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Over the past 2 years, two pieces of media have made me want to shout at my screen. The most recent one was about Channel 4’s documentary The Great ADHD Myth?, which is due to air next week. It questions whether the rise in ADHD diagnoses is a genuine reflection of need or a symptom of modern over-diagnosis.^[1] The other was a Lancet series arguing that menopause has become “over-medicalised” and that most women should navigate it without hormone treatment at all.^[2]

I’m writing this in the middle of exploring my own possible autism and ADHD diagnoses, at perimenopause, alongside my Hashimoto’s and hypothyroidism and it’s been a challenge. But also very revealing at the same time. So I have a vested interest here. But you don’t need my personal stake to see the pattern. You just need to notice what these two stories have in common and what’s missing from both of them.

The pattern

On the surface both stories are about caution. Don’t over-diagnose. Don’t over-treat. Nobody wants unnecessary medication after all.

But if you look at who these cautionary tales are about, it tells a different story. ADHD diagnoses are rising sharply in adult women, many of them in their 40s and 50s. Menopause care, specifically HRT, is a treatment that exists almost exclusively for women. Both cases show a moment when women are finally getting diagnosed and treated for something they’ve lived with for decades. Which is now being reframed, in prime time and in a leading medical journal, as a problem of excess.

That’s not a coincidence I’m willing to let stand. It’s a very old habit with a new vocabulary.

Example one: the ADHD documentary

Channel 4’s The Great ADHD Myth?, fronted by NHS psychiatrist Dr Max Pemberton, points to a genuinely real number: a 200% rise in adult ADHD referrals in England between 2020 and 2025.^[1] It uses that number to ask whether ADHD is being over-diagnosed. It then leans into the idea that modern life (screens, diet, inflexible schooling), is what’s really being behind the increase. Rather than framing this as a story of previously missed diagnoses finally being caught.

ADHD UK’s response was blunt: they wrote an open letter to Channel 4 criticising the framing before it’s even aired. Dr Chris Abbott, chief medical officer at Care ADHD, said presenting ADHD as “potentially no more than a social construct” is “scientifically misleading and risks causing real harm to children, adults and families.”^[3]

Let’s be clear: ADHD is not scientifically controversial. ADHD is recognised world wide by every major medical body. There are over 200 evidence based medical studies to support this and it has a high heritability rate at 74%. ADHD has been around much longer than smart phones and processed foods have existed. All of this and more is laid out in ADHD UK’s letter to Channel 4.^[3]

As a Nutritional Therapist I’m well aware of the impact poor diet, processed foods, screens, everyday chronic stress, poor sleep, etc can have on an individual. They can indeed make conditions, like ADHD harder to manage. Making changes in these areas can have a profound effect on health, I’m living proof of that. But it’s not the cause!

Here’s what the documentary doesn’t show: a large proportion of that 200% referral surge is adult women, many diagnosed for the first time in their 40s and 50s. That’s not incidental, it’s mechanistic. Oestrogen helps regulate dopamine, which is central to attention, motivation and executive function. When oestrogen drops and fluctuates through perimenopause, it can unmask ADHD traits that women have spent decades compensating for through routine, over-preparation and sheer effort.

A population-based cohort study found perimenopausal symptoms are more severe and start earlier in women with ADHD.^[4] In ADDitude’s survey of over 1,500 women, 94% said their ADHD symptoms worsened during perimenopause and menopause. The largest single cluster of first diagnoses landed in exactly that window.^[5]

In other words: the “sudden rise” in ADHD diagnoses that a Channel 4 documentary is using to suggest overdiagnosis is, in significant part, a population of women getting identified for the first time. Precisely because hormonal change finally made a lifelong condition visible enough for someone to notice. That’s not a myth. It’s decades of missed diagnosis catching up.

Even with an excellent diet and all the lifestyle management techniques in place, perimenopause hit hard for me and unmasked the Autistic and ADHD traits I’d previously managed to keep under control. It’s only at perimenopause that I realised that I had these traits. Not because I’d sailed through life smoothly. But because I’d built mechanisms to cope and circumnavigate them the best I could. These same coping mechanisms are now failing me and it’s this that has pushed me to explore ADHD and Autism. Something that many women may be reluctant to do after this documentary has added further stigmatisation to the diagnosis.

Channel 4 have responded and suggested that the title is purely designed to encourage debate. And that they are not questioning the validity of ADHD itself, rather diagnostic processes and prescribing of medications.^[6] I’ll be tuning in to watch the documentary on Tuesday 18th August, if it’s genuinely a balanced programme, I’ll be the first to hold my hands up. Either way the title of the programme lacks any sensitivity towards those navigating AHDH in their daily life, and reads more as gaslighting of people’s lived, diagnosed conditions.

Example two: the Lancet, HRT, and the word “overmedicalisation”

In March 2024, The Lancet published a four-paper series on menopause, including one titled “An empowerment model for managing menopause.”^[2] Its central claim: menopause has been oversimplified into a hormone-deficiency problem to be solved by HRT. It suggested that most women could navigate it without medical treatment. Supported instead by information, workplace adjustments and psychological approaches like CBT.

The pushback from menopause specialists was fast and specific. A panel of expert physicians and nurse practitioners strongly disagreed with the overmedicalisation framing. They pointed out that the series downplayed a substantial evidence base: the menopause transition carries roughly a four-fold increase in risk of depressive symptoms and a two-and-a-half-fold increase in diagnosed major depressive disorder.^[7] Recommending CBT as a first-line treatment also ignores both the access barriers to therapy and the comparatively thin evidence that it addresses the physical symptoms of oestrogen loss.

To be fair to the Lancet authors, their series doesn’t argue against HRT outright. Instead it says HRT is appropriate for some women after a proper risk-benefit conversation. But the word doing the damage is “overmedicalisation,” because of what it invites everyone else to do with it: hear “women are being given too much treatment” and conclude the treatment isn’t real or necessary. That’s precisely the framing that fuels the everyday experience so many of us already have; being offered antidepressants or told to try mindfulness before anyone raises HRT as an option, even when the underlying cause is hormonal. Looking at this as a Nutritional Therapist, it should be a joint approach of diet, lifestyle and medication to best support the individual needs of each woman.

Another point to consider

BBC Panorama’s The Menopause Industry Uncovered (2024) covered different territory; the commercialisation of menopause care. It also discussed overprescribing at a specific private clinic, and women harmed by excessively high oestrogen doses.^[8]

Worth sitting with, though, is how that story was built. The programme centred on a little over a dozen patients from that clinic who’d had bad experiences. Real and serious ones, including womb-lining changes that needed following up.

What it didn’t centre on was the far larger picture: a Care Quality Commission inspection carried out after the documentary aired reviewed feedback from 562 patients (88% positive) and 2,216 post-appointment surveys (67% rating their overall experience “outstanding”), and ultimately rated the clinic “outstanding” overall.^[9] Many of those patients describe getting individualised treatment they say they couldn’t get anywhere else. After years of being offered antidepressants, told they were “too young,” or otherwise dismissed by NHS GPs. A pattern which was documented in its own right in UK menopause-care research, where dismissive or negative attitudes from healthcare professionals show up as one of the most common complaints women raise about NHS menopause care.^[10] 

None of that erases the legitimate concerns Panorama raised, and the clinic did lose its British Menopause Society accreditation over its prescribing before the CQC’s review. But a small number of distressing testimonies, however real, isn’t the same as an accurate picture of a service several thousand women independently rated as excellent. And a documentary that leads with the former while leaving the latter to a regulator’s filing cabinet is doing the same selective framing this whole piece is about, just aimed at a different target.

That’s a real and important story about the commercialisation of menopause care and about doses, not about whether HRT itself is overused. It’s easy for the two stories, commercial overprescribing at one end, and “women don’t need this treatment” at the other, to blur into a single, vaguer message: be suspicious of women wanting hormone treatment. Both deserve scrutiny. Neither deserves to become shorthand for the other.

The double standard, in black and white

Here’s the part that made me the angriest. When women don’t get offered HRT, because their GP is cautious, because of the post-Lancet chill, because of lingering fallout from the flawed 2002 Women’s Health Initiative study that spooked a generation of doctors, they don’t stop having symptoms. They get treated anyway. Just piecemeal, one symptom at a time, with drugs that were never designed for the underlying cause:

Low-dose antidepressants can be helpful in some cases for hot flushes and night sweats. However there is evidence that they don’t touch vaginal dryness, joint pain or the cognitive symptoms actually driven by falling oestrogen. Guidelines are clear that they should not be offered as first line of defence against mood related perimenopause symptoms as there is no evidence to suggest they can help with the psychological symptoms of menopause.^[11] 

Statins and blood pressure medication for the cardiovascular risk that climbs sharply after menopause, when oestrogen’s protective effect on the heart disappears.

Bisphosphonates and other bone drugs for the osteoporosis that follows the accelerated bone loss oestrogen used to prevent.^[12] 

None of that is described as overmedicalisation. It’s just called “treatment.” Only HRT, which could have addressed several of these problems at their source gets tagged with the word.

Let’s compare that to how hormone decline is discussed in men

Testosterone prescribing in UK primary care has risen sharply too, more than doubling over the past decade. This has been driven by symptoms that are, by clinical consensus, notably non-specific: fatigue, low mood, reduced libido.^[13] 

There is a real, if much smaller and more clinical, conversation happening about whether “Low T” clinics and private equity-backed testosterone marketing constitute overdiagnosis. But that conversation has stayed in medical journals and trade press. It has not become a primetime Channel 4 documentary questioning whether tiredness in middle-aged men is a “social construct.”

It has not become a Lancet series telling men their hormone decline is best managed through lifestyle change and reframing “manopause” as healthy ageing.

The asymmetry isn’t that scrutiny of hormone treatment never happens for men. It’s that when it happens to women, it goes mainstream, moralised, and much larger than the evidence underneath it.

What the years of masking cost the body

There’s another thread in my own story that neither of these headlines touches and it might be the most biggest illustration of how much damage goes unaccounted for when women’s neurodivergence goes unrecognised for decades: what constant masking does to the body, not just the mind.

For years, before I had any language for what was going on, my way of getting through the day was hyper-vigilance, hyper-focus and perfectionism. Scanning for social missteps, over-preparing for every eventuality, holding myself to standards that left no room for error. All in the effort of counteracting both ADHD and autistic traits I didn’t yet have names for. It worked, in the sense that it got me through school, jobs, relationships. It also meant my nervous system rarely, if ever, got to switch off.

That’s not just a metaphor. The effort autistic and ADHD people put into suppressing natural traits and consciously performing “normal”, can keep the nervous system in a state of chronic activation, hyper-vigilance and may lead to burnout.^[14] A co-twin control study published in Molecular Autism found that camouflaging autistic traits was directly linked to measurable physiological stress, not just self-reported exhaustion, this is a body running its stress response for years, sometimes decades, before anyone names why.^[15]

And chronic activation of that system doesn’t stay contained to mood or energy. It shows up in the body’s own stress machinery, and not just anecdotally.

Cortisol studies in Autistic children have repeatedly found a disrupted diurnal rhythm alongside an exaggerated cortisol spike in response to acute stress, a pattern consistent with a nervous system that’s chronically primed rather than able to properly rest.^[16][17] 

In ADHD, the cortisol findings look inconsistent at first glance: some studies report lower basal morning cortisol, others report significantly elevated cortisol and ACTH. But both directions point to the same underlying problem, a system that isn’t regulating itself properly. Whether it’s blunted or spiking, dysregulation is dysregulation.^[18][19]

It’s worth naming a limitation that runs through almost all of this research: the studies behind these findings, like most of the foundational research on Autism and ADHD, were built on samples that were overwhelmingly male. One systematic review of ADHD studies found 81% of participants were male.^[20] Autism is diagnosed in males at a ratio of roughly 4:1, rising to around 10:1 in the absence of intellectual disability, partly because the standard diagnostic tools were validated on predominantly male samples in the first place.^[21] 

Women and girls are also diagnosed later, more often missed entirely, and more likely to camouflage the very traits these studies are trying to measure, which is precisely the phenomenon this whole piece is about. So it’s a reasonable question, not a stretch, to ask whether the cortisol and inflammation picture in late-diagnosed, heavily masking women like me would look any different if the research base weren’t built almost entirely on boys.

The inflammation picture tells a similar story: present, but not yet fully mapped.

Multiple studies have found dysregulated immune markers in Autistic people compared with non-Autistic controls.^[22][23] 

ADHD is murkier: one meta-analysis found IL-6 elevated in under-18 populations but no significant difference in CRP or several other markers, while a separate comparative analysis found ADHD associated with lower TNF-α levels, rather than higher.^[24]

This would suggest immune system dysregulation playing a part, but I’m not going to pretend that it’s settled science, it isn’t. Unsettled, contradictory literature is a different thing from a null result though. It’s also worth remembering how few of those studies looked at adult women in the first place.

None of this proves Autistic or ADHD people go on to develop more autoimmune disease as a result. That’s a much bigger claim. The best genetic evidence available doesn’t support a direct causal link between the two: a 2025 Mendelian randomisation study found no causal association between autoimmune diseases and neurodevelopmental disorders.^[25] 

What is well established, regardless of diagnosis, is the mechanism connecting chronic stress to autoimmune risk in general. Sustained HPA-axis activation drives cortisol and catecholamine dysregulation, which produces glucocorticoid receptor resistance, the point at which immune cells stop responding properly to cortisol’s anti-inflammatory signal, tipping the body toward chronic inflammation, shifting the immune response towards autoimmunity.^[26] 

So here’s the honest version of this argument: not “Autism and ADHD cause autoimmune disease”, the evidence doesn’t support that. But that a body running hot on cortisol and inflammation for years, which the data above shows happening to many Autistic and ADHD people. Especially those of us who’ve masked for most of our lives, is a body operating under exactly the conditions known to raise autoimmune risk in anyone.

Whether that risk is actually elevated in this population specifically hasn’t been properly studied, not helped by a research base that’s spent decades mostly looking at boys. And there’s a bitter irony sitting underneath even the incomplete picture we do have: an estimated 80% of the roughly 50 million people living with autoimmune disease in the US are women.^[27] Yet these conditions are still, on average, dismissed for years before diagnosis, in fact the average time it takes to receive an autoimmune diagnosis is 5 years.^[28] And it takes women on average 4 years longer than men for the same disease in over 700 conditions.^[29] Many patients are told their symptoms are “just stress” or anxiety and that tests appear “normal”.

Personally it took 6 years for my coeliac diagnosis and then a further 8 years for the Hashimoto’s diagnosis, yet TSH had been abnormal at the time of the coeliac diagnosis and antibodies that should have been checked were not, leaving me to struggle for a further 8 years. I went on to develop another 2 autoimmune diseases in the following 4 years, feeling like my life was slowly disappearing in front of my eyes.

This is the grim reality faced by so many women. I know now that the right diet and lifestyle can have a profound impact and have helped me get my out of control immune system back into the well regulated machine it should be. But medication, the right medication, has played a part too.

But it’s worth considering that the stress response itself may be a genuine part of the whole picture here, not a distraction from it.

So add this to the pile: the same women whose ADHD gets waved away as a hormonal blip. The same women whose menopause gets rebranded as overmedicalisation. These women are also the ones spending years being told their joint pain, fatigue or flare-ups are “in their head”, while the chronic stress of surviving undiagnosed for that long may be quietly raising the odds of the next diagnosis.

Why this matters beyond one documentary and one journal series

This isn’t really about ADHD or menopause individually.

It’s about a recurring reflex: when women finally get access to a diagnosis or a treatment that previous generations were denied, the cultural and medical response is disproportionately to ask whether we’re getting too much, rather than to ask why we went without it for so long.

The gender health gap backs this up at scale: the UK has the largest gender health gap in the G20, over half of women report their pain being dismissed by a doctor because of their gender, and less than 2.5% of publicly funded medical research goes to female-specific conditions.^[30]

Underdiagnosis and undertreatment are the well-documented, decades-long default. Overdiagnosis, when it’s raised for women’s conditions, gets a documentary and a journal series. When it’s raised for a condition affecting men, it stays in a trade publication most people will never read.

I’m not asking anyone to hand out ADHD diagnoses or HRT prescriptions without proper assessment, that would be its own kind of harm. I’m asking why the burden of proof, the media spotlight, and the word “overmedicalisation” only ever seem to land on women.

If you’re navigating this mess of hormonal imbalances, including thyroid, and experiencing likely ADHD and autism traits, and need help navigating it all, reach out to me at helen@helenmallaburn.com

References:

1. Channel 4, “The Great ADHD Myth?” — press release. channel4.com
2. “An empowerment model for managing menopause,” The Lancet (2023/2024 series). thelancet.com
3. Open letter to Channel 4 from ADHD UK. ADHD UK. https://adhduk.co.uk/wp-content/uploads/2026/08/ADHD-UK-Open-Letter-to-Channel-4.pdf
4. “Perimenopausal symptoms in women with and without ADHD: A population-based cohort study,” PMC. ncbi.nlm.nih.gov
5. “Menopause Symptoms Exacerbate ADHD in Women: ADDitude Survey,” ADDitude Magazine. additudemag.com
6. Chanel 4 letter responding to ADHD UK. ADHD UK. https://adhduk.co.uk/wp-content/uploads/2026/08/Channel-4-letter-responding-to-ADHD-UK.pdf
7. “Out of Touch on Menopause: Experts Respond to The Lancet’s ‘Over-Medicalization’ Claims,” Ms. Magazine. msmagazine.com
8. BBC Panorama: The Menopause Industry Uncovered. BBC. https://www.bbc.co.uk/programmes/m0023jdn
9. “How TV doctor’s clinic bounced back after hormone replacement therapy controversy” (Newson Health CQC ‘outstanding’ rating), The Independent. independent.co.uk
10. Bahn, S. et al., “Perceptions of healthcare provision throughout the menopause in the UK: a mixed-methods study,” npj Women’s Health. nature.com
11. “Antidepressants and Menopause,” The Menopause Charity. themenopausecharity.org
12. “Prevention and treatment of osteoporosis in women,” PMC / National Institutes of Health. pmc.ncbi.nlm.nih.gov
13. “Is the ‘male menopause’ overmedicalised?” Pulse Today. pulsetoday.co.uk
14. “What are ‘masking’ and ‘camouflaging’ in the context of autism and ADHD?” The Conversation. theconversation.com
15. “The impact of camouflaging autistic traits on psychological and physiological stress: a co-twin control study,” Molecular Autism. link.springer.com
16. “A review of rhythm and responsiveness of cortisol in individuals with autism spectrum disorders,” Psychoneuroendocrinology. pubmed.ncbi.nlm.nih.gov
17. “Enhanced Cortisol Response to Stress in Children in Autism,” PMC. pmc.ncbi.nlm.nih.gov
18. “The aetiological association between the dynamics of cortisol productivity and ADHD,” PMC. pmc.ncbi.nlm.nih.gov
19. “Hypothalamic-pituitary-adrenal axis activity and neurotrophic factors in drug-naive children and adolescents with ADHD,” Frontiers in Psychiatry. frontiersin.org
20. Attoe & Climie, “Miss. Diagnosis: A Systematic Review of ADHD in Adult Women,” SAGE. journals.sagepub.com
21. “Is There a Bias Towards Males in the Diagnosis of Autism? A Systematic Review and Meta-Analysis,” Neuropsychology Review. link.springer.com
22. “Correlation of biochemical markers and inflammatory cytokines in autism spectrum disorder (ASD),” BMC Pediatrics. bmcpediatr.biomedcentral.com
23. “Inflammatory Cytokines: Potential Biomarkers of Immunologic Dysfunction in Autism Spectrum Disorders,” PMC. pmc.ncbi.nlm.nih.gov
24. “Peripheral blood inflammatory markers in patients with ADHD: A systematic review and meta-analysis,” Journal of Psychiatric Research. sciencedirect.com
25. “Association between autoimmune disease and neurodevelopmental disorder: a Mendelian randomization analysis,” PMC. pmc.ncbi.nlm.nih.gov
26. “Chronic Stress and Autoimmunity: The Role of HPA Axis and Cortisol Dysregulation,” PMC / MDPI. ncbi.nlm.nih.gov
27. “Autoimmune Health Crisis: An Inclusive Approach to Addressing Disparities in Women in the United States,” PMC. pmc.ncbi.nlm.nih.gov
28. “Women, Autoimmune Disease & the Diagnosis Trust Gap,” Autoimmune Association. autoimmune.org
29. “The Gender Health Gap: Shocking Statistics You Need To Know,” The Women’s Organisation. thewomensorganisation.org.uk
30. “Medical misogyny: the cost of ignoring women’s health,” Women’s Budget Group. wbg.org.uk

There is an increased risk of low vitamin B12 levels with Hypothyroidism and/or Hashimoto’s thyroiditis.

This is something I was never told by my medical team, nor were vitamin B12 levels ever assessed despite all the typical symptoms of low levels, not until I insisted.

Yet on average 27% (some studies report up to 50%) of those with Hashimoto’s and/or Hypothyroidism also have low vitamin B12 levels, often due to Pernicious Anaemia. ⁽¹⁾

I suspect this may be a very conservative estimate as I feel the lower level for detection of vitamin B12 deficiency are set way to low. 

Many of my clients (and myself) experienced symptoms associated with vitamin B12 deficiency way above that lower cut off point. 

What is pernicious anaemia?

Pernicious anaemia is an autoimmune condition, much like Hashimoto’s, but in this case the immune system creates antibodies against the parietal cells in the stomach and against intrinsic factor. The parietal cells produce stomach acid to help you break your food down, so nutrients such as vitamin B12 can be extracted. They also produce intrinsic factor which binds to vitamin B12 and safely transports it to the far end of the small intestine where it can absorbed.

When antibodies are created against either parietal cells or intrinsic factor it impairs B12 absorption and eventually leads to deficiency.

What symptoms are associated with low vitamin B12 levels?

There are a multitude of symptoms and can be broken into the following categories ⁽²⁾

Neurological

• Paresthesia: abnormal sensation, typically tingling or pricking (‘pins and needles’)
• Numbness in hands and feet, reduced skin sensation
• Impaired fine finger movement
• Ataxic gait (unsteady, staggering gait)
• Balance problems/loss of sense of position
• Reduced or absent reflexes
• Clumsiness/lack of coordination
• Aphasia (problems with speaking, writing, reading)
• Sensory loss (loss of taste, smell or hearing)
• Positive Romberg sign (unable to maintain balance with eyes closed)
• Burning legs and/or feet
• Lhermitte’s sign (electric sensation that travels down your neck and back)
• Blurred vision

Neuro Psychiatric and Psychological

• Memory and concentration problems
• Dementia, confusion
• Brain fog/decreased mental concentration
• Irritability, emotional lability
• Personality changes, mania, paranoia
• Depression
• Psychosis, delirium, paranoia

Aneamia

• (Extreme) Fatigue
• Shortness of breath
• Dizziness/feeling faint/vertigo
• Postural hypotension (drop in blood pressure upon standing)
• Pallor

Gynaecological and Urological

• Infertility
• Loss of libido/impotence
• Menstrual problems/pains
• Incontinence
• Cystitis, bladder inflammation, bladder infections
• Pyelonephritis (kidney infection)

Gastrointestinal

• Loss of appetite
• Glossitis (pain, redness, swelling in mouth and tongue) 
• Diarrhoea
• Weight loss
• Nausea, vomiting
• Stomach problems, heartburn, discomfort

Other

• Fever
• Sleep disturbance
• Tinnitus
• Hair loss/premature grey hair
• Brittle nails

Which symptoms tend to present first?

Neurological symptoms tend to be the first to occur. A recent study has highlighted this in the elderly. It showed that  participants with a vitamin B12 level lower than 408 pmol/L  exhibited the following: 

• Increased white matter hyperintensities (which are associated with functional decline, gait disturbances, depression, disruption of neural networks and cognitive problems) 
• Delayed nerve signalling
• Slower cognitive processing

I experienced all of the neurological symptoms, yet was told I could not possibly be deficient despite being smack bang on the lower cut off point, displaying all the symptoms and already being diagnosed with Hashimoto’s and Hypothyroidism. Yet as my blood work did not show anaemia (it had at various points in the past) I could not possibly be vitamin B12 deficient.

Aneamia is recognised as an end stage symptom of a vitamin B12 deficiency with neurological, metabolic and cellular related symptoms displaying much earlier. Yet guidelines are still set according to when aneamia presents as a symptom, by this point neurological symptoms could be permanent, as it can take 3-5 years to deplete levels far enough to display outright anaemia!

What is the current reference range?

Current NICE guidelines (UK) show the following levels ⁽³⁾

• Less than 133 pmol/L : Confirmed deficiency
• 133–258 pmol/L : Indeterminate; possible deficiency
• More than 258 pmol/L : Deficiency unlikely

Neurological symptoms are likely occurring in those with levels higher than 258 pmol/L which is the threshold to show a deficiency being unlikely. 

Total B12 tests vs Active B12 tests

One of the reasons that symptoms may be occurring above this level is that the standard test tends to be Total B12, this test measures both holo-transcobalamin (active B12) and holo-haptocorrin (inactive B12) and we can’t use the inactive portion. Another is that the level is set to detect anaemia, not neurological symptoms.

So it’s important if you suspect a vitamin B12 deficiency then you ask for holo-transcobalamin to be tested too not just Total B12 as the issues listed above were associated with low holo-transcobalamin when tested. 

What other tests might be useful?

If your levels fall below mid range or below the 408 pmol/L and you display symptoms or have Hashimoto’s and/or Hypothyroidism then ask for methylmalonic acid (MMA) and homocysteine to be measured too as they are early indicators of a B12 deficiency. 

Further research is needed

The research paper I quoted in the elderly calls for reference levels to be re-assessed. Further research also needs to be done in other age groups, as this is not just an issue that affects the elderly alone, I was 38 when I was diagnosed and had been struggling with symptoms for years!

My advice would be to get levels tested with Hashimoto’s and Hypothyroidism regardless, but especially if you’re experiencing any of the symptoms listed. From my experience a lot of the symptoms of Hashimoto’s and Hypothyroidism overlapped, so if in doubt ask to be tested.

Need further help?

If you’re struggling to work out what testing you need for vitamin B12 or any other potential nutrient deficiencies I offer 30 minute and 60 minute Test Interpretation Sessions, which include advice on which tests may be appropriate for you personally.

Please get in touch via email to discuss further at helen@helenmallaburn.com

If you already have test results and want to book to discuss them you can do so below:

30 Minute Test Interpretation Session – for simple testing such as nutrient deficiencies and Thyroid Panels, book here. Cost is €99.

60 Minute Test Interpretation Session – for more complex functional testing such as comprehensive stool analysis, hormone panels, genetic testing, etc, book here. Cost is €199.

You might also like to read my previous article on the impact of leaky gut on Hashimoto’s, as this can impact overall gut health and ultimately vitamin B12 and other nutrient absorption.

References:

1. https://pubmed.ncbi.nlm.nih.gov/36909313/
2. https://pernicious-anaemia-society.org/symptoms/
3. https://www.nice.org.uk/guidance/ng239