VitaminB12

[Thelostboys]

Hi can you please help my Dr says i don’t need to take extra vitamin B12 as my test has come back normal. I have read on this site that everyone takes it i don’t know what to do now.

[FallingInReverse]

Please provide exact result and range!

[helvella Administrator]

Number one - don't worry.

Number two - I don't think I can remember anyone having a problem from taking a B12 supplement. Some feel one form is slightly different to another.

Number three - maybe taking the words too literally, but "don't need" is in another universe to "should not" or "must not".

Number four - a test done after you have been supplementing says nothing about what your level of B12 would be if you stop supplementing.

I am generally somewhat sceptical of most supplements, and especially the doses that there can be in many products. Sometimes too low to stand any chance of helping anything. Or so high that adverse reactions/side effects are too likely. But for B12, even the official medical people say take 50 micrograms if you are a vegetarian or vegan or otherwise have limited B12 in your diet. (Given our actual requirements are almost certainly under 5 micrograms.)

A huge part of B12 is absorption. And no matter how high the dose, we tend to only absorb a small proportion.

And as we age, our ability to absorb B12 tends to reduce. People who have been fine for decades can slowly move into the arena of being a bit low, then deficient.

I suspect that we are more likely to have an issue from the excipients used to make B12 supplements than the actual B12 itself.

I take quite high dose B12 every day. I know my Active B12 level is currently at or above the top of the reference interval. But I'm not going to stop because of that!

[Thelostboys in reply to helvella]

Thank you for replying the other problem is i have been put on antidepressants and i have read B12 helps with absorption. I don’t take them at the same time as my levothyroxine so i think they could help with both situations ⭐️

[helvella Administrator in reply to Thelostboys]

I know nothing about B12 helping with absorption of anything else!

If you find that again, please let us know!

[SlowDragon Administrator in reply to Thelostboys]

Depression is a hypo symptom…..hardly surprising you are feeling down, felt inappropriately on only 50mcg Levo

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

markvanderpump.co.uk/blog/p...

markvanderpump.co.uk/blog/p...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like calcium, magnesium, HRT, omeprazole, iron or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

Iron at least 2 hours away from all supplements apart from vitamin C.

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Post about Timings

healthunlocked.com/thyroidu...

Good vitamin levels essential to improve uptake and conversion of Levo

Low vitamin levels tend to lower TSH making it harder to get GP to increase Levo dose

most importantly you need to be on high enough dose levothyroxine …….push for next 25mcg dose increase to 75mcg daily

[Thelostboys in reply to SlowDragon]

Thank you such a tiny tablet but what a lot of confusion it causes 🤣

[SlowDragon Administrator in reply to Thelostboys]

Levothyroxine doesn’t “top up” your own thyroid

As soon as we start on levothyroxine…..TSH reduces….the message to make thyroid hormones…..and our own thyroid starts to produce less hormone

That’s why almost everyone, eventually ends up on something around the full replacement dose of levothyroxine …..approx 1.6mcg per kilo per day

Some need a little less…..some need a slightly higher dose

Dose levothyroxine is increased SLOWLY upwards in 25mcg steps…..retesting 2-3 months after dose increases

Essential to maintain GOOD vitamin levels

[SlowDragon Administrator]

previous post

healthunlocked.com/thyroidu...

GP only obliged to treat vitamin deficiency

B12 was very low …..but (just) within range

Have you started supplementing a daily B12

If not …..start now

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

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

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

In-depth article on different forms of B12

perniciousanemia.org/b12/fo...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

perniciousanemia.org/b12/le...

And why aiming to keep B12 over 500 recommended

perniciousanemia.org/b12/le...

Great reply by @humanbean on B12 here

healthunlocked.com/thyroidu...

[Thelostboys in reply to SlowDragon]

Thank you i will take a look at it ⭐️

[SlowDragon Administrator]

are you still taking a prescription folic acid supplement

Once you finish folic acid on prescription

Start taking a separate vitamin B Complex 

Retest B12 and folate in 2 months

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

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...

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

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose and may need separate methyl folate couple times a week

Post discussing different B complex

healthunlocked.com/thyroidu...

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

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 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 folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 until high enough

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

[Thelostboys in reply to SlowDragon]

Hi yes i am still taking them and iron tbs as well i have another two months of them .

[SlowDragon Administrator]

have you had dose increased in Levo yet to 75mcg

Retest thyroid and vitamin levels 2-3 months after increasing levothyroxine

[Thelostboys]

No i am still on 50mg but i told my doctor that i needed a check up every 3month and he wrote it down on my notes. Because the last time i only had one retest.

[SlowDragon Administrator in reply to Thelostboys]

You need to

A) start daily B12 now

B) get TSH, Ft4 and Ft3 tested

Request GP retest or test privately

Book early morning test

50mcg is only standard STARTER dose levothyroxine

Vitamin levels low BECAUSE of being left on too low a dose of levothyroxine

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Lots of BLACK FRIDAY offers around

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Monitor My Health (NHS private test service) offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Approx how much do you weigh in kilo

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

nhs.uk/medicines/levothyrox...

Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.

Some people need a bit less than guidelines, some a bit more

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

sciencedirect.com/science/a...

The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg.

[Thelostboys in reply to SlowDragon]

Thank You ⭐️

[helvella Administrator]

I wouldn't touch them.

Do you actually WANT to consume:

Thickener, Bacopa Monnieri Extract, Curcumin, Sweeteners, Flavouring (Orange), Emulsifier, Vitamin B12, Acidity Regulator, Folic Acid, Flavouring (Menthol)

Never heard of Bacopa Monnieri Extract.

No idea which sweeteners.

No idea what the flavouring is - obviously not just orange otherwise they'd claim so.

No idea which emulsifier.

No idea which acidity regulator.

No idea how much folic acid - and do you want to take it?

Expensive. About a gross of pounds a year. And very questionable statements/claims.

[helvella Administrator]

‼️‼️‼️‼️‼️

Contraindications

Bacopa monnieri may inhibit the acetylcholinesterase enzyme, which may result in increased acetylcholine levels. As a result, Bacopa could counteract the effects of anticholinergic drugs and may worsen bradycardia and exacerbate conditions such as gastrointestinal obstruction, peptic ulcer disease, pulmonary conditions such as asthma, and chronic obstructive pulmonary disease or urogenital tract obstruction.

Bacopa has been shown to inhibit human cytochrome P450 enzymes which could contribute to herb-drug interactions when co-administered orally with medications metabolized by CYP1A2, CYP2C9, CYP3A4, and CYP2C19. ‼️Animal research suggests Bacopa may increase thyroxine levels (T4) in mice by about 40%. It should be used cautiously (or avoided) in those with a thyroid condition or who take thyroid hormone medications.‼️

ncbi.nlm.nih.gov/books/NBK5...