I had a Whipples just over 2 years ago. I didn’t have any of my stomach removed, just my duodenum, part of my pancreas, gall bladder and some of my liver. I have now been diagnosed with low B12 of 153 and iron deficiency. My specialist said I needed injections for B12 and iron tablets but my Dr has started me on tablets instead of injections. She said that’s what they do first. After 6 weeks I will have another blood test to see if they are working and if not I will need injections. I feel so tired. Have numbness up my face and lips and tongue tingle. I had a replacement knee 6 months ago and need the other one doing but I’m getting so much pain in them, even the one I had replaced and wondered if this had anything to do with B12. Reading about it online I think I should be having injections as I can’t digest food properly having no duodenum. I’m on Creon tablets with every meal, 6 with every meal to help me digest the food. So how will I digest the B12 in tablet form. Any suggestions please.
Tablets or Injections for B12 - Pernicious Anaemi...
Tablets or Injections for B12
Not an expert at all, but just to note that tablets may increase the B12 they find at your next blood test. It doesn't mean you can 'access' the B12 necessarily, but it might skew the results of the blood test. GPs are a bit quick to decide not to inject, probably because they simply don't understand B12 issues.
Someone on here will give you more advice, but just wanted to say we know what that horrible tiredness feels like, and you're not alone!
on average 1% of B12 is actually absorbed outside the ileum so flooding the gut with large amounts of B12 can result in enough being absorbed but this isn't a very efficient way of correcting a significant deficiency. It also doesn't work as a treatment method for everyone.
It would be helpful to know what country you are in as protocols for treating B12 absorption problems do vary significantly between different countries - most of the information on this forum relates to the standards in the UK.
What is the strength of the tablets that you have been given?
It would also be helpful to know the units and range of your B12 test (there are two different units) ...
Is there any way that you could get the specialist to write to your doctor to explain in detail why they think that injections are definitely needed in your case - might help.
Hi. I’m in the UK. My results were
Serum Ferritin 10ug/L - 15.00-300.00
B12 - 153 ng/L - 180-900
I’m on Cyanocobalamin 50mcg twice a day
That level of B12 tablet is probably useless to you.
Your GP should listen to the specialist. You need injections.
As an example, I’m currently on weekly cyano 1000 mcg/ml injections and I still take 4x 5000 mcg methyl sublinguals throughout the day to feel normal.
Methyl-b12 and adenosyl-b12 are active forms in the body.
Hydroxo-b12 is an analogue that needs to get converted in the body but stores longer in the muscle (IM injections)
Cyano-b12 is another analogue that gets converted in the body. It is more stable but gets used up faster in the body.
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I’m thinking that your stomach not being touched should leave the acid and IF functions for extracting B12 from meat alone.
The illium at the other end of the small intestine should also be ok. This is where B12 is absorbed into the body.
Your GP is probably thinking that oral supplements will help you.
But since the whipple broke into the hepatic loop (liver, bile, duodenum) the recycling mechanism has been altered and doesn’t work as efficiently.
I’m no expert but my aunt had the whipple and needed B12 as well.
Hi Maggie29 wow you have been in the wars.
Do you know whether your Folate level was tested as this and B12 help your iron make red blood cells and to function properly.
I think the absorption of B12 is more dependant on Intrinsic Factor than on the Creon
Coincidentally, only yesterday I started taking Creon for a recently diagnosed underperforming pancreas. Sadly it was 59 years ago last Monday that I had two thirds of my stomach removed due to a perforated ulcer and (apparently) I should have been on enzyme medication since then. Still, I guess it's better late than never.
I am not a medically trained person but I've had P.A. (a form of B12 deficiency) for more than 45 years.
I wish you well
and hope you start to feel better soon.
GP stopped my B12 injections after nearly 40 years
B12 injections
Daily b12 injections 
B12 ranges
Stopping b12 injections 
