Advice please x

[Nikki_55]

I have had low b12, ferritin and d3 before and it is low again now.Serum vit b12 187 range ( 197-771)

Serum folate 2.3 range ( >3 )

Serum ferritin 27 range ( 30-130)

Vit D 32 ( over 50 ) adequate level

I also have low serum inorganic phosphate... that is new to me.

My gp has given me d3 tablets and folic acid. He has put off addressing the b12 as he thinks it could be low due to the low folate... should i push the b12 or wait as adivised...

Any advice would be greatly appreciated

Thanks 😊

[Polaris]

It is very important that low B12 is addressed before folate is treated. Confirmed in Sally Pacholok’s book, ‘ Could it Be B12?”, or the film about her battle to have the effects of low vitamin B12 recognised again after William Murphy, George Minot and George Whipple won Nobel Prizes for their research work.

Note: edited by admin to remove off topic discussion of high dose vitamin D usage

[Polaris]

Suggest looking at the many links posted regularly by Sleepy Bunny and then writing to your GP as much less likely to be ignored.

Very best wishes for being heard but, don’t despair if not, as many of us have self treated with v. good results.

[Gambit62 Administrator]

Nikki_55 I have removed most of the comments on this thread relating to vitamin D as off topic for this forum.

People with B12 absorption problems often have problems with absorbing other micronutrients - particularly folate and iron.

As I understand it from what I see most people these days seem to be prone to vitamin D deficiency. I would advise that you speak to a dispensing pharmacist about what is and what isn't safe in relation to vitamin D. I believe too much vitamin D can cause problems with calcium absorption so I would be wary of any recommendations to take large doses of vitamin D unless they come from a suitably qualified medical professional.

I am not sure how low folate would cause low B12. It is more likely, providing that the folate deficiency isn't dietary, that it is an absorption problem which could well be something like low stomach acidity or gastritis which would also be an absorption problem for B12. To my knowledge folate is not something that affects absorption of B12 from food and into blood and its impact on circulating B12 levels in blood should be minimal. Folate is used together with B12 to ensure that a large number of cellular processes run efficiently but I think the effect of not having enough folate should be to raise serum B12 levels rather than surpress them.

I am adding a link to the guidance published by the British Committee for Standards in Haematology published several years ago but the only major update I am aware of has been to move the recommendation for frequency of maintenance treatment for patients who have B12 absorption problems but don't have neurological involvement from 3 monthly to 2-3monthly.

Important take aways are

a) that these emphasis that it is important to treat a potential B12 deficiency before treating a folate deficiency

b) using a single serum B12 measure to assess B12 deficiency is problematic.

In terms of clinical assessment one important issue would be the timing of symptoms developing. Folate deficiency symptoms overlap considerably with B12 symptoms but develop much more quickly (weeks as opposed to years). In reviewing this you need to think about all of the symptoms and go back quite a long time. Unfortunately they also overlap with a number of other conditions, and are associated with just getting older which can make them very difficult to identify

onlinelibrary.wiley.com/doi...