Oral Vitamin B12 spray

[Mysteriillness]

Hi, My elderly mum was started on Vitamin B12 and my levels were on the low side of normal range but I was found to have pareital Cell Antibodies so my GP advised I take an oral B12 spray, absorbed in the mouth.My levels have come up to about 900 but I've now been found to be folate deficient. What is the connection re these ?

Can you be low even in the normal range?

Can auto immune illness cause these issues?

Meanwhile my 30 year old daughter had low B12 levels 184, they are now up to 435 with the oral spray but she has been found to have low folate ?

Other tests ok but feels tired all the time and has a slight tremor in her hands. Any ideas why and what we should do? I've just read don't treat folate until B12 optimised and people need different levels ?

[clivealive Forum Support]

It is also important that your Folate level is monitored as this is essential to process the B12.

There is a complex interaction between folic acid, vitamin B12 and iron. A deficiency of one may be "masked" by excess of another so the three must always be in balance.

Symptoms of a folate deficiency can include:

symptoms related to anaemia

reduced sense of taste

diarrhoea

numbness and tingling in the feet and hands

muscle weakness

depression

Folic acid works closely with vitamin B12 in making red blood cells and helps iron function properly in the body

Initially, replacing B12 will lead to a huge increase in the production of blood cells and platelets (which occurs in the bone marrow) and can lead to rapid depletion of folate and iron stores; this can then limit the expected recovery of Haemoglobin. Both iron and folate may be needed so please have these levels checked by your doctor.

bloodjournal.org/content/bl...

Note

Giving Folate to a B12 deficient person without B12 can lead to an irreversible exacerbation in neurological features

Care should be taken not to give folic acid (instead of B12) to any patient who is B12-deprived, as this may result in fulminant neurological deficit.

This may help you (same guidance as in the BNF) see:

patient.co.uk/doctor/Pernic...

Management [2]

The British National Formulary (Section 9.1.2 Drugs used in megaloblastic anaemias) states

Folic acid has few indications for long-term therapy since most causes of folate deficiency are self-limiting or will yield to a short course of treatment. It should not be used in undiagnosed megaloblastic anaemia unless vitamin B12 is administered concurrently otherwise neuropathy may be precipitated.

Useful summary contains above advice plus guidelines for B12 injections/supplements.

bnf.nice.org.uk/treatment-s...

I am not a medically trained person but have had P.A. for over 50 years.

I wish you well

[Marz]

What an excellent response from clivealive .... Testing whilst supplementing B12 produces skewed results ...