Need help interpreting blood test results

[SpinachHands]

Hi all,
My bedbound partner finally reached a point where they were able to have blood taken! The results came back (unfortunately) pretty much normal. On pressing their GP for if anything was high or low but still in the "normal" range, she said that B12, ferratin, and folate were all on the high end, and their cortisol was "inconclusive". I should be getting the printout with all the exact number next week, but wondered if anyone had any insights into these four things.

From my initial researching, high folate is usually a sign of a B12 deficiency, which is odd given their B12 is high as well. Maybe they are still deficient but their supplemental B12 is making it appear elevated? They are going through an MCAS flare from a choline supplement currently so maybe that could have raised methylfolate levels?

And with the cortisol it seems like "inconclusive" means it's on a borderline, so not quite normal, but not outside of normal enough to diagnose anything. We're waiting on results of a 24hr metadrenalines urine test too, so maybe that will shed more light.

Appreciate any insights, their GP didn't have much of a clue but is sending the results to their specialist who should have a better idea if anything needs to be done here.

 

[almost]

Appreciate any insights,

As with most things body, the folate / B12 connection isn't that simple. I wish it were, for my own sake.

I posted here on the topic about how B2 is important for use of B12. Elsewhere, I found that methionine may actually be the important player in resolving the "methyl trap" as it is commonly referred to:

Noronha & Silverman (73) and Herbert & Zalusky (41 ) advanced the "methyl trap"
hypothesis. This postulates that under conditions of vitamin B 12 deficiency the
activity of the vitamin B 12-dependent methyltransferase is significantly diminished
and folate is trapped as the 5-methyl derivative, which cannot be reoxidized
via the methylenetetrahydrofolate reductase reaction because this reaction
is essentially irreversible under physiological conditions (47). A functional
folate deficiency ensues and this results in a decrease in the tissue levels of other
folate coenzymes and a consequent impairment of folate-dependent reactions.
The slowdown in thymidylate and purine biosynthesis, and consequently of
DNA synthesis, results in megaloblastosis. The original methyl trap hypothesis
has been expanded to account for the ameliorating effect of methionine on some
of the biochemical symptoms of vitamin B 12 deficiency. The sparing effect of
methionine can be explained by adenosylmethionine inhibition of
methylenetetrahydrofolate reductase (55) , which would decrease the synthesis
of 5-methyl-H4PteGlu and prevent its subsequent trapping.

Best wishes!

Edit: OK, bad brain day, I forgot to add my thoughts: More than one thing could be going on here. There could be a utilization issue with the B12, i.e. it is in serum/blood but not tissues, which the B2 question may address, and folate could be getting "trapped". There could also be a similar usage issue, as with the B12. If I find more as I search through my stuff, I'll post.

 

[almost]

The results came back (unfortunately) pretty much normal.

Ah yes; according to my labs, (and trust me, I've hit the menu at my primary clinic very hard, thanks to my primary doc) I'm perfectly healthy. Sure.

The word "normal" is very misused in this regard. The more correct term they should use is "laboratory range." I don't know that we know what "normal" is, and if we did, it may not be normal for us. How are laboratory ranges set? I don't think population studies have been done in most cases, and if it is the middle 95% of tests run, that would suggest "normal" is the middle 95% of presumably sick people. Even then, that range is made up of many individual optimal ranges. There are people who need 500x more B2 than others. The only way to know is by trial or genetic testing. Your partner's normal for B12, folate, or anything may be the upper 2nd standard deviation of the lab range. If so, high is fine. If your partner's normal is the lower 2nd standard deviation, high is a much bigger question. I face the same problem, my serum folate is high (probably 4 SD above mean), and if I supplement B12, I can get that quite high at the same time (without changing the folate numbers). With labs, I generally try to aim for the 1st standard deviation around the mean. Within the second is a yellow flag for me, Third or more SD is a red flag.

I also factor in how I feel. If I increase or decrease B2, for example, do I feel better? If yes, then yeah, I've found the key to one door on the path to health. If not, then either B2 isn't my problem, or something else is more immediate (and B2 may still be a problem). I see the road to health as a series of locked doors. We first have to identify which keys we need, and then find them. But that isn't all, I believe. I think we have to unlock the doors in the right order, and I think that is probably the biggest challenge. What is the problem I have to treat first?

As for ferritin, again that depends on the definition of "high." If it is 1000, that is one thing. If it is 400 or 200, that is another. Mine was 450 or so the first time I tested, if I remember right. Top of the lab range, therefore "normal." For me, that may actually be true, as I am a carrier for hemochromatosis. Optimal for most people is considered under 100. As a trial, I was able to lower it to 96 using vitamin C, which chelates the iron (and any other minerals it can get its grubby little electrons on), but I don't think it really moved the needle for me on health via ferritin. High ferritin can be a good thing if you are fighting viruses or bacteria, so who really knows if it is a problem.

I think you've taken a great step with these tests. I hope they reveal some insights for you. If you all wish to go to the next level, an organic acids or nutritional test could be really useful. I'm still learning all the insights packed into mine. These can tease out a functional deficiency, and show where a cycle is getting blocked. They require blood and urine, and your partner is probably not up to anything like that now, but just some thoughts to store for the future.

Again, best wishes.

 

[LINE]

"Normal" results are normal in most cases of CFS people. One doctor said that people would be jealous of my blood results as I sat there confused.

@almost has some good points, typically b vitamins work in a network which means they can both support and antagonize one another. I have always done well on B2, it seems to normalize things for me. But that is not to say that the other b vitamins are not important. For instance, B5 (pantothenic acid) supports the CoA pathway, which is important, choline supports methylation and so on. I mention antagonize as high levels (generally through supplementation) of a particular b vitamin, can suppress the activity of others.

Mineralization is often overlooked and should not be. It can be a complex puzzle as you know. Trial and error (and observation) is often the best practice.

 

[SpinachHands]

Update: I've got the full details back now and there are some things the GP told me incorrectly/didn't mention which is annoying. The stand-out results are:

Serum cortisol was borderline low (178mmol/L), their specialist recommended the GP refer to an endocrinologist, but the wait list is a year so I'll probably look for private

Serum sodium was slightly high (145 when normal range is 133-146), but my partner does supplement extra salt for POTS

Serum potassium was slightly low (3.7 when normal is 3.5-5.3) but did only recently start supplementing this so we may increase

Serum creatinine was low (55 when normal is 59-104) but is likely due to muscle wastage from being bedbound for 9 months

Serum cholesterol: HDL (the "good" one) barely scraped normal (1.1 when normal is above 1), and LDL (the "bad" one) was high (3.3 when normal is below 3). I don't know why the GP didn't raise this at all, maybe it's another thing that's because of being bedbound? Don't know how concerned to be

Serum ferritin was low (65, when 100+ is normal, 30-99 is indeterminate, and 29 below is deficient), which may be due to the vegetarian diet, but could be good to introduce some iron tablets

Overall pretty uneventful, but the low cortisol does confuse me. We've been thinking they have problems with excessive cortisol with the adrenaline spikes/dumps, and sympathetic overactivity they get. Still waiting for the metadrenalines urine test results, so will see what else comes up there.

 

[LINE]

Something that is often missed is the relationship between the adrenal glands and M.E.

The adrenal glands are more than just cortisol production, they produce an abundance of other hormones that are vital for keeping the body healthy. The adrenals become "tired" due to the stressors. Another name of this is POTS.

Among the many things they do besides cortisol production, they control sodium and potassium balance, the hormones for this are called mineralocorticoids. I can list some other information if you like.

 

[SpinachHands]

Something that is often missed is the relationship between the adrenal glands and M.E.

The adrenal glands are more than just cortisol production, they produce an abundance of other hormones that are vital for keeping the body healthy. The adrenals become "tired" due to the stressors. Another name of this is POTS.

Among the many things they do besides cortisol production, they control sodium and potassium balance, the hormones for this are called mineralocorticoids. I can list some other information if you like.

With the adrenal glands becoming tired, are you referring to adrenal fatigue? I looked into it, but don't think it's a theory backed by science/medicine unfortunately. POTS is something that can be linked to low levels of aldosterone production from the adrenal glands, but is often more complex than that. My partner does have POTs, although reacted badly to fludrocortisone, which is a common treatment for it. My partner does ensure they supplement extra sodium chloride and have a high salt diet to help with the POTS. I do think the low cortisol is likely linked to their low BP issues, but still don't quite get why they seem to get so much sympathetic activation and adrenaline rushes if their cortisol is low..

 

[Mary]

With the adrenal glands becoming tired, are you referring to adrenal fatigue? I looked into it, but don't think it's a theory backed by science/medicine unfortunately.

I wouldn't rely on "science/medicine" for information. Yes, the party line is that adrenal fatigue is not real. They also say that no one has a problem with toxins, that a "toxic liver" is not a real thing. Though they don't talk about what a hangover (alcohol poisoning) actually is - the liver gets overloaded with alcohol. Or lead poisoning, all sorts of very real toxins get stored in our bodies, and they can overload the liver and the rest of the body too. We've all experienced this. But ask a doctor about a toxic liver or stored toxins and they'll brush you off.

"science/medicine" also for many years said that ME/CFS was all in our heads basically. They're only now starting to catch up with reality.

About the adrenals - back in the mid-1990's, before I started crashing (PEM) in 1998, I was weak as a kitten. I didn't have a clue as to what was going on with me. I went to my doctor who of course prescribed a prescription anti-depressant without any basis. It made me feel horrible and I stopped at after 2 days.

Somehow I stumbled across a chiropractor who did muscle testing - brand new and strange sounding to me at the time but I had nothing to lose and it was cheap compared to an MD. So I let him do the muscle testing and he said my adrenals were wiped out. He gave me an adrenal glandular product (Drenatrophin PMG by Standard Process), said I had to take a high dose because I was so weak, and within 2 or 3 days I felt my energy returning. It felt like a miracle and I've had to take an adrenal glandular off and on ever since. I am extremely grateful for that chiropractor and muscle testing and adrenal glandulars.

So - some might call what I still do experience from time to time "adrenal fatigue" - is what I experienced real? Very. Is it "adrenal fatigue"? I don't know, and I don't care what it's called. Ideally I might have some in depth testing done to check this but I haven't had a doctor yet who wanted to look into this. I know I'll have to educate myself enough to get the proper testing but if this didn't show up on testing? I know what I felt and still do feel when my adrenals "get tired" or "wiped out". And the adrenal glandulars always help.

Serum potassium was slightly low (3.7 when normal is 3.5-5.3) but did only recently start supplementing this so we may increase

People with ME/CFS can have low intracellular potassium despite normal blood levels, and this level is too low, as you know. So your partner may be worse off re potassium than it appears, and low potassium can be very debilitating. I've experienced that too. How much potassium is your partner taking? The daily RDA is 4700 mg, which I believe is the minimum. I had to start supplementing with potassium after I started taking methylfolate in 2010 and I've had to take it ever since. I was taking around 1000 mg a day in divided doses and recently had to up it to 1200 - 1400 mg a day to ward off symptoms of low potassium.

This thread explains how ME/CFS patients can have low intracellular potassium despite normal blood work.

You might try adding in some low-sodium V8 or other vegetable juice (high in potassium). It's an easy way to get more without a lot of sugar. But I'm not suggesting you replace your supplement with this - just see if your partner feels any better with more potassium and then you might increase their supplement.

From my initial researching, high folate is usually a sign of a B12 deficiency, which is odd given their B12 is high as well. Maybe they are still deficient but their supplemental B12 is making it appear elevated?

Do you have a value for MCV (mean corpuscular volume)? A high MCV level can indicate either (or both) low folate and B12 - the cells get extra large in an attempt to compensate for these deficiencies. Yeah, high B12 blood levels don't mean much. Mine was always high because of supplementation - but on hair analysis, my B12 was basically undetectable. I'm not sure if folate levels act similarly.