remittent relapse?

[jimmylegs]

ok so if you want to go down the nutrition road here, i'm available to help. it's a bit of info gathering and some math to start, that's all really. if nothing else you can be doing something proactive and worst case scenario, you get to rule out any possible nutritional involvement in your situation.

[NHE]

2. Confirm first that you do indeed have a B12 deficiency. You have had one serum B12 test (with a "gray zone" result of 286 pmol/L, a.k.a. 388 pg/mL). Ask for further testing: #1 HoloTc test, if available in your area; #2 serum folate test; #3 serum homocysteine test; and #4 serum methylmalonic acid test – the urinary test form is more accurate and less expensive. Do not simply start taking vitamin B supplements on your own – this can skew test results.

Agreed. It's a good idea to get the full workup for B12 deficiency before taking supplements or shots. That way, you can confirm if you have a true functional deficiency. For example, if B12 is indeed too low, then both the methylmalonic acid (MMA) levels and homocysteine (HC) levels can be elevated. Note that high MMA is thought to be more specific to low B12 than HC since HC can also be low in the case of a folate deficiency. However, some treatments, such as antibiotics, can interfere with the MMA test resulting in a false negative result, i.e., low MMA in spite of a true B12 deficiency. For the folate test, I recommend the red blood cell (RBC) folate test since it provides info as to your long-term folate status and is less effected by daily dietary variations.

Preliminary testing is also a good idea since then you'll have a baseline to compare follow-up tests to which will allow you to know if your current regimen is effective or needs to be modified. For example, my baseline HC was 16.1 µmol/L while the standard range is 4-12 µmol/L. After taking sublingual B12 supplements for about 3-4 months my HC was down to around 10 µmol/L. As such, I knew that my treatment was having the desired positive effect. This was important to me, not just for B12, but because high HC is a strong risk factor for cardiovascular disease and I had been experiencing irregular heart beat and arrhythmia characterized by fluttering in the chest sensations. Happily, these have both gone away since bringing my HC down with B12 and methylfolate.

[jimmylegs]

it's also good to consider the nutrition science that has been done about depletion in athletic individuals in particular
some research titles
https://scholar.google.ca/scholar?as_vi ... as_sdt=1,5
Clinical sports nutrition.
Prevalence of Iron Depletion and Anemia inTop-level Basketball Players
Vitamin and mineral status: effects on physical performance
Elite athlete immunology: importance of nutrition.
Exercise and mineral status of athletes: calcium, magnesium, phosphorus, and iron.
Iron depletion in athletes
Nutritional practices of elite athletes
Iron status and exercise
Practical sports nutrition
Effect of iron injections on aerobic-exercise performance of iron-depleted female athletes
Nutritional considerations for vegetarian athletes
Protein requirements for endurance athletes
Iron and the athlete

If we follow the emerging pattern here and start with the obvious iron consideration, i notice you mention fatigue as a long term symptom. since you are a fitness professional, and we can assume you're on top of the iron issue, can i inquire as to your last serum ferritin result, if you happen to have one handy? can you share any of your dietary habits associated with ensuring an iron status that is optimal for your activity level? if so, we might be able to spot patterns that could be tweaked to your benefit.

note that iron dysregulation is an issue for pwms and that anemia is often the anemia of chronic disease. still, it makes sense to ensure that iron status is good, and there is a wealth of detailed info on this site, about how best to assess iron levels and how to interpret results properly.

fact sheet: iron depletion in athletes
http://www.sportsdietitians.com.au/reso ... s%20PV.pdf

[admackenzie]

My ferritin from this last blood test was 34 (13-375) ug/L
My iron intake comes from mostly red meat. I eat red meat at least 2X per week, typically more. I have been anemic before, had my iron at 1! This is a different type of fatigue. With that I could work past the fatigue, it didn't really slow me down all that much. This fatigue is way more intense. I am having a hard time physically getting out of bed. Or keeping my eyes open. It's the most extreme I have ever experienced.

I have a doc apt in 30 min to request the MMA and HC test. Hopefully that will shed some light. Only problem is it takes more than a week to get an apt for bloodwork around here. Urg the healthcare system sucks.

Thank you everyone for your input and support. Jimmylegs I may contact you regarding the nutritional aspect of this. Changing my nutrition will be hard for me coming from a strict competitors diet, however I am willing to do whatever I need.

[admackenzie]

So I just got back from my Dr Apt. I didn't get to see my fam doctor as she is out of the country on vacation, however I did see another doctor in her practice. Wow I feel so much relief. He was like a breath of fresh air! He does not believe that my problem is a B12 deficiency but gave me the req for the tests to ease my mind, he is also going to check anti-acetylcholine receptor anti body. Not sure what that is for. He said he is convinced they will all come back normal.
But the nice thing is that he re did a full neuro exam on me, my doc did one the first time I saw her. He said in her notes she put it as normal, but he doesn't believe it is normal. He said there is definite weakness in my left leg/foot. A student also did the exam (she did it first) and she found the same thing. Not sure that this is a good thing, however it makes me feel less crazy!

[jimmylegs]

hi again thanks for the info.

personally, i usually go for serum ferritin ~80 ug/l

i am not sure that red meat 2x per week will meet daily requirements.. could be good to do some math on the daily routine. could also be wise to look in more detail re diet to examine baseline nutrient composition and possible interactions between diff elements of your diet. can you share the details of the strict competition diet? is it info that's posted online anywhere?

i used to have intense debilitating fatigue and would find out later that i had multiple nutritional issues acting together. low iron was originally part of the picture in addition to a number of other things that i learned about over a long time. i don't want to give the impression that iron is the only thing in the picture any more than b12. but your bloodwork indicates low iron, if not severely low iron, and in combo with other nutrients that you could expect to be low in active people and which also may contribute to fatigue, like magnesium, you could be dealing with a complex multifactorial issue. turning it around could be as simple as adding certain nutrient dense options to your diet and possibly revising certain meal combinations to support absorption.

no probs re the input and support - feel free to contact me to see if diet mods can be accomplished without affecting the intent of the competition regimen.

[admackenzie]

I totally see what you mean Jimmylegs. I agree it could def be a few things that are making the fatigue to extreme.
My diet is not anything you would find online, typically I eat a certain number of macro nutrients in the day. 5-6 meals per day depending if I am working out or not. For example:
Meal 1 - 25 G protein, 25 G carbs, 10 G fat, veg
Meal 2 - 25 G protein, 25 G carbs, 10 G fat, veg
Meal 3 - (pre workout meal) 25 G protein, 35 G carbs
Meal 4 - (recovery) 25 G protein, 50 G carbs
Meal 5 - 25 G fatty protein, 25 G carbs, veg
Meal 6 - 25 G protein, 10-20 G fat

So this is my typical off season diet. I have greatly reduced the amount of protein I am eating right now as I am not able to work out. When I am on plan I eat red meat daily. Either extra lean ground beef, or steak. I haven't been "on plan" since a few weeks after my symptoms started. My carbs range from oats, brown rice, brown rice pasta, potatoes, Ezekiel bread, fruit, starchy sugary veg (corn, carrots etc.). My proteins range from egg whites, protein powder, cottage cheese, yogurt, white fish, chicken. My fats range from peanut butter, whole eggs, avocado, coconut oil. Typically I will allow myself I cheat evening per week.

As for changing the diet and affecting the competition regimen, I am okay with changing it up. I don't have a competition in my near future, and honestly my health is more important.

My worry with the iron is that when I was low iron before I could not take supplements as they really affected my stomach. So I got weekly shots. They don't offer that anymore. I'm going to have to figure out a way to get the iron in, in a way that won't affect my stomach.

I got my bloodwork done yesterday so we will see what comes of that.

[jimmylegs]

heya! this is GREAT info and i can see we probably have a lot of space to play with essential micronutrient density without necessarily messing up your macro regimen. have to sleep now, crazy busy today and tomorrow but will check back in tomorrow eve