I am coeliac but have been oob a strict gluten free diet for years. But although blood tests for B12 come back normal or sometimes over normal, I have the symptoms of low b12. I already have the Gio2 gene from both parents. Also another one from each that makes me prone to certain cancers. So I wonder if I don't absorb b12. I also have Hashimoto's.
Thank you for any assistance.
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Everdean
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The fact that you have hashimotos means that you stand a good chance of also developing PA as both are autoimmune disorders. There has been some research recently that has helped to narrow down the genetic variants that make people more prone to developing auto-immune disorders. PA also tends to run in families but, as with hashimotos, it hasn't been possible to date to identify specific genetic variants that are involved. Part of this is because many of the genetic variants also require environmental factors to activate them.Given the overlap of symptoms of PA with other conditions - including hashimotos - it is very difficult to get a clear cut diagnosis - particularly as the test for B12 deficiency and the test for PA as a cause of B12 deficiency both suffer from issues that make them rather insensitive.
If you are testing serum/active B12 periodically look for significant falls in levels - 20%+ in the case of serumB12 but much less in the case of active B12 - these are indicators of B12 absorption problems.
Hashimotos also affects gut transit which can be another factor that contributes to problems absorbing micronutrients, regardless of whether PA is actually the cause.
if you only have one b12 measure then it's likely to be serum B12 - the results should give you a range - the active B12 range will start around 37, active B12 around 200
the results should give a normal range - you can tell if the B12 tset is active or total serum by looking at the range. If you are being tested for TSH then that may be the only result on the test
"in the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment"
Diagnostic flowchart from BSH Cobalamin and Folate Guidelines which mentions Antibody Negative PA.
If you click on "project documents" then on "consultation comments and responses" it gives a good insight into current issues around diagnosis and treatment.
Local Guidelines
Each CCG (Clinical Commissioning Board/Health Board/NHS hospital trust in UK is likely to have its own local guidelines on treatment/diagnosis of B12 deficiency. Might be worth tracking down the local guidelines for your area of UK and comparing the info in them with BNF, BSH and NICE CKS links.
Some local guidelines have been posted on forum so try a search of forum posts using terms "local guidelines" or try an internet search using "name of CCG/Health Board B12 deficiency guidelines" or submit a FOI (Freedom of Information) request to CCG/Health board asking for access to or a copy of local B12 deficiency guidelines.
If you want to know why I suggest getting hold of the B12 deficiency guidelines for your local area, have a look at this blog post.
Table 1 in above article is about frequent misconceptions about B12 deficiency that health professionals may have.
Links to forum threads where I left detailed replies with lots of B12 deficiency info eg causes and symptoms, more UK B12 documents, B12 books/films, more B12 websites and B12 articles and a few hints on dealing with unhelpful GPs.
Some links may have details that could be upsetting.
Wow. Thankyou so much.Got bran fog at moment but will definitely check out as much as possible. Thanks again for your time and effort put into this message.
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