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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 53083
Experience:  GP in the United States
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I'm a Caucasian male aged 68 with symptoms of possible B12

Customer Question

I’m a Caucasian male aged 68 with symptoms of possible B12 deficiency; mainly hot tingling hands and feet, poor memory and concentration, fatigue, weakness, shortness of breath, feeling faint on standing, poor balance, awkward movement, muscle cramps, joint pain and hazy vision. My blood test results of 14 April 2016:
Serum vitamin B12 level
191 ng/L (range 211-900)
Serum folate
16.9 ug/L (range 4.0-20.0)
Serum ferritin
122 ug/L (range 15-400)
Serum iron
17.0 umol/L (range 11-25)
Serum TIBC
54.5 umol/L (range 45.0-72.0)
Transferrin saturation index 31%
Serum TSH
5.6 mu/L (range 0.3-5.5)
Serum T4
14.0 pmol/L (range 10-22)
I feel generally unwell and have done so since February 2013. Since March this year I also have burning mouth syndrome (not a dental issue) and a tendency to tense my jaw. Is it possible that I have B12 deficiency even though I don’t appear to have anemia? I do have gastritis with a gastric lesion per endoscopy April 2015 and IBS. Thank you.
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. Phil, MD replied 8 months ago.
This absolutely is B12 deficiencyit doesn't always cause anemiayou need B12 shots
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 53083
Experience: GP in the United States
Dr. Phil, MD and 4 other Medical Specialists are ready to help you
Customer: replied 8 months ago.
I'm in the UK and saw my GP today. He didn't seem to be all that clued up tbh and seemed to think that B12 deficiency automatically meant anemia as well. He put me on a 3 month course of oral Cyanocobalamin tablets 50 mcg daily as a trial. This dose seems to be inadequate to me. I think it's unlikely I'll get injections on the NHS here all that easily and would like your advice as to possible dosage of sublingual tablets and the strength required.
Expert:  Dr. Phil, MD replied 8 months ago.
That oral dose won't touch ityou need 1000 mcg per day at least
Customer: replied 8 months ago.
Thank you, ***** ***** it wouldn't work. How long would it generally take to feel a bit better on 1000 mcg daily in your experience and would it be best to stay on that dose each day going forward as a maintenace dose? I've read that methylcobalamin sublingual tablets or lozenges are as effective as injections and that methylcobalamin is superior to cyanocobalamin. Is therte any merit in this and does it matter? Also I'm a bit worried tbh that my GP has missed treating me properly for the last three years and that I might have ended up with some permanent nerve damage. My hands are usually burning hot with dry heat and tingle. As they do right now. The burning mouth and tingling tongue with a strange feeling of puffiness in the lips is particularly worrisome.
Expert:  Dr. Phil, MD replied 8 months ago.
It will only work at 1000 mcg if the body is absorbing itmost people with deficiency aren't absorbingit might take 3 months or longer
Customer: replied 8 months ago.
I more than probably have an absorbtion problem what with age, general diffuse gastritis per endoscopy and IBS. I also had H.pylori infection and successful triple therapy in 2014. Sublingual tablets or lozenges are meant to get round this issue. Worth trying?
Expert:  Dr. Phil, MD replied 8 months ago.
Worth trying. Yes
Customer: replied 8 months ago.
Ok. Thank you for your assistance. Bye.
Expert:  Dr. Phil, MD replied 8 months ago.
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