Hello, please could I get some advice on what b vitamins I should be taking?
I now know (thanks to this forum) that vitamins need to be optimal for thyroid function and my vit D and ferritin are not bad as I’ve been supplementing over the last year (128 and 70). But I’m confused about my b12 results:
August 24 (Medichecks):
Serum folate 28.2 (8.83 - 60.8)
Active B12 pmol/l 150 (>37.5)
Ferritin: 70.2 (30 - 207)
Nov 24 (NHS):
No folate
Serum B12 1305 ng/l (182 - 692)
Ferritin (Medichecks): 72 (30 - 207)
I was taking Nutri Advanced Vitamin B Complex which contains methylated forms of b vits. I’ve since stopped this due to the high serum b12. Was that the correct thing to do? I know serum b12 and active b12 are different….
How do I go about optimising the other b vits if I stop b12, do I take them separately? If so is there a complex without b12 available?
Many thanks 🙂
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I’ve had similar results in the past. High B12 can be an inflammation marker so maybe you have some condition that is causing it to rise. I recently learnt that folate levels are directly connected to B12 levels, I think your folate was low. This suggests that adding in a separate folate supplement could lower your B12.
There’s also a train of thought that having very high serum B12 suggests you may be not absorbing the vitamin & are therefore deficient. It’s known as paradoxical B12 deficiency. You might try posting a question about it on the PA pernicious anemia forum. You also could get an active B12 test. It might show a difference.
Thank you Bert, that’s very informative and given me a few things to investigate. I’ll definitely add active b12 to my next blood test after Christmas. It might be better to stay on my b vit complex after all and add in folate as you say. Especially if there’s likely no harm from high serum levels as helvella mentions to below.
High B12 without supplementing is an issue because it suggests the possibility that B12 is being inappropriately released from your liver (or wherever). Not because the B12 is high.
Serum B12 is all the B12, whereas Active B12 is only the part which can function as B12. Serum B12 includes what is measured by an Active B12 test plus the other forms of B12.
So far as I am aware, there are no issues in having high B12 levels. Think how much is in the blood after an injection of B12. Or an infusion as used to treat cyanide poisoning where they use 5 grams - which is five thousand times the common 1000 microgram B12 supplement.
Hi, did or do you have any symptoms that could be b12 deficiency related prior to starting supplements or now?, if so have they improved ? Such as breathlessness., fatigue, pins & needles, vision issues, brainfog,etc.What I now do is make a basic chart so I can track results over times and jot down symptoms relative to those times. Trying to compare active b12 to serum is difficult, so a good idea to try to get both results each time.
Don't know if this will reassure you, as we each have different needs and I'm not saying what is safe, but my b12 needs to be 2000+ for me to feel anywhere near well, at times it's been 5000+ but I wasn't so well.then, but as others have mentioned my iron and ferritin weren't good then, once I raised those the b12 serum results lowered to 2000 and they seemed to work alongside each other better.
You could check full blood count and look at mch/mcv which overange can at least maybe give u a picture of inadequate b12.
An iron profile will tell you if your iron/ferritin is adequate and whether it's safe for you to take iron-Drs not akways very good at recognising that! 70 may still not be high enough fir you, again, how do you feel? Many need to keep.between 80-100, but again it's individual.
It's symptoms that are ultimately important. I've a functional b12 deficiency, after injections stopped over covid & relying in sublinguals, my serum level was 608 earlier this year, yet I was at a standstill with weakness down one side, exhaustion, nausea, poor vision left eye, breathless, starting to stammer, to name but a few, so it does to show that serum levels do not tell the whole picture!
My iron/ferritin/folate have dropped further since b12 injections, so seeing that as a sign everything is being made better use of and need to keep supplements up. So worth checking your folate.
I've now got monthly jabs back, as every 2 months nowhere near enough & still had overange mch,etc. I've also recently started sublinguals daily, 1000 a day, still long way of feeling well-just to give you an idea that high levels of b12 are not a worry if that's what you need to feel well
Personally I'd get a full blood count, folate, iron profile and pop results back on here and PA site. Take care...
Thanks helvella, yes, can just be helpful part of picture if they lower after 4mnths if getting adequate b12, its all trial and error it seems. Could you poss outline other causes of raised mch/mcv please?
This is a reasonably comprehensive article. As so often, it reads as a horror story but most of the issues are unusual to rare and can be treated:
Etiology
In most cases, the etiology of macrocytosis may be related to abnormal RBC development, abnormal RBC membrane composition, increased reticulocyte count, or a combination of these 3 factors. Abnormal RBC development may occur in settings such as vitamin B12 or folate deficiency. Vitamin B12 deficiency may be related to prolonged, strictly vegan diets. B12 is dependent on normal gastric and small intestine function. Its absorption needs intrinsic factors from the stomach and normal small bowel absorption. Immune interference with the intrinsic factor results in no B12 absorption. Impaired vitamin B12 absorption may occur due to gastrointestinal abnormalities, including pernicious anemia, gastritis, celiac disease, inflammatory bowel disease (IBD), as a late complication of gastrointestinal surgeries such as gastrectomy, gastric bypass, and ileal resection, as an adverse reaction to medications such as proton pump inhibitors and metformin, or as an adverse effect of nitrous oxide abuse. Folate deficiency may be dietary, especially in cases involving alcoholic or elderly patients. Folic acid absorption also depends on health good GI small bowel absorption.
Folic acid stores may be affected by alcohol as well. Impaired folate absorption may be related to a similar range of intestinal abnormalities, including celiac disease, IBD, and small bowel resection. Folate metabolism may be impaired by medications such as methotrexate, phenytoin, and trimethoprim. In addition to its association with poor nutritional intake, ethanol also impairs folate absorption and metabolism and induces changes in the RBC membrane via its metabolite, acetaldehyde.[1] Furthermore, folate deficiency may be induced by conditions that increase folate requirements, such as pregnancy and chronic hemolysis. Of note, these nuclear maturation deficits are often associated with MCV in the 116 to 130 range, compared to other causes that often elevate MCV to the 100 to 116 range.
Increased reticulocyte count directly increases the MCV as these immature red blood cells are, on average, significantly larger. Reticulocytosis may occur as a response to hemolytic or blood loss anemia. A low reticulocyte count is expected in anemic states caused by impaired RBC production. However, transient reticulocytosis may occur during recovery from these states once the factors causing the anemia are corrected (eg, iron store repletion, hematopoietic cell transplant, or spontaneous recovery from parvovirus).
Additional etiologies of macrocytosis that are not completely understood but are presumed to be multifactorial include the following: hypothyroidism, pregnancy, liver disease, Down syndrome, HIV, myelodysplastic syndrome (MDS), multiple myeloma, and hereditary stomatocytosis. Common medications not already mentioned that may induce macrocytosis include the following: valproic acid, hydroxyurea, allopurinol, and reverse-transcriptase inhibitors such as zidovudine, stavudine, and lamivudine. Artificial changes in MCV may be reflected in laboratory tests for various reasons. Cold agglutinins are associated with MCV clumping, which may result in the interpretation of an elevated MCV. Clumping may also occur to an extent due to inflammatory or neoplastic conditions. Severe leukocytosis or hyperglycemia may also result in MCV overestimation.
And yet again hypothyroidism rears its head ! It seems to have SO many knock on effects to the body. I’m not sure why I’m surprised by this (I’m not really) but it’s interesting how far reaching it is. To affect MCV etc is fascinating (and annoying in equal measure 😂). I certainly tick the box on being ‘inadequately treated’ ….for now
Thanks so much Jo5454. It’s really hard to tell on the symptoms front as I have so many that cross over on many things for quite a while. Perimenopause, hypothyroidism (untreated for a long time), I was active doing sports and so always fatigued from that with various aches and pains. Brain fog, deteriorating vision for as long as I can remember!
It’s reassuring to hear your experiences and that numbers (as we know) don’t necessarily correlate with symptom control and what works for each individual. I’d like to try to increase my folate and ferritin a bit more and see if it makes a difference.
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