Ferritin etc

[Leah25]

Ferritin 21 (30 - 400)

Folate 3.6 (4.6 - 18.7)

Vitamin B12 190 (180 - 900)

Vitamin D 25.8 (25 - 50 deficient)

Taking 800iu vitamin D and 210mg ferrous fumarate. Thanks

[Nanaedake]

How long have you been supplementing with vitamin D and ferrous fumerate because as you can see you are still very deficient. What has your GP said about these and what is your GP doing about it?

Folate is also too low and B12 is only just in range and much too low. Please post your B12 and folate results on HealthUnlocked Pernicious Anaemia forum for best advice on B vitamins.

[Leah25 in reply to Nanaedake]

Supplementing vitamin D since 2014 and ferrous fumarate since 2015. GP monitors my ferritin and complete blood count every 3 months. Will go to the other forum.

[SeasideSusie Remembering]

Leah25 This is part of your problem, these results are dire, you're not being treated properly for them, and thyroid hormone can't work until they are optimal.

Ferritin 21 (30 - 400)

210mg ferrous fumarate

As your ferritin level is below range, did you have an iron panel and full blood count done to see if you have iron deficiency anaemia? If not ask for them to be done, if you have been diagnosed with it then the treatment is 3 x ferrous fumarate daily.

For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range. As your level is below range, ideally you need an iron infusion so ask for one, but you may only be prescribed the tablets which will take months to raise your level whereas an infusion will raise your level within 24-48 hours.

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.

You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

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Folate 3.6 (4.6 - 18.7) Vitamin B12 190 (180 - 900)

You are folate deficient with very low B12. Do you have any signs of B12 deficiency b12deficiency.info/signs-an... You should post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc Quote your Folate, B12 and Ferritin results, iron deficiency information if you have been tested and diagnosed, and any signs of B12 deficiency you may be experiencing. You may need testing for Pernicious Anaemia and you may need B12 injections.

I have read (but not researched so don't have links) 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?" by Sally M. Pacholok:

"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."

Folate should be at least half way through range. If your GP prescribes folic acid for your folate deficiency, don't start taking it until other investigations for possible Pernicious Anaemia have been carried out.

You need to ask your GP why these results have been ignored. You may be told that B12 is in range, but there is no excuse for ignoring your folate deficiency, that is pure negligence.

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Vitamin D 25.8 (25 - 50 deficient)

Taking 800iu vitamin D

You are 0.8 away from severe deficiency and 800iu D3 isn't going to ever raise your level. It is hardly a maintenance dose for someone with a reasonable level.

You need loading doses. Check NICE treatment summary for Vit D deficiency:

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)."

Each Health Authority has their own guidelines but they will be very similar. Go and see your GP and ask that he treats you according to the guidelines and prescribes the loading doses. Once these have been completed you will need a reduced amount (not the paltry 800iu) to bring your level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and then you'll need a maintenance dose which may be 2000iu daily (not 800iu), it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

There are important cofactors needed when taking D3

vitamindcouncil.org/about-v...

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

naturalnews.com/046401_magn...

Check out the other cofactors too.

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These deficiencies are most likely caused by gut/absorption problems which tend to go hand in hand with Hashi's which we know from your other thread that you have. SlowDragon will post more information and links about this when she is around.

[Leah25 in reply to SeasideSusie]

Thanks complete blood count and iron panel showed iron deficiency anaemia and the GP is not treating me correctly for this. I will go to the other forum now.

[SeasideSusie Remembering in reply to Leah25]

You need to ask your GP to treat you correctly for iron deficiency anaemia, and ask why he didn't do it in the first place.

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...

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.

You may not get a reply on the other forum until tomorrow as it's so late now.