B12 injections Vs tablets

[Mead15]

I’ve been prescribed 3mths tablet for low B12 (which I also had 3 years ago). At what level or reading should you be offered injections rather than tablets please?

[Hidden]

What was your levels ? Is your folate, iron etc fine?Are you vegetarian ?

Sorry if you think I'm interrogating you, (should be your doctor doing that) Did the doctors establish why you were difficient three years ago, and how did they treat it last time ?

Personally I would be more comfortable you having injections especially if you have neurological symptoms.

Perhaps a more details of your symptoms !

[Nackapan]

It depends on your symptoms and if you have a good mixed diet you obviously ard not absorbing enough .I waz told dietary

However I was never asked what j had to eat !!

I was given injections ax had very severe symptoms and a serum b12 level of 106(200-900)

They advised me to wean off injections with tablets.

If never happened because I couldn't absorb enough from tablets.

Some have s 'in range b12 reading but ard still deficient.

Should be on symptoms

I hope the oral b12 works for you

[wedgewood]

The reasons for your b12 deficiency depend on what treatment you get . Do you know what caused your deficiency ? Also we need to know what your symptoms are. Reasons for B12 deficiency—1) Lack of B12 in diet. eg Vegan or strict vegetarian diet

2) Certain medications deplete B12 — eg PPIs - Proton pump Inhibitors. Other medications include Metformin for diabetes . There are other medications

3) Stomach surgery that removes parietal cells that produce the intrinsic factor and stomach acid .

4) Infestation of fish tapeworm, which can be found in raw fish and insufficiently smoked fish .

5) Abuse of Nitrous Oxide ( “laughing gas”)

6) Certain diseases eg Crohns

7) Pernicious Anaemia,which is the most common reason .This is an auto-immune condition , where antibodies destroy the parietal cells in the stomach , These cells produce the Intrisic Factor and soma h acid , both of which are needed for the breakdown and absorption of B12. It can be difficult to diagnose a# most doctors are very ignorant about it .

[Sleepybunny]

Hi again,

Do you know the actual serum (total) B12 result along with the reference range for your area?

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...

Link about "What to do next" if B12 deficiency suspected or recently diagnosed

b12deficiency.info/what-to-...

Unhappy with Treatment (UK info)?

Letters to GPs about B12 deficiency

b12deficiency.info/b12-writ...

PAS (Pernicious Anaemia Society)

Based in Wales, UK.

pernicious-anaemia-society....

There is a helpline number that PAS members can ring.

Testing for PA

pernicious-anaemia-society....

PAS website has lots of useful articles and a page for health professionals that your GP might find useful

pernicious-anaemia-society....

pernicious-anaemia-society....

When I read your post I wondered if you were in Gloucestershire, an area of UK which has a poor reputation on this forum as to how B12 deficiency is managed.

See blog post below

b12deficiency.info/gloucest...

Although some forum members manage their condition with high dose oral B12, the evidence that oral treatment is as effective as B12 injections is as far as I know of low quality.

See links below about oral treatment.

Note on oral treatment - B12 Institute (Netherlands)

b12-institute.nl/caution-no...

Articles that suggest evidence that high dose oral is as effective as B12 injections is of low quality.

cochrane.org/CD004655/ENDOC...

pubmed.ncbi.nlm.nih.gov/295...

smw.ch/article/doi/smw.2017...

B12 article from Mayo Clinic in US

ncbi.nlm.nih.gov/pmc/articl...

Table 1 in above article is about frequent misconceptions about B12 deficiency that health professionals may have.

Oral treatment is mentioned in the article.

PAS news item on Oral Tablets

pernicious-anaemia-society....

My understanding is UK guidelines indicate that severe B12 deficiency especially where neuro symptoms are present should be treated in UK with B12 injections whatever the cause.

UK B12 documents

NHS article about B12 deficiency (simply written, lacks detail in my opinion)

nhs.uk/conditions/vitamin-b...

BSH Cobalamin and Folate Guidelines

b-s-h.org.uk/guidelines/gui...

Summary of BSH Cobalamin and Folate Guidelines (main points from above document)

pernicious-anaemia-society....

Diagnostic flowchart from BSH Cobalamin and Folate Guidelines which mentions Antibody Negative PA.

stichtingb12tekort.nl/engli...

BMJ B12 article

bmj.com/content/349/bmj.g5226

Emphasises need to treat patients who are symptomatic even if their B12 level is within range.

Dietary B12 deficiency is sometimes treated with low dose cyanocobalamin (50 mcg) tablets.

BNF Cyanocobalamin

bnf.nice.org.uk/drug/cyanoc...

There are moves across UK to use high dose cyanocobalamin tablets as an alternative to b12 injections which in UK are usually hydroxocobalamin.

Although this is often promoted as easier for patients, my cynical nature suspects that the move to high dose oral B12 has a financial incentive (cheaper).

BNF Hydroxocobalamin

bnf.nice.org.uk/drug/hydrox...

NICE CKS B12 deficiency and Folate deficiency

cks.nice.org.uk/topics/anae...

There are currently new NICE guidelines in development for Pernicious Anaemia and B12 deficiency. These should be published in 2023.

nice.org.uk/guidance/indeve...

If you click on "project documents" then on "consultation comments and responses" it gives a good insight into current issues around diagnosis and treatment (over 40 pages)

Too many of us on this forum have met health professionals whose understanding of PA and B12 deficiency from other causes is lacking.

Useful to know what some of the common wrong ideas (misconceptions) about B12 deficiency are.

1) See Mayo Clinic article in this thread.

2) Other articles about misconceptions about B12 deficiency

Misconceptions about a B12 deficiency

(From Dutch B12 website - units, ref ranges, treatment patterns may vary from UK)

stichtingb12tekort.nl/engli...

Blog post that mentions misconceptions about B12 deficiency

b12deficiency.info/a-b12-se...

UK treatment guidance has changed since above blog post was written.

Diagnosis and Treatment Pitfalls(From B12 Institute in Netherlands - units, ref ranges, treatment patterns may vary from UK)

b12-institute.nl/en/diagnos...

Links to forum threads where I left very detailed replies with lots of useful B12 deficiency info eg causes and symptoms, more UK B12 documents, B12 books, B12 websites and B12 articles and a few hints on dealing with unhelpful GPs.

Some links may have details that could be upsetting.

Some of the info will be specific to UK.

healthunlocked.com/pasoc/po...

healthunlocked.com/pasoc/po...

healthunlocked.com/pasoc/po...

I am not medically trained.