Viapath Nutris B12 Test Results- Can anyone assist me in interpreting them?

[ARRozental]

Hello

I had some B12 related tests performed last week by Viapath Nutris and require some assistance in interpreting them. The tests and results are as follows:

Test Result Units Reference Interval

Vitamin B12 (Serum) 509.0 ng/l 187.0 - 883.0

Methylmalonic Acid 135 nmol/L 0 - 280

Active B12 (HoloTC) > 128 pmol/L 25 - 108

Homocysteine 13.5 umol/L 0.0 - 15.0

Serum Folate 3.1 ug/L 3.1 - 20.5

The results came with the following commentary (from the lab that did the tests, presumably):

Total serum B12 within our reference range, Active-B12 (holotranscobalamin - HoloTC) above the upper limit of the reference range and methylmalonic acid (MMA- functional marker of vitamin B12 deficiency) within the reference range suggest good vitamin B12 status at present. Total serum folate and homocysteine are within our ranges suggesting adequate folate status at present. However, homocysteine is close to the upper limit and serum folate close to the lower limit of our ranges which may suggest declining folate levels. Diet rich in folate e.g. green leafy vegetables, marmite, fruits and cereals should raise folate levels.

I should add that the tests were performed about a month and a week after I received 6 'loading' shots of Vitamin B12.

My question is, do these results indicate that I have no Vitamin B12 absorption problem? Also, do the results mean that I can rule out Pernicious Anaemia? Since the 'loading' shots were administered to me a month and two weeks ago, some of my symptoms have improved- less muscle pain and reduced clumsiness. I also generally feel less fatigued. However, my energy levels do sometimes crash, and I still sometimes suffer from headaches, low concentration and poor short term memory. As such, I can say that whilst my symptoms have improved in a general sense, some of them still persist.

I had planned to self-administer Vitamin B12. However, given the test results, will it be worth it? I was going to try self-injecting, but given that the results don't indicate a problem with absorption, should I try oral supplements?

Could the low Folate Serum result indicate a B12 absorption problem, even when the other results contradict that? Should I consider taking Folic Acid supplements?

I have, for two to three years or so suffered from intermittent but consistent bouts of constipation (My other symptoms began about four and a half years ago). I have previously chosen to ignore it, as it was intermittent. However, since October last year, the constipation has become constant, with associated haemorrhoids and abdominal pain. My doctor requested that I maintain a food diary during my last appointment, which has been frustrated by the fact that there seems to be no correlation between the food that I eat and the constipation to record. Anyway, my question regarding this is could my digestive/bowel problems indicate a condition that prevents B12 from being absorbed properly, that has not been shown in the test results?

[Gambit62 Administrator]

It isn't really possible to manage a B12 absorption problem using serum or active B12 as a guide as the normal range no longer applies. After your shots your B12 levels would have been off the top of the measurable scales and will have dropped over time to where they are now. The likelihood is that they will continue dropping until you become deficient again - which by the look of it may well be before you get to a 3 monthly maintenance shot.

Intermittent constipation/diarrheoa is associated with B12 deficiency and also associated with thyroid problems.

Your folate is getting towards the low end of the spectrum - this could be because your body is healing damage done whilst you were B12 deficient so is using more folate at the moment. Please follow the dietary advice given.

Have you looked at a full list of B12 symptoms. If not - please do and mark off all that seem relevant even if you have had them for years .... and monitor where those symptoms are as those are the best guide to when you need to top up.

pernicious-anaemia-society....

[taka Administrator]

I'm not a medic but your results show you your levels of B12 are in "normal ranges" (or above range for active B12) just as they should be after a course of loading doses. Everyone is different in how rapidly their levels will fall after injections - symptoms are a better gauge of things than blood tests once you are on injections. They don't, however tell you anything at all about whether your previous low B12 was due to problems absorbing B12 or PA or due to any other reason.

As you tested negative for anti-intrinsic factor antibody previously you may or may not have PA. Depending on the method of testing 40-60% of those with PA test negative so a negative result doesn't rule out PA. Sadly not may doctors know this.

PA leads to low / no stomach acid which can in turn lead to problems with your digestive tract and some people with PA have IBS like symptoms. PA may be the reason but it may not be. Other things can also cause B12 deficiencies - coeliacs for example. Have you been tested for coeliacs and / or been referred to gastroenterology to investigate your GI issues further? Would seen a reasonable thing to do given your symptoms.

[ARRozental in reply to taka]

I was tested for Coeliac about a year ago, with negative result. I believe that it was the Coeliac antibody test, which I gather is about as accurate as the IF test, so I guess that is still inconclusive. I don't know what my stomach acid level is. I have intermittent bouts of heartburn and reflux perhaps two or three times a month, lasting a day or two each. I am aware that some anti-acid treatments can suppress Vitamin B12 absorption- I take ranitidine two or three times a month, so I don't really attribute it to my B12 predicament. At my last appointment, my doctor asked me to keep a food diary, which I have done- unfortunately from what I have recorded thus far, there seems to be no correlation between my daily diet, constipation and abdominal pain (the pain is not severe, more like a dull pricking or bloating sensation). I would certainly welcome being referred to a consultant regarding this- whether my doctor consents to that is another matter.

[ARRozental]

Thanks for your replies! Having read your opinions, I think that it might be best for me to repeat these tests in about a month's time. I am scheduled to have a B12 injection in May, so it would seem appropriate to have the tests done shortly before then. Is it the case that if I repeat the tests and the results show a decline in Serum and Active B12 levels (as well as attendant changes in the Methylmalonic Acid and Homocysteine), then the indications are that I have an absorption problem? Also, should I supplement my Folic Acid if I mean to repeat the Folate test?