Could I have anemia

[APeter]

Hi there,

I'm a 27 year old male.

I was told by a poster on another forum to come here for advice because my symptoms sound like anemia. For a good portion of my life, but more so in the last 5 years, I've had symptoms of lethargy, weakness, feeling like my body doesn't "breathe" properly, paleness, feeling faint and weak and pale whilst lifting weights (body building), dizziness, disorientation, cognitive issues, fuzzy/ blurry vision (hard to focus eyes and when I look from one object to another I don't focus right away). etc. Basically 90% of the symptoms of either low folate, low b12, and low iron.

Most doctors I've seen in the past usually ask if I want to get my iron or b12 checked, I'm assuming because I show the classic symptoms of deficiencies of these nutrients. I'm very pale, even for a Scandinavian (I just look sickly and unwell) and have always been lightheaded and foggy. I would agree to the blood tests but since I never heard from them I guess my levels were normal. I was diagnosed with ADD-PI 2 years ago so maybe that's all it is?

I have the MTHFR mutation and so my methylation may not be optimal, and I responded with neurological brightening, energy increase, easier ability speaking clearly, marked visual sharpening (and instant accommodation, i.e. no more fuzziness and lack of focus when looking from one object to another as previously stated above), etc. to the following supplements: SAM-e, TMG, Methylb12, and possibly methylfolate. I was actually quite floored vitamins could make this much of a difference for me as I assumed my symptoms were all just psychological or something (I do have dysthymia and anxiety issues).

Also, my Mother has told me my Grandfather had RBC issues, but doesn't know the specifics. She thinks it runs in the family, as her and her sister are on the borderline and supplement with b12.

I had my b12 and ferritin blood levels tested, and here were the results:

B12: 306 pmol/L ( >133)

Ferritin: 64 ug/L ( 25 - 200)

It looks normal to me. My doctor didn't say anything. Is it possible that I have some kind of anemia even though my levels are normal? Should I explore further and test for folate? Any advice?

Thanks!

[pvanderaa]

There is such a thing as a hidden deficiency if the B12 levels are below 400 pg/ml. An active B12 test rather than all B12 might identify a cell adsorption issue.

Also testing for high homocysteine and methylmalonic acid either in urine or blood is an alternate was to diagnose a B12 deficiency.

Also low testosterone levels can affect energy. This is typically an old man problem.

How about diet? Dairy or gluten give you any symptoms?

Just checking that you aren't vegan?

If you get your blood test results and post them, there are members here who can provide additional hints.

How about metals? Copper, iron, potassium? Do you take a daily multivitamin?

[APeter in reply to pvanderaa]

Hi, thanks for the reply :).

I am sure I have high homocysteine as TMG cleared my allergic stuffy nose substantially in a matter of hours. This improvement has maintained.

My testosterone is normal maybe a little low for my age (around 300). I'm not vegan. I've been tested for food allergies and not allergic to dairy or gluten. I will consider cutting them out to see if I improve.

I have high aluminum and arsenic from a hair mineral analysis. The regimine of supplements I'm on has caused eye twitching so I'm wondering if that's a detox response ?

I take a B-complex and a slew of other vitamins/minerals. Potassium and magnesium should be covered with the daily electrolytes I take.

[Gambit62 Administrator]

The measurements you quote above are measures of markers of potential causes of anaemia - and they won't tell you if you actually have anaemia - to do this you would need to have a full blood count.

Ferritin is a protein that binds to iron allowing the body to use it - low iron is one reason why it can below but is not the only reason. The type of anaemia caused by iron deficiency results in smaller red blood cells.

Low levels of B12 and or folate (B9) can cause a different type of anaemia - macrocytic - in which the blood cells are larger than normal. However, anaemia isn't present in 30% of those that have a B12 deficiency and it certainly isn't the only thing that causes the symptoms of B12 defiency.

If both iron and B12/folate deficiencies are present then interpreting a full blood test gets a bit more tricky.

MTHFR affects processing of folate more than it affects B12 but as the body needs folate to process and uses folate and B12 together problems with folate will have an impact on how your body processes and uses B12. Do you know if you are homozygous (2 copies) or heterozygous. The mutation affects processing more if you are homozygous. I take it that the symptoms resolved when you were using the supplements which did include one form of B12.

[APeter in reply to Gambit62]

Here is my CBC. The biggest issue that stands out is possible kidney dysfunction, however I've been supplementing with creatine for my workouts and I think that would lead to a higher creatinine number, which would give a false positive diagnosis. I see my endo in a couple weeks and will discuss this further. Everything else looks normal.... I guess it's not anemia ?

WBC

: 6.1 (4.0 - 11.0) x E9/L

RBC

: 5.28 (4.50 - 6.00) x E12/L

Hemoglobin

: 152 (135 - 175) g/L

Hematocrit

0.450 (0.400 - 0.500) L/L

MCV

85 (80 - 100) fL

MCH

28.8 (27.5 - 33.0) pg

MCHC

338 (305 - 360) g/L

Platelets

284 (150 - 400) x E9/L

RDW

13.3 (11.5 - 14.5) %

***Differential

WBC

Neutrophils 3.2 (2.0 - 7.5) x E9/L

Lymphocytes

2.0 (1.0 - 3.5) x E9/L

Monocytes

0.6 (0.2 - 1.0) x E9/L

Eosinophils

0.1 (0.0 - 0.5) x E9/L

Basophils

0.0 (0.0 - 0.2) X E9/L

***General Chemistry

Creatinine

104 (67-117) umol/L

Glomerular Filtration Rate (eGFR)

84

**** An eGFR from 60-89 ml/min/1.73 m2 is consistent

with mildly decreased kidney function. However, in the absence of other evidence of kidney disease, eGFR values in this range do not fulfill the KDIGO criteria for chronic kidney disease. Interpret results in concert with ACR measurement. KDIGO 2012 guidelines highlight the importance of eGFR and urine albumin creatinine ratio (ACR) in screening, diagnosis and management of CKD. Results for eGFR should be interpreted in concert with ACR.

Urate

364 (230-480) umol/L

Albumin

45 (35-52) g/L

Alanine Aminotransferase

32 (<50) U/L

Aspartate Aminotransferase

29 (<35) U/L

***Thyroid Function

Thyroid Stimulating Hormone [TSH]

1.14 (0.32-4.00) mIU/L

***Pituitary Function

Follicle Stimulating Hormone [FSH]

1.1 (1.0-8.0) IU/L

Luteinizing Hormone [LH]

3.6 (1.0-7.0) IU/L

Prolactin

7.1 (4.0-19.0) ug/L

***Adrenal Function

Cortisol AM 341nmol/L

Cortisol PM

163 nmol/L

Reference interval AM: 135-537 nmol/L

PM: up to one-half of

patient's AM value.

***Reproductive and Gonadal

Testosterone

12.5 (8.4 - 28.8) nmol/L

Testosterone Bioavailable

5.7 (3.6 - 11.2) nmol/L

[APeter]

Hi, I am heterogeneous for MTHFR. I take methylfolate and methylb12. The thing is if appears I don't have a b12 deficiency.

The symptoms that have improved the most with the methylation support are more characterized by neurological brightening of sorts, as opposed to fatigue relief, which I'm not getting like I did my first few days on TMG

[Gambit62 Administrator in reply to APeter]

on the face of it it doesn't look as if you actually have anaemia on the blood tests above - however, I'm not a medic but if your GP hasn't mentioned anaemia in relation to the above then anaemia looks unlikely.

B12 deficiency isn't as simple as anaemia - and the anaemia in 'pernicious anaemia' is an historical thing and often not very helpful. 30% of people with B12 deficiency present with symptoms other than macrocytic anaemia long before they present with anaemia.

Heterozygous for MTHFR will reduce your ability to methylate B12 a bit and your ability to methylate folate a bit - it won't stop it completely - think it generally reduces B12 by about 20%. That means that you may be deficient at the cell level in respect of methylcobalamin - one of the 2 forms of B12 used at the cell level - so you may still have a B12 deficiency but one that is operating at the cell level not at the level of getting the B12 into your blood. The symptoms of folate deficiency and B12 deficiency overlap a lot because they are used together for a lot of things in the body. MTHFR affects methylation of folate a lot more than it does B12 so possible that what you are experiencing is much more to do with folate than B12.

Another possibility is that there are actually 2 forms of B12 used at the cell level - methyl and adenosyl. Whilst most people have no problems converting methyl to adenosyl there are some documented cases of people who have had problems so it may be worth trying some adenosyl cobalamin as well as methyl and see if that works with the fatigue any better.

[APeter in reply to Gambit62]

Wow this whole thing has been so confusing for me to understand and you just explained it all so clearly; I definitely have a better idea of this now. I really, really appreciate that ;).

I am currently supplementing with methylfolate at well. I have 1000 mcg pills but have stopped that recently because I just added a B-complex with the same amount of L-Methylfolate. As I continue to titrate my methylb12 however from 1000 mcg up to 5000, I will probably take an additional methylfolate pill daily.

With that said, do you know a good ratio of methylfolate to methylb12. Should it be 1:1?

I will look into adenosyl b12 for sure... I'm also probably going to take IRON since my MCV and ferritin are on the low side?

[Gambit62 Administrator in reply to APeter]

Please talk to your GP about supplementing iron - whilst folate and B12 are things that you can't 'overdose' on, you can overdose on iron. Ferritin is only one indicator of an possible iron based anaemia and your full blood count doesn't seem to be pointing to an iron based anaemia.

Can't give you a ration for folate to B12 -it's going to vary so much from person to person and I'm really not an expert in MTHFR ... and think that probably goes for a lot of people who claim that they are. Not convinced at all by the methyl is best argument - not least because it overlooks the fact that there are two forms of B12 used at the cell level. An alternative to using methyl would be to use hydroxo/cyano - both of which can be converted to either methyl or adenosyl ... but just that you would need slightly higher doses than someone who doesn't have MTHFR - possibly by 25%if you are heterozygous.