Hi I sont believe I have pernicious anaemia, but due to my low foliate and ferritin levels, which don't seem to improve, I'd just like some advice please.
Drs said my levels are fine at 340, range something like 190-700 ish..but I've recently been ill, found out my thyroid has issues, and wondered where you source your b12 injections from..id rather have methylcobalamin...
I have had most if not all my ilium removed, am exposed to nitrous oxide at work (theatre), and now have hypothyroidism.
Any help will be appreciated. ..ive read the book 'Could it be b12'..
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Michaela_l
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What many doctors consider a normal result is very often not normal and, in any case, should be considered in the context of history and symptoms - serum B12 tests are unreliable for many reasons. As you probably already know, thyroid disease often coexists with PA/B12deficiency and nitrous oxide can inactivate already low B12. Low folate and ferritin results that don't improve could also mean an absorption problem
It is especially important to be monitored after bowel surgery,* as outlined in all the guidelines and latest research and, if you are experiencing any neurological symptoms, it's important they are treated adequately without delay to avoid permanent damage.
Below is an extract from the BMJ research document with useful summary (GP will probably be able to access full document behind a paywall) :
Intrinsic factor is a protein, produced by the parietal cells of the cardiac and fundic mucosa of the stomach. It binds vitamin B12 to allow its absorption through the gastrointestinal tract, by way of a receptor on the intrinsic factor that is specific to cells at the terminals of the ileum. * If there is resection or disease of the gastric mucosa or terminal ileum this leads to vitamin B12 deficiency as a result of malabsorption."
The document also contains information regarding frequency of injections for neurological symptoms:
"Standard initial treatment for patients without neurological involvement is 1000 μg intramuscularly three times a week for two weeks. If there are neurological symptoms then 1000 μg intramuscularly on alternate days should be continued for up to three weeks or until there is no further improvement.4 25 In irreversible cases, for example, pernicious anaemia, the treatment should be continued for life. "
I hope the above helps in getting your GP to take this seriously michaela but, if you need to source your own supply, most of us find Hydroxocobalamin from Versandapo.de or mycare.de works really well and is less expensive than methylcobalamin.
This was a good explanation of the differences Michaela - in Rapid REsponses of the BMJ research document above:
"There are two active forms of the B12 enzyme in the human cell. First, Methylcobalamin acts as a co-enzyme for the conversion of homocysteine to methionine. Methionine then acts as a methyl-donor to a great number of reactions that need a methyl group, including the synthesis of myelin, serotonin, dopamine, noradrenalin, DNA and phospholipids.
Second, Adenosylcobalamin is a co-enzyme for the conversion of L-methylmalonyl-CoA into succinyl-CoA which feeds into the citric acid cycle.
Is it important which form is used in treatment? In most people, it does not matter. They can convert cyano- and hydroxo-cobalamin into the active forms needed. However, I have recently reported a case in which it did matter. The severe vitamin B12 deficiency, including dementia and psychosis, responded to treatment with high dose oral methylcobalamin, but not to equally high dose oral hydroxocobalamin. [1]"
1. Rietsema WJ. Unexpected Recovery of Moderate Cognitive Impairment on Treatment with Oral Methylcobalamin. Journal of the American Geriatrics Society 2014;62(8):1611-12 doi: 10.1111/jgs.12966[published Online First: Epub Date]|.
Hi sorry for the late reply..my phone broke and rather than it being repaired it's been sent to be recycled! !! It all comes at once doesn't it! I seem to get numbers, dizziness, tingling..so I wondered if methylcobalamin was best.
No, methylcobalamin is converted to cobal(II)amin as soon as it has entered the cell. Hydroxocobalamin and cyanocobalamin are also converted to cobal(II)amin as soon as it has entered the cell.
Once it gets into the cell they are all equivalent. Despite the stuff you might read on the interwebs.
Methylcobalamin is not licensed in the UK I believe, so is also more difficult to source.
You could try Hydroxocobalamin injections (as usually prescribed by U.K. GPs) - the German pharmacies sell ampules in smaller quantities - and also take Methylcobalamin sublinguals and see how you get on? Sally Pacholok recommends having both....
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it's the numbness and tinnitus that worries! Oh and feeling dizzy. Thanks again 
B12 Levels
B12 ranges
B12 levels
B12 serum versus B12 active 
Measuring B12 levels after PA diagnosis 
