bb11B12 absorption trststests

[mabs79]

wwhat tests can Dr do to check my absorption of b12 and folate through my stomach. I am on loading doses 3 x a week for 2 weeks. I have neuro symptoms and psych symptoms by t Dr will put me on tablets after my injections. Just worried that I need injections rather than tablets and worried my psych symptoms will get worse. I am struggling to cope as it is. Have tablets worked out for anyone?

[Nackapan]

Injections should continue every other day until no further improvement. Nice guidelines .

Tablets did not work for me .

IFAB test for antibodies.

As PA An auto immune disease .

[mabs79 in reply to Nackapan]

wworried about my iron levels with EOD injections as I heard they can deplete ferretin / iron and my levels are already critically low. Do you think it best I change my injectioninjections to maybe once a week or so just while trying to get iron levels up

[Nackapan in reply to mabs79]

Depends on your symptoms. Taking iron at the same time not a problem.

[Gen89]

generally GPs just do serum b12 levels. You usually need referral or private for homocysteine,MMA, active b12 although some on this site have been able to get their GP to do those. Whether tablets will work depends on the reason for your low b12 levels. If you have a low dietary intake then tablets may work as you are just not eating enough b12. If you have PA so don’t have enough intrinsic factor which is needed to combine with b12 for absorption through the gut wall then generally regular injections are needed. If your levels are low due to taking ppis which reduce stomach acid or have low stomach acid for another reason tablets may work, you would need to have a follow up blood test to see. There are also various other reasons for low b12 eg coeliac, fish tapeworm, previous gut surgery. If you are low then injections work best to get your b12 levels back to normal quickly. Depending on the cause, further injections usually very two to three months or tablets are then used. The nice guidelines say that if you have low b12 and neurological symptoms you are supposed to have injections every other day until your symptoms stop improving. However, my GP said that was only done in a hospital setting under the guidance of a specialist if you are bad enough to be hospitalised eg struggling to walk. You might have more chance of getting monthly or weekly injections from your GP. I think some on this site have had this. Also remember there are many reasons for neurological symptoms not just low b12 so you might want to ask for referral to a neurologist.

[mabs79 in reply to Gen89]

ii am that low on many things I don't know what symptom is caused by what deficiency. I just don't want to die! My iron and ferretin are extremely low but my haemoglobin is normal so GP won't do anything.

[Gen89 in reply to mabs79]

I also have very low ferritin levels and have had for eight years but my haemoglobin is ok. I struggle to take iron supplements and even when I did manage for six months my ferritin level barely went up. I asked my GP about iron infusions but she said she could only refer for this if I was very anaemic. I also have low vit d levels but these at least go up with vit d tablets which don’t upset my guts thank goodness so that one problem I can solve!!

[mabs79 in reply to Gen89]

ii think I am having issues as a result of having my gallbladder removed 4 years ago! I don't think my body is absorbing it

[Gen89 in reply to mabs79]

if your Gp refuses further b12 injections ask for a blood test to check your b12 levels every three months. Your level is likely very high after the injections. If you absorb the b12 tablets hopefully your levels would only drop slowly I think. I would definitely ask for my b12 level to be monitored by regular blood tests if I was put on tablets

[mabs79 in reply to Gen89]

ddo you suffer with low b12?

[Gen89 in reply to mabs79]

I developed neuropathy symptoms a few years ago. When I had blood tests my b12 levels were borderline low and had been slowly decreasing for the previous six years during which I had been taking omeprazole which is a ppi. So I had b12 injections whilst waiting for a neurological referral.

[Cherylclaire Forum Support in reply to Gen89]

Your GP is wrong about hospital setting: I was given 2 injections a week at my local practice - which should have been 3 as requested by GP but nurses unable to fit this in - and this continued for 6 months. She also managed to get MMA tested - after 2 laboratory refusals.

A referral to a neurologist will take time to arrange. Treating the neurological symptoms appropriately with b12 injections in the meantime would prevent deterioration.

[Gen89 in reply to Cherylclaire]

I think you have struck very lucky with your GP.

[Cherylclaire Forum Support in reply to Gen89]

I think so too. Unfortunately for me, I think she has now left the practice and is working in a hospital now.

However, the medical guidance for those with neurological symptoms is very clear about starting with EOD injections until no more improvement can be had - and does not restrict this treatment to hospitalised patients - in fact, makes no mention of hospital at all. The British National Formulary (BNF) is known as the Doctors' Bible.

[EllaNore]

If you do go get tests make sure you have no B12 in your system for 2 weeks or more. If you can go a month I would do that. You should not have any B12 in your system when you get tested or it will muddy the waters. That's very important.