Recent folate & B12 results:
Serum Folate 11.2 ug/L (normal range 3.4 - 12.2).
B12 434 ng/L (normal range 211 - 911).
9 days before these results ferritin level test was shown as low: 21 ug/L (normal range 22 - 322).
What can I infer from these figures?
I don’t know if I should hope for average numbers, or whether it’s like LDL & HDL cholesterols: one high the other low.
What can I infer from these figures?
Serum Folate 11.2 ug/L (normal range 3.4 - 12.2).
This is at the top of the range so unless you're supplementing I expect you're eating lots of folate rich foods.
B12 434 ng/L (normal range 211 - 911). ng/L is the same as pg/ml
This is on the lowish side according to an extract from the book, "Could it be B12?" by Sally M. Pacholok which states:
"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."
9 days before these results ferritin level test was shown as low: 21 ug/L (normal range 22 - 322).
Obviously that's below range and low ferritin can suggest iron deficiency anaemia. You should ask your GP to do a full blood count and iron panel.
Interesting info.
I am very cautious in my view of the B12 levels that should be maintained according to Sally M. Pacholok as quoted. She is a nurse, it seems. Not wishing to downplay the expertise and wisdom of nurses, they have my full respect and both my mother and daughter were, but are her views endorsed by any medical authority? Or by demonstration in some other way that they are valid?
"Medical authority" on the subject of ideal vitamin and mineral levels doesn't really exist. Doctors get taught nothing about nutrition in terms of optimal health.
They may get some limited training on deficiency diseases, but personally I want optimal, not just one point over deficiency levels.
What you get from this forum is the benefit of hundreds, if not thousands, of people finding out what levels of nutrients make them feel healthiest.
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Regarding vitamin B12 and folate, both are water-soluble nutrients and are not poisonous, even in very high doses. You have to ask yourself how the recommended dietary allowances were created and how likely is it that the people used as the basis for reference ranges were actually optimally healthy themselves. (Answer : Not very likely at all.)
This quote from Dr Malcolm Kendrick suggests what we are up against :
I do not think the RDAs for vitamins are remotely accurate, or useful. They were established in times of absolute deficiency. The agreed Vitamin B12 levels, for example, were based on seven people, over sixty years ago, and remain unchanged to this day. All seven had pernicious anaemia (caused by vitamin B12 deficiency).
and comes from his blog :
Source : drmalcolmkendrick.org/categ...
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For info on vitamin B12, this post from the Pernicious Anaemia Society (here on HU) is worth reading - and follow the links within the post for lots more information :
healthunlocked.com/pasoc/po...
...
The optimal levels suggested on this forum are :
Vitamin B12 - Top of range. Even over the range is not going to cause any problems - it's just a waste of money to supplement to these very high levels for most people. The Active B12 test is far more reliable as an indicator of B12 level than testing using Serum Vitamin B12.
Folate - Upper half of the reference range.
Vitamin D - Depending on source... 125 nmol/L, or 100 - 150 nmol/L. These levels are equivalent to 50 ng/mL, or 40 - 60 ng/mL.
Ferritin - mid-range.
Iron - See this link : rt3-adrenals.org/Iron_test_...
For anything else - unless you can find specific information that says otherwise, aim for mid-range.
Looking at your previous posts....think you are on vegan diet?
Vegan diet is very low in B12 ....actually almost no B12
chriskresser.com/what-every...
Ppi also lowers B12
Very Low in iron too
everydayhealth.com/anemia/a...
Very important when hypothyroid and on Levothyroxine to have OPTIMAL B12, folate, ferritin and vitamin D
What vitamin supplements do you currently take?
All the time I have been on a vegan diet, 5 months, I have taken the Vegan Society VEG 1 Multivitamin supplement. This has 1000% of the EU reference B12 intake.
Why are you on ppi ?
Often hypothyroid patients have low stomach acid
articles.mercola.com/sites/...
thyroidpharmacist.com/artic...
stopthethyroidmadness.com/s...
healthygut.com/articles/3-t...
naturalendocrinesolutions.c...
Ppi lowers vitamins
pulsetoday.co.uk/clinical/m...
gov.uk/drug-safety-update/p...
When hypothyroid we frequently need higher dose of supplements as gut function is often poor
Suggest you also take extra B12.
Jarrow sublingual B12 lozenges are good option. Or Better You do B12 spray
You need vitamin D test
GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve by self supplementing to at least 80nmol and around 100nmol may be better .
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly via vitamindtest.org.uk
Vitamin D mouth spray by Better You is good as avoids poor gut function.
It's trial and error what dose each person needs. Frequently with thyroid disease we need higher dose than average
Local CCG guidelines
clinox.info/clinical-suppor...
Government recommends everyone supplement October to April
gov.uk/government/news/phe-...
Magnesium
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Bone pain
easy-immune-health.com/pain...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
intechopen.com/books/cell-s...
I take daily aspirin post bypass surgery to thin blood. This may cause stomach ulcers. To counteract this I’m prescribed the PPI.
For a number of years we’ve supplemented vitamin D during winter months and it is also in the Multivitamin. Why do you think I need the test?
Because anyone whose hypothyroid is likely to be vitamin D deficient.
Vegan diet has no vitamin D
Vitamin D needs testing annually.
In UK the vast majority of people have low vitamin D. We just don't get enough sun, or cover up too much/shower too frequently...,darker skin colour needs higher amounts of sun to generate same vitamin D
Some GP's no longer think PPI is necessary with daily baby aspirin. (Or they think the side affects of ppi are worse)
Unfortunately until I take the PPI. In the morning I feel the “fire” beginning to smoulder internally. Really not sure I can take baby aspirin without something to damp that fire and not have an awful lot of discomfort.
Your ferritin is extremely low. GP should be running full iron panel testing for Anaemia
You can have low ferritin and normal iron, but it's very difficult to maintain iron levels on plant based diet, especially when hypothyroid
So you may need iron supplements virtually continuously
Acid reflux is common hypothyroid symptom
You need to take Levothyroxine well away from taking any other medication, at least four hours after PPI, magnesium, iron or vitamin D (spray vitamin D can be closer as it is absorbed in mouth)
willsie01
For a number of years we’ve supplemented vitamin D during winter months and it is also in the Multivitamin. Why do you think I need the test?
You need to test to ensure you are taking an appropriate amount of D3 . Too little and it wont be enough to ensure you're level is within the range recommended by the Vit D Council/Vit D Society/Grassroots Health - 100-150nmol/L. Too much and it will be stored and may reach toxicity level.
Thank you SlowDragon. That’s a lot of info to follow up. I rely on you very knowledgeable forum members a lot with all my various ailments. 😊
I think to try several of your suggestions, namely the vitamin D test and Better You B12 & D sprays. I should do one thing at a time so I can gauge if any one action makes a difference in how I feel.
I've ordered the Vitamin D kit and hold off on the Better You sprays until I get the result through.
Incidentally, I have been using the Better You Iron spray together with ferrous sulphate pills since my ferritin was found to be low. Pills were prescribed by my GP and spray suggested by my wife's GP friend.
Yes
We always recommend only making one change at a time
Wait at least 2 weeks to assess results before adding another change
Be interesting to see if you find iron mouth spray is effective...not had very positive reviews on here
Unfortunately, my attempt with the vitamin D test kit was a disaster. Could not squeeze out enough blood to create the 4 spots as per the requirements for the test card. This is so weird. Going to ask them to send me replacement card and lancets and get advice about the difficulty.
Tips for getting blood out
Get moving about before you do it...eg go for a walk, go up and down stairs a few times etcetc
Make sure hand is warm
Prick finger on side about halfway up nail....not on very top of finger
I can do the vitamin D card as it's only drops of blood
But Medichecks I would often struggle to fill the test tube...so I now get private blood draw
I do think the lancets aren't as vicious as they use to be
I explained the problem I had with the test to the lab, asking for a replacement card to try again but they told me to send in what I had and they would see what they could do with it. Today they emailed me the result, which was that my Vitamin D is 64.3 mol/L. In a previous posts it's suggested that 100 mol/L is better for those of us who are hypothyroid, so I think I try the Vitamin D spray for a couple of weeks and see where I am.
Suggest you use 2000iu -3000iu daily for 4 weeks then 1000iu as maintenance dose
Retest in 3 months
It's trial and error what dose each person needs
You may need to supplement all year....perhaps more in winter
As you take ppi you will probably be low in magnesium
medsafe.govt.nz/profs/PUArt...
Vitamin D needs magnesium
sciencedaily.com/releases/2...
As a vegan a lot of food I eat has magnesium in it but is that another test to establish?
No point testing magnesium
Link about low magnesium when on PPI
On looking a little deeper I see that B12 absorption can be impaired by PPI's and I do take one, lansoprolol, so potentially this is a culprit? I also see that nerve/balance issue may be due to a deficiency and this is something I think I may have an issue with.
PPIs are not recommended for someone on thyroid hormone replacement as it affects absorption of the medication.
Previous thyroid post
healthunlocked.com/thyroidu...
Just testing TSH and FT4 is completely inadequate
You need to get TSH, Ft3, FT4 (and both TPO and TG thyroid antibodies tested if antibodies have not been tested)
Look through old blood tests to see if you ever had thyroid antibodies tested
medichecks.com/products/thy...
Also......noticed you say you don't see brand on Levothyroxine as you get dosset box of medication
Does this mean you don't even know which pill is Levothyroxine?
Levothyroxine is extremely fussy medication and MUST be taken on its own, on empty stomach and then nothing apart from water for at least an hour after
Vitamin D
birmingham.ac.uk/research/p...
Unsurprisingly, nearly half of the UK population were vitamin D deficient in the National Diet and Nutritional Survey. Amongst the UK residents, the Black, Asian and Minority Ethnic (BAME) groups are most at risk, as darker skin produces far less vitamin D than lighter skin.
Does this mean you don't even know which pill is Levothyroxine?
No, I recognise all my meds. At the time of saying I didn't know the brand I wasn't aware of any issues between brands so never paid attention. NHS rightly looks to economise on drugs I thought. I was diagnosed with Hypothyroidism up to 15 years ago. Was put on Levothyroxine, which fixed the symptom of tiredness instantly, so never had a reason to question the efficacy of the drug. Until joining this forum recently I'd never heard brand was an issue.
Levothyroxine is extremely fussy medication and MUST be taken on its own, on empty stomach and then nothing apart from water for at least an hour after
Yes, for almost 15 years I didn't know to do this but without any ill effects. Again, it was only after joining this forum I became aware of the advice and have been following it but not accurately because I have forgotten to take it on time occasionally. It does always get taken on its own with water but maybe a little less then an hour before eating. It's got to a point I have several meds I need to take at set times before and after eating. It's all getting more complicated!
Blood Results
Blood results
Folate supplement/Test results
Hypo, anaemic or both?
results & feeling bad 
