Vitamin b12

[sylus_911]

Hi, I had a blood test taken,my b12 came back as low 178(120-625)I was advised to have an Active B12 taken.That has come back as 92(37-187)Can anyone please tell me what I should do next?I feel so tired all the time,and miserable,something clearly is,nt right.Thank you.

[fbirder]

You were advised to get an 'active' B12 test because the normal serum test is neither precise, nor accurate. So your serum B12, while being normal, not low, might not have been accurate.

The 'active' B12 test is supposed to be much more accurate. And yours is well above the bottom of the normal range.

While those results do not rule out a B12 deficiency, they make it quite unlikely.

You need to discuss other possible causes with your doctor. They might be persuaded to try you on a course of B12 injections, but I'd be surprised.

Try a course of B12 tablets, then have another blood test in two months time. If the levels are sky high then you know you don't have a B12 absorption problem.

[sylus_911 in reply to fbirder]

fbirder,thank you.

[suztango in reply to fbirder]

No don’t take b12 tablets until b12 deficiency has been ruled out. Active b12 results can also give misleading results. You need to do an MMA test next. If MMA is high, then you have b12 deficiency. Then you’ll need injections not tablets.

[fbirder in reply to suztango]

This is why taking the tablets is the best thing?

If sylus911 does have a B12 absorption problem then the B12 will not be absorbed. A B12 test will show levels have not been raised and that, therefore, there is an absorption problem and injections are required.

If sylus911 does not have a B12 absorption problem then the B12 will be absorbed. A B12 test will show that levels have been raised and there is, therefore, no need to have injections - just keep on with the pills.

It's important to distinguish between a deficiency caused by an absorption problem and that caused by a dietary insufficiency - because the treatments are massively different. When serum B12 is indeterminate, and Active B12 is well into the normal range, an absorption problem is unlikely (but not impossible). In that case it's best to ascertain if such a problem is present.

[suztango in reply to fbirder]

If the diet is normal, and B12 low, then b12 absorption should be investigated.

From suppliments, there can be a 1% absorption through the gut even if you have PA or another b12 absorption problem. So that skews results, even active b12.

Whether you have b12 deficiency should be investigated by MMA. This is affirmed by the British Society of Haematology guidance.

[fbirder in reply to suztango]

"If the diet is normal, and B12 low, then b12 absorption should be investigated."

Which is what my suggestion does. Having an MMA test only measures if there's a deficiency, not the cause of it.

"From supplements, there can be a 1% absorption through the gut even if you have PA"

If a person can absorb 1% via passive absorption then a single 1000 mcg tablet a day will give them all they require. No need for injections. Indeed, no need for any of us to have injections - if that myth were true. It isn't.

pernicious-anaemia-society....

[suztango in reply to fbirder]

Absorption from suppliments is not enough for people with a deficiency to heal and get better. Injections is the only route.

You agree that MMA is best to detect deficiency. Then why not recommend it as a next step? Suppliments will only skew results. It does not show what is happening in the cells. MMA will tell the person this, not taking suppliments. So if the person has a normal diet, then surely this is the next step?

[fbirder in reply to suztango]

If you can absorb 10 mcg from an oral supplement then that will get more B12 into your body that a single 1000 mcg injection every three months. Injections are the only route for people who cannot absorb any B12 orally - like everybody with PA.

"You agree that MMA is best to detect deficiency. Then why not recommend it as a next step? Supplements will only skew results."

How can supplements 'skew' the result?

Suppose I do take oral supplements and my MMA is low. It could be low because I never had a B12 deficiency. Or it could be low because I had a dietary deficiency. Or it could be low because I am one of those mythical people who can absorb 1% of an oral dose.

Who cares?

I have proven that oral B12 can get enough B12 into the cells without having the pain and inconvenience of injections.

If I take supplements and my MMA is high, I've proved that I have an absorption problem and I'm not a lucky 1%er. I've proved that I need injections.

What has been skewed?

[ktwing in reply to fbirder]

"How can supplements 'skew' the result?" - every reputable source I've read suggests that oral supplementation can skew results and therefore not to begin this until all further testing has been completed, and the haematology consultant that my GP referred me to agreed that my oral supplementation meant that further investigations, including MMA and Holo-TC were no longer worthwhile. I'm not medically trained, but in this situation, I would try to obtain second line tests before beginning supplementation.

[sylus_911 in reply to suztango]

Hi suztango,would it be worth my while getting an MMA test done and do they do it on the NHS.Although I had to pay private for my Active b12.I cant see my Doctor taking any notice of the outcome as he has completely dismissed the b12 tests and has suggested I have an iron infusion,because I feel so tired and weak.

[suztango in reply to sylus_911]

Yes you can try. Print out the British Society of Haematology guidance and show them what they should be doing. There is a nice clear diagram for the GP to follow.

onlinelibrary.wiley.com/doi...

Other than that, you could try private testing for MMA. Companies like Medichecks do this.

[sylus_911 in reply to suztango]

Thank you.

[suztango in reply to fbirder]

Here are the guidelines from the British Society of Haematology. Shows the next step is MMA etc...

onlinelibrary.wiley.com/doi...

[fbirder in reply to suztango]

You should have read the rest of the guidelines from the British Committee on Standards in Haematology.

Dietary alterations or oral supplementation may be considered according to the clinical situation