I was just diagnosed with AG (from biopsy).
Next they tested my B12 - 339 so on the lower end
Started b12 subling - and now B12 >2000
I also have esophageal symptoms of burning there and in my throat...
Took Pepsin test and they detected Pepsin in my saliva
Gastro says since there was no acid found on my bravo test that the pepsin isn't dangerous without acid.
Has anyone had a similar experience and what's the treatment plan for you? Thank you for any info.
330 isn't at the low end. It's just about average for normal people. The fact that oral B12 shot your level to above the top of the range strongly indicates that you do not have an absorption problem.
Pepsin in the saliva is common. It is found in one-third of normal people and is more common in those with gastro-oesophageal reflux (which would cause your burning).
Hi fbirder, you constantly amaze me with the amount of knowledge you have regarding B12 def. and PA. I, on the other hand am having trouble understanding this. If iankerudder took oral B12 and her levels shot up so high, wouldn't it mean the B12 is not being absorbed and just floating around in the blood? Help! I'm confused again.
An absorption problem means there is a problem getting B12 from outside the body into the blood. If you take oral B12 and the amount in the blood rises then there is no absorption problem.
You are describing a functional B12 deficiency whereby there is lots of B12 in the blood, but it's not getting to the right places in the cell. One speculated cause of such a deficiency is a problem with the mechanism that transports B12 from the blood into the cell.
What would cause the B12 to not be able to get into the cell?
Getting B12 from the blood into the places in the cell it is supposed to be is a fairly complex operation. The B12 has to bind to a protein called transcobalamin (TC). There are receptors on the outside of the cell that grab hold of the TC and bring it into the cell, where special enzymes remove the TC.
The B12 then has the top ligand (methyl, adenosyl, hydroxo, cyano) removed (by another enzyme) to form cob(II)alamin and transported to the places in the cell it is required (by other proteins), then other enzymes activate it depending on what reaction it is supposed to be taking part in.
Any of those steps can fail. Normally, if they do fail then they do so before birth and produce obvious symptoms. But people are looking into various genetic problems that might cause faults in any of those processes.
Wow, no wonder it is so hard for some to find out why they have B12 deficiency. I think we all want easy answers and treatments. I think this is the most complicated thing I have had to deal with regarding my health. I am so grateful to you, fbirder, You have a way of explaining things so that they are more understandable. God bless you for that my very well informed friend. Just by reading some of your posts I know that you have been through a great deal and you have taken those struggles and used them to help others, the mark of a good soul. May your health be only better and your life be made of only the things you dream of.
Not being absorbed is usually the description of B12 not getting from the gut into the bloodstream.
Any that isn't absorbed through the gut will just pass straight through.
Therefore the blood level will not be (significantly) raised.
However, in this case, the blood B12 level is rising, so it is not a matter of failure to absorb through the gut.
Thank you helvella. I think I am starting to get this now, but if you don't have gastritis, what would cause the B12 to not get into the cells?
Why do you think B12 isn't getting into your cells?
My point was really that you are absorbing B12 such that it is rising in your bloodstream. I really know nothing about transfer into cells.
Wouldn’t sublingual B12 bypass gut absorption?
No. The B12 molecule is both too large and too hydrophilic (water-loving, fat-hating) to pass through biological membranes unaided. That is why the body needs IF to get B12 from the gut to the blood. And why transcobalamin is needed to get it from the blood into the cells.
Various studies have shown little difference between the amount of a sublingual dose that is absorbed and the same amount absorbed orally.
If sublingual dosing worked then none of us would need injections.
Thanks all! I am taking 1,000 sublingually twice a day...
My levels went from 300 & symptomatic) to top of the range (reduced symptoms) after a month on sublingual 5,000mcg methylcobalamin, the starting level being despite high dietary B12 & daily B complex. I started injecting because it was cheaper rather than sublinguals being ineffective, however, I now need a lower dose of thyroid hormone which is nice.
Hi,, I am alka... I have b12 and d3 absorption problem. In july2019 my b12, d3, was low so Dr told me to take supplements and I took and in Nov 2019 it came to 635 and d3 was also 55...but again in feb2020 I had severe fatigue so I tested again it came down to 235 and d3 30.
I am 44 becoz of this absorption I have irregular periods/spotting.
I have milk issues so not taking it.
Please suggest some remedy to improve absorption.
Confusion over conflicting information regarding low b12 
Low B12 Absorption AND Low B12 Transport to Cells
Autoimmune Atrophic Gastritis and Pernicious Anaemia
I've got PA and wonder if I need any other supplements other than B12 shots.
Low stomach acid DUE TO b12 deficiency 
