Latest #s - Is my B12 sublingual 1000mcg daily working?

Hello, My Friends (who are most likely asleep as I write this from Ohio). On June 14th I had updated blood tests done that I specifically requested based on suggestions made on this forum so we could see if maybe my B12 treatment is getting into my cells. My B12 blood serum is close to 1000, but we know that can be meaningless. The final test results (below) came in today. Previous testing on most of these was done last March. You will see that only one (ferritin) is below normal but some others are low normal. Any insight you can give would be appreciated - like what my next steps should be. You should also know that all my specialists - endo, gastro, hematologist, and primary care have no idea how to treat me. They tell me to stay on the B12 and take a multivitamin.

vitamin D Hydroxy - 67.2 (last time 58.4) range: 31-80

homocysteine - 9.2 (last time also 9;2) range: less than 15.1

Iron - 63 (last time 108) range 41-186

TIBC - 368 (last time 341) range: 232-386

Transferrin - 17.1 (last time 32) range: 15-570

Ferritin Bld - 13.6 (last time 17.1) range: 14.7 - 205

Methylmalonic Acid - 190 (last time 142) range: 79-376

Folate Serum - greater than 20 (last time the same) - range: greater than 4.7

Magnesium Bld - 2.1 (last time same) range: 1.7-2.3

Sleep well, everyone...

[helvella]

The UK's National Institute for Clinical Excellence says:

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency. However:

Ferritin levels are difficult to interpret if infection or inflammation is present, as levels can be high even in the presence of iron deficiency.

Ferritin levels may be less reliable in pregnancy.

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

Assuming your test was also in micrograms/L, it would appear you are iron deficient.

[Hidden in reply to helvella]

Thank you for this information. Ng/ml is what the ferritin test was in. Interesting about the infection/inflammation issue. I have autoimmune atrophic gastritis - lots of inflammation.

[Gambit62 Administrator]

According to the above results you have enough B12 to ensure that the processes that recycle MMA and homocysteine are functioning okay.However, the real answer to your question is what is happening to your symptoms

[Hidden in reply to Gambit62]

I wanted to write earlier, Gambit, but I was feeling poorly all day. I think it was from the iron I started two days ago. I have always had a difficult time taking iron supplements. I need to find a brand that is easier on the stomach (especially now because of the autoimmune atrophic gastritis I was newly diagnosed with a little over a year ago). Doctor won't order infusions because it's not that low. But with regard to how I have been feeling in general, I have good and bad days. My toes are still numb but not as bad as they were before the B12 ; I'm still foggy; some days light headed (like today along with the upset stomach); and I'm fatigued by 3 or 4 p.m. in the afternoon. These are the main symptoms. I am very glad, however, that the tests reveal that I have enough B12 for the processing of MMA and homocysteine as I was most concerned about that. As I have said many times before, this forum is a Godsend. I read postings nearly every day and always glean valuable information. Thank you.

[FlipperTD]

Uh? You've woken me up!!!! Welcome to UK, from the Banks of The Ohio, perhaps???

Anyway, hi. Scientist, not medic.

If your 1mg sublingual is your only supplemental source of B12, well, it's definitely getting into your blood, and that's a good start. If however you're having injections too, it's impossible to say.

As my background is Haematology, I have to ask "how's your Hb, MCV, MCH and RDW? Have they changed?"

Good luck!

[Hidden in reply to FlipperTD]

Hi Flipper!

While both Olivia Newton John's and Dolly Parton's rendition of Banks of the Ohio are really good, I'm in the northern part of Ohio - more like the banks of Lake Erie :).

I'm not having injections, so the sublinguals are doing all the work.

Thanks for asking about the other blood tests. My last CBC+DIFF was taken in March 2022 but wasn't ordered this month with the other tests. The results for tests you queried about from back in March are: Hb - 14.4 (11.5-15.5); MCV - 93.9 (80-100); MCH - 30.3 (26.0-34.0); RDW - 12.4 (11.5-15.0). Looks pretty good - eh? Could they change dramatically in two months time? Should I ask to have the tests ordered again?

Thank you!

[FlipperTD in reply to Hidden]

Hi.

Your CBC results look good. It looks like the sublinguals are doing the busines for you.

Red cells are replaced at the rate of around 1% per day, so if something changes and you 'run out' of something such as iron, then your MCV will drop slowly. Likewise, you would see an increase in the RDW because that measures the width of the size distribution of the red cells. So, RDW settles at around your level when you're on an even keel, but can rise spectacularly a couple of months into a developing deficiency.

[The same logic applies to B12 &/or folate, but the MCV goes up in that case.] So, if you're in pursuit of 'what's going on?' then a couple of months would show a change if anything was happening. Of course, a spreadsheet of these things is great to monitor their changes. In actual fact, the MCH is slightly preferable to the MCV for some od technical reasons that I won't get into here, but the RDW is a great friend of mine.

[I suppose if you're closer to Lake Erie, I'll just have to think 'Low Bridge, everybody down' instead of the other song.]

Keep well.

[Hidden in reply to FlipperTD]

I am going to print out this last bit of information you have provided...it will definitely come in handy. Appreciate it.

(By the way, I listened to the latest song..

Eww.. don't like it. The Ballad of the Edmund Fitzgerald puts you just about where I am ... US side. )

[FlipperTD in reply to Hidden]

Gordon Lightfoot is a favourite of mine.

I realise the Erie Canal is another thing entirely, but I somehow ended up with a CD of Bruce Springsteen, with it on there. I'm more on Pete Seeger's side, but if I was 10% as good as him on the banjo, well...

Glad I've been of some use!

[Hidden in reply to FlipperTD]

Well I had to Google Erie Canal - and it wasn't the Boss singing it for sure. I'll bet his rendition is much better. I will listen to it. I also like Seeger. In the meantime, you must be a Boomer like I - or close to it.

[FlipperTD]

Seems like you have found my range. 1950. I think that qualifies me!

[Hidden]

It does! So I just listened to Bruce sing Erie Canal - love it! I also listened to Seeger sing it - lovely but I liked Bruce better. I think the one I first listened to was from 1905 when it was written!