B12 reading 103

I have low B12 reading of 103. My diet is good but I am on PPI's. My doctor is refusing injections and saying I must take 3 50mcg tablets (150mcg) a day for 3 months. Any similar experiences.

[fbirder]

If your low B12 is caused by the PPIs then it is possible that the tablets might fix it.

Nobody seems sure just how PPIs affect absorption of B12 from food. Most experts believe that the lack of stomach acid (achlorhydria) prevents the B12 in food being absorbed. This B12 will be bound to proteins in the food, and the stomach acid itself will release the B12 from the protein. Additionally, the main stomach enzyme responsible for digesting proteins - pepsin - only works in an acidic environment.

If this is what happens then the B12 in tablets will be unaffected and you should be able to absorb it. If you take the three tablets at different times then you should be able to absorb about 10 times the recommended daily amount. That should get your blood levels back to normal over the three months.

However, there some doubts as to whether this is the right mechanism. Partly because some studies show that PPIs inhibit B12 absorption, while H2 Antagonists do not. But H2As also stop production of stomach acid. However, other studies also show inhibition of absorption with H2As.

The good news is there's a good chance that the pills will work and that you won't need injections.

[Hidden in reply to fbirder]

Thank you for your reply. Can I take it that the tablets may work and the injections definitely work?

[fbirder in reply to Hidden]

That's right.

Some people, especially those with PA, just cannot absorb B12. Those people need injections.

Some people have a lack of B12 in their diet. Those people can use pills, but injections would also work.

Some people have a problem because they take certain medication (PPIs and metformin - for diabetes - are the most common culprits). But nobody seems sure if pills will work for them.

If pills do work then they are the preferred option. They are less painful, less hassle and you get a more even level of B12. Injections give you a really high level of B12 in the blood which then drops until the next injection. Often the gap between injections is enough to bring back the symptoms of a deficiency.

But pills allow you to put a small amount in the blood frequently. It'l like having a leaky bucket. With injections you're using a barrel to fill the bucket to overflowing, then allowing it to leak until it's empty again. Pills allow you to keep the bucket topped up using a mug every day, keeping it nearly full all of the time.

[wedgewood in reply to fbirder]

Love your explanation ! Excellent ! Very graphic . 👍

[Marz]

Just wondered how long you have been taking a PPI as I believe they are designed to be a short course. Also that low and high acid symptoms are very similar ...

Do you have a thyroid problem ? - as it's very common to have low B12 & low acid with Hashimotos. Did they also test Folate - Ferritin - VitD - as they too could be low ...

[Hidden in reply to Marz]

have been taking ppi's for 20 years for GORD/GERD. had them increased by a consultant last year from 20mg a day to 40mg.

need to take them every day.

[Marz in reply to Hidden]

Have you tried natural alternatives ? I appreciate you would have to wean off PPI's slowly but I have read of others who have been successful. Have you had any thyroid tests done ? When we have LOW stomach acid - food can remain in the stomach for too long and begin to ferment. Sometimes it is the upward movement of the fermentation into the oesophagus that can cause the problem ... Low Thyroid can be one cause of lowered motility both in the stomach and the gut.

It is not only the B12 that is lowered by the PPI's - but other valuable nutrients your body needs. I recently read of their link to Alzheimer type illness ...

[Alfabeta]

Stop taking ppl’s - they’re one of the causes of b12 deficiency! Try and see if there’s a dietary cause for your acid reflux eg some cheeses cause it.

[Sleepybunny]

Hi,

In UK, my understanding (I'm not medically trained) is that national guidelines suggest injections should be given whatever the cause of B12 deficiency if neurological symptoms are present.

Do you have any neuro symptoms eg brainfog, tinnitus, tremors, tingling, pins and needles, memory problems, balance eissues etc?

UK B12 documents

BSH Cobalamin and Folate Guidelines

b-s-h.org.uk/guidelines/gui...

Flowchart from BSH Cobalamin and Folate Guidelines

stichtingb12tekort.nl/weten...

BMJ B12 article

bmj.com/content/349/bmj.g5226

BNF

bnf.nice.org.uk/drug/hydrox...

NICE CKS

cks.nice.org.uk/anaemia-b12...

B12 books I found useful

"What You Need to Know About Pernicious Anaemia and B12 Deficiency" by Martyn Hooper

Martyn Hooper is the chair of PAS (Pernicious Anaemia Society).

"Living with Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper

Has several case studies.

"Could it Be B12?: An Epidemic of Misdiagnoses" by Sally Pacholok and JJ. Stuart (USA authors)

Very comprehensive with lots of case studies. There is also a paediatric version of this book "Could It Be B12? Paediatric Edition: What Every Parent Needs to Know".

PAS (Pernicious Anaemia Society)

Based in Wales, UK.

pernicious-anaemia-society....

PAS tel no [phone] answerphone

B12 Deficiency Info website

b12deficiency.info/

Unhappy with Treatment (UK info)?

Letters to GPs about B12 deficiency

b12deficiency.info/b12-writ...

CAB NHS Complaints

citizensadvice.org.uk/healt...

HDA patient care trust

UK charity that offers free second opinions on medical diagnoses and medical treatment.

hdapatientcaretrust.com/

More B12 info in pinned posts on this forum. I've also written more detailed replies on other recent posts, may be worth searching for them.

[username7]

I stopped daily Prilosec and suffered for awhile before I realized I have a sulfite sensitivity. If I avoid sulfites, I have no GERD (and no food-triggered asthma either). Just thought I'd mention that in case you're looking for the underlying trigger... could be sulfites. They're sneaky.

[Sleepybunny]

Hi again,

Has your GP said your low B12 is due to PPIs?

pulsetoday.co.uk/clinical/c...

It is possible to have more than one cause of B12 deficiency at the same time so I hope GP will consider other possibilties as well as PPIs eg PA, Coeliac , H Pylori infection and other possibilities.

Risk Factors for PA and B12 Deficiency

pernicious-anaemia-society....

b12deficiency.info/what-are...

b12deficiency.info/who-is-a...

Were you tested for PA (Pernicious Anaemia)?

In UK, test for PA is Intrinsic Factor Antibody (IFA) test. IFA test not alwyas reliable and it is still possible to have PA if IFA results are negative. Some other countries use parietal cell antibody (PCA) test. PCA results can be negative in a small percentage of people with PA.

labtestsonline.org/tests/in...

labtestsonline.org/tests/pa...

NICE guidelines Coeliac Disease (2015 version)

nice.org.uk/guidance/ng20/c...

Coeliac Blood Tests

coeliac.org.uk/coeliac-dise...

H Pylori

patient.info/digestive-heal...

Nitrous Oxide

gov.uk/drug-safety-update/n...

Any chance of internal parasites?

Fish tapeworm and Giardia Lamblia are two I have read about that can be associated with B12 deficiency.

Diet

You mention your diet is good.

Do you eat plenty of B12 rich foods eg meat, fish, shellfish, eggs, dairy and foods fortified with B12? Being vegan or vegetarian can be a risk factor for B12 deficiency.

Marz mentions that "low and high acid symptoms are very similar". Has your doctor considered the possibility of low stomach acid as the cause of GERD/GORD symptoms?

drmyhill.co.uk/wiki/hypochl...

nhsinform.scot/illnesses-an...

"low B12 reading of 103."

Do you mean 103ng/L? Some countries use ng/L and some use pmol. If it's 103ng/l that seems really low.

Untreated or under treated B12 deficiency can have severe consequences.

If it's 103ng/L I am surprised you are not on injections as I would have thought doctors would want to get B12 levels up as quickly as possible to prevent possibility of neurological damage.

Neurological Consequences of B12 Deficiency

PAS news item

pernicious-anaemia-society....