Total B12, Active B12 and Folate Results.

[lucylocks]

Hi

I recently had some private blood tests to monitor my thyroid and had additional test done at the same time.

I am concerned about the following results,

Active B12

Result

73 pmol/L

Range 37.5 -188 pmol/L

SOME ABNORMAL RESULTS

Total B12

Result

296 pmol/L Insufficient

Range 300 - 569 pmol/L

Folate

Result

7.5 nmol/L Deficient

Range 8.83 - 60.8 nmol/L

Doctors report says,

Your Active B12 levels are normal but your Total B12 is low.

Total B12 is the traditional way of measuring B12, but includes forms of B12 that the body can’t use effectively.

Your Active B12 is a better way of measuring B12 in a form that is usable, so this is rather less important.

However, your Total B12 levels may improve if you eat more meat, fish, eggs and dairy, or if you take Vitamin B12 supplements.

Low B12 can be associated with low mood and energy, though more worrying signs are numbness and tingling with very low levels, in which case I would recommend a review with your GP.

My folate is under range and also my total B12 is just under range but Active B12 is in range.

Should I supplement with folate and B12 or just folate.

Any advice would be really appreciated.

Thank you.

[Nackapan]

B12 first. You are only just under range . If you can absorb b12 take tablet s and eat b12 rich food.

Then retest

Then treat folate level when b12 gone up

Thats how I understand it.

Your gp should advise

[lucylocks in reply to Nackapan]

Many thanks for your reply.

[Gambit62 Administrator]

Questions:

a) what is your diet like - both in terms of fruit and veg (folate) and in terms of animal products (B12)?

b) what symptoms do you have?

c) have you had earlier B12 tests that showed significantly higher levels for serum B12 (ie 20% higher)

Please note:a) this forum is not a substitute for professional medical advice - if you can't talk to your GP then try talking to a pharmacist.

b) accuracy of serum B12 means your actual B12 could be in range

c) the serum B12 range being used for the test actually has quite a high low point compared to most labs - its indicating a grey area rather than a 'clear' deficiency

d) serum B12 levels vary a lot from individual to individual - falling levels over time are a useful indicator of an absorption problem that will lead to a deficiency whilst a single point measure is difficult to interpret on its own. Symptoms need to be evaluated as well though this is complicated by the folate deficiency

e) dietary intake is best for folate - if you aren't eating the right amount of folate rich foods please try diet first.

f) as stated in the test results above your active B12 is good.

g) a folate absorption problem usually means a B12 absorption problem

h) usually active B12 is about 1/5 of total serum B12. There are a number of genetic variants that affect the efficiency with which B12 is used in cells but these are outside the scope of this forum which is about a particular auto-immune absorption problem. I am also not clear if the presence of the genetic variants is related to significant variations in the ratio of active/serum B12 levels.

i) if the test was a home test then it is possible that conditions collecting the sample may have affected the results.

[lucylocks in reply to Gambit62]

Many thanks for your reply.

a) My diet is quite good, I eat plenty of meat and fish, vegetables, not a great deal of fruit but lots of veg.

b) Symptoms are mainly fatigue, dizziness, sometimes my eyes don't focus properly, carpel tunnel when in bed, general aches and pains.

I also suffer from hives and eczema, general itchiness, and I am hypothyroid so I do know symptoms can over lap.

c) A previous serum B12 was 365 which was done at the G.P. surgery, I started taking supplements to get it up a bit and it went up to 620 also done at surgery.

This recent test was a home finger prick test.

I will try and eat more fruit then retest.

Thank you again.

[Gambit62 Administrator in reply to lucylocks]

The supplementation (particulary if it was with doses around 1000mcg) makes it impossible to really interpret the B12 results - stop4 six months if you want a baseline, Difference between 365 and 296 is more or less the margin of error for the test, A higher level when supplementing implies no absorption problem and the drop after that is what would be expected. People vary a lot in what they need by way of B12 levels and it may be that around 330 is where you naturally sit. I know there is a lot of mention of 'optimal levels' on the TUK forum but when it comes to B12 that's a nonsense because what is optimal is what is best for an individual and that could be anywhere within the normal range + a little bit on either end (that's how statistics work and the normal range is based on statistics). Picking on one particular point is like saying that everyone has to conform to an average and that just isn't how life works. On the face of it there is no reason why someone with a thyroid condition should need a higher B12 level than anyone else. The one thing that does seem to affect things is having been treated for B12 injections - which seems to push the average up a lot but within that there will be some people who are fine with the general normal range and others like me who need levels over the top of the measurable range so again, stating that everyone needs levels of x is not true.

Hope that the diet helps but if not then please do try and speak to your GP and get them to rerun the tests if you can.

[lucylocks in reply to Gambit62]

Many thanks again.

Best wishes and stay safe.