Supplement advice please

Hi here are results of vitamins and minerals, despite supplementing for a number of years I feel no improvement and have noticed no improvement either. Iron infusion done May 2016, results all done a month ago. Folic acid started January 2017. B12 started 2015. Vitamin D 800iu started 2012. Thanks

Ferritin 48.2 (30 - 400)

MCV 78.2 (80 - 98)

MCHC 381 (310 - 350)

Iron 12 (6 - 26)

Transferrin saturation 16 (10 - 30)

Folate 2.3 (2.5 - 19.5)

Vitamin B12 331 (190 - 900)

Vitamin D 33.5

7 Replies

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  • Just a guess here. If you've been hypo a long time sometimes our stomach is not producing acid to assist in metabolising thyroid meds and nutrients. This happened to me.

    Recent blood tests showed everything low despite taking same thyroid dose of meds and supplements. I started taking HCL Betaine with pepsin - has to be with pepsin. One tablet halfway through a meal.

    Alternatively you can take apple cider vinegar - start with one teaspoonful in a full glass of water before mainly protein meals. You can increase to one tablespoon.

    My blood tests are now back to where they should be.

  • Thanks I was diagnosed Hashimotos in 2014. I will look at the apple cider vinegar and betaine.

  • Echo2

    Ferritin 48.2 (30 - 400) Iron infusion done May 2016

    MCV 78.2 (80 - 98) MCHC 381 (310 - 350) Also meant to be monitored for iron deficiency but GP has passed recent results as satisfactory

    For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range. You need an iron supplement and/or 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...

    As far as your iron deficiency is concerned, your MCV/MCHC results are not satisfactory, they continue to suggest iron deficiency and this needs to be addressed. Speak to your GP and ask for further treatment or to be referred back to your haemotologist. I thought when Ferritin dropped below 50 it was normal for another iron infusion or re-referral to your specialist.

    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.

    Any iron tablets should be taken 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.

    **

    Folate 2.3 (2.5 - 19.5) Folic acid started January 2017

    Vitamin B12 331 (190 - 900)

    Is your folic acid 5mg daily? It should be, and you shouldn't still be below range after 8 months.

    Do you have any signs of B12 deficiency b12deficiency.info/signs-an... If you do have then you should post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc otherwise your B12 needs increasing.

    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."

    Sublingual methylcobalamin lozenges are what's needed if you self supplement, start with 5000mcg daily then when that bottle is finished change to 1000mcg daily as a maintenance dose, along with a good quality B Complex, such as Thorne Basic B, to balance all the B vitamins.

    **

    Vitamin D 33.5 800iu started 2012.

    I really can't understand how doctors ignore this type of thing. 5 years supplementing and you are still at the lower end of the deficiency category. If your level was below 30 to start with you should have been given loading doses. Have a read through the following and ask your GP if he will now give you the loading doses to kick-start your Vit D status, I don't see how he can refuse after 5 years of getting nowhere with 800iu which, by the way, isn't going to ever raise your level. It is hardly a maintenance dose for someone with a reasonable level.

    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 as the 800iu hasn't worked, and that he prescribes the loading doses. Once these have been completed you will need a reduced amount (not a 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.

    **

    You said on your other thread "Despite supplementing for a number of years I feel no different and have noticed no improvement in levels" and this could very well be due to the Hashi's causing you gut/absorption problems. I will ask SlowDragon to comment as she has information and links about this.

    SlowDragon - here is the other thread healthunlocked.com/thyroidu...

    **

    Echo2 - you have been treated appallingly by your Endo and your doctor has been extremely negligent about these dire nutrient levels. Please give very serious consideration about making complaints, it's not only you who is being treated like this, here will be several other patients too.

  • Thanks folic acid is daily. I will speak to GP today.

  • Please let us know how it goes Echo2. Good luck.

  • I've read your other post.

    Definitely never see that awful endo again. Many of us have had similar awful experiences. I always now take a supportive friend or family member along. They dare not be so abusive if there's a witness

    Or if that's not an option record the consultation

    But usually people bluster and are unpleasant when they are out of their depth. This endo certainly doesnt seem to know much about Hashimoto's

    As you have Hashimoto's then hidden food intolerances may be causing issues, most common by far is gluten. Changing to a strictly gluten free diet may help reduce symptoms. Very, very many of us here find it really helps and can slowly lower antibodies.

    thyroidpharmacist.com/artic...

    thyroidpharmacist.com/artic...

    amymyersmd.com/2017/02/3-im...

    chriskresser.com/why-changi...

    scdlifestyle.com/2014/08/th...

    Low stomach acid can be an issue

    Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

    thyroidpharmacist.com/artic...

    Other things to help heal gut lining

    Bone broth

    thyroidpharmacist.com/artic...

    Probiotics

    carolinasthyroidinstitute.c...

    Great film definitely shows why just testing TSH is inadequate and how complex it all is

    drbradshook.com/understandi...

    Vitamin D - personally I find vitamin D mouth spray good as avoids poor gut function

    "Better You" 3000iu (2x daily) or 5000iu 1x daily) strength to increase levels, 1x3000iu as maintenance once at decent level

    Calm vitality Magnesium powder is cheap and easy to use.

    Both D and magnesium take At least 4 hours away from Levo

    Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

    verywell.com/should-i-take-...

    Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription.

    All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, or T3 in12 hours prior, delay and take straight after.

    Lastly

    Once you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

    endo.confex.com/endo/2016en...

    endocrinenews.endocrine.org...

    Stick with this support group and you will make progress

    If you read people's profiles you will see many have had terrible treatment and battles

    We have to read, learn and manage our condition ourselves, most medics seem to have little idea. Hashimoto's is equally a disease of the gut - of which an endo knows sweet FA

  • SD - I really must try and remember to mention the spray Vit D where there's Hashi's, not being Hashi's myself it doesn't pop into my mind. I must try harder :)

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