In 2021 my 15 yr old daughter had symptoms of B12 deficiency (sleeping too much, poor appetite, exhausted in sport, depressed, moody) so I had her blood tested privately via online company and the Active B12 results were low normal (against adult ref ranges) so we had the recommended MMA which was high (also against adult ref ranges). The IF antibody test was ‘normal’. We took these results to the GP who had never heard of any of these tests and just recommended a supplement and improving her diet (doesn’t eat much meat).
Active B12: 44 pmol/L (25.1 - 165)
MMA: 35.5 ug/l (<32)
IFA: 0.99 AU/mL (<1.2)
Folate: 4.3 ug/L (>2.9)
MCV: 96.7 fL (80 - 99)
MCH: 31.5 (26 – 33.5)
Haematocrit: 0.436 (0.33 – 0.45)
After much reading, I bought Methylcobalamin sublingual drops. We managed to increase her levels into the normal range although this took several months. She was a different child. Not maintained so well the past 3-4 months and now symptoms have returned.
My daughter is now 17 and an athlete on a British programme, so tested for banned drugs randomly. B12 isn’t an issue for doping control unless high doses intravenously, so I’m not worried about that. I haven’t retested because it will mean coming off supplements and she needs to get her levels up asap as it’s affecting her performance massively. I am paying for private injections now for Hydroxocobalamin (only every few weeks though) along with the sublingual drops. I suspect this will take 4-6 weeks to improve her levels. How can I get her GP to recognise this properly and offer injections so that it is formally recorded on her medical file for her competing or at least recognise it and I pay privately for injections? The NHS seem to be removing these injections going forward anyway.
Thank you for any advice.
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srf831
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Now having b12 she can safely take 400mcg folic acid daily a recommended on NHS website for women of child bearing age.I realise she is young but if menstrating fits this criteria.
Hoping your G.p gets on board and engages with your daughter
I'm not really sure how testing would work out if she is on injections - any test may well show levels off the measurable scale but...
Have you thought about consulting a specialist nutritionist?
Not eating much meat may not be the issue if she had a good diet and was getting plenty of protein from other animal products - such as fish, eggs, cheese - if the GP only mentioned meat then it may be worth going back over that.
It may also be worth retesting IFAB - it's not a sensitive test and is prone though it is unlikely to give false positives (unless done too close to an injection).
Good luck in dealing with GP - may be worth pointing them at the area of the PAS website aimed at helping medical professionals improve the diagnosis and treatment of PA
Since your daughter is an athlete I would highly recommend working with a sports nutritionist. I would be careful not to assume a B12 issue purely based on symptoms when there are high metabolic demands for athletes and proper nutrition is of great importance and can be a challenge.
Not eating much meat is not an issue provided the nutritional contribution often provided from meat is accounted for. These are specifically:
(1) B12 : Unless absorption issues are present, a moderate 50-100mcg daily supplement would be adequate for maintenance. Many vegetarians get by without any B12 supplementation but this is a good precautionary approach, just in case.
(2) Protein :Of crucial importance for athletes of course but its important to ensure a high protein food at every meal for any athlete. In terms of plant-based foods this would include legumes (beans, lentils), seitan, soya based foods like unsweetened soya milk, tofu etc. Protein powder may be useful if legumes are an issue for whatever reason, or where more convenient but shouldnt be relied on solely.
(3) Omega 3's : If oily fish are not eaten regularly, ensure a source of ALA (2 tablespoons broken/ground flax seeds daily) and perhaps an algal EPA/DHA supplement, of at least 400mg DHA.
(3) Iron : Often an issue for athletes due to sweat losses, and there are higher requirements for menstruating women. Legumes/Lentils are key here again, onions, garlic and beta-carotene (orange foods) eaten at the same meal help absorption. Check iron status with a full iron panel. If enough cannot be obtained from diet, consider moderate alternate day supplementation but only if absolutely required since iron can be inflammatory and exacerbate any gut issues.
(4) Zinc : Can be slightly lower on vegetarian diets, check intake with the "cronometer" app and increase higher zinc foods or take a moderate dose supplement under 10mg.
If she does not consume much dairy I would also look at Calcium and Iodine intakes and possibly Selenium.
These are broad strokes and a registered dietician or qualified nutritionist may have some more specific recommendations once they have the full picture.
The following page is on vegan nutrition, not vegetarian, but may give some ideas on whether there is a shortfall somewhere:
Even if you only track a day or two, it can pay off big time in just getting an idea whether requirements are being met or not and by how much.
A registered dietician will be able to give much better tailored advice. Beware of nutrition advice from doctors, its not a subject they receive much training in and getting some reflexive advice to "eat more meat" tells me that this doctor likely does not have much of a clue about health or nutrition, which is fairly common (unfortunately).
Beware of the use of the term 'Nutritionist'. It's not [as far as I'm aware] a protected title although the individual may well be highly qualified and experienced. 'Dietitian' is a protected title, and to use the term the individual must be qualified and registered with the HCPC.
Links to forum threads where I left detailed replies with lots of B12 deficiency info eg causes and symptoms, UK B12 documents, B12 books, B12 films, B12 websites and B12 articles and a few hints on dealing with unhelpful GPs.
Some links may have details that could be upsetting.
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Anyone able to help me with latest Haematology results ? 
Stupid Question alert. Serum B12 or Active B12. What are the Uk ?normal ranges. 
MMA & B12 Results
Help with diagnosis?
High B12 whit high MMA whit no supplementation
