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advice please b12/folate

Emmy1991 profile image
12 Replies

Hi,

So a few years ago I had a b12/folate deficiency. I had easy bruising, unexplained weight loss, funny sensations just to make a few. In the end I was really unwell and had Macrocytosis so I was started on loading doses of b12 (followed by injections every 3 months and folic acid.

My levels went up to 1800 and treatment was stopped.

a few years on and my levels have gradually gone down again. My last blood test which was last September showed my b12 to be 183 and my folate 2.2. So I was given b12 tabs and folic acid.

I’ve now started to feel unwell again and I had a blood test Monday just gone so waiting for the results.

I had a PA blood test a few years ago (2017) but it was negative. I had an endoscopy mild gastritis (2017). My great nan had PA and was given treatment for life.

I’m wondering if my levels come back low. Where do I go from here?. Do I ask for injections? And just need some advice really.

Thanks

Emmy.

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12 Replies
Nackapan profile image
Nackapan

I'm amazed you managed for? So many years after b12 injections were stopped.

Once on injections 💉 levels should not be tested

In their guidelines!

Mean nothing as whole point is to keep levels high.

Should go by symptoms and clinical response .

Ask for injections as symptoms returning.

Treat b12 before folate

Only 50% of those with PA test positive your Gp should know this !

Have anotherIFAB before injections 💉

Sleepybunny profile image
Sleepybunny

Hi Emmy1991,

Welcome to the forum. You'll find lots of help and support here.

I'm not medically trained but with many symptoms suggestive of B12 deficiency and PA in the family, I don't think your injections should have been stopped.

A negative result in Intrinsic Factor Antibody test does not rule out PA. It's possible to have Antibody Negative PA.

Take a few days to look through links below so it's not so overwhelming and please bear in mind that some links may have details that could be upsetting.

Link about "What to do next" if B12 deficiency suspected or recently diagnosed

b12deficiency.info/what-to-...

How to write letters to GPs about B12 deficiency

b12deficiency.info/b12-writ...

The link above has letter templates covering a variety of situations linked to B12 deficiency.

Point 1 is about under treatment of B12 deficiency with neurological symptoms.

I suggest putting queries about treatment and diagnosis into a letter as I feel it is harder for GPs to ignore. Always keep a copy.

Has your GP got a list of all your symptoms? Include every neurological symptom.

I used the PAS checklist below and added extra symptoms at the bottom of the list.

Symptoms of B12 Deficiency (folate deficiency also mentioned)

pernicious-anaemia-society....

b12deficiency.info/signs-an...

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

b12-institute.nl/en/symptom... (from B12 Institute Netherlands)

Symptoms of Peripheral Neuropathy (damage to peripheral nerves)

nhs.uk/conditions/periphera...

Peripheral neuropathy can be associated with B12 deficiency and sometimes with folate deficiency.

It's vital to get adequate treatment. Inadequate treatment may increase the risk of developing permanent neurological symptoms. In severe cases the spinal cord may be affected.

PAS article about SACD, sub acute combined degeneration of the spinal cord

pernicious-anaemia-society....

Have you considered joining PAS (Pernicious Anaemia Society)?

Membership of PAS is separate from membership of this forum.

pernicious-anaemia-society....

You do not need a confirmed PA diagnosis to join PAS.

PAS (Pernicious Anaemia Society)

Based in Wales, UK.

pernicious-anaemia-society....

There is a helpline number that PAS members can ring.

PAS support groups in UK

pernicious-anaemia-society....

Testing for PA

pernicious-anaemia-society....

UK B12 documents

NHS article about B12 deficiency (simply written)

nhs.uk/conditions/vitamin-b...

Summary of BSH Cobalamin and Folate Guidelines

pernicious-anaemia-society....

BSH Cobalamin and Folate Guidelines (aimed at health professionals)

b-s-h.org.uk/guidelines/gui...

Diagnostic flowchart from BSH Cobalamin and Folate Guidelines which mentions Antibody Negative PA.

This may be a good one to pass to GP.

stichtingb12tekort.nl/engli...

BNF Hydroxocobalamin

bnf.nice.org.uk/drug/hydrox...

NICE CKS (Clinical Knowledge Summary) B12 deficiency and Folate deficiency

Aimed at patients and health professionals.

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

New NICE guidelines for Pernicious Anaemia and B12 deficiency will be published in 2025.

nice.org.uk/guidance/indeve...

Local B12 deficiency guidelines

I urge UK forum members to find out what's in the local B12 deficiency guidelines used by their ICB (Integrated Care Board) in England and Health Board in Wales/Scotland.

If can't find them online or by searching forum threads here then best bet is to submit a FOI (Freedom of Information) request to ICB/Health board asking which B12 deficiency guidelines are used locally and for a link to or copy of them.

Some local B12 deficiency guidelines in UK are not helpful. See blog post below.

b12deficiency.info/gloucest...

NICE guidelines Coeliac disease suggest that people with unexplained B12, folate or iron deficiency should be tested for coeliac disease.

nice.org.uk/guidance/ng20

More info on Coeliac UK website.

coeliac.org.uk/information-...

Two useful B12 books

"What You Need to Know About Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper

Martyn Hooper is the former chair of PAS (Pernicious Anaemia Society).

"Could it Be B12?: An Epidemic of Misdiagnoses" by Sally Pacholok and JJ. Stuart (US authors)

Very comprehensive with lots of case studies.

Many UK forum members here have met health professionals with a poor understanding of PA and B12 deficiency.

Misconceptions about a B12 deficiency

(From Dutch B12 website - units, ref ranges, treatment patterns may vary from UK)

stichtingb12tekort.nl/engli...

Diagnosis and Treatment Pitfalls

(From B12 Institute in Netherlands - units, ref ranges, treatment patterns may vary from UK)

b12-institute.nl/en/diagnos...

I don't know why your B12 levels were tested.

PAS article "Testing B12 During Treatment".

Has some useful quotes from UK documents.

pernicious-anaemia-society....

From Stitchting B12 Tekort, a Dutch B12 website

Testing B12 During Treatment

stichtingb12tekort.nl/engli...

Help for GPs

May be worth suggesting your GP looks at these.

PAS have page for health professionals. Your GP can join PAS as an associate member, no charge.

pernicious-anaemia-society....

Club B12

Club B12 is a group of researchers, doctors and other interested people who are looking into B12. They have regular zoom meetings.

club-12.org/

Self treatment

Some UK forum members turn to treating themselves when NHS treatment is not enough.

Some get extra injections from private GPs or beauty salons. Some try high dose oral tablets but these don't work for some people and some as a last resort try self injection (SI).

There is more info I could pass on. Just let me know if you want more.

Good luck and I'm hoping you get the treatment and support you need.

wedgewood profile image
wedgewood in reply to Sleepybunny

Hou are a STAR Sleepybunny ! 🎖️ ***** Wonderful information!

B12life profile image
B12life

are you by chance vegetarian?

If so, then oral supplements may help and an intitial set of b12 injections may help get you back up to speed then oral supplements to maintain.

however, if you do eat meat (and it must be daily), then this means you do not absorb b12 and have a long term issue that will need to be treated with injections, most likely for life.

Thus injections shouldn't be stopped.

find a doc to get you injections or get your own supplies and start self injecting.

I was 190 and felt horrible. bed ridden from the fatigue, brain fog, high heart rate, back pain, numbness, and all the other symptoms.

It took 2.5 years of daily (with cyanocobalomine or every other day with hydroxocobalomine) to get 80% back to normal. I now climb mountains (metaphorically and literally).

Don't mess around. Don't let any physician tell you that you don't need B12. Your tests have revealed you have a definite deficiency. Get doing injections and in the mean time, work your way through Sleepy Bunnies links! they are fantastic. The number of links may be ovewhelming, but just think about what you want to know and the order in which you want to know them and bite off each one in pieces at your own pace.

If left untreated the symptoms can be permanent. I have yet to 100% clear up the loss of coordination and the brain fog; although I have come a long way.

AND REMEMBER, this is the best forum you can be in for community support for b12. So give yourself credit for finding this forum. Don't be afraid to ask questions or just vent!

B12life profile image
B12life in reply to B12life

To add to my previous reply, trust me, most of us if not all here went through the same exact thing you did where we were told we didn't need injections, then ended up worse off.

That's why we say, don't listen to the docs that don't understand B12. There are plenty of medical journals coupled with the clinical experience of all the b12 deficiency patients out there... both of which get completely ignored by the medical community. The PAS (Pernicious Anemia Society) works hard to bring awareness but it's slow due to the lack of recognition of the gravity of this deficiency. Ultimately it comes down to the fact that B12 is responsible for cell generation. our bodies regenerate cells (brain cells, nerve cells etc) every 120 days. This process stops w/o b12. It is so incredible HOW this simple fact is ignored. It's a deadly deficiency if left untreated! It's just as bad as cancer, yet has a simple fix of b12 injections!

Take treatment into your own hands. That's what a lot of us here have done and it has worked. That being said, I still work with a doc who does listen. I have him get various tests when needed. I keep him updated on my progress and try and encourage him to recognize and help others with this issue. I should do more, but my career keeps me so incredibly busy these days. If anything, I bring awareness to one doc and help others that he sees.

Emmy1991 profile image
Emmy1991 in reply to B12life

thank you so much I really appreciate all the information and support :) and no I’m not a vegetarian but have looked at my diet and do need to increase my meat intake. I eat a lot of greens as I am quite healthy.

Emmy1991 profile image
Emmy1991

I had all my blood tests back . My iron serum was slightly low 7.7 (lab range 9.0 to 30). Ferritin is 25 (lab range 15 to 204). So my iron levels are low? But my fbc was fine?

My vit d is slightly low aswell but other than that my thyroid, kidney, liver, c reactive protein test was all normal.

The doc did not send off for my b12/folate which I’m frustrated and annoyed about so I have decided to pay for a Superdrug premium b12 test as I had to wait 2 weeks just to get a blood test from my docs last time, I feel so unwell right now i can’t function :(

Dizziness, fatigue, pins and needles sensation on my scalp, brain fog, loss of appetite.

B12life profile image
B12life

be prepared to ask for more injections. You need I jections for life. You need daily injections.

Sleepybunny put a link to how to write a letter. Get that prepared.

healthunlocked.com/redirect...

Read and give a copy of this to the doc justifying your need for frequent injections.

ncbi.nlm.nih.gov/pmc/articl...

Create a summary page of the doc and highlight the key points that justify frequent injections, otherwise they won't read it.

Get them to teach you how to self inject. If they won't, find someone who will.

It took 2 years of daily injections and I still do them. But I'm living life well now.

Now the vit D:

That can make you very tired as well.

Also, take 10,000 units of vitamin d a day to help get your D up for 2 months then get tested unless they told you a diff dose. You can overdose on vit D but that level for that long should be ok. Unlike b12, vit D can be tested at any time. It usually takes 2-3 months to build the level up.

Have you had your gallbladder out?

Emmy1991 profile image
Emmy1991 in reply to B12life

thank you so much for the info and no I haven’t had my gallbladder out.

Sleepybunny profile image
Sleepybunny

Hi,

"So my iron levels are low? But my fbc was fine?"

Have you had a full set of iron tests?

labtestsonline.org.uk/tests...

B12 deficiency and Folate deficiency can lead to enlarged red blood cells (macrocytosis).

Iron deficiency can lead to smaller red blood cells (microcytosis).

A person with both iron deficiency and b12 deficiency/folate deficiency may appear to have normal sized red blood cells on Full Blood Count.

Links about Full Blood Count.

labtestsonline.org.uk/tests...

Next link is aimed at doctors.

patient.info/doctor/periphe...

Emmy1991 profile image
Emmy1991 in reply to Sleepybunny

I’m not sure. I have had the enlarged blood cells before a few years ago.

I had my fbc which was fine

urea & electrolytes - all fine

serum c protein - all fine

liver function - all fine

iron transferrin - low

serum ferritin - all fine

serum TSH - all fine

Vit d. - low

I have now booked in my b12/folate that they missed out but I’m having to wait 2 weeks just to get the blood test done and I feel so poorly :( I feel like my doctors are not taking me seriously at all. They seem to fob off b12. In the meantime I’m looking privately just to get a blood test done. I also have asked for a PA one. I had one a few years ago but it was negative but I know they are not 100% accurate?

Sleepybunny profile image
Sleepybunny in reply to Emmy1991

You could show this diagnostic flowchart to your GP.

It explains when Antibody Negative PA should be diagnosed.

Diagnostic flowchart from BSH Cobalamin and Folate Guidelines which mentions Antibody Negative PA.

stichtingb12tekort.nl/engli...

Have you managed to find the local B12 deficiency guidelines for your area yet?

Your GP is likely to refer to these for guidance on treatment and diagnosis.

I think people on the forum should protect their privacy but if you don't mind people knowing which area of the country you are in, someone might be able to help you find the local B12 deficiency guidelines for your area.

Threads from HU can sometimes appear on the NHS website.

If you want to change the setting of your thread to a more private setting....

1) Go to your original post. Click More then click Edit.

2) Scroll down page to Share. Click Community Only then Post.

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