B12 levels

[Sheryl5013]

Hi all

I’m trying to find out if my vitamin B12 is ok at 378ngl?

Dr say it’s normal level but I’m going through menopause and feel it’s on low side

Thanks in advance 😊

[Fruitandnutcase]

What is the lab range?

My B12 most recent result is 128 with a lab range of 37.5 - 150 to me that’s an enormous range so I would want to be near the top of the range.

[SeasideSusie Remembering in reply to Fruitandnutcase]

Fruitandnutcase

Yours is Active B12 with the narrower range, that test measures only the active/free B12 that's available to the cells. Sheryl's test is Total B12 with a much wider range, it measures the total of both bound and free B12 but you are correct in that her level should be nearer the top of the range.

[Sheryl5013 in reply to Fruitandnutcase]

The range for total is 200-900 in my lab….so definitely in lower end😊

[Fruitandnutcase in reply to Sheryl5013]

You definitely are. Hopefully it shouldn’t take you too long to boost it.

[SeasideSusie Remembering]

Sheryl5013

Of course your doctor will say it's normal, it's within the range and that's all they care about, they have no concept of what's optimal.

According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml (or ng/L, they're both the same) to at least 450 pg/ml or ng/L because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml or ng/L."

So even though you haven't given the range you can see that it is low.

Some people with a B12 level in the 300s have been found to need B12 injections. It's all about symptoms, not numbers, with B12. Do you have any signs of B12 deficiency – check here:

b12deficiency.info/signs-an...

b12d.org/submit/document?id=46

If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results and if you have B12 deficiency and it is not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.

If you don't, and you want to improve your level, then you could consider taking a sublingual methylcobalamin B12 1,000mcg supplement along with a good quality B Complex to keep all the B vitamins balanced. One bottle of B12 will probably be enough to bring your level up to 550 and then you could just continue with the B Complex.

Suggestions for supplements:

B12: Cytoplan is a good one as it contains two forms of bioavailable B12 cytoplan.co.uk/vitamin-b12-...

B Complex: Thorne Basic B or this liposomal one from Amazon is very similar and a bit more budget friendly amazon.co.uk/Yipmai-Liposom...?

When taking B Complex we should leave it off for 3-7 days before any blood test as it contains biotin and this causes false results with any blood test.

[Sheryl5013 in reply to SeasideSusie]

my dr has said my results are normal so won’t do anything but I’ve been fed rubbish for months general aches and pains,permanent dizziness and ear problems at moment so they have referred me to ENT ..I was wondering if my B12 could be to blame as most of the women in my family need b12 injections..I just blame everything on low oestrogen😂

[SeasideSusie Remembering in reply to Sheryl5013]

Is there pernicious anaemia in the family, which is usually what B12 injections are given for I believe?

You have Graves which is an autoimmune condition. PA is autoimmune. It's not uncommon when you have one autoimmune condition to develop another.

Did you check the signs and symptoms of B12 deficiency? They should take precedence over numbers so if you have any you meed to push for further testing.

[Sheryl5013 in reply to SeasideSusie]

I have a few of the symptoms but Dr said there was no anemia as other blood results were fine..no PA but I do have Graves and psoriasis.😊

[SeasideSusie Remembering in reply to Sheryl5013]

OK so what sort of "anaemia" is the doctor talking about? Let's see these other results, with their reference ranges,.to try and understand a bit more.

[Sheryl5013 in reply to SeasideSusie]

It was a cbc so size of red cells etc and platelets were all in normal range😊

[SeasideSusie Remembering in reply to Sheryl5013]

What were results/ranges for MCV and MCH?

[Sheryl5013 in reply to SeasideSusie]

MCV was 83.5 fl range 75-105

MCH was 28.9 pg range 26-35

[SeasideSusie Remembering in reply to Sheryl5013]

OK, so I would try supplementing as outlined above with B12 and B Complex.

[Sheryl5013 in reply to SeasideSusie]

so both a B12 and b complex?

[Sheryl5013 in reply to Sheryl5013]

I did look at a spray which was 1200 mg but thought that might be too much..?

[SeasideSusie Remembering in reply to Sheryl5013]

I did look at a spray which was 1200 mg but thought that might be too much..?

B12 supplements come in mcg not mg. I suggested a B12 1,000mcg supplement above, that is not a high dose (you can get 5,000mcg) but should be adequate for your needs.

[SeasideSusie Remembering in reply to Sheryl5013]

so both a B12 and b complex?

Yes, I explained why both are needed above.

[Sheryl5013 in reply to SeasideSusie]

will look at those.. thank you for your help😊

[bookish in reply to Sheryl5013]

Just be aware that you do not need enlarged red blood cells to be B12 deficient, nor do you need to be anaemic. B12 testing is far from ideal and there is no test which can rule out a deficiency. B12 and folate processing is strongly genetic, so if you do have PA in the family (or a functional B12 problem other than PA) you may well already have, or end up with, the same. If at all possible, do some more testing before you start taking supplemental B12 or folate/folic. If it is PA in family, you could tell your doctor that it runs in the family and ask for anti-intrinsic factor antibodies, gastric parietal cell antibodies, homocysteine and MMA (methylmalonic acid) to be tested. You may need genetic testing (that is where I'm at). From this ncbi.nlm.nih.gov/pmc/articl... it looks as if asking for homocysteine to be tested in view of the psoriasis would be a perfectly reasonable request anyway, and B12/folate might be a sensible treatment. (One more note, doctors don't seem to distinguish between vitamers - ie types of vitamins. Folate can be as folate (methyl(tetrahydro)folate) or folic acid or folinic acid. Some do better with one than another. Folic is the common one and did nothing for me, but I improved noticeably with a small amount of methylfolate. Don't let anyone give you large amounts of folic acid until you've got to the bottom of your B12 problem (which may take some persistence) as it can make the whole issue a lot worse.) Best wishes

[SlowDragon Administrator]

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

What were folate, ferritin and Vitamin D results

[Sheryl5013 in reply to SlowDragon]

my total vitamin D was 78 nmol

Serum folate was 5.3 ugl

Ferritin was 44 ugl

[SlowDragon Administrator in reply to Sheryl5013]

Folate and ferritin both very low

Vitamin D might be better nearer 100nmol

How much vitamin D are you taking

Low B12 symptoms 

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and add a separate vitamin B Complex after a week 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week 

B12 drops 

natureprovides.com/products...

Or

B12 sublingual lozenges 

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid 

healthline.com/nutrition/fo...

Do you have Hashimoto’s

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay 

Other options 

healthunlocked.com/thyroidu....

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12

[SlowDragon Administrator]

low ferritin

Look at increasing iron rich foods in diet 

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin 

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Effective supplement 

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin 

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Excellent article on iron and thyroid 

cambridge.org/core/journals...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron 

healthline.com/nutrition/he...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Ferritin over 100 to alleviate symptoms 

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary 

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

Low Iron implicated in hypothyroidism 

healthunlocked.com/thyroidu...

Ferritin range on Medichecks 

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes: 

Males 16-60: 30-400 ug/L

Female's: 16-60: 30-150

Both >60: 30-650 

The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘

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

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron 

Medichecks iron panel test 

medichecks.com/products/iro...

[Sheryl5013 in reply to SlowDragon]

Thank you for all the information.I’ve just ordered a medicheck thyroid function test that includes some vitamins for up to date results and will start to take a B12 once test is done😊