Help with supplements please

Hi I am taking 800iu D3 since 2013, ferrous fumarate 3 times a day since 2013. Current symptoms are dry skin, pain and swelling in front of neck, hair loss, feeling colder, muscle cramps/spasms, sores on and in mouth, loss of concentration, weight gain, puffy areas on feet, irregular periods but when they come they are heavy, bruising more easily so any ideas what to do next please? Thank you

May 2017

Ferritin 17 (15 - 150)

Folate 2.3 (2.5 - 19.5)

Vitamin B12 197 (180 - 900)

Total vitamin D 40.5 (25 - 50 deficiency)

Haemoglobin 116 (115 - 150)

Iron 6.5 (6 - 26)

MCV 74.8 (80 - 98)

14 Replies

Has GP given you supplement for D3 deficiency? I am on six week corse of 25000iu twice a week. Blood test when finished then endo recommends 2000iu a day. Your supplement is very low. Look up Nice guidelines for Vit D defficiency.

I have been on D3 of 800 IU since 2013 is this not correct? Thanks

If you are D3 deficient you need an immediate massive dosing to get you above 75 then a maintenance of 1000 or more. This is NHS guidelines and even my Gp who normally will give nothing has given me this huge boost. After 6 weeks of this you have another blood test. 800 will take forever what did GP say about your low result?

GP just said he will test at end of the year and yes diagnosed vitamin d deficient

Shona3 I really do wonder sometimes what doctors keep between their ears, because some of them certainly don't seem to have a brain! Has your GP never mentioned that your levels haven't improved since supplementing?

I am assuming that these results are recent and my reply reflects that.

Ferritin 17 (15 - 150)

MCV 74.8 (80 - 98)

Ferrous fumarate 3 times a day since 2013.

Dire ferritin and iron deficiency anaemia. You need to ask your GP why, after 4 years of supplementing, are your results still this bad.

I would ask for an iron infusion which will raise your ferritin level within 24-48 hours.

Are you under a haemotologist? Have you been tested for Coeliac disease? Any other investigations? Is your doctor following the guidelines for iron deficiency anaemia?

NICE Clinical Knowledge Summary here - you can Google for local guidelines which should be similar - and see whether your doctor is doing what should be done. If not, tell him you wish to have the further investigations and be treated appropriately.

Are you taking each iron tablet four hours away from thyroid meds and two hours away from any other medication and supplements as is necessary as it affects their absorption? If not you need to do so.

Are you taking each iron tablet with 1000mg Vit C to aid absorption and help prevent constipation? If not you need to do so.

Ferritin needs to be at least 70 for thyroid hormone to work and T4 to T3 conversion to take place.


Folate 2.3 (2.5 - 19.5)

Vitamin B12 197 (180 - 900)

What has been said about your folate deficiency and very low B12? If nothing, then point these out.

Check for any signs and symptoms of B12 Deficiency here list them and show your GP if you have any.

You could pop over to the Pernicious Anaemia Society forum here on Health Unlocked for further advice. Post these results, any signs of B12 Deficiency, plus your ferritin/iron information. They may advise asking to be tested for Pernicious Anaemia, if so don't take any supplements for folate and B12 until after testing.

Folate should be at least half way through it's range and B12 should be at the very top of it's range, even 900-1000 for us Hypos.

When taking any supplements for B12 we need a B Complex to balance all the B vitamins.


Total vitamin D 40.5 (25 - 50 deficiency)

As you can see, you are still deficient despite supplementing for four years. The reason for this is because the dose you have been given isn't even a maintenance dose for someone with a reasonable level to start with. Maintenance doses generally are around 1000-2000iu daily.

The recommended level for Vit D is 100-150nmol/L according to the Vit D Council.

You would be better off just buying your own D3 softgels like these and take 5000iu daily for 6 weeks then reduce to 5000iu alternate days. Retest after 3 months, privately if necessary with City Assays

When you've reached the recommended level, your maintenance dose may be 5000iu alternate days, or you may need less, it's trial and error which is why it's recommended, when supplementing with D3, to retest once or twice a year to keep within the recommended range.

When taking D3 there are important cofactors needed

D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds

Thanks for reply GP has made no mention my levels haven't improved and results were done a month ago. No longer under haematologist and haven't been tested for coeliac. Is it likely I have it? No other investigations. I take iron 4 hours away from thyroid meds and I take them with vitamin c

Coeliac is just one of the tests mentioned in the iron deficiency treatment guidelines, have a read through and see what your doctor should be doing then you can ask him to arrange for them to be done.

Print Nice guidelines and go back and insist you are given high dose supplement. It is disgraceful to leave you deficient since 2013! Vit D does all sorts for the body . I have much better skin after 4 weeks of supplement hair not so dry and nails beginning to grow. Be strong go and ask for proper supplement supported by NICE guidelines. Let us know how you get on good luck.

Unfortunately the NICE Clinical Knowledge Summary guidelines don't consider 40.25 to be Deficient, they consider it to be Insufficient

"Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.

Treat for vitamin D insufficiency if serum 25(OH)D levels are in the range of 30-50 nmol/L "

and for Insufficiency they state

"For the treatment of vitamin D insufficiency, maintenance doses should be started without the use of loading doses."

Each Health Authority will have it's own guidelines and most are very similar to the NICE Clinical Knowledge Summary, so it's very likely that Shona's GP is already following guidelines and can only prescribe 800iu, but she can Google for her own area's guidelines to check.

Mmmm mine was 39 and my GP said guidelines state large doses if under 75. Maybe we are in different units?

I doubt it, normal unit of measurement in UK is Nmol/L and recommended level is 100-150.

It's most likely different area health authorities, they have their own guidelines, the NICE Clinical Knowledge Summary is just that, a summary, it's not set in stone.

Sorry was diagnosed vitamin d deficient in 2013 hence why given vitamin d 800iu

Yes but 800iu isn't even a maintenance amount you need a LOT more.

Look at Vitae's D council link for health professionals.

The Vitamin D Council recommends maintaining serum levels of 50 ng/ml (equivalent to 125 nmol/L*), with the following reference ranges:

Deficient: 0-40 ng/ml (0-100 nmol/l)

Sufficient: 40-80 ng/ml (100-200 nmol/l)

High Normal: 80-100 ng/ml (200-250 nmol/l)

Undesirable: > 100 ng/ml (> 250 nmol/l)

Toxic: > 150 ng/ml (> 375 nmol/l)

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