Pernicious Anaemia Society
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Help with b12 and folate levels

This is my first time on this forum, I have hashimotos and PBC and recently my b12 and folate levels are not good and I’m wondering what could be the symptoms as with having hashimotos it’s hard to tell the difference. My symptoms main ones are poor sleep! Lack of motivation and energy and night sweats. I am post menopause. My levels used to be mid to upper in the range but since November last year they have dropped. I have a hiatus hernia and digestive issues that doc put me on nexium. I was on 20mgs for about 14months and I have been reducing gradually and now I’m on 5 mugs and hope to come off it soon.

My levels

November 17.....folate 5 (3.o-26.8 ) b12 366 (197-771 )

December 17.... folate 3.3 slightly haemolysed b12 349

January 18... folate. 4.4. B12 356

May 18........folate 4.2 b12 390

These levels are within range so I’m not sure if they would cause symptoms.

From January I supplemented with liquid folate but not b12 which I know is not good from reading this website. In May my levels had not gone up much.

Any information would be gratefully accepted.

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Your B12 levels are perfectly fine.

Your folate is towards the low end. Eating more folate-rich foods (leafy green veg, pulses and seeds) would b3 a good idea. Taking 400 much of folic acid a day couldn’t hurt.

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Thanks fbirder I think I need to eat more greens

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Gwelos, did the drop in levels co-incide with starting on nexium?

Your B12 levels do seem to be quite steady over the period covered by the above results - there are limits to the B12 test and one is that testing the same sample several times will actually give results in a range of +20% to -20% around the actual result and all of the results above seem to be in that range - so not giving any real signs of dropping B12 levels - though is definitely worth monitoring it over time given the hashi's and the high crossover with PA. It can take decades for absorption problems to develop but once they get to a tipping point then the levels tend to drop quite quickly and that isn't what is going on in the levels above. Liver damage can also affect B12 levels.

what supplements were you using for folate - to be honest the best source is food so it would be better to look at your diet and make sure it is rich in folate rich foods. The levels in your blood are quite responsive to changes in diet as it isn't significantly stored anywhere in the body, unlike B12.

As you say it is difficult to say anything based on symptoms given overlap with other conditions and to be honest the symptoms of the menopause can actually go on for many years after the formal declaration that you are 'post menopausal'.

You could ask for a referal to a gastric specialist and investigations - and you could try looking at whether you have low stomach acidity - there's a home test that involves bicarb ... but I'm not sure of the details.

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forgot to say - taking folic acid before B12 if you are B12 deficient carries a miniscule risk of causing nerve damage and with the B12 levels above it's basically zero. It would have happened by now if it was going to happen anyway so that isn't something to worry about. Whilst it is also true that good folic acid levels can mask the development of macrocytosis this isn't a defining characteristic of B12 deficiency and shouldn't be used to rule out B12 deficiency - 25% of people with B12 deficiency don't have macrocytosis.

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Thanks Gambit62..for the detailed reply much appreciated. I started taking nexium about 9 months previously. I’m glad to know my levels aren’t too low..I was taking a bio care product folguard I think there’s about 400 in 4drops. I think I need to look more closely at diet and try to get off nexium completely. Symptoms could be my Hashis or the PBC!

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