Blood Chemistry advice please?

[pinboard]

18m ago I had roux en y bariatric surgery.
since then I have lost 7st (so 9 in total and now weigh 11st, BMI 24.5)

but I am SO SO tired and my concentration is shot to pieces

my bloods are taken annually and are 'normal' according to Gp

but I had to push hard to get actual results copies

they seem normal but some are only just in the normal range:

ferritin: 19 (normal 12-150)
folate: 3.2 (normal 3-20)
urea: 2.8 (normal 3.5-7.2)
vit D 26.70 (deficient

I’m not a doc, but your folate (think that’s b12 if I recall correctly) is on the low side, and your vit d is low. I get told to aim for 70 min.

Ask for a gp appointment. Ask about those two.
I don’t know anything about the surgery you’ve had, but they will be best placed to advise.

On a side note- it really shouldn’t be difficult for you to get copies of your results. I ask at reception for mine, or the GP/nurse just prints them right off.

HI JuniperBeer
thanks for the reply
I have asked GP and specialist weight managment team for further advice as i feel so much more ill than before i lost the weight but they just say' well, you've lost lots of weight, you are going to feel rough'.

I dont have a lot of faith in the team as i was supposed to have a loading dose of Vit 12 injections after surgery which i never got. I just found out my B12 injections should have been done in April and July but i was never called in (and stupidly i forgot to ask, but that is how bad my brain fog is).
I have been fainting a lot and am cold and dry skin too

Go back to your GP. See a different one. Push (nicely). Make sure you keep a record of when your injections are supposed to be now you know and mark them on your calendar for the next time.

I’m not surprised you feel rubbish with low b12 and your vit d is in its boots!

Are you losing hair? My Ferratin dropped to 30ish when my periods went bonkers, and my hair was falling out. And I was so, so tired, dizzy and breathless.

I had a total gastrectomy with my duodenum removed which also involved a roux en y. My surgery was a lot more drastic than yours but is very similar. I have my complete macro and micro nutrients taken ever four weeks. I have iron infusions and B12 shots but also take forcival, which is a prescription multi vitamin. I also take prescription vitamin d, zinc, folic acid, selenium and magnesium (and a couple more can't think of.) I also have an nhs nutritionist/dietician and only recently had my j tube removed. It's very easy to get malnourished after such operations and because I was underweight when I had my surgery it's a constant fight to maintain a healthy weight.

This is the Lead GP of the practice (rural, no other practice avail) and won't disagree with the Hosp anyway

I won't get any more NHS help so I'll have to get what I need privately but not sure where to start? I am also physically disabled (musculoskeletal stuff) so i get tired from that too

Yes hair loss is really bad still 18m later.

Goodness, walnutwhipster that sounds hard. I hope you are feeling stronger now?
can I ask if you get all the supplements on the nhs and if not where you source them please?

You have quite a few things that are probably making you very tired, in particular the vitamin D, folate (which is vitamin B9 btw, not B12) and ferritin. For example, I had my ferritin checked recently and it was 95.

I'm not sure how you feel about taking tablets, but I prefer sprays.
There's a company called BetterYou and they have multiple individual daily sprays including Vitamin D, B12 and Iron.

They also have a multivitamin spray containing Vit D, B12, folic acid etc. Those components are at a higher percentage than the estimated nutritional requirement values, so might help you get your levels up quicker.

Women can have symptoms if their ferritin is below 50. And you obviously don't have enough vitamin d - it says insufficient quite clearly.

Have they checked your B12 and thyroid? I can't see these results there.

I would get 5000iu of vitamin d and k2 (see oxford vitality(. Take one a day for 8 weeks then retest. You can then adjust your levels accordingly. Ideally you want this up towards 100. You do need to retest as too much vitamin d is toxic.

If you can tolerate it get ferrous fumerate 210mg tablet three times a day. If you can't tolerate it you could try solgar gentle iron. Take iron with vitamin c 500mg to aid absorption and reduce constipation. Don't rake iron with calcium or tea/coffee.

Stop taking the multivitamin they are a waste if money. They don't contain enough if anything to correct deficiencies and contain lots of things that don't agree with each other like iron and calcium.

Get your b12 and thyroid tested preferably TSH and FT4 (you are unlikely to be able to get FT3 tests in the NHS).

Don't take any b12 or b complex before having your b12 tested. It can skew the results.

Don't rake any supplements with biotin in for 4/5 days before any blood test as it gives false results on any test done with an immunoassay.

If having your thyroid tested get the test din as early in the morning as possible and fasting.

oh this is all hugely helpful thanks!

thyroid not tested no
I dont see it on bloods results and I'm not aware of it done separately?

vit b12 seems fine as it was 654 (mind this was just after my last B12 shot)

can i ask WHERE I'd get tested privately? (I'm near Edinburgh?)

@pinboard - You can use an online company like Medichecks. You order the tests (and pay for them online) they send you the pack, you get your bloods done and post back. If you need more than a pinprick of blood you can also pay to have it drawn. I'm in Edinburgh and use Newington Pharmacy. You put your postcode into Medichecks and they tell you your closest place. You can also have someone come to you to take bloods but that's more expensive. HTH

Oh, vintagebella thanks, that's really helpful.

I had lots of IVF some years ago so I am fine re needles / SI ;)

@pinboard all on the NHS because they're much higher doses than you can buy over the counter.

You probably have absorption issues as a result of your surgery, so yes, ferritin is very low, folate is also very low, as is vitamin D.

You can buy a decent methylfolate supplement and vitamin D softgels online, but you should ask our GP about iron supplements.

sorry I am on iron supplements already (I prob forgot to say, sorry)

I take 410mg of ferrous fumerate per day, have done for 18m

I take it with a small glass of OJ and no tea or coffee for 1 hour either side. I am able to eat red meat and cruciferous veg and oranges and kiwis (I eat one of each per day) but I still cant seem to get my levels up.

My GP just shrugged