GP refusing iron and B12 testing

[Lemonthyme]

I'm so fed up with my GP. Looking back through my test results, My iron and B12 levels were on the low end of the normal range 2 years ago. I'm struggling with energy, weight loss and feeling cold. Recently had some blood tests and the GP didn't bother to repeat them.

He's saying because they were in spec it's fine despite there being loads of evidence out there that people who exercise a lot need more than scraping the bottom of the range.

I have a GP appointment soon and he's refusing to repeat these tests before I see him. After my last appointment he referred me to the county "weight loss service" who aren't accepting patients anyway but helpfully sent me advice on diet and exercise (I exercise 5-7 days a week already and already eat healthily and drink no alcohol).

To say I'm p---ed off with this idiot is understating it. We have poor provision where we live for GPs so I can't even move practice (I'm outside the catchment of other practices).

I'm perimenopausal but utterly f-ked off by being gaslit by male GPs who think "eating less and moving more" is a magic wand for all weight loss despite the fact that most people find that advice really hard to follow but I'm one of the unusual cases where I AM ACTUALLY DOING IT ALREADY!

Since my last consultation, no thanks to him, I read up on B12, ferritin and how that can elevate HbA1c results (mine were 5.8% despite my lifestyle) but in any case am trying 1 x 24 hour fast per week which so far DOES seem to be helping, albeit I'm pretty knackered. Possibly glycogen depletion but if my HbA1c is high genuinely, what is the alternative? I just want some f-king advice that isn't bloody patronising. Is that too much to ask?!

The point in asking for the tests is because you can often have absorption issues so supplementation may not work.

Why does it feel that as a middle aged woman in the UK you're on your own when it comes to health? Drives me potty.

I 100% agree with you.

Whilst I’m not in that age bracket or at age of perimenopause yet. I wasn’t taken seriously when my periods became so heavy that they led to iron deficiency aged 30-33. I am 35 now and I take regular b12 and iron supplements, but nhs GP care has been negligent at best. I work for a private medical insurance company so fortunately get some cover through work… the private endocrinologist took my blood work way more seriously than any NHS GP has done. I work in primary care as well and my only defence on their behalf is that NHS GPs are overloaded with work and thus lack of time and probably very burnt out which impedes empathy and covering all bases throughly enough. It shouldn’t be this way.

The op is describing symptoms (low energy , weight loss, feeling cold). It's the responsibility the GP to make a diagnosis and offer treatment, that is literally their entire job. That hasn't happened so OP has been driven to self diagnosis. What do you think the GP's role is here? Do you think it's okay for them to shrug their shoulders and tell OP to lose weight?

It took my mum four years to get referred for testing for Parkinson’s disease, her symptoms were put down to ‘anxiety’. My dad saw the same GP for much less obvious symptoms and had an immediate referral for testing.

My GP told me my low serum iron and ferritin of 5 could be treated by eating spinach 🤔 I have no time for any of them any more, I’d trust Dr Google and ChatGPT before I’d trust a single word that comes out of a ‘health professionals’ mouth.

They should check your ferritin levels, rather than just iron.

I think that's what they're doing. And frankly if they miss something again, I'll give up and get it tested privately.

Dear god... spinach being high in iron was based on someone recording the decimal place incorrectly. 🙄

It also has quite high levels of oxalates which is problematic. I cannot believe your GP was getting nutrition advice from Popeye.

It's not just anecdote either the difference between men and women for pain management:

Pain bias: The health inequality rarely discussed

But any of us who have a mirena know that. Imagine men having a piece of plastic shoved down their todger and the only pain relief being a paracetamol and a sensitive smile as a healthcare assistant holds your clenched hand?

Leafy greens are high in iron but we can’t extract the iron from them easily. Sources from animals, such as liver, kidney, red meat and egg yolk are much better sources of iron for us.

Leafy greens are not "high in iron". They do not contain enough. They would be classed as "a source of iron" which has a lower quantity needed to make that nutritional claim under UK labelling law. And as I previously explained, the oxalates make absorbing most of that iron pretty difficult.

So it was stupid advice either way from the GP.

Can you donate blood ? They’ll test your iron levels there & then , and you’ll be doing a good deed too,
can’t help with b12 though

I've previously had my blood refused as I often felt faint when I used to donate and I have also got a heart arrhythmia which isn't dangerous but the transfusion service had kittens and refused by donation last time.

But as I said, they're now finally agreeing to test it. Turns out the GP hadn't been asked.

Iron in food is haem ie blood iron, or non haem iron. Non haem iron is less well absorbed but generally vegans are not low in iron. There are studies that suggest that vegans adapt and absorb non haem iron better than meat eaters do. There is no evidence that 7th Day Adventists and other committed vegans are iron or folate deficient

I don't see how any of this is relevant? Or helpful? To suggest to a non vegan that spinach is a good source of iron is patently BS especially if they have a deficiency already. Based on a measurement error from the 19th century.

I'm struggling with energy, weight loss and feeling cold

They should be checking your thyroid levels too op, classic symptoms!

Already checked. That's why I went in the first place. TSH is fine.

Send an email to the practice manager

Sadly this practice is immune to complaints, there is no other practice in the area which is accepting patients. So people have no choice.

I've complained to the councils, the ICB and my MP about it. All admit there is a problem. None of them is doing anything to fix it. Most recent reviews are 1 star. We had 4 week waits for appointment before covid. Now it's ridiculous.

You'd need barrow loads of spinach to make any difference, not practical whatsoever

Are you actually on HRT?
I train heavily 6 days a week so always take additional Iron (Nutrition Geeks Iron Energy and Feroglobin Plus) as my requirements are a lot higher. For ref I take 18mg a day, more when I am menstruating. I think you need to be a bit proactive here. Take some supplemental iron and B vits for a while and see if there is an improvement. I also eat duck liver (milder than lambs) and have a steak once a week. Have a look at any dietary changes you could make. If you are training a lot of will need to be clean and nutritionally balanced.

Do you know the actual numbers op? The guidance is to treat symptoms if levels are subclinical - you might be 'within range' but can still feel dreadful. Optimal levels should be aimed for, not 'above minimum'

Bang in the middle of range. Unlikely to be an issue.

Results - Ferritin absolutely fine. B12 low. Not quite at deficiency level but low enough to be in the "if having symptoms recommend supplementation" range (and a quick google puts active people like me as needing more than that still) so started a mouth spray today (thank you whoever mentioned it as the evidence is MUCH better than tablets).

I did a bit of Gemini doctor today though, please don't judge me, see above for evidence my GP is not great. But what I found really interesting is the links between B12 and cold intolerance and tiredness but also breathing pattern disorder (which I was diagnosed with as part of long covid). It's given me the kick up the bum I've needed to get some B12 spray (bought this morning and started as soon as I walked out of Supadrug) and restart breathing exercises.

Let's see if this makes a difference? Glad I didn't start supplementing though till the results as I'd have done iron as well which I don't need and too much iron can do more harm than good. But what is also interesting is a lot of the foods I eat which are high in iron are also high in B12 so it does suggest an absorption issue but I wouldn't have known about the sprays / sublingual dosing if it hadn't been for MN so thanks for that. My GP certainly isn't sharing this information. Expensive but if it works it will be 100% worth it.

I already eat quite high red and organ meats (including duck liver strangely enough but only because Morrisons sells it rather than chicken liver). I had black pudding for breakfast for example. (With home made sauerkraut, don't knock it till you've tried it.) I have that fairly often and black pudding is meant to be an excellent source of B12 so I guess I'm not absorbing it fully which I believe becomes more common as you age.

All of this information would be great to be shared by my GP but well, you know...

So sick of people saying "just go private". Why should we have to pay twice when we already pay tax to support the NHS. It should be doing what NICE tell it to do and functioning properly, we have already paid!!

It does take forever. I've been on 100mg per day for four months. My iron went up from 13 to 18..