle over the top of the dam and be available downstream.
People vary so much in how much B12 they need that going by serum B12 levels is no more than a guide - how you feel is much more important.
I'd advise against going for really high serum levels. B12 isn't toxic but there is always the risk of the reaction mentioned above
The latest BMJ research document summary (full document behind a paywall) above states that there is no reliable test and, (bottom of page 4 ' under, 'How is Response to treatment assessed'), once treatment is given blood levels will inevitably increase but it is the clinical condition of the patient that is paramount:
"Cobalamin and holotranscobalamin levels are not helpful because they increase with vitamin B12 influx regardless of the effectiveness of treatment, and retesting is not usually required."
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If the cause of B12 def. is dietary and not an autoimmune condition, oral supplementation and a nutritious diet will usually suffice but, if you have an autoimmune condition, H/Pylori, or problems with digestion (coeliac, Crohns, gastritis, gastric surgery etc.), the condition is more complex as B12 from food is not likely to be absorbed, depletes over time and oral supplements are not usually absorbed either. There is further risk for those over the age of 60, as hydrochloric acid (which begins the process of extracting B12 from food) is more likely to reduce significantly, leading to severe deficiency, especially as this age group is even more likely to be on various medications which deplete vitamin B12 further.
Researchers now believe leaky gut/intestinal disease/gastric atrophy is the source of autoimmune disease, and this is likely to eventually lead to low hydrochloric acid needed to begin the process of absorbing B12 as well as other essential vitamins and minerals. I believe this is at the bottom of all our own family autoimmune/Hashimoto's thyroid/PA/B12 problems.
Dr Marc Ryan's excellent article on his Hashimoto's Facebook page was a lightbulb moment for me in the search for answers to the cause of, not just Hashi's autoimmune disease but B12 def. in particular:
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"Hashimoto's Health Tip: The Little Paint Brushes in Your Tummy"
"Anyone who has lived with Hashimoto's knows that this is so much more than a thyroid problem. The biggest axis of trouble is often found in the thyroid-brain-gut connection. And one common problem that causes this is leaky gut or intestinal permeability.
Many researchers believe that this is ground zero for autoimmune disease.
It is the place that autoimmune disease is born and the place that makes it get worse and worse. And when things get worse in the gut, problems in the thyroid and brain often follow. In this post, I wanted to shed light on some little known but very helpful enzymes called brush border enzymes.
The small intestines are the place where leaky gut often happens. And the walls of the small intestines are lined with tiny little hair like protrusions called microvilli. On a regular microscope they kind of look like a tiny, fuzzy paint brush. This fuzzy appearance is why they came up with the term "brush border" to describe them.
This is the place where absorption happens.
And many people with Hashimoto's suffer from deficiencies of important vitamins and nutrients (like vitamin D, vitamin B12 and B6, zinc, selenium, magnesium, iron, etc.)
One of the reasons for this is the breakdown of these brush borders.
Foods high in lectins or other inflammatory substances (like gluten, and other grains, beans and nightshades) can actually cause these brush borders to get crushed and destroyed.
The microvilli (little hairs) that make up the brush border have enzymes for this final part of digestion anchored into their membrane as membrane proteins. These enzymes are found near to the transporters that will then allow absorption of digested nutrients."
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Personally, I take daily spoonfuls of sauerkraut (more good bacteria than any other probiotic I'd tried) and avoid gluten in the hope that this will help heal these microvilli lining the digestive system, enabling better absorption and thereby strengthening the immune system.
This did work for quite a while but, being over 60 years old (when hydrochloric acid had obviously begun to reduce) as well as having had Hashimoto's, H. Pylori and gastric problems for years, I found myself having to begin self injecting every other day after two viruses led to the onset of neurological problems (crippling fatigue, dizziness, memory problems, pins and needles etc.) Ten months later, symptoms have hugely improved but stress or overdoing exercise brings them on again.
The reason many of us must take b12 for life really comes down to malabsorption. A normal person would absorb more without a problem, but having PA on top of absorption issues, means we have even a lesser percentage that gets absorbed than the average person does. As someone else posted in another reply, it’s like filling a gas tank that has a hole in it. And many of us, if we go even a few days without any b12, the symptoms all start to return. That’s why for a lot of us, it means b12 supplementing for life.
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Advice please: what do I do next?
Why would Active B12 blood test not be recognised by GP when I have lots of symptoms?
Just got diagnosis, what else should I be taking
What should be monitored if we have ongoing B12d and SI?
I wrote a letter, and this is what I got back. 
