B12 Deficiency

[Ulrich-vi]

Hi I am a diabetic from Mumbai India. and end May 2020 was diagnosed with b12 deficiency as I was feeling fatigue, anxiety , numbness , tingling feeling my b12 was 174 serum level. Was started on oral supplements beconcnx D3 with probiotic and levels rose to 434 serum levels but after a few weeks dropped down to 360 as I started having numbness and electrical feeling on my feet . Visited a neurologist in August 2020 started treating nerves with oral tabs Nuhenz. Feel a lot of gas symptoms when I take oral tablets. As symptoms were not improving I started on sublingual nature’s bounty b12 1000mcg methyl tabs for a week but also forced my doc to start me on injections for b12 . Prescription given for neurobiology forte - contains Methylcobalamin (1000mcg)+ Vitamin B6 (Pyridoxine) (100mg)+ Nicotinamide (100mg) for 5 injections every 5 days also taking a tablet Antoxid + Lonazep 0.25 for sleeping for next 15 days as I have sleeping issues due to this and anxiety as well . Doctor has also prescribed depression medication but am not taking it . My diabetes HBA1c reports are 5.4 , thyroid test are normal and also cholesterol is under control ... am I on the right track . I am non vegetarian what could have caused my b12 to drop . I have taken my first injection had a fast heart beat the first day but feeling better from day 2 . I have also purchased sublingual tabs 1000 mcg from Jarrow methyl b12 .

[Gambit62 Administrator]

are you on metformin? it is a common drug for type 2 diabetes and can cause B12 absorption problems

[Ulrich-vi in reply to Gambit62]

Hi I was on Teniva 20 (teneligliptin 20mg) for 3 months prior to that was on homeopathy medication for 2 years . I have been off diabetics medication now for 3 months as I got on a low carb diet been able to keep my sugar under control .

I have a very sensitive stomach though which I realised only after I read on b12 deficiency. Initially when taking b12 oral tablets was also taking PPI’s due to acid reflux issues ... but now that has been sorted out .... 😊

[Gambit62 Administrator in reply to Ulrich-vi]

the acid reflux could be the result of low stomach acidity - something that off its own will cause B12 absorption problems - PA (which is an auto-immune condition that targets the cells that produce the protein IF needed to facilitate absorption in the terminal ileum, and also attacks gastric parietal cells which produce stomach acids) is another possibility - and the most likely explanation.

PPIs lower stomach acidity but if it was only a few months that is unlikely to have caused a B12 deficiency - though it could have accelerated a deficiency due to an underlying absorption problem.

[Ulrich-vi in reply to Gambit62]

Thanks for this information. How do I check if I have an issue with IF are there any test I could do ? Presently as I have just started out on injections I did not want to get myself tested . Also today as I did not take the Antoxid capsule I was not bloating or gassy .... I don’t understand the purpose of the Antoxid capsule the doctor started ...

[Gambit62 Administrator in reply to Ulrich-vi]

Antoxid seems to be prescribed for vitamin deficiencies A, E and D

netmeds.com/prescriptions/a...

Unfortunately the test for PA as a specific cause of B12 deficiency - IFA or IFAB - is not very sensitive and gives false negatives about 50% of the time - it tends not to give false positives unless done two close to B12 injections - so now probably isn't the time to try for the test.

If your doctor doesn't give you the information you need about your medication then it may be worth speaking to the dispensing pharmacist.

[Ulrich-vi in reply to Gambit62]

Thanks 🙏🏻

[Ulrich-vi in reply to Ulrich-vi]

Hi , does Sauerkraut improve your stomach lining and also help in absorption of b12 in the stomach ...

[FlipperTD]

This is a scientist's opinion, not a doctor's.

If your B12 level rises significantly, like yours appears to have done on oral supplementation only, then my guess is that you are secreting Intrinsic Factor and this is facilitating the absorption of B12 from your bowel.

Pernicious Anaemia seems unlikely, given this infromation.

If any B12 you ingest isn't absorbed into your bloodstream then it's excreted faecally. If an excess is absorbed into the bloodstream however, it's excreted in the urine.

Congratulations on controlling your diabetes, by the way! Well done.

Good luck.

[Ulrich-vi in reply to FlipperTD]

Thanks.

I had taken a probiotic as well when I took the oral supplements.... which I guess helped me ....

I am now trying injections get my second dose tomorrow and three more after that to see how things do .

I also got a nerve induction test done last week and the reports came in as normal ...