B12 deficency or not?

[ILR2019]

Was hoping someone here could offer some advice. My GP recently ran blood tests to exclude Pernicous Anemia and B12 deficiency (both of which have now been ruled out - see results below)

Intrinsic factor Abs = 1.77 Unit

METHYLMALONIC ACID 0.27 umol/L [0.1 - 0.42]

Is it normal to exclude B12 deficency when serum B12 has been consistently under 300 for at least last 2 years (see results below)

19th Dec 2017 - 190 ng/L [180.0 - 915.0]

20th Sep 2018 - 281 ng/L [187.0 - 883.0]

18th Apr 2019 - 230 ng/L [187.0 - 883.0]

10th July 2019 - 238 ng/L [187.0 - 883.0]

[Nackapan]

Unfortunately yes. They seem to monitor if you are lucky as within 'normal limits.

Perhaps get an active b12 done as a baseline as you've not had b12 yet. I wish I had.

Also go by your symptoms. Have toy tried b12 tablets to see if they help.

A family member was hovering with levels like yours and tablets and more meat brought their levels up in 3 Months.

[ILR2019 in reply to Nackapan]

So sorry for late reply. Thank you for replying. I follow a pretty good dietary plan and always try to consume foods high in B12 as well as foods fortified too. For a while I was taking Boots B12 vitamins (Boots 10mg) , but after 30 tablets my levels were barely raised.

I do have symptoms of B12 deficency, but also am undermedicated for hypothyroid and I know some of the symptoms are very similar. Im at a loss what else to do as i have been flat out refused injections and told to adapt my diet 🙄 although I don't see what more I can eat to increase levels. Perhaps I should attempt a longer trial period of supplements?

[fbirder]

It is possible to have a B12 deficiency with serum levels in your range.

The fact that your MMA isn't raised is a strong argument against it (many argue that MMA levels are a better early indicator than anything else). Your IFAB is negative (which doesn't mean much). Your serum B12 has remained fairly stable over the last year (the 2017 result was from a different assay) at around 250 ng/L which also argues against an absorption problem (in which case you would expect to see values decrease).

Suggest to your doctor that the best option would be a trial of B12 injections. This document from Hull and East Yorkshire NHS explains their procedures. If somebody has the symptoms of a deficiency, but serum levels in the intermediate area, they are given a series of loading injections to see if there is a clinical response.

hey.nhs.uk/wp/wp-content/up...

[ILR2019 in reply to fbirder]

Thank you so much for your help. I asked here as my GP doesn't seem to have a great knowledge of vitamin deficencies and isn't forthcoming with explanations/advice when I challenged him. I suspect, like with my thyroid, he's not up to speed and I have found better advice from forum members like yourself than my surgery.

As I briefly explained to the poster above, I do have symptoms (have had for several years), but always told 'normal'. Some of the symptoms I know are due to thyroid so without getting one or the other optimally medicated I dont know which problem is causing which symptom.

My GP has flat out said no to any type of B12 medication