Low folate and b12, GP now checking vit D?

[helenemma]

Been feeling generally unwell and exhausted for months. More recently problems with memory, headache, blurred vision, tingling and numbness in hands, occasionally unsteady on feet, angular chellitis, restless legs. Had bloods done this week. Not seen GP after but office staff have said I need further bloods to check vit D and prescription for ferritin. Returned for bloods today. Phlebotomist said B12 was 190 (170-1000) and folate 2.3 (2.7-15). My question is why is GP checking vit D and what should I expect GP to suggest for treatment as only folate is below 'normal' levels even though B12 is very much at lower end of range.

[clivealive Forum Support]

Hi helenemma

Lower level Vitamin D deficiency can lead to a number of non-specific symptoms, including possibly chronic fatigue (experts have for many years noted an association between sufferers of chronic fatigue syndrome or myalgic encephalitis (CFS or ME) and low blood levels of Vitamin D).

It has been estimated that between 50-70% of people living in the northern Europe (where daylight length reduces your chances of receiving adequate sunlight in the winter) are deficient in this vitamin by March each year.

Symptoms of vitamin D deficiency include chronic pain, weak bones, frequent infections (recent research has detected an association between vitamin D deficiency and severe pneumonia), depression and fatigue.

You are Folate deficient and your doctor may well want to treat you for this.

Symptoms of a folate deficiency can include:

symptoms related to anaemia

reduced sense of taste

diarrhoea

numbness and tingling in the feet and hands

muscle weakness

depression

Folic acid works closely with vitamin B12 in making red blood cells and helps iron function properly in the body and your B12 levels are "bumping along the bottom" of the range.

I am not a medically trained person but I've had Pernicious Anaemia (a form of B12 deficiency) for more than 46 years.

I wish you well.

[helenemma in reply to clivealive]

Thanks for your speedy reply. Would a B12 of 190 warrant treatment in view of my symptoms? As the symptoms of folate deficiency and B12 deficiency are so similar how is it known which is the cause when both are low?? Thank you.

[clivealive Forum Support in reply to helenemma]

It may be that your doctor wants to "rule out" Vitamin D as being the cause of your symptoms.

Symptoms of B12 deficiency tend to develop slowly and may not be recognised immediately. As the condition worsens, common symptoms include:

Weakness and fatigue

Light-headedness and dizziness

Palpitations and rapid heartbeat

Shortness of breath

A sore tongue that has a red, beefy appearance

Nausea or poor appetite

Weight loss

Diarrhoea

Yellowish tinge to the skin and eyes

If low levels of B12 remain for a long time, the condition also can lead to irreversible damage to nerve cells, which can cause the following symptoms:

Numbness and tingling in the hands and feet

Difficulty walking

Muscle weakness

Irritability

Memory loss

Dementia

Depression

Psychosis

The British Society for Haematology guidelines say on the Diagnosis of B12 and Folate Deficiency "In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment".

google.co.uk/url?sa=t&rct=j...

Although "within range" your B12 level is very low - together with your Folate deficiency suggests that your doctor should be addressing them.

Make a list of your symptoms and present this to your doctor and ask him to treat you according to your symptoms and (perhaps) even start you on loading doses "until there is no further improvement" according to the N.I.C.E guidelines below. Click on the link, then on "Scenario: Management" and scroll down to "Treatment for B12 deficiency"

google.co.uk/url?sa=t&rct=j...

If possible take someone with you who can validate your neurological symptoms as the doctor is less likely to pooh pooh you in front of a witness.

Please remember I am not medically trained.

[helenemma in reply to clivealive]

Thank you. My vit D is apparently normal. Not seen GP yet (was told routine and within next 3 weeks) but receptionist said GP had made a note to say I need ferritin and no mention of folate or vit B12. I cant see that my low results are diet related as I'm not vegetarian and eat a fairly balanced diet. Should the cause of my low results be investigated further? Cant help feeling I'll be given prescription for ferritin and dietary advice only. My memory problems and numb hands in particular are really concerning me and am anxious that I have a problem that will not be addressed and potentially get worse. Thanks in advance.

[clivealive Forum Support in reply to helenemma]

This is the dilemma that your doctor has addressed as the symptoms of a low ferritin level mirrors many of those of a B12 and/or Folate deficiency.

unexplained fatigue.

dizziness.

chronic headaches.

unexplained weakness.

ringing in your ears.

irritability.

leg pains.

shortness of breath.

Hopefully when you start the supplements your symptoms will improve.

[helenemma in reply to clivealive]

Sorry I'm confused - when you say this is the dilemma my GP has addressed do you mean its reasonable to just give me a prescription for ferritin and do nothing further with a folate level of 2.3 and vit B12 of 190 considering the symptoms I'm having? Sorry if I've misunderstood!

[clivealive Forum Support in reply to helenemma]

No ! it's my Bad ! I missed the Folate Deficiency. All three need addressing.

Anyone at any age, can become B12 deficient. However, certain people are at an elevated risk. They include the following:

Vegetarians, vegans and people eating macrobiotic diets.

People aged sixty and over

People who’ve undergone any gastric and/or intestinal surgery, including bariatric surgery for weight loss purposes (Gastric bypass).

People who regularly use proton-pump- inhibitors. H2 blockers, antacids, Metformin, and related diabetes drugs, or other medications, or infections such as h-pylori that can interfere with B12 absorption.

People who undergo surgeries or dental procedures involving nitrous oxide, or who use the drug recreationally.

People with a history of eating disorders (anorexia or bulimia).

People with a history of alcoholism.

People with a family history of pernicious anaemia.

People diagnosed with anaemia (including iron deficiency anaemia, sickle cell anaemia and thalassaemia).

People with Crohn’s disease, irritable bowel syndrome, gluten enteropathy (celiac disease), or any other disease that cause malabsorption of nutrients.

People with autoimmune disorders (especially thyroid disorders such as Hashimoto’s thyroiditis and Grave’s disease) Type 1 diabetes, vitiligo, lupus, Addison’s disease, ulcerative colitis, infertility, acquired agammaglobulinemia, or a family history of these disorders.

Women with a history of infertility or multiple miscarriages.

You have ruled out the top one but can you see yourself among any of the other people.

Sorry about my above comment - must be the heat...

[helenemma in reply to clivealive]

No worries. So Ive seen GP today. She has prescribed ferritin and folate and to check bloods again in 3 months. I enquired regarding the low B12 but she replied its well within nomal limits (normal being 170 to 1000 so not what I would describe well within at 190). The only box I semi-tick would be possible IBS. I do often have bouts of loose stools in morning but no real other symptoms of IBS and have never had a diagnosis of this as such. GP did offer to do a stool sample to check for inflammation of bowel but stated it was highly unlikely to be in any way positive. Should I just take the ferritin and folate and and see how I go? Should I start taking B12 supplements? Should I push for any further investigation? Really concerned with the memory problems, numbness in hands and some visual disturbance. I understand these could be down to the folate deficiency but am worried the low B12 could be playing a part and have read that some neurological changes can be irreversible if not addressed. Thanks for your help and best wishes.

[clivealive Forum Support in reply to helenemma]

Please do start the folic acid and ferritin your doctor has prescribed.

If you are prepared to " go it alone" and supplement with B12 you will not do yourself any harm - the trouble being that when your bloods are re-tested in 3 months they may be sky high and your doctor will be even less likely to treat you.

Personally I use a Methylcobamalin B12 "Boost" spray (between my three weekly injections) which can be bought online or from well known health food stores. At the maximum dose of four sprays a day it will last about six weeks by which time you will know whether or not you feel the benefit or not.

Alternatively you could try to eat more B12 containing foods, meat, fish, eggs, seafood, poultry, dairy produce - together with leafy green vegetables for Folate - although of course your IBS may put a limit on this.

Please remember I'm not a medically trained person