Hi guys, my Folate wa only midly low, been prescribed Folic Acid and GP just said I can make an appointment in a couple of months "if I want to"
Reading on the NICE website, I see it says the following
What monitoring is required after treatment for vitamin B12 or folate deficiency has started?
Perform a full blood count and reticulocyte count:
Within 7–10 days of starting treatment.
A rise in the haemoglobin level and an increase in the reticulocyte count to above the normal range indicates that treatment is having a positive effect.
If there is no improvement following initial B12 treatment, check serum folate level (if this has not been done already).
After 8 weeks of treatment.
Blood counts and mean cell volume should have normalised.
At this point, also measure iron and folate levels in people being treated for B12 deficiency to ensure that other deficiencies have not been masked.
On completion of folic acid treatment to confirm a response.
At each follow-up appointment, ask the person if their symptoms have improved or worsened, or if they are experiencing new symptoms that could be linked to vitamin B12 deficiency.
No mention of Full Blood Count 7-10 days after starting Folic Acid from my GP, just make an appointment to check Folate in couple of months "if i want"
Should my GP be following those guidelines for a mild Folate deficiency, or are they only if treating B12 deficiency?
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Serum ferritin level 19 ng/ml [30 - 150]; Below low reference limit; Note raised CRP. The Ferritin value may be lower than this once; the acute phase response is over
Serum C reactive protein level 13 mg/L [0 - 5] - Above high reference limit
Do you know if they should be following those NICE guidelines above for treating mild folate deficiency with Folic Acid? Where it says perform FBC within 7-10 days of starting treatment? Or is that only for B12?
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)
This can help keep all B vitamins in balance and will help improve B12 levels too
once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can affect test results
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Recommend getting FULL thyroid and vitamin testing 6-8 weeks after adding last vitamin supplement
It will probably take many months to improve low ferritin
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Testing options and includes money off codes for private testing
Thanks SlowDragon , speaking of NICE, I also notice it says the following for iron:
Prescribe all people with iron deficiency anaemia one tablet once daily of oral ferrous sulfate, ferrous fumarate, or ferrous gluconate — continue treatment for 3 months after the iron deficiency is corrected to allow stores to be replenished
I have no idea if mine is iron deficiency anemia or just iron deficient. Does the above mean that once the ferritin is back in normal values, they are supposed to continue treatment for 3 months after?
We see numerous posts on here where either deficient ferritin is completely ignored for years, or small dose iron prescribed for short while, ferritin rises tiny amount and prescription not continued
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.
It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:
Females 18 ≤ age < 40. 30 to 180
Females 40 ≤ age < 50. 30 to 207
Females 50 ≤ age < 60. 30 to 264l
Females Age ≥ 60. 30 to 332
Males 18 ≤ age < 40 30 to 442
Males Age ≥ 40 30 to 518
The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.
Also SlowDragon , i've read a few posts online saying that when people have been treated with Folic Acid, they've then ended up with B12 too low. Should i be asking GP to test B12 again as well as Folate in 3 months?
Thanks SlowDragon , regarding Folate, how long should GP be treating my level of 3.7 for? I notice on the NICE webzite it says that in most people Folic Acid will be required for 4 months
My GP just said take the Folic Acid and get my Folate tested in a couole of months if i want so no idea if i should be on it for 4 months
Hi SlowDragon , they've prescribed 5mg Folic Acid to be taken once daily. No idea how long for. NICE website says most people will need Folic Acid for 4 months, whether GP will prescribe them for a few months
Thanks SlowDragon 😊one thing with the Ferritin. My CRP is 13 & Ferritin 19, when I've completed the Ferrous Fumerate, how would GP know it's not still defficient if my CRP is still high?
One of the problems is that GPs can only prescribe 5mg - or nothing. They cannot prescribe low dose folic acid.
Another problem is that some members feel bad taking such a high dose of folic acid, at least, in the longer term (like months).
You might need to continue with some sort of folic acid supplement long-term, as in years. But would only need a low dose - like 200 or 400 micrograms - after achieving a satisfactory level. But diet is significant so changes to include more folate might be just as good.
And, while I refer to folic acid, there are many who argue for methylfolate or folinic acid.
The only way you can know where you are is to have another blood test - and at suitable intervals into the future.
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