So confused with different advice abo... - Pernicious Anaemi...

Pernicious Anaemia Society

31,973 members23,121 posts

So confused with different advice about suppliments.

Clara5672 profile image
51 Replies

Hi all. Iv been si hydro eod for almost a year my b12 was 170. I did not take the advice from a said fb group and only take 200mg of folic acid. I take a b complex multi vitamin and also heme iron tablets 80 mg daily, as my ferritin is 28. During winter months I was taking vit d 3+ k2 and have my bloods done 3 monthly for vit d and ferritin.

My question/ concern here is why do I still feel so rubbish. On the days of my b12, I do feel much more energy but my skin still itches, iv still got dizzy head and after a year I can't say I feel massive improvement.

Does anyone have the same deficiencies as me and are you concerned with the amount of pills/ suppliments that is advised 😌

Written by
Clara5672 profile image
Clara5672
To view profiles and participate in discussions please or .
Read more about...
51 Replies
Gambit62 profile image
Gambit62Administrator

Whilst ferritin is a generally food measure of iron status, it is an indicator and there have been instances of iron toxicity as a result of GPs acting on the basis of ferritin without doing a full iron panel.Whilst having a B12 absorption problem does make you more prone to problems absorbing other mineral and vitamins it isn't a guarantee that you will and taking huge doses of some vitamins and minerals can cause problems. Do not take more than 1000mg of folate or 100mg of B6 daily unless under medical supervision. UK upper limit for B6 is much lower than 100mg - think it is about 12.5 and EU IS 25.

Hamayeshguy profile image
Hamayeshguy in reply to Gambit62

1 g heme iron equals 3.47 mg elemental iron which is nothing

Clara5672 profile image
Clara5672 in reply to Hamayeshguy

Iv recently changed to simply heme by three arrows and I'm slowly building up the dose

Hamayeshguy profile image
Hamayeshguy in reply to Clara5672

It's good to hear that. But for improvement in dizziness in addition to good supplementation and good diet like keto diet (which stimulate nerve repair) it's required to stimulate muscles and also supplement them like iron or other micronutrients like D3 and so on. But the most important part in improvement is to exercise which constrict blood vessels. After injection nerves signal interrupted and related muscle like blood vessel muscle go to relax mode which causes lower blood volume and burning feet effect and dizziness so along with injection and keto diet and proper supplementation exercise especially muscle resistance exercise constrict blood vessels and stimulate them and bulid their muscle by taking back their myoglobin and iron. Iron works to oxygenate muscles. So after workout whey protein shake is so helpful to feed muscle with myoglobin. Even muscle electrical simulator help fir skeletal muscles to get back to normal faster and right away after exercise feed them with whey shake. Since you are taking other supplements like iron then you can get back to normal much faster.

wedgewood profile image
wedgewood

You don’t say how often you self-inject. Maybe you need more regular injections. We are all different . I know people who need daily injections. I need weekly etc etc . It’s good to know that we can’t overdose on B12 .I would experiment with more frequent injections . Your Folic acid supplement sounds fine , as do the other supplements .

Clara5672 profile image
Clara5672 in reply to wedgewood

Thank you Wedgwood. I inject every second day

wedgewood profile image
wedgewood in reply to Clara5672

Well you really cant do more than that . As we know that an autoimmune condition seldom comes alone , maybe there is something else involved . The most common “companion” autoimmune condition with PA is Thyroid abs some symptoms overlap , but there are 100 others . Worth looking into .

Hamayeshguy profile image
Hamayeshguy in reply to wedgewood

Or maybe fibromyalgia

deniseinmilden profile image
deniseinmilden in reply to wedgewood

EOD is short for "every other day".

I don't know why medicine, especially, is so full of acronyms! Maybe is part of the "mystique" that is used to try to make it seem inaccessible to us "plebby layman patients"?

helvella profile image
helvella in reply to deniseinmilden

Although this document is targetted towards thyroid issues, it does have a lot of abbreviations and acronyms. Including EOD. :-)

helvella - Vade Mecum for Thyroid

The term vade mecum means:

1. A referential book such as a handbook or manual.

2. A useful object, constantly carried on one’s person.

Abbreviations and Acronyms

Don't get put off by the number of pages!

dropbox.com/s/vp5ct1cwc03bl...

deniseinmilden profile image
deniseinmilden in reply to helvella

Wow, that's brilliant! 😀

I don't think I've ever seen anything quite so comprehensive!

I know the common veterinary ones and there is a table of acronyms available with one of the GP things I can access which has a few but this must have the lot!

I've saved your link, if that's OK?

Thank you!

helvella profile image
helvella in reply to deniseinmilden

I suggest you download the whole PDF. And do so again in future. It is frequently updated.

(I only recently merged lots of my documents into this one as people simply didn't know what documents existed. Now I have two main documents and a few others.)

Also available in numerous other formats here:

archive.org/details/helvell...

Though updates might be slower there - and the link changes for each update. :-(

deniseinmilden profile image
deniseinmilden in reply to helvella

Thank you, I will put it on my computer!

Very best wishes!

Nackapan profile image
Nackapan

My ferritin was the same as yours . Had dropped from 61. It took a yesr of prescribed iron to raise it enough to reduce symptoms. It now is 57ug/L

I'm 3 years in .

I'm now able to reduce my iron and finding a maintenence dose. First time I went 6 months between a blood test.

I akso take 200mcg of folic acid in a multivitamin and last time done was okay 14ng/ml

I think unfortunately it takes a long time.

Im slowly improving very frustrating.

Hopingyou won't take as long

I started at a lower point.

You sound like you are doing all you can.

I lso take vit D with k2

In hindsight the first vitamin d was deficient in. A sure sign of more to come

!

Hope you have some okayish days soon and work out a regime

Clara5672 profile image
Clara5672 in reply to Nackapan

Thank you. As per, Mr doctor stated that 6 months ago my ferritin was in range at 18. After 3 months I did a private ferritin test that came back 28. Nov I'm due my next 3 monthly test( private) so hopefully it would have risen

Nackapan profile image
Nackapan in reply to Clara5672

Have you still got low ferritin symptoms. ? We all do operate at different levels

and it not wises to look at it in isolation.

I woujd try sbd get your private tests put on your medical notes .

That said its written in anaemia guidelines now that below 30 is s sure sign with symptoms you need more iron.

It was only when I questioned the Gp she decided to put me on iron.

They do seem to ignore very low levels as the range is so vast

So symptoms like b12 is so important

Also to keep serum ferritin above 50ug/L if possible .

That level should stop hair loss and getting out of breath. I wax shaking less too.

When I reached 40 ug/L I felt tge difference .

There are links with thyroid problems too.

Ferritin levels do rise with inflammation in the body too.

If you Google it you will see this information.

Hamayeshguy profile image
Hamayeshguy in reply to Nackapan

Your folate was 57 and Iron as well is 57?Can I ask you what was the dose of iron your GP prescribed?

I have started to take iron on my own but afterwards I'm feeling better. I think even for men takes long time to raise iron. Unfortunately I didn't know that I should take iron and even for folic acid I didn't take it everyday. But from now on I'll do so. But I think vitamin D3 if multivitamin is not enough and some of it's micronutrients can't get absorbed. In the meantime I think methyfolate should be taken instead if folic acid because just methyl of folate can be used in methylation cycle to synthesis methionine for make ATP of cell is a necessity. Now I have stopped injection because I need to raise my iron and methyl folate in order to get rid of their symptoms first which is now mixed with B12 neuropathy, but taking B12 pills for a while. I tried to find quality multivitamin with bioavailable micronutrients but they are so expensive that's why I take seperately each of them which is so painful. No multivitamin I found that come methyl folate it allathiamine or pure omega 3 or k2 and enough D3 in the meantime zinc mangenese magnesium iron can not get absorbed in the presence of calcium. I wish I had enough information regarding iron and folate before starting injection.

Nackapan profile image
Nackapan in reply to Hamayeshguy

I only took iron when prescribed by my doctor. It wax tested 3 months later.

J had symotknx when my ferritin levrl wax 29 ug/ L

J coujdnt tolerate the prescription if iron with fokate 320 mg

Tge Gp then prescribed 210 ferrous fumerate I took that every other day.

Then solgar gentle iron 20mg

14mg in a multivit 3x a week and spartone

Alternating

The Gp is informed of everything i take.

K havd regular blood tests

She monitors

Iron is complex.

O take more big D as go by blood results

Mine was only 21 nmol/l

So prescribed loading doses

J now buy my own.

Ferritin is 57ug/L

Folate 14ng/ml

( typing error on first reply)

I'm happy with that.

Trying to increase vit D a bit more. Sitting in the sun too.

I as Sallyanni ssud i stopped everything at one point. I'd never taken vits before ( shame I didn't fir b12) but maybe not absorbed it anyhow ??

Just to make sure they were not adding yo my symptons

The only thing j found wax omega 3 made me More nauseous at the time .

I've never taken very high levels on anything apart from b12 and vit d .

Hope you find a regime thst helps you.

It can send you crazy trying to get the balance of food nutrients supplements.

.

Hamayeshguy profile image
Hamayeshguy in reply to Nackapan

My GP has not prescribed iron I'm taking on my own but right away after taking my iron related symptoms improved. I had bad back ache and couldn't stand on my feet but hopefully to somehow improved but B12 problem is still there. My abdomen muscle is like tormented. But I have rheumatologist and internist appointment. Probably something else is involved like fibromyalgia, but I'm not sure yet. My symptoms are mostly muscle related as I was so physically active during b12 deficiency. I have double vision which also related to eyeball muscles. I had severe blurry vision and now is improved to somehow. My dizziness improved but I have some lightheadedness and ataxia specially at night. I want to lower frequency if my b12 shot but I take B12 pills. I'm glad that your ferritin and folate are going well.

Clara5672 profile image
Clara5672 in reply to Nackapan

Nacpan, so do you have any advice on whether the b6 complex actually helps absorb the b12 used by injection as iv previously been told it won't work without b6 ? Hence the reason I don't want to completely stop my intake

Nackapan profile image
Nackapan in reply to Clara5672

I've not heard that. I think it's just keeping things balanced.

Initially I just had b12 abd it was certainly working of course plenty of b6 in food like milk eggs avocado ect

I carried on absorbing folate from food as 400mcg too much for me as i went above range . Sitting at 12 now.

I started a multivit with the lowest folic acid I could find

I chose a supermarket one alternating with a 50yr + one

Less is more at times .

I think everything works together .

Only supplement if you are deficient .

I bought a vitamin complex for vision.

It had an alarming amount of vt b6 in.

I'm not taking it.

You have to be so careful.

Ironically I couldn't read what was in the 'vision' mix. Someone else read it.

I am eating a little differently.

I've always eaten little and often.

Really have to do that with b12 injections.

So I would just try a multivit with sensible rda of a wide range of vitamins and minerals.

Have you tried eliminating the supplements. I was far worse on supplements and the itching was awful .You just have too experiment, for example not take supplements (b vitamins and folic) and keep a diary for a while. That way you might establish what is causing the problem. Unfortunately we are all unique and what works for one doesn't always work for another.

tradkita profile image
tradkita in reply to

This would be my plan of action as well. I found out too much B6 mirrors my B12 issues. Journaling out your symptoms and supplements might help you get a clearer picture. Wishing you good health.

Hamayeshguy profile image
Hamayeshguy in reply to tradkita

It's so interesting.

Clara5672 profile image
Clara5672 in reply to

Thank you for your advice. I'm afraid that if I cut out any suppliments it will affect my si b12 and it will all be a waste if time. I take the 2 month break form the b complex as advised because of the b6 toxicity. Iv tried adding things and taking things away but I'm no better for it. It's a hard lonely journey doing this alone. Thank goodness for forums like this x

Clara5672 profile image
Clara5672 in reply to Clara5672

Also. I have a b complex that does not contain b6. It cost a pretty penny so I'm presuming it must be a food brand. How vital is b6 in helping the b12 jabs work. Sorry for all the questions

Nackapan profile image
Nackapan in reply to Clara5672

They will work whatever . The healing process and other nutrients might deplete as not able to absorb them in the right quantity either. Woykdnt I be nice to know what all the leveks were when healthy .??

MorningMist profile image
MorningMist in reply to Clara5672

Not sure if b6 is needed for injections to work, but b6 is needed with folate and b12 to lower homocysteine and that’s an issue for a lot of people deficient in b12.

in reply to Clara5672

It is hard lonely journey, and one that is experimental in many ways. This is why I keep a diary, and I dont like taking tablets when they make the situation worse for me. When I just keep to a good diet I find I can eliminate food that doesn't agree with me easier.I found that too much folic acid is not good in my case and never take it unless blood tests are low.

I really can't help as we all are different and have different diets etc.

I wish you well in finding what works for you!

Sleepybunny profile image
Sleepybunny

Hi,

Sometimes the rate of improvement in symptoms when treating B12 deficiency can be very gradual especially if person was left untreated for a long time.

It took months before there were obvious improvements when I started treatment and I am still seeing some improvement years later.

Perhaps your GP would consider doing a set of iron tests?

labtestsonline.org.uk/tests...

Do you know what your current Vitamin D level is?

Some people have spent more time indoors during pandemic and NHS link below suggests that people who have been spending more time indoors should take a Vit D supplement during Spring/Summer.

nhs.uk/conditions/vitamins-...

Have you had folate levels tested recently?

Maybe worth putting any thyroid results you have on Thyroid UK forum on HU.

In UK, GPs often only test TSH which won't give a full picture of thyroid function.

There are other thyroid tests they can do.

Thyroid tests

thyroiduk.org/getting-a-dia...

Accessing Health Records (England)

patients-association.org.uk...

Some people access test results and medical records with NHS app.

nhs.uk/nhs-app/nhs-app-help...

PAS (Pernicious Anaemia Society)

Based in Wales, UK.

pernicious-anaemia-society....

There is a helpline number that PAS members can ring.

B12 Deficiency Info website

b12deficiency.info/

Two useful B12 books

"What You Need to Know About Pernicious Anaemia and B12 Deficiency" by Martyn Hooper

Martyn Hooper is the chair of PAS (Pernicious Anaemia Society).

BNF treatment info in this book is out of date.

"Could it Be B12?: An Epidemic of Misdiagnoses" by Sally Pacholok and JJ. Stuart (US authors)

Very comprehensive with lots of case studies.

I am not medically trained.

Sammyo23 profile image
Sammyo23

Have you tried supplementing with b1? You could get some Allithiamine and see if that helps you. It's fat soluble and is a different kind than the one in your b-complex.

It's done more for me than benfotamine did as far as my neuropathy symptoms go.

deniseinmilden profile image
deniseinmilden in reply to Sammyo23

That's interesting - my (ex) husband has extra Thiamine and when I fill his pill dispenser up I often take one because I crave the taste - which is often a sign that you need something. I should ask for blood tests for the full B vitamins range but it's so hard to get anything done.

Nackapan profile image
Nackapan in reply to deniseinmilden

I agree what you crave you need

deniseinmilden profile image
deniseinmilden in reply to Nackapan

Chocolate!!!!! 😂❤️

Nackapan profile image
Nackapan in reply to deniseinmilden

🤣🤣

deniseinmilden profile image
deniseinmilden

Hi!

Well done for being cautious and trying things with care and research for yourself.

You say that you take 200 mcg of folic acid - is this just what's in the B Complex? Or in addition to that?

As the processes of cell repair and energy release that use B12 also use a huge range of other vitamins and minerals, if any one of those is in short supply it will limit the working of everything and you won't get the benefits of anything.

Because everything needs to be in careful balance it can be hard to achieve.

As you know, some things are toxic in too high amounts so it is important to use blood test results as your guide to taking supplements. Easier said than got these days, I know!

The best source of everything is your diet - but that's not always possible if you have absorption issues.

Unless you have a specific reason not to (eg you are on anticoagulants, you have hemochromotosis or things like hyperkalaemia), to get a good balance of everything it is better to take a broad spectrum A-Z multivitamin and mineral supplement, rather than just the B complex as the A-Z has everything you need, as well as the B vitamins.

Be aware of what you are starting with in that, and what you are testing short of, and what you really can't/don't get from your diet and go from there.

As a guide, those of us who need frequent jabs usually need a good diet, the A-Z plus extra folate, potassium, magnesium, iron and vitamin D3 + K2 - as a minimum.

A few of us need some additional methyl - I get mine by taking methylfolate.

And some of us just plain need more B12! I need 1.5 mg every day (that's 3x what you have) and I have friends who need more than that - there are several people who have been injecting twice a day for years!

While this doesn't give you any specific answers, I hope it reassures you that there are still plenty of options to try (as well as looking into the other autoimmune possibilities) and lots of improvements to be had!

Good luck with finding your answers!

Ajane profile image
Ajane in reply to deniseinmilden

Hi again deniseinmilden 😊. You say above….’As a guide, those of us who need frequent jabs usually need a good diet, the A-Z plus extra folate, potassium, magnesium, iron and vitamin D3 + K2 - as a minimum’…..

I’ve never seen this written so specifically before & find it very interesting. I have, up to now, been focussed on getting all the nutrients I need from my diet, plus a daily Vit D with K supplement. The last bloods I had done (pre pandemic!) we’re ok. Can I ask how you arrived at this list of supplements please? Was it just trial & error, or have I missed some basic advice? I am sooo much better than I was & have been SI every other day for several years now, but would love to get back to full health & lose the feeling that my get up & go has just got up & left 🤣.

Kindest regards.

deniseinmilden profile image
deniseinmilden in reply to Ajane

It's a combination of personal experience heading me in the direction of lots of extra research, especially into the greater details that are available these days online in the Kreb's/Citric Acid Cycle, some background knowledge from a qualification in animal nutrition, and helpful input from lots of good people on here and other online resources.

We are all very different individuals so there is no blanket remedy but I have learnt that these are the most common things for us to keep an eye on.

Ajane profile image
Ajane in reply to deniseinmilden

Thank you. That is all very interesting. Just looked up the Krebs Cycle & can see I need to do some more learning! Fascinating stuff 😊.

deniseinmilden profile image
deniseinmilden in reply to Ajane

metabolic-pathway.com/fullM...

This gives you an idea of how the Kreb's Cycle fits into metabolism... And shows how in depth/bonkers it is....

But if you go into it you will see that it is just juggling and re-juggling the same basic "building block" ingredients into different compounds and these processes use up (from food) and release energy (to power our nerves and muscles) as they go.

You will see that the same basic ingredients are needed to fuel the whole process.

Ajane profile image
Ajane in reply to deniseinmilden

Wow - that should keep me busy for a while! Bonkers indeed - but fascinating 😁.

Clara5672 profile image
Clara5672 in reply to deniseinmilden

My folate is at 20 so I only take the 200 mg that's in the b complex. What a very informative reply. Thank you so much x

Hamayeshguy profile image
Hamayeshguy in reply to deniseinmilden

Actually methyl in methyl folate is the only source if methylation process in synthesis of methionine so it's a requirement to take methyl folate and if you Google you'd see it's not recommended to mix folic acid and methyl folate. Some of micronutrients in multivitamin are not bioavailable just through passive way they may get absorbed not actively. Really taking good supplement is a dilemma but variety in diet is so helpful. Fir example even proteolytic enzymes in pineapple papaya and kiwi are important in some muscle recovery after related nerves recovered, because some muscles get damaged during deficiency because if nerve doesn't be functional, muscle loses its myoglobin and iron. Myoglobin causes strength of muscles that's why athletes are recommended to take whey protein shake right after their exercise sessions because it enhances myoglobin level of muscle cells

laurmichelle profile image
laurmichelle

Some people (around 15% of the population) with MTHFR SNPs cannot process synthesize folic acid which is in most multi and b complex vitamins. They will have a high need for folate too. Supplementing with methylfolate (the version already converted for your body to use) really helped me. B12 and folate need each other. I have MS and had severe chronic fatigue which I manage amongst other supplements with b12 injections every 3 days and mythylfolate drops every day. If I miss I know about it. Hope this helps. I hadn’t realized I was making myself worse with some of the vitamins that have folic acid in. I also stay away from all foods fortified with folic acid.

Hamayeshguy profile image
Hamayeshguy in reply to laurmichelle

For MS U think BCD oil should be so helpful or even marijuana is recommended but CBD oil doesn't have any side effects, but finding pure form is difficult.

deniseinmilden profile image
deniseinmilden in reply to laurmichelle

Really interesting, thank you!

I'm sorry you feel so ill. x

Parlay profile image
Parlay

Alongside all the valuable information above I would keep a food diary because coeliacs obviously have trouble absorbing vitamins and minerals and feel really crap like you do and some people have what’s called silent coeliac disease. Also are you getting enough magnesium the most abundantly needed mineral for every process in the body. Threonate and glycinate being the most gentle but don’t touch citrate as it depletes vits and mins and is used as a laxative.

Clara5672 profile image
Clara5672 in reply to Parlay

Yes I take 200mg magnesium glycinate before bed x

Hamayeshguy profile image
Hamayeshguy in reply to Parlay

For keto diet banana is not in the list but for magnesium and potassium I think should be included in the diet or even sweet potato

Sleepybunny profile image
Sleepybunny in reply to Parlay

Hi Parlay,

For anyone who suspects coeliac disease ( spelt celiac in US).

UK guidelines below suggest anyone with unexplained B12, folate or iron deficiency should be tested for coeliac disease.

NICE guidelines Coeliac Disease

nice.org.uk/guidance/ng20/c...

Link from Coeliac UK website

Coeliac Blood Tests

coeliac.org.uk/coeliac-dise...

Ghound profile image
Ghound

Like Nackapan, I only feel truly well if my ferritin level is 50-60. Hope your health improves soon. x

You may also like...

So deflated and confused

favour in that he wants to change b12 injections back to once a month . I’m ok with that as I was...

Confused about injection frequency

injections a month for 2 months and then moved to monthly injections and felt much better. 3 months...

Confused about what should a be concern

be a problem for me. B12 deficiency? I straight out asked my doctor about b12 and she said that I...

Iron infusion due confused about levels

see my ferritin level maintained at 52 (it was 59 on 28/04) but this is probably due to monthly B12...

Confused & could do with some advice please...

apart from my Iron is very low, so I need to eat some Iron Rich foods. I was told that my B12...