high b12, high homocysteine, low t

[BvB]

Hello,

I am a 41 year old male from South Africa.
In the last 3 years my health has been slowly deteriorating.
Symptoms:
- - Heart palpitations
- - Feel that im going to faint from time to time
- - Stomach problems

I went to see 3 specialists (Cardio, gastroenterologist, specialist doctor). No problem could be found. Despite my illness I kept to a regular exercise program. During last year my symptoms got worse. During exercise I collapsed.
Symptoms:
- - Tingling in hands and feet moving up to my entire body
- - Muscle contractions
- - This lasted about 10 to 15 minutes

I went back to GP and insisted on blood tests including Testosterone. All blood tests were normal except for Testosterone which was very low (8.5 nmol/L [range 8~30]). Since December last year I am on Testosterone replacement therapy (Nebido). New blood tests show that Testosterone is now normal (20 nmol/L).

The problem is that I still feel very bad,
Symptoms:
- - Elevated heart rate (resting heart rate was 50, is now 70)
- - Tingling in hands and feet
- - Visual disturbances (blurry vision)

So I read up (most on this forum) and asked for B12 blood tests. The results were:
> B12: 429 pmol/l [range 83 ~ 418]
> P-Homocysteine: 15.6 umol/l [range 5.7 ~ 12.9]
> S-Folate : 16 nmol/L [range 10~70]
Unfortunately the lab could not do MMA. Will look for a lab that can do MMA today.
From what I understand from previous posts these results point to a possible functional B12 deficiency.

My questions are:
1. - What other blood tests can you recommend to look for the root cause of the problem
2. - What are my treatment options?

Thank you very much.

Bernard.

 

[rlc]

Hi, BvB, one thing that you could look into is Folate deficiency, although your levels are within the range, they are only just, and miles away from even being close to the middle of the range. My doctor would certainly supplement levels that low.

Folate deficiency can have symptoms similar to what you are describing, such as fatigue, visual disturbances, tingling in hands and feet (paraesthesia), heart problems, gastro problems etc, see http://www.buzzle.com/articles/folic-acid-deficiency-symptoms.html and http://www.patient.co.uk/doctor/Folate-Deficiency.htm

For some completely unfathomable reason, labs all round the world use different reference ranges! On page two of this article it states that the normal reference range used for B12 is 130-850pmol/L, see http://www.sah.org.au/assets/files/PDFs/Pathology%20PDFs/Vitamin%20B12%20Update_San%20Dr.pdf

My local lab uses a similar range, what this means is that your B12 is not high, it is in the middle of the normal range used by most labs, for some unknown reason your lab is using a high end that is a lot lower then is the excepted norm, (and a Low end). So I doubt there is any problem with your B12 levels.

However because your B12 is at a very healthy level, it may be cancelling out signs of anemia on your whole blood count, that could be caused by your low folate, leading to your doctors not thinking that your lowish folate, is the source of the problem.

Because high Homocysteine can be caused by low folate, it is possible that your current folate level is too low for you, even though it is just within range. Other causes of high Homocyteine are listed here http://en.diagnosispro.com/differential_diagnosis-for/homocysteine-serum-lab-increased/14546-154.html If anything on this list has not already been ruled out by your doctors, get them to investigate it.

I would recommend that you talk to your doctor about raising your folate levels to the middle of the reference range and see if your symptoms improve and your Homocysteine normalizes.

If Folate doesn’t turn out to be the cause of all your problems, I recommend reading these two articles, which explain conditions that are often not checked for by doctors, or are missed by using out of date reference ranges, and get your doctor to make sure that all these conditions have been properly ruled out, see http://www.bmj.com/rapid-response/2011/11/01/myth-chronic-fatgue-syndrome and http://www.bmj.com/rapid-response/2011/11/01/chronic-fatigue-syndrome-nice-and-cdc-miss-boat

Hope this helps

All the best

 

[BvB]

Thank you very much for your response. I really appreciate your input.

Regards

Bernard

 

[Gavin09]

Hi,

now you got me confused will a reading of 556pmol/L be high?

 

[rlc]

Hi, Gavin09, 556pmol/L is a healthy B12 level, unfortunatly labs all over the world use different referance ranges, for all kinds of things, even though the science has often shown for years that they are wrong. Why? Apart from stupidity I don't know.

My local labs uses a b12 range of 130-830 pmol/L, which is about standard for the high end, and you are nowhere near over that. However research has shown since 1996,that the absolute lowest for B12 should be 221pmol/L yet most labs are still using 130pmol/L.

So I don't think you need to worry about your b12 level, but double check with your doctor to make sure.

Hope this helps

All the best

 

[Gavin09]

Hi Rlc, i thank you for your help i have after speaking to some people and you decided to phone some labs in cpt,jhb and pta and asked them what there reference range was, I soon noticed that my labs reference range in pe is very low (83-418pmol/l) all the other labs (131-753pmol/l) average. Why is this and don't labs and docs make enough money by letting us test for stuff that we should not have too..............If i went to any other lab my B12 would have read ok so now who does one believe?

 

[rlc]

Hi, Gavin09, all these differences in reference ranges happen for reasons that can only be described as nuts, and completely unscientific, logically you would think that there would be international, or at least national standards for what reference ranges should be, and there would be people making sure that they were constantly being updated with the latest science.

The reality is that all the different labs in the world employ their own doctors, and they are in charge of deciding what reference ranges their particular lab uses, if those doctors have not bothered to update their knowledge for years, then they use reference ranges that are completely out of date, and wrong. Which leads to a large amount of wrong, or no diagnosis.

It is estimated that in medicine it takes on average thirty years for a new piece of information to become standard practice, by which time it is out of date. This has lead to many reference ranges being wrong, and because of this the doctors can’t diagnose people properly and they end up with a CFS diagnosis by default, Dr Mirza states in this article that many key reference ranges are outdated behind modern research by 17 years, some by as much as 50 years! See http://www.amazon.com/review/R28ZY8OYSWP0R

The reference range your lab is using (83-418 pmol/L) is so far behind the science it is scary.

The lowest it should be according to modern research is 221 pmol/L with an upper range around 750-850 pmol/L. Homocysteine and Methylmalonic acid should still be measure if people are in the lower part of the modern reference range because some people can still be deficient even at level a bit above 221 pmol/L.

The good news for you is that your B12 levels are very good, your labs just using a reference range from the dawn of medicine. But there are bound to be a lot of people having their B12 deficiency missed who use that lab.

What it does make me wonder is, if they are using such a out of date reference range for B12, maybe something has been missed on other tests you have had done, that are possible also using wrong reference ranges??

So I don’t see any need to worry about your B12, its very good, just the reference ranges of your local lab.

Hope this helps

All the best