NICE Draft guidelines for Vitamin B12 Deficiency out for consultation

Guideline webpage : https://www.nice.org.uk/guidance/indevelopment/gid-ng10176

Expected publication date: 16 January 2024

Vitamin B12 deficiency in over 16s: diagnosis and management

 

Really, they use 350 as the cutoff for "indeterminate"? Some people think even levels in the 500s can give you problems and B12 is so easy to supplement. A B12 level around 550 caused me mouth ulcers.

 

I try to keep mine over 1000 and I only use methylcobalamin supplements with occasional use of adenosylcobalamin. Since doing this my almost lifelong eczema has 95% disappeared and the spots I had since puberty disappeared (in my 50s).

I don't have any problems absorbing B12 with tablets, but it has to be the right kind for me to get any benefit.

 

The lab reference range according to my latest blood test for serum b12 is anything over 145ng/l.

 

That is truly appalling!

 

Having a peek at the [E] Evidence review for vitamin B12 replacement it says there is little RCT evidence that supplementing B12 leads to improved quality of life even if the numerical value is increased, but that they know there are plenty of people saying they feel better with supplementation. I am probably misunderstanding but if the evidence isn't good enough then isn't a lot of the guidance around values a bit arbitrary?

 

Years ago my B12 level was just above 200 but my GP didn't feel it was serious even after I told her my tongue felt numb. I took 1000 mcg methylcobalamin supplements for 6 months and the numbness/tingling disappeared.

I got retested 6 months later and the receptionist called to tell me to stop taking B12 b/c it was over 1000. I didn't stop. I continue to take B12 from time to time with my natural yeast which contains B vitamins.

 

That suggests to me that the RCTs referred to were probably just getting people to raise their levels to just inside the bottom of the reference range and saying "Look! Nobody feels any better! It's useless!"

[sarcasm on] Researchers use similar shenanigans when doing thyroid research. Get the TSH just down to the top of the reference range, Free T4 just into the bottom of the range, don't bother testing T3, and Bob's your uncle. Nobody needs T3, and a TSH of 4.5 is absolutely fine. And if TSH is higher than that in someone over 50 well, old people don't get any benefit from thyroid hormones do they? [sarcasm off]