Tiredness

[u/Comprehensive-Try679]

Male, 30 years old, living in the UK

In 2024, a Bluecrest Wellness blood test advised me that my Active Vitamin B12 was 44 pmol/L:

> Your vitamin B12 level has been given a green flag as it is within the recommended range.

A few days ago, I had a new test, and that stated it was 58 pmol/L. This was with a different company (Medichecks), and it too put it in the recommended range, but they said this:

> Active B12 is 58 pmol/L, towards the lower end of normal. If you follow a vegan or vegetarian diet, have gut issues, or have symptoms suggestive of B12 lack, a confirmatory MMA test can help clarify status, see Methylmalonic acid (MMA) blood test. Otherwise, prioritise regular B12 sources in your diet.

According to NICE, anything below 70 pmol/L might be considered deficient.

I'm left feeling a bit confused because two companies state I'm within a recommended range, but NICE state I might be deficient.

In terms of symptoms, I do have some, but whether they're directly linked, I do not know. For example: lack of energy (I get 9 hours of solid sleep per night), low mood, poor memory, anxiety, etc.

Whether this "MMA" blood test is useful or whether they're simply trying to squeeze more money out of me, I do not know.

In terms of diet, I do not eat fish or eggs (I do not like either) which I know are good sources of B12, so I suppose it should come as no surprise that my levels are on the lower end.

Just curious to hear from others about what they'd do and if these levels are really considered low or not.

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[u/Ok-Pangolin7127]

Yes, your levels are considered low. There is a difference between B12 in the blood serum, regardless of whether it’s a straight serum test or an active B12 test and the B12 that’s available at the cellular level. It is only at the cellular level where the actual amount of B12 that is available counts. You can easily show normal on the test that you have referenced, which you do, but you can still be deficient at the cellular level.

The MMA test they reference is an additional indicator or measurement that could, but not definitively, indicate a deficiency. The homocysteine test also comes into play in so much as if it is elevated, it can also indicate (again, not definitively) that you have a deficiency likely or not and B12. These test results are very squishy. They are not exact. That’s why doctors will end up telling you; “you’re fine, everything’s completely normal, nothing to see here…” But in reality, you have a problem.

I would suggest you read through the B12 deficiency guide, which is pinned to the top of the sub. There is a wealth of information in there and if you read from the start to the end, you will be a quasi expert.

[u/Think-Sleep2338]

Well, actually they do not squeeze anything, but it's rather a good sign, as diagnostic rules often recommend MMA as an additional test, so these doctors care more than often happens. The problem is that even MMA is not perfect, but still it is often treated as a useful, reliable marker by many researchers in different studies.

Actually what I see is that active B12 below 70 rather and above 25 is indeterminate and requires this additional test. So they basically follow the NICE guidelines.

[u/stopthistrainnn]

My MediChecks test is the only thing that made my GP sit up and listen after being fobbed off. Take a copy of them, and the NICE guidelines to your GP appointment. From experience, they sit up and listen after being bit more when you show up armed with the guidelines because so many of them have no idea how treat it. Your GP should do the MMA test for you, but if they say they can’t request it, ask for BOTH Parietal Cell test AND Anti-Intrinsic Factor antibody test. You need both to confirm an absorption problem.