I have recently received my B12 results from Medichecks-
ACTIVE B12 49.700 pmol/L 37.50 - 188.00
VITAMIN B12 194 pmol/L 140.00 - 724.00
Folate is pretty low too
FOLATE (SERUM) 6.64 ug/L 3.89 - 26.80
and Ferritin is 40.9 ug/L 13.00 - 150.00
I have ME/CFS and my Paternal Grandmother had PA. I have a strict vegetarian diet and a lot of symptoms that it is difficult to say if these are ME or B12 including migraines, IBS, tiredness, premature grey, tinnitus etc.
The Medichecks doctor has advised me to supplement with B12 for 3 months after which, if the levels come up fine, if not more testing for an absorption problem. How much would you recommend to take and when should I stop it for the retest?
Can anyone advise what I should do in March if the levels are low- IFA or MMA and if the current level is a worry?
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Marigold57
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Actually if you want to do MMA or homocysteine the time to do it would really be before you start supplementing. Did you have a full blood count done - and were there any signs of anaemia.
What is the dose of B12 that you are taking - the normal amount for correcting a dietary deficiency would be around 50mcg. This would bring your levels up in a few months if you don't have an absorption problem. If it doesn't bring the levels up then that would be quite good evidence that the problem is dietary.
Folate is quite sensitive to dietary intake so levels would be lower if you took the test as a fasting test. The test is also much more accurate and easier to interpret than serum B12.
Thank you so much for your reply. Would you suggest doing my next test in March without fasting, as I did the test for B12 Folate and Ferritin fasting which might explain the lowish Folate. Does B12 fall on a fasting sample too?
No I have only done these tests and not a full blood count, but as I am vegetarian I think the doctor felt it could be dietary.If the levels don't come up in 12 weeks then how long would you suggest waiting before testing MMA- is it a few months without supplementation? Also is 12 weeks long enough to see a rise from supplementing? Do you think my levels are only marginally low as according the the NHS they would be happy with them anyway?
if the levels don't come up with supplementation then that's evidence that it isn't dietary and you shouldn't need to waste money on other tests.
B12 levels tend not to be responsive to dietary intake because the body regulates levels using significant stores in the liver but the mechanism for releasing these is the same one as you use for absorbing B12 from your food so doesn't work if you have an absorption problem - which is why absorption problems need to be treated differently from dietary deficiencies.
I don't think there is any need to do folate as a fasting test.
Ferritin is only one measure of iron status - a full iron panel would include a full blood count. Not aware of anything that means this should be a fasting blood test.
Your level for both is in the normal range - meaning that most people are perfectly fine with these levels. However, it's based on averages and there is a logical problem with applying an average and concluding that a particular individual is okay. The tests are really diagnostic guides rather than absolutes - helping your GP to decide what are the most likely things so they can narrow down searches more easily.
Just one further question if you don't mind Gambit. I have been taking the supplements orally as told to do so by Medichecks doctor priot to retest in March. They are tablets but I did notice today on Amazon some Lozenges by Jarrow that dissolve in the mouth. As these dissolve in the mouth could I try these before my next test, or do you think that is not testing to see if there is an absorption issue from the stomach? I guess this leads onto my other thought that if these worked to raise levels would you ever need injections at all if you did have an issue like PA? In other words does it matter if you can raise levels this way or are injections the gold standard?
what is the strength of the supplements you are taking - it may be that they are trying to rule out a dietary B12 deficiency. Taking higher dose supplements at this point could make further tests inconclusive so would advise against not taking them until dietary deficiency has been ruled out.
It is highly unlikely that anyone with PA would be able to correct the deficiency purely using even very high dose tablets. For some people high dose oral can be useful in maintaining levels but there are some doubts about the clinical efficacy of oral supplements.
Thank you so much Gambit. I am taking Nature's Best 100. I was thinking if levels have improved this would be proof I can absorb b12 orally and so doing more tests would be unnecessary is this correct? The doctor at Medichecks said no supplements for one week before the retest. I wasn't deficient, just in the lower end of normal, but my gran had PA so I am a little concerned. Also vegetarian lifelong.
Not sure where the 1 week before testing comes from in relation to B12 - the whole thing about B12 is that your body regulates levels quite closely using stores in the liver so stopping B12 for 1 week would be pretty irrelevant.
I am confused as to what you are doing at the moment. I thought you said that medichecks had told you to supplement? May be I misread. What is the amount of B12 in the tablets that you have been taking?
Yes they did tell me to take a B12 supplement for 3 months and then retest. My level was VITAMIN B12 194 pmol/L (range is 140.00 - 724.00) in December. I am taking the Nature's Best B12 supplement 100µg. Should I stop before the retest or just take them anyway up to the day? I would have thought that if oral supplements work it was due to a dietary deficiency, which figures as I don't eat any meat or fish at all.
100mcg daily is a dose that will work if you have a dietary deficiency but not if you have an absorption problem so if the re-test shows higher levels then it would show that the deficiency was dietary - you could stop a couple of days before hand as requested but personally don't think it will make a difference to interpreting the results of the rest but best to play by the rules of those doing the test
Don't supplement with anything containing more B12 than that though.
Most B12 is absorbed in the ileum but small amounts are absorbed outside the ileum (varies from person to person but averages 1%) high dose oral supplements aim to use passive absorption theory being that flood the gut with enough B12 and enough should be absorbed. The difference between absorption of high dose oral and high dose sublinguals is pretty negligible.
If you’ve got the money, I’d do homocysteine and MMA. Does medichecks do the Mthfr test as well, may be handy to ensure you start taking right folate.
Once you start supplementing, you’ll want to ensure you use b12 injections as the pills are highly unlikely to correct a deficiency, they’ll only mask it. Expensive to have tests done, but better you start on right foot moving forward.
Thank you so much for your reply. Can you explain about the Mthfr test and how it affects the right Folate choice? Also just wondering if people feel I have enough B12 and that testing further is warranted if levels don't rise with supplements. NHS seem happy with very low levels, much lower than say Viapath recommendations for testing are.
There is an enzyme called methylenetetrahydrofolate reductase (MTHFR) that is coded by a gene, also called MTHFR. About 10% of the population have a mutation in this gene (called homozygous C677T) that reduces the efficiency of the enzyme to about 30% of normal. Most of those people can easily cope with this just by making more of the enzyme.
This is what one of the big gene testing companies say about MTHFR (remember - they make more money if more people test).
Our Take on The MTHFR Gene," is a 23andMe blog posting (January 5, 2017), a meta-analysis finding that the past two decades of scientific evidence as it relates to specific MTHFR-influenced health conditions to be inconclusive or conflicting, with two exceptions, 1. women with two copies of C677T variant, 2. a very rare variant that may cause homocystinuria. Their takeaway, "Based on the existing data, scientists at 23andMe have concluded that people should not interpret their genotypes at the common MTHFR variants as having an effect on their health.
If you are still worried then take methylfolate as a supplement instead of folic acid. It will bypass the MTHFR step. The only downside is that it's more expensive. But it's still cheaper than genetic testing.
Hello again Gambit62 and everyone else kind enough to read my post. I have been supplementing with B12 Iron and Folate on the advice of the Medichecks doctor due to my previous results being on the low side. As my paternal grandmother had Pernicious Anaemia I was concerned as I am also vegetarian.
Today I have received my updated results which the doctor is happy with. They are no longer doing serum B12 but the active figure is available. As my B12 result is a lot higher am I right in assuming my previous low result was due to diet as I can obviously absorb supplements so no chance of PA at the moment? I have also changed my diet and am now incorporating more foods containing B12.
December Active B12 level was 49.7 pmol/litre- now it is 102 pmol/litre
December Ferritin was 40.9 now it is 53.6 ug/l
December Folate was 6.64 ug/l now it is >19.8
Would you recommend continuing to supplement with a multi vitamin to ensure levels stay good? Then maybe test once a year?
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