Please could someone confirm the benefits of a B12 injection v taking a supplement? Are we just talking about larger doses and / or ability to avoid the stomach and increase absorption?
Is availability of B12 injection really restricted on the NHS?
If I decide to go down the chemist route, do I need to request a certain type? Any recommendations?
How do people supplement - should I combine a regular injection with daily B supplements? Some posts seem to reference monthly, quarterly injections etc. but I am not sure how people decide how often to have a shot.
Thanks for the advice.
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N5girl
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First we need to find out what our levels are for several vitamins - ferritin, folate, B12 & D3.
Before trying to work out what you might benefit from you need to know your blood numbers and how much of each you need.
Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/testing/priva...
There is also a new company offering walk in& mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...
Only do private tests on a Monday or Tuesday to avoid postal delays.
Unless you have pernicious anaemia and issues aborbing B12 a good quality methyl high dose supplement is uually plenty. This group usually recommends a B complex to help keep all the B vitamins in balance as they work together.
Its recommended to take separate supplements that are better quality with active ingredients rather than a multi which tend to have lower doses of what we need. Also, multis contain iodine and iron which isnt a good idea to mix with other vitamins.
Are you vegan or vegetarian? If not:
B12 - do you have symptoms of B12 deficiency? The reference range for B12 is very wide and cut off point too low. theb12society.com/signs-and...
If you do then you should discuss this with your doctor for further tests for Pernicious Anaemia.
If not, then start with a methyl B12 sublingual spray or lozenge for a week, then add a good B complex. Once you run out of the separate B12 just continue with the B complex.
Thanks - this is v helpful. I had not seen the B recommendations despite having read a lot of posts over the last few days.
Ferritin - 81
Vit D - 48 - endo has put me on a six-week course to boost it.
Folate - not mentioned in consultant’s letter . I will ask for a test
Calcium -2.34
Endo only mentioned Vit D as an issue. Yes, I do have some of the b12 symptoms on that list BUT it is a big wide list. I will raise it with my Endo but i assume treatment is with b12 anyway?
Ferritin should be around 90 - 100 for best use of thyroid hormone. Suggest increasing iron rich foods in diet and eating them often. Chicken livers, pate, red meat etc
GlobForte available at Victoria Health are fantastic high quality Iron with very good tolerance and absorption, if anaemic then two capsules daily for 3 months is what I take to restore a perfect blood count of Iron. I guess one capsule would be a sufficient supplement if not too low.
If you can absorb B12, there is not usually a reason to go for injections. They are relatively expensive, uncomfortable and require a prescription in the UK. However, a few people who are seriously low on B12 sometimes get one or more injections to begin with.
B12 isn't absorbed in the stomach - but closer to the terminal ileum.
There are several reasons that this route might not be effective:
● Pernicious Anaemia in which the stomach produces no Intrinsic Factor - which is vital to proper absorption.
● Lacking part of the intestine where the terminal ileum would usually be - for example after an operation.
Individual ampoules are not that hugely expensive (around a pound each) but you have to buy them from abroad (typically Germany). Plus syringes and needles. And if you really need them, you could need one a day, or every other day.
And you need to do them yourself - or maybe a friend or family member would do them?
Commercial rate for B12 injections is far more expensive. Cheapest I know of is £29 and some are much more.
There are many different formulations of B12. I currently have some cherry-flavoured ones that are supposedly sublingual. However, I'm not entirely convinced they don't just dissolve and get swallowed. Though they do taste nice.
You ain't kidding, I'm no wuss, a lifetime of blood tests and injections for various things over the years means I'm pretty resilient but I hate having B12 jabs, they are very uncomfortable and sting.
Its not the needle going in, its the fluid going into the muscle. It doesnt matter if they do it fast or slow. I'm not the only one who thinks so 😫
Just to say I dont want to appear ungrateful. I appreciate I'm lucky to get jabs on the NHS, when a lot of people cant, I just dont enjoy the process.
A lot of people who administer their own injections use an auto-injector. Good for the needle averse and the needle doesn't have to go into muscle, it can be a sub cutaneous jab.
I've bought mine, now waiting for a ferritin test on monday to see if it's high enough to start 🤞🏻My friend has PA and she uses an auto injector just fine despite being pretty needle phobic, that's what convinced me to give it a go!
Hi Sparklingsunshine, I'm a real needle phobe and yet I'm good with the B12 ! If you ask them to inject it real fast instead of slow as they usually do, it doesn't hurt..just an initial dull quick wee sting..
As I said I have Fibro so process pain differently to other people. I dont have any trouble with blood tests or vaccinations. Just B12 and also the rhesus factor jab they give you after having a baby if you have rhesus negative blood.
If you do your own injections it doesn't hurt like the ones they give at the surgery, I hardly feel the liquid going in, most times not at all. I occasionally get one at the surgery that is fine, but mostly they hurt!
I'm glad its not just me lol. I dont consider I'm cowardly with pain, I walked around for 4 days with acute appendicitis before it dawned on me it wasnt just a stomach upset. There is just something about the B12 shots that make them really sting.
Yes, and sometimes the pain shoots right down my arm! I tell them not to do it slowly as it's worse, but some of them say they weren't trained that way. I inject slowly in my leg (alternate top and side of thighs) and it's fine mostly .They all ought to have a B12 shot to see what it's like!
Some people have problems absorbing B12 from pills because they lack intrinsic factor (or have very low levels of it). This is known as Pernicious Anaemia (PA).
I don't have PA but I think I have Functional B12 Deficiency i.e. I absorb B12 from pills but my body has problems making use of it. I deal with this by supplementing with only the active forms of B12 (in pill form) which are methylcobalamin and adenosylcobalamin. (I use methylcobalamin most of the time and adenosylcobalamin occasionally.) When I supplement I do so with pills in a dose of 1000 micrograms per pill.
When I started doing this I got rid of about 95% of my eczema for the first time in 40 or 50 years. Also I got rid of my "teenage" spots for the first time in about 40 years.
I have recently become lax about taking my supplements and my eczema has come back for the first time in quite a few years.
Note that for the body to make use of B12 you must have good levels of folate too, but B12 must always be supplemented first for a week or so, before adding in folate supplements if you need them (but keep taking the B12).
I can vouch for the siblingual nature provides bioactive B12 3000mcg. Works well for me. I know when my levels are pretty high when my excess is excreted in urine and it changes colour
If the nhs deem that you are low in b12 they will offer you injection. The reason injection is better that supplements is that it avoids problems with intrinsic factor. The stomach contains intrinsic factor which enables you to absorb b12. If you lack intrinsic factor then that is probably the reason you have low b12. You could try taking methylcobalamin liquid b12 orally at a high dose of 1000 - 5000mcg every few days but it still may not be absorbed. You may have watermelon stomach or some other impairment.
Consider if you do have an impaired ability to absorb b12, that will explain a lot of fatigue, and cascade of other problems, compounding hypothyroid.
The problem is that the NHS do not have a consistent approach to diagnosing anything as straight forward as B12d. Neither my mother nor I weren't deemed B12d, but we are now both responding well to self treatment. I SI and mum uses sublingual.
The NHS now accept that I have a real problem, 2 years after telling me how low my level was in an appointment where I listed symptoms (again) that clearly pointed to a B12d issue. The treatment they offer is inadequate, so I continue to inject when I need to.
Thank god I found the PAS section on this website.
If your B12 is low you need to establish if you can the cause. Are you vegi or vegan, do you take proton pump inhibiters? Have you had any nitrous oxide? If there is no known cause then permicious anemia the likely culprit for which you will need injections.
I don’t think I am deficient - my most recent score was 324 based on diet alone. I get that I will feel better running at a higher level so I am happy to supplement as there isn’t any risk of overdoing it other than a lower bank balance.
The reason for the post was really to see if I could speed up the process by having a jab.
Do PPIs affect the absorption of B12? I suspect I’m deficient in irons…. and took 40mgs PPI per day for 5 months recently and wonder if this short, low dose could be the cause?
This was simply the first PIL I found, for the first PPI I thought of. I think you will find similar or identical warnings for many, possibly all, PPI products.
I suggest you look at the PIL for the product you were taking.
Thanks, it was Omeprazole. I suspect the 5 months I was taking it is considered a short time. Being veggie I try to eat iron rich foods to support my metabolism and have been reading here about supplements as also GP says I’m subclinical which simply means he’s not going to test or treat me. Thanks for the info
I find use of terms like "long" spectacularly unhelpful when used like that.
(Note that for frequency of side effects, they actually use numbers these days rather than "rare" and "uncommon".)
One month is a long time in someone who was on the edge of B12 insufficiency. A year might be a long time in someone who has plentiful B12 and a working entero-hepatic recirculation.
I'd regard five months as long-term. Indeed, I'd possibly start to think "long-term" as commencing when a second prescription or a repeat is required.
That’s interesting thanks for your reply. It’s difficult to know what’s short or long term when the PILs can be obtuse. Reading here I know I need to start with two B supplements and then stay on one if I am indeed in need of vit B. GP won’t test and from what I’ve read here private testing with results showing deficiencies does NOT guarantee GP acknowledgment, prescribing or support hence I’m trying to learn about supplements to support my body but golly it’s complicated .
I would suggest only having B12 injections if you cannot absorb it orally and I doubt a GP would prescribe it anyway. Why would you?
Injections are also limited and many people who rely on them find that they are not prescribed often enough and they feel rubbish prior to having the next one.
Check your diet for B12 and top up with supplements if needed first.
From experience unless you’re deficient or have underlying conditions that warrant injections you won’t get B12 injection which are commonly every 12wks but you can get more often in certain circumstances.
My elderly mum had been under range for sometime and given her age 83 and she definitely had symptoms, along with family history of pernicious anemia but was at least 6 months they left her until my sister and myself (who have pernicious anemia) waded in to argue her case quite appalling she is much brighter now on them.
A friend of mine had watched her levels drop significantly and she put her case for needing them as she was on prescribed antacid medication another known med that can cause B12 problems.
If you have any absorption or digestion problems injections are probably best as anything taken orally might not actually do much, so if it’s only topping up I’d probably take orally and monitor if they are actually being absorbed if you have a clear case of digestive problems and your levels are dropping sharply ever 3 months or so, present that to your GP…,they will ask you regarding any symptoms so be ready to tell them your symptoms.
I didn’t go through any palaver initially as my levels were double figures and I didn’t even know I had such severe deficiencies due to mostly coeliac disease we think… I have other autoimmune conditions 🙄
Methyl types of B vitamins are best if taken orally…the injections I have are hydroxocobalamin given at my Drs surgery.
You normally get a loading doses of several injections over 2wks then it’s every 12wks.
I have B12 injections quarterly. B12 blood test is needed first but I see yours is low.
Mine tends to run at 700. The injections are freely available on NHS and they are not really painful. I have mine in upper arm.
Make sure if you are having bloods at the same time that the injection is given afterwards. Despite being told it would make no difference and it being given first, my B12 came back as 1476. Last blood test I had I made sure it was given after bloods taken and it came back as 700 ish.
Mine are given by nurse practitioner at my doctors so they sort the prescription. Can’t be doing with even more tablets so it’s easier for me.
As with so many things, we are all individuals with our own requirements.
B12 deficiency has been identified in some with a serum B12 of 500. While others seem fine much lower.
Remember, serum B12 includes B12 that is inactive. Hence the development of the Active B12 test. But, whilst probably better than serum B12, that too has not proved as good as hoped.
Deficient being below 200 is a grossly simplistic view but, unfortunately, all too common including within medicine.
If you had B12 test every day, and were not taking any, the result could vary substantially. Enough for you to be diagnosed one day and told all is well the next.
The ranges I have are that B12 should be between197 and 771. I feel much better at the higher end. I know when my B12 is low because it affects my vision!
Strangely I had visual field tests due to an eye disorder every 9 months. I lost the upper part of my vision and it was gradually getting worse. After I had started my B 12 injections I went for a visual fields test and then saw the consultant. She was puzzled and said they must be someone else’s, but they were mine. She said she couldn’t understand how my visual field was almost completely normal and asked if I had started any new medication. When I said B12 injections only she told me that she had 4 other patients who had the same problem and their vision improved after taking B12. She said it was something that ought to be researched and would ask her colleagues if they had patients with the same results.
I tend to have trouble seeing any words on the tv screen a few weeks before I am due my B12 injection. After B12 injections my vision improves and I feel so much better in myself. I really notice the difference. Yours is mid range but it’s better to be on the high side in my experience and not just for my thyroid.
Hello N5girl, I have a thyroid problem too , have had for years, about 2 years ago my Gp said he thought I would benefit from B12 jabs quarterly , I can't get anymore out of them as to why , but as I'm due for a jab soon , I'll ask again ,and I will be interested to see what replys you get , btw I'm also taking 200 mg iron supplements also from gp ,hope this help .
Unfortunately (or fortunately depending on how you view it), I don’t see a NHS GP - my employer provides a GP. I will have a chat with one of them on Monday to see if they recommend a regular jab to get my levels up immediately. They tend to be quite good at discussing a holistic approach.
I'd recommend that if you have symptoms of B12d , they could of course be thyroid symptoms, you take a look at the PAS section of this site. Tablets did nothing but increase my levels, so with the help of the PAS members I tried injecting. What a difference!
My B12 levels are almost certainly through the roof these days, (testing is pointless once injecting) but if I don't inject eod my symptoms start to come back.
Good luck
this wasn't meant to trivialise pain or discomfort, my daughter is a highly qualified vet, and autistic, is also hypersensitive to all the senses. I too have to have B12 shots every twelve weeks, but I'd rather put up with the discomfort than be constantly poorly.
And my point was that as someone with PA I dont get a choice, I have to have them, and I do, every 2 months. but the original poster N5girl was asking about whether she should get one as her B12 was on the low side, but not deficient.
And I pointed out that I find them painful, so if you can get by with tablets then give the jabs a miss. I wish I could manage without. Your intention may not have been to trivialise my experience, but unfortunately it came across that way.
Hello Sparkling sunshine I have to say your name sounds lovely , just what we all need now , but back to your comment , I also find B12 jabs painful , have been told relaxing my arm would help , but I find giving the injection site a good firm rub emediantly after really helps , might be worth a try , hope it helps .
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