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Old 04-23-2012, 03:56 AM   #1
axx axx is offline
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B12 and Ferritin in range but low - monitor, supplement or investigate further?

I was hoping someone would be able to give me some advice. I would be really grateful as I am unsure what to do next and do not know any doctors who have lots of experience in this specific area.

I had a blood test done because I have been feeling unwell lately (very long list of symptoms, notably fatigue, mood changes, anxiety, depression, insomnia, pain in my hand below my ring finger, tingling in my lips).

I am concerned about my B12 and Ferritin status:
B12 = 370 pg/mL (273 pmol/L, normal > 180 pmol/L).
Ferritin = 37 ng/ml (range 10 - 120 ng/ml)

From the research I have done, optimal B12 should be above 800 pg/mL (below 500 pg/mL is regarded as deficient in some countries) and optimal Ferritin should be 70 to 90 ng/ml.

I would like to understand whether there is a valid cause for concern and if so, it is important for me to investigate the cause of this. I have a very healthy lifestyle - no drugs/alcohol, no processed/junk food, I cook everything at home and my diet is based on quality whole foods. It seems strange to me that my blood test results would be less than optimal and so I am trying to understand what could be causing this.

I have considered the following options:
1) Eliminate gluten from my diet and monitor results in a few weeks/months . I do not have any digestive issues when I eat gluten, however I read that many people can be sensitive to gluten and that this may inhibit the body from absorbing nutrients. I thought that I could try eliminating gluten for a period of time and check whether my B12 and Ferritin levels are higher then.

2) Supplement B12 only. If so, I would look at sublingual B12 (both active forms) plus a b-complex. I thought that maybe if I had higher B12, my body might be able to absorb and store more iron (this may be completely inaccurate, it is just an idea).

3) Supplement B12 plus iron. I am a bit nervous about supplementing iron because I have read that it may cause an imbalance with other minerals (such as zinc and copper) so I would make sure I take those minerals also in recommended ratios. This is my least preferred option because I am worried about throwing my natural balance out and prefer to get nutrients from food. I am less concerned about supplementing with B vitamins because they are water soluble.

4) Investigate possibility of hypothyroidism/hashimioto's thryoidosis. While my thyroid results are all in a desirable range, I seem to have a lot of symptoms that suggest hypothyroidism (i haven't listed everything above) and so I am considering testing for the TGA and TPO-Ab antibodies. I am not sure whether this is an over reaction when my TSH, FT3 and FT4 are all good. I would like some advice about whether this is necessary/advisable.

5) Investigate B12 deficiency further by testing urinary methylmalonic acid (MMA), homocysteine and maybe holotranscobalamin. I am not sure whether this is advisable.

6) Determine whether I have pernicious anemia by doing a blood test for Intrinsic Factor Abs and Parietal Cell Abs. Is this unnecessary?

7) Doing a blood test for celiac. I am reluctant because I don't have digestive issues with gluten and the blood test is not entirely accurate anyway so I don't want to waste anyone's time (e.g. the doctor, lab technicians etc).

In case it is relevant, here are some other results:
Iron = 20.2 umol/L or 113 mcg/dL
Saturation = 32% (range 13 - 51)
Folate (red cell) 806 ng/ml (1826 nmol/L , normal > 450)
HB = 130 g/L (range 115 - 165)
TSH = 1.89 mIU/L (range 0.35 - 5.5)
Free T3 = 5 pmol/L (range 3.5 - 6.5)
Free T4 = 15 pmol/L (range 9 - 25)
Blood pressure = 100/60

The supplements that I currently take include:
Whole food multivitamin (includes 18 mg iron and 800 mcg folate, hence the high folate blood result)
Omega 3 + D capsules
Magnesium 400 mg

Thank you in advance. I would really like to hear advice from people about whether my levels are a cause for concern and if so, what I should do next.

 
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Old 04-23-2012, 07:53 AM   #2
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Re: B12 and Ferritin in range but low - monitor, supplement or investigate further?

Well, I really wish I knew the answer to your questions because I'm in a similar situation. My ferritin was last measured at 12 (low is 10) and my B12 at 199 (low is 180).

I've learned that numbers don't tell the whole story. The symptoms of a lot of nutritional deficiencies look the same. And even if you're looking at the right numbers, there's room for variation in the results.

Last year I was in a bad way with symptoms similar to the ones you are describing plus some others that are more specific to iron deficiency (food cravings, sore tongue, hair starting to fall out). My ferritin measured at 19. I took iron supplements, felt dramatically and immediately a whole lot better, got retested 3 months later and my ferritin had fallen to 15. One year later, after taking iron supplements for about 9 months in total, it's down to 12.

Recently, I started feeling worse again so went back to get checked and got the results I posted above. It was the first time I'd had my B12 levels checked. Currently I've decided to take the B12, but not any more iron.

Nerve damage caused by lack of B12 can be irreversible so I don't really want to take any chances with that.

With the iron, I am worried that my body is low on iron as a protective response to a chronic condition, although I have no way of knowing if this is correct, so it's a bit of a gamble.

BTW, if you want to get tested for celiac disease, you have to get it done before cutting gluten out of your diet, so bear that in mind.

I hope you find a medical person to talk this through with, even if they're a non specialist, it has to be a good idea so long as they are sympathic and willing to try and work out what's going on with you.

 
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Old 04-24-2012, 04:35 AM   #3
axx axx is offline
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Re: B12 and Ferritin in range but low - monitor, supplement or investigate further?

Quote:
Originally Posted by eniluap View Post
Well, I really wish I knew the answer to your questions because I'm in a similar situation. My ferritin was last measured at 12 (low is 10) and my B12 at 199 (low is 180).

I've learned that numbers don't tell the whole story. The symptoms of a lot of nutritional deficiencies look the same. And even if you're looking at the right numbers, there's room for variation in the results.

Last year I was in a bad way with symptoms similar to the ones you are describing plus some others that are more specific to iron deficiency (food cravings, sore tongue, hair starting to fall out). My ferritin measured at 19. I took iron supplements, felt dramatically and immediately a whole lot better, got retested 3 months later and my ferritin had fallen to 15. One year later, after taking iron supplements for about 9 months in total, it's down to 12.

Recently, I started feeling worse again so went back to get checked and got the results I posted above. It was the first time I'd had my B12 levels checked. Currently I've decided to take the B12, but not any more iron.

Nerve damage caused by lack of B12 can be irreversible so I don't really want to take any chances with that.

With the iron, I am worried that my body is low on iron as a protective response to a chronic condition, although I have no way of knowing if this is correct, so it's a bit of a gamble.

BTW, if you want to get tested for celiac disease, you have to get it done before cutting gluten out of your diet, so bear that in mind.

I hope you find a medical person to talk this through with, even if they're a non specialist, it has to be a good idea so long as they are sympathic and willing to try and work out what's going on with you.
Thanks for replying.

Have you considered doing any tests to determine whether there are any underlying causes for your symptoms? I would really recommend this, especially if your diet is adequate.

Do you eat red meat? I am not sure whether taking extra B12 can increase ferritin or not. I read somewhere that it might, but it wasn't a credible source. I think you definitely should take action to increase your ferritin level - I understand your caution about supplement as I am the same, but maybe you could investigate whether you have any underlying conditions that are causing malabsorption (e.g. celiac). If you ran various tests and couldn't find anything and you are confident that is not due to diet, I would then probably resort to supplements because you don't want to risk causing damage.

Are you female? If so, do you have heavy periods? Perhaps you could try taking the contraceptive pill continuously for a few months to skip your period and see whether this changes your test result. It's just an idea.

Thanks for the tip about the celiac test. I did consider this, however I have read that the blood test and biopsy are not entirely reliable. I have already cut out gluten for the past 6 weeks or so (except for 3-4 occassions) so I am concerned if I took a test now the results would be inaccurate anyway. I read that genetic testing can be undertaken any time and that could definitely rule out the possibility of celiac. Having said that, I don't think I have celiac because I don't have any digestive issues with wheat. Perhaps I am sensitive to gluten, which wouldn't show up on a test anyway, but I'm really not sure.

I think it is wise to supplement your B12 to risk nerve damage. The only thing I would suggest is to consider getting a baseline urine MMA and homocysteine test before you start supplementing. Also, I have read that cyanocobalamin is not desirable and you should look at taking sublingual form of the 2 active types of b12 methyl and adeno. Maybe you should also get a test for pernicious anemia before you start supplementing, by testing your intrinsic factor and Parietal Cell antibodies.

One thing I am wondering is that if I supplement with B12, do I need to supplemetn with anything else? I have read that it should be combined with a b-complex at least (especially for the folate), however my folate is already so high I don't want to take any more. I am also considering whether i should take inositol with it. I am planning to cut out my multivitamin and just keep taking the fish oil with D plus the B vitamins, while eliminating gluten and then retest in a few months.

 
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Old 04-24-2012, 06:45 AM   #4
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Re: B12 and Ferritin in range but low - monitor, supplement or investigate further?

Quote:
Originally Posted by axx View Post
Thanks for replying.

Have you considered doing any tests to determine whether there are any underlying causes for your symptoms? I would really recommend this, especially if your diet is adequate.
There have been some investigations, although the GP doesn't always tell me what's being tested, only that the tests are normal! I know that I've been tested for rheumatoid arthritis, celiac disease and OVP. I also paid for comprehesive digestive stool analysis via a nutritionist (one of the few alternative tests that doesn't look like complete woo), but declined their dietary and herbal advice.

My thyroid's been tested multiple times over the years and is apparently okay, but I have doubts, as the UK range for normal is incredibly generous. One of my longest standing problems is feeling cold and poor thermoregulation, which is a very classic symptom! I don't think they've done the full thyroid panel, but my bravery with doctors is running out. I've just been reading this morning about the link between hypothyroidism and low iron, so maybe I will pursue this later.

Quote:
Do you eat red meat? I am not sure whether taking extra B12 can increase ferritin or not. I read somewhere that it might, but it wasn't a credible source. I think you definitely should take action to increase your ferritin level - I understand your caution about supplement as I am the same, but maybe you could investigate whether you have any underlying conditions that are causing malabsorption (e.g. celiac). If you ran various tests and couldn't find anything and you are confident that is not due to diet, I would then probably resort to supplements because you don't want to risk causing damage.
Yes, I eat red meat. At the moment, I eat everything except gluten. I do eat oats and don't seem to have a problem with them. My Mum keeps telling me to eat more red meat! I aim to eat more meat and veg and foods that aren't highly processed.

Quote:
Are you female? If so, do you have heavy periods? Perhaps you could try taking the contraceptive pill continuously for a few months to skip your period and see whether this changes your test result. It's just an idea.
Yes and yes. I'm pretty sure that being low on iron makes periods heavier, although this isn't the only influence, and actually right now they're not too bad. I was on the pill in my early 20s and was horrifically hormonal and emotionally unstable so decided not to take it ever again. If push comes to shove, I'd rather take iron than the pill.

Quote:
Thanks for the tip about the celiac test. I did consider this, however I have read that the blood test and biopsy are not entirely reliable. I have already cut out gluten for the past 6 weeks or so (except for 3-4 occassions) so I am concerned if I took a test now the results would be inaccurate anyway. I read that genetic testing can be undertaken any time and that could definitely rule out the possibility of celiac. Having said that, I don't think I have celiac because I don't have any digestive issues with wheat. Perhaps I am sensitive to gluten, which wouldn't show up on a test anyway, but I'm really not sure.
I didn't really think I had digestive issues either - the change was gradual and it became my normal. But in fact I was chronically constipated. The problem with celiac testing is that it doesn't detect anything subclinical - unless you get a biopsy and have enough villi damage then you can't be officially diagnosed, and I have no desire to have a tube down my throat if at all possible. The official diagnosis would only get me free prescription foods, which I don't think I'd want to eat anyway - long-shelf life gluten-free breads are chemical laden and tasteless. I tried cutting out gluten to see what happened, and found it helped a lot with my digestive problems - that'll have to be good enough for now.

Quote:
I think it is wise to supplement your B12 to risk nerve damage. The only thing I would suggest is to consider getting a baseline urine MMA and homocysteine test before you start supplementing. Also, I have read that cyanocobalamin is not desirable and you should look at taking sublingual form of the 2 active types of b12 methyl and adeno. Maybe you should also get a test for pernicious anemia before you start supplementing, by testing your intrinsic factor and Parietal Cell antibodies.
I'm taking sublingual methylcobalamin, and occasionally take a broad B vitamin complex instead, which also has vit C, E. I bought some fish oil with vit A and D, but am not sure if that's too many changes at once and I won't be able to work out what made the difference. And I've been looking at thyroid support supplements. But I haven't ruled out malabsorption problems, in which case taking supplements could be just like pouring money down the drain. I was relieved to find that studies show sublinguals are as good as injections - I don't really want injections, but had been worried that I wouldn't absorb it from a tablet. Malabsorption or some kind of gut problem is certainly on the table as a reason why I have nutritional deficiencies despite eating what most doctors would consider to be a healthy diet.

Quote:
One thing I am wondering is that if I supplement with B12, do I need to supplemetn with anything else? I have read that it should be combined with a b-complex at least (especially for the folate), however my folate is already so high I don't want to take any more. I am also considering whether i should take inositol with it. I am planning to cut out my multivitamin and just keep taking the fish oil with D plus the B vitamins, while eliminating gluten and then retest in a few months.
Sounds like a plan! (Although I've never heard of inositol, so can't comment on that.) Whatever you decide on, it's possible you'll have to change from time to time as your needs change. Taking one supplement over an extended period doesn't seem like a good idea unless you absolutely know that you still need it, and even then a few supplement free days might be a good idea to give you a chance to absorb another nutrients that are antagonised by the supplement.

If and when you do get retested (and if you didn't do this already), I think it's a good idea to come off all supplements beforehand because it can influence the results. Your levels can spike and don't return to their baseline for a few days. For instance, I'm pretty sure that the advice is to stop taking iron supplements for 48 hours before testing and some people say longer. Just something else to bear in mind.

 
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