Hello, I am posting vitamin and mineral results for my daughter. She was diagnosed iron deficient 4 years ago - treated with iron infusion in 2016 but never fully resolved with continually low and sometimes below range MCV which coincides with periods and taking 1 iron tablet per day (used to be 3); vitamin D deficient 4 years ago; folate deficient 4 years ago and then again 1 year ago and possible B12 deficiency 1 year ago.
Her hips and ribs have a constant dull ache and it is making her short of breath.
She has gotten a very bad urine infection, this is her 3rd one this year.
She has constipation throughout the day.
Her period has come late and she gets knifelike pains when it's due.
She is tired throughout the day.
Eyebrow hairs dropping off her face and eyelashes malting under her eyes.
Face muscles twitching.
Dark circles under her eyes.
Getting dehydrated easily.
If anyone could advise I would be grateful. She wouldn't come on here in person because her partner has been playing down her symptoms saying they might be nothing untoward and this made her feel low and a hypochondriac but I don't think she is imagining anything.
Thank you
August 2017
Ferritin 47 (30 - 400) taking 1 iron tablet per day
MCV 78.3 (80 - 98)
MCHC 388 (310 - 350)
MCH 28.1 (28 - 32)
Haemoglobin 121 (115 - 150)
Haematocrit 0.44 (0.37 - 0.47)
Red blood count 4.43 (3.80 - 5.80)
White cell count 6.18 (4.00 - 11.00)
Platelets 254 (150 - 400)
Iron 9.9 (6.0 - 26.0)
Transferrin saturation % 16 (12 - 45)
Folate 2.38 (2.50 - 19.50) taking 5mg folic acid once a day
Vitamin B12 228 (190 - 900) before B12 injection, GP wants intrinsic factor antibodies repeated despite it coming back negative before
Vitamin D 36.6
(<25 severe deficiency
25 - 50 deficiency
50 - 75 suboptimal
>75 adequate) taking 800iu D3
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Julie1166
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I will come back and respond more fully tomorrow if no-one else has replied, I am off to bed now, but if GP is testing intrinsic factor I believe she shouldn't be taking folic acid at the moment. Double check that with the Pernicious Anaemia Society forum healthunlocked.com/pasoc
800IU of vitamin D is too low. Due to her level being over 25 but low she needs to sort this out herself asap unless she wants permanent bone damage. The NHS won't do this because her level is deficient not severely deficient. This is one of the reasons she will feel terrible, be in pain, be fatigued and have hair loss.
She needs to get some 5,000IU vitamin D3 tablets and take 2 daily for 6-8 weeks then go down to one every other day. If it hurts to take 2 per day, which it may do especially ribs and hips due her bones stopping leaching calcium and starting to remodel, she should at least take one for 12 weeks. After 12 weeks she should retest which will have to be done privately. Use City Assays, who do a finger prick test by post. Then start a new thread with the result on what to do next if not over 75nmol/L.
With the vitamin D3 she must take the important co-factors vitamin K2-MK7 and magnesium.
Vitamin D3 must be taken with a fatty meal.
All supplements should be brought online, use Amazon for ease, so you can find sufficient doses and not be told rubbish by pharmacists or health food shops.
She needs to take vitamin C with iron. Take the iron on an empty stomach and away from the vitamin D plus 4 hours away from any thyroid medication.
Has she been checked for thyroid disorders including autoimmune thyroid disease?
Oh and the partner isn't nice and very ignorant. On it's own her vitamin D will be causing problems added in the period, vitamin B12, folate and iron issues then it's not surprising she feels terrible. The partner needs to be told clearly it is not normal to feel this bad and no going on the pill won't solve the underlying problems with her period, instead it will cause worse side effects.
The doctor may say she has subclinical hypothyroidism but NICE guidelines state she can be trialled on levo.
They don't have to be followed by the GP, but the GP should be asked politely if her thyroid isn't the problem what is? And can she have a trial as you are aware from talking to other hypothyroid suffers, from thyroid UK - a charity recommended by NHS Choices - within a few years most of the nutrient deficiencies resolve once on a proper dose of levo*.
If the GP says she must be referred to an endo first she must say she wants to think about it to the doctor. Then come here and ask for a list of endos that specialise in thyroid disorders as most specialise in diabetes and badly treat thyroid disorders.
*This isn't the entire truth as you still need to take supplements but you actually start absorbing them if your TSH is around 1 or less, Free T4 is in the upper quarter and Free T3 is in the top third of the range.
For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range. She 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...
MCV 78.3 (80 - 98)
MCHC 388 (310 - 350)
MCH 28.1 (28 - 32) taking 1 iron tablet per day
These results suggest iron deficiency anaemia and she is on the wrong treatment, it should be 2 or 3 x ferrous fumarate a day - see NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines):
•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.
She needs to be discussing this with the doctor.
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.
**
Folate 2.38 (2.50 - 19.50) taking 5mg folic acid once a day
Vitamin B12 228 (190 - 900) before B12 injection, GP wants intrinsic factor antibodies repeated despite it coming back negative before
I suggested you post on the PA forum about whether she should be taking folic acid whilst waiting for the intrinsic factor test, I'm sure she shouldn't be. Please go and ask them for confirmation.
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."
**
Vitamin D 36.6
taking 800iu
800iu D3 isn't going to ever raise her level. It is hardly a maintenance dose for someone with a reasonable level. She need much more, as Bluebug has mentioned.
The level recommended by the Vit D Counci is 100-150nmol/L.
As she is Hashi's, for better absorption SlowDragon recommends an oral spray such as Better You. There are D3 only sprays and there are D3/K2-MK7 sprays (K2-MK7 being an important cofactor of D3). I agree with starting off with 10,000iu daily then reducing to 5000iu daily and then retest in 3 months. When she has reached the recommended level she will need to find her maintenance dose, it may be 2000iu daily, may be less, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. She can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/
There are important cofactors needed when taking D3
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 helps D3 to work and 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. Due to her constipation problem I would suggest the magnesium citrate.
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