Vitamin and mineral levels

[LouiseC1966]

healthunlocked.com/thyroidu...

FERRITIN 22 (30 - 400) Iron infusion done 2016, not on iron

FOLATE 2.1 (2.5 - 19.5)

VITAMIN B12 195 (180 - 900)

Not on B12 or folic acid. Thanks

[SeasideSusie Remembering]

Louise

Your sister is going to have to have a face to face appointment, and someone will need to go with her and get this sorted.

FERRITIN 22 (30 - 400) Iron infusion done 2016, not on iron

She needs another iron infusion pronto. Did the haematologist not say she should be referred back for another infusion if her ferritin fell below 50?

You said in your other thread that she has been diagnosed with iron deficiency anaemia. Why is she not on iron tablets? The treatment for iron deficiency anaemia is

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.

Go to the link, print off the information, ask the GP to treat her appropriately.

She should 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.

Also, to help raise her ferritin level, she should eat liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in her diet apjcn.nhri.org.tw/server/in...

**

FOLATE 2.1 (2.5 - 19.5)

VITAMIN B12 195 (180 - 900)

Not on B12 or folic acid.

She is folate deficient with very low B12. Does she have symptoms of B12 deficiency - check here b12deficiency.info/signs-an...

You should post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc

She probably needs intrinsic factor antibodies testing, she may have Pernicious Anaemia, she may need B12 injections. All this must be looked into so whoever goes with her should insist. Once she has had further investigations and B12 started, then folic acid can be introduced, it must not be taken before.

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."

**

From your other thread:

Vit D level of 13 NMOL/L

You have said she is having loading doses of 300,000iu. This is the 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 maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU 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 regims 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)."

So however her loading doses are to be taken, it will total 300,000iu. Ideally she will then be retested to see what maintenance dose she needs, but it's very likely her GP wont retest and will just give her 800iu D3 as a maintenance dose but that wont be enough. I strongly suggest that she gets her own Vit D test, she can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/ at a cost of £28. When she has her new level, make a post on here for a suggestion of her next dose (link back to this post if you like so we know the background).

The Vit D Council recommends a level of 100-150nmol/L so she must aim for this, and when she's reached this she will need a maintnace dose which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range.

Doctors wont know, because they are not taught nutrition, but 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 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

naturalnews.com/046401_magn...

Check out the other cofactors too.

As she has Hashi's, when she comes to buy her own D3 an oral D3 spray is recommended for best absorption, eg BetterYou.

[LouiseC1966 in reply to SeasideSusie]

Hi yes her haematologist has asked to see her for another infusion if her ferritin is below 50 She is not taking iron tablets since her ferritin was sorted in 2016 and her GP at the time stopped her iron as her ferritin level was higher but iron below mid range. She has symptoms of B12 deficiency as well. Thank you

[SeasideSusie Remembering in reply to LouiseC1966]

So has it been arranged for her to have another iron infusion? If not then insist it is arranged urgently.

Once levels are sorted, they need to be maintained. Just stopping supplementing means that eventually the level will plummet again. As mentioned, she can help raise ferritin by eating liver, then when her level is optimal (which is a minimum of 70 for thyroid hormone to work, recommended is half way through range), eating liver once every couple of weeks may very well maintain that level.

For her B12, when you post on the PA forum list the symptoms of B12 deficiency she is experiencing, give the results of B12, folate, ferritin, and mention the iron deficiency information.

[LouiseC1966 in reply to SeasideSusie]

Hi no it hasn't been arranged for her to have another infusion. The GP said since her haemoglobin is in range she does not need an infusion. But if her ferritin is below range surely she needs one?

[SeasideSusie Remembering in reply to LouiseC1966]

If her haematologist asked to see her for another infusion if her ferritin is below 50, then haematologist trumps GP and GP needs reminding of what haematologist said. Or contact haematologist to relay what GP has said.