I have large red platelets and nearly every symptom of B12 deficiency. Dr stopped injections three years ago as he said B12 has gone too high. I can’t eat protein so then developed neurological symptoms. I can’t walk or stand. I have Hashimotos and have developed skin pigmentation. Dr agreed to give me one injection then a blood test. He is saying B12 normal but it is nearly out of range. I am scared I will be in a wheelchair forever. What can I do.
B12 deficiency : I have large red... - Pernicious Anaemi...
B12 deficiency
Self inject , manage your own health if the Dr refuses anymore B12
I believe that nearly all members on this forum have had to turn to self- injecting to keep well . It’s just madness for your doctor to say that your B12 reading is too high . It HAS to be high . You have Hashimotos and skin pigmentation ( vitiligo probably -I have it on my legs ) Two autoimmune conditions. So your B12 deficiency is like Pernicious Anaemia , Autoimmune conditions seldom come alone . . Your doctor has seen how you have deteriorated since your lack of B12 injections. If you cannot persuade him to do the right thing and re-instate your injections , please consider self-injecting . It is not onerous at all , and not too expensive -about £2.20 a shot . At worst . You can get all the info4mation here if you decide that is what you want to do . It’s easy and straightforward . You don’t have to inject Intra Muscularly . It works well sub-cutaneously also . . I’ve just started sub-cut after 9 years of I.M.
A "too high" serum b12 is worrying only if it can't be explained by strong supplements or injections. If someone has a very high b12 without supplements or injections it can be a symptom of something else being wrong, but the high b12 isn't dangerous in itself.
I think you need to find another doctor or self inject and when you are well enough consider legal action. Somebody ( excuse my memory) was very successful ingetting a good payout after similar ill treatment recently.
These were my thoughts exactly. I have had appalling treatment. My daughter has already made a complaint but that was before I knew all about the symptoms of B12 deficiency. She complained because the dr hadn’t bothered to refer me to haematology until I mentioned it two months later.
There has been a legal firm advertising for client with poor B12 care wish I had taken down the name but it is also possible if you dont mind filling out forms to represent yourself. I will try to find out name of legal firm.
Show your doctor the information from the Pernicious Anaemia society that says blood tests are irrelevant if having B12 injections. pernicious-anaemia-society....
I tried that and GP wrote to Haematologist who stated that B12 can be stored for years in the body . I thought this was a water soluble vitamin and the body will only keep what it needs and discard the rest? If B12 is stored, then why do we need supplements?
My understanding is the same as yours, that B12 is a water soluable vitamin and cannot be stored by the body. Could you show your GP information in this? Or approach another GP in the practice?
it was the Haematologist not the GP who said this!
The water-solubility of a vitamin says nothing about whether the body stores it or not. For example, folate is water soluble and also stored, there is a four month reserve.
ref : nhs.uk/conditions/vitamin-b...
It also does not speak to toxicity - B6 is water-soluble but can be toxic in high doses.
B12 is stored in the liver and muscles (perhaps elsewhere too?). But the main store in the liver likely cannot be utilised in PA because there is no intrinsic factor to pickup the B12 which the liver would secrete into the bile. At least this is my understanding.
Thank you, that helps me to understand.
In my case of PA diagnosed the old fashioned way by Sternum bone marrow aspiration at the age of 28. I had virtually no B12 stores available. I was diagnosed with PA, both Macrocytic and Microcytic Anaemia and was very ill.
That was nearly 40 years ago. It’s only in the last few months that I feel that my Hydroxycobalamine is not lasting more than 6 weeks.
There are of course other considerations such as diabetes, NAFLD, NASH however, symptoms improve when I have my B12 injection.
If a doctor doesn’t know what the NICE guidelines say about testing B12 levels , introduce them to them.
see this reply a couple of days ago
While some GPs seem to still believe that B12 deficiency is characterised by "tiredness", there are some that recognise other symptoms. In your case, there is no real need to list all of your symptoms, other than for your own comparison, when you start to get improvements once proper treatment starts.
You have large red platelets. A haematological condition which must have an explanation. Pernicious anaemia is already indicated as the most likely cause of your symptoms, given the Hashimoto's (a common companion autoimmune condition). There is no PA test as such. An IFab (intrinsic factor antibody) test result, if positive, will confirm PA for about 50% of those who have it. A negative result will not therefore tell a GP that you don't have it - but not all of them seem aware of this. I doubt that your GP will be.
A serum B12 blood test post-injection will do nothing but measure what has been introduced. The medical guidance from all the usual sources (NICE, BCSH, etc) advise against this.
My B12 has likely been over measureable amount (>2,000 ng/L) since 2016. This is due to frequent B12 injections which manage my symptoms. It stops me deteriorating. So "too high" is the only level at which I have been able to function these past seven years. Deciding to self inject is never easy, but along the line, can become the only available route out.
My Oral Medicine consultant, treating my angular cheilitis and burning tongue, was very distracted by and concerned about this B12 serum level. So worried that he once asked my GP surgery to help me gradually reduce my injection regime. Now, a complete about-face: he says that I should not reduce my frequency, that I must carry on and that B12 tablets would be useless for me. Talking to experts within his hospital has changed his mind.
One B12 injection might have little effect on your wellbeing, but may satisfy your GP that this is not the problem if your serum result is high. Which it will be, won't it ? That's why the medical guidance for GPs is NOT to be led by that. In fact, not to do the test at all, post injection.
Far better to measure your MMA (methylmalonic acid) - if your B12 is unavailable in bloodstream, your MMA will build up. Normally, a link is made between the two and then continues, taking active B12 to cell/tissue level. If the B12 is not there, the link can't be made and the MMA is left trapped and increasing in the blood. Generally, this level will rapidly reduce after B12 injections and completely normalise after loading dose.
Take someone with you to appointments if possible - as support, to confirm what you say or to take notes. It also is invaluable if you have cognitive and memory problems.
Wishing you well.
Hello Cherylclaire. Thank you so much for such a detailed reply. My drs are absolutely useless. He didn’t even refer me to haematology until I mentioned it two months later. How do I get all the tests you have mentioned as I have never heard of them.
A haematologist can easily test for MMA level. Haematologists tested my MMA four times. A haematologist, you would expect, would have decided already to do this, as a secondary test for suspected B12 deficiency, where perhaps B12 not below range, but symptoms pointing that way. Since you have already presented with large platelets, it seems a bit late in the day to bother with.
Neurological symptoms should be treated by every other day injections until no more improvement can be gained by doing so. This is the medical guidance given to GPs when treating those with B12 deficiency with neurological symptoms. This is also what my own GP was advised to give me when she suspected functional B12 deficiency.
This does not mean "until the nurses cut up" or "until the GP decides that nerve damage must have healed" - it means until the nerve damage repair is as good as it can ever be, because the next stage will be a maintenance dose. Be sure you are at a stage that you would want to maintain. Bear in mind that that nerve repair can be a slow process. You may be unlucky and have some permanent nerve damage - but this decision is your's to take. Who else would you want to decide this on your behalf ?
Livid.
Here are some helpful & concise links, that contain medical footnotes.
stichtingb12tekort.nl/engli...
stichtingb12tekort.nl/engli...
stichtingb12tekort.nl/engli...
All the best to you
Hello Litatamon. Thank you for your reply and all the links. I really appreciate it.
You're welcome.
My sister had similar nonsense, due to a lack of knowledge & training. Which translates to ego in my mind.
Good range - off, back down - on, this went on for years for her. It is criminal.
Then they cut her off completely in the pandemic & when they restarted they did it with only documented Pernicious Anemia patients.
How can educated people lack common sense?
1) Testing only confirms just over 50% of those who have it
And
2) Those who do not have it still have an absorption issue that needs to be treated, if dietary reasons has been ruled out
And then her doctor went bat shit crazy when she found out I was injecting my sister, when they were the ones that cut her off! Laughing. They are just too ridiculous. I just can't. All came with Is she a nurse? Like only a nurse can fill a vial and send a needle in an arm. Because it is THAT difficult. Insert eye roll.
Okay I need to stop for my own good..😁🤭💯
You are right. This really is criminal that doctors who think they are gods are treating people like this. Your poor sister. I am so scared that the nerve damage won’t recover. I am bedbound virtually, losing my balance and nearly every symptom on the list. I have numb hands feet and mouth. I didn’t even know till a few days ago what the symptoms were. I am so angry that they stopped my injections over three and a half years ago. My blood platelets are too large which looks like macrocytic anaemia which if left is serious. Thanks for replying. I hope your sister is better now. Thanks for replying. I really appreciate your kindness.
Your greatest threat is the macrocyctic anemia. So time is of the essence Meerkat, get right on injections however you can. I only say that because another poster on here had correspondence with warriors in the field of b12 - those doctors who get it & push the boundaries - and one clearly said that that stage is truly serious as well. And makes it harder to recover. Not trying to be negative, trying to light even more of a fire under you.
As for all your symptoms and being bedridden, some good news - I had them all. And I have recovered around 80% of myself. Around 32 symptoms and tons went poof - gone. So great news on that front. Leg strength - despite zero atrophy, walking, brain fog & fatigue are still an issue. However, I had a thyroidectomy last year so there might be some overlap.
Do note I ignored my doctor about frequency because I had __________ (brain fog) I went every other day with injections the month after loading doses until there was no further improvement.
My sister is not great. I have suggested many a time she go to a more frequent schedule (cyanocobalamin - monthly) but she does not want to go off the recommendation. She has started taking sublinguals in between and feels they do something - good news as they did nothing for me.
Thank you for your reply. I am going to the doctor on the 22nd to see the nurse for B12 injection and my husband is going to speak to her. I am pleased you are 80 per cent better. The haematologist is ringing on 17th July about the anaemia. I hope your sister is doing okay. Macrocytic Anamia is serious and I am scared. I am also extremely unwell with Hashimotos.
I guess I just want to put out, in case you are not aware, that even some specialists do not know what they are talking about with b12 deficiency. So whatever comes out of all this - look after yourself and be proactive.
I once had a neurologist tell doctors shadowing him that I should eat more meat for my pernicious anemia. The irony was that I was there for diagnosed trigeminal neuralgia ,which completely disappeared with b12 injections.
I don’t think any of them have received any training in B12 deficiency.Who diagnosed your Pernicious Anamia and what did it do to your blood. That is incredible with your neurologist.
My GP 'diagnosed' me yet without the faulty test, because her words "there is no other reason, so no need it is pernicious anemia". And added "injections for life either way, anyway".I said But how do you know I don't have celiac, a tapeworm or h. pylori?
GP: You do not.
Me: But how do you know?
GP: Because you would be in pain or this or that
I said Doctor do you think your patients tell you everything? Sometimes people have issues for decades, even childhood and they just think that is how it is - perfectly normal. And would not say a word to you.
Great conversations! Laughing. Now I have been injecting so long the test has more chance being erroneous apparently
I no longer get any blood tests Meerkat, as I would just be off the charts with b12 - but no macrocyctic anemia, I do know that.
Morning Litatamon. Thanks for your reply. When I eat I do get terrible pain. The doctor wants me to have a celiac test but I have been gluten free since 2013 and when I get accidentally glutened I am very unwell for days. I did have a tapeworm when I was a kid. I could have H Pylori. I caught norrovirus twice in 2011.
Oh man. That is a lot. I just had a thyroid test back where my TSH was 25.4, and that was after a hormone increase where it was 18 previously. So something is up. Makes no sense. Definite issue in my digestive system. I understand pernicious anemia can bring low stomach acid and that affects absorption but I still feel something has not been found all this time.
And that is frustrating, to not be listened to - now I will have to get the endocrinologist off a non-compliance rant. Laughing, it is so endless.
So glad you helped your sister.
When I told my GP that I was (finally) going to self inject, she asked me when I was going to start and what frequency. I told her "yesterday" (so she could not talk me out of it !) and "every other day". To her credit, she did not protest - she asked how she could help. She knew how far this had gone; how many consultants I'd seen and tests I had had - and what I had lost along the way.
She also said that, if I asked, she was sure that one of the nurses would show me how to self inject safely. But in fact, none of them would commit to that. Most of them had been very wary of the two injections a week she had requested for the past six months - on advice that she had been given by consultants. I think she had done all that she could by then and I think she understood why I had no option left but to do this.
She told me that she wouldn't give up and she didn't. I did. But that was way back in September 2017 - and frequent self-injection at least got me a phased return to work after four terms off sick.
I still inject frequently (with Pascoe, a three-day gap between injections) and am well aware that all my symptoms still exist, just fending them off better than I have before. Better controlled, and better by me.
Cheryl Claire,
I just lost an entire reply to you somehow.
Good on your doctor, for at the least verbal support.
It is such a relief to self-inject, isn't it? I am so grateful for HealthUnlocked, as it is the reason I started to do that so early. I still fought the fight for other patients & will continue to but so peaceful not to bang one's head against the wall continuously.
There don't seem to be many GPs willing to give frequent injections with an open mind regarding monitoring by observation. It was only when I got worse again after six months that she decided I needed secondary care.
It was only when this happened that I realised that the people she was relying on to help me knew much less than she did about B12 deficiency. I think that surprised and dismayed her just as much. This is why she was amenable to my starting to self inject.
It felt like it was the only way I could get back to work, even for one day per week, and a relief, even though I was really not that adept !
Hello, first let me say that without more information it is difficult to know exactly what to say or recommend, but one thing is for sure, you cannot have too much B12, it's water soluble. So if your Dr. refuses to give you B12 shots, "I would" find another Dr. who would. We recently had to do that ourselves. As for too much protein, a few years ago my wife had kidney stones and so the Dr. said she was eating too much protein, well she held back from consuming protein and now she has Vit. B12 def because that is one of the main sources of B12 (animal). Yeah, Doctors love to say certain levels of "whatever" are within normal limits, but who cares what the lab values are after a lab test, they only help a little, but what about this: you have a lab test and the doctor says you are within normal limits of B12, but you have a stabbing electric- shock-like symptom running down your leg and your feel wore out after three straight nights of 9 hours of sleep and you keep dropping things, you are forgetful and seem to be stressed out all the time, maybe your eyes burn and you have the pins and needles in your hands or feet or both. OK, all of those are symptoms of Vitamin B12 deficiency and the whole point is go on your symptoms not what the lab values say. Look up all the B12 symptoms and see how many you have. Then be sure you trust your doctor, because if you have read what I just typed you probably know more about B12 deficiency than he does.
Hello MrJustatip. I looked up the symptoms of B12 symptoms and I have nearly all of them. My doctor stopped the injections over three and a half years ago. I then went numb in hands and feet which is the most worrying. I have neurological symptoms which I am worried cannot be reversed. I have only just found out that I have nearly every symptom which I wasn’t aware of it. I can’t eat protein and like your wife have ended up with severe B12 deficiency. My blood platelets are too large which points to macrocytic anaemia. I hope your wife is feeling better. Thank you for taking the time to reply.
Hi again. Sorry to hear about your situation. My wife and I have both been B12 def for over a year now and of course, that's when our very severe symptoms begin. We're sure we've been B12 def for years and even though the doctors have misdiagnosed us for years with all sorts of conditions. At one point my wife was diagnosed with Sjogren's Syndrome, a rare condition that won't allow one to make tears or saliva. So the doctor (A rheumatologist) a specialist mind you, put her on a heavy dose of steroids, which made her sick and she ended up in the hospital for over a week. While in the hospital she caught pneumonia and almost died. Later we learned she did not have Sjogren's. We didn't know it then, but now we know she was simply low in B12. I have been diagnosed with several conditions as well including a stomach ulcer which that particular doctor put me on what's called the purple pill (Nexium) which is a proton pump inhibitor. Proton pump inhibitors are one of the main causes of vitamin B12 deficiency. We now know when you have a B12 deficiency you "MUST" take your health into your own hands (which isn't easy when your B12 def), and not rely on doctors. They have nearly killed both of us several times. W have many more stories about doctors, but I won't bore you with those now. I'm sure we both have permanent symptoms since the B12 def was not caught early. When one has nerve damage, you must take extra B1, and B12 of course, and include B9 (folate)as also important. Picture your nerves like a wire, the plastic coating on the wire is like the myelin sheath on your nerves, when you peel away that plastic coating, and then touch the live wire, it gives you an electric jolt, that is what happens when you lose that myelin sheath on your nerves, it causes sciatic-like pain. We now are having B12 shots every other day and will eventually go down to 2 a week for a few more weeks then down to once per week then hopefully down to once or twice per month for the rest of our life. All the things I've mentioned are important, but in my opinion, learning what is happening to you is the most important, because you can't do anything if you don't know what the problem is. Here are two books I recommend to get you up to speed (sort of speak) Could it be B12? by Sally Pacholock and Jeffrey Stuart and also What you need to Know About Pernicious Anaemia & Vitamin B12 Deficiency by Martyn Hooper. Most of this is reversible, some are not. Hope I have been at least a little help to you and good luck.
I am so sorry for what you and your dear wife have been through. I have been really sick for over three years. I am sleeping downstairs in our dining room as I am too weak to climb the stairs. I have only just found out how very serious B12 deficiency can be. I have neurological symptoms like you describe. My husband is at his wits end and so are my grown up children. I asked for B12 and the doctor didn’t want to give me any. He finally agreed to give me one on the 22nd then he wanted a blood test. What is the point of that. Apparently doctors get no training on B12 defficiency. The doctor stopped B12 injections in February 2020 because he said it went high and he didn’t know why. Apparently there is no danger to this. He was only giving me one every three months anyway. In March 2020 I then went numb in hands feet and mouth with terrible electric shocks through my feet. I also had drop foot which is a symptom of B12 deficiency. I also have nearly every other symptom of the deficiency on the symptom checker on the PA site. I am scared that I will be in a wheelchair for the rest of my life because of their negligence. I have severe eating problems which I have told every doctor I have seen and they have taken no notice. The doctors have an oath of First do no Harm which is a joke as they nearly killed your wife and they are killing me. My son is getting married in October and I can’t go as I cannot walk or stand. I missed his engagement party and my husband’s 70th birthday party. I feel seriously sick and nearly dead. I have large red blood platelets and most of my blood results are abnormal. A haematologist is ringing me in July. What is the point of a phone call. I am sorry to go on and on but you and your wife’s story and mine make me so angry. I will look at the books you told me about. Thank you 🙏
Hello once more. Yes, I too am sorry for your issues. So sad. Sorry I usually don't type this much, but in your case, I feel you need the information.
If someone were found surviving being lost in a desert for 10 days and the person who found them gave them one drop of water (ONLY) that is about what one B12 shot does. Of course, a B12 shot is good, but it's like removing 1 flea from a dog that is covered with fleas. You need B12 shots every other day, and in your case maybe every day. Keep in mind I'm not a doctor, so I cannot give you professional advice, but I know if I was in your condition, I would find some way to get as much B12as I could, shots would be the first thing I would do and as many as I could get.
There are 4 stages of B12, the fourth stage is the worse and it sounds like you are in stage 4. You can work with doctors if you can or want to, and you may not have much choice, but it seems you have been B12 deficient for a long time. Just a little tip here, so pun intended, but when they do lab tests, they test for how much B12 is in your body, that is how much B12 is actively flowing in your system (carried by your red blood cells in your blood), that's all well and fine, but what it does not measure is how much B12 you have in your storage area in your liver where B12 is stored in reserve.
When you need more B12 your body says I need more B12, but when it says "Oh there is not any to send to my brain (for instance), then it says alright, hey Mr. liver can I have some from your reserve tank, and if you have enough B12 in your liver, it send it out, but what if your B12 reserves are also depleted, then you have what is referred to as Vitamin b12 deficiency. So the lab tests show values that reflect how much active B12 you have flowing in your body, but the lab values do not show how much B12 you have on reserve to use (if any). So yes, lab tests and lab values can be helpful, but go by your symptoms, not your lab values. Previously after showing my deficiency, my lab values showed me to have a number of 1650 for lab values after a number of injections, but I am still having the symptoms.
So when should one stop being treated and announce that they are back to being healthy? All the information I read and hear about states that from the start of treatment, it usually takes from 6 months to a year before a person starts feeling back to a healthy state (and usually one can expect not to get continuously better during that time). I know it seems rather, hopeless at times, but it really is a slow agonizing trip. Most people cannot understand what you are going through either. At first, my wife did not understand when I was being stabbed in my hip and leg with a knife, but then she began to have that pain too, and then she also had most of the other symptoms as well.
I could go on and on but just know there is hope and you and your husband may need to take control of your own health and use the doctors only for whatever you feel absolutely you must use them for. Of course, again, I am only sharing with you some of what we have endured. We're both not out of the woods yet. A lot of what this is sounds like conspiracy theory stuff, but when you have all these horrible symptoms, it is like a living nightmare. All the terrible medications we have been prescribed has contributed to our bad condition. I am an author but have not been writing anything since the past few years have messed me up with this B12 stuff. Take care and again, there are people who understand what you are going through. Suck up B12 like a vitamin vampire.
Morning. That was such a good and detailed explanation. I do feel hopeless and I didn’t know any of that. You are so kind to take the time and trouble to explain. I can tell you are an author. We are seeing the nurse tomorrow so I will let you know how we get on.
You can definitely eat protein. Almost all foods contain protein so the only way you could avoid eating protein would be not to eat any food. Which is inadvisable. If you have PA you will be unable to absorb B12 from food and thus will need injections, or if it works for you, high dose oral B12, which, in large enough quantities, should be absorbed by passive absorption, which is independent of the normal B12 absorption method (intrinsic factor). But many find oral does not work or does not work sufficiently well for them so injections may turn out to be the only effective choice.
Hello Technoid. Since 2013 I have lived on white gluten free bread, gluten free basmati rice, vegan slices, vegan margarine, jacket potatoes, vegan yoghurt. If I eat fish or meat I cannot digest it and I am in agony for days. Eggs make me sick. Not much protein there. What is the intrinsic factor?
Intrinsic factor is a "transport" protein, kind of like a car that carries and protects B12 on the way to its absorption site in the digestive system. In PA, an autoimmune attack destroys this protein, with the result that any ingested B12 cannot be absorbed by the intrinsic factor mechanism.
There is protein in all those foods, although not huge amounts for sure. You don't need to eat fish, meat, or eggs to get protein. Legumes, nuts, seeds and soya/tofu have adequate amounts of protein.
But leaving aside protein concerns, if this describes your entire diet it is a recipe for ill-health. I would strongly advise to work with registered dietician or equivalent to help improve the nutritional content of your diet. If you can swing a referral to a gastro this would also be great. As a very temporary elimination diet it might make sense but healthy foods need to be re-introduced to return to a healthy dietary pattern. A healthy dietary pattern looks like:
hsph.harvard.edu/nutritions...
The sooner you can start to move toward a healthier diet, the sooner and greater the impact on health issues. Diet and Nutrition are no.1, everything else is just supporting struts to the main structure you build with a good diet. If you are avoiding animal products for either health or ethical reasons its important to add a supporting vegan-specific supplement such as the "Complement" multi. But Complement will not rescue a diet like you described, its only intended to be complementary to a dietary pattern thats already "dialed in".
Thank you for explaining all that to me. I have seen a dietitian and just told me what foods to eat. Obviously I know what I should be eating but I cannot digest it. I will have to see a gastroenterologist. My doctor wants to test for Celiac but I cannot eat it as I become extremely unwell. I have Hashimotos so soya gluten and dairy are bad for that. I have tried seeds nuts and legumes which put me in serious pain. Thank you for the link.Thank you for replying.
As you suggest, I agree that working with a good gastro is an excellent plan. Over the last 10 years, your diet is looking like the equivalent of a carpet-bombing of your microbiome. With such a restrictive diet, your microbiome no longer contains much of the good gut bugs that are needed to digest fibre and many of the other foods mentioned.
But this doesn't need to be a permanent situation. It should be possible to slowly reintroduce more nutritious foods, allowing the microbiome a chance to adapt. Over time, the good gut bugs will return and take up residence again, greatly improving your gut health and allowing you to eat a variety of nutritious foods again.
Finally, some advice from a registered dietician on soy and hashimoto's:
"The internet loves to hate on soy. So let’s clear this up: soy does not harm your thyroid as long as you are getting the iodine you need. Same for any of the ‘goitrogenic foods’ that are on the internet like kale. Get your iodine, eat normal amounts of soy foods and greens and your thyroid will be fine.
If you are taking thyroid medications, however, you need to know one thing: soy can interfere with your absorption of your medication. The fix? Don’t eat tofu with your meds. Instead, wait 2-4 hours after your morning medication before you consume soy foods. "
desireerd.com/hashimotos-di...
Thanks for that information and link. The Hashimotos was only diagnosed in 2021 so it is all new to me. I will not have many good gut bacteria. My eating problems began after having norrovirus twice in 2011 and I have read that the infection can stay. I also had to take powerful antibiotics and I vomited green liquid and then my stomach lining like brown coffee grounds then black. Called ambulance and they said I was okay but I have no faith in the medical profession NHS or private. They are the same doctors after all. I should think my micro biome is shot to pieces. I have also been on psych medication since 1994 so that won’t be helping my stomach.