gp visit

[jazzanne]

Hi all , my gp apt yesterday with my son (age 22 )was abit of a waste of time she said all his bloods are normal and too try and eat more cereal , his serum folate was 4.4 (range 4.6 - 18.7) Active B12 28 (range 25.1 - 165 ) ferritin 165 (range 30-400) .x these blood ranges are from a private lab

[Gambit62 Administrator]

folate is low which isn't going to help with B12 absorption. Cereals tend to be fortified with additional folate - and some with some B12 but ... sounds like you had a bit of a chocolate teapot experience.

What are your son's symptoms? Sorry if that is in an earlier post of yours. If they include neurological problems then you could try quoting the BCSH guidelines at GP or ask for a referral to a haemotalogist/neurologist.

Unfortunately GPs just don't get that interpreting purely on the basis of test results isn't going to do the trick - let alone having any understanding of problems with the test ranges.

Although it is best to try and get a diagnosis before supplementing things can be so loaded against getting a diagnosis that you may need to take things into your own hands and try things out for yourself.

I presume that thyroid problems have been ruled out for your son as I note from your profile that you seem to have thyroid problems. It could always be that both are actually going on.

[jazzanne in reply to Gambit62]

The GP did mention testing his thyroid , will it be a tsh test or should they do all the thyroid test t3 etc , he was really unwell a few weeks ago with every syptom of b12, but after much rest and medication for Vit D def. he seems abit better but still tires easily

[Gambit62 Administrator in reply to jazzanne]

Sorry - I can't help with the thyroid - posting on the thyroid community might be more use though there are a number on here who do know about thyroid.

Good that the VitD helped ... though guess the deficiency might be indicative of a general absorption problem ... although most vitD comes from sunlight some does come from food, I think.

[jazzanne in reply to Gambit62]

what do you think is the best test to indicate a absorbtion prob MMA or homocysteine

[Gambit62 Administrator in reply to jazzanne]

both are tests to help clarify if there is a B12 deficiency when results aren't clear - which is probably most of the time. Neither actually tells you if there is a problem with the gut - you would probably need a referral to a gastrologist or the like - someone who specialises with problems in the gut.

[Polaris in reply to jazzanne]

The MMA is more specific to B12 deficiency. High homocysteine is linked to other diseases too, eg. Thyroid.

[jazzanne in reply to Polaris]

thanks , and thanks for your email x

[fbirder in reply to jazzanne]

You're more likely to get the GP to agree to the MMA test. The homocysteine test is complex and the sample needs to be analysed within 2 hours of being taken.

When I last saw my GP I showed hime the BMJ artice that mentioned the two tests and how I realised that the homoCys test was complex, so I'd just have the MMA. He agreed immediately.

[jazzanne in reply to fbirder]

how did your MMA test turn out, and what do you think about the Intrinsic Factor antibodies test, ?

[jazzanne in reply to fbirder]

plus does this test show your not absorbing B12 ?

[fbirder in reply to jazzanne]

I'm still waiting for my MMA and active B12 results.

The MMA test is a good indicator as to how well your B12 is doing its job. A high value shows that B12 isn't working properly. That could be down to low overall blood levels, low active B12 or other, unknown reasons.

[jazzanne in reply to fbirder]

if b12 is not working should you get injections ?

[fbirder in reply to jazzanne]

You really need to find the cause. It could be

Low B12 in the diet.

Nitrous Oxide abuse.

Stomach surgery.

Infection with Helicobacter pylori.

Autoimmune gastric atrophy.

If the first three can be ruled out then you're best bet is to have a test for anti-intrinsic factor antibodies and a referral to a gastroenterologist.

[jazzanne in reply to fbirder]

do you think anti-intrinsic factor is better than a MMA test if the first 3 are ruled out.

[jazzanne in reply to fbirder]

my son was on the powerful drug acutane for his skin a few years back , i was reading up on it, it says A statistically significant decrease was detected in post-treatment vitamin B12 and folic acid levels (P < 0.05).

[fbirder in reply to jazzanne]

There's a difference between statistically significant and medically significant. A drop from 278 to 255 isn't going to make much difference medically. So I'd be surprised if it were responsible.

[jazzanne]

thanks for your help x

[Polaris]

Does anyone know why replies come out without paragraphs and cannot be edited?

I've just tried yet again to reply and cannot edit ! I have messaged you.

[Sleepybunny]

Hi,

Has the GP asked for a fbc (Full Blood Count) test? there can be useful clues on this. High MCV and high MCH can indicate the possibility of a macrocytic anaemia.

patient.info/health/full-bl...

patient.info/doctor/macrocy...

[helvella]

Struth! "Eat more cereal" is precisely why we need to be wary of fortified foods.

Some companies, sometimes, add small amounts of certain vitamins/minerals to some of their products. And in no time what is supposed to be bona fide medical advice becomes "Buy more of these companies' products". Not even (apparently) identifying those which are appropriately fortified.

Also seemingly ignoring the high sugar and carbohydrate content of many cereals.

We can also see artefactually raised levels in tests of those things that are added to foods. Instead of seeing a nice, clear "deficient" result to a test, we see a fudged borederline result because of the minor level of supplementation provided by the fortified food. So, "woefully indequate but not low enough to be overtly deficient" becomes a common state.

Consuming increasing quantities of cereals does not, to me, seem the best way of ensuring adequate folate and B12 intake. Gambit62 has already given good advice.

[Polaris in reply to helvella]

Especially, as the extra folic acid fortification in them can mask B12 def,