I live in Switzerland and I was given B12 infusions at the Drs, more effective than tablets. However, you’d prob have to go private, don’t fancy your chances of getting that on the NHS.

Regarding supplementation: take those B12 tablets now as an emergency solution, but also consider taking them for as long as you don't change your vegetarian diet. Your B12 can get up to normal in blood results pretty quickly, but symptomatically it might actually take months.

Regarding nutrition: if you stay with vegetarian, eat plenty of eggs and diary products, e.g. cheese.

Regarding sport: you weren't hospitalised, so I recon you won't die because of the deficiency. You won't get your best performances nor training results either, but you're ok to continue training. Remember the shitty energy / mental state you're now as a reference point for the future. Edit: use the time now to work more around LT1 and avoid any LT2 work.

Side note: I'm no medically educated, but it'd be interesting to see your other results incl. hematocrit (possibly low %), iron (possibly low), ferritin (possibly low), vit. D (possibly low), testosterone (possibly mid-low) and creatine (high if overtrained and muscle deteriorated). These're all my guesses, but I'm pretty confident in hitting at least a few. Also wonder how homogenic the size of your red blood cells might be, indicating that you're not boost creating new ones.

Very common according to my doc to be low on b12.

My doc put me on this supplement and my numbers jumped in 3 month to normal.

https://shop.bioticsresearch.com/...ts/b12-2000-lozenges

He also said to avoid getting supplements from Amazon as they have a lot of fraud supplements being shipped

I struggled with chronically low B12 for most of my racing career, late 20s to mid 40s (most of that time was 15+h/wk for the bulk of the season)

Was on B12 sublingual 5000mcg once daily for about a decade and starting about 4d before a race 2x/day. That was probably more placebo than anything. Often took one in T2 as well for 70.3 or longer events.

Had low hematocrit for most of that time, 38-42. I just trained normally, well as normally as my insomnia allowed me. Did a lot of afternoon back to back treadmill runs then masters swims and a lot of work in the 1:30-4am time frame. Mostly i was fine as far as performance, there were a few races where I'd get to the race and sleep 12h and a few races where I'd get there and sleep 2h. 95% of the time I was fine on race day but then might be dragging arse for a few extra days after.

I'd advise you to train how you feel. If you're dead to the world then train easy & short or not at all. If you're feeling peppy then go for it.

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not medical advice but my own observations from looking into this for myself when I had low b12 and iron. been vegetarian for 4-5 years.

Can you get injections in UK? I had low b12 and the dr said 2 x week for 2 weeks, then once a fortnight for 1 month, then 1 a month. Here you can buy b12 vials from the chemist and small needles and do it at home. but then go back and get tested in a few months and see if the levels are back up.

people say b12 tablets work fine - I am sure they do, but injections get completely absorbed as I understand it and you don't have to have them every day.

for b12 I aim for high, not normal. for ferritin I aim for high normal.

when my b12 was low my hemoglobin, ferritin and hematrocit hadn't gone down either so I wasn't feeling the fatigue. you can maintain very good blood levels on vegetarian diet but if you're going long term with it I would suggest getting quarterly or 6 monthly blood tests and keep an eye on this - your iron will go down if you stay vegetarian so you need to supplement that too. so your main supplements long term should be iron and b12.

if you start getting your b12 and iron levels up (ferritin) if they are low, you will start feeling better quite quickly as long as there is not some other significant over training symptoms from having low red blood counts.

too much training and stress lowers your hemoglobin and hematrocit (which also can't be kept at a good level if b12 and iron are low) - so just trying tow ork all that out and listen to your body signals to what is too much for yourself is a long process too

good luck mate

Here you go.

Creatine is actually low, but your other suggestions seem right

*Clearly I need to work out how to embed images! Sorry

Thanks for posting the results. Honestly, you don't look that bad. I thought that even your B12 levels would've been lower based on what you wrote. You wouldn't normally qualify for B12 infusions in Switzerland.

However, I'd be looking also at the ferritin (you have 45ng/ml, where your lab's norm is 12-250 and my lab's norm is 30-400 -> low end) and haematocrit (you have 40.7%, where your lab's norm is 40-54% and my lab's norm is 40.5-50.9% -> very low end). Maybe it's NHS style (or maybe I know shit), but it looks like the norms on your side are very liberal and you wouldn't be alarmed/treated until absolutely necessary.

Again, take your supplements. I'd also take iron if I were you. Continue training but focus on LT1 (endurance) rather than LT2 ("threshold") for some time. Good luck.

Thanks to the OP for sharing this.

I sustained nerve damage in my hands after 40 hours on the bike over 4 days and was given B12 injections to help with recovery.

Jury remains out on how much recovery I will get but three weeks in they continue to improve day to day but it is slow.

But man do I sleep better and feel better with B12. I suggest everyone look into their B12 levels given how widespread this deficiency appears to be in the general population.

40 year vegetarian here. It was about 5 years ago that I started experiencing severe neuropathy in my lower extremities. Pain, weakness, instability even walking.
Even though my bloodwork came back on the low end of normal it was surmised that long term low B vitamin levels could be the culprit. Mri's etc...ruled out other neurological possibilities.
It took two years of B vitamin supplementation along with purposefully eating foods higher in B to start to turn things around. Im about at 90 percent of normal now with just slight toe numbness but it is quite a frightening experience.
I caution any vegetarian/vegan to supplement.

I am a family doc in Canada. My lab calls b12 between 120-150 a 'possible deficiency" You have normal sized red blood cells and a normal ferritin so if you have b12 deficiency it is slight. If you have been vegan for many years likely a slow decrease in b12 from not getting enough. The oral b12 should be fine. Likely good you got it checked as it would likely have continued to go down. If you are feeling really tired I'd be surprised it was from low b12.

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

2 years of B12 injections or oral supplements?

My Dr said oral B12 is just about useless

Thanks for the feedback, I'll see how the supplementing goes and I might look see if I can find a GP friend to stick me with a needle. I'll look carefully at my diet, I have little interest in eating mass produced meat due to ethical reasons but I'd probably be more accepting of game, so might look into that + supplementing. If I remember to I'll update the thread in a couple of weeks with how it's going

Dudaddy, did you maintain you veggieness or move back to meat?

MrTri123, don't the majority of people get all there b12 orally?

Check out Nutritional Yeast as a seasoning to help increase B12 (and other B vitamins) on a vegan/vegetarian diet.

Maybe like 2x a month have some fish? I realize that opens the can of worms and it's hard to make exceptions and maintain the lifestyle, but if you make it a firm commitment like that, would it be ok for you? Otherwise, eat 60 eggs a month... which sounds like it would get pretty old quick.

I used to have low liver function and did did biopsy years ago. Liver specialist suggested taking B12 and milk thistle supplement and test numbers have been perfect ever since. Look into milk thistle as well.

A few years ago, I became severely anemic due to blood loss from gut issues (HCT was down to 25.6, hemoglobin was 8.5). I don't recall anything regarding B12 on my lab results, but I was put on iron and B12 supplements, and after about 6 weeks I was back up to feeling better than I had been for the better part of the previous year. I don't know how much was due to the B12 vs iron, though...

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"I'm thinking of a number between 1 and 10, and I don't know why!"

If you are on FB there is a good, dedicated FB group for B12 deficiency. There are a few "zealots" in the group. You will certainly be told that your B12 is super low by them. I am not sure how easy it is to access B12 infusions in the UK?

Your ferritin is low, although I need to double check your lab units. But, basically, your red cells are your oxygen carrying cells to your tissues (read muscles for exercise). You have a comparatively normal haematocrit, but will almost certainly see some improvements by replacing your iron (oral in the first instance, and best with tablets as you won't be able to bring it up easily with diet). You will likely, after 3-6 months, see a boost in your haematocrit, which would potentially have some performance benefits. In cycling, with the UCI, there used to be a cutoff Hct of .50, after which you would be restricted from competing. That is one of the key things EPO does, along with training at altitude. You just have some nice room to move.

I had symptomatic B12 deficiency (sudden onset) and the symptoms went away after about a week of oral B12.

Your doc sounds smart - completely agree with this. How much of oral vitamins just pass through the system and make expensive urine - don’t know but injections much more effective

In Australia you can walk into the chemist and say can i get b12 vials and they sell it no prescription required. You can buy needles in some chemists and then watch a YouTube video how to do a b12 shot and you should be sweet. Otherwise go to the health and needle service and you can get them free

I’m not sure if you’re vegan or vegetarian but people who say you need to eat meat or fish or eggs to get these levels up miss the point imo. As thought vegan and vegetarians are the only populations who suffer from anemia related issues …. When really this is a widespread issue in society with people not eating enough, not sleeping enough, working too hard in the office or training

Good luck and if you’ve got ethical convictions don’t think you need to eat meat or fish or eggs to maintain your athletic lifestyle

Check out the vegan cycling YouTubers on b12 and iron too. Even really high level cyclists who try out vegan / vegetarian don’t get blood tests and then blame being vegan on tanking their blood values. Really they just need regular blood tests and supplementation if required.

https://bmjopen.bmj.com/content/10/8/e033687

We have been using oral b12 very successfully for decades. Aside from a few pts( that have things like the part of the stomach that absorbs b12 being removed) it works quite well

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

Thanks to everyone who has contributed. It's really interesting the different takes on B12 levels depending on country/lab. I'll definitely be supplementing both b12 and iron, if there's no improvements I'll look to getting the injections.

Thanks, Matt

Oral plus lots of B12 B6 rich foods.

Im technically a "lacto vegetarian" I suppose now. I added back milk products such as yogurt.