Could I be on to something?

This forum has been so helpful, and I learned so much reading everyone’s posts. I’m completely new to the topic. And I am completely confused. Unfortunately, I’ve reached the end of the road in the official healthcare system in my country. I’m willing to go private, but I’m not even sure vitamin B deficiency is a road worth pursuing or if this is all in my head. For background, I’m female in my late 40s.

I believe I’ve had symptoms for literally decades: tiredness and just a general lack of energy, sometimes extreme, brainfog, difficulties to focus to an extent that made me wonder if I can continue in my career. My fingernails have had deep ridges for many years. More recently, I’ve also had numb lips and cheeks, with a tingling sensation in my cheeks. I used to exercise 3-5 times a week (nothing wild, just gym classes and some running), which now feels like an ordeal. Over the past year or so, I also have more and more difficulties to sleep through the night.

Of course, I’ve seen plenty of doctors over the years. It sometimes turned out that I had iron deficiency and they prescribed iron tablets. But my symptoms never completely disappeared. And now I'm just told that perimenopause is the culprit wherever I go.

Having lost trust in the official healthcare system, I decided to bypass them this time—as I felt I was getting worse—and went straight to a private lab for some blood tests. I wasn’t looking for anything specific, so I went for a general check-up panel with all kinds of things. Result: both B9 (folate) and B12 were low: at 6.0 nmol/L and 133 pmol/L respectively. That was the first time I ever really heard of vitamin B. After some googling, I decided to take these results to an “official” doctor. I also bought some B12 supplements (cyanocobalamine) and took some right away.

The doctor was much more interested in some slightly elevated cholesterol markers, but agreed to order some more tests. Because my private tests were outside the official system, they somehow don’t count (although I now know that the official system uses the exact same lab.) He also prescribed the same B12 supplement I had already bought over the counter, as well as folic acid.

These new tests were done exactly one week after the initial private ones, and after I had taken a total of 2mg cyanocobalamine. The results: folate at 8,6 nmol/L and B12 at 182 pmol/L. That’s just barely within the official range (7.0 and 140 respectively as the lower limit). I am not sure if my doctor ever even took into consideration that these results are probably skewed because I already took supplements (1mg of cyanocobalamine 5 respectively 6 days before the test). According to him: problem solved, he’s now entirely focused on cholesterol which is also slightly high. He is convinced that my diet was the issue (which it is not, I’ll die on that hill. I know what I eat.)

Since I already expected something like that and he told me that he wouldn’t order any other vitamin B-related tests other than serum, I went ahead and booked a “B12 package” privately. The samples for that were taken the same day, about 1 hour after the “official” test and analyzed by the same lab. Results there: B12 148 pmol/L. Active B12 came back at 78 pmol/L. MMA was completely normal (0.16 μmol/L), while homocysteine is officially within range, but still above ideal at 13 μmol/L. B9 was not tested this time.

I know that these results are skewed by the supplements I took 5/6 days before the test. I just wanted at least some sort of baseline that was taken before I started supplementing with high doses. That makes the homocysteine even more interesting, I believe.

In all these tests, my blood looks perfectly normal. No anemia. Iron is normal. But ferritine is elevated and transferrin saturation is just above range. All thyriod results came back normal, including antibodies.

I've since started supplementing for “real”, 4mg daily of cyanocobalamine and folic acid. It’s been a few days, and I don’t know if it’s the placebo effect, but I think I already feel a little better. Just a little less brainfog.

I somehow had hoped for high MMA to get a clearcut answer. But I truly wonder if it is worth digging deeper on the B9 side of things (while keeping my B12 supplements, of course). I just don’t believe that this is “solved” now simply because test results are within range. I've read enough about B12 defciency to not even take those ranges seriously. So many things would fall into place if I had some malabsorption issue. I’m just not willing to let go of that hypothesis yet.

Since I’ve reached the end of the road in my official healthcare system, I’ll now have to go private. I’m willing to do that to finally get an answer and understand the reasons behind these test results. But I would be extremely grateful for two things in this forum:

Those of you who have a deeper understanding of vitamin B deficiencies, based on my numbers, would you agree that I might be onto something?

And does anyone have recommendations for an expert to consult and get their interpretation of my test results? Preferably online, so anywhere in the world would be fine?

Thank you so much indeed!