Struggling with low vit D and iron

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Struggling with low vit D and iron

Postby Punchy » Fri Aug 04, 2017 2:15 pm

My neurologist doesn't monitor vitamin D levels, but I'm preparing for weight loss surgery and discovered in April that mine were only 26.

Since then I've made a huge effort to get my levels up by take no 4000UI daily in tablet form plus 400 as part of my multivitamin. I've been drinking fortified milk and orange juice daily, eating fortified cereal each day, tuna, salmon, lots of beans, spinach. I've also been spending my lunch hours out in the sun, a few trips to the beach (ended up with a sunburn).

I had follow-up blood work last week and it has only increased to 40. Also my iron serum is only 5 umol/dl with just 8% saturation. Not good.

The only good news is my phosphorous and magnesium is normal, they were just below normal range in April.

Does anyone have any tips for getting these levels up quickly? I'm seeing an internist but he's rather conservative. My nurse at the weight loss program suggested an iron infusion and Rx for 50,000ui/week of vit. D but he doesn't want to do that.

Feeling pretty frustrated!
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Re: Struggling with low vit D and iron

Postby jimmylegs » Fri Aug 04, 2017 4:11 pm

heya :) what was the recent normal serum magnesium result, if you happen to have it handy? were your se mag levels above 0.95 mmol/l?
also do you have a serum zinc level kicking around? were levels near 18 umol/l?

how much magnesium is in your multi, and in which form? same questions for zinc.

if your mag was, as it sounds like, low normal, a d3 megadose could feasibly make it worse. if zinc status is low, a push with iron could be expected to do the same.

Serum Magnesium Concentrations [SMC' in the Canadian Population and Associations with Diabetes, Glycemic Regulation, and Insulin Resistance
http://www.mdpi.com/2072-6643/9/3/296/htm
Body mass index, glycated hemoglobin, serum glucose and insulin concentrations, and homeostatic model assessment of insulin resistance were negatively associated with SMC. This is the first study to report SMCs in a nationally representative sample of the Canadian population. A substantial proportion of Canadians are hypomagnesaemic in relation to a population-based reference interval, and SMC was negatively associated with diabetes and indices of glycemic control and insulin resistance.

and that's before we revisit the pile of lit criticizing said population based reference interval, ie "(0.75–0.955 mmol·L−1) established in the United States population as part of the NHANES I conducted in 1971–1974."

i really think it's worth paying some attention to what we've learned about magnesium during the intervening four decades since this reference interval was established...!

New perspectives on the regulation of iron absorption via cellular zinc concentrations in humans
http://www.tandfonline.com/doi/abs/10.1 ... ode=bfsn20
"This review provides evidence that much of the massive extent of iron deficiency anemia in the world may be due to an underlying deficiency of zinc. It explains the reasons for predominance of cellular zinc status in determination of iron/zinc interactions and for the first time thoroughly explains mechanisms by which zinc brings about these changes."

Lower serum magnesium concentration is associated with diabetes, insulin resistance, and obesity in South Asian and white Canadian women but not men
http://www.tandfonline.com/doi/abs/10.3 ... .v59.25974
"A substantial proportion of South Asian (18%) and white (9%) women had serum Mg <0.75 mmol/L indicating hypomagnesemia. Use of diabetes medication and indicators of poorer glucose control, insulin resistance, and obesity were associated with lower serum Mg in women, but not in men."

again, study is using a problematic serum mag level for the lower cut-off.

Relationship between zinc and obesity.
http://europepmc.org/abstract/med/8409780
"Patients followed a severe hypocaloric diet (737 Kcal) for 60 days. Serum Zn levels and BMI were evaluated. Zn levels in obese patients were significantly (p < 0.01) lower than in controls, whereas the BMI values were significantly greater. At the end a severe hypocaloric diet, serum Zn and BMI levels returned to normal values."
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
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Re: Struggling with low vit D and iron

Postby ElliotB » Fri Aug 04, 2017 5:13 pm

"4000UI daily in tablet form"

First off, 4000 IU is not a high dose, consider taking more.

What kind of tablets are you taking? Typically, for proper absorption, Vitamin D needs to be accompanied by fat, which is why they are usually in gel capsules.


You may find this article useful:

http://www.dummies.com/health/nutrition ... correctly/
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Re: Struggling with low vit D and iron

Postby Zyklon » Sat Aug 05, 2017 4:13 am

Please monitor your magnesium and calcium levels. 4000 IU is not a high dose but needs attention. Daily 4000 IU D3 may mess up your calcium and magnesium levels.
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Re: Struggling with low vit D and iron

Postby jimmylegs » Sat Aug 05, 2017 6:07 am

hear hear, z. (esp coming from someone currently dealing with this exact challenge, while on 3000 IU/d of supplemental d3).
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
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Re: Struggling with low vit D and iron

Postby NHE » Sun Aug 06, 2017 1:41 am

Punchy wrote:My neurologist doesn't monitor vitamin D levels, but I'm preparing for weight loss surgery and discovered in April that mine were only 26.


Weight loss surgery can interfere with your body's ability to absorb vitamin B12 from your diet. Following weight loss surgery, you will need to take a vitamin B12 supplement to prevent becoming deficient. I recommend a sublingual methylcobalamin supplement. A simple Google search for "weight loss surgery" "vitamin b12" should bring up numerous references. Note that a vitamin B12 deficiency can cause severe neurological impairment. You may wish to read the book "Could It Be B12? An epidemic of misdiagnoses" by Sally Pacholok and Jeffrey Stuart as a reference. In addition to Amazon, your local public library may have a copy.
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Re: Struggling with low vit D and iron

Postby Punchy » Wed Aug 30, 2017 5:39 am

Thanks all, sorry I went MIA for a bit there.

Jimmylegs, I was hoping you'd weigh in!

I don't have a copy of my counts, but I wrote down what the doc told me.

Iron serum - 7 umol
Iron saturation - 0.08
Hemoglobin - 134
Vit. D - 60 (up from 26 in June)
Phospherous - now 'normal'
B12 - 222
Magnesium - "normal"
Creatinine - 71

He did not test zinc but I will ask for it in next month's panel.

My energy level is still pretty low, likey bc of the iron. We know what caused that - I was put on blood thinners after an embolism and I had extremely heavy menstruation. Thankfully I'm off of the thinners.

I am very much aware of the absorptive issues presented by WLS, which is why I want to ensure I'm at good levels going into it. The type of surgery I am having, called vertical sleeve gastrectomy, does not remove the duodenum and jejeunum, which is where most nutrients are absorbed. That said, my food intake will be restricted and I will have to stay on top of supplements and eat only nutrient-rich foods for the rest of my life. As much as I'd luke to just go for an iron and Vit. D infusion, I should probably learn how to keep everything balanced myself.

I've become somewhat of a guinea pig, as the first patient at the bariatric program to take Tecfidera. BioScript is following me closely. Should be interesting!
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Re: Struggling with low vit D and iron

Postby jimmylegs » Wed Aug 30, 2017 7:34 am

heya punchy :)

question re test results. you're down the road from me i think - can you sign up for that lifelabs deal or dynacare or whatever it is, where for a fee (not huge i don't think) you can access all your lab results via their web site? i'm strongly considering it but haven't yet bitten the bullet.

re iron numbers. did you have a full iron panel done? when you say iron saturation do you mean % transferrin saturation?
any serum ferritin numbers kicking around? curious re true iron deficiency vs anemia of chronic disease.
related: https://labtestsonline.org/understandin ... test/#what
hemoglobin looks good at least.

assuming your D test is the right one and units nmol/L, yea not a big move BUT there is lag time involved. still, cofactors certain deserve attention.

speaking of which, with P and Mg only recently having crept in to the normal range, think we can assume levels are not awesome. worth knowing - might be worth a couple bucks to be able to log in and see actual numbers for mag in particular.

re b12 @ 222 if i can assume that is in pmol/l you want to go for at *least* 370.

so many factors at play here. i'm really curious re your zinc status lately - potential knock on effects where iron and b12 and maybe even d3 are concerned. will be good to see that result come in.

nutrient rich foods sounds like a great plan - so tasty :D what's your day to day diet/supplement regimen been like lately?
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
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Re: Struggling with low vit D and iron

Postby ElliotB » Wed Aug 30, 2017 11:48 am

Just reread your original post and noticed this "I'm preparing for weight loss surgery". Since you have MS, this elective surgery may not be a great idea.
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Re: Struggling with low vit D and iron

Postby jimmylegs » Fri Sep 15, 2017 8:06 am

any news punchy?
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
User avatar
jimmylegs
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Posts: 10703
Joined: Sat Mar 11, 2006 3:00 pm

Re: Struggling with low vit D and iron

Postby jimmylegs » Sat Sep 16, 2017 8:19 am

bump
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
User avatar
jimmylegs
Volunteer Moderator
 
Posts: 10703
Joined: Sat Mar 11, 2006 3:00 pm


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