Optimum folate and ferritin levels: what should they be? Opinions vary

[Noelnoel]

As above

[fuchsia-pink]

My simple mantra is TSH - best low; free T4 and T3 - best high; nutrients - best in the middle. But SeasideSusie is the nutrient queen so will hopefully pop up in a bit with more detail

[Noelnoel in reply to fuchsia-pink]

Thank you fp, I think you’re right

[Noelnoel in reply to Noelnoel]

Just had a thought though fp. How can we know the optimal folate when we don’t get given a ref range. My recent result is 21.52ug/L > 5.38. Great, so if my level was 5.39, that would be fine would it. After we’ve slogged to get nutrient levels up it’s not the kind of comparison we want is it. Grrr. I’m not ranting at you btw, just the system

[humanbean]

Folate - if the reference range has a top of range then I would suggest an optimal level of upper half of the range

e.g. (using made up numbers)

Folate = 10 Range = 5 - 35

Mid-range is 20, so I would suggest an optimal level of 20 - 35.

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Folate = 10 Range = greater than 5 i.e > 5

This type of result for folate is a pain in the neck, and is really very common.

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I've had ranges for my own results of the following - always in mcg/L :

NHS, Blue Horizon : 4.6 - 18.7

Blue Horizon : 3.9 - 26.8

Medichecks : > 3.89

I've seen other ranges for folate, quoted by other people, that have an upper level in the 60s.

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I work on the assumption that a level for folate between 20 and 30 mcg/L or possibly 15 - 25 mcg/L, is absolutely fine. I don't think folate is particularly toxic for most people if it goes too high, but you should do your own research into the subject.

People with pernicious anaemia (even if it is only suspected rather than proven) need to get their vitamin B12 levels up off the floor before increasing folate.

You need to be aware when researching folate toxicity that folic acid and folate are NOT the same, and folic acid toxicity is possible in some people who can't convert folic acid to folate.

But lots of people writing articles on folate are actually talking about folic acid. Please read this for more info :

chriskresser.com/folate-vs-...

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For ferritin we normally suggest on this forum that a level which is mid-range or a little bit over is fine. Be aware that ranges vary wildly, so always use the range that came with a test result.

For optimal levels of other iron-related results see this link :

rt3-adrenals.org/Iron_test_...

For info on iron-deficiency anaemia see this link :

who.int/vmnis/indicators/ha...

Other iron-related links you might find helpful :

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

dailyiron.net/

irondisorders.org/Websites/...

[Noelnoel in reply to humanbean]

HB

Thank you, I had no idea about raising B12 before folate

Also, thank you for providing various range comparisons. mcg/L is the same as ug/L (am I right?), so if I were to use blue horizon’s ref of 3.9 - 26.8mcg/L, my range of 21.52ug/L is just fine

For ferritin we normally suggest on this forum that a level which is mid-range or a little bit over is fine. Be aware that ranges vary wildly, so always use the range that came with a test result.

Do you mean that a little bit over mid is fine or a little but over range is fine?

[humanbean in reply to Noelnoel]

Thank you, I had no idea about raising B12 before folate

You don't have to raise B12 by much before starting to supplement folate. If someone has both B12 deficiency and folate deficiency then treatment should be started to treat the B12 deficiency, and then after a week or so treatment can be added in to begin treating the folate deficiency.

The problem is that if someone has almost no B12 at all then taking folate could induce a condition called "subacute combined degeneration of the spinal cord".

There are some conflicting sources on this problem and whether it is necessary to start B12 before folate.

See this link

patient.info/doctor/folate-...

under the heading "Management" :

Quote :

Folic acid may produce a haematological response in vitamin B12 deficiency but may aggravate the neuropathy and also precipitate subacute combined degeneration of the spinal cord. Large doses of folic acid alone should therefore not be used to treat megaloblastic anaemia unless the serum vitamin B12 level is known to be normal.

However if you look at the wikipedia article on the issue it claims that this is no longer believed to be a problem :

en.wikipedia.org/wiki/Subac...

Quote :

"It has been thought that if someone is deficient in vitamin B12 and folic acid, the vitamin B12 deficiency must be treated first. However, modern research has shown that folic acid will not exacerbate the symptoms of vitamin B12 deficiency.[7] And that if this were the case, then the mechanism remains unclear.[8]

Administration of nitrous oxide anesthesia can precipitate subacute combined degeneration in people with subclinical vitamin B12 deficiency, while chronic nitrous oxide exposure can cause it even in persons with normal B12 levels.

My feeling is that if I was at risk of developing subacute combined degeneration of the spinal cord I would start B12 treatment first and just delay folate treatment by a week or two. I wouldn't want to risk the spinal cord problem so I would err on the side of caution, whether it was really necessary or not.

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Also, thank you for providing various range comparisons. mcg/L is the same as ug/L (am I right?), so if I were to use blue horizon’s ref of 3.9 - 26.8mcg/L, my range of 21.52ug/L is just fine

If a folate test result had a top and bottom to the range that was supplied with the result I would always use it. But I offered some of the ranges I've seen so that you have a rough idea of what to aim for if the range is just "greater than X".

And yes mcg/L is the same as ug/L, or more pedantically is the same as μg/L. But u is easier to type than μ on a standard English keyboard.

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Do you mean that a little bit over mid is fine or a little but over range is fine?

I'll give an example. If the reference range for ferritin is something like 20 - 400, then mid-range is 210.

The optimal level for ferritin would therefore be something like 210 - 250 i.e. mid-range up to something a little bit higher.

I would definitely not be happy if my ferritin or any other result that was iron-related was over the range.

[helvella Administrator in reply to humanbean]

For slightly more detail about ucg/mcg/μg my document just might be helpful?

dropbox.com/s/sgv815w8hkexl...

[humanbean in reply to helvella]

I'd forgotten you'd written that document.

[Noelnoel in reply to helvella]

Thank you hellvella but the link won’t open. I’ll try again later

[helvella Administrator in reply to Noelnoel]

It works for me - but it might be a bit picky on some devices. It is just a simple PDF.

Do let me know what happens.

Indeed, please, anyone who sees this, give it a whirl.

[Noelnoel in reply to helvella]

Will do

[Noelnoel in reply to Noelnoel]

Helvella, I tried again and this time it was fine. Really useful, thank you

[Noelnoel in reply to helvella]

Helvella, I tried again and this time it was fine. Really useful, thank you

[Noelnoel in reply to humanbean]

That’s a lot of information, thank you and for the clarification too