Has anyone heard of or have knowledge about B12 deficiency, folate/iron deficiency affecting Hba1c results and causing raised levels? I was extremely surprised when my Hba1c levels came back high pre diabetic recently. I am about 6kg overweight at 67 but am very active taking several classes a week..
Thanks
Hi doityourself that's a bit strange and a new one on me personally.
I've had P.A for over 51 years and supplement daily on folic acid and ferrous fumarate in addition to my three weekly B12 injections and my last HbA1c result in September 2022 was 50.
I've had type 2 diabetes since 2015
I thought the HbA1c test was looking at the sugar levels over the previous three months.
I'm not a medically trained person so don't know whether deficiency in B vitamins can affect Diabetes test results. Maybe it's more a "diet thing"
I wish you well
Sort of true. The A1c test is actually looking at the current blood sample. The result shows your average blood sugar level for the past three months. The A1C test measures what percentage of hemoglobin proteins in your blood are coated with sugar. Why three months? Because red blood cells have a life span of 3 months. after three months they die and are gobbled up by Macrophages a form of white blood cell. So the A1c typically is taken no sooner than every three months because of that.
A variety of things can affect blood sugars, diet is a small part of it. High levels of cortisol are often the culprit. Being ill can raise blood sugar levels to 'diabetic' levels. I'd assume lack of B12 could result in high blood sugars as well.
I have type 2 diabetes and have been looking into the factors 🙂
Thank you for your reply. I'm inclined to agree. Have looked into it in detail now. Anemia can cause glucose to stay on red blood cells/platelets (unsure which) because their renewal is apparently less frequent in people with anemia they have longer to build up. However bottom line is - overweight/too much sugars - loose weight/reduce sugars intake.
Just another thing to add to the 'worrying about' list for us.
X
I am not and never was overweight, or eating too much sugar. That idea in general was debunked over a decade ago. People who eat healthily and get plenty or exercise get diabetes. It it was anything to do with diet/lifestyle, then why doesn't changing diet/lifestyle prevent or reverse the diabetes?
I know two women who are clinically speaking morbidly obese and sedentary, neither of them have diabetes, or high cholesterol, or any other such issues.
I also know a woman who's skinny AF, has high cholesterol.
And a woman who was told she was prediabetic, started going on 5 mile walks every day, cut 'all' sugar out of her diet. Now has diabetes and is very ill with it.
This is interesting because my A1c levels were also raised (slightly above range) and I got the pre-diabetic letter thing even though I had none of the 'risk factors': not overweight, ate a healthy and varied diet and hiked miles every week. I also had raised cortisol.
Here's a recently (2022) paper about b12 deficiency anemia causing falsely elevated HbA1c.
Conclusion: Elimination of vitamin B12 deficiency anemia before making a diagnosis or treatment decision according to HbA1c level will prevent patients from misdiagnosis of diabetes and unnecessary treatment changes in diabetic patients.
pubmed.ncbi.nlm.nih.gov/364...
Hi PalmierThanks for that article link. I had read this but know my GP will say, Ah but you are not b12 deficient now with my last b12 levels at over 1000 following frequent injections. The study was on b12 deficient people before treatment I believe. But then it raises the issue of. Do these b12 level test really test levels of b12 actually utilised by the body following treatment .
Im very confused!
Once again thanks.
The paper seems to relate HbA1c more to haemoglobin than to b12, so maybe check what your Hb was at the time of the HbA1c test? B12 deficiency can of course lead to anemia, but many factors affect Hb. I get the impression from the paper that the lower the Hb, the more glucose per Hb molecule, and therefore a higher HbA1c. As if it's the glucose/Hb ratio that matter. But I don't know.
Thanks will have a look. Not much'out there' on the topic but interesting. Trouble is many GPS take a 1 cap fits all approach.
Yes, GPs have that approach because they are not educated to find root cause of anything. They treat symptoms, that's what they're trained to do in Med School. Med School both here and in UK curriculum is heavily influenced by the Pharmaceutical Industry. Hence, Oh you have a high A1c, diagnosis: type 2 diabetes; Treatment, prescriptive meds. There that GP visit only took 10 minutes! problem solved! You're in, you're out, your GP didn't even get to know your name and if he did he does not remember it once you left his/her office because they are immediately on to their next 10 minute patient visit. ☺️
We don't even get a visit now, 10minutes telephone and they only deal with o e issue. What happened to the holistic approach?
I believe that if you would lose a few kilos , your high sugar level would disappear. I speak from personal experience . You probably don’t want to hear this ( I know that I didn’t ) I was only a few kilos overweight and lost them . It worked !
Best wishes .
Thanks Wedgewood.
Nobody wants to here that but you are of course right :-))
Im just trying to avoid the dreaded Metmormin! Yes those 6kg plus have got to go. :-(. It's just galling when you're as active as I am already.
Nothing to do with the cake biscuits and chocolate I eat of course!
But I do think this issue as to whether Anemia affects Hba1c levels deserves further investigation.
Phd anyone??
After eliminating as much sugar as possible , after a few weeks I began to dislike sugary foods . High glycaemic foods need to be avoided also . I endeavour to avoid all white wheat flour . I now eat whole rye bread instead ( takes some getting used to ! ) No wheat pasta etc . It is doable !
Yes you want to avoid becoming diabetic at all costs . It affects all your organs . Best of luck .
Many thanks Wedgewood 😁
I was diabetic before my P.A. diagnosis and can't say that B12 jabs made any difference to my HbA1c levels at all. I'm a skinny bird and my weight hasn't changed, so maybe that's the difference? I'm the same weight as I was in my teens and I'm now 60. Maybe the confusion is that weight gain can increase A1c levels and maybe the B12 symptoms coincided with weight gain? Just a thought, but I could be wrong.
There are some results about vitamin D supplementation lowering HbA1c. That could be something to look into.
Excellent question! Yes, Megaloblastic Anemia caused by B12 deficiency will cause your A1c to be elevated. It's completely counter intuitive as one would think that fewer and deformed red blood cells would carry less sugar. But they also carry less oxygen and as your cells are starving for oxygen your energy correspondingly is sapped to the point in my case with severe B12 deficiency of 70 pg/mL I didn't realize it but I was eating hoards of sugar months leading up to my diagnosis. I craved anything with sugar! I began eating bags of candy, drinking sugary sodas, energy drinks, you name it. When I had my first blood test that show my B12 was at 70 pg/mL my A1c was 9.5. I was diagnosed with B12 deficiency and Type 2 Diabetes. I was prescribed oral medication for the diabetes but an interesting thing happened as my B12 injections continued and the Anemia was resolved my A1c kept dropping. Now some of that of course was due to the diabetes meds. But the thing is my blood sugar ended up dropping too low where I was getting dizzy and almost passing out. My prescription? stope the diabetes meds and eat and ice cream! For a year my A1c was perfect between 5.1 and 5.6. Until January 2023 when I crashed with iron deficiency. Again I began craving anything foods that would give me energy of course mostly sugar laden foods or sugar itself anything to boost my energy. But again iron deficiency for a different reasons causes too few red blood cells and less oxygen to your cells. Your body has a marvelous coping mechanism called cravings to deal with this. So the blood test results for iron deficiency also showed an elevated A1c of 7.8.
I've since read that there is a correlation between anemia and type 2 diabetes. I personally think it's really not type 2 diabetes but rather just your cells screaming for energy and your body responding with cravings of sugar.
I've now had 7 iron infusion IVs since February 2023 and watching my A1c slowly go back to normal.
Please note that there is a condition called Iron Deficiency Without Anemia (IDWA).
Hope this helps some, Rexz
Sorry, I mention a B12 level of 70 pg/mL in my response it should have been 70 pmol/L
Thanks RexzWhat you say rings lots of bells here. I certainly won't be taking Metformin. It depletes B12.
Im cutting out the sugars and refined flour etc if for no other reason than they're not good for the body and I carry some extra Kgs anyway.
Dont suppose my GP will have any idea about all this!
X
Haha, Nope your GP will most likely not know that. It's really not their fault it's just they haven't been taught about these things. Regarding Metformin...it actually does not "deplete" B12 but rather inhibits or blocks its absorption. So if you've been diagnosed with PA, you already have the malabsorption issue, and you're receiving B12 via injections then it should be OK to take Metformin. Now Nitrous Oxide does deplete B12 in your system. Si if you ever have surgery or endoscopy/Gastroscopy anything that requires anasthesia make sure they understand to NOT use Nitroues Oxide. There are alternatives so it's no problem for them they just need to know.
I too have cut out all sugar, gluten, dairy, caffeine, and significantly reduced salt. No gluten was, and still is, the hardest as I'm a bread lover and gluten free breads just are not the same!
Best wishes, Rexz
Drug safety update June 2022 on GOV.UK advises that B12 def is a common side effect of Metformin , severity and damage done increases with dosage and duration of treatment . Patient information leaflets are being updated and new advice is being given to GP's for monitoring patients at risk
Thank you for those details I shall certainly make a note as may need to refer to the update, hopefully not.
Polo22, Yes, this safety issue regarding Metformin is 100% correct. However, metformin blocks absorption of B12 not harms or destroys it. So, if you have PA with no Intrinsic factor you already cannot absorb B12 in the terminal ileum. Therefore, Metformin will have no impact on your B12 since with injections you are bypassing that whole absorption process anyway.
Yes it is 100% correct, considering most GP's seem to deny the existence of B12 deficiency, and even those diagnosed with PA fail to get the appropriate lifetime treatment they need, Any improvement in guidance to GP's to raise awareness of the need to monitor patients for B12 def and appropriate treatments is to be welcomed. So the point is mute, many with B12 def do not receive injections, and B12 def PA or otherwise is routinely dismissed by medics so awareness of the seriousness of this def and need for monitoring is hopefully going to improve the situation for many.
7! Having my 1st one next week 🥳
7 Yes, and I have one more scheduled week after next. There's nothing I'd rather do than get stabbed!!!! 🙄😆
Wow 7! Do you think that once your iron levels are stable, you'll be able to keep levels up by taking something that increases stomach acid plus iron supplements? Or is there more to it, e.g. small intestine also affected, causing malabsorption?
My iron has recently fallen more than I realized and I've always had trouble keeping it up, though in my case supplements do work - I just have to remember to take them LOL.
Yeah, 7 ouch! Because unlike B12, too much iron can be toxic and deadly even, so with iron they bring levels up slowly. I had four infusions then they wait a week and test for levels. Then four more. Supplements for me don't work as I cannot absorb iron. I think is because I have zero stomach acid. I do take Betaine HCL and digestive enzymes before each meal but I'm not sure that the plant based HCL is the same as natural gastric HCL. Although it does help me mightily with my digestion. The plan going forward forever is my iron levels will be tested every three months and if Ferritin drops below 100 ng/mL i'll have another iron infusion to bring it back up.
Anyone with AMAG should watch their Ferritin levels and track it over time. When it drops below 100 ng/mL then you are most likely deficient even though your hemoglobin is within normal range.
Iron malabsorption is a not so uncommon problem with AMAG/PA.
Yes indeed iron can be toxic. Sounds like they have a good plan in place!
And I definitely agree with this: "Iron malabsorption is a not so uncommon problem with AMAG/PA. "
Have you tried lime juice? I used Betaine HCl for years but at some point they stopped working - digestion remained sluggish no matter how much I took. I switched to lime juice and immediately noticed an improvement in digestion. Just a thought.
I had not considered lime juice. I will give that a try... just drink some before a meal?
I've always been worried about Betaine HCI and how it differs from actual gastric acid. Betaine is a plant based acid. There are differences I've just not been able to find any paper that definitively describes that.
I recently measured it out - I take 1/4 cup lime juice in 1 cup water, using baking cup measurements. Sometimes I take double that if it's a high protein/fat meal. I actually have a squeeze bottle and just give it a big squeeze, and make sure it tastes tart enough 😅
You might want to start on a lower amount and see how that works out.
I sip it during the meal. I tried taking it right before a meal but then it just upset/burned my stomach.
I've never actually investigated the workings of betaine hcl but what you describe also makes me wonder.
here's the link gov.uk/drug-safety-update/m...
Diet related b12 deficiency 
With normal levels of b12 can you still be deficient 
How long will it take for the B12 jab to work
Functional vitB12 deficiency - anyone else?
I’m confused if I have a deficiency or not?
