Low Vitamin B12 Not anaemic

[Paul2624]

I'm new here. My B12 level was 110 which was low, my GP says I am not anaemic. Other blood results are thyroid normal and folate level slightly above normal at 21.5.

I have no obvious symptoms but am on Metaformin and stomach acid reducing medication which can interfere with absorption.

GP said "Your B12 remains a bit low - as previously; we could start a supplement cyanocobalamin but not necessary really as you are not anaemic. Rest OK."

So basically no action. Should I take the suggested tablet supplement and see what happens? I am not vegetarian and don't eat too much meat, mainly chicken but do drink milk and have a daily yogurt.

Any advice would be really appreciated, Thanks. Paul

[staceyhx]

Hi Paul. No, you need to be put on injections. I can’t believe how clueless Doctors remain to be.

Do not take the tablets as they will maybe raise your blood levels of B12, but won’t actually fix the issue.

You do not need to be anaemic to have a B12 deficiency 🤦🏻‍♀️

The deficiency will most likely be due to the metaformin and stomach acid reducing medication, so you need injections.

A level of 110 is very low.

[Paul2624 in reply to staceyhx]

Can injections be done at home? I'm also an agoraphobic. If the tablets raise my levels of B12 then isn't that helpful?

[staceyhx in reply to Paul2624]

I mean, you could speak to your doctor and ask if it’s possible to have a home visit and have them done at home, I’m not sure about that.

And no, because it just raises your levels. The only way tablets would help was if your reasons for being deficient was due to being vegan, otherwise you need the injections.

[Gambit62 Administrator]

It's a pity that GPs think that B12 deficiency is all about anaemia - it isn't - 25% of people who are B12 deficient do not present with anaemia and neurological problems and damage can occur in this group of people if the deficiency is left untreated.

The symptoms of low stomach acidity are pretty much the same as those of high stomach acidity - and include acid reflux so may be that you do have PA and the medication, along with the metformin is making the absorption problem worse.

So, you can either try and educate your GP, or you can try the tablets and see if they make a difference - if not then that would be really good evidence that the problem is absorption and you need injections, rather than dietary.

Assuming you are in the UK you could try pointing your GP at the BCSH standards on diagnosis and treatment of cobalamin and folate deficiencies which give good emphasis to the fact that neurological problems need to be treated promptly and your GP shouldn't be waiting until you become anaemic.

onlinelibrary.wiley.com/doi...

your GP can access these through the BNF if based in the UK

[Paul2624 in reply to Gambit62]

Yes I am in the UK. My Folate is slightly above normal does that have any bearing?

[Gambit62 Administrator in reply to Paul2624]

folate tends to be very responsive to diet. May be something genetic going on but there's a lot of the genetics of B12 and folate that really isn't fully understood.

[fbirder in reply to Paul2624]

Low B12 can raise folate levels. It’s quite complicated, but the ‘Folate Trap’ works like this...

One of the important reactions that B12 is involved in is the conversion of homocysteine into methionine. In this process the chemical tetrahydomethylfolate (THF) gives a methyl group to a cobal(II)amin molecule to form methylcobalamin, which then gives the methyl group to homocysteine, forming methioine. The cobal(II)amin comes from B12.

If there’s not enough B12 around then there isn’t enough cobal(II)amin to accept the methyl group from THF. And that’s the only way for THF to be recycled into other forms of folate.

Soon almost all of the folate in the body is stuck in the THF form. Other forms of folate (which are needed for other reactions) are depleted.

But the blood test can’t differentiate between all the different forms of folate, so it looks as if there’s plenty in the body, even though most of it is in an unusable form.

[deniseinmilden in reply to fbirder]

I love it when you make things clear like that - thank you!

[Dham]

Hi Paul, when I was initially diagnosed gp would only give me the tablets despite consultant asking for injections. They slightly raised b12 levels but did not help at all. After 2 yrs I had my 1st injection yesterday. Good luck with your fight

[dianewilson1900]

Hi Pual. Low B 12 symptoms are nearly identical to anemia! My B 12 is 119.3 and I SWORE I was anemic too, buddy! I wrote out four hand written pages of low B 12 symptoms that I SWORE was anemic symptoms prior to B 12 testing and was SHOCKED to learn my hemoglobin was normal. Folic acid, iron, and B 12 levels can all vary from one another where one is normal, two are low etc yet it is also very common for people with anemia to also have low B 12 and iron at the same time. My ferritin and hemoglobin happen to be normal. Go figure....Lab tests are like a vial of confusion. You never know what your gonna get! 😀😀😀