Blood results & Folic acid question

The pattern looks like PA with a macrocytic anemia. That will correct with time. Your red cells cycle over  3-4 months. Your GP will monitor the trend.

MA is related to folate. The levels look ok but a good proportion have an impaired ability to transform that into the active tetrahydro form. You can't tell that without gene testing or trying the more active form should you not respond as expected in say two more months.

However some research shows that the gut villi come under attack and that the appearance of antibodies is at an endstage of damage. This suggests that there is an inflammatory process under way beforehand probably due to gluten giving wider malabsorption probably of the fat soluble vitamins. So the lack of intrinsic factor is a consequence not a cause.

Further a guy Read I think who did a lot of original research showed that while B12 deficiency occurred in the winter the public ward patients at  his hospital developed anemia and folate deficiency, whereas the private patients did not. He attributed this to their being able to afford fresh fruit and vegetables in winter. In any event the anemia was related to folate not the B12 as such or perhaps rather both.

You it seems have PA as shown by the RCV being elevated. Your red cells are renewing and the Hb + and RCV down. You would expect this over 3-4mths.

However this depends on iron stores (ferritin) and folate being available. I would prefer both to be higher because the B12 is using more to replace the deficient cells. Midrange would be okay.

As far as folate goes some 10-20% can't use folic acid the usual and cheap form. Another 20-30% have a limited ability to use it. Although you can be tested for the MTHFR  gene some places restrict the test. However it is available elsewhere at a low cost for a range of tests. The interpretation however requires other sources. Just as easily you can try the special forms eg quatrefolic - the usable form. You can check out MTHFR. You may be ok or not.

The other part is a lot of gps operate on the 3 mth basis for B12. The guidelines here which I suspect are the same as the UK are 3 mths for deficiency and 1 month or as required for PA or eg after gastric surgery. The BMJ has just put out new guidelines 2014 but I don't have ready access.

The US CDC guidelines say "Some providers have used quarterly injections after the initial dosing protocol. However, experts state that in pernicious anemia or severe malabsorptive deficiency, quarterly injections are not sufficient, noting that cobalamin levels start to fall prior to the 1 month follow-up (Allen RH. University of Colorado [personal communication] 2006-2007).

OralLarge daily oral replacement doses might be an acceptable alternative if patients are compliant.7 Sufficient amounts of vitamin B12 are absorbed via passive diffusion in the small intestine.2,11 A study by Eussen et al. demonstrates a linear response in the reduction of metabolites and increased serum B12 levels with increasing dosages of oral cyanocobalamin.80 A common therapy is 1 milligram (1,000 µg) of vitamin B12 consumed daily."

Unfortunately a lot of doctors either misread the guidelines or are out of date.

You may need sublinquals.

I would also supplement folates and iron and probably a good multi B.

I would also ask if my fat soluble vitamins were ok and try a few days gluten free - your gut will show you.

I assume your diet is good and you are not vegetarian. Your hair and no doubt various other symptoms will improve with time but it may take 9 months or so. The getting to that state after all took years.

I trust this is some help. It won't please your gp - nor did it mine. However needs must and I say well this is what I am doing and these are some of the effects.

Finally they will also say oh your B12 level is ok now. But what they don't know or recognise is that the test has a known limitation in that it measures total cobalamins not those biologically available in the form required for people to use. Some can't use cyanoCBL most can use hydroxyCBL some need MethylCBL  or ADCbl.  They also do  not know the functions of all the various forms in which it is stored in the body. In any event after dosing the level may be elevated but it is your response that is paramount. I wish they had stickys as this comes up all the time.

Good luck.