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Ferritin/B12/folate/vitamin D

Taking 1x ferrous fumarate for iron deficiency. 5mg folic acid for folate deficiency. 800iu vitamin D for vitamin D deficiency. All on prescription. Results after supplementing. Thanks in advance.

Ferritin 23 (30 - 400)

Folate 4.1 (4.6 - 18.7)

Vitamin B12 251 (180 - 900)

25 hydroxy vitamin D2 <6

25 hydroxy vitamin D3 32.8

Total 25 OH vitamin D 32.8

(25 - 50 vitamin D deficiency. Supplementation is indicated)

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Zoe080 Oh, I've just got to get this out I'm afraid - I take it your doctor is stupid then? I really do despair sometimes at their lack of knowledge when even us Jo Publics can find the treatment guidelines!

Ferritin 23 (30 - 400) 1x ferrous fumarate for iron deficiency

As you have a diagnosis of iron deficiency, the treatment is supposed to be 1 x FF two or three times daily.

NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines)

cks.nice.org.uk/anaemia-iro...

Have a read through but this is the treatment:

How should I treat iron deficiency anaemia?

•Address underlying causes as necessary (for example treat menorrhagia or stop nonsteroidal anti-inflammatory drugs, if possible).

•Treat with oral ferrous sulphate 200 mg tablets two or three times a day. ◦If ferrous sulphate is not tolerated, consider oral ferrous fumarate tablets or ferrous gluconate tablets.

◦Do not wait for investigations to be carried out before prescribing iron supplements.

•If dietary deficiency of iron is thought to be a contributory cause of iron deficiency anaemia, advise the person to maintain an adequate balanced intake of iron-rich foods (for example dark green vegetables, iron-fortified bread, meat, apricots, prunes, and raisins) and consider referral to a dietitian.

• Monitor the person to ensure that there is an adequate response to iron treatment.

Take each iron tablet with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.

Ideally, as your ferritin is below range, an iron infusion would be best and that will raise your level within 24-48 hours whereas iron tablets will take months. You could ask your GP for one but you may not get it.

Ferritin needs to be half way through it's range.

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Folate 4.1 (4.6 - 18.7) 5mg folic acid for folate deficiency

Well, he got that right!

Vitamin B12 251 (180 - 900)

Do you have any signs of B12 deficiency b12deficiency.info/signs-an... If so pop over to the Pernicious Anaemia Society forum here on Health Unlocked for further advice, quotng these results, ferritin/iron information, and signs of B12 deficiency healthunlocked.com/pasoc

If not then you might want to increase your low B12 level as anything under 500 can cause neurological symptoms.

I have read (but not researched) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

And an extract from the book, "Could it be B12?":

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

That's good enough for me and I keep mine around 1000. Sublingual methylcobalamin lozenges are what's needed to supplement B12 yourself (5000mcg daily to start then when the bottle is finished take 1000mcg daily as a maintenance dose) along with a good B Complex to balance all the B vitamins.

**

Total 25 OH vitamin D 32.8 800iu vitamin D for vitamin D deficiency.

You are just above the NICE Clinical Knowledge Summary level for Vit D Deficiency. Ask your GP if he will treat you for this with loading doses as per the Summary, your local area guidelines which he may refer to should be similar

cks.nice.org.uk/vitamin-d-d...

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

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

When the loading doses are finished you will need to achieve the level recommended by the Vit D Council which is 100-150nmol/L.

If your GP insists on continuing to prescribe 800iu daily this wont be enough, so you can ask on the forum for guidance at that time.

Once you've reached the recommended level a maintenance dose will be needed which may be 2000iu daily, it's trial and error which is why it's recommended to retest once or twice a year to stay within the recommended range. You can get a private fingerprick blood spot test from City Assays vitamindtest.org.uk/index.html

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Ok will go back to GP about results thanks

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How long have you been supplementing for? Your levels are all very low. How much iron is in your ferrous fumerate tablet? You need to take about 80-100mg a day - make sure you take it with 1000mg of vit c (to aid absorption and reduce constipation) and ideally on an empty stomach as lots of foods (particularly calcium) affect absorption of iron.

Your vit d supplement is way too low - it's a maintenance dose, not a loading dose. See below for NICE recommendations on loading doses, which you might want to show to your GP:

"For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders.

Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

Your B12 is low but probably not low enough for GP to do anything about it. If you are getting symptoms of B12 deficiency, you may want to get some further tests done privately eg active B12, MMA and homocysteine, anti-parietal cell/anti-intrinsic factor antibodies, to try to rule out pernicious anaemia (have a look at the PA forum on health unlocked) before supplementing as the tests can be skewed if you supplement. Otherwise, think about supplementing 5000mg a day - lots of people on here use a lozenge as it is more easily absorbed such as Jarrows.

Continue with the folate supplement. Think about adding a b complex - I've read on here that you need to balance the b vits when you supplement with b12 but I've not read/seen evidence of this - perhaps someone could post a link?

I can see from your other post that you've just been diagnosed and your GP has put you on 25mcg levo, which is the starting dose for older people - if you are not elderly, then the GP should have put you on 50mcg - I would go back to them and ask for an increase now and then retest in 6 weeks. I suspect you might have some trouble with your GP so I would arm yourself with info for the next conversation. You need to be aiming for your TSH to be below 1 and your T3 and T4 in upper third of range - get the BMJ book - Managing Thyroid Disorders as a start.

You need to be aiming for most vits to be mid range (not just in range), B12 at about 1000 and vit about 100. You need ferritin to be mid-range otherwise levo doesn't work properly.

Sure others will be on to add to this!...

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Iron is 210mg per tablet, positive intrinsic factor antibodies and supplementing for 4 years

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OK - I am pretty sure that means you have pernicious anaemia and should be receiving vitamin B12 injections. Please go to the Pernicious Anaemia forum for more advice on this - there can be serious and permanent effects for not receiving proper treatment for PA.

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210mg should be enough with vit c and away from other foodstuffs for low ferritin, but if you have iron deficiency anaemia then it should be more than that as seasidesusie has said above.

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Your GP seems determined to "under-treat" you.

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Zoe080 - the iron tablet says 210mg but the amount of actual elemental iron will be about 65mg-70mg

From the Patient Information Leaflet medicines.org.uk/emc/medici...

Each Fersamal tablet contains 210mg ferrous fumarate which approximates to 65-70mg of elemental iron- reference: (1) Goodman & Gilman's The pharmacological Basis of Therapeutics, 10th Edition, page no. 1499 (2) BNF

Recommended Doses:

(a) Iron Deficiency anaemia: 100 to 200mg elemental iron per day- [reference 1) BNF (2) G&G]. This equates to Fersamal 1 tablet two or three times a day.

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