Low vitamins and minerals, GP suspects coeliac

[Dinahj]

Hi I have Hashimotos and poor absorption of thyroid meds, GP is testing me for coeliac because of this and low vitamins and minerals and stomach/gut problems. Results for vitamins and minerals done 3 months ago except for B12 which was done February 2017. Had first B12 injection in June 2017 for low B12, haven't had a second one since then. Also prescribed iron tablets to take once a day for iron anaemia and I take 5mg folic acid which was stopped in August 2017 and I now take this every day since then. Vitamin D 4000iu D3 spray since October 2017 as 1000iu D3 spray and 800iu prescription did very little for my levels. Since taking folic acid been getting more dizzy and unsteady and jelly like feeling in legs. Advice welcome thanks.

VITAMIN B12 335 (190 - 900)

FERRITIN 41 (30 - 400)

FOLATE 2.2 (2.5 - 19.5)

VITAMIN D 54.2

(<25 SEVERE VITAMIN D DEFICIENCY

25 - 50 VITAMIN D DEFICIENCY

50 - 75 VITAMIN D MAY BE SUBOPTIMAL

>75 ADEQUATE VITAMIN D)

[Clutter]

Dinahj,

I'm a bit confused whether you stopped taking folic acid or are still taking it? 3 months x 5mg folic acid should be long enough to correct deficiency. Your GP can retest to make sure.

B12 335 was within range and not particularly low so I'm surprised you were given a B12 injection. Unless you have Pernicious Anaemia it is unlikely you need regular injections.

You can probably continue with 4,000iu D3 until Mar/April when you should retest.

I would retest ferritin 6 months after you started taking iron. Take each iron tablet with 1,000mg vitamin C to aid absorption and minimise constipation. Iron should be taken 4 hours away from Levothyroxine.

[Dinahj in reply to Clutter]

Stopped taking folic acid in August then restarted it when levels dropped. I have pernicious anaemia and ferritin retest was due 2 months ago thanks

[Clutter in reply to Dinahj]

Dinahj,

You should have 3 monthly B12 injections as you have PA. healthunlocked.com/pasoc are the experts on PA and folate deficiency.

[Dinahj in reply to Clutter]

Does iron likely need increasing or do I wait 6 months please?

MCV 70.3 (80 - 98)

MCH 28.2 (28 - 32)

MCHC 377 (310 - 350)

HAEMOGLOBIN ESTIMATION 109 (115 - 150)

HAEMATOCRIT 0.40 (0.37 - 0.47)

IRON 5.7 (6.0 - 26.0)

TRANSFERRIN SATURATION 13 (12 - 45)

[Clutter in reply to Dinahj]

Dinahj,

Were those results before or after you were taking iron?

[Dinahj in reply to Clutter]

Thanks they were after

[SeasideSusie Remembering in reply to Dinahj]

Dinah

Those results suggest iron deficiency anaemia and 1 x iron tablet a day is inappropriate if that has been prescribed - see 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 can help raise your ferritin 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... Ferritin needs to be at least 70 for thyroid hormone to work

Are you taking D3's important cofactors? Magnesium helps D3 to work, and K2-MK7 directs the extra uptake of calcium to bones and teeth and away from arteries and soft tissues. You're aiming for a level of 100-150nmol/L which is the Vit D Council's recommended level.

[Dinahj in reply to SeasideSusie]

Thanks I take vitamin D with K2 and MK7 and started this 2 weeks ago

[SeasideSusie Remembering in reply to Dinahj]

If not already taking it, then you need magnesium which helps D3 to work.